Enduring Effects of Trauma in Newtown and Beyond

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This month’s Sundance Film Festival, a 10-day salute to movies that are often hailed as tapping into the national zeitgeist, have two films this year on gun violence: Katie Couric’s “Under the Gun” and Kim Snyder’s “Newtown.” Both will be screened by influential audiences this week with a plan for larger distribution over the year. And both will no doubt question what we as Americans should do to prevent mass shootings and to heal afterward.

The ripple effects of mass shootings are immense. Earlier this month school leaders in Newtown testified to Connecticut’s state board of education about the ongoing mental health difficulties that children in Newtown are having three years after the massacre at Sandy Hook. As a trauma psychologist and a pediatrician, we were saddened, but not surprised, by this report. Working in New Haven, just 20 miles from Newtown, we both have colleagues and patients who are in those concentric circles of Sandy Hook and have felt the effects in our professional and personal lives. As health care professionals, mothers, and neighbors of Newtown, we wondered what we as a nation have learned about long-term healing ­in places like Columbine and Virginia Tech.

We wondered about long-term healing for children and adults. We wondered about long-term healing for those closest to the tragedy and for those a degree or two or three away. As it turns out, we still have plenty to understand.

Residents of traumatized communities have strong, complex, and enduring feelings, including fear, rage, guilt, sadness, and anxiety. They have changes to the way they think about themselves, other people and the world. Their sense of security may never return to what it was. And how can it when their trust in a just world was stolen?

We know that early interventions right after the trauma accelerate recovery and prevent long-term mental health problems. One key early intervention is psychological first aid. In psychological first aid, health care providers gather information on current needs and concerns: Is the survivor currently displaced from their home? Are they separated from or concerned about the welfare of a loved one? Psychological first aid includes offering practical assistance to address essential matters, advocating for survivors to connect to social support systems, and providing information on healthy coping strategies including the basic do’s and don’ts of good mental health: Do get adequate rest and meals. Don’t use drugs or alcohol to cope.

In the first few months after the trauma, some survivors warrant a diagnoses of depression, anxiety or PTSD. For survivors with these diagnoses, mental health providers can reduce suffering through proven techniques that enhance the survivor’s capacity to manage emotional responses and challenge unhelpful thinking. But for survivors who are suffering with sadness or issues of trust and hope, and don’t warrant a specific diagnosis, we don’t have evidence-based interventions for healing.Most of the research on medium and long-term healing comes from survivors of natural (earthquakes, hurricanes) or man-made (oil spills, bridge collapses) disasters. We don’t know as much about the effectiveness of treatments in survivors of mass violence. We don’t yet know how to reduce traumatic grief for whole communities.

In some ways, this speaks to the good fortune of Americans until Oklahoma and 9/11–community-wide violence—in places where people felt safe and secure only the day before—used to happen only to children and families who lived elsewhere so we were not faced with how to facilitate long-term community-wide healing. Yet even in the international literature, there are only expert opinions and not evidence for what to do for long term healing after a community-wide mass shooting. Promoting a sense of safety and connectedness and instilling hope are important health care intervention principles, for sure. But they clearly are not enough: over three years after the Newtown massacre the wounds are still gaping.For all of these communities of vulnerable mourners, where losses were sudden, violent, and of human malice, maybe out-of-the-box interventions need to be designed and tested? Restorative retelling where mourners give voice to the most painful particulars of traumatic loss might prove effective. But we don’t know.

If we want to build national capacity for addressing the long term mental health needs of traumatized communities that have experienced mass violence, we need more research and we need more federal funding committed to research — to indicate if and how healing is possible, what it looks like, and how to get there, for Newtown, Charleston, San Bernardino, and—unfortunately–so many other communities.

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