Too Soon to Reflect on 9/11?

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March 8, 2002 -- On March 11, two parallel towers of light powered by 88 searchlights aimed toward the heavens will light up lower Manhattan in remembrance of the twin towers of the World Trade Center that once dominated the New York City skyline.

While the gaping hole in the sky once occupied by the towers may easily be replaced, the void in the hearts and minds of many Americans after the terrorist attacks of Sept. 11 has yet to be filled. Six months after the tragedy, a new documentary scheduled to air on CBS on March 10 with footage shot inside the towers after the first plane hit is already stirring controversy from those who say it's too soon to revisit the scene of horror, and others who say it's a way to honor the victims.

But mental health experts say that kind of debate is to be expected because everyone is dealing with the events of 9/11 in their own way, which is just how it should be.

Too Soon for Reflection?

"I was a block and a half away when it happened, and I am curious. What did it feel like inside?" says psychologist Marilyn Puder-York, PhD, who lives and works in a private practice in lower Manhattan. She says it may actually have been easier for her to come to terms with 9/11 because she was faced with it every day once she returned home after being evacuated for five weeks.

For people who weren't directly affected by the events, she says it could be helpful to watch these types of accounts because they humanize the tragedy and bring people into the experience, making it more realistic for them.

Those who have screened the CBS documentary say it doesn't show any gruesome images of victims, but it does contain realistic portrayals of how people reacted to the events -- expletives and all.

"It's for people who want to experience a reliving of the event and get more data about it, but feel that they can handle it," says Puder-York. "Or even if they can't, if they need to cry and want to further experience it, then they should watch it."

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For those more personally affected by 9/11, experts say the decision to watch or not to watch may be more complicated. Some people process their grief by learning as much as possible about the circumstances surrounding their loved one's death. Others want to be left alone to deal with their grief in private.

Mila Tecala, MSW, is a grief and bereavement specialist in private practice in Washington, and has several clients who lost a loved one in either the Pentagon or World Trade Center attacks. She says one of her patients who lost a child on 9/11complains that, "No one is letting us move on."

Tecala says some relive the horror of their loss over and over each time they watch the towers fall. For them, avoiding any type of stimulation that makes them feel uncomfortable is recommended until they come to terms with their loss. She says it is not unusual for there to be a delayed reaction to a sudden death, and it often takes three to six months to process what has happened.

Experts say everyone should try to adhere to a "buyer beware" type of policy when confronted with these or any other images that stir up memories of the past that they aren't prepared to deal with.

"If anyone is extremely vulnerable and does not want to be provoked or to feel, they shouldn't watch the TV," says Puder-York.

Psychological Distance and Healing

Others say it's not necessarily the physical proximity to the events of 9/11 that could put some people at risk for emotional pain and suffering.

"It's how psychologically close you are to the events that matters," says Chicago-based child and adolescent psychiatrist Eitan Schwarz, MD.

Special groups, he says, such as people who live or work in skyscrapers, refugees who fled from wars in their home countries and now live in the U.S., and people who are naturally overanxious or preoccupied may suffer in silence.

For these people who are suffering from severe emotional trauma and not receiving professional help, things are likely to get worse before they get better, says Schwarz, assistant professor at Northwestern University Medical School.

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Tecala agrees and says even those who didn't suffer tangible losses due to the attacks may feel real grief because it resurrects their own feelings of loss. They may wonder what might have been if it had happened to them. "These were innocent people that were attacked, and we put ourselves in that position and personify them," says Tecala.

But for most people, the healing and recovery process is already well underway. Schwarz says, "As more time goes by and less happens, there will be more normalization. People will recover quickly, but it's important to connect with other people."

Although post-traumatic stress disorder (PSTD) has been talked about a lot in media reports, he says the fact is that PSTD is the exception to the rule. Only about 20-40% of those who are actually exposed to trauma develop it.

What About the Children?

While adults grapple with their own feelings about 9/11, parents must also try to judge how their children are coping.

But Schwarz says parents should follow their children's lead and not try to force them to experience anything they're not ready for yet. For example, it might not be a good idea for some children to watch the documentary if they aren't already curious about it, especially if they were not directly affected.

"If a child is not in the process of dealing with this, there is no point in exposing them now," says Schwarz. But it may be useful for older children to get to know more about 9/11 as a historical event.

While remembering and mourning our losses are certainly part of that discussion, he says children should also see evidence of the healing process and how we as a nation and a world are coping and rebuilding after the tragedy.

For those closer to the events, both physically and emotionally, parents may be suffering from a new set of issues with their children. It doesn't necessarily take a visual re-enactment like a documentary to trigger a reaction in children.

For example, Puder-York says her 10-year-old daughter recently heard a fire engine siren from their lower Manhattan living room and asked her, "Oh my God, Mom, do you think it's another terrorist attack?"

"And I have to deal with the reality that it's not completely irrational for her to have reacted like that at 10 years old," says Puder-York.

But she says parents have to continue to try to raise their children with a sense of normalcy, even though the kids may have a new sense that mommy and daddy can't protect them all the time.

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Where Do We Go From Here?

As the six-month, one-year, and other anniversaries of 9/11 approach, Schwarz says it's important to remember that anniversaries are not only an opportunity to revisit and re-experience, but also to heal and share how we've survived.

"That's what anniversaries are for. It shouldn't put you through the trauma again, not alone," Schwarz says.

As for the patients she sees in her downtown Manhattan office for counseling, Puder-York says the one generality she can make is that there is still a general sense of sadness, but it's how people react to it that makes the difference. Some have become more angry and prone to conflict, but others have become more spiritual with the realization that their fate is out of their control.

"It's the most serious provocation than we've ever experienced before in our lives," says Puder-York. "But we all have to do what we need to do in order to function, and we all need to find our own way of adapting."

A 30-year-old New Yorker who saw the second plane hit the south tower just feet away from the roof of her apartment building says she's just now returning to a state that seems "normal" compared with her post-9/11 haze. For her, that means getting back to work as a freelance writer, flying back home to California often, and a new apartment in a high-rise building on the Upper East Side.

But others who were thousands of miles away from New York, Pennsylvania, or Washington at the time of the attacks say they're not ready to fly and aren't sure if they ever will be. And many who live in high-rise buildings from Chicago to Los Angeles are drastically more aware of their surroundings.

Experts say it's perfectly normal to be more aware and alert about your surroundings in a post-9/11 world. In fact, the U.S. government is encouraging its citizens to do so. But the key is to strike a balance that allows each individual to go on with their life in a way that makes them feel comfortable.

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As Tecala tells her patients, the goal should be to "live cautiously, but live fully."

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