Beyond Tragedy: Finding the Right Help
By Jeffrey P. Kahn, M.D.
The tragedy of 9/11 will long
live in our emotional memories. Thousands died. Tens of thousands
were affected by deaths of friends and relatives, injuries,
narrow escapes and economic reversals. Fear, anger and despair
overwhelmed countless others. Much attention has been paid
to the psychological needs of those suffering the after effects.
Reminders of 9/11, they are an ongoing focus of those who
recognize the practical and emotional significance of the
While most people are returning
to normal, others still live with daily distress. Who are
the most affected? Some are among the most directly harmed:
it takes a long time to recover from the death of a loved
one. Some were already enduring a significant stress at the
time of the attack: a divorce, a new child, a promotion or
a financial setback. Some had few social supports to draw
on: fewer now if they no longer have their office social network.
Still others have a predisposition to depression, panic disorder
or alcoholism: the attacks made their symptoms worse. Many
have some combination of these factors.
Likewise, ongoing post-traumatic
stress disorder (PTSD) is typically caused by a combination
of such causes. By itself, a single event doesn't often trigger
lasting emotional harm. PTSD is not an inevitable consequence
of one emotionally traumatic experience: it is far more likely
to be the proverbial straw that breaks the camel's back. Nor
is PTSD necessarily a chronic illness that must or should
be tolerated for a long time. Just because someone has endured
a tragic event, doesn't mean they should have to keep on suffering.
Treating the Problem
Unfortunately, many of those
still suffering have not found effective treatment, or even
treatment at all. With all the attention to the psychological
care of 9/11 victims, the importance of quality mental health
care can get lost in the shuffle. Media accounts of those
with enduring pain make some of this clinical need clear.
While depression and panic disorder are often hidden, even
people whose symptoms seem obvious in a newspaper story have
not been offered the specific medication and skilled psychotherapy
that they need. Just as importantly, where hidden family and
work problems may be major causes of distress, they can remain
hidden unless addressed by a skilled clinician.
Merely labeling all symptoms
after 9/11 as part of PTSD is not accurate or helpful. The
label can obscure helpful solutions, or even lead to the notion
that treatment would be of little value. And it is always
difficult for someone in distress to realize when better help
is needed. Finding effective treatment starts with a thoughtful
psychiatric interview, which looks carefully at all of the
traumatic, symptomatic, spiritual, personal, family, work
and medical issues. These issues may have started before,
during or even after the attacks.
When patients find their way
to the right treatment, their lives can get better swiftly.
Therapy can untangle the complex interactions of traumatic
events, personal concerns, family interactions and so many
other issues. When the right medications keep painful and
intrusive symptoms under control, people can feel better,
make far more progress in therapy and more effectively seek
real solutions to the practical problems in their lives. The
tragedy will always be there, and many losses can never be
compensated. But emotional lives can recover, and the business
of life can go on.
Dr. Kahn is president of
Manhattan based WorkPsych Associates (www.WorkPsychCorp.com),
providing executive assessment, development and treatment
services, as well as management consultation. He is past president
of the Academy of Organizational and Occupational Psychiatry
and teaches at the Weill Medical College of Cornell University.
He is also co-editor of the forthcoming Mental Health and
Productivity in the Workplace: A Handbook for Organizations
and Clinicians (Jossey-Bass: Fall 2002).
Newsweek. Used by Permission.