9/11: Emotional Wounds Heal Slowly

Experts look at ways that Americans are coping emotionally five years after the terror attacks.

From the WebMD Archives

As we mark the fifth anniversary of the terrorist attacks that occurred on Sept. 11, 2001, leading psychologists tell WebMD the scars are still visible for us as a nation. And for those who were personally affected, the emotional wounds are far from healed.

How we are dealing five years later "depends on how old we were at the time that it happened, how much we were affected by it, and the nature of our experience on that day," explains Donna Gaffney, professor of nursing at Seton Hall University in South Orange, N.J. Gaffney is an advisory board member of the Families of September 11, a nonprofit group that supports families affected by the terrorist attacks and champions domestic and international policies that respond to the threat of terrorism.

"Certainly family members who lost someone or people who survived the attacks are going to have a very different experience than people who live in other geographic regions of the country," she says. "Family members are still very raw and this is a part of their lives that they haven't moved on from, nor should they ever," she says.

New terror attacks and terror alerts, the release of movies and documentaries on 9/11 -- as well as the trial of Zacharias Moussaoui, the only person in the U.S. charged in connection with the Sept. 11 attacks -- all serve as aftershocks and can reopen old wounds, she explains.

Watershed Moment

"9/11 was such an extenuating circumstance," agrees Carol Goldberg, PhD, a clinical psychologist and TV personality, based in the New York City area. "People are still grieving and the level of their grieving is affected by how close they were geographically to the World Trade Center or the Pentagon, if they lost a relative or friend, or if they had some connection to the buildings themselves," she says. "Even though New Yorkers pride themselves on being hale and hearty, underneath it all, they are feeling very vulnerable and I don't think they have forgotten it by any means," she says.

"Although 9/11 is over, there are continuing issues of terrorists and terrorism throughout the world," she says. Situations such as the recent foiling of a major terror plot to blow up planes in flight from the U.K. to the U.S. can bring it all back in an instant, she points out.

Continued

Cycle of Grief

In her book, On Death and Dying, Swiss psychiatrist Elizabeth Kübler-Ross created what is referred to as the grief cycle. This cycle starts with shock and is followed by a denial stage, an anger stage, a bargaining stage, depression, testing, and finally, acceptance.

But this way of looking at grief does not apply to 9/11, says Robert R. Butterworth, PhD, a psychologist at International Trauma Associates in Los Angeles. "Unlike a mourning process where somebody dies and you start getting over it, this is a question of issues continuing to pop up," he says. "Anxiety about terrorism is reoccurring so the national psyche can't use the [grief scale]."

In a way, he says, "we are stuck in the anger stage and that's connected to our fears," he says. "I don't think anyone can have acceptance. How can we accept the fact that the world hates us and we are going to be injured?"

But as a nation and as individuals, "we are putting one foot in front of the other and going through the motions," Butterworth says. "We are functioning at 80% as the anxiety is not forcing us to alter our behavior. We may be nervous, but we still do what we have to do," he says.

New York City-based clinical psychologist and psychoanalyst Janet Bachant, PhD, agrees. Bachant is the founder and board chair of the New York Disaster Counseling Coalition, an organization which serves the mental healthmental health needs of the uniformed services.

"9/11 has changed our world forever," she tells WebMD. "For many people, it will be with them probably for the rest of their life," she says. "I think we are doing remarkably well as a nation, but I think we are all struggling with the aftermath of 9/11 in terms of the unsafety of the world in general."

"We are doing better every year," adds Robyn Landow, PhD, a clinical psychologist and a consultant to the Fire Department of New York (FDNY), the Port Authority of New York and New Jersey, and the World Trade Center Building Trades Alliance. "We are healing despite the fear of something happening again," she says.

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Coping Strategies for the 5th Anniversary

The best way to cope with the anniversary and any aftershocks is to try and turn helplessness into action, Bachant says. "Everybody has something they can do and do well that will help them feel better," she says. "It can be a simple action of just getting family together and sitting down to dinner or going to a movie."

On the actual anniversary, "find a way to acknowledge it in a way that can bring you together with loved ones or people who you care about," she suggests.

Goldberg adds that "if you had lost a close relative or friend in the World Trade Center, it might make you feel better to go to the memorial at Ground Zero because you may feel better grieving than not grieving," she says.

Media Reminders

Movies such as the World Trade Center and United Flight 93, which depict and dramatize the terrorist attacks, may retraumatize people who were affected by the tragedy, but some may find them cathartic, she says. "There are many people who will not go see them and for others, it may be something that they find helpful," she says. "People should know themselves. There are people who can handle it and others who can't."

The bottom line is "do things that make you feel better, not worse," she says.

"I told clients affiliated with 9/11 not to see World Trade Center as it will only be traumatizing," Landow says. "In New York, tapes of 9/11 are released constantly, so they are hearing and seeing enough on the news and newspapers and don't need to be traumatized to that degree."

Gaffney's organization, the Families of September 11, has published an online guide to help families make the decision about whether or not to see these movies.

WebMD Feature Reviewed by Louise Chang, MD

Sources

Published Sept. 5, 2006.

SOURCES: Carol Goldberg, PhD, clinical psychologist. Robert R. Butterworth, PhD, psychologist, International Trauma Associates, Los Angeles. Robyn Landow, PhD, clinical psychologist. Janet Bachant, PhD, founder and board chair, New York Disaster Counseling Coalition. Donna Gaffney, professor of nursing, Seton Hall University, South Orange, N.J.; advisory board member, Families of September 11.
© 2006 WebMD, Inc. All rights reserved.

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