It's the central question of our post-Sept. 11 world: Can we cope with terror? The key, experts say, is to find meaning.
Terrorist acts shred the fabric of our world. By definition, they strip away our day-to-day life. Human beings have many ways of dealing with trauma and fear. Some help us heal. Some make the pain worse.
"Before Sept. 11 there was tremendous danger from weapons of mass destruction in the world, but Americans were almost completely unaware of it," Psychologist Charles B. Strozier, PhD, who treats people traumatized by the World Trade Center attack, tells WebMD.
"After Sept. 11 there is a level of panic that sometimes exceeds the level of danger. But our response is becoming more realistic. It is not appropriate not to be afraid of weapons of mass destruction. This is real scary stuff. It is really healthy to think about it, to be aware of it, to be prepared for it, to make ourselves safe. We can't put our head under the pillow the way we did in the 1990s. We have to keep moving forward." Strozier is director of the center on terrorism and public safety at New York's John Jay College of Criminal Justice.
The Danger: Accepting Violence
In societies that face constant, ongoing terror, the effects can be devastating.
Rona M. Fields, PhD, leads a Washington, D.C.-based community psychology practice and is co-author of the American Psychological Association's fact sheet on coping with terrorism. Fields worked in Chile during a time of state-sponsored terror and, more recently, in Israel. She says acts of terror -- and constant false alarms -- put us in an acute state of stress. If this keeps up long enough, violence becomes accepted as part of normal life. The result: an unstable society.
"In Chile, people came to accept abnormal and destructive and dehumanizing behaviors as normal. That was very sad," Fields tells WebMD. "In the Middle East, where I have done studies among Palestinians, the society itself becomes polarized, fragmented, and numb. It's not that they are coping. It is that they are numb. There are serious social consequences to this kind of thing."
Christine Nadori, RN, is medical program officer for the humanitarian group Doctors Without Borders. She recently returned from Israel where she worked in Palestinian communities.
"The fact of the matter is that normal life doesn't look anything like normal life for the Palestinians. And it has changed for the Israelis, too," Nadori tells WebMD. "We are dealing directly with patients who have trauma, PTSD [posttraumatic stress disorder], aggressiveness, depression, and so on. ... Certainly there are deaths due to war, but in very small numbers. What actually causes the most suffering is the psychosocial trauma from pervasive violence in the community. There is increasing hopelessness."
Americans aren't faced with this kind of day-in, day-out terror. Instead there is the very real threat of violence on a large scale: bioterror, dirty bombs, chemical weapons, suitcase nukes. This makes it very hard to know what to prepare for.
"You can only imagine the future based on your understanding of the past," Strozier says. "We had Sept. 11 and the Oklahoma City bombing. They are not models you can carry forward. It is unlikely there will be hijacked planes next time. It is not like in Israel with individuals blowing up pizza parlors -- you can be pretty sure it will happen again. The example of terrorism that we are responding to is unique. It doesn't point forward to anything specific or concrete, like 'protect all pizza parlors.' We don't know what to do. This is difficult for us as a culture."
Fields says that the constant stream of post-Sept. 11 security alerts keeps Americans stressed out. She worries about what this means to our collective mental health.
"The American public is still trying to find something we can do to prevent these intermittent shocks, and there is nothing we can do," she says. "We are creatures who look for meaning. We are looking for meaning that helps us cope. Some find meaning by waving flags constantly. And some are developing very neurotic defense mechanisms to cope. ... It's important to help people find a sense of meaning."
Meaning: The Heart of Human Resilience
"It is the kind of meaning we put on events that protects our resilience, that makes us capable of being resilient, that lets us cope and adapt," says psychologist Bernhard Kempler, PhD, professor emeritus at Atlanta's Georgia State University.
Americans have lost their sense of being safe. Losing that illusion was painful, but Kempler says it gives us the chance to find our place in the real world. From this search comes resilience.
Kempler's own sense of safety was shattered during his childhood in war-shattered Europe. Separated from his parents, he and his sister became homeless. Eventually they were captured by the Nazis and sent to a concentration camp. Both survived -- and grew stronger.
"By golly, seeing those airplanes hitting those towers will rip apart your illusion. At some point you feel it is definitely real," Kempler says. "Americans in general probably are quite resilient. I do believe that Americans as a whole rise to the occasion. I think part of it is diversity. We value a great number of perspectives. We value variety for its own sake. We believe it makes us creative and resilient. You would see much less resilience in a country that sees things in more black and white terms -- a more fanatical or totalitarian culture."
Resilience depends on several things: the ability not to take things personally, the ability to remain curious and engaged in solving problems, the ability to share our lives with family and friends.
"Resilience is the capacity to find new and creative ways to assert life despite great trauma and obstacles," Kempler tells WebMD. "Resilience is people going on with their lives and finding themselves living more assertively and more purposefully."
Strozier is not blind to the ongoing suffering the events of Sept. 11 left in their wake. But like Kempler, Strozier finds Americans to be remarkably resilient.
"In New York we say to terrorists, 'To hell with you, we are going to stay here no matter what.' But we also have a very keen sense of dread," he says. "We know that New York is the crucible of America in terms of terrorism. Sure there is a level of denial to this. It's a mixture of awareness and denial and an attitude of cussedness and the feeling we aren't going to give in. Yes, it is a picture of mental health."
Originally published Sept. 9, 2002.
Reviewed by Michael W. Smith, MD.