The Oct. 1 mass shooting of people attending a country music concert in Las Vegas ended 59 lives, left nearly 500 others wounded and created thousands of other victims: relatives and loved ones of those who were gunned down or injured at the show. More such victims were created on Halloween when an apparent terrorist allegedly inspired by the Islamic State killed at least eight people and injured 11 others when he drove a rented truck through a busy bike path.
Many relatives, spouses, partners and close friends of people who are killed, injured or traumatized during an act of mass violence suffer from anxiety, nightmares, sadness and feelings of guilt that they couldn’t protect the victim or weren’t there when it happened, says Jeffrey R. Gardere, a board certified clinical psychologist and assistant professor of behavioral medicine at Touro College of Osteopathic Medicine in Middletown, New York. After an act of mass violence, such as a shooting with multiple victims, relatives and other people close to victims “may also experience survivor’s guilt and anger at the shooter and society for allowing this to happen,” Gardere says.
The number of people coping with the emotional fallout of being close to someone victimized by mass violence numbers well into the thousands in recent years: In June 2016, a gunman fatally shot 49 people at the Pulse nightclub in Orlando, Florida, and wounded 53 others. In December 2015, a married couple opened fire at a holiday party in San Bernardino, California, killing 14 people and injuring another 22. Three years earlier, in December 2012, a gunman shot and killed 20 children and six adults at Sandy Hook Elementary School in Newtown, Connecticut. And in the single worst act of mass violence in the U.S., more than 2,700 people were killed in the attacks on 9/11.
An array of symptoms can plague people close to victims of mass attacks, experts say. Typically, between 10 and 40 percent of survivors – including people who were injured during the assault and their relatives and close friends – experience post-traumatic stress disorder, says Leo Flanagan, Jr., a trauma and resilience psychologist with Tuesday’s Children. The organization is a nonprofit created to support people affected by the 9/11 terrorist attacks, including relatives of the nearly 2,800 people killed that day. Learning that a relative or close friend was killed, injured or threatened with death or serious injury can put someone at risk for PTSD, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5. People with PTSD may experience nightmares, hypervigilance, mood changes, emotional distress and a loss of interest in their usual activities, according to the DSM-5.
Feelings of guilt are also common among relatives and others close to victims of mass violence, experts say. In the wake of an attack like the shootings in Las Vegas, it’s common for many family members, partners and close friends of victims to feel like they could and perhaps should have done something to protect their loved one, says Dr. Don Mordecai, Kaiser Permanente’s national leader for mental health and wellness. Some relatives and close friends will lament: “I shouldn’t have let them go,” Mordecai says. “Some will believe if they’d been there they could have shielded or protected their loved one.”
Be aware if you’re having trouble sleeping, eating too little or too much, having difficulty concentrating, feeling unusually irritable, experiencing short-term memory loss and nightmares or isolating from people you are close to. If one or more of these symptoms persist for more than two to four weeks, you may be suffering emotional fallout connected to mourning or helping a loved one who was a victim, says Stephanie Dowd, a child clinical psychologist who specializes in mood disorders at the Child Mind Institute in New York City.
Maintaining one’s own mental health while providing emotional support to a loved one can be challenging. Experts recommend these strategies:
1. Talk to someone about your feelings. Whether it’s a close family member, a spouse, a friend, a spiritual adviser or a therapist, it’s important to talk about your feelings, Dowd says. “Emotions don’t go away if we ignore them, they can build up over time and become toxic,” she says. “Emotions need to be acknowledged, processed and let go of.”
If you are part of a religious or spiritual community, it’s a good time to engage or reconnect, Flanagan says. “If you believe in God or a higher power and are angry at God, it’s better to give voice to your anger and sadness. Otherwise, you bottle up those feelings, which is unhealthy.”
2. Maintain or boost your your self-care routine. To the best of your ability, try to maintain whatever routine you typically adhere to, and increase it if possible, Dowd says. Grief and healing take time, but people benefit from the security of regular routines and knowing that life goes on. If your self-care regimen involves working out three days a week, bump it up to four or five workouts weekly. If meditating, attending religious services or praying is a regular part of your life, stick to it. Maintain good eating habits and endeavor to get as much sleep and rest as you normally do to remain healthy. Bear in mind that in the wake of a tragedy, “it’s normal to feel a range of emotions, such as grief, sadness and anger,” she says. Increasing your self-care regimen will help you cope with those emotions and in the long term build resiliency, Dowd says.
4. Join an advocacy group or volunteer. Donating your time to an advocacy group can be empowering, Gardere says. For example, if your relative or loved one was a victim of a mass shooting, you could join a group that advocates for stricter gun laws. “This is a way of turning pain into power, so people are not just working through their own grief but working to prevent this kind of pain for others,” he says. Volunteering can also be healing. Jim Giaccone, of Bayville, New York, suffered recurring nightmares, feelings of depression and mood swings after his brother, Joseph, was killed in the 9/11 attacks. Joseph worked in the north tower of the World Trade Center when terrorists slammed a plane into it. In 2006, Giaccone, 56, started volunteering with Tuesday’s Children, mentoring two young boys who lost their father on 9/11, taking them fishing and hiking – activities Joseph enjoyed. In a small way, sharing those activities with the boys helped keep his brother’s memory alive, he says. “Volunteering for me was a lifeline,” Giaccone says. “It had a definite healing effect.”
5. Seek professional help. If you’re having trouble sleeping or focusing or experiencing these or other symptoms that aren’t improving after a month or so and are causing you significant distress and/or impairment, consider talking to a trained therapist, Kaiser Permanente’s Mordecai says. “Professionals can help you discern whether you’re dealing with a normal reaction to trauma or something out of the ordinary that requires treatment” he says. “If you do require treatment, professionals can help you figure out the next steps.” They could involve talk therapy, medication or a combination of both.