Mental Health Effects of Terrorism Focus of APA-Sponsored Panel

Beneath a 38-foot-tall American flag, the American Medical Association convened its interim meeting last month in San Francisco. Amid patriotic themes and messages of national unity, the medical and mental health aftershocks of the terror attacks of September 11 took center stage, with three presentations on bioterrorism and disaster preparedness.

The last of the three presentations was organized and delivered by APA members to educate America’s largest physician group about the mental health aspects of disaster.

AMA President Richard F. Corlin, M.D., told those at the opening session of the AMA’s House of Delegates that one of the association’s primary roles lies in “educating physicians on recognizing and responding to biological attacks.” With more than seven hours of educational sessions on the subjects, Corlin said, the AMA hoped to deepen physicians’ clinical and professional skills in this area.

Nancy Nielson, M.D., Ph.D., the AMA’s vice speaker, stressed that a vital part of physicians’ response should be a “deeper and straightforward understanding of the mental health aspects of these attacks.”

“The best antidote to public anxiety,” Corlin added, “is full, accurate information. Our job is to deliver that information so patients and doctors can respond to rapidly changing circumstances.”

The presentations were videotaped so they can be developed into an online educational resource. “The AMA wants every physician in the country to have access to the vital information being shared during our meeting. Developing an online program will ensure that all physicians have access,” he told the group.

Taming Terror

The APA presentation, titled “Medical and Health Effects of Disasters: Dealing With the Aftermath,” was moderated by Joseph T. English, M.D., former APA president and senior APA delegate to the AMA (see Original article: story on facing page). As chair of psychiatry and behavioral sciences at St. Vincent’s Catholic Medical Centers and associate dean and chair of psychiatry and behavioral sciences at New York Medical College, English is familiar with the traumatic effects of the World Trade Center disaster. St. Vincent’s is the closest trauma center to that site.

“It became quickly evident to all of us as we sat [waiting in St. Vincent’s emergency room for victims on September 11] that there was a mental health catastrophe developing,” English said, opening the session.

English’s staff and faculty provided counseling and support services to more than 7,000 people in the first two weeks after the attack, and their help line received more than 10,000 calls in those first two weeks.

“As dramatic as those statistics may be, I fear that we have just scratched the surface of the need for mental health care that traumatized and grief-stricken victims will need,” he said.

During the presentation, what is currently known or theorized about the psychological steps leading to acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) was detailed by David Spiegel, M.D., a professor of psychiatry and behavioral sciences at Stanford University School of Medicine. Spiegel is a former member of the APA Committee on Psychiatric Dimensions of Disasters.

“That which makes us the most human is after all that which makes us the most vulnerable—namely, our compassion for other beings, our empathy, and the emotions that we feel when we experience the sort of stress we have all lived through in the last three months,” Spiegel emphasized.

Spiegel said that the cognitive ability to reorganize overwhelming sensory input, to manage emotions, and to find effective social support all lead to resiliency following traumatic events.

However, managing emotions is the most difficult step for most people. “Emotion affects cognition; it makes it difficult to carry on our usual routine—in essence it hijacks the cognitive processes in our brain,” Spiegel said. People think they are doing just fine, he explained, but stories abound of car accidents in parking lots and briefcases or purses left in unusual places as people, distracted by the emotional impact, drove their cars into one another or walked off without something they would ordinarily not forget.

Social contact is extremely important in combating the development of posttraumatic stress, he said.

“One of the rather odd advantages of this terrorist attack is that it was an attack on all of us,” Spiegel said, “it was an attack on our social fabric. In the aftermath, building social connections— talking about it—really helped many people to weave that social fabric back together. Most people instinctively turn to social support at times of stress.”

Children’s Reaction

The same is true of children, said David J. Schonfeld, M.D., an associate professor of pediatrics at Yale. But, he emphasized, children have a harder time reweaving that fabric because they have not fully developed their social skills. It is important to create environments where children feel it is safe to ask questions, to learn, understand, and make meaning out of the events of September 11, he said.

Following Schonfeld, Peter Katona, M.D., an assistant professor of clinical medicine at UCLA, discussed the medical perspective of dealing with the aftermath. He emphasized that America is experiencing a paradigm shift, culturally, politically, economically, and certainly clinically and psychologically.

“Dustin Hoffman was paid more to star in ‘Outbreak’ [a movie about the release of a biological warfare germ] than the CDC received in one year to combat bioterrorism,” he noted.

“Bioterror is best fought through perspective,” he continued. “Taking a bath or eating your dinner is statistically more lethal than the chances of dying from anthrax.”

Katona cited 1991 CDC statistics showing more than 5,000 deaths annually are due to food poisoning, nearly 1,300 per year result from “inhalation or ingestion of food,” and more than 300 deaths come from “drowning or submersion in a bathtub.”

Health Fallout Will Linger

Several hundred AMA members attended the presentation including Nielson, the AMA vice speaker.

“Long after the physical damage is cleaned up and rebuilt, long after the medical aspects of anthrax are dealt with, we physicians will continue to deal with the enormous aspects of the mental health implications of this past fall,” Nielson told Psychiatric News.

The AMA’s Web page on disaster preparedness and bioterrorism is found at www.ama-assn.org/ama/pub/category/6206.html. Spiegel’s Web page at Stanford is found at http://coping.stanford.edu/. ▪