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 Emotionally Surviving Disaster Successful Surviving After 9-11 Sustaining mental health: Understanding and coping with the reactions of adults and children in the aftermath of 9-11.
At times like these we feel a sense of disturbance, anxiousness, even panic about our safety and the safety of our loved ones. We worry suddenly that we are in imminent danger of losing our life styles, our livelihoods and our possessions. We feel a disturbing sense of disconnectedness from former expectations. At times like these we forget that we have long known of many dangers and that we know how to forget about things we can't do anything about. We forget that we are going to die no matter what happens, no matter how safe we keep ourselves. We forget we had faith in a higher power or luck or the distance between us and the disasters of others. We forget how to feel comfortable and we forget how to let our loved ones out of our sight and still feel sufficiently connected. At times like these actual events and possible future events of tragedy and disaster are discussed, detailed, reviewed, dissected, hypothesized, predicted, warned and worried on several tv channels and in newspapers and magazines. We can become anxious, obsessed and distressed. Some or all of our best qualities shine and some or all of our composure disappears. What's normal for adults What's "normal" is really not known. No such tragedies with such a direct line to so many people's awareness have occured before. Never has news reporting been so capable of relentlessly, graphically presenting every image, nuance and thought. No society has ever had such things happen in front of their eyes, and then repeated day in and day out from before breakfast to the last thing at night. Twenty years from now, we will be able to say what was "normal" for adults and children following the disaster of 9-11. There may be a number of reactions that are not now expected on the basis of what is "normal" in less public disasters. We may be surprised to find extremely devastating reactions previously unseen. We may be surprised to find extremely positive, adaptive reactions. What's "normal" in reaction to 9-11 may not necessarily be okay to dismiss without finding professional help. Focus on the goal of being emotionally and physically healthy with a stable sense of hope for the future. A roller coaster of emotions. Adults can expect it to be "normal" in the initial days and perhaps the initial few weeks after such a disaster to experience a rollercoaster of reactions ranging from disbelief, anger, panic, numbness and distress. Confusion and forgetting. Adults may find themselves forgetting or confusing important details of projects or meetings. Going someplace and finding one's self ending up someplace else or arriving places without remembering the process of getting there will be common. Being more anxious away from loved ones and/or being more snappish and irritable with loved ones and others will be normal. Snake-fascinated - glued to the news. Finding one's self glued to the television, re-watching the same scenes again and again, wanting to catch anything that might come up new, devouring magazine and newspaper articles, is "normal" but may be very counter-productive to mental health. Stress and anxiousness symptoms. This includes trouble sleeping, queazy stomach, muscle tension and being easily distracted. Surprising symptoms of stress and anxiety. Even if it seems you have a pretty good handle on things, you may find yourself exhibiting or experiencing evidence of stress and anxiousness. This is because we can get things out of our consciousness that can stay in our minds without our recognizing them except for indirect evidence. This is normal and doesn't mean anything more than you are more stressed than you had realized. A pressure to do something -- anything. A "normal" response to disaster is to feel a panic and pressure to do something, anything, to re-acquire a sense of power and control over one's own life. It is "normal" to have the urge to do something even if there is nothing to do. It is "normal" to want to do something no matter how poorly thought through or likely to be ineffective or even counter productive. Some people may find themselves pressuring officials to do something without caring what. Some will turn to Faith and others to turn their back on their beliefs altogether. Some people may find themselves feeling they need to change their career, where they live, how they dress or what car they drive. What's normal for kids Pre-schoolers, can be expected to be more clingy and needy of affection and closeness to parents -- unless parents have somehow managed to not let them know about or suspect any of the anxieties the adults around them may have. Preschoolers may have occasional nightmares and may regress somewhat (i.e., need diapers again after months without, talk more immaturely, want to be carried more). For elementary school age children, it can be normal to want to be playing with toy planes and acting out plane crashes and disasters or playing with war toys, acting out war scenerios with terrorists, crop dusters, or anything else that might become a topic of discussion on the news and among the adults and teens around them. There may be occasional nightmares, fears, occasional incidents of bedwetting and an increase in anxiousness when separated from parents. For teens, it will be normal to want to be with their family and their friends in the initial days after disaster and later more with their friends. It will be normal to exhibit anxiety or bravado or both at different times. Teens may tend to work out their nervousness by engaging in dangerous activities, watching horror movies or movies about terrorists -- and may feel that they should go ahead and experiment with drugs or engage in sexual relations. Teens may exhibit an attitude that since they may be dead soon, they should have as much fun as possible and do all the adult things they might otherwise never get to do. What's trouble What indicates a need to seek help What's trouble for adults, whether it is "normal" or not, is experiencing a sense of hopelessness or extreme anxiety for more than two weeks. Two weeks is considered the amount of time the brain and nervous system can sustain a high level of upset without having its chemistry altered to such a degree that medications and psychotherapy may be needed to reverse the situation. If this occurs, consult a psychologist, MD or other appropriate professional. Similarly, if repeated nightmares, significant problems with confusion, extreme irritability and/or extreme emotional numbness are experienced