"We cannot assume that everyone will have trauma reactions, Dass-Brailsford says. "We shouldn't be projecting that." Patricia Watson, of the National Center for Child Traumatic Stress at the University of California, Los Angeles, explains that labeling someone as needing help just based on their exposure also implies "that they don't have the resources to recover on their own, effectively undermining their own abilities and their chances of viewing themselves as a stronger person via having to solve their own problem."
Another reaction frequently projected on survivors of the attacks is the notion of survivor guilt. Although it is no longer recognized as a formal condition—now living, diagnostically, as a part of PTSD—it is especially common among those "who used to fight together or endure adversity together, such as firefighters, police officers or soldiers," Neria says. And for victims of 9/11, it is much more likely to play a role in overall PTSD if the affected individual survived and a close friend or colleague did not.
An uneven recovery
In general, the prevalence of PTSD tends to decline steadily in the months and years after a traumatic event, especially if people can get back to relatively normal routines. Research conducted in New York showed that the rates of PTSD among the general population eased from about 5 percent a year after the attacks to 3.8 percent two years later, according to work published in 2006 in The Journal of Nervous and Mental Disease.
Even many of the first responders and long-term cleanup workers seem to have largely recovered psychologically. But one group of workers has curiously not followed this trend: retired firefighters. In some studies, they seemed to have an increased prevalence of PTSD as time went on.
Some 22 percent of retired firefighters who responded on 9/11 were still suffering from PTSD some four and six years after the event, according to research published earlier this year in Public Health Reports.
Dass-Brailsford suggests that in addition to having to cope with the trauma of the event, having gone on disability or into early retirement "means that you're not working, you're not occupying your time, and you have more time to sit and think about what happened to you, so your reactions become stronger." Additionally, leaving behind a highly active and service-oriented job might result in a feeling that "you're not able to do anything meaningful," she says, which could add to depression and stress levels.
First responders of any type also rely on having delayed emotional reactions to best perform their stressful jobs. "They develop a capacity to contain their reactions so they can deal with it later" and get through the task at hand—whether it is rescuing people from a fire or pulling the injured from a car accident, Dass-Brailsford says.
And in the general population as well, "in the immediate aftermath of a traumatic event, a lot of people are numb," Dass-Brailsford explains. "For some people that state of shock and numbness can last a long time, sometimes for a number of years." After Katrina, for example, widespread mental health problems, such as debilitating depression and suicides, became more widespread several months after the event.
Research has also found that basic differences in socioeconomic status can make big differences in how likely someone is to have sustained PTSD. One study found that 9/11 survivors who earned less than $25,000 a year had a 49 percent chance of having PTSD, whereas those who made more than $100,000 per annum had only a 6 percent risk.
And not everyone who suffered from PTSD or other symptoms the event had any direct contact with the attacks—or even lived in the affected areas. One survey, published in 2002 in JAMA The Journal of the American Medical Association, found that in the month or two afterward, some 4.3 percent of the general population had signs of PTSD. The more graphic television coverage of the attacks a person had watched in the intervening time, the more likely they were to report the major symptoms.
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Add CommentThank you for this article. The theme of resilience and stress reactions being a normal response to abnormal events is core to traumatic experience recovery in my professional experience as the mental health clinician over the past 25 years. I do wish to comment, however, that associating stress debriefings, designed originally to help first responders deal with events outside their usual response situations, and mental health crisis response should not be paired or compared. My clinical specialty for many years has been crisis response and longer term trauma recovery with individuals and groups from military combat members to abuse and hostage survivors , internment camp survivors and victims of crimes including family violence. I also am CISD advanced level trained and experienced. These techniques and their goals are entirely different. Each has merit in the correct context. I believe to repeatedly view CISD as a mental health response is erroneous and a disparagement of a technique that is much like a psychological autopsy, piecing together for responders and rescuers the mosaic of coordinated response so that their roles fit within a larger picture and their sensory and emotional experiences have a context of normal for them. The purpose of this is to quickly enable them to be on scene again without being brought to a standstill by evocation of neurosensory memory bringing them to a halt just when they need to be lightning fast in their work. The last piece of a CISD is to provide education for self-care and recommendations for support as and if needed without an assumption all are traumatized pathologically. With mental health crisis response the usual affected group is usually far more repeated trauma naive so that the sensory impact and resources for coping are not attuned. The type of response, whether individual or group is sensitive to this psychological exposure naivete and require tremendous cultural, generational and situational attunement. THe goals and techniques are completely different.
