What Happens to Those Who Survive School Shootings?

Research of gun violence victims offer some insight into what the U.S.'s 150,000 (and counting) school shooting survivors are going through.

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Another week, another school shooting.

The shooting at Marjorie Stoneman Douglas High School in Parkland, Florida is the eighth school shooting resulting in death or injury this year, yet we have only completed seven weeks. It is, according to the Gun Violence Archive, the 1,607th mass shooting since the rampage of Sandy Hook Elementary School in Newtown, Connecticut, widely thought to have been the country's best hope at changing gun control laws.

It didn't. And gun violence in schools continues.

But in the midst of the gun control debate, it can be easy to forget that there are humans—often children—who have borne witness to terrifying nightmarish scenes that will haunt them for the rest of their lives. What will happen to them?

While much research has been done into the minds and motives of mass shooters, the psychology of school shooting survivors is in its infancy—though the rate and increasing population of subjects means that it is a burgeoning field. According to The Washington Post, there are more than 150,000 school shooting survivors since the Columbine High School massacre of 1999, considered to be the first of modern school mass shootings.

School shooting survivors have some constant characteristics: They are almost all minors, they have all been exposed to gunfire in an environment that they consider safe, and they face life in the aftermath of a shooting that requires trying to be "normal" in a world where a lot of people don't necessarily understand the unique combination of witnessing gun violence in a school.

Much of the research on shooting survivors and children focus on those who have witnessed gun violence.

Witnessing a school shooting is especially traumatic given the malleable shape of the brain of school children. Younger pupils are developing foundational skills that will allow them to learn more complex skills, while older students are balancing emotional and intellectual maturation through puberty.

A 1997 paper looking at the neurobiology of children who'd witnessed gun violence (this was two years before Columbine) found that heinous violence and aggression can alter the shape of the brain  by changing the organization of the brain stem nuclei, which helps to respond to stress. Attention deficit disorder is common, along with behavioral impulsivity. Because children who have witnessed gun violence have been exposed to an extremely violent act, they can become numb to the effects of violence and resort to it to solve problems. The authors also note sleep disturbances, anxiety, notable cardiovascular differences, along with cognitive issues. Primate studies have shown hippocampus damage, which is where emotional and memory processing occur.

What will happen to them?

Post-traumatic stress disorder is a notable aftereffect of those who have witnessed and gun violence. A 1996 study on children who have experienced violent crime found that a significant number of them were affected by PTSD: 44.3 percent showed signs of "moderate" PTSD, while 18.6 percent were experiencing severe PTSD.

And suffering from PTSD can, in a terrible loop, cause further damage to the brain. A 2006 overview of traumatic stress on the brain found that the amygdala, which processes information on stress and emotion, is affected—which is why many survivors will report to feeling "numb" or seem unable to respond in the immediate aftermath of a crime. Cortisol—a stress response hormone—is heightened, while the hippocampus seems smaller and the prefrontal cortex, which helps in developing a person's personality and navigating social situations, can shrink.

While Columbine is not actually the first school shooting in the United States, it arguably instigated the crime's modern frequency and paved a path for a disturbing cult of fans along with the subsequent desensitization of the public to shooting victims. The shooting at Marjorie Stoneman Douglas High School is the 25th fatal school shooting since Columbine, which occurred on April 20, 1999, with gunmen killing 12 students and a teacher before committing suicide.

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Nearly 20 years later, those teenagers are now in their mid-30s, and still struggling to process what they went through. Survivors like Marjorie Lindholm, who's written a book, A Columbine Survivor's Story, told WebMD that the experience—being trapped in a classroom for "four or five hours" and attempting to save the life of a teacher who had gotten shot during that time while pipe bombs and gunfire continued, until they were rescued by a SWAT team, was life-changing. She dropped out of high school and couldn't bring herself to go to college.

For Lindholm, what hurts most and gives her PTSD are televised coverage of shootings that can literally break her down. "Last semester I quit going [to college] again because there's been so many shootings on the news, and every time you read the news and something like that happens, you kind of relive what you lived through," she said. In the end, Lindholm switched to earning her degree online so she wouldn't have to step into a classroom.

The fact that students are often at a point in their lives where their academic future hinges on their success in school, and where that success can falter due to the mental distress of stepping back into a school where violence occurred, has detrimental aftershocks. In a March 2016 study published in Educational Evaluation and Policy Analysis, researchers looked at high school student performance in the aftermath of a shooting using data from California. They found that enrollment dived; for those who stayed in school, test scores in math and English dropped significantly.

Those test results are important for getting admission into college, which means survivors might have to settle for lower quality colleges, affecting their future earnings. Compound that by race and gender wage differentials, and these students can be on the route towards a lower quality of life compared to their parents.

It's important to remember that it's not only students that are affected—the adults that often protected students and saved lives are deeply affected. In a 10-year anniversary look back at the survivors of Columbine, chemistry teacher Kent Friesen reported uncontrollable urges to cry and vomit from triggers, like loud noises and gunfire.

Survivors of gun violence have to learn how to live knowing they were spared while their colleagues, peers, or friends were gunned down, a survivor's guilt that can linger for the rest of a person's life. Counseling can help, and psychiatric therapy is often required for people as they maneuver stages of their lives with the weight of the past hovering over them. A college graduation after a high school shooting can seem like a moment to celebrate, for example, but for a survivor, that can be a moment that reminds them of the people who would have otherwise stood by them at this moment—and aren't.

One thing that researchers have pointed out before—and due to the sad increase of school gun violence survivors in this country, has improved—is the speed and depth at which counseling services are made available. In a 2010 paper in Educational Review, researchers argued that not only was it important for schools to prepare for active shooting situations, but the aftermath of a shooting. The speed by which survivors are offered support and counseling can make a huge impact, especially in the aftermath of a shooting, when they are in shock and perhaps pass themselves off as being okay, when in actuality, they simply haven't had time or the emotional space to absorb the horrific incident they had to live through.

The day after the shooting in Parkland, grief counselors were available, and people congregated at local establishments like Starbucks to share their anguish. The reason for their being there was tragic, but their existence will hopefully allow students and their families to cope with an event that undeniably has altered the course of their lives.