Gun Violence Trauma: Beyond the Numbers
By Christina Reardon, MSW, LSW
Social Work Today
Vol. 20 No. 1 P. 10

Mass shootings are happening almost weekly, instilling fear, hopelessness, and hypervigilance in individuals and communities. Learn how the trauma impacts individual survivors, professionals who care for the victims, and areas left to suffer the impact. Some are taking action to unite and heal in their grief.

When describing a social problem, people often focus on numbers: How many people in a city are experiencing homelessness? What is the crime rate in a neighborhood? What percentage of a population experiences poverty?

But numbers only tell part of the story. Social problems are complex, and an understanding of them cannot be gained through quantitative data alone. Such is the case with gun violence. Every time there is a shooting—particularly a mass shooting—the first piece of information often shared is the number of people killed or wounded. But the trauma caused by gun violence ripples out far beyond the victims and the more social workers know about these effects, the better they can respond to this trauma, particularly in communities where gun violence is an everyday occurrence.

“Gun violence is way more than a body count,” says Sara Moore Kerai, MA, LPC, a counselor in private practice in Washington, DC. “It creates a sense of hopelessness. People believe that no one cares about what’s happening.”

Wide-Ranging Effects
Trauma caused by gun violence is so destructive because it affects not only the victims but also their friends, family members, neighborhoods, and communities. “Gun violence is a systemic trauma in that it permeates and impacts the social and interpersonal systems of those shot,” says Charles Figley, PhD, a professor of social work and director of the Traumatology Institute at Tulane University in New Orleans.

The mental health effects of gun violence can include anxiety, depression, and PTSD. Consider the following:

• Gun violence survivors interviewed by Francis (2018) reported increased fear and vigilance; some were so fearful that they did not want to leave their homes.

• Within a group of urban adolescent girls assessed at an adolescent medicine clinic, two-thirds of those exposed to violence—including gun violence—met PTSD symptom criteria (Horowitz, Weine, & Jekel, 1995).

• Sullivan and Weiss (2017) found that women who were survivors of intimate partner violence were more likely to have more severe symptoms of PTSD if they had been threatened with a firearm by their intimate partners or feared that their intimate partners would use a firearm against them.

• Nearly one-third of parents in the Washington, DC, area surveyed after the 2002 “Beltway Sniper” attacks said that their children experienced at least one psychological distress symptom related to the shootings (Self-Brown, Massetti, Chen, & Schulden, 2011).

Fear leads many survivors of gun violence to avoid situations where they might be reminded of the violence, says Julieta Macias, LCSW-C, PhD, who has worked with such clients at her private practice in Rockville, MD. These clients can experience agitation and sleep disturbances, react in fear toward anyone who resembles perpetrators, and worry that perpetrators are going to seek revenge. To cope, these clients might avoid spending time in the area where the violence occurred or even move from the area and limit social activities. “It’s about constricting their experience of the world in order to manage their fears and anxieties,” Macias says.

While secondary trauma is often associated with those closest to gun violence surviors, it affects others—from first responders assisting the scene of gun violence to health care workers who see the horrific damage gun violence causes, says Chad Dion Lassiter, MSW, executive director of the Pennsylvania Human Relations Commission. “There are a lot of people walking around with undiagnosed and unacknowledged PTSD,” Lassiter says.

Trauma’s impact can be magnified if a person is repeatedly exposed to gun violence. “Most often, gun violence survivors are similar to war veterans who must adapt to being exposed to danger and skilled at staying safe,” Figley says. Examples of such adaptive behaviors include learning how to interpret noises, faces, and body language for possible threats. In these ways, gun violence survivors learn to accommodate the violence in their lives, but that comes at the cost of their psychosocial, medical, and mental health, Figley says.

In communities where gun violence is common, residents can experience hopelessness and a sense that the violence is just part of everyday life. Francis (2018) describes how one gun violence survivor recalled an incident where she had seen a boy get shot in the face and reported that the boy later died: “There was no outward emotion exhibited and she simply stated it as a fact of daily life. It seemed to be expected. She believed the violence is always present and people learn to adapt.” Exacerbating the problem is that people living in such communities often also face barriers such as poverty, lack of education, and minimal job prospects that limit their options for the future, Francis says.

In addition, mental health problems can affect a gun violence survivor’s physical healing. A study of adults hospitalized for firearm-related injury found that those with preexisting depression had an increased risk of discharge to a care facility or in-hospital mortality (Kalesan & Galea, 2015).

