Widespread anguish gives scientists rare view of coping

Most Americans showed signs of psychological distress after the terrorist attacks of Sept. 11, but since then many have bounced back by instinctively doing things mental health professionals would have recommended to speed their recovery, researchers say.

In a special report published Wednesday by the New England Journal of Medicine, specialists in psychology, pediatrics, psychiatry, sociology and statistics attempted to assess the damage to the nation’s psyche when people were collectively confronted by grief and fear.

The horrific attacks were also an unprecedented opportunity to document the widespread effect of a catastrophic event.

“For scientists like us, this was all new,” said Dr. Mark Schuster, a UCLA pediatrician and lead author of the study, produced by the Rand Corp. in Santa Monica, Calif. “Most studies have measured the effects on people who have been in close proximity to a disaster.”

Although the researchers found that stress reaction rates were highest in the New York City region, significant rates and symptoms were found across the nation, in large cities and small towns--which seems to indicate that one need not be at the scene of trauma to experience its horror.

The study involved a nationally representative sample of 560 adults contacted by telephone a few days after the attacks. Among those surveyed, 9 out of 10 reported stress reaction to some degree. Those included feeling very upset when reminded of what happened (30 percent); repeatedly having disturbing memories, thoughts or dreams (16 percent); having difficulty concentrating (14 percent); having trouble falling or staying asleep (11 percent); and feeling irritable or having angry outbursts (9 percent).

The reactions were higher among women, non-whites and people with pre-existing psychological problems. More than a third of children 5 or older expressed worry about their safety or the safety of loved ones.

Victimization fears wane

Since the Rand research was conducted, however, the scientists have noted--and other researchers have documented--a drop in the percentage of people suffering clinical signs of stress.

“Last week, we published a survey showing that the fear of victimization has been declining among the public, even during the publicity about anthrax,” said Andrew Kohut, director of the Pew Research Center for the People and the Press, which along with other polling organizations has been tracking the recovery process.

Debbie Dolan of Homer Township southwest of Chicago did not know any Sept. 11 victims. Still, she said, the attacks brought on strong feelings of sadness as she recalled the death of her husband in a boating accident 14 years earlier.

“I was really personalizing it,” said Dolan, a grade school teacher. “I would see a grieving mother in an interview, and I would think, `How could she be standing there, seeming so strong?’”

Dolan said she has recovered from the stress of Sept. 11 by relying on past coping strategies. She gave herself time to grieve, and she concentrated on helping others, such as coordinating activities at school that memorialized the victims. She began to “pull back” from the news.

“I had to stop watching and focus on what to do, how to help somebody else,” she said.

Such actions were common among people surveyed in the Rand study. The researchers found many people talking to other people about their feelings (98 percent); turning to religion for comfort (90 percent); engaging in group activities (60 percent); and donating blood or money (36 percent).

“We found that people all over the country were doing things on their own that professionals would tell them to do to cope with stress,” Schuster said.

The researchers said their data indicate clinicians, psychologists and school counselors throughout the country should anticipate that even people who are personally distant from future attacks may have trauma-related symptoms.

Some will heal on their own, but others may develop the longer-lasting symptoms of post-traumatic stress disorder.

“It remains to be seen if people can develop PTSD from having experienced the attacks from afar,” Schuster said. “That’s something we want to find out.”

The disorder’s causes are unknown, but generally the most vulnerable people seem to be those closest to the devastation.

Coping in New York

In New York, Tom Severance said time and counseling have helped heal the emotional scars from losing an employee at a trade show in the World Trade Center. Over the weeks, Severance has tried to focus on helping the man’s survivors.

“Right at this moment, I’m looking at paperwork for five trust funds that have been set up for his children,” said Severance, explaining that about $20,000 has been raised among employees of his Toronto-based firm. “We want to do something, and this seemed like the right thing to do.”

Severance said the company, Algorithmics, has made counselors available on a regular basis since Sept. 11.

“People are starting to get back to normal,” he said. “But at the same time it seems people are still nice to one another.”

Without therapy, people with post-traumatic stress disorder can end up with severe mental scarring. But most people will never reach that point.

“Everything we know about trauma exposure is that most people will recover on their own--even people on whom the trauma has made a direct impact,” said psychologist David Riggs, of the University of Pennsylvania’s Center for the Treatment and Study of Anxiety. “We perhaps can extrapolate to our own recovery from that.”