Americans know mass shootings like the ancient Greeks knew tragedy. It’s a narrative, played out in stereotyped acts. Confusion begets horror. Rescue teams arrive. We tally the dead. Reporters introduce us to the face of evil. And in a final, protracted scene, a dazed killer sits subdued before a judge as we search his demeanor for answers.

When police officers shot down Wade Page at the site of his rampage this Sunday in Oak Creek, Wis., the classic narrative abruptly ended. Without this last scene, survivors of the Sikh temple shooting will have a very different psychological recovery process  than those who sat in a packed courtroom last week to see the arraignment of James Holmes, the man accused of opening fire on a theater full of people last month in Aurora, Colo. Nor will they experience the resolution that Jared Loughner imparted on survivors on August 7 when he pleaded guilty to murdering six people and other charges associated with the 2011 shooting rampage in Tucson, Ariz.

According to trauma experts, seeing justice unfold can sometimes be a positive part of the healing process . But there are many reasons to think that survivors whose assailant dies on the scene will recover faster from the psychological wounds.


Most experts seem to agree that a trial ending in a conviction imparts some benefit —a sense of achievement for those who took part, and catharsis for the rest. " There is certainly relief when it is over, relief if justice is achieved," says Barbara Rothbaum, director of the Trauma and Anxiety Recovery Program at Emory University. "And sometimes survivors are proud of themselves for doing the right thing even though it was difficult."

Seeing a perpetrator confront and account for his crimes can also be helpful for those who ask, “Why?”

"My general experience is that people feel better when they can resolve things," says Carol North, director of the Trauma and Disaster Program at the Veterans Affairs North Texas Health Care System. "W hen they know the answers, it satisfies a need .”

Families of the Oak Creek victims will never hear Wade Page explain what made him enter a Sikh temple with a nine-millimeter handgun. But this may not end up being a bad thing. Although trials help witnesses and families of the deceased to get answers, they can actually interfere with recovery on a deeper level.

Yuval Neria, director of the Trauma and PTSD program at Columbia University, which recruited him to New York City after the September 11 terrorist attacks, explains that rebounding from trauma is "an individual process in which the person reviews his or her trauma—a personal experience of fear, confusion and helplessness—in a gradual manner until the essence of the fear and pain is processed. A trial, on the other hand is a public event, which emphasizes justice, in a societal context."

The longer the affair remains in the public realm, the longer it can take for those affected to look seriously at themselves and to inspect how their perceptions of the world have changed. Survivors of the Loughner shooting that nearly killed former U.S. Rep. Gabrielle Giffords last winter have been waiting more than a year for justice to be served. Had Loughner claimed innocence, the process would have continued for much longer. A ll that waiting may come at a price. "The trial is usually a painful process, lengthy, and may eventually delay effective and rapid processing of the trauma and loss," Neria says.

During these periods of limbo, a conviction is never certain. Here, too, the survivors in Oak Creek may have benefited. The object of their fear was destroyed almost as quickly as it was created and they will never stay up at night wondering whether Wade Page will be free again.

But for a small percentage of survivors whose symptoms of trauma reach a level of clinical severity, it probably does not matter how the massacre ended. Whether the assailant is dead or neutralized behind bars, symptoms often persist in survivors who have descended into post-traumatic stress disorder (PTSD) and have generalized their fears.

"PTSD is a sense of vulnerability to danger around every corner," says Rothbaum of Emory University. "Even if that particular assailant is no longer a potential threat, people often feel they have seen the dark side and that it can strike again anytime, anywhere. I have seen people become afraid of and avoid situations that had nothing to do with the original event due to their sense of vulnerability, like becoming scared of flying after a sexual assault."

An analysis of late 1980s and '90s U.S. shooting survivors suggests that many of those who lived through the recent events in Wisconsin and Colorado will develop PTSD .

In 2008 North, the VA crisis psychiatrist, compiled data from four mass shootings in the U .S. Of 222 subjects, 19 percent were classified as having PTSD , with symptoms ranging from nightmares to amnesia to increased cautiousness. The rate varied depending on how much brutality witnesses were exposed to, but North says we’re likely to see a similar number of PTSD cases among recent survivors in Aurora and Oak Creek .

For this more severely afflicted population it may not matter whether a killer dies on the scene. The object of their horror is no longer one man, but the entire world.

For those survivors of the Oak Creek massacre who do not develop PTSD, recovery may come more swiftly without Wade Page around.