Posttraumatic Stress Disorder and 9/11

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The September 11th Trauma

The events of 9-11-01 have caused great consternation, confusion, grief, and sadness throughout our nation. It is probably still too soon to estimate the damage to the nation's collective psyche (functioning mind). In fact, it is possible that symptoms suggesting posttraumatic stress disorder (PTSD) will yet occur in many people across the nation, even miles from the actual physical traumatic events. Of course, the people directly affected by the actual tragedies have had and will still be expected to have a variety of responses to this posttraumatic stress.

In the wake of the September 11th tragedies, the main questions regarding PTSD are:

  • What is the difference between normal grief and the pathological (abnormal) PTSD illness? (Freud talked about this in Mourning and Melancholia)
  • What are the transient (temporary) posttraumatic stress symptoms that anyone would be expected to experience?
  • At what point in the duration of symptoms would some treatment make sense?
  • Are there ways to prevent the development of the pathological PTSD illness?

What is posttraumatic stress disorder (PTSD)?

PTSD, as such, has been a part of organized psychiatry for only the past twenty years. The concept of PTSD, however, has been well known for over a hundred years under a variety of different names. Certainly, Freud thought that traumatic events in childhood had an effect on an individual's subsequent emotional development. Actually, however, it was his contemporary, Pierre Janet, who wrote most brilliantly and eloquently on traumatic stress. In fact, he was really the first person to describe the full syndrome (group of symptoms) of posttraumatic stress disorder.

During World War I, PTSD was called shell shock, and during WW II, it was referred to as combat fatigue. After the Vietnam War, it was often mistakenly called the Post Vietnam Syndrome. Indeed, the understanding and effective treatment of PTSD were actually described in the psychiatric literature well before the Vietnam War. A psychiatrist from Harvard Medical School, Dr. Eric Lindemann at Massachusetts General Hospital in Boston, was the first to report on the systematic management of PTSD. He did this work after the Coconut Grove fire and tragedy in the 1940's.

Posttraumatic stress disorder is defined in terms of the trauma itself and the person's response to the trauma. Trauma occurs when a person has experienced, witnessed, or been confronted with a terrible event that is an actual occurrence. Alternatively, the person may have been threatened with a terrible event, perhaps injury (physical or psychological) or death to themselves or others. Then, the person's response to the event or to the threat involves intense fear, helplessness, and/or horror.

It is important to note, however, that having strong reactions to trauma is normal. What's more, there is a range (spectrum) of expected reactions depending on a person's prior exposure to trauma and even on hereditary (genetic) factors. Most importantly, you should understand that there are efficient and effective treatments for PTSD.

The scope of posttraumatic stress disorder

Sadly, the September 11th tragedy is only the most recent causative (precipitating) event for posttraumatic stress disorder. The scope of the PTSD problem in our society is actually substantial. For example, a current diagnosis of PTSD has been found in 15% of 500,000 men who were Vietnam veterans. Likewise, almost 18% of 10 million women who were victims of physical assault have PTSD. As a matter of fact, eight to 10% of the population will suffer from PTSD at sometime in their lives.

The consequences of PTSD for both the afflicted individual and society are significant. For example, studies have shown that patients with PTSD will have an increased number of suicides and hospitalizations. Also, patients with PTSD will have an increased frequency of alcohol abuse and drug dependency problems. In addition, we know that patients who have been victims of criminal acts subsequently have a much higher utilization of medical services in general. Most significantly, one third of PTSD patients will have related symptoms 10 years after the trauma. The majority of these people will also suffer from other psychiatric, marital, occupational, financial, and health problems.

The symptoms of PTSD

In general, posttraumatic stress disorder can be seen as an overwhelming of the body's normal psychological defenses against stress. Thus, after the trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms. The symptoms are produced in three different ways:

  1. Re-experiencing the trauma
  2. Persistent avoidance
  3. Increased arousal

First, symptoms can be produced by re-experiencing the trauma, whereby the individual can have distressing recollections of the trauma. For example, the person may relive the experience as terrible dreams or nightmares or as daytime flashbacks of the event. Furthermore, external cues in the environment may remind the patient of the event. As a result, the psychological distress of the exposure to trauma is reactivated (brought back) by internal thoughts, memories, and even fantasies. Persons also can experience physical reactions to stress, such as sweating and rapid heart rate. (These reactions are similar to the "fight or flight" responses to emergencies described by Dr. Walter Cannon.) The patient's posttraumatic symptoms can be identical to those symptoms experienced when the actual trauma was occurring.

The second way that symptoms are produced is by persistent avoidance. The avoidance refers to the person's efforts to avoid trauma-related thoughts or feelings and activities or situations that may trigger memories of the trauma. This so-called psychogenic (emotionally caused) amnesia (loss of memory) for the event can lead to a variety of reactions. For example, the patient may develop a diminished interest in activities that used to give pleasure, detachment from other people, restricted range of feelings, and a sad affect that leads to the view that the future will be shortened.

The third way that symptoms are produced is by an increased state of arousal of the affected person. These arousal symptoms include sleep disturbances, irritability, outbursts of anger, difficulty concentrating, increased vigilance, and an exaggerated startle response when shocked.

Medically Reviewed by a Doctor on 3/20/2017

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