U.S. Mental Health Suffers a Major Blow

In her mind, Arlene Charles can’t stop hearing the walkie-talkie messages from a colleague, telling her to hurry out of the World Trade Center. She made it--carrying a severely burned co-worker down 78 flights of stairs--but the colleague on the radio is missing, and Charles feels guilty for having escaped.

Three thousand miles away, in Los Angeles, Joan Smith keeps finding herself in tears, even though she didn’t know anyone in the towers, in the Pentagon or on the planes. “I keep wondering what those people were thinking,” she said. “I keep wondering whether I would have jumped.”

Never before has America seen a disaster so big, or been so widely affected by its trauma. Because of television, the terror’s breadth and the sheer number of victims, this attack strikes right at the national psyche.

Counselors from coast to coast are mobilizing to shore up the nation’s mental health. But there is no systematic way to track and treat all those who might need help, experts say, leading some to fear a quiet national crisis of body and soul.

“All of us in the whole country are survivors,” said Robert Jay Lifton, a psychiatrist and expert on survivors of terrorism. “But because Americans, more than any other group in the world, tend to consider themselves invulnerable, we are having difficulty dealing with it. We have no psychological place to put this, and that absence contributes to our deep confusion and our pain.”

Disaster studies have shown that those closest to the epicenter experience the strongest and longest-term reactions. The effects diminish with distance, like ripples in a pond.

But some experts say this disaster is different because it affects every American in some way. Though the epicenters were New York, Pennsylvania and Virginia, the victims in the buildings and the airplanes were from all over the world.

And the weapons used were all the more terrifying in their familiarity: jumbo jets, not missiles or bombs. Box cutters, not machine guns or dynamite. The perpetrators were a small number of terrorists who had lived and studied among us, not uniformed soldiers in a formal war, and that pushes the terror into another dimension.

“It’s not the same kind of diminishing ripple,” said John Schorr, director of the Institute for Social Research at Stetson University in Deland, Fla. “The ripple in New York is very high. But the rest of the nation is also deeply affected by this. . . . Out here in the hinterland, you really have the feeling that there’s a tremendous sense of deep grieving for this. Also fear and trepidation about what’s next.”

Not only are Americans and others dealing with their immediate shock and grief, but they are also grappling with multidimensional fears.

“The scale and scope of this is unprecedented,” said Charles Figley, a trauma expert and founder of the Green Cross. “We don’t really know how to deal with it. We are going to do things that we know have worked and multiply it.”

After the Oklahoma City bombing in 1995, which claimed 168 lives, counseling teams targeted 9,369 rescue workers, survivors and the victims’ family members for immediate debriefing and 10 regular sessions. They followed up on the bombing’s anniversaries and during the trials.

But how to handle even just those directly affected by the 6,000-plus deaths?

“There are not enough traumatologists to help everybody,” Figley said. “Just like with physical wounds, we are going to have to do triage in terms of the people who need it the most.”

Outside of New York, counselors are telling people they are entitled to feel anxious and depressed. At Los Angeles International Airport, therapists met with United Airlines flight attendants who were preparing to get back on airplanes.

“They tend to minimize what they’re going through, comparing it with what they think their colleagues back East are feeling,” said John Sheehe, a psychiatric social worker with the Los Angeles County Department of Mental Health. “Then they walk in a room and see their crew all suited up and they lose it.”

For most, these are normal reactions to an abnormal event. But barring more attacks or a war, people will slowly slip from their grief into the grip of daily routines, bound mostly by a collective memory of “Where were you when?”

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Times staff writers Lee Romney, Tom Gorman, Elizabeth Mehren and Kim Murphy contributed to this report.