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Affiliation
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Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and School of Medicine, Case Western Reserve University, Cleveland, Ohio lydia.furman@uhhospitals.org. |
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Abstract
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Gun violence has become a topic we cannot escape. School shootings, mass shootings, and 1-on-1 firearm violence are widely reported. Commentaries on the public health crisis of firearm violence headline medical journals. However, beyond the sheer volume of senseless deaths, the agonizing ripple effects of exposure to gun violence on young witnesses and survivors remain largely underrecognized. The door to this topic was opened in the lay press with a recent Washington Post article, “Scarred by School Shootings”; the authors counted students who were exposed to school shootings (in addition to those who died) and focused on victim impact: “Many are never the same.”1
The deep and invisible wounds inflicted by fear, personal loss, and desensitization if violence is repetitive may be hidden from physicians’ eyes and underreported by parents until behavior erupts or sadness strips meaning from everyday life.2,3 Although not every child or adolescent who witnesses or experiences gun violence will develop emotional, behavioral, or academic problems, the increased risk is documented in numerous old and new studies.2–5 Factors that promote resilience include a connection to a caring adult, ready access to mental health and substance abuse services, and friendships with peers who solve problems nonviolently. However, for youth in high-risk communities, the availability of protective factors is typically reduced, and violence exposures tend to be repeated and ongoing, increasing the risk for adverse personal outcomes.5 As pediatricians, we can act to (1) identify and listen to affected youth, (2) refer each identified individual to optimal psychological care, and (3) partner with first responder and community programs that are doing the same work.
It is easy to see flesh wounds from bullets, but it is harder to “see” gaping psychological wounds. Millions of Americans watching America’s Got Talent heard Flau’jae, the 14-year-old rapper from Georgia, perform “Put Your Guns Down!” (her moving rap elegy to her rapper father, who died of gun violence before her birth). Not all teenagers will be able to eloquently express their pain like Flau’jae did on a national stage, but we can make the choice to ask and to listen at each encounter. Pediatricians practicing in urban areas encounter survivors and witnesses of gun violence routinely, but the circumstances are rarely directly revealed to us. Many children and teenagers bear their pain in silence, and any intractable emotional, behavioral, or learning problem may be the only window through which we can identify an affected survivor or witness. A 15-year-old girl with depression, for example, is failing school and up all night on social media; ultimately, we learn her brother was murdered in her presence several years earlier, and she obsessively and endlessly wonders what she could have done differently. A 9-year-old boy has an abrupt deterioration in his grades and becomes physically aggressive at home; his mother did not realize that witnessing a shooting on the playground could affect him so directly. These are just 2 examples of visits in which a “gut feeling” that there was more to understand led us to a history of exposure to gun violence...
Language: en |