One Year Later, and Still StrugglingMental health experts offer coping techniques for the 9/11 anniversary< September 10, 2002 > The searing images of September 11 still haunt us. Study after study has shown that the prevalence of mental health ills among American children and adults has increased in the wake of the terrorist attacks. And mental health experts say the first anniversary of 9/11 will rub raw emotional wounds that have only begun to heal. Yet acknowledging the still-shocking memories of the Twin Towers and pieces of the Pentagon lying in ruins, realizing how well we have coped since, and trying to move on with our lives are the best ways to deal with the emotional upheaval that will accompany the next few days. There are five questions people ask themselves when exposed to traumatic events outside their normal experience, says Florida State psychologist and trauma expert Charles Figley:
"The vast majority of people have had a year to figure it out, and have already answered those questions. But the anniversary date forces them to revisit what has happened since that day and fine-tune their feelings," Figley says. "Anniversary responses are important in a useful sense," he adds. "You can see the anniversary of a traumatic event as climbing a mountain. You can look up and see that you still have a long way to go, but you can also look down, see how far you've come and celebrate that." Figley is founder of Green Cross Projects, a group of 150 trained and licensed "traumatologists" that he formed in response to the 1995 Oklahoma City bombings. He and members of the group spent several weeks last fall counseling employees who worked at the World Trade Center. He suggests people do something "tangible" to mark the 9/11 anniversary. "People can use the occasion to do whatever they feel is important," he says. "If remembering the day makes you step outside of your own individual cell and realize we're connected as neighbors, as a community, as a state, nation and world, then do something to show that. Like giving blood, or hanging up a flag at your house." For those more directly affected by the terrorist attacks—people who lost loved ones or those live in New York City and Washington, D.C.—the memories will be far more painful. Their best way of coping may be to avoid dwelling on the anniversary, says a noted New York therapist. "The people I know who have lost someone are quite private about it, dealing with it in their own ways," says Dr. Naomi Leiter, a Columbia University psychiatrist who has been treating a number of patients who lost loved ones or friends in the World Trade Center attack. "Most of them are going on with business as usual," she adds, and she recommends that approach when dealing with the anniversary. "Try to make the day as ordinary as possible," she says. Rather than taking the whole day off from work or school, she suggests going to church or synagogue or observing a moment of silence. Above all, stay away from the television, Leiter says. "The whole city has been traumatized, and I hope that the anniversary will be used to put the event to rest," she says. "There's a wonderful saying in yoga that 'the past is history, the future a mystery and the present a gift.' One really has to move on." Others susceptible to an "anniversary effect" could be people for whom the terrorist attacks unleashed personal anxieties that may have had nothing to do with events of 9/11. For instance, war veterans and people mourning the deaths of loved ones are particularly vulnerable. Figley's advice: Try to confront those anxieties head-on. Doing so is often liberating and will allow you to resume a more satisfying life. There is even a place for denial in handling the anniversary of 9/11, Figley says. "Sometimes we don't want to get more information. We just don't want to hear it," he says. "Denial is often the salve that takes care of our society." The National Mental Health Association offers these recommendations for coping with the anniversary:
Always consult your physician for more information. Helping Kids Cope With 9/11 -- All Over AgainChildren who have suffered other traumas are vulnerable Children traumatized by the events of September 11 will probably face increasing dread and anxiety as the first anniversary of the terrorist attacks approaches, child psychologists say. Taking care of these children will require parents, teachers, friends, and loved ones to perform a difficult balancing act. They will have to acknowledge chaos while maintaining order, and be strong while facing their own weaknesses. They also will have to understand that the hard times that have tested them have made them more capable of withstanding trauma than the children who were raised in the peace and security of the 1990s. Dr. William Beardslee, psychiatrist-in-chief for Children's Hospital Boston, says the "anniversary effect" will take hold as the media replay the images of 9/11—the World Trade Center towers crumbling, the Pentagon burning. "It's important to remember [that] after September 11 there was enormous shock in the country as a whole," Beardslee says. "Many children saw those images, which were absolutely striking. I'm sure many children will be anxious, will have their fears reawakened." Untold numbers of children suffered post-traumatic stress following the attacks, says Dr. Ricky Greenwald, director of the child trauma program at The Sidran Institute, a national non-profit group in Maryland that specializes in "traumatic stress education and advocacy." Greenwald has been training teachers and mental health professionals in New York City to help children there suffering from stress. One study published in the New England Journal of Medicine found the impact of the attacks on New York City was so devastating to children living in Manhattan that nearly 25 percent of them received some sort of counseling almost immediately. Greenwald says children most likely to suffer post-traumatic stress—and most likely to feel dread at the anniversary—are children who suffered through disturbing events, such as the death of a parent, before the attacks. "Prior trauma or major loss gives us a wound, a sore spot where we might overreact," he says. "If something hits us on that sore spot before it's healed, it's really going to hurt." Children traumatized by September 11 have suffered symptoms ranging from intrusive memories and nightmares to withdrawal or jumpiness, he says. Some children have become discouraged and depressed, while others have become angry or anxious. Beardslee says these children have found it harder to put the disaster behind them, possibly because they were raised during a time of prosperity and do not know things will eventually be fine. "We adults have both memories of times that have been tough and know our history as a country, where we have made it through difficult times," he says. "I don't think children have those memories, because the '90s were not a time like that. They were a time when there was an appearance of prosperity. The children haven't gone through a time when the country's mettle has been tested." Adults make two mistakes in dealing with children who are worried about a tragedy, Greenwald says, and he is urging these mistakes not be made during the 9/11 anniversary. The first is to focus all their attention on the attack—explaining it, memorializing it, allowing it to distract from the daily routine. "The message kids get is that this is so overwhelming that it affects everybody," Greenwald says. "Even the adults can't handle this." The second is to ignore the event entirely, figuring they do not want to upset their children. "The message kids get there is, 'Wow, this is so bad and scary that my parents can't deal with it.' Both extremes give kids the bad message that no one can help them," he says. Adults must strike a balance, Greenwald says. "What's really ideal is for adults to acknowledge that this is the anniversary, but you still have to do your homework, you still have to brush your teeth," Greenwald says. "When kids see that, that adults can acknowledge it but still go through the day, then the kids feel like the adults can handle it and maybe it is manageable. "When you do that," he adds, "that's more powerful than saying, 'Do you want to talk about it.' That's demonstrating that you can handle it." Greenwald says parents also need to understand they are suffering as well, and to take care of themselves so they can be there for their children. "You should assess what feelings the anniversary's going to trigger, and have people you can go to for support," he says. "Just being a hero forever doesn't work after a while. We have to take care of ourselves, or we won't be able to come through for our kids." The National Institute of Mental Health offers the following tips for parents and adults to help children cope with the aftermath of a traumatic event:
Always consult your child's physician for more information.
