VIOLENCE
HELPING OUR CITY TO HEAL: How Psychological First
Aid Can Stop the Development of Violence-Related Post
Traumatic Stress Disorder
Matthew C. Bozeman, MD, FACS and Robert A. Campbell, MD
Gina Phillips, The Arrow Of Time Is A Lie (detail), 2010
T
he patient is a 60-year-old female
who has resided in the same Lou-
isville inner-city neighborhood
virtually all her life. Over the past
three years her nephew, her neigh-
bor and her best friend’s son have all been
killed by gun violence. All three murders oc-
curred in her neighborhood. Most recently,
there had been a murder less than two blocks from the home that
she had lived in for over 40 years. She heard the gunshots only 20
minutes before. When she came upon the crime scene, she noted a
body covered by a blanket, dozens of police officers, and yellow tape
roping off the area. When interviewed, she’s anxious, intermittently
upset, and has an obvious cause for her distress.
“Doctor, I’m having nightmares about what I’m hearing and what
I’m seeing in my neighborhood. All this killing going on! I can’t
sleep at night, I can’t eat, I’m irritable and angry, I can’t concentrate
at work, and I am crying all the time. I’m having visions suddenly
come into my head, bodies on the ground and the funerals I’ve been
to recently. Some of my neighbors are getting to be the same way.”
The eruption of gun violence in some of Louisville’s neighbor-
hoods is taking a toll on its inhabitants. In the early 2000’s, homicide
and gun violence rates were a fraction of today. The year 2003, for
example, saw 42 total homicides in the city. 2016 set a dubious re-
24
LOUISVILLE MEDICINE
cord for the city with 117 homicides, and 2017 wasn’t much better
with 107 killed (1). Like many other urban areas such as Chicago
and Baltimore which have become synonymous with gun violence
in recent years, 80 percent of Louisville’s homicides occur by gun
and in concentrated areas in the city. The Russell Neighborhood
in west Louisville saw 117 murders from 2003-2017, while large
areas of east Louisville saw fewer than five in the same time frame
(1). These concentrated areas of violence lead to repeated episodes
of trauma for the people living in them. Both perceived and real
issues related to resource utilization in terms of policing, commu-
nity support and outreach add to mental stress and the anguish of
dealing with violence.
The repeated cycle of violence experienced in large part by those
living in Louisville’s inner-city neighborhoods puts their psycho-
logical well-being at risk. Urban trauma has historically involved
local groups of individuals involved in the crimes, and can often
lead to the victim and perpetrator knowing each other. Increasing
the stress and feeling of hopelessness on these violent relationships
is a code of silence which often exists when these crimes are inves-
tigated, meaning the perpetrator may never be brought to justice.
From 2010-2018, 576 homicides were tracked, and the percentage
without an arrest was 45 percent, with a majority occurring in the
West End (2).
Previous studies have shown that inner-city students who are