Some of the kids were suffering from post-traumatic stress disorder. Technically, they didn’t qualify for the diagnosis until a month after the shooting. For the first thirty days, a severe trauma reaction is classified as acute stress disorder (ASD), not PTSD. The condition is marked by symptoms like prolonged distress; problems with sleep, concentration, or memory; an inability to experience positive emotions; hypervigilance; a dissociation from reality; and recurrent dreams or memories. ASD is diagnosed in trauma survivors experiencing distressing symptoms and a marked impairment in the ability to function. PTSD is essentially the persistence of ASD beyond one month.
About 6 to 12 percent of survivors suffer ASD after an industrial accident, 10 percent from a severe burn, and 13 to 21 percent from a car accident. The risk surges if the survivor has been attacked by another person: the numbers go up to 20 to 50 percent after an assault, rape, or mass murder. These are wide ranges, due to differences in the nature and severity of the trauma, each person’s coping skills, and other risk factors. Prior trauma, or existing struggles with depression or drug abuse, drastically increase the risk. And much of our response is determined by how we perceive the event. “The way two people experience and perceive the exact same trauma can be totally different,” said Dr. Alyse Ley. “Even if they saw the same thing, they can have a very different experience of that event.” Dr. Ley specializes in child and adolescent trauma, and is the director of the child and adolescent psychiatry fellowship program at Michigan State University.
About half the people treated for ASD are eventually diagnosed with PTSD, and the other half improve enough in that first month to avoid it. While it’s optimal to get treatment as early as possible, the one-month milestone is a good marker for parents or friends to observe. At that point, the afflicted survivor with full-blown PTSD needs more sophisticated help than loved ones can generally provide.
And there are additional conditions to watch for. “Individuals who have experienced a trauma injury may also develop panic disorders, major depressive disorder, substance abuse, and anxiety disorders,” Dr. Ley said. “Often if you have one, you have the other—sometimes the disorders have overlapping symptoms and are difficult to tease apart.” Major depressive disorder is serious, and extremely common in trauma survivors. “So what a parent is really going to want to watch for is a change in the child, in their behavior and their functioning,” Dr. Ley said. “And major depression is not just a sad mood—it affects your entire body. It affects your sleep, your appetite, your feelings about yourself, feelings of guilt and worthlessness. Their energy level is affected. Suicidal ideation is also extraordinarily common in a person who has major depression.” Weight change is also a major marker of depression, but it can look different in adolescents who are still growing. A loss of appetite might lead to failure to make expected weight gains, or to dropping off the growth curve. “Children and adolescents who have been traumatized need to be monitored for depression and anxiety, as well as PTSD,” Dr. Ley said.
The long-term consequences can be heightened for adolescents, because these symptoms can alter their cognitive development. “There’s a negative filter across everything you do and see and how you view people and yourself in relationships,” Dr. Ley said. “Untreated PTSD can change the developmental trajectory. The goal of the therapist is to get the young person back on track with developmental milestones and coping skills.”
I met Dr. Ley at the three-day Academy of Critical Incident Analysis (ACIA) conference on the Las Vegas shooting in early May, along with two survivors, Chris and Jenny Babij. We discussed the MFOL kids at length. Chris and Jenny had experienced their attack side by side, but completely differently. They had been standing right in front of the Route 91 music festival stage, so hundreds of people were taken down by gunfire all around them. Chris was badly wounded in the shoulder, and he’d tripped as they fled the grounds. Jenny was running just ahead and did not discover until too late that he was gone. They were separated until the morning, and Jenny was wracked by guilt for “abandoning” him, despite her relentless attempts to reach him. Chis lay on a gurney within the chaos of an overwhelmed ER awaiting treatment for several hours. Over and over, a custodian rolled a bucket by to mop up all the fresh blood. So much blood. A triage nurse came by with three color-coded tags: Chris was tagged as non-life-threatening, which meant he had to wait. He said he didn’t mind. He had seen so many people in a horrible state. It was actually a great comfort to get tagged, he said. It meant he was in the system, would not be forgotten, and would be treated after the people in danger of dying.
