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Tanzina Vega: I'm Tanzina Vega and this is The Takeaway. It's become a phenomenon unique to the United States. Mass shootings whose carnage is impossible to keep track of. This year alone there have been at least 152 mass shootings. As public spaces from grocery stores to workplaces become increasingly dangerous, we're talking to two folks who's going to help us break down the mental health effects of mass shootings and policy changes that must take place.

Ron Acierno is the executive director of The Trauma Resilience Center and professor of psychiatry at UTHealth Houston. Ron, welcome to The Takeaway.

Ron Acierno: Thank you.

Tanzina: Adam Skaggs is chief counsel and policy director for Giffords Law Center. Adam, thanks for being with us.

Adam Skaggs: Thanks for having me.

Tanzina: Ron, I'm just going to skip the first question I have and just be honest, which probably as a journalist isn't a good idea, but I don't want to leave my house right now. I spent the weekend looking, could not keep track of the number of mass shootings that have taken place. I call this a sickness and I don't know how else to explain it.

Ron: When you look at homicide rates across the industrialized world in what we call "First World countries," we blow everybody else out of the water in terms of homicide and mass violence. I think your response is the appropriate one in terms of disgust, perhaps not in terms of not wanting to leave the house, but we are an extraordinarily violent country for the first world and no one else is close to us.

Tanzina: What do you say to-- I mean, this is happening, it was happening in schools. It's happening in grocery stores. It's happening at workplaces. Obviously, we have to leave the house, but leaving the house has become a situation where you just don't know if you're going to return from quotidian activities.

Ron: Well, let me first say that statistically, you are safer leaving the house, and rationally it is a thing you can do. It's when we start changing our behavior based on perception as opposed to reality that it becomes a problem, a functional impairment. I just want to put it out there, it's not dangerous to leave your house. Although it might be more dangerous here, overall it's not dangerous to leave your house.

When you have as many violent events with as much press coverage as we have, the perception that it's extraordinarily dangerous is going to be there, and it probably should be. W shouldn't accept these things as if they were normal. Unfortunately, the statistic you just gave, and I think we've had six since Friday when you called me to be on the show, six mass shootings, sort of makes the normal normal and that's what I'm worried about. That this is becoming too commonplace such that those who are not afraid to leave their house don't even think twice about it.

Tanzina: Adam, are there any demographic or geographical trends in terms of where this type of violence is taking place?

Adam: The short answer to that is unfortunately it's taking place everywhere, when you talk about these mass shootings. We've had more mass shootings than days this year thus far. I think it's also, when you think about gun violence in this country, it's important to note that the vast majority of deaths don't take place in these mass shootings that get so much media attention. They just take place in day-to-day incidents of violence that often don't get very much coverage.

Last year we had a pandemic that exerted a devastating toll on public health. We also saw a massive increase in gun violence and in deaths from fatal shootings. The FBI is still releasing data, it hasn't finalized the 2020 data yet. But we've seen the 50 largest cities in the country, we've seen in almost every single one of them a massive increase. An average of about 35% increase in fatal gun shootings last year.

Then of course suicide drives a huge amount of this violence. So it's unfortunately something that affects communities of all kinds across this country.

Tanzina: What type of effect does this type of violence, or even the perception of this type of violence, have on our brains?

Ron: When you're exposed to violence in person, if it's directed at you or it's directed towards someone right next to you, you have a fight or flight response. You get activated. You either need to run away from the situation or deal with the situation. If this happens repeatedly, your brain quite literally starts to burn itself out. You can only sustain such intensity for so long, so a coping response, and your prior guess was straight on. She said some of these coping responses are very negative. Could be withdrawal, could be substance abuse, some way to numb the things.

The bottom line is you don't just get used to it. Now, getting used to it and getting desensitized to it are two very different things. When you hear it on the news but you're not experiencing it yourself and you hear it all the time, you get desensitized to it. When you experience it in the family or first hand which as Adam said, then you start to get burned out, you start to get anxious, you have problems sleeping, you might have problems with your stomach.

Different people manifest in different ways, but the anxiety and the depression and the withdrawal are the most common symptoms. When this happens repeatedly, you don't get used to it, you get more sensitized.

Tanzina: Adam, are we seeing more political engagement around this issue because of what we're seeing on media and the fact that, for example, we just had six mass shootings in a couple of days?

Adam: I think the public has made it clear. The public opinion is clear that we've had enough of this. We want action. We want our leaders, whether in Congress or at the state or local level, to take action to do something about this. Gun violence is only increasing and the status quo is unacceptable. I think we've seen the public make very clear they want to see action.

