On September 11, 2002, the anniversary of the attack on the World Trade Center, Gotham Gazette held live chats with Dr. Joan Hardin, a psychologist in private practice, Dr. Richard Shadick of Pace University's Counseling Center, Dr. Joseph Hirsch, adjunct professor of psychology at Seton Hall, and Dr. Lisa Kaplan, Mental Health Advisor for the World Trade Center United Family Group. Find out what they said during our conversations as they addressed the issue of coping with September 11 one year later.

A Conversation With Dr. Joan Hardin and Dr. Richard Shadick
11:00 AM -12:00 PM, September 11, 2002

Gotham Gazette: Today, many of us can’t help but remember where we were on September 11 2001. Where were you?

Dr. Joan Hardin: I was at home, about a mile north of the WTC. I heard the first plane.

Dr. Richard Shadick: I was at Pace University just 3 blocks from the site.

GG: How did you become involved in Sept. 11 crisis counseling?

Shadick: Being so close to the site, we had a number of survivors come to the university for help. We triaged a lot of people who were traumatized and counseled them during the days and weeks after.

GG: For those who aren't familiar with medical terms, what do you mean by "triaged"?

Shadick: Triaged means determining who is in immediate need of help -- that is they had medical injuries versus counseling.

Hardin: A number of people who realized they'd been traumatized by the events came for therapy though the American Red Cross .

GG: What are some of the psychological effects of the attacks that you have seen?

Hardin: Reliving the events, previous traumas getting stirred up, sleep difficulties, feeling afraid a lot, general feelings of unease and worry.

Shadick: Some of the symptoms are:

Recurring and intrusive thoughts of the incident
Becoming afraid of everything
Isolating yourself
Having difficulty maintaining daily routines
Tremendous sense of loss
Reluctance to express your feelings
Moodiness, agitation, feeling overwhelmed
Strained relationships
Depression or anxiety
Thoughts of wanting to hurt yourself

GG: Are there any specific cases that come to mind that have stood out from the rest?

Shadick: Well these symptoms I have listed are common reactions that we may all have and that in and of themselves are not cause for concern.

Hardin: There was someone who was intimately involved in providing services to the rescue workers for many months. When the need for her services was over, she found herself depleted with no one around to support her because they were depleted too.

GG: What kind of services did she provide? Psychological services?

Hardin: Confidentiality bars my saying.

GG: We have a question from "ferret."

ferret: Many of my friends have worked through so much of the profile you mention only to confront a terrible inertia, indecision, and inability to get on with our lives, to restore our homes (which were adjacent to ground zero), to deal with the various agencies who were supposed to help us. We have tried everything, books, counseling, group. How long can this stage last? Is it forever now?

Shadick: It is important to remember that these reactions come in waves. Some days and weeks are better than others. It probably won't last forever, but it is important to do things to prevent the symptoms from getting worse or hanging around.

Hardin: No, it doesn't need to be forever even though it feels hopeless. It's very important to take good care of yourself even though that may feel unimportant, to try to grow by discovering effective ways to regain our feelings of safety and personal power. Many people are choosing to become closer with friends and family, Do yoga, start projects they've put off, generally. Deciding to enjoy life in the present even though that life is very difficult. Many people are entering or re-entering counseling or therapy to help them figure out how to feel more comfortable and satisfied in their lives - even in the face of such an enormous upheaval.

GG: We've read that membership in health clubs has gone up since September 11. Is this an example of what you're talking about?

Hardin: Indeed.

GG: Are there other examples of New Yorkers trying to regain their feelings of safety and personal power?

Hardin: Some people have decided to get married now rather than later have babies now rather than later. Trying to build a personal network of warmth and safety.

Shadick: Maintain your normal routine. Recognize that the nature of terrorist attacks creates fear and uncertainty about the future. Continue to do the things that you enjoy. Don't get preoccupied with the things you cannot control to the extent that they prevent you from living your normal life. Understand that our government is combating terrorism and restoring safety and security. Recognize that trained officials throughout the country are mobilized to prevent, prepare for, and respond to the attacks. Limit exposure to newspaper, television, and radio coverage.

