Marjory 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.

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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.

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  • Gun control is a threat to all women. As an elderly woman who lives alone, I would be an easy target for anyone who wants to prey on me.

  • Will cars be taken from all to save DWI deaths?
    Consider how maby babies have been taken by the hands of those who should protect and save lives. THOSE NUMBERS ARE TRAGIC also.

  • It’s lawful to kill a child in the womb, but once that child is born he/she is “protected” by the law. If that reality is not only grossly sinful but downright schizophrenic, I don’t know what is. Time to stop the insanity.

    As Aaron said, we can’t stop all killers. But we can stop some of them. The greatest human holocaust in history is abortion. Millions of innocent children have been brutally slain. We might begin by taking drugs and knives away from abortion doctors. Strip them of their weapons of mass destruction. Closing all abortion clinics could potentially save thousands upon thousands of lives. And it would send a clear message to the entire world. Let us be the forerunners of life! How can we teach our children that killing is WRONG, when one need only walk into a Planned Parenthood clinic and see it is just A-okay and perfectly lawful?

  • I’m sorry but I disagree. We do not have the power to remove guns 100% from our population even if we were to foolishly remove one of the 2 biggest safeguards the fathers gave us against a run away government.

    The truth is pressure differential. If their is a force that wants to kill then it is only resisted by a force wanting to protect. Then which ever side has more power will win. We need to boost the power of the defenders. For instance, people like the hero Security guard who died protecting children, should instead have been able to defend them with weapons of his own.

    We can’t stop the killers, they are natural product of our society that is to focused on feelings and not enough on right and wrong.

    • How can kids know right from wrong? The 10 Commandments are not taught in public schools, or even posted there. By legalizing abortion, the Supreme Court is guilty of sanctioning literally millions of deaths in this country, so I suppose posting the Commandments would only illuminate the lawlessness/sin. May the offending Justices hang their heads in shame!

      Mr. Cruz is one more lost soul among thousands of “special needs” students… which raises the question: why are there so many special needs students in the first place? There certainly were NOT so many when I grew up in the 60’s. School shootings were unheard of. Out-of-wedlock pregnancies were rare and frowned upon. Most kids had the support of both a father and a mother. What has happened to this country? There is a spiritual malignancy… a cancer which is seemingly growing out of control.

  • Interesting intellectual take that totally defies real world logic. How did outlawing drugs work? Legal drinking age? the list goes on. You make the nonsensical mental error of assuming you can take away one portion of it. Everything these people do is illegal already, and you assume that suddenly outlawing a inanimate object will solve the issue? Our hearts want to do something for a micro problem but in the scheme of things it is a big zero. 4300 deaths a year from underage drinking alone. Stop playing the political agenda if your serious apply your logic where it might actually help.

  • Based on the comments I read here, I’m probably wasting my time with this post, but …

    Here’s someone who faces the problem on a daily basis and is willing to talk about the problems that others seem to want to ignore or cover up:

    https://www.facebook.com/kellygraley/posts/10156224702772958

    What is government doing to address this problem?
    For a reasoned response to this problem that, so far, the Florida Legislature has refused to address I give you the following link:

    http://web-extract.constantcontact.com/v1/social_annotation?permalink_uri=2sGVluH&image_url=https%3A%2F%2Fimgssl.constantcontact.com%2Fui%2Fsmm%2Fspui%2Fpost-images%2FEmail-2-lrg-fb.jpg

    I know, this is not what the people leaving comments here want to hear, but perhaps it’s what they need to hear and won’t see presented in the media that is doing everything they can to prevent this being heard.

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