Related topics: •  Special Report: Talking to Children About Terrorism

Editor’s Note: It’s hard to believe 2008 marks the 7-year anniversary of 9/11. The events, emotions, and images of that day still evoke strong reactions in most of us. For some, things have gone back to normal. For others, problems related to the attacks linger.

In the wake of the tragedy, studies showed that 7.5 percent of New Yorkers and 20 percent of those who were near the World Trade Center when the attacks occurred suffered from Post-Traumatic Stress Disorder (PTSD). While follow-up studies revealed their PTSD to be short-lived, those affected by the tragedy developed important coping mechanisms to help overcome their trauma. Developing social networks, redefining and adjusting priorities, and talking about the tragedy all helped these survivors to manage.

PTSD was not the only consequence of 9/11. In a study published in the January 2008 issue of the Archives of General Psychiatry, researchers found a strong correlation between the stress of the attack and heart problems. In a national sample of nearly 3,000 adults, researchers discovered a 53 percent increased incidence of heart trouble within three years of the attacks -- even after adjusting for pre-9/11 health problems and risk factors like diabetes and smoking.

While the physical and emotional trauma for some remains, important lessons have been learned, making this story as timely today as it was when it was first written.

The morning after the World Trade Center towers crumbled to dust, Amanda Fuqua arrived at her job 3,000 miles away in downtown San Francisco. She sat down at her desk, attempted to start working, and astonished herself by falling apart. "When people tried to talk to me, I just burst into tears," Fuqua says. "I was sobbing. People said I should go home, and I'm glad I did. I couldn't concentrate on anything."

Fuqua, a 22-year-old human resources consultant, didn't lose anyone close to her in the Sept. 11 terrorist attacks on the trade center and the Pentagon. But she did have a good friend visiting from New York who clung to his cell phone all day, talking with his girlfriend as she stumbled home from the attack zone, and trying to locate other friends (who escaped unharmed). A friend's uncle, a New York City firefighter who rushed back from vacation to help out, arrived on the scene after the rest of his unit had gone into one of the buildings. He survived, but it's likely his fellow firefighters did not. "We're pretty sure all of his unit is gone," Fuqua says.

Like Fuqua, Americans close to the epicenter, as well as people thousands of miles away, will continue to feel the effects of terrorism in the days and months ahead. Trauma experts say that you can be acutely affected by a tragedy even if you weren't in a life-threatening situation and didn't have to search for a lost loved one. As a nation, we're having a normal reaction to vastly abnormal events.

"We're asking each other the same questions: 'Where were you? What did you see? How did you feel?'" says Robert Butterworth, PhD, a psychologist and director of International Trauma Associates, a research and consulting firm in Los Angeles. "We're doing a nationwide psychological debriefing."

Hospitals, mental health services, churches, and schools are providing counseling to those who are having trouble coping with the national tragedy. In Los Angeles County, nonprofit mental health agencies felt compelled to offer crisis counseling to local residents.

"It's the first time our country's been attacked in 60 years. Adults and children are personally affected by witnessing those events on television," says Bruce Saltzer, executive director for the Association of Community Human Service Agencies, which represents 75 mental health centers in Southern California. In addition, people all over the country have friends and family who worked in or near the World Trade Center. "Things that happen in New York affect people across the entire country."

That rings true for San Francisco resident Tom Young, who was distraught during the 48 hours he awaited word of his aunt, who lives three blocks from the World Trade Center, and a friend who worked in one of the towers. Both are safe, but he later found out another college friend perished in the attack. "Even now it's still hard to feel that it's time to move on and go back to normal, when it's clearly not normal," Young says.

"I have so many pictures of myself as a child on the observation deck of that building," says Young, a production manager at Consumer Health Interactive. "To see it destroyed with all those people inside hits me with all these emotions. There's a connection to every single American. You know they're all going through the same thing you are."

Roxane Cohen Silver, PhD, a professor in the Department of Psychology and Social Behavior at the University of California at Irvine, says people tell her they find themselves crying for no reason. Others, she says, "feel an overwhelming sense of sadness... A woman at my son's school said she feels the need to hug people. People feel a need to be connected to others at this time."

As the death toll mounts into the thousands, faces will emerge from many of the nameless casualties, and with those faces will come a more tangible grief. Psychologists and trauma experts are bracing for that grief to turn into hundreds, even thousands, of cases of clinical depression, anxiety, and in some cases, post-traumatic stress disorder (PTSD).

What most people are feeling, mental health experts say, is acute stress. They may be unable to concentrate, have trouble sleeping, or feel a nagging anxiety. These feelings are magnified for people closer to the tragedy, those caught or injured in the explosions, or rescue workers and emergency medical technicians whose job it is to help those who were hurt. Those who are the most deeply affected will show signs of depression or acute anxiety. If those feelings don't subside after a month, these individuals may develop PTSD, a syndrome commonly associated with war veterans exposed to combat. PTSD can also affect doctors, firefighters, police officers, nurses, and journalists -- anyone who responds to national disasters. And as rescue efforts continue, the aftershock may overwhelm the people who still work at the Pentagon, and those who live and work close to the site of what was once the World Trade Center.

At least three different sets of symptoms are associated with PTSD, says Carol North, MD, an associate professor of psychiatry at Washington University School of Medicine in St. Louis, Missouri, who has studied survivors of disasters. North, who talked to people soon after the 1995 bombing of the federal building in Oklahoma City, Oklahoma, says more than three-fourths of the people she interviewed reported symptoms of depression and anxiety on the day of the bombing.

