WEDNESDAY, Sept. 11, 2002 (HealthDayNews) -- Today, maybe after this morning's moment of silence to commemorate the lives lost in last year's terrorist attacks, most of us are bound to ask ourselves the silent, burning questions:
"How am I doing? How are my family and friends doing? Has my psyche recovered -- or should it ever? Am I doing what I should to heal psychologically and move on? And if I am, why do I still choke up 365 days later when TV flashes the New York skyline image?"
What's normal for now?
It's the kind of question mental health professionals abhor. What's normal for one, they'll hastily say, is not for another. Yet, the human need to measure ourselves against some sort of yardstick, to give ourselves a grade, a pat on the back, a scolding, whichever is deserved, is universal. Even among the mental health experts.
While there's no "Top 10" list of signs that your psychological recovery is progressing, experts say there are patterns, common characteristics and well-traveled ruts in the road to psychological healing that typically follow such a trauma.
So where should we be now, psychologically speaking?
"There is no such thing as 'should,'" says Michael Nuccitelli, a psychologist who has counseled dozens of those who lost loved ones in the 9/11 attacks.
"One of the biggest things we have to understand is, we're made up of many individuals going through a grieving process," says Nuccitelli, who is executive director of SLS Health, a New York behavioral health-care facility 60 miles north of Manhattan. "It's in some ways the same as losing a family member, but it's happening nationally, all at the same time."
However, he adds, the people going through the experience, one by one, are very much individuals.
"There's a general theory that a person has about 18 months to express or suffer through grief," Nuccitelli says, noting it's only a rough guideline. Some have a harder time than others.
Now, at the one-year mark, among those having the most difficult time, he says, are those who already had some sort of psychiatric disorder, such as depression, or those who are experiencing a lot of other stress in their lives.
Whatever the length of the grieving and healing process, it's unique to each individual.
"I know people who have lost immediate family in Ground Zero and don't want to be reminded," says Dr. Saul Levine, director of the Division of Child and Adolescent Psychiatry at the University of California San Diego School of Medicine. "So they avoid any memories. That is their right."
"At the other end of the spectrum are those so preoccupied with the attacks that they devour everything they can; they read, they talk about it. And other people will say to a fault. We should remember that people deal with it in their own way," he adds.
One important thing seems to be dealing with the psychological fallout rather than giving up. According to a study in today's Journal of the American Medical Association, Roxane Cohen Silver, a professor of psychology and social behavior at the University of California Irvine, polled more than 2,700 adults after the attacks and found that psychological stress was common, even though most were not directly affected by the attacks. However, those who gave up trying to cope by distracting themselves immediately after the attacks or by denying the severity of the situation were much more likely to have continued psychological problems, she found.
Those who kept trying to cope, by reaching out or doing something useful such as donating blood, had less distress.
However a person chooses to grieve and to cope, most will experience what mental health experts call an "anniversary reaction" this week.
"People will relive some of the immediate grief effects," says Dr. Francine Murphy, deputy undersecretary for health policy coordination at the Department of Veterans Affairs. "And some will actually re-experience some of the feelings that occurred on the day of the event."
Although the short-term effect may be uncomfortable, she says, "it helps people work through some of the grief and anxiety."
It's also a time to take stock, Levine says. "The fact is, this is a seminal event in everyone's life. On the anniversary, pay homage to who you lost and think seriously about what you have lost."
Going to a memorial service might help, as well as taking part in some favorite family pastime. "Living with ambiguity is what is so scary," Levine says. "We need rituals, tradition, familiarity. It gives us a sense of immunity, and makes it easier to live with ambiguity."
With a year's perspective, Levine says, we can also take stock of how terrorism has changed us as a nation and whether that change might be good. "What it did is make us, even for a short time, look inward at ourselves and our way of life. In the decade before, shallowness had run amok. We were getting richer, fatter, intolerant and shallow in our sense of values."
While we can't be thinking as constantly about the 9/11 attacks as a year ago, he says, the immediate post-9/11 reaction to be more civil, even kind, may have disappeared too quickly. For a while, he notes, we were hugging each other, figuratively and literally, and learning to reach out and help or to reach out and ask for help. "We became much more of a community," he says. "We became much more of a village."
While some argue the terrorist attacks have damaged the nation's psyche and spirit, making us feel weak, others say the events have strengthened us.
"America is very strong, and we've dealt with this very well," Murphy says. "But that doesn't mean we don't have the right to feel vulnerable and to recognize some of the prolonged health and psychological reactions that can occur after this type of event. To ignore that [reality] can actually increase the feelings of vulnerability."
Again it comes down to the individual. Silver says that in her years researching how trauma affects people, she has found the only constant thing is that it's unpredictable.
In one study, she asked parents who had lost an infant to sudden infant death syndrome (SIDS) whether the tragedy made them more or less religious, or about the same. "As many said they were more religious as less. Some said they returned to religion." Others, though, turned their backs with a vengeance.
The more worthwhile question to gauge psychological health after 9/11, says Nuccitelli, might be not whether you are feeling stronger or weaker, but "Are you practicing gratitude?"
"Are you still looking at your children, for instance, and saying, 'Thank God'?" he asks.
If you are doing that and in other ways practicing gratitude, as Nuccitelli calls it, it's a good sign that psychologically, you're coming back. "That shows you have processed it, are doing well and are moving on," he says.
What To Do
For information on coping tips, visit the American Psychiatric Association or the National Institute of Mental Health.