Reply | Report Abuse | Link to thisBest regards,
Aliceann Carlton, LCPC
For a thorough debunking of the 2002 JAMA paper, point by point, see
Reply | Report Abuse | Link to thishttp://www.psychologytoday.com/blog/the-skeptical-sleuth/201109/september-11-2001-did-americans-suffer-virtual-trauma-television-co
and
http://www.psychologytoday.com/blog/the-skeptical-sleuth/201109/after-911-the-mental-health-crisis-never-came
PTSD is a terrible thing. I have a friend who just returned from Iraq and he was suffering from PTSD. We try to help him but he is half the man he was.
Reply | Report Abuse | Link to thisAlvin, you are right and I am sorry for the loss of the friend you knew before his Iraq experience. This article is really trying to redefine what is acute stress and a normal and expected reaction and what is post-traumatic stress which persists and becomes debilitating over time. I take issue with the concept that there is less PTSD than the author and cited sources are presenting because whatever it is defined to be, a person exposed to such emotional and neurosensory impact is forever changed and will never be the same. So what is happening in the United States now is an effort to "neutralize" horror and turn it into something a resilient mind can survive. That's a "well duh" sort of claim as most of us who grew up with children whose parents were in Nazi death camps learned very quickly. It's like watching a sturdy tower collapse and then rebuild itself, sometimes haphazardly and sometimes with sand rather than stone and morter. I am literally stunned by the lack of inclusion of first responders and family members in the 9/11 NYC Memorial as the trauma was shared by all at ground zero, and by the entire country where the ripple effects still wash over the consciousness of citizens, fueled of course by a warmongering leadership for some years. To say that an acute stress reaction and post-traumatic stress problems are normal reactions to abnormal events is accurate, to say many "get over it" is partly accurate, to say that life resumes as normal for most people is inaccurate unless you also posit that "normal" is the adaptation to hypervigilance, hypersensory or hyposensory acuity, flashbacks triggered by normal life events many years after the experience, and relationship changes so profound many are ruptured or badly strained for ever.
Reply | Report Abuse | Link to thisI did not think about 9/11 disaster much in past decade but after bin ladens death its having an impact on my mind.Its like iam being lifted to a new state of mind.
Reply | Report Abuse | Link to thisHi,
Reply | Report Abuse | Link to thisMany years ago I fought in Vietnam.One of the things that often bothered me was I would wake up often thinking I was back there.It went on for years.
I did have a problem with depression .My kindly therapists recommended Recovery Inc.I have been going for several years now and have setbacks only whe I didn't practice their method.
Dr. Low the founder of Recovery Inc.has a saying about memories.The brain knows very well how to forget.All you have to do is not keep reviewing the past.Don't work up the past,it's outerenviroment and we can't control it.
My mental health is most important to me.That is why I continue going to Recovery Inc. meetings and practice.
John,
Reply | Report Abuse | Link to thisThank you for your service and sacrifice. Also, you are to be commended for your continuing work to deal with your PTSD.
My father was WWII veteran who fought at Gaudal Canal. When he was in his early '80's he was still waking up from nightmares screaming "Japs, Japs, Japs."
My father was always on edge. Some said he was a rage-aholic, but in my early adult years after reading about PTSD in children of alcoholics, I realized why my father was the way he was. My family was horrible. Because of my father's condition, by mother and the 4 kids were all abused emotionally and physically, to the point that we suffered PTSD ourselves. Few seem to realize the devastation that occurs not only to our Vets, but to their family members as well.
Those interested might appreciate the work of the Climate Institute who are looking into the effects of natural disasters on mental health. You can read more about the Climate of Suffering at www.climateinstitute.org.au
Reply | Report Abuse | Link to thisThose interested might appreciate the work of the Climate Institute who are looking into the effects of natural disasters on mental health. You can read more about the Climate of Suffering at www.climateinstitute.org.au
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