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September 21, Introduction On September 11, , terrorists hijacked four commercial airplanes. Two planes were used as missiles to destroy two towers in the World Trade Center. One plane crashed into the Pentagon. One, crashed into a field in Pennsylvania.

This horrible tragedy resulted in the loss of thousands of lives, treasured structures, cherished beliefs and a valued sense of ongoing safety. In addition, we have each been affected in an individual way by this tragedy. Heroes have and will emerge. We can all become heroes by courteously and sensitively helping ourselves to recover, helping each other to recover, enhancing the safety of all, and, when possible, finding ways to act that make life better now and over time.

Psychological First Aid 1 In all cases, behave responsibly Restore equilibrium Recognize the impact of this event on current functioning Act to restore equilibrium without overuse of avoidance or denial When reasonable, postpone major life decisions until stress is reduced and equilibrium restored Acknowledge and appropriately process grief, pain, anger, etc.

This paper is addressed to all of them in honor of those who died, those who survived, and those who will be called to serve.

Terrorism: September 11, 2001: Trauma, Grief, and Recovery

We are a nation of survivors. Reaching Overload We have been inundated with painful images and stories. The stresses have been unrelenting. The danger has not ceased. We wonder about the threat of another terrorist act. In New York there is continued danger from building debris, rescuer overwork, and other aspects of the cleanup process. For a long time, we hoped that people remained alive under the debris. Many people have experienced varying levels of overload. A sense of being overwhelmed may result and may manifest as numbness, exhaustion, confusion, irritability, ready tears, anger, withdrawal, unexplained smiles or laughter, jokes dark humor , or immobilization.

Good self-care is essential. Methods used to recover from overload will vary for different individuals: Neighborhood groups have gathered to light candles, cry, sing patriotic songs, commiserate, talk about what might happen or needs to happen.

On the one hand, support is important. On the other hand, recovery must be an individualized experience. Finding Balance As well as restoring safety and health physical, mental, emotional and spiritual , it will be important to restore balance and a newly defined normalcy. For most of us, some issues require immediate attention for example, safety and emotional recovery ; other issues for example, evaluating beliefs and practices must wait until some recovery occurs.

Faulty decisions can be made when overwhelmed or emotionally distressed.

December 2001 - Volume 51 - Issue 6 : Journal of Trauma and Acute Care Surgery

When reasonable, some decision-making will need to be postponed until after stress reduction. Decisions will be made by each individual about when to watch and listen, when to take action and when to rest. Decisions must be made about when to be alone and when to be among others; whether to seek support or also to seek counseling. We must determine when and where to be more cautious.

For example, airports have already increased security measures. We will be confronted with finding balance in our protective reactions. For example, recognizing the line between reacting to deter assault or oppression and becoming the oppressor; recognizing the difference between reacting wisely and reacting without assessing long-term consequences. Accepting Varied Reactions Specific reactions as well as stress levels, grief, and trauma will differ based upon our individual experiences of the event, associations with those directly and indirectly affected, our past histories, cultures, belief systems, biochemical and physiological make-ups, temperaments, personalities, and the potential for long-term personal impact.

For those who have had previous traumatic experiences, symptoms may be reawakened by these events. Multiple responses are likely.

Individuals are unique and will respond uniquely. Although some responses may be the same for many of us e. Some people will seem unaffected by this experience. Some people are numb or shocked and may have a delayed response. Some individuals endure their pain silently. Some people may feel elated or relieved by having survived the worst.

Some individuals will feel irritation and annoyance because of the inconveniences that have and will occur as results of these events.

Some will be irritable as a part of their stress reactions. Some will see the horrific images every time they close their eyes. Some individuals will be immobilized. Reactions will occur in many variations and on many points of a continuum from one extreme to another.

Valent (2001) Right Brain as a Substrate for Reforging Psychoanalytic & Trauma Therapies

People may vary their behaviors under differing circumstances. For some, this experience has been and will be uniting. For others it engenders a sense of separateness. Some will become more faithful and spiritual. Others will become more doubtful and question spiritual beliefs. Some will use this as an opportunity to rethink their lives and beliefs. Some will better appreciate their lives.

Some will become disorganized. Others will become organized. Many will have a variety of thoughts regarding children, their ongoing safety, and their growth and development.

