We’re experiencing a national trauma crisis. Can it change how we treat trauma?
More than 45 mass shootings occurred within less than a month, CNN’s Madeline Holcombe reported on April 18, 2021. The New York Times, NBC News, and other news media stations continue to focus on this urgent, unfolding national crisis.
Mass shootings are a collective trauma, regardless of where they occur. A spate of them during a time when we are already psychologically vulnerable after a year of distress is even more devastating.
The psychological impact of these random acts of violence simulates the trauma impact of domestic terrorism, though there is no known link between these acts of violence. In fact, the lack of connection between these events can heighten the trauma response for several reasons. This article will explore the psychological impact of these acts of mass violence and will highlight the need for us to address our national trauma crisis in more effective ways.
As a psychologist, I have given several interviews in the context of recent mass violence events. The first question asked was this: “How are these events connected?” The frequency of this question demonstrates a public desire to explain the unexplainable. We struggle to detect the an invisible thread (or threat) to help us understand senseless acts of violence. Even if we know that we can’t control all of our exposures, the feeling that we can understand why something happened can restore some of our psychological sense of control. Yet mass shootings often bring no clear answers.
As a rule, anxiety exists in proportion to what we don’t know. We can often adjust to a known threat, but the psychology associated with mass violence is complicated and often inexplicable. The fear that we ourselves, or those we love, might be suddenly taken from us, without cause or concern, can feel simultaneously paralyzing and terrifying. This primal fear has been a primary cause of trauma in relation to COVID-19—that we ourselves, or those we love, might be lost to an invisible virus that we did not see coming.
In this way, the recent surge of mass shootings is echoing the trauma that we have all faced for well over a year— the lack of control we feel facing more invisible threats in the world around us.
In addition, this is an especially vulnerable time. After a year of trauma and sheltering in place, we are starting to re-emerge. We are craving normalcy and a safe world. Many of us are relearning how to navigate both spaces and relationships. As we begin to resume more expansive lives, we’ve been repeatedly confronted with acts of mass violence.
Psychologists often make a distinction between “state” and “trait” anxiety. “State” anxiety is situational, changeable. “Trait” anxiety relates to a baseline emotional condition—being an anxious person, for instance. The combination of COVID-19, which has set off a chronic threat response for many of us, and the recent surge in mass violence creates the kind of conditions that can convert state anxiety into trait anxiety, in the context of extreme, continuous environmental pressures.
After a mass-violence event, it is natural to put ourselves in the picture—to imagine what could have happened if we ourselves, or someone we love, were subjected to someone’s killing rage. It is possible to experience vicarious trauma and a version of flashbacks, even if we were not directly exposed to an act of violence.
The occurrence of mass shootings in spaces like spas or supermarkets—places that are generally safe—can heighten our sense of danger in these places. As psychiatrist Jonathan Shay observed during the Vietnam war, “American soldiers felt tortured by their enemy [because]…every familiar item of the physical world could be made to be or to conceal an explosive…whether a fountain pen, a bicycle, a coconut, [or] Coke cans.” (p. 34). The contamination of safe spaces, just like the contamination of safe objects, can lead to generalized fears and create an additional layer of anxiety as we come back into the world.
If there is a silver lining in this past year of trauma, it is the collective realization that trauma is not a unique challenge that some “other” group—for example, veterans or first responders—must confront. Going through trauma is a human universal. The challenge as we re-emerge is twofold: 1) to resist the tendency to form fear narratives and 2) to take up space in the world with shared courage and kindness. To do this, we need to change how we address human suffering. Here are five examples.
Collaboration, not Competition.
We need all hands on deck working to address trauma symptoms in a unified way. In a public health approach to healing, we all have a role to play. The care of those who suffer from trauma is no longer a zero-sum game. We must actively partner with other healers to develop a comprehensive continuum of care.
Elimination of mental health stigma.
Those who suffer from PTSD were once told that it is “all in their head.” Now we know that it is, literally, in their head—and visible on a brain scan. By changing the way that people view post-traumatic stress—from a mental illness to an injury—we can eliminate mental health stigma.
Leading with HOPE.
The belief that post-traumatic stress is a life sentence is killing people across America. People need to know that there is life beyond trauma —not just survival, but a good life, a connected, emotionally fulfilling existence. We must continue to explore and advance a number of treatments that can help people recover after trauma exposure.
Those exposed to trauma need healers who practice “radical empathy.” Healers must be intentional about how they interact with patients throughout their recovery journey. Physical spaces where patients are treated must be considered and processes must be evaluated from a trauma-informed lens so that we “do no harm” to those who seek help.
Those who suffer from trauma deserve the best care we can provide, care that is practical, effective, and informed by modern neuroscience. Trauma causes a biological injury and we now have effective treatments for acute and enduring trauma symptoms, including interventions flowing from polyvagal theory, biological treatments like ketamine infusion, and innovative treatments that have crossed over from other disciplines such as stellate ganglion block. Innovation requires courage. Innovators will be met with resistance. Nonetheless, we must innovate as if our lives depend on it —because they do.
References and Resources
Jonathan Shay, (1994). Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner), p. 34.
Alison Escalante. “Helping PTSD with a Shot: The New Treatments that are Changing Lives.” Published in Forbes on 2/2/2021.
Clifford Lazarus. “Do you Confuse People’s States with their Traits?” Published in Psychology Today 10/20/2017.
Link to a free downloadable series of Case Studies to Illustrate a Public Health Approach to Suicide Prevention. Published by the American Association of Suicidology.