for more than two weeks, a professional should be consulted. If problems controlling the use of alcohol or drugs occurs for more than a day or two, a professional should be consulted. What's trouble for kids, whether it's "normal" or not, is any blatant, significant acting-out behavior or risk-taking behavior or attitude. Elementary school kids or teens that exhibit such behaviors and attitudes should be talked to in depth and if it seems possible that they remain likely to engage in such behavior or attitudes, consult a professional. The impulsiveness and dangerousness of teens' behaviors, especially, should not be taken lightly. Nightmares and fears are normal but if nightmares are fairly constant for more than a week or if the child seems impossible to reassure about fears and if significant fears don't seem to remit after a week, consult a professional. What you can do for yourself Try to keep your life as normal as possible. Keep to normal routines and normal pastimes and hobbies to whatever extent you can accomplish this without stressing yourself out. DO NOT avoid fun things because you don't feel like having fun. Go and do your best to have fun. Expect that after awhile you may find yourself being able to let anxious thoughts go for a time only to have them slam back into your thinking. This is common after tragedy or trauma. It's a part of your mind (the part of your mind that thinks its supposed to watch out for danger 24/7) suddenly realizing it hasn't been checking for dangers for awhile. It really is good to let that part of your system relax and rejuvenate once in awhile. It can't really protect you 24/7. It needs brief periods of rest now and then to function correctly -- even though for many people, that part of their mind seems to not know this. This process of accepting that jolt of re-orienting back to troubles and dangers. It is the mind learning it can let itself relax and yet come back to full alert and awareness quickly. Most people, after trauma, need to let themselves re-learn how to let themselves relax enough to rejuvenate. Don't avoid socializing. Try to be around positive people. Try to keep negative, angry people at a minimum. If others are "bringing you down," tell them to knock it off because it hurts you. Avoid drugs and alcohol except in moderation and/or advised by a physician. Eat right. Push yourself to get adequate nutrition if you don't feel like eating. Close the refrigerator for reasonable periods if you find yourself turning to it for comfort. Get some exercise. Walk instead of driving short distances. Go to the gym. Use your anxious energy. Turn off the reporting on the disaster and/or war except for a maximum of one hour a day. Don't be pushing yourself or others to make changes or do things without well thought out reasons. Remind yourself that you should be counting your blessings and revising your values so you are spending quality time enjoying the good things in your life. Don't spend valuable time mourning losses that haven't yet happened. Enjoy and value the things and the people around you now even more in case you do lose them later. Plenty of time for mourning later. No need to start early -- there's no rush. Better to have loved and lost than never to have loved at all -- that goes for people and things, both. Take at least five minutes a day (ten is better, twenty is best) to focus on muscular and emotional relaxation and deep breathing. Remind yourself that you can handle change -- and that things are just things. Everyone breathing has dealt with countless changes and survived every one. The worst that is likely to happen to most of us is that we will need to cut back on or do without some of our things. For those of us that may lose or have lost loved ones, remind yourself that you don't have power over life vs. death and that the worst that really happens when we lose someone is that we will miss them terribly but only for the rest of this life. Focus on what it may be like beyond the loss. It is unknown what happens after death, but in all likelihood, either there will be a re-uniting after death or there will be an ending to our sense of missing anyone or anything. If you feel like you're going crazy, get help. Be responsible for yourself and as much of your life as you can be. If you've turned your back on your Faith, turn back to it. If you feel that your Higher Power has become angry, vengeful, mean, unfeeling or arbitrary, work to accept the possibility that you may not be able to understand what good purpose there is to disaster but that doesn't mean there isn't one. Remind yourself that we all die one day. If you thought God only let bad people be hurt in this life, recognize how silly that idea is -- there is much too much evidence that that cannot be the case. A handy strategy is to recognize two facts of this life and apply them to the possibility of the afterlife: 1) times goes by faster and faster as you age; and 2) we experience life as contrasts and the greatest pleasures come in areas where we have had the greatest losses, needs and fears. Recognizing that time goes by very quickly as you age can help you grasp the idea that if there is a God and a life after death, perhaps He allows terror and hurt because first of all He realizes that in the context of eternity, a lifetime of torture passes in a blink. And second, that He may allow terror and pain because it makes the afterlife better, and reuniting that much better -- in the same way that having almost starved makes every meal thereafter taste better than it could ever have tasted if you had never been hungry. Comfort yourself. Tell yourself it will all turn out all right. You have always survived everything. Self-talk is powerful and important. Assume there are parts of your mental self that listen to your thoughts when you talk to yourself in the same way a child listens to his or her parents. Focus on quality of life and not quantity. Focus on quality of attitudes and coping -- and not on things. If there is a God and an afterlife, it will be most important how you live, not how long. It will be more important how you live with respect to your fears and your faith -- not with respect to how many luxuries or physical securities you have. If there is a God and if God is mean or mad, God is still God -- there is no sense in griping unless you feel it's more likely that he will feel kindly toward someone with gripes than someone with faith. If you cannot find any sense of connection to a Higher Power, comfort yourself. Tell yourself it will be all right. If you believe there is no God and no Afterlife, and if you are right, when you die you will no longer care about anything -- nothing that happens