Post-traumatic Stress Disorder Experienced by 9/11 Attacks Survivors
11th September the year 2001 is the most remembered day in the history of US terrorist attacks. Boeing 767 jet crashed into the North Tower of the World Trade Centre, followed by another plane crash in the Southern Tower (Fink, 2019). The two buildings collapsed just as a third and fourth planes hit the Pentagon and in a field in Shanksville, Pennsylania respectively. This attack led to the death of more than 2800 people and left many others psychologically traumatized and most survivors suffered from post-traumatic stress disorder (PTSD) (Fink, 2019). Trauma can be defined as a mental health disorder triggered by an event that is terrifying, either by experiencing it or by witnessing it (North et al., 2015).
Individuals that experienced traumatic events in their lives have temporary problems when it comes to adjusting and dealing with life situations. This research focuses on the psychological trauma that was experienced by the survivors, the extent of the trauma, the symptoms experienced and the treatment strategies applied to help deal with trauma. The study will also analyse the effectiveness of the treatment, mentioning some of the treatment strategies that were helpful and those that were not. The study will conclude by highlighting some of the lessons learnt from the attack on the best strategies to manage PTSD.
The survivors of 911 attacks
On the commonly known date of 11 September of 2001, The U.S was faced with one of greatest tragedies. The people that experienced most trauma from the attack were the ones that were in close proximity, this include the people that were in the buildings that were crashed. Six months after the attack, most of survivors could vividly explain their experiences clearly explaining what they saw and the most traumatizing images that they saw (Vitelli, 2018). Most survivors of the 9/11 attacks experienced varied PTSD symptoms months after the attacks. The largest number of them lost their jobs since their work stations were destroyed, and this led to increased stress because idleness led them to keep rethinking about the attack (Vitelli, 2018). One of the negative feelings that were experienced by most of the survivors after the attack is guilt. Most of them felt like they did not do enough to save their colleagues and friends, who were not as lucky as they were to have survived the attack. More than 70% of the 9/11 attack survivors suffered PTSD symptoms months after the attack and this greatly affected their lives after (North et al., 2015).
Symptoms of PTSD experienced by 9/11 attack survivors
PTSD symptoms can begin within the first month after the traumatic event, they can start to show even years after the event. The symptoms of PTSD can have significant effects on the lives of the victims as observed through the 9/11 attack and it can greatly affect their social lives and also affect their ability to conduct their normal duties (North et al., 2015). The symptoms of PTSD that were experienced by the 9/11 attack survivors can be grouped into four define types including;
- Intrusive memories
The survivors of 9/11 attacks have confessed in many research studies to have experienced unwanted distressing memories of the traumatic event. The survivors have also experienced flashbacks of the attack where they relieve the attack experience like it is happening all over again (Bowler et al., 2017). The survivors have also indicated that they could not sleep well because they kept having nightmares on the attack a year after.
- Avoidance
A common behaviour with people suffering from PTSD is avoidance. Most of the survivors of the 9/11 attack have confessed that they are not able to discuss the attack and they try as much as they can not to think about the happenings of that day. These survivors have illustrated in the studies that they have fear of fires, loud bangs and even fear getting into tall buildings because they remind them of the attack (Bowler et al., 2017).
- Negative Variations in reasoning and attitude
People suffering from PTSD tend to have a very negative thinking, they are always thinking negatively about themselves and the people around them. Most of the survivors had a very limited hopeful thinking, months after the attacks. Most of them had no defined plans set for the future because they felt that the future was just a dream that could be destroyed in a minute (Yu et al., 2015). Most of the survivors did not have any friends and they often feel detached from their families. They were not able to maintain close relationships because they always felt emotionally distressed feeling like people would never understand their situations. Most of the survivors indicated their lack interest in leisure activities, things that they used to enjoy doing before the traumatic event no longer seem fun for them (Bowler et al., 2017).
- Variations in both physical and expressive reactions
People with PTSD experience a change in their emotions whereby they easily get frightened, causing them to always be prepared for danger. Most of the 9/11 attacks survivors have been reported to have indulged in alcoholism and most of the have been served with over speeding tickets more than two times since the attack (Bowler et al., 2017). Insomnia was a common problem that was registered among the survivors and it can be linked with the fear that they will have dreams related the attack when they sleep. Most of the survivors up until now have no jobs all because they cannot concentrate, they often struggle with aggressive behaviours and this causes them to feel devastating embarrassment and guiltiness (Yu et al., 2015).
