Sherrie Lawson was in a meeting when she heard the gunshots.
Because she was on a Navy installation where firearms were heavily restricted, Lawson assumed the loud bangs were the sound of people dropping tables or chairs.
Less than a minute later, when more shots rang out, she and her colleagues realized something was wrong. People ran by, shouting about a shooter on the grounds. Lawson joined the crowd and they ran, trying to get away from the sounds of gunfire.
Soon they found themselves in an alley, facing an eight-foot brick wall. Lawson scaled it with the help of her colleagues. Minutes later, the gunman shot and killed someone in that alley. He had been behind Lawson’s group.
“It didn’t make a lot of sense to me until later, when I was kind of given a timeline of what happened,” Lawson said. “Why the gunshots were so loud in my experience, and why I felt he was right there.”
Four days after the shooting, Lawson got on the bus to return to the Navy Yard, in southeast Washington, D.C., and get her laptop. When she reached her stop, she realized she couldn’t get off the bus. She stayed on for a few more stops, then got off, walked to the middle of the sidewalk and burst into tears.
“I think that was the first time it all just kind of hit me,” she said.
The procedure for the aftermath of a mass shooting is by now depressingly familiar. News stories list the number of dead, the number of wounded, the status of the gunman, the timeline of events. In the Washington Navy Yard shooting, which happened in September 2013, 12 people were killed and eight were injured.
Yet these tallies don’t account for hundreds, perhaps thousands, of other people directly involved in these events. Most people who are present during a mass shooting are not physically injured. Most do not die. But that doesn’t mean they emerge unscathed.
In the aftermath of a mass shooting, a nation’s sympathies and fundraising dollars are directed toward those who died or were physically injured. Meanwhile, people like Lawson are left grappling with guilt and shame over wanting to ask for extra help, even as they are swarmed by psychological symptoms.
“It feels very selfish as a physically uninjured survivor to ask for resources when others died or were shot, which is one of the reasons why this group of people goes without,” said Lisa Hamp, a survivor of the 2007 Virginia Tech shooting. “We stay quiet because we realize how lucky we were, and how much worse others have it.”
On April 16, 2007, Hamp was barricaded in a classroom in Virginia Tech’s Norris Hall while a gunman fired at the door and pushed to get inside. Hamp and a few of her classmates were on the other side, pushing against the door to keep him out. The shooter ultimately killed 32 people that day, and then himself.
Staying quiet has its costs. After the Navy Yard shooting, Lawson’s post-traumatic stress disorder was so severe that she had to leave her job and her doctoral program. She drained her savings to pay for specialized treatment. Hamp struggled with an eating disorder and subsequent fertility issues, and she estimates she’s spent a few thousand dollars on counseling since 2007.
Usually, when people talk about “trauma,” they’re using the term to describe an emotional reaction to an event. In this colloquial sense, the greater a person’s distress, the more “traumatic” the event must have been. But in the medical sense, trauma is a physical, chemical experience, where a person believes their life or body is under threat ― and it triggers temporary changes to a person’s strength and cognition in order to help them make it out alive.
During this “fight or flight” response, the brain sets off a series of hormonal changes that help the lungs take in more air, send blood to the muscles, sharpen the senses, increase mental alertness andgive the body a burst of energy. These enhancements give a person extra strength to flee, as Lawson did, or fight, as Hamp did.
When trauma happens to a group ― as in the case of a mass shooting ― these physical reactions take place in dozens, hundreds or even thousands of people. For most, their bodies return to normal functioning soon afterward, and even though they may experience serious distress in the short term, they will be able to recover and return to life as it was before.
But a minority of people develop post-traumatic stress disorder, which occurs when the mental and physical responses to danger don’t switch off. These responses, which are normal and often helpful in traumatic situations, linger on and become an intrusive, sometimes intolerable part of daily life. Regular, everyday stimuli canjolt a person back to the day they thought they were going to die, cuing hypervigilance, crying, panic attacks or worse.
After the attack, Lawson grew frightened in grocery stores. She couldn’t see over the rows of food; anything might be back there. When she heard a siren or a helicopter, it could trigger a crying jag or a panic attack. At night, she would dream she was running. Fall is Lawson’s least favorite time of year, because the smell of Pumpkin Spice Lattes brings her back to the breakfast she ate the day of the shooting.
