Terrorism: Changing Our World
September 11, 2001 is a day that will be embedded in our memories for the rest of our lives. I was participating in a morning meeting at the New York State Psychiatric Institute, when we were interrupted to be told that the World Trade Center was being attacked. We rushed to my office, from which there is a direct view to the south, down the Hudson River, and saw with horror the black billows of smoke pouring out of the World Trade Center. Disbelief, denial, shock, and outrage were universally experienced throughout the city, as we watched the cascade of events, followed by grief, fear, and devastation as the extent of the disaster became clear.
In spite of the prior assault on the World Trade Center, the Oklahoma bombing disaster, and the destruction of the American embassies in Kenya and Tanzania, there was no emotional or psychological preparation for this event. Ordinary minds rejected the reality of these historical warnings, and the possibility of a “clear and present danger” seemed the stuff of fiction until September 11. But a new, brutal reality has been unavoidable ever since. Relentless media coverage hypnotized the nation with images of the collapsing towers. I had occasion to join several state and federal officials for a police-escorted, hard-hat visit to “ground zero,” around and into parts of the smoldering ruins, and nothing in the media adequately conveyed the magnitude of the destruction. A visit to the Family Center at Pier 94 put human faces into this new reality, and a walk down the wall of photographs of those lost, reading the hand-written personal messages from the survivors to their lost loved ones, produced a wrenching awareness of their pain and suffering.
Outreach volunteers abounded, with a generosity of spirit and concern that was remarkable. Training sessions were organized, focusing on what disaster experts have learned about providing help shortly after a disaster, and identification of appropriate long-term treatment needs and methods. Calls for help came from many quarters and took many forms. Individual counseling was provided by psychiatrists and other mental health professionals, for requests ranging from needs of companies whose offices had been in the World Trade Center, to advice for physically unharmed but emotionally traumatized occupants of buildings near the site.
A major teleconference was held in October, involving live presentations from a broadcast studio in New York by NY State Commissioner James Stone, NY City Commissioner Neal Cohen, myself, and Dr. Joseph English, Chair of Psychiatry at New York Medical College and Director of Psychiatry at St. Vincent’s Hospital, the medical facility closest to ground zero. We were joined by a number of presenters from the American Psychiatric Association (APA), on site in Washington, DC, including Dr. Steven Mirin, Medical Director, and Dr. Robert Ursano and Dr. Ann Norwood, from the Disaster Psychiatry Committee of the APA. In turn, we were linked to a plenary session of the World Psychiatric Association (WPA) in Madrid, with presentations by Dr. Juan Lopez-Ibor, President of the WPA, and by world experts in disaster psychiatry. One of the points emphasized by those participating in this event is that, though the World Trade Center disaster is an event in the past, terrorist activity is ongoing, with bioterrorism now a reality, sustaining a new level of apprehension in our city, our state, and our country. Ours is a changed world, and a vast and sustained response capacity will continue to be needed in this time of heightened stress.
In this issue, in addition to our regular review articles, our columnists focus on some of the many aspects of this new reality: Reid discusses the psychological aspects of terrorism, Pandya and Weiden review the impact of trauma and disaster on psychiatrically vulnerable populations, and Clemens comments on the ways that these events intrude in ongoing psychotherapy.