GG: Speaking of exposure to media coverage -- as the anniversary approached, so did the coverage. Did this cause an increase in the number of patients you see or in their symptoms?

Shadick: Yes it does and I will tell you why. People who have put aside the awful experience of 9/11 are now having to confront their feelings again because of this exposure, and it naturally brings up these responses. It is important to remember that these symptoms will be with us for a few days after the anniversary, not just today.

Hardin: An Israeli patient of mine who grew up in a country that has experienced many wars and much terrorism says visitors to Israel wonder why Israelis spend so much time in cafes with friends. This is how they cope with uncertainty, by enjoying themselves in the present with people they enjoy and love. That notion of remembering that you're okay in the present, in this very moment, can get you through any number of difficult events and feelings.

Shadick: Yes, that is an important point that Dr. Hardin brought up. The issue of resilience. Resilience is the process of adapting well in the face of adversity, that is bouncing back from a difficult experience. Most of the people who have witnessed the WTC attack are resilient and are doing well and coping in adaptive ways. That doesn't mean that they don't experience symptoms, just that they are taking steps to help themselves, steps that both Dr. Hardin and I have advocated.

GG: Who are the people who are less resilient? Do they fall into particular categories?

Shadick: These people who are less resilient are ones who have been directly impacted. They are the ones who have lost loved ones, their apartment, their job. They may also be people who have been struggling with coping and stress issues before such as depression, anxiety, alcohol or drug abuse, things like that.

Hardin: The events of 9/11 and all that followed, are too big and too out of the ordinary for us to process in the way we usually process our fears and losses So it's not at all unusual for us to still be upset by them. Our relation to the world outside us is different now and finding different ways to feel safe in this world We shouldn't feel ashamed, weak, guilty, or angry at ourselves if we're still upset only a year later.

GG: Are there other things that people should keep in mind in order to help them cope with the anniversary?

Hardin: Breathing, in and especially out, is very useful in getting through difficult feelings, those waves of fear and anxiety that come.

GG: How should New Yorkers judge whether their emotional responses are "normal?"

Hardin: If they're unable to function, work, take care of their children, sleep. If they feel out of control, then they might want to seek out help in sorting out their feelings and coping strategies.

Shadick: The fact that people are not feeling better is not surprising because we are currently in a "coping mode" as opposed to a "recovery mode" -- that is that we are dealing with ongoing stresses such as anthrax, the potential war in Iraq, the ongoing terror threats. These all make it difficult to move beyond our feelings.

GG: Dr. Shadick -- earlier you mentioned that some people are more resilient than others. Can someone learn to be resilient?

Shadick: Absolutely. There are strategies to build resilience: make connections with others, avoid seeing crises as insurmontable problems take decisive actions in your life, look for opportunities for self-exploration and discovery these are all great ways to build resilience.

Hardin: I wanted to talk a little about the symptoms of post traumatic stress: that there can be physical symptoms as well as emotional symptoms. Prolonged emotional stress can aggravate or create illness in the body. If you say to yourself," I'll never feel better" you may indeed never feel better.

If you learn how to deal with your emotional stress then you're on the road to figuring out what could help you feel okay. You might start with telling yourself that you're going to become aware of what you're saying to yourself to discourage and scare yourself. Then, once you become aware of these dreadful tapes you're running in your own head, things you'd probably never dream of saying to another person, you can train yourself to change the message. So if you hear yourself telling yourself that you're weak or a loser, or whatever awful comment you're making about yourself in your own head, then you can change it to perhaps "I'm doing the best I can" or something more positive. This is the basis of cognitive therapy, which is very helpful with post traumatic stress.

GG: A question from "LEOS."

LEOS: Personally speaking, what does one do with those emotions of revenge and hatred we've heard coming from our national leaders and others?

