As Neria points out, as well, "the mental health toll of disasters and terrorism is not limited to post-traumatic stress disorder." They can also trigger major depressive disorder, generalized anxiety disorder, complicated grief (recognized in the mental health world as being unusually strong and long-lasting), substance abuse and a host of other symptoms that might come and go over time.
But diagnosing these conditions and getting the right help to the right people has become much more efficient in the past decade. Researchers have learned to work through schools, workplaces and other institutions to more efficiently screen larger populations of people and address their specific needs.
The hazards of an anniversary
A decade is more than enough time for most witnesses to 9/11 to have recovered from any initial stress response. But that does not mean that the anniversary this year will be smooth sailing—at least emotionally.
A major anniversary of any difficult event—the death of a loved one or a damaging natural disaster—can be a tricky time. And the already extensive rehashing of 9/11 means that, "for many people, they begin to re-experience the reactions they would have had at that time," Dass-Brailsford says. Whether they were at the site of the attacks or not, people might have nightmares, trouble sleeping, difficulty concentrating or a general sense of irritation. These symptoms can be especially difficult because they "can creep up on you, and you will start feeling odd, and you won't know why," she notes.
But there is one event that might help those especially affected by the events of 9/11 to further ease their anxiety. "The new wrinkle this year will be that bin Laden was captured and killed," Dass-Brailsford says. "In doing trauma work, usually when the perpetrator is brought to justice it can be very healing for survivors," she explains. As when a burglar who has been on the loose is finally captured, locals fell safer
But in this instance, "that safety is very relative because we know that the organization that he belonged to didn't depend just on him," Dass-Brailsford says. Nevertheless, now that he has been dispatched, "for some people, now they can start working on healing and recovering.
Fortunately, large-scale traumatic events such as terrorist attacks are relatively rare, but that means that their effects on mental health are tricky to study systematically. And as Neria and his co-authors noted in their paper, "In the immediate aftermath of disasters, it may be both inappropriate and unethical for researchers to assess some of [the] key variables related to exposure [and] short-term outcomes."
In the meantime researchers are pressing on to better understand how major disasters play out in minds across the world. Disasters can leave a vastly different mental health footprint depending on where they happen, Watson notes. "Disasters occurring in developing countries, whether human-caused or natural, cause more numerous and severe mental consequences than do disasters in developed countries," she says.
And despite the new cautions against assuming people exposed to trauma are unable to rebound on their own, Watson says that she and peers in the field are hoping "to get the message across that people may need a little assistance to feel better or function better, without needing formal diagnosis or treatment," to help overcome the stigma that remains attached to seeking psychological help.