And when Hamp returned to school for her senior year, she was haunted by the fact that during the shooting in Norris Hall, her teacher and a classmate took charge of making the barricades and directing the other students to their positions. Hamp herself just numbly followed along. Back in the classroom, she vowed to be more vigilant about her surroundings, and to always formulate a plan to take action if things went wrong.
In a 2013 research reviewabout the mental health consequences of mass trauma events like shootings, terrorist attacks and natural disasters, Dr. Sandro Galea, anepidemiologist and dean at Boston University’s School of Public Health, writes that PTSD may be present in as many as 30 to 40 percent of disaster survivors, and 10 to 20 percent of rescue workers.
And while the research on this point is mixed and still emerging, Galea notes that disasters of human origin ― those that are caused by technology, like a nuclear accident, or those that involve mass violence, like terrorism ― appear to have a “more pronounced psychological impact” than natural disasters like hurricanes or floods.
Lawson’s symptoms were so severe that her doctor recommended she leave her job as a Defense Department contractor and withdraw from her Ph.D. program. She filed for short-term disability andworker’s compensation(which her company appealed three times), drew down a $20,000 nest egg and tapped into her 401(k). She had a lot to pay for: out-of-pocket therapy sessions; copays for doctor’s visits and prescriptions, including a partially covered six-month PTSD outpatient program at the Psychiatric Institute of Washington; and frequent trips to her family in North Carolina for emotional support.
Last year, Lawson filed for bankruptcy over the debt she’d incurred from medical bills since the shooting. This debt also included bills from when she had a stress-related mini-stroke in 2014.
She says she also lost her social network due to her depression.
“I had some friends accuse me of wallowing in my sorrow and refusing to get over what happened,” she said. “I was told that I should just be thankful I’m alive. They couldn’t understand why I was still struggling and upset.”
Like Lawson, many survivors have little recourse for financial help if insurance and community support don’t stretch far enough for them.
After high-profile events like terrorist attacks or mass shootings, donations tend to pour in from all over the world to help survivors and loved ones deal with losses of income, or to help supplement hospital, rehabilitation and funeral bills.
But technicalities about who is considered a victim in need of financial help ― meant to protect the charitable donation pool from being diluted by an abundance of claims ― mean the psychologically injured often don’t receive money, explained Camille Biros, deputy fund administrator at the law offices of Kenneth Feinberg, the firm most often called upon to oversee these funds.
The Feinberg law firm has helped, pro bono, to determine which victims get a portion of donated money after the Boston Marathon bombing, the Virginia Tech shooting, the Aurora theater shooting and the Pulse nightclub shooting. The firm is also helping define the criteria for how victims of the Las Vegas shooting will qualify for money, but it will not be in charge of administering the distribution.
“Typically, the people who are covered are the families of the deceased and the physically injured,” Biros said. “Sometimes the emotionally traumatized are included in some of these types of funds, but it really all depends upon if there’s enough money.”
In the case of the Boston Marathon fund, for example, people who were psychologically traumatized but not physically injured were not eligible to receive anything. After the Virginia Tech shooting, however, physically uninjured students in the classrooms the gunman entered were able to receive money. (Hamp was not among that group, as the shooter never made it into her classroom.)
Because of the sheer number of dead and wounded after the Las Vegas shooting, Biros expects those deliberations will be even more difficult. At least $11.5 million has been collectedfor the Las Vegas Victims Fund ― a testament to the generosity of the American people. But when you consider that 58 people were killed, hundreds were wounded and about 22,000 people were actually in attendance at the music festival, suddenly that amount looks quite modest.
If emotionally traumatized survivors can’t rely on the funds collected after a mass tragedy, their next step is to apply for the victim compensation program in their state.
Every state has a special fund for the victims of violent crimes, sustained mostly from the fines and penalties that offenders pay as part of a court order. At a minimum, these programs are “last resort” funds to help victims with expenses once private health insurance, disability and worker’s compensation run out. But these benefits vary widely.
