Two years after what we now refer to as 9/11, or the day that changed America forever, are we still saying "I love you" to our partners as they head off to work? Are we still making efforts not to go to bed angry or to perform random acts of kindness for our neighbors?
To find out, WebMD spoke to the very experts who were on the front lines in New York, Washington, and Pennsylvania when disaster struck and those on the sidelines all across the map who fervently worked -- and are still working -- to heal our country.
Here's what they have to say.
"From a totally personal perspective, we are doing better than I ever imagined," says Randall D. Marshall, MD, director of trauma studies and services at New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons, both in New York City. "Given the hell we went through and the way that the community was in danger of being destroyed after 9/11, we have pulled through remarkably well," he says.
Blackout Shines Light on Changes
"The blackout is a nice example," he says, referring to the blackout of 2003 that took out power across the Northeast and parts of Canada. "Perhaps there could have even been some panic before 9/11, but once we heard that it was not any kind of attack, people were remarkably calm and drew on their experience in 9/11."
Specifically, people were taking rides from strangers, enjoying free ice cream from local parlors, and there was no massive looting or lawlessness as was seen in previous blackouts, he says.
"Part of the joy of the blackout was that it wasn't a disaster," says Bruce Jackson, PhD, professor of American culture at the University of Buffalo in Buffalo, N.Y. "Everyone in New York City's first reaction was, 'They've done it again!' And then when people gradually realized it was not terrorism, there was huge wave of relief," he says. "People were talking to one another," even people who have lived anonymously in the same building for years, were talking to their neighbors for the very first time, "which is good but a helluva way to get to know your neighbors."
Studies conducted after Sept. 11, 2001, suggested that in some respects, Americans had become kinder, more loving, and more grateful since Sept. 11. Has it lasted?
Not really, says Barbara O. Rothbaum, PhD, an associate professor of psychiatry and the director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine in Atlanta.
When it comes to saying "I love you" every morning and trying not to go to bed angry, "What people said they were going to do has fallen off," says Rothbaum. "Those are the kind of things we are vigilant about after things happen, but we have returned to baseline."
But there is a new baseline for some behaviors. "Our overall daily life is not significantly different than it was before 9/11, but we have adapted to a lot of things," she says.
Notably, "Our flying experience is much different now, but for those of us who fly a lot, we don't notice it anymore -- whether its taking our shoes off or allowing extra time to clear security."
Speaking of airports, David Baron, MD, professor and chairman of the department of psychiatry at Temple University in Philadelphia, says that "when it first happened, people had no problems with airport security; now they are annoyed."
So how are we doing overall?
"Overall, there is a greater cautiousness, but as time goes on, we see a gradual return to what things were pre 9/11," Baron says.
"We have learned a lot of things in terms of how to be better defended structurally, but psychologically we still have a long way to go," agrees psychiatrist and psychoanalyst Stuart Twemlow, MD, director of the HOPE unit at the Menninger Clinic, now located in Houston.
"Initially, 9/11 caused a sense of togetherness in the country -- particularly New York," he says. But, Twemlow says, "I don't see people as more tolerant, patient, or altruistic. I think they are possibly even less so because they are worried about their own safety and more aware of the potential to lose everything."
Richard Fox, MD, past president of American Psychoanalytic Association and an analyst in private practice in Dana Point, Calif., agrees. "I don't see any particular change in friendliness or community spirit here on the West Coast, but I sensed from reports of the blackout that people did respond differently than in the past, and perhaps there was a shared sense of community."
Never Forget
Stephen Paolucci, MD, chairman of the division of psychiatry at Geisinger Health System in Danville, Penn., sees it this way: "As a community, I do believe we are looking out more for each other and are more aware of each others needs, [but] it has still made us somewhat more insular in the sense that people have been shaken to the core and have higher anxiety, distrust, and fear about what may be going on in the world around them."
For this reason, many people have chosen to move closer to home and spend more time with family. In fact, a recent poll by the market research firm Yankelovich has found that perhaps since 9/11, more people are choosing to spend time at home with friends and loved ones, a phenomenon known as "hiving," which means that home is the new command central where we engage and connect with people via various home-based actives such as renting movies and playing board games.
"People are doing much better, but they have not forgotten," Paolucci tells WebMD. "In practice, I still see people who come into the hospital because of increasing fears about what they see on TV."
"Society heals and people are moving on," Paolucci tells WebMD. "We don't want to forget, but we don't want it to become such an overwhelming part of life that we can't live."
PTSD Rates Falling, but Many Still Need Help
A lot of people still can't move on, adds Columbia's Marshall.
The most recent data on posttraumatic stress disorder (PTSD) suggests that the rate in the greater New York area dropped from 10% to less than 1%, he says.
"The bad news is at this point, these folks will probably remain ill without an intervention because if they still have PTSD two years later, it's likely to become chronic," Marshall says.
There are 13 million people in the greater New York area, so that means about 300,000 have PTSD, and there is no good data on depression, substance abuse, family problems, and work problems resulting from 9/11, he explains.
Calls still pour into Project Liberty, an outreach and crisis counseling program for individuals, families, and groups most affected by Sept. 11 and its aftermath, he says.
What About the Children?
Many expressed concern about children, but "Children are very resilient and are sponges and tend to absorb what's going on with the adults around them," says Emory's Rothbaum.
If adults remain calm and collected, children will follow suit, she says.
In fact, research suggests that the vast majority of American children probably were not traumatized by the Sept. 11 terrorist attacks, but there are clear exceptions, including New York City children -- particularly those who had a loved one injured or killed that day and even those who had loved ones escape unharmed.