Nashville Covenant School. Sandy Hook. Uvalde. Highland Park. Las Vegas. Monterey Park. I likely do not need to explain what those locations refer to. They are embedded in our collective consciousness and our collective grief as a nation.

Sadly, I can go on and on and list hundreds of towns, schools, places of worship, concert venues and other places where people had gathered to learn, worship, work, and enjoy life’s moments, but instead perished from senseless and horrific acts of violence.

I am writing this article on April 4, 2023, which is the 94th day of the calendar year. As of today, the USA has had 134 mass shootings so far in 2023 alone. That’s more shootings than days of the year. As we collect the mounting images and memories of these tragic events in our minds, the need to address the psychological effects of these tragedies also surges.

We are all impacted by mass violence. The psychological scars can impact those who had direct exposure to the incident, the first responders who urgently rushed into the catastrophic situation, those who were in near proximity and those who had witnessed the tragic events unfold and then replayed over and over again in the media. We are all affected on some level.

In Illinois, one of the most recent mass shootings was during the 2022 Fourth of July parade in Highland Park when the attacker opened fire into the crowd of parade onlookers and parade participants, killing seven people and injuring 47 others. Those 54 people had friends, family, co-workers, and loved ones that will also be impacted by the tragic loss. But the anguish and despair actually has a further reach. The community grieves, the city grieves, the nation grieves. We all grieve and react to the senselessness and horror of such shocking violence. It grips us with grief, anguish, despair, anxiety and trauma.

Repeated exposure to catastrophic events leads us to be more vulnerable to experiencing increased stress reactions. It is difficult to heal and recover from these traumatic events when they keep erupting so frequently. What we collectively have is one trauma on top of another trauma on top of further trauma as these traumatic events cascade at such a frequent pace and pile up to towering heights within our psychological consciousness. Add to that the context of the pandemic, an increasingly volatile political and economic climate, plus our own personal stressors, and we can feel the weight of our mental health burden grow. Our mental health reserves are being depleted which is resulting in increased rates of depression and anxiety within our society.

The trauma reactions that result from large scale traumatic events will affect each individual differently based on their proximity to the event, the amount of social supports they may have, their own trauma history and their own current mental health status.

Critical traumatic reactions can occur in immediate survivors of a mass violent event. The people who were at the actual mass shooting event, and survived it, can experience devasting traumatic reactions. That being said, no two people will be affected in the same way. Some individuals may want to avoid the location in the short term or in the years to come as a way of distancing themselves from the traumatic memories. Some will not be able to get the event out of their minds and will be plagued by nightmares, flashbacks, heightened reactions, crying spells and a litany of other reactions.

It is important to note that traumatic memories are not stored in the same way as other memories. Trauma is linked to our fight and flight response. We immediately go into survival mode when exposed to critical events. These experiences are typically stored in our sensory centers such as visual, auditory and olfactory memory. This is why people who were exposed to trauma will have flashbacks. They will repeatedly see the same images. They will recall the exact sounds. They might recall smells. Trauma also activates a small part of our brain called the amygdala. The amygdala is a small, walnut shaped part of the brain that is highly specialized. It works ahead of the conscious brain and activates faster than any other part of the brain. It triggers fight or flight or freeze. It is responsible for regulating the emotions of fear and aggression. This is why, in Post-Traumatic Stress Disorder (PTSD), flashbacks emerge along with a strong fear or anxiety response any time a traumatic memory is triggered. The recollection is linked with the fear response and this is why people become overwhelmed when recalling a traumatic memory.

To illustrate, if I ask you to recall the events of 9/11, what comes to mind? Is it the voice of the reporter telling us in disbelief that the Twin Towers just came crumbling down? Maybe. But chances are, as soon as I said “9/11,” you likely had an immediate mental recollection of an image – that of the airplane striking the Twin Towers in New York and the buildings crumbling down. There’s a reason for that. Trauma has no words because traumatic events are usually outside of our ordinary experiences. Thus we often do not have immediate words to describe the trauma because the scale of emotions and the horror of the experience defy the normal range of vocabulary we have in our daily repertoire. But our brain encodes the memories through the senses ( i.e., the image of the Twin Towers), and links it to the associated feelings (i.e., shock, disbelief, horror) and thus the two are paired in our mind.

