Abstract
The effects of the terrorist events which occurred over a decade ago are still evident today, with many of the first responders bearing both visible and invisible scars, serving as a reminder of that fateful day. While many of the responders and mental health workers involved in the aftermath had engaged in training prior to 9/11, nothing could prepare them for the impact the attacks would have in downtown New York. The following paper analyzes the psychological impact of the 9/11 disaster, how the local jurisdiction responded to the mental health needs of the community, and the impact the interventions had on the individuals who responded. Additional suggestions are provided, which build off of some of the research that emerged following the events that happened that fateful day in September.
Terrorist events, by nature aim to make some sort of change in the lives of others, and the hijacking of the three planes on that fateful September day did indeed succeed in changing not only individual lives, but also has a lasting effect on society as a whole. According to terrorism research, there are six components common to all terrorism: the act is intentional, rational, uses violence to cause fear in a particular target audience for the purpose of bringing a change to the behavior of individuals that are within the audience (cjc.deleware.gov). When examining the events of 9/11, it appears that the terrorists followed the guidelines closely. An additional aspect that is usually common among terrorist activities was also present during the attacks, namely the terrorists will often target locations that have either symbolic or economic value in order to increase the likelihood of gaining public attention for their cause. While not a direct goal or component of terrorism, psychological trauma following a terrorist attack such as the events on 9/11 are often a side effect of the actions themselves, and as such, attention should be paid to the mental health needs of the survivors just as safety and security measures are addressed.
The Psychological Impact of Terrorism
After the physical injuries have mended and healed, the psychological scars can often persist and interfere with the lives of the survivors for years after the event. According to the American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a traumatic event is described as a “life-threatening situation that evokes feelings of intense fear, horror, or hopelessness (APA 463). Research into the effects of 9/11 found that nearly half of the United States population experienced substantial distress in the week following the terrorist attacks, with rates for post-traumatic stress disorder (PTSD) symptoms being present two months later (Perlman et al. 925). Of interest in these findings surrounding the aftermath of 9/11 is that the psychological impact of the trauma extended further than only those individuals who directly experienced the event, such as those who lost loved ones on the planes that were hijacked or the individuals who survived the impact in the World Trade Center buildings.
The Spread of Psychological Trauma
Research into the impact traumatic events have on the population indicates that individuals can experience vicarious symptoms of post-traumatic stress disorder (PTSD) through watching the events on the news or other media outlets. As technology improves, so does the reach it has, the ability for it to permeate society through outlets such as cell phones and social media has allowed the impact to spread further than in previous generations, thus increasing the number of individuals who could potentially be exposed to repeated images of traumatic events.
While traumatic events have occurred in the past, new research methods have allowed for an increased amount of data collection systems to be developed, which contribute valuable resources and references to assist studies which aim to collect information both before and after the events of 9/11. By comparing the pre- and post-9/11 data, researchers can assess the effects, both locally and nationwide. Among individuals who were first responders to the attacks on the Pentagon, studies revealed that the mental health effects increased in duration and severity the longer the responders remained on the scene (Robbers and Jenkins 236). Additionally, research suggests that the rate and likelihood of an individual developing stress-related disorders increase as the level of stress increases (McKoy 4).
While PTSD is one of the common diagnoses associated with experiencing a traumatic event, the presence is often accompanied by other psychological issues, such as depression, panic disorders, and anxiety. Studies have indicated that if there was a diagnosis of PTSD in first responders and those who witnessed the terrorist attacks through repeated media exposure, individuals who had a diagnosis of PTSD were up to 86 percent more likely to experience an emotional disturbance such as a panic disorder or depression when compared to individuals who did not have a comorbid diagnosis of PTSD (Perlman et al. 926). While first responders often receive training prior to experiencing a traumatic event, the controlled environment associated with the planned exercises cannot effectively portray the overwhelming and often dangerous and chaotic atmosphere that is associated with the actual event, no matter how much research has gone into the development of the lesson plans and execution of the information.
Mental Health Services in the Aftermath
While the physical health problems have been well-documented, such as asthma and a possible link between certain types of cancer and working rescue, recovery, and cleanup positions at Ground Zero, the psychological effects and associated coping strategies often do not receive as much media attention, as the external injuries are easier to observe than the invisible internal scarring. Critics of how the New York fire department handled the mental health needs of the first responders suggest that the actions were inadequate to treat individuals with PTSD or other emotional issues. In order to provide some assistance in the immediate aftermath, in some cases graduate student interns from local mental health facilities were tasked with counseling firefighters and other first responders, and due to the nature of internships, the graduate students cycled out every six months. Such a high turnover rate during a time of great distress can often cause more harm than good, as new therapeutic relationships were required to be formed each time a new cycle of graduate students assumed the role of trauma therapist (“Inadequate Treatment”). In addition to the counseling student interns, local psychologists and other mental health care workers swarmed local hospitals and Red Cross shelters in New York, yet due to the time it took to screen the applicants the volunteers often were sidelined while being vetted for quality control (Levin 25). When counseling services were provided by the FDNY Counseling Services Unit (CSU), the sessions were not promised to be confidential and were often held at the firehouse, where the peers of those seeking treatment would be aware that one of their fellow firefighters were seeking assistance.
