Witnessing Violence and Death: What Happens to People and How Can They Be Helped?

When most people hear the word “trauma”they understandably think about combat veterans and Post-Traumatic Stress Disorder. But traumatic events are not confined to the battle field. They include being involved in an accident, being the victim of crime, surviving an earthquake or other disaster, or even witnessing others go through terrible things (e.g., some children were traumatized by news reports of Christina Taylor-Green’s murder in Tucson). Like the events themselves, immediate reaction to them is very hard to predict, as I know from painful experience.

Many years ago, my wife and I were driving home at night on Highway 101 and saw something that we wish we could forget, but never will. An apparently intoxicated man was walking slowly across the interstate, and the car next to us hit him at full speed, having no chance to stop or swerve when the man suddenly became visible in the headlights. The man was thrown high into the air and landed on the highway, to be immediately run over and killed by the car behind us. I write about this horrific experience now to tell you what you might expect if you ever experience a traumatic shock and how you can help someone else who has been through one.

My wife and I illustrate the extremes. She began screaming as soon as the man was struck and thrown into the air, while I just stared silently, as if I were watching a movie from the very back of the theater. As he was run over a second time, I heard the sound of his head being struck by the bumper and his body being crushed into the pavement by the undercarriage. With windows rolled up and the second impact taking place as we were already past the spot of the first collision, hearing that sickening impact — like the sound a bowling ball makes as it comes out of the return chute and collides with the other balls — would have been impossible, yet in my head I heard it. I turned to face directly forward, gripped the wheel tightly and stared into space, dimly aware that my wife was yelling somewhere in the distance.

Many people react to trauma as my wife did, with an explosion of emotion. But others do what I did: “dissociate”, a psychological form of self-protection that is experienced as emotional numbness and a detachment from reality (e.g., my auditory hallucination). Debating or judging which is better or more adaptive is pointless as they are instinctive reactions that people can’t easily control, and communicating this fact to people who have been traumatized can help comfort them

I came out of the shock in less than a minute and exited the highway so that we could call for help from a gas station. The 911 operator had already been contacted and had dispatched the highway patrol and an ambulance. Feeling that our effort to help was ineffectual, we were wracked by guilt for not getting the man off the highway ourselves. That trying to carry a body across a dark interstate while dodging 70 mile an hour traffic would have succeeded only in getting ourselves killed did not lessen our sense of failure. My wife felt further guilt because she saw the man before I did, and “failed to warn me in time”. But again, this made no sense because the only person to whom a warning would have mattered was the driver who hit him.

Profound, irrational guilt is an extremely common reaction after a traumatic event. Even people whose families die in natural disasters blame themselves. It sounds like self-torture, but it’s adaptive in the sense that accepting a complete lack of control over life-threatening forces is terrifying, so we blame ourselves for the comfort it brings; it lets us believe that we could have made things turn out differently when actually we were helpless. Irrational guilt is best met not with argument but with empathy, e.g., It’s awful to feel that you didn’t do enough to help someone.

When we got home we told a mutual friend what happened at least a dozen times, breathlessly, uncontrollably. We imagined slightly different scenarios, e.g., if the man had been walking a little slower, would we have hit him? Would we have killed him? Would we have crashed? It had to be boring to hear it over and over, but rather than interrupt us or say “For God’s sake I get it already” he largely just kept nodding, listening and letting us go on and on. This was the perfect reaction and a model to emulate if you are ever in his role. Putting a traumatic event into words and a narrative is how many people dissipate fear and regain some sense of control and safety.

One might wonder about the opposite situation, namely, the person who will not talk about what happened. Should you prod and push them to open up? For years this was the dogma of psychological crisis work, but it was subsequently proved to be disastrously wrong-headed. People who were randomly assigned after a serious accident to be debriefed by a trained trauma worker were more likely to suffer long-term psychological trauma than those who were left alone. Rather than force someone to “process their feelings”, let them know you are willing to listen, including listening to them say nothing if that’s what they need to do.

After hours of repeating the story, we were finally exhausted and went to sleep. And then I saw the man in my headlights and tried to slam on the brakes but they wouldn’t work! I woke up yelling, pumping my right leg furiously. Sleep disturbance and nightmares are another common reaction to trauma. Traumatic events can increase noradrenergic arousal, also known as “sympathetic activity”. This “flight or fight” reaction is directly contrary to what normally occurs during sleep, namely an increase in “parasympathetic” activity, essentially your brain telling your body “You are safe now, it’s okay to relax”. According to my colleague David Spiegel, sympathetic arousal interferes with sleep, including REM, with awakenings during REM sleep being more likely. In my own case, these symptoms faded in a few days, but for an unfortunate minority they become chronic.