Tanzina: Adam, President Biden announced some executive actions to address gun violence. What do we know so far?

Adam: I think the fact that the president and the Biden-Harris administration has acted on this issue within the first 100 days is a promising sign. I think it's a good start and I think some of the actions that they have announced are going to be important, they're an important first step. Particularly, they've announced they're going to re-assess and promote a rule that will address how to deal with so-called ghost guns. These are do-it-yourself homemade guns that people can buy without background checks.

That's a really serious threat to public safety. They've announced that they're going to address the type of weapon that was used in the shooting in Boulder. This is basically effectively a short-barreled assault weapon and they're going to address that. Ultimately we need Congress to act. The House of Representatives has already passed two really important pieces of gun legislation this year. Extending background checks to make sure that anytime somebody buys a gun, they pass a background check, and that the FBI has time to complete the background check, so that nobody actually acquires a gun while their background check is still ongoing.

Those are really important pieces of legislation. They are now in the Senate and obviously, there are some political challenges there. But the fact that the president and the administration have already announced they are going to do what they can do via executive action, I think is a very important sign of the seriousness with which this administration is approaching this terrible threat to public health.

Tanzina: It is a threat to public health. Ron, I'm wondering your thoughts on what-- we started talking a little bit about how people react to hearing the news. Yes, the news media is reporting on it, I'm not sure if you have any thoughts on what we should or shouldn't be doing in terms of that reporting. The fact is it's happening and Americans are probably very anxious about it.

What should people be thinking about in terms of their own anxiety levels if they are paying attention to this and feeling some sort of way, feeling like they need help? In particular, those people who have either been in close proximity to one of these shootings or know someone who was a victim of one of these shootings in terms of survivors? What mental health services do we need to start putting in place? Is it just a question of mental health, Ron?

Ron: First, I do think the news needs to report on it, people need to hear about it. But also, seconding what Adam said earlier, inter-personal violence in this country is not just mass shootings. It's also shootings of domestic partners and physical assaults and the whole gamut, so you're extraordinarily over your lifetime likely to have been exposed to violence either at school or in the household in this country.

That has mental health effects, avoidance, depression and withdrawal, and to answer your question directly, what can we do? The first thing you have to realize is when there's a problem. If you are changing the things that used to give you joy, if you're doing things differently, if you are withdrawing, if you're not fulfilling the roles that you need to fulfill during the day, then it's an indication that this violence has negatively affected you.

If somebody witnesses violence, for example at school, or witnesses a mass shooting, and then they stop going out of the house and they stop living their life. That is an indication that you need to get some help, some evidence-based counseling. I say evidence-based counseling because this treatment is not simply talking about the weather, talking about your childhood. The treatment is focused on exposing yourself to realistically safe reminders of the event. You might still have to go to the store, you might still have to go to places, but places that are realistically safe.

Tanzina: There's a bigger problem here in that why do we have to live like this, I think is what I'm hearing from a lot of people. I don't know if you, Ron or Adam, either one of you want to weigh in like that, but there's something that we're getting used to the fact that this is happening? Go ahead.

Ron: No, we accept it. We've accepted violence as a communication style. We've accepted violence is the way it is, and it doesn't have to be that way. 75% of the population want better background checks and gun control, but I would take it a step further. We have too much violence in the household. We have accepted domestic violence as a way of life. After the '70s, the '80s, the OJ Simpson trial, things like that, we said, "No, domestic violence is bad." But in fact, domestic violence during this pandemic has exploded. Elder abuse has increased.

All of these things we're accepting. I think it's it's got to come from a general putting the foot down and saying, "We're not going to accept violence as a communication style in school, in the home and all of these places," because we are an extremely violent society. If you look at how many people have been physically assaulted by the time they're age 65, it's a tremendous proportion of the population. That's odd. When you say, "Why are so many people having psychological effects of this?" Well, because they're normal, and that's the normal response to being beaten up.

Tanzina: I think you're absolutely right, Ron. Adam, I'm just curious about, we talked a little bit about what President Biden's executive orders are meant to do. To be honest, I look at the infrastructure. I look at the culture of violence in the United States that we have. I look at the infrastructure for purchasing guns right now and I just don't see a clear path to getting past this violence, societal violence, at least not from a legislative perspective for quite some time. It just feels like we're chipping away at a problem while people are still dying.

Adam: I think that's right. Look, nobody is saying that any one law or any one bill pending in Congress is going to solve this problem. We obviously have cultural changes that we need to see before we're able to eliminate this violence that, Ron's absolutely right, pervades our society. But there are important legislative steps, there are important policies that can be adopted. We have policies that we know have been proven to reduce gun violence, and starting with those initial steps is critically important at this point.

