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Living with the Dead
History, Politics, and Loss

Additional Scholarly Responses to Sept. 11

As someone who researches post-traumatic stress disorder (PTSD) and treats people affected with this disorder, I’ve 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 the violence.

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 Association’s 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 person’s 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 bull’s-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 didn’t think twice about before. Has a day gone by that you haven’t thought about what happened? If you had emotional difficulties or vulnerabilities before the terrorist attacks, they likely have been exacerbated.

What about the future, our emotional future? Our sense of invulnerability as Americans has been shattered, but I don’t 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 monster—not 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 www.emory.edu/ACAD_EXCHANGE/sept11.html.