Treatment of PTSD for the 9/11 survivors
In trying to deal with the psychological distress that affected the survivors of the 9/11 attack the Department of Mental Health (DMH) responded very fast joined by other medical agencies (Jordan et al., 2019). They began by identifying three priorities; it first began by providing crisis intervention to the bereaved survivors. A mental health hotline that is sponsored by DMH known as LifeNet offered counselling in 5 languages via telephone (Jordan et al., 2019). The number of calls to this hotline increased and actually doubled in the days after the attack, meaning that people were really in need of counselling. DMH went ahead to establish care centres that helped in providing counselling and also to help the people search for their relatives in various hospitals (Lowell et al., 2018). The second thing that was done is that DMH working with the other providers developed a long-range plan to provide mental health services to the survivors. Support services were created through what was defined as Project Liberty and within a short time 120 sites had been established (Lowell et al., 2018). The third priority was to ensure that the public mental health system that was funded by DHM was maintained to help cater for the mental distress of the survivors and everyone that was affected by the attacks (Jordan et al., 2019).
Helpful Treatments
Trauma treatments basically involve counselling, which can be very complicated and the effectiveness depends on the structure used to implement it. One of the most helpful treatments of PTSD after the 9/11 attack was through the outreach educational program that was implemented under Project Liberty (Tull, 2019). The outreach educational program was structured to serve the purpose of what is known as the psychological first aid. This is where trauma victims are treated step by step by professional that analyse and understand the intensity of the trauma on the victim and what needs to be done after the first stage (Petrsoric et al., 2018). This strategy was most beneficial to the 9/11 attacks survivors because it helped educate the society about trauma.
The people were educated on the symptoms that determine if one is suffering from PTSD and so it helped the people to understand their symptoms and decide whether they wanted to be part of the program or not. The program was set up in such a way that it provided a short term crisis counselling services for everyone in need, after which a referral to longer term specialized mental health treatment was offered depending on the intensity of one’s trauma (Lowell et al., 2018). The survivors that were found to have intense trauma were directed to professional psychological counsellors that enrolled them into psychological programs to help them deal with their PTSD symptoms (Petrsoric et al., 2018). This was a much different from the common mental health counselling and it helped deal with some of barriers to mental health for instance lack of knowledge about the availability of services. It helped the society to understand the effects of the attack on mental health thus helped the society to offer more support to the survivors. The outreach program is an effective PTSD treatment program that worked and helped many survivors of the 9/11 attack deal with PTSD, it should be adopted in dealing with PTSD in major tragedies in the future.
Unhelpful Treatments
The choice to open up the normal counselling care centres where the survivors could go for brief counselling was a great idea, though it was not really effective. Research has showed that the prevalence of the PTSD symptoms among the survivors after the 911 attack only decreased by one third meaning that most of the trauma victims did not benefit from the set treatment PTSD options (Tull, 2019). There are many barriers to mental health treatment, and they may have affected the survivors from accessing the services provided to help deal with the psychological trauma from the attack.
For one most of the survivors were trying to avoid remembering the events, and so visiting the counselling centres was not an option for them because they would need to discuss the events of the attacks (Vance et al., 2018). Most of the survivors may have chosen not to visit the care centres because they did not realize that they were trauma victims, they had no knowledge of what PTSD is all about and did not know what the symptoms were (Tull, 2019). There is also the issue of stigma that surrounds the mental health issue; most of the survivors chose not to go to the care centres because they did not want the society to label them as mentally unstable. For those that chose to go for these brief counselling sessions, they were not really helpful to them because they only helped them feel better at that time without concentrating on the emotional processing of the trauma and this only increased the anxiety levels for the survivors (Vance et al., 2018).
The telephone counselling was also just like the visit to the care centres unhelpful, because it only provide some quick surface counselling that did not really touch on the progressive emotional distress faced by the victims (Tull, 2019). Most of the people that called the centres were people looking to find out about the details of their loved ones but not for real counselling that the survivors required. The call centre agents were not psychology professionals that understood how to deal with trauma victims (Vance et al., 2018). This means that they were ineffective in offering any real psychological help to the survivors that called in looking for some counselling after the attack.