will matter in another few decades. If you hear of and become anxious about "psychic predictions" about the future that include further disaster, recognize that if such "paranormal" stuff is a reality, then this is proof of there being more to life than what we generally see and this suggests a strong possibility that there actually is something that transcends time and death. Remind yourself that you have been able to put things out of your mind in the past. There has always been danger of terrorists, nuclear war, regular war, mugging, burglars, asteroids from space hitting the earth, car crashes, plane crashes, train crashes, disease, tornadoes and -- if nothing else -- death in old age. What you can do for others Encourage them to do the above. Be available to listen to worries and fears or to just listen to mundane things. If possible, involve them in something other than catastrophizing or anxiety reinforcing discussions -- listen to anxiousness but don't reinforce it. Be positive. Take them with you to some life affirming movies or activities. Don't take negativity or irritability personally. Share your spirituality but don't push it. Be patient with their reactions and anxiousness without adopting them yourself. Don't go beyond your limits of healthy tolerance for negativity and anxiety. Don't let yourself adopt the anxiety, anger or negativity of others. If you find yourself unable to stay positive, disengage before you become a negative support or before you decide you can't give further support ever. What you can do for children For pre-schoolers, act as if you are sure things will be okay and that your child(ren) will be okay -- you are sure. Be a good actor and keep an eye on how convincing you are. Most little kids want to just believe their parents if they say everything is okay. On the other hand, though, little kids pick up on anxieties in parents even if the parents think they're covering them up. Try to keep to daily schedules and routines. Carefully listen to your child(ren) to get as good an understanding as possible of any fears or concerns. Read happy stories and be careful what tv shows are seen. Just before bedtime, talk to your child(ren) and tell them stories of being together in the future when they are very, very successful (e.g., "when you grow up maybe you'll be a banker -- a very rich banker -- and we can all live together in a big house you'll have with just the kind of swimming pool that we can have wonderful times in...") -- stories that suggest you will be together, you will all be happy, your child will be very successful. Keep in mind that the last things they think about before sleep will probably color their dreams through the night. You can make a game of having a different story every night or the same story with different little details. [Note: this is for little kids. Little ones up to 9 or 10 are comforted by thinking they will continue to be connected with parents when they're adults. Don't tell teens such stories unless they've ingested something you want them to vomit up.] If frequent nightmares or bedwetting or very regressed behavior is noted for more than a week, consult a professional. For elementary school age children, keep in mind that kids may have a wide variety of reactions and that these may not make immediate, logical sense to adults. Tell children that everything will be okay, one way or another. Be honest and open about the disaster but be careful of wording and phrasing and be mindful of their reactions as you speak (i.e., don't talk to them while doing something else). Keep television news watching at a minimum and only with an adult watching along with to process information and assure the child's understanding. Monitor other television watching and avoid shows with negative or frightening messages. Allow children to express their feelings -- be there to listen, let them express feelings in drawing, story telling or letter writing. If your child seems very anxious or depressed or if nightmares or bedwetting or significantly regressed behaviors repeatedly occur for more than a week, consult a professional. Do not give false reassurances. Kids in this age group can understand there was danger and that many adults think there still is. If spirituality is a part of the lives of your children, remind them of it. For teens, keep in mind that friends are the most profound influence on teenagers. Try to have contact with teenagers' friends so you know how they are dealing with things. Watch for negative thoughts or catastrophizing. Watch for ideas suggesting that it makes no difference what behaviors are engaged in because of imminent demise. Be available to teens so they can talk to you if they feel a need and be sure they know you are. Ask them to tell you how they feel about events and allow some degree of down-playing if you believe you aren't just getting code for "I don't want to talk about it." Insist that they indulge your silly anxieties and that for the time being they make sure you know where they can be located and what they're up to. Monitor and limit media exposure. Keep in mind that there may be a lowering of teens' personal restraints about things like sex or experimenting with drugs or other dangerous behaviors. Many teens will catastrophize and have very emotional reactions and some will feel that they don't want to postpone any looked-forward-to adult delights if there is any chance they may die before they get to them. If spirituality is a part of the lives of your teens, remind them of it. If you see signs of significant increases in risk-taking behavior or if prolonged anxiety or depression seems to hang on for more than two weeks, consult a professional. Frequent nightmares, regressed behaviors, bedwetting, school refusals or increased hostility is also cause for concern for which you should consult a professional. Biting the Bullet - Getting Some Help If you need to see a counselor, you need to see a counselor. Many people will try to deny, rationalize and blatantly lie to themselves and others to avoid going to a counselor. Most are afraid to open up about feelings and secrets, feeling they will lose control or be overwhelmed by emotion and look foolish. Some people don't want to go to a counselor because they want to feel bad -- they don't want someone taking away their feelings and fears or they feel they deserve to feel bad because of some sense of guilt. Almost nobody actually admits that to themselves or anyone else. Most say something like, "Why bother going to a shrink? What can a shink do for me? He's not going to put the World Trade Center back up -- he can't stop the fact of terrorism."
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