AFRICANGLOBE – Last October, Aireana* and her boyfriend were driving through Oakland when a man on the street opened fire on their car. Her two children, ages 6 and 1, were in the backseat. Aireana remembers feeling something slam into her jaw and hearing a sound like a firecracker popping in her head. Her boyfriend hit the accelerator and swerved down the street. He and Aireana turned at the same moment to check on the kids. They were safe. Then her boyfriend looked at her and saw blood spurting from her neck. “Oh, my God,” he said, panicking, and crashed into a parked car.
In the shock after the crash, Aireana had only one coherent thought: I cannot die in front of my kids. They cannot see me die. She unbuckled her seat belt and pushed herself out of the car. As she stood, she felt dizzy and closed her eyes. But the thought of her children propelled her forward. They can’t see my body lying here dead. Still dazed, she walked away from the car. She could hear her daughter screaming behind her, “My mom’s dying!”
Earlier that afternoon, Aireana had gotten her kids ready to go to the park. She had taken meat out of the freezer to thaw for dinner. Her life, at 24, finally felt on track. That year had been hard: She had been unemployed for the first half of 2013 with no stable place to live. After scoring a new office job that summer, she moved into a two-bedroom apartment. She remembers feeling pretty as she looked at herself in the mirror on the way to the car.
A bullet had smashed through her front teeth, grazed her tongue and broken her jaw. In the emergency room, the surgeons repaired her tongue. Later, they wired her jaw shut so that it could heal. Aireana stayed in the hospital for more than a month. When she went home, her face was still puffy and swollen, and she had a hard time talking. Fragments of the bullet were still lodged in the side of her neck.
“You’re so lucky,” her friends kept telling her. “Why are you still so sad? You’re okay—you’re alive.” But Aireana couldn’t stop thinking about the shooting. She felt guilty, as if it were her fault that she had been hit. Why hadn’t she lifted her arm to block the bullet? Why hadn’t she ducked? The shooting played over and over in her dreams. Sometimes, reliving it, she remembered to duck, and then the bullet passed over her and hit one of her children. She’d wake up in a panic, soaked in sweat.
Every day at 3 p.m., Aireana paused at her front door. She knew she should go out and meet her daughter, who would be walking back home from school just around the corner. But the busy street overwhelmed her. Sometimes she would make it down to the end of the driveway in front of their apartment and then turn back.
In the aftermath of the shooting, she struggled to pay her bills. The phone company cut off her cell phone, but she didn’t care. She didn’t want to talk to anyone. Instead, she spent most of the day asleep. When she became tired of lying in bed, she’d curl up on the living room floor.
In America, violent crime is down significantly since 1993, when the nation’s gun homicide rate hit its peak. But there are still neighborhoods in cities like Oakland, Detroit, New Orleans, and Newark, New Jersey, where shootings are a constant occurrence and where the per capita murder rates are drastically higher than the rest of the country. Some 3,500 American troops were killed during the eight-year war in Iraq. Within the same time period, 3,113 people were killed on the streets of Philadelphia. According to FBI data, between 2002 and 2012 Chicago lost more than 5,000 people to homicide—that’s nearly three times the number of Americans killed in action in Afghanistan.
Over the past 20 years, medical researchers have found new ways to quantify the effects of the relentless violence on America’s inner cities. They surveyed residents who had been exposed to violence in cities such as Detroit and Baltimore and noticed symptoms of post-traumatic stress disorder (PTSD): nightmares, obsessive thoughts, a constant sense of danger. In a series of federally funded studies in Atlanta, researchers interviewed more than 8,000 innercity residents, most of them African-American. Two thirds of respondents said they had been violently attacked at some point in their lives. Half knew someone who had been murdered. Of the women interviewed, a third had been sexually assaulted. Roughly 30 percent of respondents had had symptoms consistent with PTSD—a rate as high or higher than that of veterans of wars in Vietnam, Iraq and Afghanistan.
Experts are only now beginning to trace the effects of untreated PTSD on neighborhoods that are already struggling with unemployment, poverty and the devastating impact of the war on drugs. Women—who are twice as likely as men to develop PTSD, according to the National Center for Post-Traumatic Stress Disorder—are more likely to show signs of anxiety and depression and to avoid places that remind them of the trauma. In children, PTSD symptoms can sometimes be misdiagnosed as attention deficit hyperactivity disorder (ADHD). Kids with PTSD may compulsively repeat some part of the trauma while playing games or drawing, have trouble in their relationships with family members, and struggle in school. “School districts are trying to educate kids whose brains are not working the way they should be working because of trauma,” says Marleen Wong, Ph.D., the former director of mental health services, crisis intervention, and suicide prevention for the Los Angeles Unified School District. Men with PTSD are more likely to have trouble controlling their anger, and to try to repress their trauma symptoms with alcohol or drugs. Though most people with post-traumatic stress are not violent, PTSD is also associated with an increased risk of aggression and violent behavior, including domestic violence. The Atlanta researchers found that civilians they interviewed who had PTSD were more likely to have been charged with a violent crime and incarcerated than other people of similar backgrounds without PTSD—but the cause and effect behind this wasn’t clear. For some people, PTSD symptoms may have contributed to their involvement in the criminal justice system, while others may have developed PTSD later. “Neglect of civilian PTSD as a public health concern may be compromising public safety,” the researchers wrote.
Despite the growing evidence of PTSD in civilians, little is being done to address the problem. Hospital trauma centers often provide adequate care for physical wounds, but do almost nothing to help patients cope with the mental and emotional aftermath of trauma. A 2014 survey of 21 trauma centers in the nation’s most violent cities found that only three—in New Orleans, Detroit and Richmond—routinely screened victims of violence for the disorder. Trauma surgeons said they were aware of the burden of post-traumatic stress on their patients, but it was hard to get hospitals to spend money on new programs or staff to deal with PTSD. Even Chicago’s Cook County Hospital, where researchers found that 43 percent of injured patients showed signs of the condition, has struggled to raise funds to support a new program. Doctors said they also worried about the scarcity of mental health providers, especially for low-income patients without insurance. Some said they were reluctant to screen patients for PTSD because they could not be sure they would get treatment.