In Their Own Words: Psychiatrists in New York and Washington Share Their Experiences of the Past Month

WE WERE HERE in the Foggy Bottom area of Washington [where George Washington University Medical Center is located and within blocks of the White House and State Department], unsure if we were personally at risk since there were all kinds of rumors about attacks on the U.S. State Department, the White House, and the Capitol, and for a while there was a plane unaccounted for that could have been headed our way.

Most of the day we braced ourselves for a flood of casualties that never arrived. . . . My colleagues reacted very professionally, following the departmental/hospital disaster plan, staying at their posts despite the threats, and at the same time getting in touch with the people they love or those who depend on them. People were kinder and more patient with each other than usual, it seemed.

I felt steadied by the steadiness of people around me and protective of the medical students. I was grateful to have learned and thought about trauma for a long time, so that I could monitor my own reactions, observe irrationalities in myself, and give myself permission to feel scared.

—Julia Frank, M.D., director of medical student clerkship in psychiatry at George Washington University Medical Center in Washington, D.C.

WE HAVE BEEN VERY BUSY, I'm afraid, since the World Trade Center disaster, helping families and workers both at our Family Assistance Center and also downtown in the “hot zone.”

The people we have helped have had many more “normal” reactions than abnormal ones—lots of insomnia, general anxiety, nightmares, problems with concentrating, loss of appetite. But there have also been some cases of more severe depressive symptoms, psychosis, catatonia, and even mania/hypomania. Children's reactions have generally been within what is considered normal, except for a few cases where they were too preoccupied with death themes.

Fortunately no one my wife and I know was directly affected. Emotionally, though, we are drained and stunned by both the tangible and intangible impact this event has had on our city, as well as by the immense clinical and organizational effort our organization's response has required. One feels hurt in the face of this tragedy, driven to do whatever one can as a psychiatrist.

—Craig Katz, M.D., president of Disaster Psychiatry Outreach, a nonprofit group based in New York City that provides psychiatric assistance to people affected by disasters

INITIALLY WALTER REED RESPONDED to the news by preparing for a mass-casualty situation, and mental health assets were positioned in the emergency room. . . .The majority of patients were actually admitted to other hospitals because those hospitals happened to be closer to the site of the attack. So we didn't see a lot of people in the emergency room, but we ended up dispatching teams to the various hospitals in the area that received these victims. . . .

Initially, there may have been some distrust or caution because we were from psychiatry, and there is some concern about the stigma attached to talking with anybody in the mental health business, especially in a group of people that may be concerned about their security clearances. But we presented ourselves as being there to support them and that our contact with them did not indicate any pathology on their part....We [also] provided them with an opportunity to speak in a confidential and safe environment. Almost every patient responded to that very positively.

—John Stasinos, M.D., director of clinical services at Walter Reed Army Medical Center in Washington, D.C., about six miles from the Pentagon

I HAVE HAD CONTACT with injured victims, family members of missing persons, and our own hospital staff. People have reacted in a variety of ways to the catastrophe—most have reacted with anxiety, depression, and insomnia, some with phobic reactions and physical symptoms, and a few with symptoms of major psychiatric illness.

I lived in Los Angeles during the riots and earthquake there, but this experience has for me been associated with much more intense feelings of fatigue and sadness.

—Spencer Eth, M.D., medical director of behavioral health services at St. Vincent’s Hospital in New York City, the hospital that operates the trauma center closest to the World Trade Center

WE COUNSELED 55 OR 60 PEOPLE at our center within the first two weeks after the World Trade Center catastrophe. We saw many people who had escaped the building and survived, and we saw others who had narrowly escaped being caught in the rubble. We saw numerous eyewitnesses. We also had a number of people come in almost as a family—say, community members who had smelled the smoke or had seen the news or had known people affected.

People's reactions depended in part on the dose of trauma they had experienced. They generally experienced increased emotionality. They would think they had their feelings under control, then burst out crying. We saw many people who were having insomnia or panic symptoms. We saw individuals who were dazed and somewhat disoriented. We saw adults who didn’t want to be alone, who wanted to sleep together in the same room.

We also counseled some rescue workers. Some had narrowly escaped being trapped in the rubble. One had been temporarily trapped, but had been able to dig himself out when the buildings came down. Although the workers showed varied emotional responses to the extreme stresses they were experiencing, on the whole they coped amazingly well and had every intention of returning to work at the catastrophe site.

Being a doctor in Manhattan, I was part of the disaster community itself, of course. On the one hand, I sometimes felt intense despair and helplessness. On the other hand, I believed that my efforts to help people counted—that every little piece counted. And that kept me intact.

—Molly Poag, M.D., assistant director of education and training in the department of psychiatry at Lenox Hill Hospital in New York City

I HAD CONTACT WITH some families directly affected by the Pentagon crash. It was on Saturday, September 15, at the U.S. Department of Defense Family Assistance Center in Crystal City, Va., less than a mile from the Pentagon. People had a variety of reactions, ranging from feeling numb over the sudden loss, to feeling angry and agitated, to feeling sad.

One person who lost his brother described being upset over statements about killing the people who engineered this crash. He said that he didn't want other families to have to go through the pain and loss that his family was suffering. I witnessed a lot of courage among these families. . . .

I was also impressed by the way the military and all of the volunteer organizations worked together to support these families. . . .The therapy dogs were a nice addition to the center, providing warmth and comfort to the people in distress.

—Lisa McCurry, M.D., a child and adolescent psychiatrist and an assistant professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md.