Although trauma related to gun violence is usually associated with the victims and their social networks, there also is trauma related to perpetrators, says Natalie Kroovand Hipple, PhD, an associate professor of criminal justice at Indiana University. With incarceration comes trauma for perpetrators’ family members—for example, women who are left to care for children on their own and children who can only see a parent by visiting a prison. And when perpetrators are released back into the community, they return having experienced the trauma of incarceration.

Perhaps the most disturbing traumatic effect of gun violence is that it can lead to more violence. Feeling unsafe, expecting to be victimized, and doubting that police will protect them, people in high-violence communities may choose to carry firearms for protection, says Jesenia Pizarro, PhD, an associate professor of criminology and criminal justice at Arizona State University. “Firearms are a prime facilitator of violence, and [a firearm] is a tool that increases the odds of violence,” Pizarro says. “It becomes a never-ending cycle. Violence begets more violence.”

There are myriad factors that can affect an individual’s risk of being exposed to gun violence and how the individual reacts to that violence, Figley says. Risk factors include exposure to violence and living in high-crime areas, while protective factors including having the ability to self-regulate, having a social support system, and taking care of physical health (e.g., getting enough sleep, eating nutritious foods). “People are more resilient when they are running on all cylinders,” Figley says.

Mass Shootings and Trauma
There is an elephant in the room when talking about trauma and gun violence: The trauma experienced by survivors of mass shootings often attracts far more attention than that experienced by residents of urban communities, even though mass shootings are much rarer. According to the Pew Research Center, victims of mass shootings account for a small fraction of gun-related murders in the United States (Gramlich, 2019). “We give a lot of attention to [mass shootings], but with the everyday shootings that happen in urban areas, there doesn’t seem to be the same outcry and urgency,” Lassiter says.

A combination of factors leads to this discrepancy, Lassiter says. For example, mass shootings are sensationalized in the media. And race plays a role as well; people tend to be moved emotionally by the suffering of mass shooting victims and survivors, but are not as sympathetic to people in communities of color affected by gun violence.

The focus on mass shootings can exacerbate feelings of fear in the general public about events that are still unlikely to affect them. A survey of adults conducted in August 2019 on behalf of the American Psychological Association found that nearly 80% of adults said they experience stress as a result of the possibility of a mass shooting. One-third of adults said fear of a mass shooting prevents them from going to certain places or events, and one-fourth said they had changed how they live their lives because of fear of a mass shooting (American Psychological Association, 2019).

Hipple says the emphasis on mass shootings diverts important resources—e.g., time, money, and policy initiatives—away from addressing the trauma of gun violence in those areas that need the resources the most. “[Gun violence] is happening all the time every day all over this country,” Hipple says.

Healing the Wounds
Addressing the trauma caused by gun violence requires a two-pronged approach of helping people who have experienced trauma while also working to reduce gun violence. Lassiter believes social workers are especially well suited to these dual tasks because they understand how different issues related to gun violence intersect at the micro, mezzo, and macro levels. “It makes all the sense in the world for social workers to be involved in this work,” Lassiter says.

There are a variety of tools clinicians can use when working with gun violence survivors, Macias says, including cognitive behavioral therapy, acceptance and commitment therapy, and cognitive processing therapy. It is also important to teach clients to use mindfulness, meditation, and other techniques to calm the physiological responses—such as rapid heart rate and shallow breathing—that might arise when recalling the trauma or being in a place that reminds them of the trauma, Macias says.

The term “trauma-informed care” has become popular among mental health professionals and health care workers to describe the approach they use in working with people who have experienced trauma. However, social workers need to reflect on whether their practice really reflects tenets of trauma-responsive care such as collaboration and focusing on strengths, says Elizabeth Power, MEd, founder of the Trauma-Informed Academy and an adjunct instructor in psychiatry at Georgetown University. “You can believe all those things, but you might not always be doing all those things,” Power says.

A challenge when trying to address the trauma experienced by people exposed to gun violence is that such violence has often become such a regular part of their lives that they don’t see the need for mental health services or they feel stigmatized by reaching out for support, Hipple says.

Furthermore, giving people the chance to share their stories does not have to be limited to counseling settings, says Mary Francis, RN, MSN, PhD, an assistant professor of nursing at Widener University in Chester, PA. Francis also is a trauma nurse practitioner at Cooper University Hospital in Camden, NJ, where she interviewed 16 gun violence survivors about their experiences and found them eager to talk. “They really wanted their story to be told,” Francis says. “We should not assume that they do not want to tell us. Their input is invaluable.”

