Oct. 16, 2001

Assessing the Emotional Toll of Terrorism

A Conversation About Post-Sept. 11 Psychology

From the Airwaves is a transcript of “The GW Washington Forum,” the weekly public affairs radio program produced by GW, hosted by Richard Sheehe, and broadcast on WWRC-AM 1260 in Washington. This conversation with Jeffrey Akman, MD, chair of the Department of Psychiatry and Behavioral Sciences at the GW Medical Center, comes from a recent program.

Richard Sheehe: What are people going through who have lost loved ones in New York, Virginia, and Pennsylvania?

Jeffrey Akman: This has been a horrible tragedy for everyone here in the United States and the range of responses is tremendous from those who were at ground zero to those who have family members and loved ones who have lost someone or suspected they’ve lost someone, to those who have been traumatized by watching this on TV. I think as a nation, everyone can relate to feeling wounded in some way. We all are stunned, depressed, sad, anxious, fearful, and experiencing these feelings. I think the issue is that this is normal, certainly as it gets played over and over in the media, to have these feelings. This is different than psychiatric illness. Most people who experience trauma and disasters do not develop psychiatric problems, but may go through a series of symptoms and feelings of a sense of loss. We’re starting to see some of that. People are coming into the emergency room or calling about feeling very upset and anxious and fearful, as well as despondent. A lot of people are feeling helpless in the face of this. What can I do? How can I help? I think we’re seeing that reflected in the amazing outpouring of people at blood banks across the country. For those people who were close to the disaster or lost someone in the disaster, there’s some research in this area in terms of how devastating and how terrifying and what makes someone more vulnerable. Clearly, aspects of the trauma that increase the likelihood of psychiatric distress include the sense that there wasn’t a warning, that it came out of the blue. The sustaining injury would lead to the likelihood of more distress. The death of a loved one would be much more likely to lead to some sort of psychiatric symptoms. With the direct exposure to the horrifying events, for those people who were eyewitnesses, are more likely to have symptoms. Some data show experiencing the trauma alone could lead to more disability. Then, I think one of the things that’s on people’s minds now is the possibility of recurrence. We need to feel reassured that we’re safe, that we’re OK. That doesn’t fully exist yet.

RS: There’s been a weird sense, especially right after the attacks, with airplanes flying overhead. I’ve heard planes go overhead all of my life and I’ve never had that feeling.

JA: I live in Arlington, not far from the Pentagon, and I could hear the rumble through the night of fighter planes. It’s a different sound than regular passenger planes. It was a constant reminder that things weren’t back to normal.

RS: Does the fact this was an intentional act make it more difficult as opposed to all of these people dying in an earthquake, for instance?

JA: I think it does. The sense is that it could happen again and there’s a sense of lack of control. When it happens by an earthquake or a flood, you can say it was Mother Nature… you can sort of rationalize it. That the horror was associated with people purposefully trying to kill innocent people makes it much more difficult to process.

RS: How do we get over it? What are some of the ways to process this event?

JA: Here’s where the media have their good and bad because we experience this trauma many times a day, if you’re watching TV and watching the planes fly into the World Trade Center and the Pentagon. We continue to re-experience the trauma. It’s as if the wound can’t heal. On the other hand, the constant information the media provide does help us make sense and reassure us. They do give us information that the government is moving forward on this. Clearly, the best thing is that we talk about it, share our feelings, and that we are around our friends and family. The most important thing is that we’re actively talking about it.

RS: How can someone tell the difference between just being upset and really needing some counseling?

JA: Survivors of trauma do have a wide range of psychiatric problems. They can include depression, anxiety, and lingering symptoms of fear and anxiety that make it hard to go to work or school. I think in the initial state, we’re certainly expecting people to have intense feelings about this. Certainly, if it goes on for weeks, that would be problematic. The sense of an acute stress disorder, which is really the most common psychiatric disorder following a traumatic event, has symptoms where people have persistent nightmares or flashbacks of the trauma. They may feel numb. They have difficulty responding normally to usual life situations. They can be on edge, feeling angry, having difficulty sleeping and seem excessively watchful and vigilant. I think we look at one’s overall level of functioning. The first few days following this tragedy, most of us were not very effective at work or school. We weren’t focused, we weren’t concentrating, our thoughts were elsewhere. But, gradually, we got back to work and we’re able to be effective. When the lack of functioning persists, it really is a hallmark that there is a problem.

RS: How do you tell children about this?

JA: It depends on the age of the child.

RS: Is there an age that you shouldn’t even mention this?

JA: I think with infants and toddlers, there’s no way they can understand what’s going on. Very young kids do have sort of a sixth sense. They can pick up anxiety and fear in a parent that may lead them to cry and not be able to sleep. But, for toddlers, it doesn’t really make sense to talk about this unless they are asking questions. The response would be age-appropriate. When you get into early childhood, preschoolers, they may be more tuned into what’s happening. They’ve probably heard about it, they’ve seen media reports, and they’ve probably heard others talking about the attacks. They’re probably most concerned with their own safety, the safety of their parents. They’re not always able to distinguish between fantasy and reality. You have to acknowledge that something very scary has happened, that you and other adults will make them safe. Let them know you love them. Hug them. Try to maintain the child’s normal routine. They’ll probably need more comfort, especially at that time. School-age kids are going to be even more aware of what’s going on. It’s important to be honest with these kids. Tell them what you know about what happened without exaggerating. Let them talk about their feelings. Again, emphasize they are safe. Limit TV coverage for kids up to this age. It’s very scary for them to sit and watch this over and over again. Middle school kids will be more aware and may have talked about it in school. Reassure them and let them talk about it.

 

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