Taking Care After September 11th: Lessons from DPO

What should we do to respond to the terrorist attacks of September 11th? Some want to flee New York City while others want to work at "ground zero." Some want to watch the news all the time, some want to fight in Afghanistan, and others want to forget the whole thing as quickly as possible. If you are struggling to figure out the best way to react to these horrible events, perhaps you should consider the experiences of Disaster Psychiatry Outreach (DPO).

DPO is a group of psychiatrists that volunteer their time to give psychiatric services to individuals affected by disasters. DPO was formed in 1998 by psychiatrists that worked with the families lost in the Swissair flight that crashed near Halifax, Nova Scotia. Since that time, DPO has responded to the EgyptAir crash in 1999, the El Salvador earthquakes earlier this year, the terrorist attacks of September 11th, the Anthrax scares at Rockefeller Center and at ABC studios, and the crash of American Airlines Flight 587 in the Rockaways in November. In addition, DPO has provided education and outreach in hospitals, public libraries, community centers, a police station, a synagogue, a law school and some affected private businesses.

From these experiences, DPO has learned a great deal about the ways that people cope with disasters. Here are some of those lessons:

- Mental health care consumers are at risk for becoming more sick in this time of stress. Both consumers and families should take this into account. Depending on how much one is affected by the disaster, it may be best to postpone stressful situations or seek out greater support from family, friends or professionals.

- It is "OK" to be afraid. It is important to remember that we as humans are risk-assessing machines. We are always balancing risks and benefits. When we cross the street, we need to balance the risk of an accident with the benefit of getting to the other side. When we become aware of new risks, such as the risks of terrorism, war, or martial law, we need time to assess these unfamiliar circumstances. This can take days to months depending on a variety of factors. If you are struggling with the process of deciding what is safe, try speaking to friends, family or a support group. You can find communities trying to grapple with these tough questions on the internet. Another option is seeking individualized professional help with a therapist, a case manager or a psychiatrist.

- Give yourself time for major decisions. Many individuals affected by these disasters question their values and seek to change basic elements of their lives. Some people want to move out of New York City, change jobs, stop medications or give up on sobriety as a result of these life-changing events. While it is good to explore your options, remember that disasters can create a sense of urgency that can lead to rash decisions.

- For a period after a disaster, many individuals will "regress" or return to maladaptive patterns that they used when they were younger. Competitive people may seem more competitive and passive people may seem more withdrawn. This can lead to conflicts. For example, law-abiding adults who are usually mature enough to talk through their differences may end up fighting on the street as the police and firefighters did in October. If you remain aware that this immaturity may be partially due to the psychological effects of a disaster, you may be more sympathetic and less angry and scared.

- Finally, remember: although it is natural to be distressed by these recent events, that does not mean that you should not seek professional help or that you must suffer alone. After all, it is natural to feel pain if you break an arm, but that does not mean that a doctor can't help! If someone suggests that you get some help, that does not mean that you are weak or bad. It just means there may be some better way for us all to get past this pain together.

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