I'm a Los Angeles-based medical doctor who, for the past 25 years, has specialized in treating the LGBT community. I've witnessed the ravages of AIDS, the physical and psychological trauma of violent hate crimes, and depression and suicide in a community specifically targeted for discrimination because of who we love.
After years of hard-fought battles against death, disease, violence and depression, I was convinced that we had turned a corner with successful HIV treatment, PrEP, anti-discrimination laws, anti-bullying initiatives, hate-crime legislation and, most recently, marriage equality. I honestly believed that my generation (I'm a 55-year-old Baby Boomer) and my gay-pioneer predecessors had succeeded in creating a safer world for the next generation of LGBT young people. And then, Orlando.
While senseless mass killings have happened countless times before, this time the victims of the mass shooting ... were gay people in what should have been a safe haven.
Orlando has shaken the LGBT community to its core. Nearly everyone I know is grieving, feeling outraged, fearful and in a deep state of profound despair. But why such an extreme reaction in the LGBT community?
LGBT citizens have endured an HIV plague, incessant bullying, state and religion-sanctioned discrimination, estrangement from families, beatings and hate crimes. And we survived. And began to thrive.
It got better for many of us. Some of us even dared to feel somewhat secure about our social acceptance in American culture. For a brief and blissful moment.
Unexpectedly, the Orlando massacre feels like that "punch in the gut" 9/11 moment for the LGBT community. While senseless mass killings have happened countless times before, this time the victims of the mass shooting, which was BOTH a hate crime and a terrorist attack, were gay people in what should have been a safe haven – a gay nightclub.
There are two triggers to the waves of renewed fear and despair we find ourselves experiencing, one rooted in the present and one in the past.
In the present, we are again reminded of the unchecked homophobia rampant in some sectors of our society, driven by hatred, ignorance and religious “conservatism” and leveraged for political gain.
I'm convinced that the far right's cynical "God, Guns and Gays" divide-and-conquer messaging strategy to win church-going, rural and low-information citizens' votes finally culminated in a perfect storm that made the Orlando massacre of LGBT innocents not only possible but inevitable.
To America, it is yet another horrific mass gun shooting in a string of such atrocities in recent years. But to the LGBT community it is a direct blow to a nation of survivors.
And then there's the past, the cumulative abuse of decades of mistreatment of the LGBT community, of American citizens who have been pummeled by hate, shame, threats, violence, disease and death.
This experience of layered trauma underlies a latent post-traumatic stress disorder (PTSD) syndrome in which we suddenly find ourselves immersed.
PTSD is a condition that's triggered by a terrifying event, either by experiencing it or witnessing it. Symptoms may include recurrent, unwanted distressing memories of the traumatic event(s), feeling emotionally numb, hopelessness about the future, always being on guard for danger, insomnia, irritability and difficulty concentrating.
So what happened here? A man walks into a gay bar with an AR-15 semi-automatic rifle. He kills 49 people and wounds 53 more. To America, it is yet another horrific mass gun shooting in a string of such atrocities in recent years. But to the LGBT community it is a direct blow to a nation of survivors.
The ensuing script is predictable. Shock, horror, social media in hyperdrive and wall-to-wall, 24/7 cable news coverage. The reading of names. The personal stories of victims, the survivors, their families and loved ones and of the courageous rescuers.
"Thoughts and prayers" are offered by the usual public figures. An outpouring of grief, cries of "love over hate," mountains of flowers and candles, vigils and donations from well-wishers flood into Orlando.
All of these are simple, well-intentioned gestures, but they do not address root causes or move us toward solutions. Nor do they shed a ray of light on what has happened within the psyches of LGBT citizens across the nation and around the world. They are merely a well-learned, reflexive response by a society now inured to this type of self-inflicted horror and tragedy.
Next, the predictable finger-pointing game begins. Easy and well-deserved targets are the bought-off politicians who block sensible gun laws in exchange for campaign donations, unhinged religious homophobes and the much-reviled National Rifle Association (NRA) which protects the billion dollar gun manufacturing industry and lobbies to block any gun legislation. They are all complicit in this atrocity.
But frankly, as Americans we’ve all been here before. The difference this time is that the victims were exclusively gay people and the casualty numbers are so high.
We identify with our dead and injured brothers and sisters, and the shock pushes us back into fear for our personal safety and toward the profound despair that is now gripping the LGBT community, both young and old.
To the LGBT community Orlando has reopened old wounds and left an entire community feeling raw, angry and depressed. We had (erroneously) believed that we were well-healed by now.