In Wyoming, for example,the maximum award is $15,000, while New York listsno maximum award for expensesrelated to medical and counseling care. Some state funds reimburse crime victims for services like crime-scene cleanup, relocation and rehabilitation, but others only offer the bare minimum — funeral expenses, wage loss and medical and counseling bills. And in some states, receiving a donation counts against you when applying for reimbursements.
The result is that state-funded survivor compensation and access to reimbursement for health services are highly varied and unequal.
Last year, with shots ringing out in the dark, police Officer Omar Delgado ran toward the Pulse nightclub in Orlando, Florida.
“Picture tons and tons of people trying to get out as we’re trying to get in,” said Delgado, who was among the first officers to arrive on the scene that night. “Just riddled with bullets. People were bouncing off us.”
Inside, Delgado’s eyes slowly adjusted to the dim lighting. The floor was slick with blood and alcohol, and his feet slipped as he dragged injured clubgoers to safety. The gunfire continued.
When Delgado got home the next morning, he locked his bedroom door. When his kids knocked, he wouldn’t let them in. His parents called, but he didn’t want to speak to them. “I shut everybody out,” he said.
Almost a year and a half later, it’s still hard for Delgado to get out of bed in the morning. He takes temazepam to help him sleep, but only manages three or four hours a night and wakes up screaming from nightmares. He wasn’t cleared by a psychologist to go on patrol, so he had to give up the overtime shifts that used to earn him an extra $1,200 to $1,500 per month.
After cycling through a series of mental health providers, Delgado now sees a psychiatrist once or twice a month. Before he switched to a provider covered by worker’s compensation, his psychiatrist cost him $280 out of pocket for an initial visit and between $75 and $100 for follow-up sessions. The therapist he also sees once or twice a month adds another $50 to $70 per session to Delgado’s expenses.
“I’m not me,” he said. “I’m not the old Omar.” Most of all, he said, he worries about not being able to react if he finds himself in a situation like Pulse again. “If I freeze, even for a minute, how many people’s lives do I put at risk?”
Those who were inside Pulse at the onset of the shooting received $25,000 from the OneOrlando Fund, regardless of whether they were wounded or taken hostage by the shooter.
When Delgado applied for the fund, which has distributed $32 million to Pulse victims, he was denied. People who were outside the club when the shooting began were not eligible for benefits, explainedJeffrey Dion, deputy executive director of the nonprofit National Center for Victims of Crime, which helped administer the fund alongside the Feinberg firm.
“That was kind of a low blow,” Delgado said. “As first responders, we don’t get in it for the money. Obviously we do it to save people. But I was in need of help. When everybody needs help they pick up a phone and dial three numbers. They expect us to get there and solve all of their problems. But when we need help, who do we call?”
Ultimately, it was the local committee in Orlando that had the last say on who would get benefits, Dion explained. “They’re the final arbitrators of who is eligible and what the distribution plan is.” (The office of Orlando Mayor Buddy Dyer, a Democrat, told HuffPost that under Feinberg’s supervision, OneOrlando arrived at its parameters for distributing the funds ― including the requirement “that the victim applying for funds had to be inside of the Pulse building when the shooting began” ― after considering “feedback” from “two town hall meetings open to anyone who wanted to attend.”)
Without other options, an acquaintance set up a GoFundMe page for Delgado in July 2016. As of last week, his fund had still only raised $1,540 of its $25,000 goal.
One intriguing way to financially compensate more victims of mass shootings presents itself in the examples of the September 11th Victim Compensation Fund, established in 2001, and the National Vaccine Injury Compensation Program, established in 1986.
In these cases, Congress passed laws that barred Americans from suing the airline industry and the pharmaceutical industry, respectively, for damages ― but also established a compensation pool so victims could apply to get money for their injuries. These laws shield businesses from liability, but still allow Americans who were hurt by a vaccine or by the Sept. 11 airplane hijackings to receive money for their injuries. (However, emotionally injured 9/11 victims were not eligible to apply for that money.)
When it comes to the firearm industry, though, Congress has only done one of those two things. In 2005, lawmakers passed the Protection of Lawful Commerce in Arms Act, which shields gun manufacturers from liability when people commit crimes with their products. However, the PLCAA did not establish a compensation fund for victims of gun violence.