Four months into their recovery, Parkland rattled Chris and Jenny Babij—enough to impede their progress temporarily. They were awed by the MFOL kids but concerned. Recovery had been their primary pursuit, advancing at a pace that worked for them. Chris was just then preparing to return to work. Were the kids taking on too much?
“We have to trust them,” Dr. Ley said. Adults can be too eager to step in and “help” people like Emma. “People just assumed, ‘Oh, she’s having a breakdown,’” Dr. Ley said of Emma’s tearful speech. “So what? Shouldn’t she? My first thought was, ‘Yeah, it’s about time. Look at what this kid has been through.’” If she were breaking down hourly, riddled by intrusive thoughts, and couldn’t sleep or function, that would be entirely different. But crying can be cathartic, even onstage.
“Adults will always think of ten thousand reasons why you can’t do something,” Dr. Ley said. “Kids won’t do that. That’s what’s glorious about young people: the still-developing impulse control. They see something, they see a cause, and they say, ‘I’m going to do what’s right. You’re not going to stop me.’”
Still, the responsibility the kids had hoisted onto their shoulders posed risks, Dr. Ley said. So did the painful glare of the spotlight and the abject cruelty of their adversaries. Nobody can anticipate how badly that spotlight can twist you, she said, and trusting the survivors doesn’t mean trusting them blindly. “We need to have parents who are very aware,” she said. “A parent has to be able to sort of look at their own child and say, ‘Yeah, they’ve got the coping skills to handle some of this’—but be watchful and know when to say, ‘Wait a second, you’re beyond your limits. This is not going well.’ Then they have to take steps back. What’s really important in trauma work is finding out what the individual needs.”
She talked about siblings on different trajectories, and she could have been describing David and Lauren Hogg. David was relentless, and he seemed not just capable of the responsibility, but buoyed by it. His parents, Rebecca and Kevin, gave him wide latitude—insisting that one of them chaperone him out of town, but generally letting him chart his own course. Lauren was in no position to take that on, and her parents were far more protective of her. Lauren saw her own limits and eased into the MFOL group gradually.
Dr. Frank Ochberg, who was part of the committee that first created the diagnosis of PTSD, concurred. “There are going to be adults who criticize the kids and the supporters of the kids, saying, ‘Hey, you’re abusing them, they’re abusing themselves, they’re missing out on teenage life,’” he said. “Yes, there’s a certain risk, but let’s not patronize them or overly parent them. Let’s celebrate their wisdom and dedication and leadership.”
There’s a profound therapeutic benefit of their activism, he said, and Dr. Ley elaborated. What most people failed to see in Emma’s tears—and in the march, in the movement—was the power of reasserting control. Control. Such an elusive element. Control is crucial to recovery—recovering the feeling that was ripped away in the moment of violation. It’s especially profound in violent crimes: gunshots, rape, assault, and mass murder. “At that moment you’re being terrorized, there is chaos,” Dr. Ley said. “You feel like you have no control of your body, your destiny, your future. And that fear of the unknown, of whether you’re going to live or die, sticks with you. So one of the main things in treatment is allowing a person to reassume the control of their own life, their body, their destiny.” That can mean a long, arduous recovery. It’s rarely possible to reassert control over the brutalizer, or effectively counteract the damage. Therapists help their patients simulate control, or visualize, but that can feel contrived to some, and painfully slow to others.
“That’s why what these Parkland kids are doing is so powerful,” Dr. Ley said. “They’re saying, ‘Hang on. Stop. I’m going to regain control. We’re going to do something about these weapons that we had no control over.’” To hell with simulations—they made it real. They could not rewrite Valentine’s Day, but they could reframe it. They had looked beyond that powerless afternoon, determined they had been made powerless their entire childhoods by gunmen who could strike at any moment. They set their sights on that larger problem, and reclaimed their power by working to protect seventy-four million American kids. To hell with simulations—reality felt more powerful. They didn’t start this as a form of therapy, but Dr. Ley said they could hardly have designed a better treatment plan.