In years past, to be gay could be an emotional, social or literal death sentence. And gay bars have traditionally been "safe spaces" from all of the hatred, violence and discrimination in communities outside their walls. This time, like a deadly virus infecting a healthy cell, the hate made its way inside, heavily armed, with horrific and deadly consequences.
To the shock and surprise of many, me included, our collective trauma(s) are cumulative and archived, always lurking just beneath the surface, waiting to be re-triggered by the right catalyst. And Orlando was that perfect, if appalling, spark.
To the LGBT community Orlando has reopened old wounds and left an entire community feeling raw, angry and depressed. We had (erroneously) believed that we were well-healed by now. But these wounds never fully heal.
In the wake of Orlando, like traumatized military vets, we drop to the ground reflexively for cover and safety, hearing those gunshots directed at us.
I've been literally overwhelmed by (heretofore emotionally stable) LGBT patients calling in with PTSD-like symptoms that I’m experiencing myself -- despair, sleepless nights, hopelessness and a renewed sense of fear.
Freshly re-traumatized, we in the LGBT community are now faced with a choice -- cower in the shadows overcome with anxiety or become soldiers with a unifying cause. If we rise up as we did with AIDS and continue our fight for equality under the law and social acceptance, I believe we will witness those feelings of despair dissipate. Better to fight – and maybe die -- for a worthy cause than to be shot in a dark nightclub.
That is exactly what we MUST do to heal ourselves. Get up and push back. We are an LGBT community of survivors, and we know how to fight.
A Facebook blogger rightly and defiantly declared, "You can wound us, kill us, attack us, propose bills to take away our rights. You can judge us, bully us, project your fears on to us, you can censor us, ignore us, but you will never stop us. We are a community of survivors. We have battled persecution from our families, our schools and our governments. We lived through the holocaust, and then a plague. We have always dared to let our dreams reach beyond us. Every time we got knocked down, we got right back up. That is just what we do."
That is exactly what we MUST do to heal ourselves. Get up and push back. We are an LGBT community of survivors, and we know how to fight. We've learned the lessons and we're visible, organized, determined and powerful.
I hope Orlando will reenergize a recently complacent LGBT community back into action. After our gay marriage euphoria, it Cher-slapped us back into the reality that the fight for our social acceptance and civil rights must continue unabated.
We're watching history unfold as everyone from the president to Hillary to multinational corporations to political leaders to billionaires like Bill Gates and Michael Bloomberg and Tim Cook to average citizens publicly express their disgust and their conviction to combat homophobia and to (finally) pass sensible gun legislation, starting with assault weapons.
The timing and sheer scale of this carnage may finally make real change possible -- it's a presidential election year and citizens are paying attention, and not only because "The Donald" is making reason and truth seem like rare virtues again.
We are outraged, and we are mobilizing. I'm 100 percent committed to getting an LGBT-friendly president in the White House, an LGBT-friendly Senate and three Supreme Court appointees who will shift the arc of history toward justice.
Now is the time to act. To stand up, to be counted, to come out, to vote, to march, to provoke, to organize, and to embrace one another as a cohesively diverse community once again. It's our second ACT-UP moment in the last 30 years.
Stephen Colbert was spot on when, in his Monday night Late Show opening monologue, he eloquently noted that, "despair is a victory for hate." And LGBT citizens have not survived every indignity by wallowing in despair. Now is the time for love and focused action. But Colbert rightly cautioned, "Let's remember that love is a verb, and to love means to do something."
Here are FIVE simple things that you can do to respond to the "Orlando Effect":
Don't despair alone. Call your friends, call your mom, call your shrink.
Educate yourself about gun violence, assault weapons, homophobia and the terrorists, politicians, preachers and media commentators who seek to harm us. Likewise, learn which public figures and organizations support us.
Vote for the LGBT-friendly candidate for the White House and for LGBT-friendly senators, representatives, governors, mayors, state representatives, city council people.
Email your elected representatives with your outrage at homophobia and lax assault weapon laws. Better yet, meet your representatives in person. Join groups that lobby them like Human Rights Campaign (HRC) and Everytown.org.
Be courageous. Be unafraid. Come out. Publicly show affection for those you love.
Remember, just like in the "old days" of 30 years ago, that "Silence = Death." So "Act Up, Fight Back, Fight Hate!"
Dr. Gary Cohan is a Los-Angeles-based, board-certified Internal Medicine physician, HIV/AIDS expert, author and LGBT advocate.
Copyright © 2016 Gary R. Cohan, M.D., F.A.C.P.