That’s because there was simply no political appetite for holding gun manufacturers accountable for victims’ injuries, says Timothy Lytton, a law professor at Georgia State University and editor of the bookSuing the Gun Industry: A Battle at the Crossroads of Gun Control and Mass Torts.
Before passage of the federal law,32 states had already passed similar legislationshielding gun manufacturers from liability. And from the late 1990s to mid-2000s, every lawsuit failed that tried to hold firearm manufacturers responsible for gun injuries sustained in a crime, Lytton explained. In addition to lawsuits brought by individuals, more than 30 municipalities sued the firearm industry. Most of those cases were thrown out. Other municipalities lost their cases or abandoned them because of state immunity laws.
“So Congress took away the right to sue, but they took it away in a context where no one had ever actually won one of those lawsuits,” Lytton said. “As to a direct parallel to the protection of the pharmaceutical companies or the airline companies, it seemed that the pharmaceutical and airline companies did face serious prospects of liability, whereas that’s still very much uncertain with regards to the firearm industry.”
There is one glimmer of hope for those who think gun companies should be held accountable for deadly mass shootings. Five years after the Sandy Hook Elementary School shooting in Newtown, Connecticut, some of the survivors areattempting a novel legal approachfor suing firearms manufacturers. The idea is to hold the company liable for entrusting the public with the Bushmaster AR-15-style rifle, which hasa high riskof criminal misuse. The case is being heard at the state Supreme Court level in Connecticut.
After a mass trauma like a shooting, countries that have a comprehensive health care plan can put that infrastructure to work for the victims. In the wake of the2011 attack in Norway that killed 77 people and injured hundreds more,municipal crisis teams reached out to survivors and their families. Later, when researchers surveyed the survivors, more than 80 percent said they had received early, proactive mental health outreach. Seventy-three percent of survivors surveyed had seen a psychologist or psychiatrist, and only 14 percent had unmet mental health needs.
Normally, the news of another massacre sends Heather Martin, aColumbine High School shootingsurvivor, into a series of flashbacks and occasionally a debilitating anxiety attack.
But in 2012, after news of theAurora theater shooting broke, Martin realized she could do something to help.
“You know what this community is in for,” Martin said of the survivors. “You know what’s coming, and it’s awful.”
With a friend, Martin foundedThe Rebels Project― a support group for survivors of mass trauma events like terrorism or mass shootings. To date, the network has almost 500 members from 29 different survivor communities. Most of them are people who lived through mass shootings, but some lived through bombings, mass stabbings or even the 9/11 attacks. Lawson, who survived the Washington Navy Yard shooting, is the group’s director of development.
For the past five years, Martin’s local group has met monthly in Colorado to swap stories, offer advice and simply listen to each other. TRP also has an online support network, and once a year, survivors from around the country get together for a weekend. A survivor of the 1997Heath High School shootingin Kentucky once told Martin that’s her weekend to feel normal.
“We basically just realized that one thing that we were missing throughout all those years was somebody to talk to that wouldn’t judge you and wouldn’t make you feel bad for what you were feeling, or feel wrong, like something that you were going through was wrong somehow,” Martin said. “We figured that we could provide that to a new community that was in just the early stages.”
That community ― the diaspora of people whose lives, following one awful day of violence, have never really returned to normal ― is growing larger all the time. As mass shootings seemingly happen one after another, Americans barely have time to mourn each tragedy before the next one erupts. Few people in 2017 are still talking about Columbine or Virginia Tech or the Washington Navy Yard. These shootings, we think, are in the past. But for some of the people who lived through them, they are in some sense still happening.
The Rebels Project has big goals for 2018. Martin hopes to begin a pilot program offering mental health services to members. She’s raising money for that effort, and is trying to take TRP’s story to the media. But she keeps running into two problems: Most of the group’s members were not physically injured, and the massacres they’re recovering from are already yesterday’s headlines.
“When we try to do a fundraiser, we’re like, ‘Hey, you are helping survivors!’” Martin said. “But it’s old news. Society has moved on.”
This article originally appeared on HuffPost.