Newsweek Mental Health - Critical Incident Stress Debriefing

Coping With The Aftermath Of Tragedy
by Avram H. Mack, M.D., Richard J. Frances, M.D. and Jeffrey P. Kahn, M.D.

The September 11th attacks have had a profound emotional effect on New Yorkers, Washingtonians and all Americans. Some of us were there. Everyone was confronted with frightening images and information through television and the press, with consequences on their personal lives and with fears of ongoing danger.

How can we get through this awful event, these terrible emotions, this fearful time? How can we comprehend this tragedy, return to a semblance of normal life and adapt to the way our world has changed? While everyone will have a different reaction, there are four steps that many will find helpful and that may prevent psychiatric complications.

First, take an inventory of all of the large and small ways that your life has been touched by loss, inconvenience, unpredictability and change. Be sure to include effects on your family and others close to you. At the same time, take note of other changes you've experienced recently. And don't overlook any positive events in your life, because they can be especially stressful at a time like this.

Second, recognize that these changes can stir up powerful feelings of grief, fear, anger, uncertainty, guilt and preoccupation with the disaster. Reach out for help and talk about these feelings with people to whom you feel close. Family, friends, colleagues, neighbors and clergy are having some of the same feelings that you are, and most will find discussion as helpful as you will. Some people will find it too hard to talk just yet, so be available without pushing too hard.

Third, after taking a personal inventory of the way your life and your feelings have been affected by this disaster, find practical ways to cope with change and distress. Your ordinary coping mechanisms have not left you. Keep occupied with problem solving, work, family, prayer, exercise, movies, music and more. The goal is to focus your energy in positive directions, and give your mind a respite from troubling emotions without trying to deny those feelings. If you've had some problems before, it is important to make sure you are getting good help now.

Fourth, after having benefited from the help of family, friends and others, reach out to help those who have not yet become aware of how their lives have been changed by this tragedy. Helping is more than a coping mechanism: it makes you feel better. Within a few weeks most people will find that their most intense emotions come under control. But recovery may be more difficult for people with greater losses, prior traumas, other life problems, fewer social supports, a history of commonplace anxiety, depression, or addiction disorders, or for those who are faced with the emotional dilemma of tragedy combined with positive changes.

Signs of greater distress may include ongoing sadness, hopelessness, anxiety, irritability, fearfulness and changes in sleep, appetite, concentration, impulsivity and abuse of alcohol or drugs. Sometimes, severe distress needs more than just your support. While you shouldn't try to be an armchair psychiatrist, you can help people seek evaluation by a psychiatrist or other mental health professional. These tragic events remind us to pay attention to our own and others' feelings and emotions, and the importance of reaching out to each other.

Dr. Mack, the author of Concise Guide to Alcoholism and Addictions, is a resident physician in child psychiatry at Columbia-Presbyterian Medical Center and a trustee of the American Psychiatric Association. Dr. Frances is the medical director and CEO of Silver Hill Hospital, New Canaan, Conn., professor of clinical psychiatry at New York University Medical School and founding president of the American Academy of Addiction Psychiatry. Dr. Kahn is president of Manhattan-based WorkPsych Associates, providing a range of services to corporations and executives. He is past president of the Academy of Organizational and Occupational Psychiatry and teaches at the Weill Medical College of Cornell University.