Sunday’s mass shooting at a Baptist church in Sutherland Springs, Texas, underscores the unique harm that mass shootings, and firearms in general, pose to America’s children.
Children make up about half of the people who died as a result of that shooting — either12 or 14 deaths out of 26, according to initial reports. The youngest victim was just 18 months old. Another 20 people were injured. The big picture is no less grim: Every year, an estimated1,300 children die and 5,790 children are wounded by firearms in the U.S.
Yet even this doesn’t tell the whole story. When a mass shooting happens in any community ― especially one as small and tight-knit as Sutherland Springs, population 600 or so ― it has the potential to do unique damage to the local children, whether or not they were at the scene in person.
“We know that one of the biggest predictors of PTSD is how close one has been to the scene of a traumatic event, and how close one is to people who have been affected by the traumatic event,” said Alicia Lieberman, a psychiatrist and director of the Child Trauma Research Program at the University of California, San Francisco. “In such a small community, where everybody seems to be related to each other in one way or another, where there are very close community connections, there are going to be a lot of people who are missing and who are no longer there.”
CNN estimates that Sunday’s massacre wiped out4 percent of Sutherland Springs’ population. This means it’s likely that child survivors and the children of the town will know people who died. At some point, if they haven’t already, they’ll probably also see wounded and disabled survivors, and watch adults cry and mourn.
Studies on the psychological effects of mass shootings tend to focus on adult survivors, but there is some research about how children react after being exposed to a life-threatening event.
According to a 2014 review of the literature onmass shootings and their effect on children, there are four principal ways that the trauma of a mass shooting can reach a child: They can be an injured victim; they can see the emotional impact the shooting has on someone else; they can personally know someone who was a victim; or they can watch the event vicariously, on TV or social media. The closer a child is to the event, the higher their exposure to trauma, and therefore the higher their risk of severe post-traumatic stress symptoms.
After exposure to a life-threatening event like a mass shooting, about 30 to 40 percent of children and teens will meet the criteria for diagnosable post-traumatic stress disorder, according to the 2014 review. PTSD is characterized by fear, feelings of helplessness, anxiety, recurring intrusive thoughts, nightmares and attempts to avoid reminders of the event. These children and teens may also experience disturbed sleep, difficulty concentrating and irritability — all on top of the grief they may be feeling for the people who have died.
In addition to the risk of PTSD, these events burden young children with a “premature and precocious” fear of death, Lieberman said.
Under ordinary circumstances, a parent can give their child a gentle introduction to the concept of death ― for example, bringing it up if they see a squished bug or a dead pigeon on the sidewalk, Lieberman explained. Later, maybe a grandparent, or someone else in the child’s life, may get sick and begin to decline, allowing the parent to explain the concept of dying as a process.
But when 26 people of various ages and levels of health are killed in an act of mass bloodshed in a public gathering place like a church, this kind of chaotic death wreaks havoc on a young child’s understanding of risk and safety in their everyday world.
“A child is yanked away from a developmentally expectable understanding of death ― that it happens one at a time ― to something that happens catastrophically,” Lieberman said. “So the fear of dying that comes from knowing people who die will be exponentially higher for these children.”
As the nation hems and haws over whether mass shootings can be prevented, it’s crucial to stop and think about the effect of this constant, shocking violence on the country’s youngest citizens, Lieberman said. Growing up in a country that won’t make an effort to prevent these massacres means growing up in a world where children can’t trust their neighbors, can’t feel safe in institutions that were built for them, and can’t feel confident that their parents are powerful enough to protect them. “A key component in emotional health is the ability to trust your mother and father,” said Lieberman, who specializes in child-parent psychotherapy after a trauma. “It’s very easily lost when you see your mom and dad, who you thought were all-powerful, could not stop this from happening.”
A catastrophic sense of death, combined with a lack of confidence in their caregivers’ ability to keep them safe, could lead to a sense of fear that pervades a child’s life.
“One of the things that I anticipate is that they’re going to be scared of society, essentially,” Lieberman said of the children in Sutherland Springs. “Can I trust my neighbor? How do I know that if I go to school I will be safe? How do I know that if I go to church I will be safe? How do I know that even being close to my mommy and daddy will keep me safe? Are you going to die, Daddy? Are you going to die, Mommy? Am I going to die?”
Single-shooter massacres in public spaces may be becomingmore frequent and more deadly. Some political leaders have declared these events unacceptable, and arerallying for policy change. Others are already anticipating the next massacre, and urging theirfellow citizens to take up arms. But for the foreseeable future, mass shootings appear to be part of the fabric of American life. In maintaining this status quo, Lieberman says, we are the architects of a nightmare world for our children, where no one can be trusted and no one is strong enough to protect them.
“We are really hurting the emotional health, happiness, well-being, confidence and know-how of our children,” she said.
This article originally appeared on HuffPost.