Many have flashbacks and continue to relive the horrible memories. Others are jumpy and easily startled, and some can't sleep because they're afraid. And a third group of people has the opposite reaction -- they have numbed themselves and continue to function as if nothing has happened. The closer you are to the tragedy, the more likely it is you're going to suffer. "People at the epicenter are going to have the highest rates of problems," she says.

Even if it weren't for the constant sound of emergency vehicles outside her home, it would be easy for editor Kristin Kloberdanz to mistake her neighborhood in Manhattan for a war zone.

"My apartment is filled with a gassy, acrid smell, like burnt rubber or plastic, that seeps through even shut windows. People have been milling around wearing surgical masks and bandannas to keep the smell out," she says. Dazed by the explosions and hoping to be useful, Kloberdanz headed to a hospital to donate blood only to be turned away. "Since the tragedy on Tuesday, New York has been a ghost town... Everyone on the street looks shocked and somber. There's very little laughter."

Richard Sussman saw the smoke pouring out of the World Trade Center from his office window a half-mile away. He and some colleagues decided that before things got much worse, they would catch a ferry home to New Jersey. As the boat pulled away from the terminal, the group watched in horror as the second tower collapsed. "We all knew people who worked in the World Trade Center," says Sussman, who is managing director at Goldman Sachs. "It was a very sobering boat ride." Today, in his hometown of Rumson, New Jersey, many are still missing, including two fathers of his children's friends. At one local school, 10 to 15 parents haven't come home.

Butterworth and others warn that the worst isn't over for the country in terms of psychological anguish. In many areas that have been hit by a disaster, like an earthquake or flood, researchers have found that a year after the disaster the divorce rate goes up and the incidence of violence and alcohol or drug abuse increases as well. Those problems tend to occur when people deny that they're under stress. The best way to avoid experiencing similar difficulties is to spend time with other people and to talk about what you're experiencing, says Butterworth.

"[This trauma is so recent] that we in the mental health community have no idea how big a problem this is going to be," says Russell J. Kormann, associate director of the PTSD program at Rutgers University in New Jersey. "We're going to be seeing the repercussions of this for months and years to come."

Although air travel has resumed, many Americans will refuse to take an airplane in coming weeks, experts say. Some will be afraid to enter a high-rise or other large public building. It's natural to feel afraid after you've been exposed to repeated visions of planes crashing into buildings and people jumping more than a hundred stories to their deaths, says Julie Turovsky, a psychologist who specializes in anxiety treatment, and the associate director of the Anxiety Disorders Clinic at Rutgers University.

"Many of us are afraid to travel or keep vacation plans," Turovsky says. "We're afraid to leave our loved ones. Our sense of safety has been shattered."

Fuqua echoes many when she says this is the first time she's felt this vulnerable being an American. "Before this happened, I thought a lot about how my generation takes our safety for granted and believes that war could never come to the United States," she says. "Once something like this happens, you can never assume that it won't happen again."

If you're feeling acute stress symptoms, experts say there are a number of things you can do to help yourself.

•Limit your television viewing. Some experts believe that overexposure to scenes of the explosion are psychologically damaging. Only you know when you've seen too much, but if you're feeling anxious, try turning off the television and doing something you enjoy that takes you away from the TV. (This is especially true for young children, who may become upset from viewing explosions repeatedly.) Go to an art museum, visit a park, or take a long walk.

•Talk about your feelings. Not everybody will need to talk to a therapist. But talking to friends, relatives, or colleagues can really help. You may also want to write down your thoughts about the events in a journal.

•Try to get back on track. Watching 24-hour news coverage on CNN and other networks disrupts many people's normal routines. Make sure you eat well and get enough sleep. Sleep deprivation can contribute to depression and other problems. Keith Armstrong, associate clinical professor of psychiatry at the University of California at San Francisco medical school, suggests cutting down on caffeine, sugar, and other substances that can interfere with your rest.

•Be understanding. Remember that everyone else is under enormous stress, too. A little extra kindness couldn't hurt. If you're an employer and some of your workers are waiting for news of loved ones, give them the option of taking time off. If you work in a high-rise, be flexible about letting your employees work at home or elsewhere.

•Do something to restore your faith. Visit a church or synagogue, donate blood, or do something special with your children. In these times it's difficult to remember that the world can be a caring place. But experts say it's important, especially if you have young children who depend on you for guidance, to remember that life gets better. And it's important to do the things that restore your spirituality, like giving to charities that provide aid to victims, or taking a stand against intolerance.

Turovsky is taking her own advice and spending time with loved ones after her relatives had their own brush with fate. The first attack on the World Trade Center occurred shortly before 9 am, when her father was due to have a meeting in one of the towers. Luckily, that meeting had been moved to 10 am. Her brother, who also works in the area, was late to the office that day.

"My sister-in-law just gave birth, so I'm taking a break and going to the hospital," she says. "I'm looking at a new life instead of at death."

-- Psyche Pascual is the articles and book review editor of Consumer Health Interactive. Elaine Herscher is the editor of special projects at CHI. Kristin Kloberdanz, interviewed for the story, is a contributing editor at CHI.

Further Resources

National Center for Post-Traumatic Stress Disorder. This site is primarily to help health-care professionals recognize signs of post-traumatic stress disorder. http://www.ncptsd.org/

National Alliance for the Mentally Ill. This site includes a useful fact sheet on how to recognize symptoms of post-traumatic stress disorder. http://www.nami.org/helpline/ptsd.html

American Academy of Pediatrics. This site offers information on talking about disaster to young children. http://www.aap.org/advocacy/releases/disastercomm.htm

References

First published September 14, 2001
Last updated February 26, 2008
Copyright © 2001 Consumer Health Interactive

or find more on:

Back to top of page