with the Dead
History, Politics, and Loss
Scholarly Responses to Sept. 11
someone who researches post-traumatic stress disorder (PTSD) and
treats people affected with this disorder, Ive had to confront
the traumatic aftermath of September 11. After the attacks, many
of my patients who already suffered from PTSD came in looking like
deer caught in headlights and reported feeling terribly vulnerable.
In every session with every patient after the attacks, it has come
up. And new patients are calling with severe anxiety and depression.
Some commentators have suggested that all Americans are suffering
some form of PTSD because we all were, in a sense, witnesses to
PTSD is an anxiety disorder characterized by symptoms of re-experiencing
the trauma, like flashbacks and nightmares. Emotional numbing, detachment,
and avoidance of reminders of the trauma are also symptoms. Those
suffering with PTSD experience an increased state of arousal, manifested,
for example, by sleep disturbances, exaggerated startle reactions,
and hypervigilance. In the general population before September 11,
the prevalence of PTSD was estimated at 9 percent to 12.3 percent.
Obviously, the terrorist attacks constitute a major traumatic stressor.
There was a massive loss of life, severe injury to survivors, and
enormous property destruction. The immediacy of television saturated
society in images graphically relaying all these threats. These
images are seared into our minds eyes.
Though we have clearly all been affected by these tragic events,
I would argue that what many of us are suffering is not PTSD. The
American Psychological Associations diagnostic criteria for
PTSD states the person experienced, witnessed, or was confronted
with an event that involved actual or threatened death or serious
injury, or a threat to the physical integrity of self or others,
[and] the persons response involved intense fear, helplessness,
or horror. Even though the definition of the trauma includes
witnessing, I believe it means actually being present at the scene
and potentially being in the line of danger. An example would be
witnessing a shooting and fearing the gun could turn on you. To
define who is most at risk for PTSD, I picture a map with bulls-eyes
centering on New York and D.C. and concentric circles emanating
across the U.S. and the world. The closer people were to the actual
sites, the more likely they will be to suffer post-trauma reactions.
PTSD is not the only reaction to trauma, however, and possibly not
even the most severe, although it certainly has devastating consequences
on functioning and quality of life. I do not want to underestimate
our responses and the emotional processes we all are undergoing.
Initially, we were shocked. The word of the day on September 11
was unbelievable. We began grieving and grieve still.
Then it seems we either became angry or anxious, and we may still
be in that phase. What is normal and what is pathological in our
responses? Nearly universal reactions in the immediate aftermath
include sadness, numbness, an inability to concentrate, a desire
to be at home and close to loved ones, and a hunger for the information
the ever-present television or radio serves up continuously.
What about now? Uncertainty and anxiety about what may happen next
in terms of military or terrorist actions seem widespread. The first
time we fly again, we can be assured of thinking of those doomed
passengers and looking at our fellow passengers suspiciously and
trying to figure out if there is a U.S. marshal on board. Many report
feeling a bit uneasy about travels away from home that they didnt
think twice about before. Has a day gone by that you havent
thought about what happened? If you had emotional difficulties or
vulnerabilities before the terrorist attacks, they likely have been
What about the future, our emotional future? Our sense of invulnerability
as Americans has been shattered, but I dont think has disappeared.
We hear over and over that there will be a new normal, a new baseline.
We still believe that our increased security and vigilance will
protect us. Is this naïve?
As a mother and wife, a daughter, sister and friend, I pray that
it is not. But as a psychologist, I fear that this trauma has unleashed
a monsternot the organized terrorist, but the angry and embittered
person. Just as there have been more school shootings in the wake
of Columbine, I fear there will be more acts of angry violence.
Before Columbine, there were many angry school children with aggressive
fantasies. Aggressive fantasies are normal. But after Columbine,
acting on those aggressive fantasies became more imaginable for
some. It became an option to take a gun to school and shoot people.
My fear is that it is now an option to attack American civilians
on U.S. soil.
So how do we cope? Probably the way we always have. We hope and
pray and distract ourselves. We talk to our friends and families
and colleagues. We work. We play. We work. We trust. We work. We
seek information, and we deny. And we know that our options are
few, except to go on assuming this will continue.
Additional faculty responses to September
11 through disciplinary
lenses are available at