How Am I Doing? How Are We Doing?
(Column: Ask the Therapist)
Rita Seiden, C.S.W., Ph.D., Executive Director, Park Slope Center for Mental Health
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How are you doing? This is the question that everyone has asked and attempted to answer in the aftermath of the World Trade Center debacle. What do we feel when something this enormous happens to me, thee and all of us?

Numbness and Denial. My first reaction, on getting a phone call from a friend, was "Yeah, right. She always worries about something." Then, I went on to work where I sat with others in front of a TV watching disaster unfold. I couldn't decide to close the office until those workers with young children announced that they couldn't stay any longer. They needed to be with their children. Now, the next questions that I hear being asked are also about that initial denial and numbness: where were you when you heard? What did you think? Over and over again, people report not believing what they heard or even saw with there own eyes. We went numb and didn't want to believe because it is just too big to get our minds around. That sensation -- that it is just too enormous to comprehend -- applies to wherever you are located within our society, and whatever you think about your own significance. Perhaps those with a big sense of personal significance may be the hardest hit -- if you think you are in control, there is nothing like something of this scale to remind you of how human you are, how little control we have, how little we finally differ whether we live on Welfare or earn a fancy living. We may be unable to concentrate, feel restless, feel unmotivated, burst into tears, have emotional outbursts regardless of our station in life.

Guilt. Sometimes guilt fits -- sometimes, indeed, we could have done something before hand that we didn't do. But what could I have done to stop the hijackers? Sometimes we feel guilty (and ashamed) that we are glad to have survived when others died. It could/should have been me. One friend told me that he called in sick, and as a result his colleague went to teach a class at the World Trade Center that he was supposed to teach. The colleague never came home. My friend wept for his "responsibility" in this, for the young man's mother, for himself. We may be inclined to volunteer beyond our capacity, we may try to help others when we need to help ourselves. We may ruminate on what could have been. But, for better or worse, you and I were not in charge.

Anger. I feel violated. I feel that the sidewalk is not safe. What can I trust? Who would dare do this to me? But don't let this anger turn to hatred of essentially innocent people. We may understand the impulse to attack those who seem to represent our "enemy" but we cannot get at our enemy through an innocent citizen. Even President Bush has to establish some "proof" of who is the enemy before he can take action. If you are angry, channel the energy of that anger into being productive and helpful. Otherwise behavioral impulses to act-out against others can be re-awakened. You may look for a fight or a way of satisfying your anger that really has nothing to do with why you are angry.
Sadness/Despair. Something very big has happened. None of us will be the same. We will suffer from direct or vicarious loss. We experience fear, hopelessness, a sense of being overwhelmed, helplessness, confusion, anxiety, sadness, loneliness, isolation. Depression can be re-activated. Look to reduce your isolation. Be with friends, or in friendly situations. Find places where people feel able to talk and socialize.

Re-awakened emotions. For those of us with histories of mental health problems, be aware that a disaster of this magnitude can and will stir up old memories, losses and stimulate stuff that we would just as soon not re-awaken. Measure yourself; use all the tools and insight you have developed as a mental health consumer. Know that you are more vulnerable to renewed pain if there has been old pain and more extreme emotional reactions in your past. There are numerous ways that this particular disaster touches on old pain: the sheer size of the destruction can feel like the end of the world; the sudden deaths of "ordinary" family members can and will remind us of the deaths of loved ones; the smell of burning and death can remind us of natural disasters and fires that may have affected us. If you have been watching for every possible bit of news coverage, you may need to step back and decide how much is enough, and at what point the TV can only make you more miserable. In some ways, the edited and concentrated imagery provided by television and newspapers may be more potent, more devastating than the same sadness offered to us in small doses by friends and relatives.

If you already suffer from post-traumatic stress, pay attention to taking care of yourself. If you already suffer from hallucinations or delusions, know that this kind of tragedy can aggravate those symptoms. Get the help and the comfort that you need. If it feels like you are having a relapse don't be shy about asking for help. But remember also to ask for comfort from those in your life who provide the ordinary emotional solace.

Regardless of our prior mental health, no one can escape the eerie feelings of sadness and despair that have crept into our lives. Yet, we must also bask in the daily kindnesses and heroic acts of strangers toward strangers. Yes, the legacy may be heightened vigilance for our safety, but it will also be a heightened sense of our interconnectedness, our interdependency, and our community.
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