I went to Highland Park the day after the mass shootings to offer psychological crisis debriefing to the survivors. One woman, who was driving one of the vehicles in the parade and who was shot at, stated that once she fled the vehicle, she was bombarded with sensory details. She recalled a person lying face down on the ground in a yellow shirt. She said “I can’t get that yellow shirt out of my mind.” She also saw blood on the streets, smoke billowing around fleeing children and recalled hearing the gunfire which she confused for be fireworks in those first moments. She looked distressed as she held back tears, looked down at her feet and was experiencing panic and anxiety as she recalled the memory. This is a typical reaction for someone who has directly witnessed a traumatic event. Her reactions may increase, decrease or change as time goes on because her brain will continue to process the information, and no one’s recovery looks the same or follows a set timeline.
Trauma is broadly defined as occurring when an individual is exposed to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing it; learned that it occurred to a close family, friend or co-worker; or experienced it through repeated or extreme exposure to the aversive details.

Hearing about a mass shooting on TV and seeing the repeated exposure to visual images and hearing about the specific details and can also result in vicarious trauma. That means even if you were not present at the parade in Highland Park during the Fourth of July parade, you can also experience traumatic stress.

How can you tell if you are experiencing traumatic stress reactions? Some common emotional signs of traumatic stress are detachment, shock and disbelief, anxiety and hypervigilance. It is normal to also feel angry, preoccupied, nervous, feeling overly sensitive, blaming others and feeling guilty. Those who have directly experienced the trauma may be at an increased risk for feeling isolated, feeling like no one can understand their experience, feeling helpless and having intrusive memories of the trauma. Behavioral changes that can occur after trauma include insomnia, changes in appetite, flashbacks (whether it be from direct observation or from media depictions of the event), crying, headaches, fatigue, poor concentration, nightmares and avoiding things related to the incident. These effects can arrive immediately or later. Trauma does not have the same timeline for everyone.

It is important to realize that these symptoms are expected reactions to an abnormal situation. Horrific events are not normal. Mass shootings are not normal. We are not going to respond in our usual ways to events stemming from this caliber of violence.

Mass shootings make us feel helpless and vulnerable. After all, if these shootings can occur at a parade, at a mall, a movie theater, a school and a church, we feel very threatened and our collective sense of security becomes very fragile. It is important to counter that mentality by also realizing that with every tragic event, the positive aspect of human nature also emerges. The same woman who has a disturbed memory of a person lying down with a yellow shirt, also had witnessed another person pause and do CPR on a person. You see heroic acts of selflessness and people rushing in to help one another. Offering support is a way to overcome our sense of feeling powerless. Use your power for change: to legislate for new reforms, to contribute to a Go Fund Me page, to not neglect your own self-care. Seek therapy if needed. If you are having severe traumatic symptoms, seek EMDR (Eye Movement Desensitization Reprocessing), which has been shown to be an evidenced based practice to diminish traumatic responses.

As we grieve past events and as we experience trepidation of the possibility of future events, keep in perspective that there is a lot of good out there, that there is help and you are not alone. Just as we collectively grieve those lost to these horrific acts of violence, we can also collectively embrace each other in mutual support and outreach. Reach out your hand to help others and reach for a hand when you need it yourself.

Disaster Distress Hotline: 1-800-985-5990
National Suicide Hotline: 1-800-273-TALK (8255)
Text Crisis Line: Text HOME to 741741

Alexandra Tsang, Psy.D., is the director of the Kane County Diagnostic Center. She can be contacted at TsangAlexandra@16thCircuit.IllinoisCourts.gov.