In addition to treating trauma, social workers can take steps to help prevent gun violence. They should advocate for more resources to be used toward helping people—particularly children—learn conflict resolution and emotional regulation skills so they have better tools to deal with violence, Kerai says.

Pizarro adds that working to improve relationships between communities and police is vital so people in high-violence communities feel that they can trust the police to protect them rather than resorting to carrying firearms.

Finally, social workers can get involved in political action to advocate for gun control and other policies to address poverty, racism, economic injustice, and other factors that contribute to gun violence. Kerai, for example, is a volunteer for Moms Demand Action for Gun Sense in America, a grassroots organization focused on promoting gun safety and violence prevention.

She suggests social workers advocate for policies proven to reduce gun deaths, such as background checks on all gun sales, red flag laws to temporarily remove guns from people who pose a danger to themselves or others, and safe-storage laws to prevent children from unintentionally shooting themselves or others.

Even though gun violence seems like an unsolvable problem, there is something each person can do to help those traumatized by it, Pizarro says. “It’s not all lost,” Pizarro says. “There are definitely things you can do. You might not save everyone, but you can help some. It’s not an inevitable thing.”

— Christina Reardon, MSW, LSW, is a freelance writer based in Harrisburg, PA, and an editorial adviser at Social Work Today.

References
American Psychological Association. (2019, August 15). One-third of US adults say fear of mass shootings prevents them from going to certain places or events. Retrieved from https://www.apa.org/news/press/releases/2019/08/fear-mass-shooting.

Francis, M. (2018). A narrative inquiry into the experience of being a victim of gun violence. Journal of Trauma Nursing, 25(6), 381-388.

Gramlich, J. (2019, August 16). What the data says about gun deaths in the U.S. Retrieved from https://www.pewresearch.org/fact-tank/2019/08/16/what-the-data-says-about-gun-deaths-in-the-u-s/.

Horowitz, K., Weine, S., & Jekel, J. (1995). PTSD symptoms in urban adolescent girls: Compounded community trauma. Journal of the American Academy of Child & Adolescent Psychiatry, 34(10), 1353-1361.

Kalesan, B., & Galea, S. (2015). The relation of depression to in-hospital outcomes among adults hospitalized for firearm-related injury. Journal of Affective Disorders, 183, 166-172.

Self-Brown, S. R., Massetti, G. M., Chen, J., & Schulden, J. (2011). Parents’ retrospective reports of youth psychological responses to the sniper attacks in the Washington, DC, area. Violence and Victims, 26(1), 116-129.

Sullivan, T. P. & Weiss, N. H. (2017). Is firearm threat in intimate relationships associated with posttraumatic stress disorder symptoms among women? Violence and Gender, 4(2), 31-36.

HEALING ONE BLOCK AT A TIME
The 6400 block of South Honore Street in Chicago’s Englewood neighborhood is a beacon of hope in the effort to heal the trauma caused by gun violence. This is the home of I Grow Chicago, a community-driven organization that provides services and a place for communication, collaboration, and respite for neighborhood residents. Reclaiming abandoned homes and vacant lots, I Grow Chicago has created a Peace Campus that includes a community center, community garden, and a healing justice court for activities such as restorative justice circles, yoga, and basketball. In August 2019, the campus expanded with the addition of the Family Wellness House, which provides more space for services and housing for a neighborhood family.

The block was once considered extremely violent, but the presence of the Peace Campus has changed that because it has given community members a place to be safe and feel acknowledged, says Robbin Carroll, founder and president of I Grow Chicago. “What we provide is that there is something here for people and they are not in the world alone,” Carroll says. “People who have been dismissed and thrown out don’t feel that way anymore.”

Community members are at the heart of I Grow Chicago’s work. All of the organization’s program staff come from the community, and the organization involves community elders in its Wisdom Council. One of the community members making a difference through I Grow Chicago is Quentin Mables, the organization’s coexecutive director. Mables grew up in Englewood and has seen both how it has been plagued by gun violence and how the community has come together to change things. For example, when two guns were recently found on the Peace Campus’ basketball court, the community came together to talk about what happened and discuss how to make sure people feel safe enough that they do not think they need guns for protection. “If we didn’t have the space to create conversation, we would have not been able to move forward,” Mables says.

Carroll believes what I Grow Chicago has done in Englewood could be done in other communities concerned about gun violence. All it takes is connecting people committed to making a change, no matter how small. “If everybody just picked a tiny space and did something to help, I think we’d live in a different society,” Carroll says. “This isn’t that hard. We just have to care about people.”

— CR