OPINION

Fighting against massacre fatigue

Intensive care unit doctors and nurses, barraged day and night by the alarms that signal dangerous changes in a patient's pulse, respiratory rate or cardiac rhythms, may gradually lose the capacity to pay attention. Not because they are bad or lazy or inattentive, but because the brain's capacity to respond diminishes when so over-stimulated. This phenomenon is known as alarm fatigue. The result can be catastrophic.

We are suffering, as a people, from massacre fatigue. Was it my imagination that as news broke of still another disastrous mass murder in Thousand Oaks, Calif., only 11 days after the massacre at the Tree of Life Synagogue in Pittsburgh, this horrendous news occupied less of the news cycle, that it disappeared from the front pages a bit sooner?

Tree of Life was shocking. But do you remember First Baptist of Sutherland Springs (26 dead)? Emanuel African Methodist Episcopal in Charleston? How about the Sikh Temple in Oak Creek? These are just the churches (and there are scores more).

How about Las Vegas, Orlando, Virginia Tech, Luby's Cafeteria, San Ysidro, Parkland, San Bernadino, the Edmund, Okla., Post Office, Columbine, Seattle, Wilkes-Barre, Camden, Aurora, Atlanta, Santa Fe, Sandy Hook (which no one in Connecticut will ever forget)? Are we even able to keep these all in mind? And yet each one of these was catastrophic, with at least 10 dead. Together, these and the many hundreds of other mass shootings in recent history are a calamity equivalent to a ground war on American soil. We are unable to see it for what it is.

Each incident sounds a new alarm. We rush to identify the killer so we can learn the motive. Sometimes the motive is hatred, but why one hater kills while the next doesn't is never answered, and more often the motive remains ambiguous.

Thoughts and prayers fall flat. We send them anyway. We call for rational gun regulation. We endure the usual pushback. Blame is deflected to the mentally ill. The mentally ill are defended. We read of the lives of the victims until we can't bear reading anymore and turn the page. This has become a ritual dance. We have become fatigued by these alarms; accustomed and even inured to the calamitous war around us.

How could this be happening to us? How is it that we can be so seemingly helpless and worn down in the face of it? Why are these horrendous outbursts of violence accelerating to a nearly weekly event? There are no ready answers, but there are important concepts that can help us to explain what's going on.

There are many bad people out there. Some may be mentally ill, many are not, and most are in a gray zone we would think of as "disturbed" though not necessarily ill. While most of us are repulsed by each incident, those who are living on the fringes of hatred are becoming disinhibited by them. The more they are exposed to hatred and violence, the more these come to seem the norm and the more whatever psychological and moral impediments to acting out they may have are eroded.

With each new shooting the glue wears down and the murderous impulses seem more acceptable to them. There's not much we can do about that, but there is a continuum between being influenced by other murders and being influenced by the general breakdown of civility, the tolerance of hatred and lesser violence, real or suggested. If you're contributing to the breakdown of civility, amping up the hatred, suggesting that violence of any kind is OK, you're edging high-risk people toward the precipice. This is not high neuroscience. It's common sense. It has to stop.

Another closely related phenomenon is that of contagion. Social scientists and epidemiologists are observing that violence (murder and suicide) seem to spread in patterns that look much like that of a viral epidemic. These patterns are being studied but such research is hampered by the prohibition against using federal funds to study gun violence. Perhaps such studies can help to explain causation but, more important, prediction of where catastrophe is likely to spread next.

Our heads are spinning senseless in the face of a calamity that we are prohibited from studying. How does this make sense? We have a new Congress. Don't let this stand.

There remains the issue of reasonable gun safety regulation: background checks, assault weapons, large capacity clips. We keep repeating the mantra but failing to enact the legislation. Gun safety regulation will never prevent all mass shootings, but there is no other viable option for gaining some traction against this contagion. How many lives are worth the inconvenience of a background check to the buyer or a lost sale to the industry?

Contagion can be controlled. Edward Jenner demonstrated this by inventing the smallpox vaccine. Disinhibition can be mastered by removing the stimuli that encourage it and modeling norms of behavior. Alarm fatigue can be resisted by calling it out and pushing it back. Gun safety can be enhanced when we value lives more than special interests. The only alternative is more catastrophes.

Harold I. Schwartz, M.D., of West Hartford, Conn., is a psychiatrist and was a member of the Governor's Sandy Hook Advisory Commission.

Editorial on 12/02/2018

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