New York State of Minds Now Emotionally Fragile

Ronnie Hirsh has absorbed so much anguish of so many New Yorkers, and yet he knows there is more to come--more pain, more nightmares, more fear, more flashbacks.

A psychotherapist, Hirsh has counseled 50 groups of people who saw or experienced the Sept. 11 attacks. He has met with LaGuardia air traffic controllers who watched the hijacked planes blinking on their screens, with Starbucks employees who comforted victims escaping the inferno and with police who rushed to the scene, including one who made eye contact with a man as he tumbled to his death from a World Trade Center tower.

“The people who are not talking about it--those who have it building inside of them, well, expect an explosion sometime this spring, probably in May,” says Hirsh, a tired therapist who like many of his colleagues here is grateful when someone asks how he is doing.

“Oh, I’m fine,” he says flatly. “Just bracing for the next wave.”

In fact, in the days after the attack, New Yorkers also seemed “fine.” They pulled together, grieved in public and held up and onto each other. They were numb.

But almost six weeks later--with the Afghanistan war underway and new anthrax cases reported almost every day in New York--the effect on the mental health of the city is growing more apparent.

From psychiatrists on Park Avenue to emergency room doctors in the Bronx, experts report that New Yorkers--already not the calmest 8 million Americans--are emotionally fragile. They are even edgier, prone to bouts of crying, clinically depressed, fighting off intrusive thoughts of new disasters and obsessing over every siren and rumor. Some started smoking again.

But how long these troubles will last or how deep they run is unclear. No one is sure whether New York is facing a mass mental breakdown or a temporary neurotic jag. And now enough time has elapsed for experts to begin to diagnose how grave the situation is.

“Right now people are responding normally to an abnormal situation,” says Dr. Jack Saul, director of the international trauma studies program at New York University. “It’s only a mental health crisis if it doesn’t abate and people suffer further consequences.”

Saul goes down the list: suicide, alcoholism, family violence, depression and other acute disorders that lead people to lose their jobs and abandon their normal lives. “Those are mental problems that last,” Saul said. “But they develop much later.”

Several official attempts have been made to tally the city’s psychological toll. The New York State Office of Mental Health says 1.5 million people will need help; the Coalition of Voluntary Mental Health Agencies Inc. estimates 2.3 million.

But this is trying to measure the unmeasurable, say other experts who wonder what it takes to consider someone to be in distress: Do only the 15,000 children who lost parents or the thousands who lost children count? Do the 25,000 people who fled the buildings qualify? And what about the Westchester matron who saw the whole thing on TV and now refuses to leave her house?

The state came up with 1.5 million by using a complicated formula based on studies of past disasters and advice from those who managed the fallout from the Oklahoma City bombing, the Northridge earthquake and other traumatic events.

“They advised us that it’s not just the people who lost family who suffer but that we need to go door to door to find people who need help who might not find us,” says Chip Felton of the New York Office of Mental Health. “We need resources to do that.”

So far the Federal Emergency Management Agency has sent $22.7 million here for mental health work in the first 60 days after the disaster, and more is expected. Private agencies also are providing services. But no one has a handle on how high the costs will rise. The FEMA money is paying for hotlines, media campaigns, classroom counselors, family centers and outreach for those who wouldn’t normally call psychiatrists.

For now, therapists report that they are getting dozens of new calls for their services, and in turn phoning in numerous new prescriptions for anxiety medications and increasing the dosage for those already taking them. And that familiar lyric about “the city that never sleeps” has never been truer: Pharmacists report selling out of over-the-counter sleeping pills.

In recent days, after tests confirmed several anthrax cases in New York, a Park Avenue psychiatrist said he had more than a dozen patients on anti-anxiety pills begging him for another “anti,” antibiotics for anthrax, even if they were nowhere near where the bacteria was found.

“Frayed nerves are just that much worse,” says the psychiatrist, who asked not to be named to protect his haute clientele.

Emergency rooms and mental health hotlines are getting twice their usual volume from people complaining of all varieties of psychic pain. And the experts insist that, despite all the barbs about neurotic New Yorkers, this is not Woody Allen hand-wringing but genuine pain and suffering.

