A man walks through debris from the collapse of one
of the WTC towers. (Photo ©AFP/Stan Horida) |
The events that added up to the worst terrorist strike in history-and their rapid sequence-stunned the world. They started at 8:45 that morning, when an American Airlines jet slammed into the North Tower of the World Trade Center. Most people thought it was a freak accident until 18 minutes later, when a second jetliner crashed into the South Tower, creating a huge explosion. Shortly afterward, a passenger jet crashed into the Pentagon, while a fourth hijacked plane, possibly intended to hit the White House or the Capitol, was forced down in rural Pennsylvania by passengers who overpowered their hijackers.
In less than two hours, both 110-story towers in New York had collapsed, burying thousands of office workers and rescue personnel under tons of debris. All of southern Manhattan was evacuated, federal workers were sent home, schools were shut down, and U.S. airspace was closed for the first time ever, stranding thousands of travelers both in the United States and overseas.
The impact of what was probably the most traumatic day in U.S. history was further magnified by the endlessly repeated media coverage of planes crashing into buildings, buildings collapsing into piles of smoldering ruins, fire fighters and police weeping as they fought the flames and searched for survivors, and relatives desperately searching for their loved ones, clutching heart-rending fliers with photos and personal descriptions.
"It's not surprising that people would have trouble dealing with these events as real," says Dr. Andrew Baum, professor of psychiatry at the University of Pittsburgh. "We have seen events like these in movies or in other countries, mostly in unreal contexts. This is such a horrific event that people need to distance themselves from it to process it."
U.S. medical personnel and volunteers
set up a triage station outside the
Pentagon as smoke billows from the
site of the hijacked airplane's crash
on Sept. 11. (Photo ©AFP/Luke Franza) |
Dr. Baum, who studies long-term consequences of trauma on the mental health of disaster victims and rescue workers, says that events like those of Sept. 11 "challenge many of the assumptions that we make as part of our basic daily lives, and until those assumptions can be repaired, people find themselves having some difficulty."
Terrorist attacks-like armed conflict and other catastrophes-invariably strain people's abilities to cope, understand, and respond, says Dr. José Miguel Caldas de Almeida, coordinator of the Pan American Health Organization's Program on Mental Health. Most people exposed to events such as the Sept. 11 attacks-even as remote observers-will be affected, he says, with varying degrees of impact on their health and psychosocial functioning.
Many people find themselves haunted by the scenes they viewed in television news coverage. This mental replay of events is explained by what experts call "attention bias," or the tendency of threatening images to rivet human attention even after danger has passed.
"The reason people can't easily shift their attention back to their normal routines is that threatening images hold our attention much longer than nonthreatening ones," says Professor Elaine Fox of the University of Essex in England, author of a study of attention bias published in the December issue of the Journal of Experimental Psychology.
This may be a function of the way the brain handles such images, according to Dr. Nancy Smyth, a trauma expert and professor at the University of Buffalo in New York. "There's a mounting body of evidence that our brains don't process traumatic images into long-term memories in the same way that ordinary events are processed," she says. "Different parts of the brain seem to be involved in processing and storing threatening sensory data and more conventional experiences. In fact, it may be that some traumatic images are never completely processed in the usual fashion." People who found themselves glued to the television, viewing the images over and over again, may experience even greater difficulty assimilating them, she says, "as will people who perceive a personal connection between their lives and the traumatic event they have seen images of."
The weekend following the terrorist attacks, nine of 10 American adults showed clinical signs of stress, according to a Rand Corporation study published in the Nov. 15 issue of the New England Journal of Medicine. Forty-four percent of those surveyed reported at least one symptom of substantial stress, such as being extremely upset when something reminded them of the tragedy, having trouble sleeping, or having unwarranted outbursts of anger.
"People reacted as if they were personally attacked," says Dr. Mark Schuster, who headed the study. "The stress was felt across all groups, all ages and all regions. Naturally, the stress was more intense the closer one was to the scenes of the World Trade Center and Pentagon, but even people who lived in places where there aren't tall buildings were experiencing substantial stress levels."
Speaking at a mental health summit in New York two months after the attack, Secretary Thompson said, "The anguish that accompanied Sept. 11th is going to stay with some people for a long time." He added that emergency workers responding to crises can show signs of psychological distress up to three years after a tragic event.
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