xxAACP Newsletter, Volume 15, Number 4, Fall 2001
DISASTERS AND TRAUMA: A FIRST-HAND REPORT
What started out as a routine trip to
Washington to attend a pair of psychiatric meetings turned into a horrific
sojourn to the depths of hell and back. As I reflect on the events of the past
week, I am filled with an odd mixture of shock, anger, exhaustion, fear,
inspiration, bittersweet satisfaction, and profound ambivalence.
I flew into DC for a meeting on September 6
to review current federal legislative and regulatory issues. Feeling somewhat
smug and satisfied that my recent experiences working in the U.S. Senate would
help me provide useful support to the American Psychiatric Association’s
government relations commission, I participated actively in a very busy and
interesting three day discussion. From there I went to Annapolis to participate
in an equally stimulating focus group on how to improve and maintain the
education and training needs for the mental health workforce in this country.
The second meeting was cut short just before it was due to end by news of the
attacks on the World Trade Center’s twin towers.
In a scene that must have been repeated
throughout the world that fateful morning, we sat glued to the television
watching first one and then the second of the buildings that had come to
symbolize the west’s corporate dominance and New York’s skyline, come
tumbling down like an exceedingly tall house of cards. We continued to watch in
shocked disbelief and abject horror as the clouds of smoke and debris rose from
the remnants of the world’s financial capitol and the United States’
military headquarters.
What would have been a time for saying
goodbye to friends became a period of confusion, indecision, and worry. We
attempted to finish our business and make decisions about how and whether to
leave. Would we be able to get home soon? Would we have to remain in this hotel
indefinitely? What was happening here, in DC, in New York, in our homes, in our
hearts and minds?
I managed to get a ride with some friends to
their home in suburban Virginia, where we took stock of our situation. My
inconvenience in being delayed in returning home seemed insignificant in
relation to the tragic loss and devastation being experienced by so many others,
not to mention the collective rape that had just been perpetrated on our
national conscience. So I resolved to sit tight and wait until a flight back to
Portland would materialize. I was somewhat surprised and dubious to get
scheduled for a flight out of Dulles on Wednesday, the day after the infamous
attack. Needless to say, that and several subsequent flights were scheduled and
then canceled.
I tried to keep myself busy: riding a
bicycle, reading, working on the computer, talking to my friends, calling home.
But I was repeatedly drawn to and consumed by the endless television coverage of
the global trauma, seeing the repetitive replays of the airplanes going into the
buildings, the eruption of debris clouds as the buildings collapsed, the
Hollywood action film imitation that life had suddenly become. How will the
networks ever outdo this newest form of "reality" television?
I was growing more anxious about getting home
to my wife and friends, but there was little I could do. I had already ruled out
driving across the country in a rental car; it would take longer than I believed
would be necessary to wait and rentals were not likely to be available. When I
got a call from my sister in New York suggesting that I might come stay with her
and provide some help in the crisis response, an idea I had already entertained,
I took the next train to New York. I felt that it was much better to be useful
doing emergency mental health work than sitting around worrying about what was
going to happen next.
I arrived at her apartment in the early
evening on Thursday, unloaded my things and got some dinner quickly before going
to the Red Cross offices to offer my services to them in whatever way they could
be used. That night I worked from midnight to 5 AM at a missing person’s
hotline. I took calls, along with a dozen other mental health professionals,
from people who were trying to find missing loved ones or friends. The
desperation in their voices and their fearful questions was matched only by the
chaos and disorganization of the folks running the hotline. I sensed the
enormity of the crisis but felt that I wasn’t being very helpful in this
setting.
I caught a cab back to my sister’s
apartment in time to get to bed just before sunrise and got myself up in a few
hours so I could determine where else to work. I had received a number of
e-mails from colleagues about several psychiatric responses that were being put
together. I struggled to get through to the office of the main one, the phone
lines being tied up incessantly, but was lucky enough to reach the director of
the Disaster Psychiatry Outreach program. She directed me to go to the Armory
building to join their efforts there, presumably to assist in grief counseling
for family members and support for the rescue workers who were likely to become
overwhelmed with the grisly task of dealing with victims and survivors, death
and destruction.
