OHSU

The Tragedy at Sandy Hook Elementary

The awful events of December 14th in Connecticut have profoundly affected the nation and amplify the fear and foreboding of our own Clackamas Town Center shooting. The rapidity, intensity and repetitiveness with which the news about these events has been spread is symptomatic  of the deep wounds inflicted by this senseless violence.  The families that have lost their children and loved ones, the traumatized friends, townspeople, police, and health care personnel are burdened with the unbearable.  Others who have experienced tragic losses struggle with re-awakened pain.  And parents, sometimes overwhelmed with a sense of dread, try to reassure their children as they send them off to school while their heart's desire is to keep them home and safe.  What can anyone do in such tragic circumstances?

First, we can help the victims.  The Connecticut Psychiatric Society (CPS) reacted rapidly and effectively to the tragic shooting.  Within a few hours, 100 CPS members responded to CPS President Santopietro's e-mail requesting volunteers to help in the stricken town. By good fortune CPS had conducted a disaster-response training session for members just a month before. By Saturday afternoon, working through the Red Cross and state and local health agencies, CPS arranged for at least two psychiatrists to be on duty with other mental health professionals for three-hour shifts from 7 a.m. to 7 p.m. at a crisis-response center in Newtown. On Sunday, they met with more than 300 local children and adults and will provide much more help in the coming months and years.

We need to recognize that the victims of such events are not only local.  The genius of our capacity for imagination and empathy carries with it a dark side, our ability to suffer emotionally when confronted with the suffering of others.  The guide appended to this article from the Center for the Study of Traumatic Stress can be a help to physicians dealing with patients and parents helping their children and I urge parents to read Dr. Ajit Jetmalani's comments.  Those who have been more severely affected should not hesitate to ask for help.

Second, we can seek to understand.  It helps us, in dealing with tragedy, to understand why and how it occurred.  The focus we see in the media on the law enforcement investigation of the event, the search for background information on the shooter, the multiple radio and television interviews of psychiatrists and psychologists represent this deep need to understand and explain.  In part, our desire for explanation helps with a sense of control.  We know from studies of the victims of disasters, abductions and assaults that people will often blame themselves rather than accept the alternative that they were actually helpless to control what happened to them.  The acknowledgement of helplessness and blamelessness is essential in resolving the guilt that survivors of an attack or disaster often feel.

It is also helpful to understand that our sense of vulnerability is not an accurate reflection of objective risks.  Typically we substantially overestimate the risks of events like shootings and plane crashes while underestimating the risk events that are much commoner such as automobile accidents.  This realization can help to reestablish a sense of safety and trust in the environment.

Third, we can seek to prevent such tragedies.  There is much to be done in this regard, some of it politically controversial, and much of it a question of societal priorities.  But that is a discussion for another day.  For now, we must grieve the dead, comfort the living and tend to our own emotional health.

George A. Keepers, M.D.Carruthers Professor and Chair, Psychiatry

Restoring a Sense of Safety in the Aftermath of a Mass Shooting: Tips for Parents and Professionals

Too often our children are exposed to violence that is both senseless and harmful. Many children, those living in close proximity to a tragic event, and those who will learn about the event through television, social media, or newspaper coverage, will be affected and upset. The timing of this tragedy — the holiday season — makes this Connecticut school shooting even more upsetting. Many children will soon be on school holidays putting additional responsibility on parents and caregivers to reassure children who may know about or ask questions around this event.

Communicate effectively with your children

A high profile event of this magnitude can result in confusion and distress among communities across the country. Distress can result in distortion about the facts of the event. Therefore, special attention should be given when communicating with children and adolescents.

  • When speaking with your children, it is best to use communication that is factual, simple, clear and sensitively worded.
  • Don’t overwhelm young children with too much information. They might want to talk intermittently or might need concrete information to be repeated.
  • Use language that is appropriate to your child’s age.
  • Young children sometimes exhibit “magical thinking” which might lead them to believe they are responsible for what happened.
  • Children may have ideas or beliefs that are difficult to know unless you ask them.
  • Adults can encourage children to talk, but should respect their wishes when they may not want to.
  • Ensure that your children are not exposed to media reports about the event that are repetitive, confusing, or frightening.

Physical safety and security always take priority

It is difficult to predict children’s reactions to learning about these types of events and whether children’s immediate reactions will lead to sustained psychological problems.

  • Common posttraumatic responses in children include: nightmares or fears related to the trauma, avoidance of reminders of the trauma, and repetitive play that mimics the trauma.
  • While symptoms are often transient, they should be clinically treated if they persist. If you have questions contact your child’s health care or behavioral health care provider to seek advice or guidance.
  • Some children may act out as a reaction. Talk to your child about what is troubling them and do not punish or reprimand them.

Answers to some common questions

Below are some common questions and answers to help guide caregivers addressing a confusing or senseless act of mass violence with children and adolescents:

Why do these things happen?

Children, like adults, often want to know the motives of people responsible for these horrible events. Past events have resulted from many causes including mental illness, rage, extreme political or religious beliefs, and frank hatred. Unfortunately, we usually can’t be sure what led a specific individual acting in such a way. It does not help children to have them fear groups of people who fall into any specific demographic categories. Doing so only leads to discrimination, stigma, and victimization of people who also are struggling to cope with these events. More importantly, help your children understand that adults, including government authorities work hard to identify and stop dangerous events before they even happen.

Will this happen again and how do I keep my children safe?

Unfortunately, violent events are likely to occur in the future. It is important to remember that despite our awareness, random violence occurs rarely and does not occur in most neighborhoods. Remember that parents and professionals strive to keep our children safe yet allow them the space they need to grow and develop. Use the following guidelines:

  • know your children’s whereabouts, who they are with and when they are to return home
  • set clear and consistent curfews
  • have a clear method of communication in normal and emergency situations (e.g. cell phone)
  • educate them about places or situations that are more likely to put them in danger and teach them to avoid high-risk exposures
  • monitor federal and local advise about risks that might surface
  • be vigilant about safety in your community
  • strive to keep open communication with children and adolescents

How does one plan for this type of emergency?

Discuss hypothetical emergency situations with your children and calmly talk with them about what they can do to keep themselves safe when danger presents itself. Instruct them to trust and seek help from police and other authorities who are likely to be on the scene quickly. Always encourage your children to say something when they see something suspicious. Establishing a communication plan for locating family members can help to reduce anxiety. Parents should know where their children are and children should tell parents when they have changed their location.

Is my child okay?

Children will show a wide variety of reactions. There is no “normal” reaction to stressful events. Some reactions include tearfulness, separation or bedtime anxiety, or regression in behaviors. More severe reactions may include reliving the trauma through dreams, emotional numbness, increased startle responses, withdrawal or physical symptoms like racing heartbeat, nausea or change in appetite.

These types of events, while tragic, can sometimes lead to positive opportunities. They become opportunities to open, or reopen, channels of communication among family members. They may provide us opportunities to appreciate each other more and to express our love for one another. They may provide opportunities for families to better plan how they will cope with future difficult times or topics. It is important to focus on what might positively emerge from these tragic events while we also acknowledge tragic losses.

Tips for Parents and Professionals provided by Center for the Study of Traumatic Stress & Uniformed Services University of the Health Sciences