Week of November 14, 2001
Living with the threat of terrorist attacks, we wonder: is fear, anxiety and disorientation our new way of life? We talk about "getting back to normal," but perhaps this is it. This special program explores what we all can do to cope with our inner uncertainty, and, perhaps, strike a blow against terrorism in the process. The program also looks at how the nation's mental health system is coping with this national crisis. Guests include: Mary Guardino, of Freedom From Fear; Dr. Robert Ursano, expert in the psychological effects of crisis and disaster; Cynthia Folcarelli, executive vice president of the National Mental Health Association; Giselle Stolper, executive director of the Mental Health Association of New York; Dr. Russ Newman, executive director for professional practice for the American Psychological Association; and Avner Tavori, an Israeli-born television and radio journalist. With commentary by John Hockenberry. Special program note: Click here for special outreach materials that you can use to continue this discussion in your own community.
Host Dr. Fred Goodwin, in his opening essay, observes that the mental health community is faced with a complex question in attempting to distinguish "normal" from "illness" in the current context of world events. Generally, he says, illness occurs when the symptoms of a disorder persist beyond a certain period of time. Grief, for example, normally includes elements of depressed mood. But should the depresed mood continue for weeks or months, psychiatrists will categorize it as clinical depression, requiring intervention and treatment. The challenge before us now is to find a way to distinguish "normal" from "disorder" when the precipitating stresses in our society continue, and appear likely to persist for some time. Dr. Goodwin says that many people are taking healthy steps to cope -- spending more time with family, at religious services -- and draws a parallel with the way Americans were able to handle the Great Depression, and, subsequently, World War II. He says he hopes this positive trend will help reverse the disturbing lack of connectedness he sees in many of his young patients. But, Dr. Goodwin says, human nature alone won't do the trick. It's critical right now that the nation pay attention to its under-funded and over-stressed mental health infrastructure in order to help the many people in need right now. "Maybe we can finally get as serious about our neglected mental health system as we are about airport security," he concludes.
Next, we turn back time for a lesson in homeland defense from three women who spent World War II living as civilians in the U.S.: Beverly Whiteley, who spent the war years on the coast of Massachusetts; Donna Summers, who lived in New Mexico; and Peg Nicholson, who lived on Long Island. They talk about food and shoe rationing, blackout curtains and airplane spotters, the lack of nylon hosiery, war bonds, and the spirit of a war effort that united young and old, celebrity and factory worker alike.
We're all trying to get back to "normal." But just when we think we're getting there, we hear more news: Anthrax attacks on Congress, on the media. Is THIS the NEW "normal?" Next, Dr. Goodwin welcomes three guests for a far-ranging conversation about about how we can live well while balancing the conflicting pressures of life in the U.S. today. Mary Guardino is founder and executive director of Freedom From Fear, a national not-for-profit advocacy group for individuals with anxiety and depressive disorders and their families, based in Staten Island, New York. Dr. Robert J. Ursano, an expert in the psychological effects of crisis and disaster, is chairman of the Department of Psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. And Avner Tavori is a television and radio writer and journalist, who spent much of his life living and working in war-torn Israel, and now lives in Manhattan.
Guardino begins by reporting that while most people seem to be handling their grief about the events of Sept. 11 through a normal process, people who are anxious or fearful by nature are having a much harder time. The continued uncertainly about personal security has caused serious set-backs for many people with anxiety disorders, she says.
Asked to define "normal," Dr. Ursano says that "normal is a moving target across the world," with our understanding varying both by culture and location across the life-span. At present, he says, our sense of what constitutes a "normal" ability to feel safe and calm has shifted for most Americans, who appear to be sharing a common sense of hypervigilance. "Normal," he says, is a combination of our understanding of what has happened before and our expectation of what's possible in the future. Dr. Ursano warns against overly pathologizing the way we're feeling right now, and observes that a perfectly normal reaction to recent events will contain some elements of disorders such as depression, anxiety and post-traumatic stress disorder.
How do people in chronically war-torn countries like Israel cope with the day to day uncertainty, Dr. Goodwin asks Avner Tavori. Tavori says that the kind of uncertainty we are experiencing today in the U.S. is actually the normal state of affairs in Israel for the past 100 years or so, and, he expects, well into the future. When uncertainty becomes familiar, it's less intimidating, he says. Israelis also grow up knowing who the enemy is, and what they're fighting for, and that indoctrination also helps engender a level of acceptance, he suggests.
Dr. Goodwin asks for some practical suggestions for adjusting to the "new normal." Mary Guardino advises people to try to focus on the present, since the future cannot be known, and to try to figure out what really matters in life. Find pleasure, she says. Dr. Ursano says it's important to remember and maintain the rhythms of life -- eating and sleeping -- and cautions that too much caffeine can worsen anxiety.
