After the Trauma: Of the Tens of Thousands Who Survived the Sept. 11 Attacks, a Third May Experience Post-Traumatic Stress Disorder. What It Is, and How to Cope
Francesco Fiorello was nowhere near the Twin Towers on the morning of Sept. 11. The 30-year-old high-school teacher was 40 miles away in Ossining, N.Y., talking to his wife, Rose, also 30, on her cell phone. Rose had just come out of the subway at Dey Street, in front of the World Trade Center, when United Flight 175 slammed into Tower 2. As Rose described what she was seeing--smoke pouring from both buildings, people plunging 100 stories to the sidewalk--Francesco begged her to run for her life. "I thought I was going to lose my wife," he recalls. "She was crying and telling me there was a fire and people were dying." Rose managed to escape before the buildings collapsed. She returned to work last week, shaken but physically uninjured. Francesco still feels as scared as he did that morning. "I'm staying away from any type of place where I know a lot of people are going to be," he says. "I won't enter the train station unless I see the police or the National Guard."
Who could blame him? Disasters cause psychic wounds as well as physical ones, and the consequences can be serious. By rough estimates, at least 40,000 people--survivors, witnesses, emergency workers--suffered serious psychological trauma during the attack on the Trade Center. Countless others will experience weeks of grief, shock, fear and even despair as they replay the televised images in their minds. Eventually, most of us will put the experience behind us. Most, but not all. Past experience suggests that a third or more of the people touched directly by this event will develop post-traumatic stress disorder (PTSD). For those people, every day will be Sept. 11.
It's no accident that we respond to life-threatening events the way we do. The stress response is a biological adaptation, as essential as hunger and as finely regulated as pain. When we perceive immediate danger, our bodies institute what Stanford neuroscientist Robert Sapolsky describes as a "triage economy." Adrenaline and cortisol speed the heart and dilate the bronchial tubes while slowing nonessential functions such as digestion and tissue repair. "You want to secrete these hormones by the boatload if you're at the foot of the World Trade Center and need to run like hell," Sapolsky says. Unfortunately, an overwhelming trauma can distort the stress response, causing symptoms that may persist for months or even years.
PTSD is at least as old as war, but it didn't become an official medical diagnosis until 1980. Its causes are still murky and its course is unpredictable, but the key symptoms are unmistakable. A month or more after the original trauma, people with PTSD remain hyperalert and easily startled. They suffer recurring nightmares and an inability to recall the experience with-out physically reliving it. Any passing reminder--a sound, a smell, a song--can trigger intense distress. Dr. Arthur Rousseau, a psychiatrist in Oklahoma City, recalls the case of an armored-car guard who was standing in an elevator when gunmen sprayed it with bullets, hitting him three times and killing the two people flanking him. The bullet wounds healed, but the guard developed an uncontrollable fear of elevators. He knew they weren't dangerous, yet he couldn't ride one without panicking.
These reactions are normal in the aftermath of a disaster, but when they persist, they can cause a cascade of other problems. To escape a terrifying memory, people with PTSD typically avoid activities that trigger it, and that response can turn them into prisoners. One of Rousseau's patients--a rescue worker who pulled a dead baby from the wreckage of the 1995 Oklahoma City bombing--withdrew from his family during the months afterward. He was contemplating divorce when Rousseau met him. During therapy it emerged that the sight of his young daughter triggered memories of the corpse. …