Over the next two days, I spent almost 14
hours meeting with over 65 individuals and families who were searching for their
missing friends and loved ones. We were provided lists of people who had been
seen in any of the area hospitals so that the hopeful and desperately worried
could check to see if, by chance, their missing person had made it out before
the buildings collapsed. Sadly, virtually none of the names were on the lists.
In trying to make contact with these friends and family members, I would ask
about where in the buildings the person they were seeking worked and if they had
heard from them during or after the attack. Not surprisingly, most of them were
on floors above the 80th, virtually unlikely to have
survived, but this was not something I could confront them with. Most of them
had gotten some call: a reassuring message that they were okay because they were
in the second tower before it had been hit, a fearful concern that the building
security urged them to stay on their floor until they could be safely evacuated,
a tearful and loving goodbye, a muffled and incoherent message, then silence
What was a desperate search for a loved one,
now four and five days into the tragedy, actually became an opportunity for us
to open the door to the grieving process and to prepare these frightened,
tearful and innocent people for the traumatic stress disorders that they were
likely to experience over the coming weeks and months. I was unable to contain
my usual psychiatric composure as I heard the stories of how these people just
wanted a sign that their loved one was safe or at least alive and injured, some
coming to the grim conclusion that this was exceedingly unlikely.
I took their names down as I searched the
lists. The names spanned the range of nationalities that makes up this diverse
and complex society. I remember the young Asian-American woman who lost her
husband and cried softly as I stroked her arm, the older Italian-American woman
who lamented the loss of her daughter and worried how her husband would handle
this loss so soon after their 14 year old son had died of a brain tumor, the
young financial analyst who managed to escape from his building across the
street from the WTC but who lost his wife. As this last man walked away after I
feebly attempted to comfort him, he turned and came back to the table where I
sat. "Oh, by the way, did I tell you she was 5 months pregnant?" I
also was struck by many folks who were showing signs of strength through the
grief: resignation mixed with compassion for the losses of so many others beyond
themselves, gratitude for the help they had received, and some flickering
commitment to rebuilding their shattered lives.
I left New York on Sunday afternoon, still
reeling from the sad and resolute faces that I had seen and the poignant,
gut-wrenching stories I had heard. The images of the faces streamed across my
mind each time I closed my eyes, bringing me to tears. I looked out the window
of the plane to escape such images only to see the distant smoke from lower
Manhattan, its newest and most dramatic skyline feature.
When I worked in the Senate in 1999, one of
the bills I helped to craft included a provision for funding research, training,
and specialized treatment services for psychological trauma, with specific
reference to witnesses and survivors of community and domestic violence. The
bill was thought to have no chance of passage until the Columbine tragedy
catapulted the issue of youth violence to the head of the Congressional agenda.
It eventually passed and funds were appropriated for such services.
Without question, this tragedy causes all of
us some measure of traumatic stress. The people I met with were among the most
directly affected. As we learned from the Oklahoma City bombing, the rescue
workers are at great risk for depression and suicidal feelings from the
overwhelming horror of the experience. People who managed to escape will live
with their own mixture of relief, shock, and possible survivor guilt, not to
mention the grief over losing so many close friends. But we are also seeing the
negative psychological effects of xenophobia, the fear of others and the
generalization of the aggressor, that leads to hostility and violence towards
anyone who looks like the imagined enemy, in this case Muslims or Arabs.
This weekend, I got a firsthand taste of what
is becoming a new and growing field of psychiatry: disaster mental health
services. Sadly, we will need this kind of support for years and years. Let us
hope the lessons we learn and our responses to this event don’t lead to more
senseless trauma.
Associate Professor of Psychiatry and Associate Director of the Public
Psychiatry Training Program at OHSU
Representative at Large, AACP
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