Shadick: That is an excellent question LEOS. It is hard to know how to deal with such strong feelings when we see our leaders indulging in talk of hate. My suggestion for you is to accept that we all feel these and other intense feelings and that we have to accept them and not act on them in hurtful or destructive ways. War, hate crimes and the like are not the answer to healing ourselves. Rather it is talking about these feelings and doing other things to take care of yourself, that is the best way to cope with the feelings.

Hardin: Feel sorry for our national leaders and others who have gotten from the attacks only hatred and a desire for revenge. Keep yourself informed as to why some want to destroy us. This could be a real opportunity for Americans to learn our history as well as the history of other, beleaguered parts of the world.

Shadick: Great point!

GG: Have you seen people who feel helpless - who feel they couldn't or didn't do enough to help after the attacks?

Hardin: Yes. A woman who resides near the WTC site felt guilty about not volunteering her time more. She was raised to feel guilty in general, so we worked on these particular guilt feelings as well as her general stance toward her life, which was to feel guilty. Feeling guilty takes up too much energy and makes people feel bad. Obviously, if you've committed some terrible wrong to someone else then it's appropriate to feel guilt about having done that.

Shadick: I found folks like that early on right after the attack. I think it is a yearning to deal with the feelings of helplessness. It is very natural. I don't see that quite so much anymore as we have all begun the process of getting in control of our feelings. However, I imagine after today it will be a common response again.

Hardin: Yes, I too expect that all those feelings of helplessness we felt after 9/11 will come up again on and after the anniversary today.

GG: At Ground Zero this morning, Mayor Bloomberg thanked those "who’ve struggled to make sense of our despair." A year later, what sense have you been able to come to?

Shadick: I see this horrible event as giving us the potential to address things that are wrong in our country and in ourselves. For example to volunteer more, to say "I love you" to those close to us, to take care of the things that are so important to our emotional health that we have neglected lately. To me that is how I think we can make sense of all this.

Hardin: I go back to what I think is an appropriate response: That it's very important for all of us in this country to take the 9/11 attacks as an opportunity to try to see the United States as others in the world see us.

GG: Last question: where can people go if they want to get counseling or help?

Shadick: I want to thank you for inviting me to join this chat particularly today, this very important day. People need to realize that there are a lot resources available for counseling including the Red Cross, Project Liberty and many other individual practitioners in the community. There has been an effort established to fund treatment for those suffering from the effects of 9/11 and they should take action now to get those resources.

Dr. Joan Hardin: Locate a cognitive-behavioral therapist or counselor. You can call the New York State Psychological Association or a social work agency. If you're a student, you can go to your school's counseling center for help. Many workplaces offer employees help through their employee assistance plans. You can also go online and look for help at sites like 4therapy.com.

A Conversation With Dr. Joseph Hirsch and Dr. Lisa Kaplan
6:00 PM - 7:00 PM, September 11, 2002

Gotham Gazette: Good evening, everyone, and thank you for coming to Gotham Gazette's live chat event. We are talking to Dr. Joseph Hirsch, Adjunct Professor of Psychology at Seton Hall University. Good evening, Dr. Hirsch.

Dr. Joseph Hirsch: Good evening.

GG: Where were you on September 11 and how did you become involved with counseling those affected by the attacks?

Hirsch: I was at home -- home office that is -- writing neuropsychological reports when I got a call alerting me to the fact that the firts plane hit the WTC. I immediately deduced that it was a terrorist attack. Since I am only about 1 mile from the WTC, I was ready to spring into action. By the following day I was with FEMA and then went right down to ground zero where I returned several times mostly with the Red Cross. I should also add that I was at the Family Assiatance Center, the Armory, etc. I also became involved after the American Airlines disaster in Belle Harbor, Queens. So, I counseled firemen, police, victims who survived, their families, displaced homeowners in Battery Park City, etc.

GG: How did you counsel? Did you have formal therapy sessions?

Hirsch: No, these were not formal therapy sessions. These were centered on people's feelings directly related to 9/11/01 although, of course, other issues exacerbated by the attacks would come up.