Tanzina: Are there other countries that are getting it right in terms of gun violence?

Adam: Virtually every other country is getting it right. Even just look north of the border in Canada, where there's actually, compared to most other countries around the world, very high level of gun ownership. Whether it's rifles and shotguns for hunting or handguns, but there is a much greater regulation of gun possession, of who purchases guns and the kind of training, the kind of education that needs to be done before they're granted a gun license.

I think we don't have to look far to see some common-sense regulation. To drive a car in this country, you need a license, you need registration. We don't have that for guns. Starting to provide training, to provide meaningful oversight and regulation of gun ownership, I think, is a critical first step at least towards addressing these problems.

Tanzina: Adam Skaggs is chief counsel and policy director for the Giffords Law Center, and Ron Acierno is the executive director of the Trauma and Resilience Center and professor of psychiatry at UTHealth Houston. Thanks to you both.

Ron: Thank you.

Adam: Thank you.

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Catherine: It's literally becoming a weekly event and while I haven't become numb to it, it's like, of course there's another mass shooting because nothing is being done about it. No change equals no change, and no change is going to happen until we acknowledge the only difference between the US and other countries who don't have mass shootings is we have too many handguns and a lot of lame reasons for why we should be able to have them. This is Catherine Ryan from New York City.

Leanne: Leanne from Los Angeles. How has the deluge of gun violence in our country affected my family? Well, my pacifist teens who walked alongside their Black, brown and Indigenous brothers and sisters in BLM protest, now want guns for their own personal protection. This is not at all how any of us thought it would turn out.

Bernard: Hello, this is Bernard, Louisville, Kentucky. I'm calling in response to the question about gun violence. Guns are not violent, people are violent. I carry a firearm for violent people. I'm not afraid of inanimate objects, just you have to be prepared for whatever may come.

Speaker 1: What about my freedom to work, shop, send kids to school, see a movie or even walk down the street. Guns should be licensed, insured and policed like cars and drivers. If people want to join a well-regulated militia, they can join the National Guard. Thank you.

Charlie: Hi, this is Charlie from Portland, Oregon. My take on this is as much as I don't like to say, we need to focus less on how these crimes are committed and focus on why these shootings are happening. I think we get mired in this argument over gun control. Both sides have valid arguments, but I think gun control boils down to collective punishment on entire nation [unintelligible 00:15:46] few, and yet in that whole argument, the bigger picture of what drives another human being to kill other human beings gets overlooked. We need to focus on that more than trying to take guns from people. We need to get help for people, is what we need to focus on.

Marigold: Hi, my name is Marigold from what used to be Sleepy San Diego. The gun violence is getting too close. It's got to be stopped. I'm afraid I will get killed when I go outside my door.

Lee: This is Lee Konzak in St. Louis, Missouri. It makes me reflect on how different we are compared to other countries in terms of the frequency of mass shootings we have seen the past 20 years. I am a gun owner. I own a shotgun and shoot once in a while for sport, but I am in favor of universal background checks and banning assault weapons for good. They are military weapons for God's sake and designed to kill people. The constitution does not give people the right to own military weapons.

Katie: Katie from St. Louis, Missouri. I have several years of experience working with grieving kids who have been affected by gun violence. I would be surrounded with 10 children, elementary age, all who have lost a significant person from gun violence and it's just devastating. The kids want peace and they want everyone to put down the gun. Something needs to give.

Pam: give. I have not grown numb to the recent mass shootings. I want reasonable gun laws enacted. I want background checks to be mandatory for every single weapon sale and I want longer waiting periods to purchase weapons enacted into law. I just want common sense to prevail. This is Pam and I'm from Louisville, Kentucky. Thank you.

Jonathan: Hi, my name is Jonathan from Louisville, Kentucky. No, gun violence has not taken an emotional or physical toll on our family. We've come to realize that it's part of American daily life every day now. All we have to do is watch our local news to see how many people are shot and/or killed each night. It's unfortunate but it has made us become more aware of what people are doing when we're are out and about in our surroundings. I guess it's a good thing to be a little more cautious.

Peter: Hi, this is Peter calling from Boynton Beach, Florida. Yes, I think it's very depressing all these shootings. I can't believe Congress won't do anything about it. I think we should leave our flags at half-mast permanently. Seems like the state we're in.

Jane: This is Jane Stackhouse from Portland, Oregon. The question today was how has gun violence impacted you, and my response is not directly and yet every day.

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