Attack On The Spirit

By Jeffrey Kluger

Molly Galo had grown accustomed to getting up at 3 a.m. to nurse her infant son. The tender moments in the quiet house were good for both mother and baby. But she won't do it anymore--at least not alone. Molly's husband Matt works on the 75th floor of Chicago's Sears Tower, "an obvious target" for terrorists, she says. Now when she gets up in the middle of the night, she gets Matt up with her. "I need company," says Galo. "I don't want to be alone with my thoughts." She now also insists that her husband always keep his cell phone on. Last Thursday, she says, "I called him 8,000 times."

There can be an odd, exponential geometry to trauma. Lose a single person in an accident, and the lives of five or six more people--family, friends--are rocked. Each of those five or six lives may touch five or six more, and those still more. If the original death toll is higher--say, 168 in a truck-bomb blast--the shock waves may extend across an entire state. And when the number of fatalities reaches the thousands, the very mental health of the nation can be shaken.

As rescue workers began weighing the destruction from last week's terrorist attacks, psychologists were similarly beginning to estimate just what the emotional cost might be. Around the country, normally well-adjusted people have found themselves jumping at shadows, avoiding crowds, giving in to little rituals (take the subway to work but the bus home in the evening) that provide not a jot of real protection but somehow offer them an irrational reassurance that if another plane comes screaming out of the sky, maybe it won't be coming for them or their loved ones.

Some people will easily shake the jumpiness, but others may not--and therein could lie a quiet national crisis. Unlike cockpit recorders and buried bodies, damaged psyches often require a long time to reveal themselves. The longer they take to appear, the longer they will take to heal. "We need a systematic approach to triage not only physical problems but also emotional ones," says Dr. Robert Pynoos, director of the trauma and psychiatry program at UCLA.

Of the three places that were hit by the hijacked planes, New York City suffered by far the greatest emotional damage. As soon as the scope of the disaster became clear, grief counselors went on duty in hospitals and emergency centers around the city. The most severely shaken people were those who had been in or around the World Trade Center and survived the explosions. At least 300 of the injured immediately flooded St. Vincent's Hospital, and at least 100 of them, says orthopedist Andrew Feldman, who worked in the emergency room, were "over the top--crying, becoming belligerent, trying to get out of their stretchers."

Just as hard to soothe, though for different reasons, were the people one step away from the disaster--the tens of thousands of relatives of people missing or killed. At Manhattan's 69th Regiment Armory, family members waited in lines for hours to scan lists of victims treated at emergency rooms or identified as dead, looking for a familiar name. When they found nothing--as most did--they filled out a seven-page form describing the missing person with details that included hair color, length of fingernails and even earrings and shoes. Some brought strands of hair plucked from loved ones' brushes, hoping that if survival was out of the question, DNA identification would at least make death a tolerable certainty.

It's this kind of clutching at strands of hope that helps define the early stages of grief and shock. In most cases the grieving move on, following familiar steps that include anger, depression and, finally, acceptance. Last week's blasts, however, may have ripped out that recovery route. "A woman kisses her husband goodbye, and the next thing she sees, the whole damn building falls down," says psychiatrist Marvin Lipkowitz of Brooklyn's Maimonides Medical Center. "There's a limit to what the mind can take."

If people who were touched by the devastation may be reaching that limit, it's possible that people living in other parts of the country may be moving close enough to glimpse it. The repeated slow-motion images of the towers swooning and buckling, the shots of victims tarred and feathered with blood and dust, the very ordinariness of the workday exploding into a doomsday may exact a psychological toll as people wonder whether the same hell will be visited on them too.

The physical symptoms that cascade from the brain when it is infected by fear are familiar--sweaty palms, accelerated heartbeat, jumpiness, sleeplessness. Frequently, long after the immediate danger has passed, anything that calls the trauma to mind--a picture of the New York City skyline shorn of its two largest shapes; the sight of an airplane gliding by overhead--can give rise to the same symptoms. All too often, the most obvious coping mechanism, if only in the short run, is simple avoidance. And this week a lot of Americans are practicing it.

Pat Yarno, 49, a rental-car-agency manager in Bourbonnais, Ill., had long been planning a family vacation in Florida. Last week she scrapped the trip. "When I made the cancellations, it was like a thousand pounds was lifted off me," she says. A national company that provides janitorial services to office buildings--including the World Trade Center--was at a loss as to what to do when its workers began balking at using elevators or entering tall buildings.

Happily, most experts don't expect the edginess to last. People who lost a loved one will naturally need a long period of grieving to recover. But others could move on fairly quickly. The acute anxiety that follows a trauma typically lasts one to three weeks before the feeling fades. It's only after three months elapse and the symptoms persist that true post-traumatic stress disorder sets in.

PTSD has been around as long as human traumas have, but it's only recently that experts have truly understood it. People with PTSD suffer repeated nightmares and flashbacks. They may sometimes feel emotionally flattened and at other times be given to outbursts. They become compulsively watchful, and some may begin dulling all these feelings with alcohol or drugs. Left alone, PTSD can become completely disabling. Treatment with a trained therapist, however, can be marvelously straightforward. Reliving the experiences in a controlled way--by talking about them, calling them up and laying them bare--strips them of their power to harm. Gradual exposure to the things that trigger anxiety--elevators, skyscrapers, airplanes--can also help. In some cases, so may antidepressants.

There's no way of knowing exactly who will develop full-blown PTSD in the wake of the recent violence, and early indicators provide conflicting clues. A TIME/CNN poll taken two days after the attacks showed that 34% of Americans will change some aspect of their lives in response to the tragedies. While that also means that more than 60% won't, some people wonder how honest the respondents were being. The public has made a great show of declaring that no terrorist is going to make Americans alter the way they live. And while such swagger has served us well in the past, this time it may simply be discouraging us from admitting how downright scared we are. Doing so could be a vital step toward recovery.

--Reported by Andrea Dorfman, Christine Gorman, Janice M. Horowitz, Alice Park/New York, Harlene Ellin/Chicago and Jeannie McDowell/Los Angeles

With reporting by Andrea Dorfman, Christine Gorman, Janice M. Horowitz, Alice Park/New York, Harlene Ellin/Chicago and Jeannie McDowell/Los Angeles