GG: Have you been getting a lot of calls from people today? As the day progresses, are people feeling better or worse?

Hirsch: For the past 1-1/2 week I have been visiting corporate sites to provide counseling to people who were in the WTC or witnessed the attacks or lost someone. The responses were quite varied. Some folks felt better than last year. Others improved after last year, initially, but saw a return of symptoms. Some are stuck where they were a year ago.

GG: Why is it that so many of us feel the need to tell and retell our stories of that day?

Hirsch: It was the most dramatic disaster, the defining moment if you will, of our lifetimes. There are octogenarians who remember Pearl Harbor, or middle-aged people like myself who recall President Kennedy's assasination. These affected us greatly, but none I fear, as much as 9/11/01. It was the first time we were attacked, since 1812, on American soil, and we all felt terribly vulnerable.

GG: There are hundreds of memorial events in the city today. Are such public events more helpful or less helpful for people who are suffering?

Hirsch: Again, it is variable. For some people, as the families of victims who attended today to whom it is very comforting. Other people, who escaped with their lives told me yesterday that they did not want any more reminders. Many of them volunteered that they would turn off the TV, something that I advised people to do last year. Saturation, for some people is retraumatizing, equivalent to rubbing salt in the psychic wound.

GG: Many people are concerned about their children on the anniversary. What should parents say and do with their children today?

Hirsch: Comfort their children. Try to reassure their children that they will do all that they can to protect them. But do tell them that everything will be alright. The very next terrorist attack and the parents will lose credibility. But simply reassure them that they will try to do their best. And try to encourage children to resume normal activities. Some children, like adults, may need to memorialize the event.

GG: In February, a New York City Board of Education survey of more than 8,000 New York City schoolchildren found that one in 10 was experiencing post-traumatic stress disorder. Did this surprise you?

Hirsch: Not at all. The numbers were not much lower for adults. If adults felt threatened then of course children will also. They feel even more vulnerable. They don't understand what has happened. Their whole secure world has been shaken.

GG: Now we've been joined by Dr. Lisa Kaplan, Mental Health Advisor for the World Trade Center United Family Group. Good evening, Dr. Kaplan.

Dr. Lisa Kaplan: Good evening.

GG: Dr. Kaplan, what is the World Trade Center United Family Group?

Kaplan: The WTC United Family Group is an advocacy group that was started by Anthony Gardner last Septemeber. The group provides resources for bereaved family members and survivors. It also provides support groups in both New Jersey and New York City. The founder has also been working with the folks from Oklahoma City and an exchange program has been in progress, including a trip with 20 New York City ambassadors to Oklahoma City for the 7 year anniversary in April.

GG: While you both are in the chat room, are there fundamental differences among counselors over what the best treatments are for September 11 trauma?

Hirsch: Yes. Some people have favored critical incident stress debriefing but others, and there are recent studies published that believe that this may be harmful. Many of us just believe in trying to provide eduaction about what is normal. That is very helpful to people to reaasure them that they are not going crazy or that something is not terribly wrong with them. Many folks are using some form of cognitive behavioral therapy. Others find relaxation techniques with or without hypnosis or EMDR helpful.

Kaplan: Definitely. Cognitive Behavioral Therapy and EMDR have been considered quite useful. I have also found that many people take comfort in talking and retelling their story in a supportive environment -- one in which a connection has been made. Many also just need to be told that what they are experiencing is normal -- that they are not crazy, but rather are responding to a traumatic event.

GG: We understand that Dr. Hirsch needs to leave us, so we just want to thank you Dr. Hirsch for dropping by.

Hirsch: Thank you for inviting me. It was my pleasure. Good night.

GG:Dr. Kaplan, could you expand on the therapies mentioned by you and Dr. Hirsch? Which ones have you found the most successful, and could you explain them briefly?

Kaplan: Some people have found EMDR to be very useful. I myself do not practice EMDR and therefore cannot speak to the specifics of the technique.

GG: What exactly is EMDR?