We compulsively talked about what happened and read every news account to find out more information for the next few days. But as we got into the routines of our lives and nothing else traumatic happened, our basic sense of security in the world rapidly returned (this of course is the advantage soldiers on long tours do not have). Today what happened is still an incredibly vivid memory for both of us (as I wrote this post I noticed that my chest tightened and my breathing became shallow) but we rapidly made a full psychological recovery. The good news is that this is the norm. After 9/11, armies of mental health workers were deployed all over the New York City area, and it turned out that many of them were not needed. The resilience of the human organism is an impressive thing, so you would be rational in being hopeful that your acute reaction will have an endpoint. And you can convey the same optimism to someone you care about who has been traumatized and worries about ever recovering.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

19 thoughts on “Witnessing Violence and Death: What Happens to People and How Can They Be Helped?”

  1. Great post, but would you clarify the last line, please? Do you mean “telling someone that you care about the same thing” or “telling someone whom you care about, the same thing.” And what “same thing”?

  2. Thanks Henry, for the kind words and the writing advice, I have edited in a way that I hope makes clear that what I mean is you can tell someone else that they too can recover from a traumatic shock.

  3. Thanks for an interesting post.

    Also, I think it’s worth noting that people with existing mental health conditions, (anxiety, depression, etc.) may be traumatized by things that don’t necessarily seem traumatic to people who are in better mental health. If a person seems traumatized, I think it’s still helpful to be supportive even if the event that caused the trauma doesn’t seem that traumatic from your own perspective.

  4. I had a similar experience about 12 years ago, except I was driving the car that struck the pedestrian. I was on my way to work on a winter morning before daylight, and he was dressed in black with his sweatshirt hood up. He had been drinking all night and darted across the road in front of me on his way to a 24-hour restaurant. Fortunately it was a 35 mph zone and the man survived (barely). To this day I can still vividly see his head bouncing off the hood of my pickup and his body pitching out in front of me, sliding face-down across the pavement, then lying motionless in the road while I waited for the police and ambulance to get there and made sure no one else ran over him.

  5. “The good news is that this is the norm. After 9/11, armies of mental health workers were deployed all over the New York City area, and it turned out that many of them were not needed. ”

    One of the comments about 9/11 was that people were either killed outright, or lightly injured. In a more ‘normal’ mass casualty situation, there’d have been thousands of horribly injured people lying around, many dying from sheer inability of people to take care of a vast number of such injuries in a short period of time.

  6. You and your wife showed two interesting extremes, but the range of responses varies on more than one axis and there are other extremes. People with training in responding to traumas tend to re-normalize so that emergency scene sympathetic arousal levels become, not normal, but much closer to normal. As a result normal life can be hopelessly non stimulating, leading to a feeling of distance and non involvement.

  7. There was nothing that you could have done differently. Last night I witnessed a fatal accident and the people I was with went into the same head space as you and your wife. I, on the other hand, have medical training and I immediately went to the scene of the accident. I did everything I knew how to do and I still couldn't save her. Sometimes its just their time to go. Not everyone is meant to be a first responder and that's okay, we all have our purposes.

  8. Thank you for this.. .. I was on a scene of what ended up being a fatal accident today but I was too late to be of any help. Everything that needed to be done was being done and I may as well have not stopped and kept going. The only thing I could think to do was to ask the people that had been performing CPR if they had someone with them as I was worried that they were alone. I had to lie to my 15 year old daughter and her friend who I had left 50m up the road. I had no idea of what to expect when I told them to stay where they were but i am glad I did.

  9. Thank you so much for writing this piece. I witnessed my thirteen year old son being struck as a pedestrian by a drunk driver who was being chased by police. My son nearly died that night this past January. I fainted in the middle of the street. I am still dealing with nightmares, guilt, and torment as the accident replays over and over in my mind. My son made a miraculous recovery after spending a little under a month in ICU. He had five surgeries and rods throughout both legs, along with a shattered pelvis and ruptured bladder, among many other injuries. I am so grateful he is alive, but I am still dealing with the emotional fallout, over 10 months later.

  10. When I was living in Boulder, Colorado I saw a mentally ill man jump in front of a truck at the bus stop where I was waiting for the bus. He was scooped up by the hood, hit the windshield and broke it, then rolled off onto the sidewalk. He wasn't killed, don't know how badly he was hurt, but he kept trying to get up and a bunch of people had to gather around and tell him not to move until the ambulance came. He had no recollection of being hit and had to guess that he was trying to kill himself.

    I was one of the few people looking directly at the event when he was hit. I dissociated hard. I could describe what I'd seen, but I was too flustered to call 911 or even give the police my correct address and phone number. The scene makes me think about about police-shooting incidents: how many people who are shot for non-compliance can't comply because, after whatever happened to bring the police, they're simply too rattled to follow instructions?

    1. I'm sorry you saw that man jump in front of a truck. And I totally agree that many people who are shot for non-compliance were just really rattled, disoriented, confused, shocked, etc. It's very disturbing to think about. That or they don't speak English, have a disability the police don't see, etc.

