“The September 11 Syndrome” – A Nation Still on Edge

By Harriet B. Braiker, Ph.D.

(NOTE: This article was written before the one year anniversary of September 11).

The nation’s mental health is riding a roller coaster of anxiety. The relative peacefulness of the recent July 4th and Labor Day holidays has taken our rickety Cyclone car to the crest of a new drop. But rather than breathe a sigh of relief, we once again are holding our collective breath as gravity – as well as the gravity of the stark images of terror in our minds’ eye – careens us toward a new threat just around the next sharp bend of a blind curve.

The by-now familiar, steady drumbeat of “nonspecific” warnings that has emanated from Washington has left the air heavy with the threat of terrorism and laden with what a recent TIME/CNN poll calls “massive anxiety” – which silently increases day-by-day.  The Homeland Security Office offers us a colorful chart that translates into a rainbow of angst. 

Yet, we still don’t really know how to think about all of this. And, how we think has everything to do with how we feel.  Modern cognitive psychology is based on the 2000-year-old concept that it is not the events of our lives that trigger our emotions. Rather, it is how we think about or interpret those events that trigger our feelings. 

On September 11, our psychological defense mechanisms endured a shock just as earthshaking and cataclysmic in proportion as the collapse of the World Trade Center towers themselves. As the buildings collapsed, our “it-can’t-happen-here” denial crumpled, too.

What September 11 changed in our minds forever is our perception of risk.

Consequently, as a result of the acute trauma of September 11 and in response to the continuous uncertainty and apprehension of ongoing terrorist threats, we now share a new kind of stress:  The September 11 Syndrome. 

The widespread syndrome is a pattern of psychological symptoms including chronic low-grade anxiety subject to periodic spikes, persistent worry and “what-if” thinking, sleep disruption, intrusive and distressing visual imagery associated with the attacks, irritability, avoidance of fear-provoking activities and/or places, and a general feeling of loss of control, helplessness and vulnerability.

The syndrome is the lingering, long-lasting psychological consequence of repeated exposure to those traumatic images; and the spiking anxiety and vulnerability that can come barreling back with the force of a body blow when threats, warnings or terrorist attempts/attacks -- either thwarted or actualized – are announced.  And we can expect more announcements and warnings – and consequently greater mass anxiety, even if muted – the closer we get to the dreaded anniversary date. 

Just last month, a New York Times/CBS News poll revealed that New Yorkers were still struggling with the psychological fallout from the attack by avoiding visits to skyscrapers, landmarks and stadiums, and reporting persistent anxiety and sleeplessness even after nine months. 

But the syndrome is in no way restricted just to residents of New York, Washington or rural Pennsylvania. The September 11 Syndrome has affected people across America in epidemic numbers. The immediacy and interconnections of television and other forms of modern communications exposed vast numbers of people to the traumatic images and unfolding events of that infamous day almost as though we were there in person, in effect bringing each of us our own “personal ground zero.”

Even now, the traumatic impact on our psyches of the horrific imagery of September 11 cannot be overemphasized. Psychologically, the replayed televised images now seared onto our minds’ eyes of September 11 mimic the mind of a traumatized individual.  

On September 11, we bore witness to visual images that will likely never leave us. It is understandable, therefore, that many people who live outside the immediate attack sites are confused and troubled by the very fact that they still feel so stressed and anxious ten months later. 

Most of us could discuss our fears and anxieties openly in conversation within the first few months after the attacks and the comparative input from others helped us to normalize and process the information overload of September 11. But in time, many people felt that such conversation became somehow unwelcome either because it was disturbing to others or it revealed too much of our own vulnerability.  

So, we began, instead, to suffer in silence, and that has been a dreadful mistake. 

The anxiety and stress did not go away just because we stopped talking about them.  Indeed, suppressing feelings often makes them worse and intensifies a worrisome sense of isolation. For a brief window, after the spate of recent warnings, we began to talk again as our anxiety came rushing back with such alacrity that it surprised many.  But the window to speak openly is closing again, and that is psychologically dangerous.

Getting a grip on our collective anxiety and the other symptoms of the September 11 Syndrome starts with acknowledging and understanding that feeling anxious – even still – is an entirely normal and appropriate response in light of what happened and to the very elements that define terrorism.

The threat of terrorism creates the textbook psychological setup for anxiety and depression to occur. Psychologists call this “anticipatory anxiety” – waiting for the proverbial shoe to drop or, in this case, terrorist bomb to go off. 

Add the element of “learned helplessness” – the perception that there is nothing or very little you can do to stop the terrorism – and depression, vulnerability, and a profound sense of loss of control will develop.  

These are precisely the conditions to which we have all been exposed since the September 11 attacks. They define the New Normalcy and the September 11 Syndrome.

While the terrorists strum on our nerves, the government offers us the oxymoronic message to live our normal lives, resume our daily routines, but remain vigilant and on alert. Remaining vigilant for prolonged periods of time is a recipe for psychological trouble. Staying in an aroused, alert state will disrupt sleep and eventually produce signs of hyper-vigilant distorted thinking and perception.  Paranoia, in a word, is a state of constant hyper-vigilance.  Of equal concern is the opposite condition:  “alert fatigue.” 

The key is to learn how to maintain an appropriate and adaptive level of stress concerning the very real, ongoing reality of terrorism. 

Performance of all types is optimized when an individual is sufficiently pumped up to be “on” but not overly “wired” or anxious. This mid-range of stress is the “zone” that athletes and other peak performers strive to achieve. 

Individuals must learn how to better cope with their negative feelings, thoughts, and images, and know what they can do to become hardened to the stress that terrorism produces.

Psychologists have long understood that certain personalities are more resistant to the harmful effects of stress than others. The secret to psychological hardiness is embodied in people who can maintain a sense of control and optimism over the course of stressful events ahead of them; who view stressful changes as a challenge; and who exhibit a deep and abiding commitment to enduring values that give meaning to their lives. These three “C’s” can be learned.

Acknowledging the anxiety and vulnerability of the September 11 Syndrome is not the same as letting your fears control you, allowing yourself to become debilitated by anxiety, or wallowing in feelings of helplessness. By bringing the threat of terrorism down to the level of what each one of us can do to cope more effectively, we can learn to process and respond to the uncertain times in which we live with a far greater sense of control, challenge and commitment.  

Most important, we have all learned to recognize and esteem courage in others and in ourselves. Courage, after all, does not mean going forward without fear.  It propels us to go forward even in the face of fear and anxiety, and to carry on with life.  

Harriet B. Braiker, Ph.D., is a Los Angeles-based clinical psychologist, management consultant and bestselling author who previously worked at The Rand Corporation. Her latest book is The September 11 Syndrome: Anxious Days and Sleepless Nights: Seven Steps to Getting a Grip in Uncertain Times.