Posttraumatic Stress Disorder and 9/11
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?
Table of Contents
Defining posttraumatic stress disorder
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:
- Re-experiencing the trauma
- Persistent avoidance
- Increased arousal
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