An estimated 9,000 people have been killed by gun so far this year in America, according to the Gun Violence Archive. More than twice as many have been wounded — and while few fatal shootings generate media attention, even less attention is paid to this second group. The survivors of shootings remain largely anonymous as they disappear into their communities. How does getting wounded by a bullet, or bullets, change a person’s life? The answer is we really don’t know.

Enter Jooyoung Lee, a 34-year-old sociologist who for several years has followed the lives of gunshot victims, documenting the myriad physical and mental traumas they must cope with. His subjects are young, working-class, African-American men — those most affected by gun violence in America — who generally lack resources and access to quality healthcare. Says Lee, “I wanted to know what happens to people who are left to fend for themselves.”

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In a 2013 article titled, “The pill hustle: Risky pain management for a gunshot victim,” published in the journal Social Science & Medicine, Lee explores what happens to black men who can’t afford pain medication. One subject, a line cook at a sports bar, was shot repeatedly in the chest and shoulder by his landlord after failing to pay rent. Under the law, the man was entitled to emergency care and even follow-up visits. “But,” Lee writes, once victims like him “are deemed healed by providers and released from continued care, [they] continue to struggle with injuries, chronic pain, and health problems that diminish their quality of life.” This is especially true for the so-called working poor, who “depend on an able body for their livelihood.” Later on, this same man is denied Social Security Disability Insurance and, desperately searching for relief, throws himself against a moving car, in a successful bid to be taken to a clinic where he can receive Percocet.

The article is part of a book Lee is currently writing based on his research. He spoke with The Trace about how the men featured in his work cope with their injuries.

In 2012 you published one of your first papers on gun violence, “Wounded, Life After the Shooting,” based on a study you began at the University of Pennsylvania. What were you hoping to accomplish with your research?

I was trying to put the problem of non-fatal gun violence on the map. I was trying to show the different ways that lingering injuries were transforming the identities of young men in Philadelphia. One of the guys I write about had a colostomy bag. He had all these traumatic experiences with the bag, like when he was en route to meet with a social worker and it would come loose. And another victim who had been shot, the bullet had hit his testicle and blew it up — he lost it. He lived with this private shame. His friends knew he had been shot and survived and were congratulating him and treating him like a king, but he was very careful not to let out that he had lost his testicle.

What was most striking about how people tried to manage the physical pain they suffered?

I wrote an article that looks at the experiences of this guy I called “Paul.” This guy was shot multiple times, at point blank range, in the arms and chest. He had nerve damage in his face and he couldn’t blink his eyes. He had to relearn how to blink. And he had retained bullets in his body that caused all kinds of grief.

I followed him around and realized he was self-medicating. He was sleeping with a woman to get pills every week, or getting them from street dealers, in areas where there were shootings. I was looking at all the risks he was taking to find pain relief. I was trying to make a case for rehabilitative services for gunshot victims who are in great pain. We seem to really understand this for combat veterans, but many people in our own backyards suffer from the same kinds of injuries and they don’t have the same support system.

I imagine that, like combat veterans, these victims also suffer from serious psychic wounds.

Another issue I write about is Post Traumatic Stress Disorder, about how people who have been shot live in close proximity to the person who shot them, or who they think shot them. This makes every day life very frightening. There was this guy I was following around in Philadelphia who had been shot and said he would sometimes see the shooter at the park or on the bus or at the corner store. It was terrifying. Imagine the feeling of running into someone who bullied you. It’s that multiplied by the nth degree. He was petrified for the rest of the day after seeing this person, wondering if the guy was going to try and finish the job.

In what other ways are gunshot victims impacted psychologically?

Getting shot really changes a person’s social world; it makes them suspicious of other people. You see them going from young and vibrant to reclusive. They go to public settings, see a crowd, and get anxious that someone is affiliated with the person who shot them. The Fourth of July is a very stressful day for gunshot victims. A lot of the young men talk about how the sound of fireworks would give them flashbacks. I had one guy who told me he was out at a bowling alley with friends, the first time he’d been out since he’d been shot, and he was having a great time, and then the sounds of pins crashing caused a flashback. He had the feeling that everyone in the place was potentially the killer. This kind of thing makes it very difficult to resume everyday life.

It changes their identities.

Yeah. Another one of the guys I’ve followed was living with abdominal hernia after being shot in the abdomen. He was living with this protruding hernia that would inflate whenever he ate. It was the size of a Nerf football — people in the neighborhood would say he was pregnant. It impacted his sexual relationship with his girlfriend. He said he felt deeply ashamed of his body. Even when she said she didn’t care, he still felt like a monster. That relationship suffered. There were different versions of this, but it really changes the way young men see themselves. It’s very emasculating for young men — you’re suddenly transformed into this older body. Your injuries change your sense of virility, your body image.

Do these men ever recover their sense of self?

I don’t think so. I mean, people are resilient and there are ways to live and cope with these injuries. But the people I followed around and check in with, they never reclaimed that old sense of self. It’s such a traumatic experience; it’s very hard to be the same person.

Besides painkillers, what are some other coping mechanisms people use?

Food is another thing that some of the victims would use to cope. That’s one of the larger health consequences of being shot: you’re sedentary, and sometimes junk food becomes a coping mechanism.

How did you first get interested in studying working class African-American men and gun violence?

When I was in grad school at UCLA, I spent a lot of time researching the hip-hop scene in the South Central neighborhood of Los Angeles. The guy I was spending most of my time with, Flawliss, got shot in a racially-motivated shooting. This was around a decade ago. I watched as he struggled with the different injuries he had sustained. He just happened to be outside one night, near his home, when two young Latino men approached him and asked where he was from, which in L.A. is a way to figure out if a person is a friend or foe. It’s called banging on someone or hoo ridin’. He said, ‘I’m not from anywhere, I don’t bang,’ in hopes that that would help him distance himself from any conflict. It didn’t work. They said, ‘We’re nigger killers,’ and shot him twice in the back as he was running away. Ever since then he’s had to use a colostomy bag.

How is Flawliss doing now?

He’s still suffering from the ripple effects of the shooting. He’s had problems with his cardiovascular health. He had a minor heart attack. But even though he has lived with these terrible injuries over the years, he is still making music, working, and making the best of his situation. That is another thing that the public misses. They think people who are injured are looking for free handouts. The victims I’ve met are really eager to get their lives back in order. They want to get back to work. They just need some help to get there.

[Photo provided by Jooyoung Lee]