Rachel Zwipf is packing. Boxes scattered around her home are being filled with pots, children’s toys and framed photos.
She’s moving to North Carolina, leaving behind a good job, her family and painful memories of Pittsburgh.
"His name was Sean Thompson, but we all called him Lydell," she said.
Two summers ago, Zwipf’s fiancé was murdered in Lawrenceville, just a few blocks from their home. They were already planning to move. Thompson had spent years in jail for a slew of offenses and wanted a new start.
For Zwipf, the aftermath has been an arduous journey, alleviated in some ways by those around her.
"My neighbors have been great support," she said. "They all talked to him on a regular basis, they all knew what happened, they were all kind of there for me … so that has helped. I do feel bad if you are in a neighborhood like Homewood or Wilkinsburg where there is violence every day. I can remember maybe two days after his death … it was close to the Fourth of July … so always hearing firecrackers would startle me."
Community violence remains pervasive. While Pittsburgh has a lower homicide rate than the national average, that means nothing to people who live in communities where gunshots ring out regularly, where schools are constantly placed on lockdown and where murder and gunshot injuries are the norm.
"If you live in a dangerous environment and you are aware of it as a young child and you become aware of it through people you know being killed, you have heightened awareness of the danger around you," said Judith Cohen, medical director at the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital.
"And you may through that rewiring of your brain and your danger alert system become constantly on guard for danger. And that is a form of trauma."
Cohen has treated thousands of young people — yet she says researchers are still learning about how the brain and body respond to trauma in childhood and adulthood.
One of the things they do know is that when a person is faced with danger, their brain becomes rewired to expect danger. It no longer responds as if the world around them is safe.
Community violence in Pittsburgh, and nationwide, has declined since the 1990s. But for people like Zwipf, who grew up then, they carry those experiences with them.
"Growing up in Wilkinsburg and visiting neighboring communities … I mean I remember being scared to walk down certain streets in the early '90s, and then as the gang violence had stopped being more comfortable, but still now visiting those areas and saying, 'Wow, it's deserted.' I remember when this used to go on, when that used to go on," she said.
Zwipf said growing up in a community with pervasive violence didn’t traumatize her, but it's still why she moved to Lawrenceville, where she thought it would be safer.
Cohen said constant exposure to violence can affect immune systems and have other secondary health effects, such as prohibiting children from playing outdoors, which might lead to childhood obesity and atypical socialization.
But two people exposed to the same experiences won’t necessarily have the same reactions. There are genetic predispositions to trauma.
"Trauma is one of those conditions, one of those predispositions that can be used — it’s not going to make itself known until you have trauma exposure," Cohen said. "Once that exposure occurs, if you have that genetic or biological disposition, it can suddenly rear its head in somebody who has that disposition much more readily than somebody who is more resilient biologically or genetically.
"And that’s why we see for example in soldiers who are fighting the war, even if they are equally exposed to combat, only about 20 percent develop full-blown PTSD."
One long-term ongoing study is the Adverse Childhood Experiences Study, or ACES. It looks at the impact of trauma in childhood over time. It’s found that for children who experience trauma and don’t have treatment, there are severe long-term negative outcomes such as asthma, allergies, heart conditions, mental health problems, substance abuse and high suicide rates.
Pam Hyde, the administrator of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services, said community violence hasn’t always been recognized as a community health issue, but she said more research is underway in this field.
"The more ACES you have, the more risk you have, not automatic, but the more risk you have as an adult to have either physical or mental health issues," she said. "So we’re getting some deeper understanding of that, and SAMSHA has certainly been supporting the issue of trauma-enforced care over the last decade."
Zwipf works in the mental health field. Within a month of her fiance’s murder, she started going to therapy sessions at the Center for Victims of Violent Crime in East Liberty, which offers free counseling to those who have experienced traumatic events.
"I’m more open to treatment … I see how it works because I’ve seen how it works in my clients," she said. "I think there is somewhat of a stigma in our community where people feel they don’t need to go talk to somebody about their problems. But when people are destroying you on the inside, you don’t have a choice. You have to find out what's going on and you have to find out why your reacting to certain situations and why you can't get over the hurt and the pain throughout your life."
Trauma tends to present biologically more than psychologically. Zwipf had specific concerns in addressing her trauma and grief — she was pregnant and less than two months away from giving birth to her fiancé's child.
Now, she keeps photographs and mementos of her son's father all over the house.
"I show Jackson pictures of his dad everyday … to the point where, now he knows that’s his dad," Zwipf said. "He gives him a kiss. I make memory boxes that I put things of Lydell's in there for him, and I’m just going to give him the memories that I had of his dad so that’s how he remembers him."
Zwipf has since moved to the Charlotte, N.C. area. She wants to give her 2-year-old son opportunities her fiancé didn’t have, and she doesn’t want him to fall into the criminal pitfalls Thompson fell into in early parts of his life.
"Everything he had been into when he was younger, he had totally elevated from that, and once he found out we were going to have a son … he needed to get away from here and didn’t see himself growing, especially with a criminal record and having opportunities that he would have in Atlanta and some other places," she said.
Now she is making that start without him, but with their son.