In the event of another attack …
That phrase, rarely said before Sept. 11, 2001, is rarely far from people’s thoughts today. For most Americans, it conjures up a host of disturbing images, from falling skyscrapers and exploding airplanes to bombed-out trains or collapsing bridges.
For mental-health experts, it also calls to mind the many people who would become secondary casualties, falling victim to fear, confusion and traumatic stress even in places far removed from the next ground zero.
“One of the outcomes that was striking about the 9/11 attacks was the nationwide impact,” says University of Denver psychologist Daniel McIntosh, co-author of a widely cited study of people’s psychological responses in the first few weeks and months after the terrorist attacks.
“There’s an assumption that in a disaster, the response is most intense among those most directly affected. But there can be a significant response even at a great distance from the event, especially one like 9/11, which had implications for our perceptions of safety and the degree to which our country can protect us.”
Researchers also found in the aftermath of the attacks that many Americans who could have benefited from psychological counseling didn’t seek it – usually because they thought others deserved it more, or they feared being labeled as mentally ill, or they weren’t properly diagnosed.
“Along with everything else, 9/11 exposed the flaws of the mental-health system,” says Leif Wellington Haase, a senior fellow with the Century Foundation, a New York think tank that published a report on “Terrorism, Mental Health and September 11” last year.
“One of the take-home messages is that primary-care physicians don’t usually screen for mental-health symptoms and don’t know how to do referrals, and mental-health specialists don’t normally deal with people who haven’t been in the system before. So you don’t get the coordination you’d expect.”
There’s another possible explanation, however, for why many shell-shocked victims of 9/11 didn’t get professional help: They didn’t see it as relevant.
“People have different ways of dealing with negative events,” says DU’s McIntosh. “Most use the personal and social resources that are available to them in their daily lives” – their families, their friends, their faith communities. This isn’t to say, though, that such informal support systems are as effective as professional therapy, he adds.
“One of the most common problems is that people often want to stop hearing you talk about an event before you’re ready,” he says. “This can leave you frustrated and feeling like your concern with it is unusual, even when it’s not.”
One further lesson driven home by 9/11 is that some segments of the population are more vulnerable to the psychological effects of terrorism than others.
The Century Foundation report noted that post-traumatic stress syndrome tended to be more persistent among people who had low incomes or were unemployed after Sept. 11; those who were divorced, separated or widowed; and those who had experienced earlier traumatic events.
In addition, the researchers said that in the short term, for reasons unknown, “Hispanics were more likely to receive a diagnosis of PTSD than were individuals of other races or ethnicities.”
This finding puzzles Ernesto Chavez, chairman of the psychology department at Colorado State University. He says other studies have suggested that Latinos, as well as African-Americans, are less vulnerable, presumably because they are likely to have strong family and social support networks.
But it does seem clear, Chavez says, that poverty leaves people more at risk.
“Poverty limits your ability to bounce back from the chaos,” he says. “If you’re poor and you have no insurance and your primary breadwinner is killed, it’s a greater loss than just the death of a loved one because your whole life is devastated. You may lose your home.”
To the poor, a disaster may be as ruinous as a rock thrown into a pond rather than a lake: “Same size rock, but bigger ripples,” Chavez says.
Staff writer Jack Cox can be reached at 303-954-1785 or jcox@denverpost.com.
