arjory Stoneman Douglas High in Parkland, Florida. Sandy Hook Elementary School in Newtown, Connecticut. Virginia Polytechnic Institute in Blacksburg, Virginia. Columbine High School in Columbine, Colorado. School shootings like these and far too many others leave behind immense grief and long-standing impairment.
According to a Washington Post analysis, more than 150,000 students attending at least 170 primary or secondary schools have experienced a shooting on campus since the 1999 massacre in Columbine.
My heart goes out to the families of children killed and wounded in these senseless attacks. As a psychiatrist who has worked with witnesses to homicide, family members of homicide victims, and shooting survivors, I have also seen the devastating psychological impact that such experiences have on those left behind. The emotional sequelae can last a lifetime, and can lead to a range of social and behavioral problems such as substance abuse, job loss, and the dissolution of families.
In all probability, the psychological casualties outnumber the physical ones. I say “in all probability” because the complexity of the traumatic experience and the diverse reactions to it make post-shooting trauma difficult to measure. It is far harder to quantify the psychological casualties of gun violence than to count those murdered or injured.
The family members of the direct victims of these shootings will need crisis intervention and long-term treatment to help them recover, each in his or her own way. So will many of the survivors, their family members, and community members. The community will also to need to come together and support one another now and over the years.
One aspect of this kind of traumatic experience is that it represents a breach of the social contract: if I act appropriately, I will be safe. Repairing that breach requires justice. Not just convicting the perpetrator, but a lasting societal response to the episode. The lack of a response from our society is justice denied, which perpetuates the traumatic response and impairs the ability to heal. Just read the Washington Post follow-up on the Townville (South Carolina) Elementary School in 2016 to understand the ongoing devastation of a school shooting.
We must do better than what we did after 20 young children and six adults were killed at Sandy Hook. Many of those affected by this shooting have never recovered and continue to be dismayed that this tragedy did not lead to substantive change in gun regulations.
I don’t pretend to be an expert on gun control or management, and I can’t argue with any expertise about the true the meaning of the Second Amendment and its relevance in today’s world. But as a physician I can recognize a growing, unmanaged epidemic. And by any stretch of the imagination, gun violence is an epidemic.
For an epidemic of malaria, Zika, or other mosquito-borne disease, we would literally drain the swamps as a means of reducing the vector — meaning the population of disease-carry bugs. In the case of gun violence, there is a question of whether the vector is the gun or the person with the gun.
From the perspective of managing this epidemic, that controversy is moot. The only vectors we can control are bullets and guns. And that’s something we must do to provide a sense of justice and an opportunity for healing for all of the victims of mass shootings.
Steven Berkowitz, M.D., is a child and adolescent psychiatrist, an associate professor of clinical psychiatry in the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Center for Youth and Family Trauma Response and Recovery.