Kaplan: EMDR stands for Eye Movement Desensitization and Reprocessing. Cognitive Behavioral Therapy is a way to look at thoughts and how one's thoughts can impact one's emotional state. By working to alter negative thoughts, or to change "unhealthy" thinking patterns, people are able to focus on more positive experiences. Relaxation techniques can often bring on a state of well being for people. Taking time to be in the moment can be very helpful. Breathing techniques, mindfulness techniques, meditation - these are all types of relaxation techniques.

GG: Dr. Kaplan, to go back to something you said earlier about Oklahoma City, how has the trauma changed in the seven years since that occurred, and what lessons are there in that for New York City?

Kaplan: Oklahoma City has taught us so much. One of the most important things that we have learned is that, 7 years later, people are still very much impacted by the bombing. Some people have been unable to move forward while others are great advocates of education. Psychologically, the people of Oklahoma City are in very different places. I had the opportunity to go to the 7 year anniversary this past April. I spoke with bereaved loved ones, survivors, and rescue workers. They continue to be impacted by the trauma, but many feel that they are able to offer New Yorkers comfort and a knowledge that while one never forgets and never "moves" on, one is able to begin a new chapter. The folks from Oklahoma City are wonderful. They have no desire to tell New Yorkers what to think, what to feel, how to create a memorial, but rather, want to offer support, love and friendship.

GG: There have been some very vigorous, if not downright nasty, debates about the memorial vs. rebuilding the twin towers, what size the memorial would be, whether the footprints should be built on. There are several questions about this. Do any family members and survivors who talk to you discuss these issues at all?

Kaplan: Yes, they do. The family members, survivors, and rescue workers want to be part of the decision making process. They want to have a voice in what happens to the land. Some believe that the ground is sacred, others feel less strongly. Ultimately, those with whom I have spoken want the site to provide a sense of comfort and remembrance for what happened to their heroes.

GG: Does trauma have anything to do with these passionate responses and disagreements about what to build or not build on the site?

Kaplan: That is a difficult question to answer. I don't think trauma per se results in these different responses. Rather, I believe that people have very different thoughts and beliefs, and that ultimately that is what impacts the response.

GG: An article in the New York Times today called the mental health efforts in New York "the nation’s largest – and least stigmatized – offering of mental health treatment ever." Has your profession changed since 9/11?

Kaplan: Definitely! Many people who would not have previously sought treatment, are now turning to professionals for help. Unfortunately, there are many people who still are not able to come forward for help for fear that it will impact their job or their reputation.

GG: You seem to see a clear connection between Oklahoma City and the World Trade Center attacks. How is New York's trauma after the September 11 attacks unique, if it is?

Kaplan: New York's trauma is different. Not only were New Yorkers impacted, but every person in the United States who had a TV or radio and every person abroad who had access to media coverage was impacted by this event. We did not just see those planes hit one time, but repeatedly. Close to 3000 people were killed in New York on September 11th. Whether you knew someone who died that day or not, you experienced the loss of safety, security, and peace. We continue to experience the trauma associated with the terrorist attack, and I believe we will continue to experience the magnitude of the event for the rest of our lives.

GG: Do you think that September 11, 2003 will be this big and this difficult?

Kaplan: I think so. The family members and survisors and rescue workers that I see, as well as myself believe that September 11th 2001 should never be forgotten. It is important that we memorialize the heroes who died that day and one way to do that is to make the 2nd anniversary important, and yet different than the 1st.

GG: Thanks Dr. Kaplan for attending our live chat. Do you have any last comments you’d like to mention for our readers?

Kaplan: I hope that people will continue to seek out services as issues and concerns become apparent. I also wish everyone health and peace. Thank you for this opportunity to communicate with your readers.

GG: Thank you again Dr. Kaplan.

Kaplan: Your welcome - this has been my pleasure.

Disclaimer: While the psychologists may provide guidance and advice in the chat, the live chat is not a substitute for clinical psychological treatment and their suggestions are not official medical advice.

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