“This is real to them,” says Lydia Liness, a Brooklyn clinical psychologist. “Every time people hear a siren wail, they jump or start weeping. They weep reading the morning papers; their partners tell them they weep in their sleep.”

One of her patients was badly bruised when she got so distracted obsessing about where the terrorists might strike next that she wandered into traffic on packed West Broadway and got hit by a car last week. “This is a rather stable woman who was nowhere near the World Trade Center that day, but she has been seriously destabilized by what is going on around her,” Liness says of her patient.

Trauma experts estimate that 10% to 30% of those most endangered in the attack or who lost family will suffer post-traumatic stress disorder. That condition is usually associated with combat veterans or sexual assault victims. It is characterized by flashbacks and longer-lasting problems in eating, sleeping and focusing.

Therapists like Hirsh worry most about those who do not shake the symptoms in three months to a year, which is why he targets May, the month in which most suicides occur. “Put an asterisk next to the names of those people,” he says, “especially if they think they can handle this one themselves.”

Hirsh recently urged more counseling for a suicidal law firm secretary who was chased from the trade center area by a wall of black smoke. “She had huge preexisting problems, and this event was a trigger,” Hirsh says, explaining that her father had died within the year, she was estranged from her mother and her dog was lost.

Trauma also hits hard at those with problematic childhoods, whether prompted by parental divorce, physical or sexual abuse or major illness.

Esther Perel, a psychologist who studied trauma, has seen patients whose vulnerabilities haunt them even more now. She mentions a woman patient who wasn’t close to the events, though her husband--who is now fine--was.

“She spent her growing-up years moving from country to country, and had no home in the sense of safety,” said Perel. “She desperately is seeking a home, safety in a way she wasn’t before.” .

In the long run, of course, the poor and already troubled may be the worst off.

Mary Ann Carlino, a family and marriage therapist, says she is advising the 30 residents she supervises at the Bronx Veterans Hospital to check on the emotional health of patients in the emergency room and free clinic.

“We have a population that is not aware of what to expect after trauma,” she says. “So they come in thinking they’re having a heart attack when it’s really a panic attack. They’re stressed to the max already. Now add this layer of grief and fear and they’re over the top.”

Carlino sees a mental health crisis for the poor near her South Bronx hospital. “Our population does not have the luxury to ignore this,” she says, adding her concern that many also do not have the insurance to pay for it.

Then she describes the wounded in her emergency room recently:

* A middle-aged woman, who worked in offices three floors beneath the south tower, came into the hospital rolling a suitcase behind her and complaining of headaches. Carlino has counseled her three times since. She is back at work in midtown Manhattan but won’t go anywhere without her essential belongings.

* A medical student made an excuse to stop by Carlino’s office. Her boyfriend escaped the north tower’s 97th floor and now won’t leave their apartment. “He’s lost his friends and colleagues, and now I’ve lost him,” the student told Carlino.

* Another woman showed up with a routine medical problem and was sent home. When Carlino learned the patient had lost a brother, the therapist made sure she was brought back and treated for depression.

“We are going to lose these people who need us the most if primary-care doctors aren’t trained to catch the mental as well as physical problems,” Carlino says.

So what’s the long-term prognosis? “That is an existential question as much as a medical one,” says Roberta Rinaldi, a Los Angeles therapist who has researched trauma. “A lot of people will need help, but the ones who will heal will do it through sheer force of will.”

Esther Perel and Jack Saul, both of whom studied terrorism in Bosnia-Herzegovina and Israel, believe that most New Yorkers will be best served seeking community.

“It is a collective trauma and requires collective healing,” says Perel. “You do community interventions, community meetings, family gatherings. You don’t just stick people in individual offices with a shrink.”

Ronnie Hirsh advises people in pain to acknowledge their feelings as a demonstration of strength. He also gives the example of the policeman who saw the falling man and who told Hirsh he felt “useless.”

“I made the suggestion that he consider he was ‘helpless,’ not ‘useless,’ and remember all the people he did help that day,” says Hirsh, adding, “The way that people say things to themselves is going to make all the difference in the world.”