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For more information, __________. New York Still Recovering and Reeling From 9/11New York City got a one-year checkup yesterday on the health impact of the Sept. 11 attacks, and the examiners found cause for both optimism and concern. In some respects, New Yorkers have rebounded remarkably from the collapse of the World Trade Center, researchers at an all-day conference said. In other ways, however, they are still reeling from it. Dr. Jeremiah Barondess, president of the New York Academy of Medicine, which sponsored the conference, said the effects of September 11 on the city's welfare "clearly were not trivial." But, Barondess added, scientists have "learned a lot" since that day about what happened, what might happen after future terrorist attacks, and how to respond better to those events if they occur. Many of the results relayed yesterday have appeared in previous forums: evidence on rates of post-traumatic stress disorder (PTSD) in people directly impacted by the attack on the Twin Towers; respiratory problems from the pollutants spewed across the city when the buildings fell; and the increased use of cigarettes and alcohol in the weeks and months to follow. But presented together, they offer a clear compendium of the legacy of September 11. David Vlahov, director of the academy's Center for Urban Epidemiological Studies, estimated that 585,000 New Yorkers had symptoms of PTSD after the event. Initial rates of PTSD dropped markedly between the fall and the spring, when the most recent surveys were conducted, Vlahov said. But 91,000 people are believed to have chronic cases of the full-blown disorder, which is marked by flashbacks, nightmares, social withdrawal, and other signs. Those with PTSD, his surveys found, were much more likely than others also to have major depression. "Clearly there's overlap" between the two conditions, Vlahov said. "Fear is disabling," said Dr. Lloyd Sederer, executive deputy commissioner in the division of mental hygiene at the New York City Department of Health and Mental Hygiene. Dealing with it, he said, will take effort. The good news, Sederer said, is that the events of last year seem to have stimulated a revival of community mental health programs designed to offer all city residents access to emotional care. A team led by Christina Hoven, a Columbia University public health researcher, surveyed more than 8,200 schoolchildren in New York, a massive epidemiological undertaking. They found that 11 percent of them suffered PTSD related to the attack on the World Trade Center. Many also had other emotional trouble, including major depression (8 percent), panic (9 percent), anxiety (11 percent), and the fear of public places known as agoraphobia (15 percent). No previous study had examined the psychological well-being of students in New York. But those numbers were far higher—between 25 percent and 525 percent—than rates identified in a prior look at four metropolitan school systems that included a New York suburb, Hoven said. In all, Hoven said, roughly 200,000 city students, or a sixth of the total enrollment, experienced some emotional distress related to the terrorism attacks and the events that followed (including the October anthrax mailings that killed five people). Girls were more likely than boys to report such problems, and very young children were more likely than their older schoolmates to have signs of PTSD. Many parents, too, were profoundly affected, said Jennifer Stuber, also of the Center for Urban Epidemiological Studies, who surveyed 475 parents. They were more likely to experience PTSD or depression related to the attacks than childless adults, Stuber said. Single parents were even more likely than married ones to have such problems, and to report increases in their smoking and drinking in the wake of the attacks. The emotional distress of parents rubbed off on their children. Kids with a parent with PTSD were nearly three times more likely than their classmates to display behavior problems. Dr. Thomas Frieden, commissioner of the New York City Department of Health and Mental Hygiene, cited surveys showing that an estimated 23 percent of adult New Yorkers reported an increase in alcohol use or smoking in the aftermath of the attack. As many as 75,000 people may have taken up smoking for the first time as a result of September 11. Given these figures, Frieden said, mental health and substance abuse treatment should be a cornerstone of future disaster planning and response. Dr. Sandro Galea, a medical epidemiologist at the New York Academy of Medicine who studied trends in tobacco and alcohol use, said the spikes in use of these substances after the attack have not subsided despite predictions that they would. One to two months after September 11, roughly 30 percent of people surveyed said they had increased their intake of tobacco or alcohol. Six to nine months after the event, that number had fallen, but only slightly, to about 26 percent, Galea said. "Contrary to our expectations, the increases in these substances has persisted," he said. That means 1.5 million New Yorkers are smoking or drinking more than they used to. People with PTSD, depression, or both were more likely to report increasing their intake of tobacco and alcohol. Yet the fact that rates of emotional distress dropped in the months after the terrorist attacks raises a dilemma, Galea said. Perhaps the persistent increase in smoking and drinking is "adaptive," a normal (if unhealthy) reaction to an abnormal event. Or, perhaps it is taking place against the backdrop of psychological trouble that is not severe enough to be diagnosed. "Where is it going?" Galea asked. Always consult your physician for more information. |