This week our nation mourns the tragic aftermath of the Las Vegas massacre, the worse mass shooting in U.S. history. As of this writing, 59 concertgoers lost their lives, and more than 500 were injured. In total, 22,000 attendees left the venue in terror or risked themselves to assist others. Just one step removed, their grief will be shared in the coming days by hundreds of thousands who will know someone personally who was there. Beyond this group, are the millions of us who were glued to our televisions when the news broke and wept with those who shared their eyewitness accounts and stories of personal loss. Many felt a degree of their anxiety and sadness, even though we may have been thousands of miles away, or knew no one present.
These growing incidents of mass domestic violence frighten, sadden and shock us. As psychologists explain, they shatter our sense of a “just world,” the belief that if we are careful, good and kind, we will be safe. And, we can easily relate to at least one or more of the victims—a teacher, a Disney employee, a policeman, a nurse, and we think, “I could have been at that concert too.”
Can there be a “normal reaction” to such a horrendous event?
Mass shooting research and response informs us that at least a third of those who attended the Las Vegas concert will need counseling. Some may benefit from psychiatric help as well. A testimony to the resiliency of the human spirit, others will experience a short period of acute distress over a few days, but will not exhibit ongoing, debilitating stress symptoms or PTSD that would signal the need for ongoing mental health treatment.
Because it is difficult to predict who will experience what level of emotional response, supportive debriefing after such an event can be very beneficial; especially when trauma occurs among a group of individuals, employees, students who will have continued contact. Critical Incident Stress Debriefing (CISD), as it is formally known, serves to support, triage, and educate those affected so that they can recognize in themselves and others what is a normal stress reaction and what symptoms indicate the need for more care. “Deputized” with this knowledge they can then, in turn, support colleagues and friends who may be in need of help but are reluctant to seek it out.
Over the past twenty years, my CISD team and I have responded to many mass shootings and other traumatic events. Our work and the available research to date has confirmed that it is normal to experience the following short-term symptoms immediately following a traumatic event:
Common emotional and behavioral reactions:
Change in behavior
Anxiety, fear, joy
Slowed thought processes withdrawal loneliness, anger
Difficulty making decisions
Difficulty solving problems
Under/over sleeping hopelessness
Lack of interest in usually satisfying activities
Limited attention span
Over interest in anything that distracts
Common physical and spiritual reactions:
Fatigue that sleep does not alleviate
Changes in relationships with family members, friends, co-workers
Flare-ups of old medical problems
Muscle &/or joint discomfort (often caused by unconscious tensing)
Questioning of beliefs, values, self
Re-evaluation of life structure
All of the above can be considered normal reactions to a crisis if…
1. The reactions do not endanger the individual or others, and,
2. The reactions begin to diminish after about 24 hours.
Mental health professionals consider symptoms that are more serious, lasting longer than three days and continuing up to a month, an acute stress reaction. The ICD-10, the international medical diagnostic code, defines an acute stress reaction as:
A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions.
Symptoms that last more than a month may be diagnosed as Post Traumatic Stress Disorder.
As one forensic psychiatrist said recently: “If you do not have any symptoms and you were directly exposed to a traumatic event, it is important to ask why.” It is normal to have even significant physical and emotional symptoms the first few days. It is our way of healing. And, it is also not uncommon to be numb for a while.
But what if one’s symptoms persist or make it impossible to “function,” go to work, or interact with friends and family?
These symptoms demand immediate attention:
1. Disorientation as to date, day of week, what has happened in last 24 hrs.
2. Too much concern over little things has become preoccupation with one idea
3. Denial of severity of problem has become denial that a problem exists
4. Visual or auditory flashbacks are being confused with reality
5. Self-doubt has become a feeling of unreality or fear of “going crazy” or “losing my mind”
6. Difficulty planning practical tasks has become inability to carry out basic life functions—eating, sleeping, dressing appropriately
7. Mild confusion has become bizarre, irrational beliefs on which the person acts
8. Crying has become uncontrollable hysteria
9. Anger or self-blame has become fear or threats of harm to self or others
10. Numbing has become complete withdrawal with little or no emotional response
11. Appropriate expression of despair or depression has become self-destructive
12. Restlessness or excitement has become unfocused agitation
13. Excessive talking or nervous laughter has become uncontrolled
14. Frequent retelling of the incident has become continual or ritualistic
15. Pacing, hand-wringing, or fist-clenching has become ritualistic or uncontrolled
16. Disheveled appearance, over time, has become inability to care for self
17. Irritability has become destructive
Reactions to trauma can be surprising.
We have found that reactions to trauma can be baffling at times. Sometimes a person who was not present the day of an event, or even on vacation, can return and exhibit a stronger emotional reaction than those who were “on scene.” For this reason, it is important to keep a nonjudgmental, open mind when assisting others. There is always something deeper to learn. Often there is a history that helps to explain why that person is presenting with a stronger response than you may think is “normal.”
These can be individuals who:
· Have experienced other traumatic events
· Have a pre-existing or past mental health challenge, anxiety, depression, etc.
· Have had PTSD in the past
· Can relate in some way to a victim—both pregnant, from the same background, etc.
· Are younger, or have never experienced a traumatic event before
Be on the lookout for delayed reactions among “first responders.”
We have found that those in a leadership position or who are “first responders’ will almost always experience a delayed reaction to the traumatic event. This makes sense, as they are focused immediately afterwards on helping others, not on their own feelings. As crisis responders, we make sure to talk to someone soon after we have assisted a site that has experienced a traumatic event and we check in frequently on-site to assess how we are doing emotionally.
Join in and heal well.
Often, just listening to how a person is experiencing the news of a tragic event is the best medicine. Keep an eye out also for those who may need additional, professional help. Be kind to one another, share in rituals of remembrance and assistance. It is how we best heal-together.
The immediate aftermath of a crisis is not a time for politics, division, or arguing, but for coming together and for healing. Focus on the stories that highlight the very best in our God-given nature–helping, serving, self-sacrifice and resiliency, not on its very worst. Hope is found in seeing the uplifting examples of service and resiliency all around you. Yes, evil has had its awful day, but it has not triumphed. Join in, serve others, grieve well, and experience the healing for yourself.