Understanding suicides of survivors of shootings in a park

Over the past two weeks, we have seen how the devastating impact of school shootings can be felt long after the immediate trauma. Last week, two survivors of the Parkland massacre in 2018 – a 19-year-old graduate named Sydney Aiello and an unnamed second-year Parkland student – both died of suspected suicides. And on March 25, Jeremy Richman, whose daughter Avielle was killed at Sandy Hook Elementary School in 2012, was also found dead in apparent suicide.

This is not the first time we have seen the harmful consequences of the trauma of shooting in a school. After the Columbine massacre in 1999, a student and the mother of a severely injured student committed suicide. And as reported by the Daily Beast, six students attempted suicide after a shootout in Ohio in 2012, which resulted in three deaths.

Aiello's mother stated that her daughter was struggling with post-traumatic stress disorder and was suffering from the "guilt of the survivor" after experiencing the deaths of her classmates. School shootings have become an American epidemic, but psychologists and trauma experts are just starting to collect data on the impact of these events on survivors and their communities in the long run. To find out what we do and what we do not know about the mental health effects of surviving a shootout in a school, we spoke to Amy Nitza, director of the Institute for Disaster Mental Health of New York State University, New Paltz. Nitza's work focuses on understanding the psychological consequences of disasters such as shootings in schools.

It was a terrible week. What do you get out of it?
It is a reminder of the degree of devastation that these events entail and its disastrous consequences for mental health. At Sandy Hook, it's been six and a half years since the incident occurred and so many mental health resources have been invested in this community, yet there is so much suffering. These suicides are likely to have a very strong impact on other survivors. I think we can expect there to be a drive effect in terms of triggering a resurgence of others' pain.

What do we know about the effects on mental health of shootings in schools?Shooting in schools opened a new set of questions. There are all kinds of questions about how best to protect children from exposure to greater trauma, as any new exposure to the environment, images, sounds or smells of the incident can potentially become true triggers. For example: what type of memorial do you do and how much? Do you keep teddy bears and gifts that people have sent? And when do you reopen school? What is the best way to help kids get their stuff?

One of the parents of one of the deceased women said that her daughter was suffering from the "guilt of the survivor", a term commonly used. What do we know about this phenomenon from a psychological point of view?
The survivor's guilt itself is not a diagnosis. it's a phenomenon that occurs. Generally, it's about triggering a conviction or asking a question about its value and value, as in the case of why I survived when other people did not survive, or why did I deserved to live and others not? This can trigger such deep existential questions that there are not really any answers. And struggling with these issues becomes a really important cognitive and emotional challenge that can build on itself and create cognitive distortions.

What do you mean by cognitive distortion?
It's like an attribution error [of blame or agency to oneself]like, for example, "if only I did not go out in the hallway, I might have saved my friend in the classroom". Survivors begin to distort their behavior and what they may or may not have. done in this situation. There is also a feeling phenomenon: since they have survived, there is a deep sense of pressure to achieve something or to meet that expectation. These distortions are related to changes in mood and depression. Survivor guilt may be one of those negative cognitive patterns associated with PTSD.

Is there a proven correlation between PTSD and the increase in the suicide rate?
I know we are seeing an increase in depression rates when someone survives a violent event like this, and suicidal ideation is definitely a risk factor associated with depression. However, to the best of my knowledge, there is currently no tangible evidence of an increased risk of suicide following an incident of mass violence or school shootings. I think that this week's events bring new information to bear in mind, as we would not usually talk about suicide as a common reaction or outcome.

It's interesting. And in terms of knowing that you have PTSD, is that the kind of situation where every student in the school would probably have it or just a small part? And are there predictors of who will likely be the most affected?
You can expect all students in the school to have symptoms of post-traumatic stress. But the majority of these will not develop a diagnostic disorder of PTSD. Having the symptoms does not mean the disorder. Those most at risk are those who had a larger dose of the event, so they were close in time and intensity. Another indicator concerns recovery resources. We know that one of the main protective factors is the sense of social and interpersonal belonging, which may be their parents or a faith community, or other survivors or therapist.

We also know that the way children adapt is predicted by the way their parents adapt. An important message that I want people to hear is the importance for parents to take care of themselves, as children are very aware of the changes in their support system.

How are school shootings different from other mass traumas in the way the community reacts?
The fact that they are intentional – whether caused by a human being – means that people are more at risk of negative reactions than in natural disasters. In no way minimize the trauma that may be associated with a natural disaster. But there is something about intentionality and the lack of humanity around shootings in schools that make them potentially more harmful to survivors. Involvement in the criminal justice system also raises problems, which only add to the additional distress.

One of the things that the trauma, by definition, does is to change the worldview – it somehow disrupts the worldview as a safe place. It is a total loss of control over the ability to take care of oneself. If school is a place where you went and you felt safe and trusted the people around you, doing the act of violence in this environment can really upset your vision. of the world. Throughout the country, children see their sense of school to some degree as a safe place.

What about the media aspect? Especially by people on social media like Alex Jones spreading lies and conspiracy theories about shooting in Newtown or the fact that Parkland students are crisis actors.
An important aspect of healing is validating your experience and feeling as if people are meeting your needs. Conspiracy theories are an invalidation of people's experiences. It's like being revictimized and re-traumatized whenever their experiences are invalidated. It is certainly another layer of distress and trauma.

With regard to the general media attention, we have debates about this in my office on whether the role of the media can be positive or negative. At a certain level, when the media appear, it shows that the world cares and pays special attention. But when the media leaves, there may be a void. The attention of the whole world has turned to other things and the lives of their lives are always devastated. The other thing that concerns me about the media is Parkland's: some of the children have been described as so strong; they fight and are activists. But there are also other people who are not there, who do not feel strong and who do not feel like walking. And I think these kids can really have a hard time feeling like it's wrong to feel like they're feeling.

Do teens treat the guilt of survivors differently from adults?
Their prefrontal cortex – the part of their brain responsible for decision making, planning and rational thinking, and which includes the long-term implications of their actions – is actively developing during adolescence. They treat the information differently. Therefore, if they develop a distorted negative thought around something like the survivor's guilt, it can be repeated and reinforced over and over again as their brain is still developing. It can treat in the brain in a way that sticks. But another message that I really want everybody to hear, is that there are several empirically validated treatments that are very effective at treating PTSD, including cognitive-behavioral therapy-oriented behavioral therapy. traumas. This situation is not without hope – help is available. We need to normalize that it is okay to go for help and that you do not have to suffer in silence or to pretend to feel strong if you do not feel strong.

If you are in crisis, please call the National Suicide Prevention Line at 1-800-273-TALK (8255) or contact the crisis text line by sending a TALK message to 741741.