Although the 10th Anniversary of the events of 9/11 is now behind us, many first responders still are not aware of or not making use of the mental health services that are available to them. Some have had unsatisfactory experiences with counselors and have dropped out. Some think that they are doing well and do not need assistance. Some continue to be concerned that if they do seek help this is evidence of weakness. Others worry that if they go for help they will be taken off the job - a serious error in many cases, as it separates people from the one area of their lives in which they feel a sense of competence. Still others worry that if they begin to look more deeply at what happened to them, they will no longer be able to function. All of these thoughts are natural and common responses after a traumatic event.
While it is true that most people exposed to traumatic events get over this experience on their own, when people are very close to what happened, physically and psychologically, the effects can be more long lasting. What happened on 9/11 is most unusual compared to other mass casualty disasters; it is almost unheard of for rescue/recovery workers to have lost and searched for so many of their own - fellow
first responders, brothers, sons and fathers.
Those first responders who were on site the first day, or during the first week, or who worked at the site repeatedly over the course of 8 ½ months, had what we in the field of traumatic stress would consider to be prolonged exposure to horrific sights, sounds and smells. This was a combat experience. What many don’t understand is that this produces chemical changes in the body (on the hormonal level), which make it difficult, if not impossible to simply “get over it”.
These chemical changes are what give rise to symptoms of hyperarousal – agitation, anxiety, difficulty falling or staying asleep and intrusive memories (flashbacks) and nightmares. Or, they can give rise to symptoms of hypoarousal – the shutting down of sensation – difficulty feeling anything. (Often times people shift back and forth between both extremes).
Ironically, shutting down the more natural response to horror (grief and rage) is what makes you so good at what you do – you train yourselves to not see what you are seeing in order to do your job. The downside is when you are unable to turn this back on and continue to not feel anything, including pleasure. This is why many of you are not able to enjoy being at home with your wives or partners (or husbands, in the case of women first responders) and children.
The shutting down of sensations and emotions also affects cognition (thinking and language), which is why many of you have trouble concentrating, remembering, making decisions and talking about what happened to you. This is physiological – although it often contributes to people thinking they are going crazy. Unfortunately, the typical response is often to self–medicate these symptoms with over use of alcohol or other drugs. This tends to be more damaging in the long run.
The shutting down of the cognitive area of the brain is one reason why talk therapy alone is generally not sufficient to heal trauma. Prescribed medications can be helpful at alleviating some symptoms, but are not a cure and should be a complement, not a substitute, to therapy.
The reason many of you have not sought psychological assistance is because as time passes it is difficult to connect current problems as being a consequence of the events of 9/11, as well as other on the job traumas (and private ones). For example, many first responders are continuing to experience irritability, anger and anxiety, and are having a hard time remembering things and concentrating. Others are unable to fall asleep or stay asleep and are operating on a level of constant fatigue.
This can lead to depression, an increase in physical complaints and medical illness, and an increase in accidents either on the job or during time off. These are some of the long-term effects of trauma and are a signal that something is wrong – ignoring them will not make them go away.
What also happens over time is that people adapt to what happened to them – by avoiding all reminders of the traumatic experience. For example, some of you have been unable to read newspapers or watch television; others have had difficulty driving over bridges and through tunnels and have gone to great lengths (literally) to get where you need to go. This can restrict many areas of daily life, and tends to reinforce the trauma experience, rather than alleviate it.
The other reason that many first responders have not sought help is that they are still numb – meaning that they do not feel much of anything. It may be hard to remember that this has not always been the case, that there was a time in the not-too-distant past that life was enjoyable and fun and had meaning. The good news is that it is possible to get back to that place and this does not mean that anyone will ever forget what happened – but that the memory of those terrible days can be put in the past where it belongs, instead of living in the present through symptoms.
So what type of therapy is most helpful? Leaders in the field of traumatic stress suggest that a successful approach needs to first address the problems people have regulating their affect - being either hyper (over) or hypo (under) aroused. Teaching people ways they can calm themselves down - or start to feel again - does this.
One method used successfully is to teach a series of tapping patterns (called TFT) on acupressure points which reduce anxiety and anger - this is a tool individuals can learn and then use when needed. Also very helpful is the practice of Yoga – which helps to stimulate the brain and increase the ability to concentrate, as well as stimulate and relax the body. The National Institute for Mental Health has funded a study on the effects of Yoga in the treatment of trauma.
A more complex treatment approach is EMDR (Eye Movement Desensitization and Reprocessing) – which is an effective trauma treatment that can only be utilized by clinicians trained and certified in its use. It has proven unusually helpful for traumatized individuals in that it extinguishes the trigger (something in the environment that causes a person to respond as if a past traumatic event is occurring in the present). It reduces or eliminates intrusive memories, nightmares and other trauma responses and enhances resilience. Central to EMDR treatment is learning to self-calm, which is taught through a variety of relaxation and containment exercises.
EMDR has been used quite successfully with Vietnam Veterans, some of whom have had symptoms clear up that had been bothering them for decades. After 9/11 EMDR clinicians treated over 850 people in New York and Washington, D.C., including hundreds of
first responders– for free. This was an unprecedented outreach by the EMDR Humanitarian Assistance Program – because of the EMDR-HAP commitment to healing human suffering. The Veteran's Administration and the DoD have recommended EMDR as "always indicated and acceptable" in their Clinical Practice Guideline for the Management of Post Traumatic Stress – for the second time, just last year.
For those of you who have had unsatisfactory experiences with counselors as summed up eloquently by one first responder, “We all need heart transplants and the department is handing out Band-Aids” – don’t give up! There are many qualified therapists, independent of your departments, who want to work with you.
On a more personal note, not a day has gone by that I have not thought about the sacrifice made by New York's first responders on September 11th.. It was a sacrifice that can never be repaid. But it would be a travesty to condemn those of you who contributed to the rescue/recovery effort to the fate of many Vietnam vets who have said, sadly, “No one came home alive from Vietnam”. You protect this city every day, putting your own lives at risk selflessly. You deserve to be taken care of, in the best possible way, and in every necessary way, for as long as it takes.
(Article was first printed in Firelines in October 2003, updated 2011)
Although the 10th Anniversary of the events of 9/11 is now behind us, many first responders still are not aware of or not making use of the mental health services that are available to them. Some have had unsatisfactory experiences with counselors and have dropped out. Some think that they are doing well and do not need assistance. Some continue to be concerned that if they do seek help this is evidence of weakness. Others worry that if they go for help they will be taken off the job - a serious error in many cases, as it separates people from the one area of their lives in which they feel a sense of competence. Still others worry that if they begin to look more deeply at what happened to them, they will no longer be able to function. All of these thoughts are natural and common responses after a traumatic event.
