Academic journal article Journal of Mental Health Counseling

September 11th Survivors and the Refugee Model. (Professional Exchange)

Academic journal article Journal of Mental Health Counseling

September 11th Survivors and the Refugee Model. (Professional Exchange)

Article excerpt

This article compares the experience of people working in the area of the World Trade Centers (WTC) on September 11th to the experience of refugees. The refugee model provides a better description of survivors' experience than a diagnostic model. The author's service provision for an organization adjacent to the WTC after September 11th serves as a basis for suggesting this' alternative perspective. Positive and negative aspects of diagnosing victims of disasters are discussed both in general and specifically related to post-traumatic stress disorder. Information regarding the refugee experience is presented and related to the experience of WTC survivors. Implications for framing the treatment process in similar disasters are suggested.


Following the September 11th terrorist attacks, the diagnosis of Post Traumatic Stress Disorder (PTSD) from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev.; American Psychiatric Association, 2000) was used to describe the reactions of people working and living in the vicinity of the World Trade Centers (WTC). Mental health professionals, the media (Fackelmann, 2002; Vedantam, 2002), government officials, and politicians used the label of PTSD as these groups discussed the effects of the terrorist attacks. Professional organizations such as the American Mental Health Counselors Association (AMHCA), the American Counseling Association (ACA), and the American Psychological Association (APA) posted information about PTSD on web sites. These professional organizations provided links to websites containing basic information as well as such specific topics as how to talk to children about the disaster.

As part of a group of professionals providing services in New York City in the weeks and months following September 11th, the first author provided crisis intervention services to the employees of an organization located across the street from the WTC. Initially, the services that were provided involved direct intervention with employees. After a few weeks, the first author extended his services to include consultation with management in order to assist managers in responding to employees' ongoing needs. In total, the first author provided services for approximately 18 months, until shortly after the organization returned to lower Manhattan.

In the first month, everyone, in the author's experience, met the criteria for Adjustment Disorder with Anxiety or Acute Stress Disorder, the precursor for PTSD (DSM-IV-TR, 2000). After that month, almost everyone the first author worked with was still experiencing symptoms consistent with PTSD. In addition, the first author observed many of the employees' family members meeting diagnostic criteria for PTSD and other anxiety disorders. Gorner and Swanson (2002) supported these observations in an article discussing PTSD in New York City after the terrorist attacks.

However diagnosis, specifically PTSD, was only one way to depict responses and help people cope with reactions to this particular event. Based on the first author's experience, diagnostic labels did not appear to provide a holistic understanding of survivors' reactions. Van der Kolk (1996) validated this concept by stating that a diagnosis of PTSD does not begin to describe the complexity of people's reactions in overwhelming experiences. Because of observations of stress reactions to this unique historical event, the first author began thinking about alternative views to describe the experience of the survivors. The resulting comparison with refugees reported here is an alternative explanation that better describes the lived experience of the survivors from the immediate area of the WTC.


In order to examine an alternative to using diagnosis for understanding survivors' reactions, it is necessary to describe the advantages and disadvantages of the standard diagnostic nomenclature. …

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