Learning Reflections
Telling whether people will suffer from PTSD after a traumatic event is not a simple yes or no answer. Judging from what happened with the 9/11 attack; there are people experience very minimal symptoms after the traumatic event. There are others who have mild symptoms over time and there are those others that experience chronic elevated distress shortly after the traumatic event and it affects their lives for many years (Cook, 2016). There is another group of people that experience a minor disorder immediately, which increase and become severe with time causing them to be impaired. All this pathways are associated with factors that occur before, during and after the traumatic event not forgetting the external forces. The length in which an individual experienced the trauma, the medical conditions that one acquired as a result of the trauma for instance asthma and prior psychiatric conditions guided the pathways of PTSD (Jordan et al., 2019).
The 9/11 greatly helped to shed the light on how programs can sensitively be implemented in-order to meet the needs of trauma survivors. The prevention, screening and the treatments should always be targeted at the survivors and other people that have higher levels of trauma exposure and hence at higher risk of distress (Cook, 2016). The screening for significant distress should be particularly directed towards the individuals that have experienced severe traumatic exposure and those that have prior psychological difficulties. Educating the society about trauma and how it affects mental health of the victims is important and it helps in building a healthy support network for the victims (Jordan et al., 2019). This support network acts as a powerful buffer against distress and it hence becomes a key component to cure.
People in the society need to be taught how to take care of one another. More people need to be trained on psychological first aid, which greatly helped to take care of the trauma victims’ psychological needs. A systematic training on psychological matters that is employed nationwide need to be implemented to teach people how to recognize problems that require professional help so that they are able to make use of the resources that are available for them.
Vicarious Trauma
Providing psychotherapy to victims of trauma can produce PTSD symptoms to the psychotherapists, this is what is defined as vicarious traumatization (VT). VT is mainly caused by the internal interactions between the clinicians and the victims as they vividly repeat their experiences. This process alters the views and the relationships of the clinicians, aligning them similarly with those of the traumatized victim (Quitangon et al., 2016). The few studies that were conducted to understand VT after the 9/11 attacks, indicate that many psychotherapists experienced trauma but their experiences were dependent on various factors. The psychotherapists that had previous trauma exposure experienced intense psychological distress as compared to those that did not have previous exposure (Clement et al., 2015).
The psychotherapists involved during the 9/11 attacks experience symptoms such as emotional numbing, intrusive thoughts and images, heightened sense of distrust and intimacy difficulties. Age and marriage also greatly impacted on the clinicians’ risk of developing VT. Younger clinicians with less experience on the field had high risks of developing VT as compared to the more experienced clinicians that had been in the field longer (Clement et al., 2015). Married clinicians experience much less symptoms as compared to the single clinicians, this is attributed to the fact that having a spouse allowed for moral support, because they could discuss the events of the day with someone and this helped to reduce the effects of trauma exposure (Quitangon et al., 2016).
Based on experiences of the clinicians that took part in Project Liberty, risks of VT for clinicians can be reduced through additional education and training on traumatology. Modern disaster management has emerged since 9/11, renewed attentions have been focused on the safety as well as the wellness of the disaster responders that suffer a great deal of trauma from the disaster. Various training programs like Webinars have been created to help these responders to assess themselves and to help provide self-care before, during and after disaster (Quitangon et al., 2016). This is an effective strategy in helping improve the outcomes for the mental health providers who work hard to help the disaster victims recover psychologically.
Conclusion
The 9/11 attacks was the worst traumatic event that have been experienced in the history of the United States. Many people suffered from trauma most especially the survivors, who experienced seeing their friends and colleagues die and they could not do anything about it. These people experienced very intense symptoms that affected a great deal of their lives. Most of these people lost their jobs, meaning that they had to spend a lot of their time after their attack doing nothing, which led to increased distress for them. The society was not knowledgeable enough to understand the impacts that trauma has on psychological health of people involved. The best strategy in dealing with PTSD is through psychological first aid system, this involves educating the society about trauma symptoms and let them understand how they can affect people’s lives. Doing this will always ensure that the people at high risks of experiencing trauma symptoms from disasters are well taken care of and they are able to go back to their normal lives.
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