Next, The Infinite Mind's Emily Fisher reports on lifestyle trends in this time of crisis. She speaks first with Gerald Celente, director of the Trends Research Institute, in Rhinebeck, N.Y., who says that Americans are feeling uniformly sad and uncertain, and that the financial future looks bleak. This financial down-turn was on the way before the September 11 attacks, says Celente and other trend researchers, including. Stefani Cook, director of strategic planning at D'Arcy, Masius, Benton & Bowles, one of the world's largest advertising and marketing firms. Cook, a psychologist by training, advises D'Arcy clients about consumer trends. She says that Americans now are looking for comfort and to "cocoon" themselves in their homes. Messages of stability and reassurance will do well right now, she says. And although patriotic themes are popular, she says she's cautioned her clients against overt references to the events of Sept. 11. "Initially we came out with a three-point directive," she says. "If you're going to reference this event, either say something that's going to make them feel better, tell them what you are going to do to make things better, or tell them what they can do to make things better. Otherwise, you have no business referencing the events of 9/11…. It's a very dicey issue how much at this point you wave the flag and how much is too much." Sally Singer, the fashion news/features director of Vogue magazine, talks next about the thought behind the November issue and its cover story, "American Fashion Waves the Flag, and writer David Colman, who reports on styles and fashions for The New York Times, talks about his search for meaningful topics in today's uncertain atmosphere.
How prepared are communities across the country to care for people affected by the events of September 11 and its aftermath?Just how secure is the nation's mental health safety net?
Next, Dr. Goodwin leads a discussion with three experts who work to help influence mental health policy on the national, state and local levels. Dr. Russ Newman, a clinical psychologist and lawyer, currently serves as executive director for professional practice for the American Psychological Association. He is responsible for promoting the association's agenda on behalf of practicing psychologists and individuals in need of psychological care. Cynthia Folcarelli is the executive vice president of the National Mental Health Association. A consumer of mental health services as well as an advocate, Ms. Folcarelli has worked for 15 years to influence public policies that impact mental health services and the rights of people with mental illness. And Giselle Stolper is executive director of the Mental Health Association of New York City.
Stolper begins by talking about the efforts of mental health teams who assisted rescue workers at Ground Zero immediately after the crisis.Dr. Goodwin then asks Dr.Newman about the range of responses people are experiencing across the country. Dr. Newman says reactions have ranged from normal to disabling, and that people with a past history of mental illness seem to be the most affected. Research conducted after the Oklahoma City bombing seems to indicate reactions will continue for years afterward, he says. How many people are seeking help? In New York City, the numbers are quite high, Stolper says, with more than 200 disaster-related calls a day to her agency's 1-800-LIFENET crisis hot line.
Can our mental health system handle the load? Both Folcarelli and Newman observe that community mental health programs were stressed before Sept. 11. Newman points to the disparities in how insurance companies and Medicaid pay for mental health care and how they pay for other health services, adding: "We're not talking about a system that's been working fine starting to break down under the pressure. We're talking about a system that didn't work before." Folcarelli says very few communities have integrated crisis mental health services into their disaster preparedness plans. Even when they do, all too often the tendency is to provide counselors for only a short period of time, perhaps 45 days. That's just the beginning of the healing process, she says.
The three offer some tips for people interested in advocating for better mental health crisis preparedness in their own communities. Stolper says training of mental health workers and coordination of services among different agencies is critical, and advises that communities set up systems like her 1-800-LIFENET hot line in advance of a crisis. Newman suggests making mental health services an issue at election time. And Folcarelli urges people to contact their local affiliate of the National Mental Health Association to get involved in local advocacy.(Click here to find the NMHA affiliate nearest you.)
Finally, commentator John Hockenberry rides the subways of New York in a metaphoric quest for what we all lost on September 11.
- June Peoples
Here are some links to other important mental health resources:
The National Mental Health Association web site includes extensive crisis response information and suggestions for people of all ages, and information about specific conditions such as anxiety and post traumatic stress disorder. The information is included in the site's "Mental Health in Troubled Times" section.
Here's what they say about knowing when to seek professional help:
" ... When feelings do not go away or are so intense that they impair your ability to function in daily life, you may have a diagnosable disorder that requires mental healthcare. There are signs that can help you determine whether you are having a normal reaction to our nation’s crisis or if you’re experiencing a mental health problem.
These signs include:
- Nightmares and reoccurring thoughts about the event
- Being unable to stop thinking about what happened
- Avoiding thoughts, feelings or conversations that remind you of the event
- Avoiding places or people that remind you of the event
- Having a sense of a foreshortened future
- Continued difficulty falling asleep or staying asleep
- Feeling jumpy or easily startled
- Being overly concerned about safety
- Feeling guilty, worthless or hopeless
- Not taking pleasure in activities once enjoyed
- Having thoughts of death or suicide
If you are experiencing these symptoms, talking with a mental health professional or taking a mental health screening test can help you understand how well you are coping with the recent events. Take that step and get help. To obtain a referral for services or for more information about mental health issues, contact your local Mental Health Association or the National Mental Health Association by visiting www.NMHA.org or by phone at 800-969-NMHA (6642).