  11. Your story has given me some hope. On Christmas Eve I witnessed a violent crime, a man was shot 3 times as I was driving down the road. I saw the shooter enough to give the police a description upon arrival. But I had a different reaction than you or your wife. The entire time I kept a completely level head. I threw my car into park, put my hazard lights on and got out of my car. I called 911 and instantly started accessing the wounds and asking the man questions trying to keep him concious. Thankfully I had recently gotten new towels so I happened to have a bag of towels and stuff in my trunk that I was going to donate to the animal shelter. I was able to apply pressure to the mans wounds until the police and ambulance arrived. By the time they came, I was able to give them the victims name, age and tell them where he was shot. I stayed in the cold for an hour on scene not wanting to leave, they wanted to know which way the shooter ran etc. I was then asked to go to the station to give a statement. The entire time I didn't even think that my family was at home on Christmas Eve waiting for me. I finally called my fiance and told him I was on my way home and he said he was worried sick because they had heard sirens but I wasn't responding to texts. I explained what happened and said I would be swinging by the house because I had groceries in the car but had to go to the station. I got to the house and carried everything in and gave him and the kids hugs and got a little teary eyed but quickly put myself in check because I did not want my kids to know what happened. Then I went to the station. I was there for 3 hours, all the while I was calm, until the very end when I told the detective that if he was allowed, I would like to know if he had a family, and if he survived and did not have a family, we would like to be his family for the holidays.

  12. This was a helpful article; Two days ago, I was walking home from high school when I heard what, at the time, I had thought was just a trash can falling over (it's been windy and that actually happens sometimes). I stopped because I was trying to call my dad. However, after a few minutes of not being able to reach him, I took about six steps further down the sidewalk and saw, just around the corner (which had not been visible six steps back), that the noise had been the sound of a car with two teenagers who were driving on the wrong side of the road run head-on into a pick-up truck. The road was deserted, but a woman ran up from her house and was yelling on the phone. I froze, the same disconnected response you described taking me over. The first to arrive were three cop cars, then a fire truck. Though the drivers of both cars were conscious and non-critically injured, the boy in the passenger seat was bleeding profusely and trapped in the car. When the ambulance and other first responders finally got him out, they did cpr for almost ten minutes and were still doing it as they drove away. He wasn't moving.
    I later found out that he died that night of internal bleeding. Somehow, it hadn't occurred to me that he could/would die – I mean, we were less than a mile from the school and he wasn't even driving! I was pretty much silent and in shock the next day, and it hit me that, had I simply looked up when I heard the noise or stopped just six steps further from where I had been, I could have called 911 minutes before the other woman had and that he could have lived. I know it's not my fault that they were drag racing, but usually, I would have been around that corner and right where the accident had occurred on most days. Maybe it would have made the accident worse had I been there, but maybe they would have stopped drag racing to begin with. Additionally, the boy's dad died a year ago and his sister has the same sickness his dad died of. I feel horribly guilty about all of this, and though I hope you are right that this guilt and grief will fade, I don't want to forget him, though because he and his family (and no one else) should have to suffer as they did and will because of one reckless moment.

  13. "Many years ago, my wife and I were driving…" This could be happened anywhere and I also saw a similar accident 10 years ago.

  14. Just happen to find this blog, while i was looking up memory loss,i am 56 years old now but have experienced many tragic events. Loss my father at the age of 5 to a drink driver. I was seventeen years old my first love we had dated two years was killed one night right in front of me. My car had ran out of gas and It was at night we just lived down the road so we started walking home.we had a fuss about no gas in the car. A went to the other side of the road and i beg him to come back It was dark i was scared. So he stated across the road on a no passing lane he young boy who had been out that night drinking he pass the car in front of him. He hit my boy friend and the boy and the other car kept going. Their in front of me laid my boyfriend I could hardly see him at first but could hear him. the blood coming out. No cell phones back then the guy in the fist car had chased the boy they stopped at a payphone and called 911. when the ambulance got their I could see how bad he was but I held his hand, until they realized I was their they made me get up. he was dead. I talked abut what had happen to me but never got help. Until 2014 My uncle was murder shot in the head by a so called friend who was robbing him. My uncle and I were very close he was my brother too my grandmother had adopted me and my sister. I went over to check on him because I had called him and called him he had not felt good a few days earlier and i had his air pump to return .My husband and i went over to his house. Long story short I got into his house and found him with gun shots to the head. I just turned around went outside and yelled at my husband to call 911. We stayed outside afraid that the gun man might still be in the house and didn't want to touch anything I was in a fog my head felt weird. . My mind was going over and over it was in shock for a few days. But one of the deputy stayed with me and she got me counselling It helped but most of all my faith in God so very gad I have him. Any way its 2018 still the guy who killed has not been to trial even though he admitted it. I have to testify so I stay strong and pray. And talk about what has happen to me.

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