Magazine article Clinical Psychiatry News

Fink! Still at Large: The Anxiety of Terrorism. (Opinion)

Magazine article Clinical Psychiatry News

Fink! Still at Large: The Anxiety of Terrorism. (Opinion)

Article excerpt

Some older patients remember the skittish days of "duck and cover." But the anxieties created by Sept. 11 and the war with Iraq are leading some of our younger patients to panic. Is there a difference in your treatment strategy based on the age of your patients?

Start With Daily Routine

Since Sept. 11,2001, America has been under sustained stress--the anthrax scare, the sniper episode, the Columbia shuttle accident, and the Iraq war. I'm not sure if there has been a similar period in the United States when so many converging events continued to put people under stress.

As a result of this, there are several categories of populations. One group rarely, if ever, suffers from clinical anxiety. The other group is at risk of exacerbating clinical anxiety they had prior to these events. These people either had clinical anxiety in remission that was rekindled by these events or they currently had clinical anxiety that was made worse by these events. For this particular group, it is ideal for psychiatrists and primary care physicians to work together to differentiate bona fide physical events from psychiatric events.

There is no single strategy to treat these patients. I think of it as a synergy of various interventions that start from a basic daily routine. Maintaining a daily routine is extremely important. A secondary intervention, such as a combination of psychotherapy and psychopharmacology, may be required to complement daily routines. For children, it is important that they have opportunities not just to be told about these events but to express their concerns, fears, and anxieties. They should be able to engage in Purposeful, constructive activities that reassure their safety and allow them to express things they would like to do or things we can do for them that can make them feel safer. This should apply across the entire life cycle.

Finally, TV viewing should be limited in these times of stress, particularly the repetition of tragic, dramatic, and violent acts. It's better to read about these events than to watch them on television.

Eliot Sorel, M.D.


Manage Preparation Behaviors

Terrorism has been present throughout the world for centuries and is, in fact, endemic in some communities in the United States. When drug dealers threaten a neighborhood to prevent reporting, terrorism is present. What is new is that terrorism is now threatening our nation as a whole, and it is from foreign rather than domestic groups. Terrorism can cause distress symptoms in those who are healthy, and it can also cause changes in behavior that affect health and mental health.

For patients already in treatment and not directly exposed, it is important to listen for their particular experience of terrorism. For some, it will be increased fear. It may be a reminder of a past event or overprotectiveness of their children. For many, it will be a feeling of a pause or distraction from what they want to be doing. For others, it may be avoidance.

An important clinical issue is how to respond to questions about real needs to prepare. Not questions about duct tape, but those about communication plans or meeting spots for family members. Do you treat these as a symptom? I think not. They are realistic and warrant realistic responses. If undue concern persists, it can be addressed as, "You seem particularly concerned today even though you have done all that can be done at this point. Any ideas why?" Similarly, what of the patient who has not mentioned the topic? One might say, "I notice that you have never mentioned all the present concerns about terrorism and preparation. I have wondered about that."

This area of treatment management of preparation behaviors is an important and overlooked aspect of ongoing treatments. This is an area in which psychiatrists can be leaders, since those in community organizations may face similar avoidance, overconcern, or preoccupation. …

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