Psychiatr News September 1, 2006
Volume 41, Number 17, page 1
© 2006 American Psychiatric Association
Psychiatrists Glean Unexpected Lessons From 9/11 Disaster
Mark Moran
Emerging from the recollections of psychiatrists is not the memory of
shock, fear, and immobilization, but resilience. Trauma did not trump people's
willingness and ability to do the right thing.
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Patrick Anderson of Michigan points at a picture of the World Trade
Center to indicate his location when the towers collapsed on September 11,
2001. He returned to the site in 2004 to honor three firefighters who had
saved his life. AP Photo/Ed Bailey
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Clarice Kestenbaum, M.D.: "People are very resilient, and children
are much more resilient than is typically thought."
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Spencer Eth, M.D.: "The natural process [in reaction to trauma]
appears to be symptom formation followed by healing."
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Joseph T. English, M.D.: The 9/11 performance of St. Vincent's staff
"is the finest demonstration I have ever seen of selfless, professional
commitment."
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Chihuahua El Duque was one of the tools used in therapy sessions at the
St. Vincent's World Trade Center Healing Services for the loved ones of 9/11
victims. AP Photo/Mary Altaffer)
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Five years ago on the morning of Tuesday, September 11, child psychiatrist
Clarice Kestenbaum, M.D., was at her home on the upper west side of Manhattan
when she heard the news of the attacks on the World Trade Center.
Later that day, and for many hours, kestenbaum was at the studio of a local
network affiliate counseling millions of New Yorkers—and the newscasters
and staff at the broadcast station—on how to deal with the shock of an
event no one could have imagined or prepared for.
"I was on the air for hours, and what was memorable was that everyone
in the studio itself was very worried," she recalled. "The
newscasters and staff at the station themselves wanted to know how to talk to
their children about what had happened. I sat at the table and talked to them
and to the people who called in, and it was like doing a live on-air
consultation."
Kestenbaum is a professor of clinical psychiatry and has been the director
of training in the division of child and Adolescent psychiatry at Columbia
University College of Physicians and Surgeons for 20 years.
Like psychiatrists throughout the city and in many other parts of the
country, Kestenbaum treated and counseled people for the aftereffects of the
most deadly terrorist attacks on American soil: the New York Council of the
American Academy of Child and Adolescent Psychiatry (of which Kestenbaum had
been president) agreed to offer free or low-cost therapy to children and
parents affected by the attacks in the days after 9/11.
But what emerges from her recollections, and from those of other clinicians
who spoke to Psychiatric News, is not the memory of shock, fear, and
immobilization, but resilience. "Trauma"—heralded and in
some ways perpetuated by the media in its continual replay of the colliding
planes—evidently did not trump people's willingness and ability to do
the next right thing: volunteers showed up everywhere, work teams formed, and
every hospital in New York mobilized to meet the calamity head on.
"People are very resilient, and children are much more resilient than
is typically thought," she said. "When you are in the middle of
something like that, you just do what you have to do. People use their own
resources and carry on."
The shock waves and aftereffects of 9/11 are still being felt by
psychiatrists in the city.
"September 11 wasn't an event; it was a process that is still going
on," said Spencer Eth, M.D., medical director of behavioral health
services at St. Vincent Catholic Medical Center, located just blocks from
ground zero.
As the closest hospital to the World Trade Center, St. Vincent's became a
hub of activity following the attack. In the weeks and months afterward, the
hospital developed a number of programs, some of which are still in place, to
meet the needs of community members and rescue and recovery workers.
In october 2005 the Child and Adolescent Services Program of the World
Trade Center Healing Services at St. Vincent's received an APA Silver
Achievement Award. The program has expanded throughout lower Manhattan to
encompass 16 elementary, middle, and high schools, where therapists have
provided evaluations and treatment to students with anxiety, depression, and
stress-related conditions (Psychiatric Services, October 2005).
Today, the WTC Healing Services maintains an office overlooking ground zero
and has served nearly 50,000 people.
"St. Vincent's has a long history of helping in disasters,"
said Joseph T. English, M.D., chair of the Department of Psychiatry at the
hospital and past president of APA, but it had never faced a disaster of this
magnitude before. Because of the close proximity of the hospital to ground
zero, however, staff knew the hospital's emergency room was a logical
destination for the injured, and they quickly geared up to handle what they
expected to be an inundation of survivors. But that didn't happen. Few people
showed up there—an artifact of the devastating nature of the attack:
many-people were killed, while others escaped unharmed or with minor
injuries.
What St. Vincent's did become a magnet for was the countless people seeking
loved ones. "By 2 o'clock that afternoon, people had started putting
flyers up everywhere with a face and a name," recalls Camille Archer,
M.D., a psychiatry resident at the time. "People were everywhere crying
in the streets; the whole place seemed very different."
English recalled that former Nebraska Sen. Bob Kerry, now president of New
York's New School, called to ask how he could help, and the hospital set up a
family relief center in the school's atrium across the street from St.
Vincent's.
For two weeks after 9/11, the center served those families. "It is
not an exaggeration to say it was the finest hour for our attending staff and
house staff, who in addition to their regular duties worked around the
clock," English said. "It was the finest demonstration I have ever
seen of selfless, professional commitment."
Normative Response Is Symptom Formation
Prior to coming to St. Vincent's, Eth had worked in Los Angeles in a VA
hospital treating Vietnam veterans and been involved in treating people
following the riots in Los Angeles. "I went into this experience primed
to help organize the St. Vincent's response to 9/11," he said.
"One of the lessons I have learned is that the vast majority of
people who were in lower Manhattan on that day and had direct exposure to this
catastrophe became symptomatic," Eth told Psychiatric News.
"There have been a number of telephone surveys confirming the fact that
the normative response was symptom formation. However, most of the people who
became symptomatic had their symptoms subside. They recovered. The natural
process appears to be symptom formation followed by healing.
"There were a minority of people who went on to have persistent
symptoms, and a small minority has gone on to be chronically and severely
ill," Eth said. "For these people, PTSD can be as disabling as
schizophrenia and bipolar illness. Something we knew from working with Vietnam
vets and relearned after 9/11 was that our best treatments are not effective
for everyone. I continue to see people who are severely affected."
Eth cited the case of a firefighter who was rescuing people from the towers
and got out just before they collapsed. "He never leaves his apartment
now," he said. "Even treatment is not effective."
Speaking to Psychiatric News just a week prior to the news that
British authorities had arrested individuals believed to be plotting an attack
that might have rivaled or surpassed 9/11 in bloodshed, Eth said New
Yorkers—and Americans everywhere—will have to live with a constant
threat of terror.
"We are entering an era in which more and more people will have to be
aware of threats and danger," he said. "This is going to become a
factor in our lives. Growing up during the cold war, [I was always aware of
the] threat of world war and the use of atomic weapons. But it didn't seem as
real as suicide bombers. In New York City there are people who are quite
anxious and vigilant going over a bridge or through the Lincoln Tunnel,
knowing that at any moment something dreadful could happen.
"The statement is often made that 9/11 changed everything," he
continued. "One of the things it changed is that the general feeling of
safety and security we had all taken for granted in America has been lost. For
large numbers of people in New York, it's not an issue for which they seek
treatment, but it has become a baseline source of anxiety." 
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