David Spiegel on 9/11 and post-traumatic stress disorder

STANFORD, Calif. -Five years after the Sept. 11 attacks, mental-health professionals continue to weigh the effects they had on Americans' well-being. David Spiegel, MD, professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, began conducting an Internet-based survey of people's reactions to those events in October 2001 and continued to track the emotional fallout. An authority on post-traumatic stress disorder, he discusses the impact the attacks had and continue to have on people's mental health. To mark the fifth anniversary of 9/11, Spiegel will speak at a Sept. 9 conference in San Francisco on grief, loss and renewal. More information about the event, sponsored by the Alliant International University, can be found on the Alliant Web site.

Question: Early reports after 9/11 indicated that many people were suffering from post-traumatic stress disorder. Just how widespread and how lasting were this and other disorders?

Spiegel: There was a lot of concern about the prevalence of serious emotional responses, such as PTSD, after the 9/11 attacks. It looks as though it was widespread but not prolonged. Studies of New York City showed an overall PTSD rate of 7.5 percent and a 20 percent rate among those living close to the World Trade Center attack. This was a very high rate of PTSD, but follow-up studies showed that rates returned to baseline levels after six months. So it seemed to be a very intense, very acute emotional reaction that resolved very quickly.

Q:Why was 9/11 a particularly significant event for mental-health researchers to study?

Spiegel: It was sudden, unexpected and affected a very diverse group of people. It is not uncommon for natural disasters to impact a specific group. The events of 9/11, though, affected a much broader spectrum of the population. Also, we have newer information technology that enabled us to study the event in different ways. We were able to get online and have thousands of people fill out questionnaires about their emotional reactions to 9/11.

Q: What were some of the lessons mental-health professionals have learned from the response to 9/11?

Spiegel: We found through our Internet survey that there were two kinds of cognitive responses to the attacks. There were some people who said, "I want things to go back to the way they were before," and those people tended to have more stress. Other people used it as an occasion to rethink their priorities, and they wound up doing better. For example, I recently spoke with a woman who had been in a building across the street from the WTC during the attacks. She said she realized she could have been killed too-and she wound up changing her life entirely. She quit her demanding job and spent more time with her daughter, and she said it made a big difference in her life.

We also saw in our survey the importance of community support. I think one of the things that gave people comfort following 9/11 was the sense of coming together as a community and as a country. We found that people with bigger social networks were less distressed, and people who felt forced to keep their problems to themselves were doing worse.

Using information technology to provide more rapid and accurate information, and to match offers of help to those in need is also very important. Good debriefing of emergency workers is key. The New York police did not require it; the NYFD did. The rates of suicide were lower among firefighters in the year after, despite much worse trauma exposure.

Q:How did the effect of 9/11 compare with that of Hurricane Katrina?

The emotional response to Katrina has been rather different. The primary problem after 9/11 was PTSD: intrusive thoughts, nightmares, flashbacks, numbing, inability to engage in usual activities and irritability. By a ratio of 2-to-1 the major problem after Katrina is depression, and the depression is growing as people realize that the city will remain a sodden mess for at least a decade. I was just in New Orleans, and it's terribly depressing. Ninety percent of the city is still a wreck, and, unlike New York after 9/11, the city has experienced little support from every level of government. The people there are faced with a kind of chronic despair and hopelessness that tends to fuel more depression about the present and the future, rather than a post-traumatic reaction to what happened in the past.

Q:Could the fifth anniversary of 9/11 - and the media's inevitable stories and images - revive some of the psychological struggles?

Spiegel: One of the best predictors of having PTSD is having had it previously or having been traumatized previously, and I have no doubt that some people will have very strong reactions to revisiting the 9/11 images. In our survey, we found that people who had too much media exposure tended to be more distressed afterwards. I think the combination of intense visual imagery and little assistance in dealing with the meaning and response to the attacks is problematic. This could also be a particular problem for children, who will see images on television and think the attack is happening now. That's why child psychiatrists got to the networks a few days after 9/11 and told them to stop replaying the images: they were worried that kids were being newly traumatized by watching.


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