It is essential to remember that different people will react differently and on different timetables. Among those who are particularly at risk are people who experienced the sights, sounds and smells; who felt the horror; whose relatives, friends, coworkers or rivals were endangered, killed or injured; who were previously traumatized; who have had mental health difficulties in the past; who have had specific, now unresolvable, interactions with someone killed in this event; or who have personalities or temperaments that make them particularly sensitive to the effects of a horrific tragedy.

Studies suggest that individuals exposed to a violent event are at risk of experiencing increased symptoms if their parents have been previously traumatized Nader, ; Solomon, Moshe and Mikulincer, Those who have had previous traumatic experiences e. This event may serve as one more confirmation that the world is not a safe place or that it is difficult to know whom to trust. It will often result in the need for additional therapy to process the interplay of this event and the past experience s.

The terrorism of September 11, has affected those who were previously traumatized in a number of ways. It may have amplified or reawakened traumatic emotions such as fear, rage, depression, helplessness, anxiety, hypervigilance, fatigue, startle, distrust, poor concentration, stress, arousal, and horror….

It may have immobilized some of the previously traumatized as well as some exposed only to this event. Although the topic of facing old demons will be discussed in more detail in another article, a few examples may demonstrate the intensity and nature of the interaction of previous trauma and this event2. Fran had been drugged, brutally assaulted and heavily scarred physically and emotionally.

She was enraged at a government that gave money to countries that housed terrorists, a government that has itself attacked innocents. This event left her even more enraged at the police who made her feel dirty and crazy and who never found her attacker.

She felt unprotected and unassisted by doctors and mental health professionals as well. Her adrenalin was pumping amplifying her sense of rage and fear and the need to strike out… Don recalled the pain of watching, as a child, while his sibling was beaten to death. He had undergone extensive therapy.

Before the terrorism of the 11th, he had been on the road to recovery. He had finally found a kind of peace during a trip he had made to a major city. On the 11th, horrible memories and emotions flooded back. He was not sure that he would ever find that peaceful place again.

In contrast to this vulnerability, there is some evidence that individuals who have successfully resolved previous traumatic reactions fare better during subsequent events.

Paula had been exposed to multiple traumatic events e. After the successful completion of therapy with a skilled trauma specialist, she did better than her husband or her friends during an earthquake that collapsed a nearby wall. Among other things, she knew to be cautious and to protect herself from the sights and sounds of horror.

Although this result may be affected by more than one factor, it suggests that a severe reaction to this current event may be an indicator that past aspects of the original event need additional resolution. A severe reaction suggests the need for therapeutic assistance regardless of past history. Reacting to reminders Reminders of the tragedy of September 11 or of a previous trauma can engender sets of memories, thought processes, emotions or symptoms related to those experiences.

Reminders may include certain mental or external images, sounds, smells, tastes, physical sensations, emotions, ideas, circumstances, weather conditions, places, people, and other things associated with the experience. For those who have been previously traumatized perhaps especially when the previous trauma was a violent event , the tragedy of September 11 is a reminder.

Different people will have varying sensitivities to different reminders of the event. Some people may be reminded by airplane sounds, by any depiction of or actual explosion, building collapse, person jumping from a high place, etc. Other individuals will only be alerted by specific things that closely approximate what they saw or heard during the event.

The grieving may be reminded of the event every time they think of the deceased. Reminders may recall any or all of the emotions and symptoms associated with the original or with this event. Seeking Support Varying levels of assistance will be important for many people. For those who were saddened or who need to sort out their thinking, talking to a friend, clergy or other counselor may assist a return to a newly defined normalcy.

There are a number of methods of healing that might be used individually or in combination. Those who are experiencing grief may benefit from seeing a grief counselor. Many people may go to one or two counseling sessions to process their reactions or to sort out their thinking.

If hopelessness does not begin to become hopefulness, if fear or anger do not become attempts to find positive actions that lift spirits, then finding help may be important. Individuals experiencing trauma or traumatic grief; anyone immobilized by fear, anxiety or guilt; anyone whose previous trauma is overwhelming; anyone who through action or inaction may harm themselves or others should seek the assistance of someone trained and skilled in assisting the traumatized.