Ironically, shortly before the terrorist attacks on 9/11, psychiatrists and other mental health professionals, along with New York City’s Department of Health took part in a series of desktop drills where they practiced response plans for various emergencies (Levin 14). However, no amount of exercises could prepare the participants for the impact the terrorist attacks would have on not only the nation, but the extent the breakdown in the mental health services provided for the first responders, which would only be realized a decade after the events.
The lack of effective counseling services led some of the first responders to self-medicate, leading to trauma-related substance abuse. Instead of the influx of substance abuse violations leading to a revamping of the counseling services being offered, instead it was met with the FDNY commissioner implementing a Zero Tolerance policy, thus leading to a number of first responders failing random drug tests and being fired, being left without health insurance or a way to obtain treatment for their trauma-related psychological disorders which contributed to their substance abuse. While those who used illegal substances as coping mechanisms were fired and left without a way to pay for their physical ailments sustained during the events of 9/11, a study by Cornell University discovered that FDNY individuals were at least twice as likely to develop drinking problems when compared to the national average, with one quarter at risk of developing moderate to severe drinking problems (“Inadequate Treatment”). The high rate of substance abuse among the FDNY personnel, despite of the substance utilized, suggests that the counseling services offered by the city of New York appear to be less than sufficient.
However, in 2010, the United States Congress passed the 9/11 Health and Compensation Act of 2010, which aimed to provide health care services and coverage for twenty-two different health conditions, including mental health conditions such as PTSD, depression, and substance abuse disorders (Mitka). The Act is a move in the right direction, as the long-term health effects in individuals exposed to not only the dust and smoke that were present in the aftermath of the World Trade Center location, but the psychological impact of losing 343 fellow firefighters, combined with insufficient counseling and coping techniques is still presenting more than a decade after the terrorist attacks (Mauer 852).
Intervention Impact
The delay in the rendering of services among first responders and those who experienced vicarious traumatization through viewing the seemingly constant stream of media coverage of the terrorist events of 9/11 may have contributed to the incidence of delayed-onset post-traumatic stress disorder and other psychological reactions to distress as witnessed in the FDNY and the wider population. However, while the services may not have been sufficient in the direct aftermath, the action (or lack thereof) among the mental health professionals has resulted in an increased body of research into effective crisis counseling in the wake of a large and traumatic event.
Prior to the events of 9/11, few people within the mental health field could imagine the impact a large terrorist event in which nearly 3,000 individuals died, would have on not only the first responders, but society as a whole. By examining how the events unfolded, counselors now have a better idea of how important and critical it is to supply specialized mental health services to individuals in crisis within a short timeframe of the event occurring. One of the challenges identified by a Marine veteran who survived the attack on the Pentagon was the chaos caused by a lack of training among the first responders to such a unique event (Shallcross). The lack of access to skilled mental health professionals also contributed to the chaos, as counseling sessions in the aftermath of the events were often held in locations such as storage closets and out of service restrooms (Shallcross). While the makeshift counseling offices served a purpose and were able to assist a small percentage of individuals requiring the services, the conditions were less than ideal.
Moving Forward
One of the lasting legacies of 9/11 is the realization of just how important mental health services are, not only to those directly impacted by the events, such as through the loss of a loved one, but also for those who are often thought as being resilient and thus immune to the negative aspects of traumatic experiences. After the shock and fear pass, there is often a series of psychological challenges that remain, and left untreated, can snowball into larger and more potentially damaging and long lasting effects. Through integrating effective counseling services, complete with individuals specially trained to work with crisis situations and training geared toward working with not only first responders, but children and adolescents as well, those impacted by such events can obtain the much needed assistance.
The terrorist attacks also allowed counselors to develop a more “trauma-aware” view, leading to further developments in not only the immediate response needs, but also the differences between combat-related and civilian PTSD. By working with the findings identified in the wake of the events of 9/11, the mental health field is better prepared with both the proactive and reactive responses, including the importance of vicarious exposure and helping individuals to develop positive and healthy coping mechanisms in response to a traumatic event. Through furthering research into the area of crisis and trauma counseling, the field of mental health care is more able to identify the early effects of trauma and intervening in an effective and efficient manner. By knocking down the stigma that surrounds the social view of obtaining counseling and psychological services, first responders and society as a whole can benefit. As long as the lessons of the past are not lost on the future, the role of mental health counseling can continue to flourish and be better prepared for whatever events occur.
Works Cited
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