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 theyve
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. Were
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 were 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, theres 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 wasnt 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 thats
on peoples minds now is the possibility of recurrence. We need
to feel reassured that were safe, that were OK. That doesnt
fully exist yet.
RS: Theres been a weird sense, especially
right after the attacks, with airplanes flying overhead. Ive heard
planes go overhead all of my life and Ive 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.
Its a different sound than regular passenger planes. It was a
constant reminder that things werent 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 theres 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: Heres where the media have their
good and bad because we experience this trauma many times a day, if
youre watching TV and watching the planes fly into the World Trade
Center and the Pentagon. We continue to re-experience the trauma. Its
as if the wound cant 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
were 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, were 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 ones overall level of functioning. The first few days
following this tragedy, most of us were not very effective at work or
school. We werent focused, we werent concentrating, our
thoughts were elsewhere. But, gradually, we got back to work and were
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 shouldnt
even mention this?
JA: I think with infants and toddlers,
theres no way they can understand whats 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 doesnt 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
whats happening. Theyve probably heard about it, theyve
seen media reports, and theyve probably heard others talking about
the attacks. Theyre probably most concerned with their own safety,
the safety of their parents. Theyre 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 childs
normal routine. Theyll probably need more comfort, especially
at that time. School-age kids are going to be even more aware of whats
going on. Its 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. Its 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.
Send feedback to: bygeorge@gwu.edu