The Invisible Victims: Psychological Injury at the Boston Marathon Day Bombing

By: Cynthia Kennedy, Senior Social Worker, Center for Violence Prevention and Recovery, Patient Care Services

As one former support group participant put it, “I’ve become a member of a club – a club of invisible victims that I didn’t ask to be a part of.”

In the aftermath of the Boston Marathon day bombing, there were three dead and hundreds of victims with horrific physical injuries. The whole nation, and even other nations, grieved with these victims and set off an unprecedented avalanche of help: money, gifts, services, letters, and prayers for their speedy recovery. Most victims, overwhelmed with the attention, were nevertheless happy for the support and report how helpful it’s been for their recovery and their spirits.

We tend to think of “victims” as those who are injured or killed as the result of an accident or traumatic event, but there are many others struggling with symptoms of post-traumatic stress that go largely unrecognized even by people closest to them. When a teenager is struck and killed by a speeding car, our attention naturally turns to the grieving family who is left behind. We may not, however, consider the impact the accident has had on that teen’s friends who were walking home with him from practice, or the neighbors who rushed to the scene, or the passenger in the speeding car. They are all witnesses to the traumatic event and will have varying reactions to it. Among these may be: intrusive imagery, nightmares, disrupted sleep patterns, and withdrawal from people and activities.

In the instance of the Boston Marathon bombing, in addition to those killed and injured, there were hundreds, if not thousands of bystanders and helpers that witnessed the chaos, experienced fear for their lives, saw the injuries, blood and mutilations, and were affected by the utter lack of understanding or control in the moment. Without knowing if there were going to be more bombs, more threats, more risk to their lives, these witnesses continue to be affected by the images, experiences and strong feelings they had in those moments, including the choices they made. These could have been whether it was an instinctual self-preserving reaction of running away, or their altruistic instincts to jump in and help. They were spectators cheering on friends and family members, runners crossing the finish line at that moment, first responders, and race volunteers. They are the “invisible victims.”

Through our work with these victims both individually and in support groups, we know that the impact can be far reaching. It can leave people feeling anxious in large crowds and feeling panicked in confined spaces such as when riding the subway, for example. Most report experiencing triggered reactions to visual reminders, smells, or noises like ambulance sirens, construction or fireworks. Many people experience difficulties with sleep, concentration and their memory. Some feel as though something has irrevocably changed inside them and they are no longer the same person they were before that day. In addition, they feel they cannot recognize themselves or understand their own reaction to the experience. They are confused, embarrassed and sometimes ashamed about their reactions – but don’t know how to make it stop. By and large, this group of invisible victims often feels alone and isolated because they do not have visible scars with which to justify their pain, difficulties at work, or difficulties engaging in day to day tasks. They often receive messages, subtle or otherwise, that they should just forget about it and move on with their lives. This kind of advice, though well intentioned, usually leaves one feeling more bereft, alone and misunderstood than before.

Possible reasons why we as a society fail to recognize the “invisible victims,” could be that perhaps it is a lack of information about the impact of psychological trauma or a desire for everyone to be “okay” so that we can put aside our own unconscious fears and anxieties and return to a level of normalcy that we have previously experienced.

In our experience, working with the invisible victims of the Boston Marathon bombing and with victims of other types of violence and trauma, we find that people benefit from validation of their experiences, normalization of their reactions, and education about symptoms and ways of coping. Many people find value in opportunities to talk with others who understand what they are going through, such as in a support group or in individual therapy with a mental health professional with expertise in the treatment of trauma. There is no one-size-fits-all approach. Nor is there a prescribed time frame for healing. But there is help available. 

Massachusetts Office of Victim Assistance, 1-855-970-MOVA, http://www.mass.gov/mova/boston-marathon/

Center for Violence Prevention & Recovery, BIDMC, 617-667-8141, http://bidmc.org/Centers-and-Departments/Departments/Patient-And-Family-Care-Services/Social-Work/Social-Work-Programs/Center-for-Violence-Prevention-and-Recovery/2013MarathonAnniversaryResources/Marathon-Anniversary-Support-Groups-and-Services.aspx Offers individual therapy and support groups for those impacted by the Boston Marathon Bombings

Boston Public Health Commission, Resource & Recovery Guide http://www.bphc.org/whatwedo/mental-emotional-health/trauma-response-and-recovery/Documents/Resource%20Guide%20Consumers%20Dec%202013.pdf#search=marathon%20bombing