The September 11th attack
Professionals can help with post-attack grief, depression

By Beverly Creamer
Advertiser Staff Writer

As people continue to feel the emotional after-effects of the Sept. 11 attacks, Hawai'i mental health experts encourage them to turn to their physicians for help if they have trouble going back to normal duties, or find themselves in tears all the time. Meanwhile, mental health experts around the country are planning a special day, Oct. 11, when free screenings and informational activities will be held to draw attention to the problem of depression.

	Walk-in counseling
	In Hawai'i, two sites will have counselors helping people who walk in on certain days this month. No appointments are necessary:
•	Oct. 10 at the Hawai'i Clinical Research Center. Call 949-4977 for information.
•	Oct. 11 at the Waimanalo Health Center. Call 259-7948 for information.
•	More information is available at mentalhealthscreening.org or (800) 520-6373.

"But if it progresses into depression or post-traumatic stress disorder, where you have nightmares of the event, flashbacks and anxiety, you might consider some medication."

A "severe emotional problem," he said, would be defined as something that interferes with your work or ability to love. You might be crying all the time, calling in sick to work and unable to go back to your normal duties. All of these symptoms could indicate a more serious problem that needs medical intervention, he said.

Malarik said if people are having problems sleeping, it would not be out of line to ask their doctor for medication to help.

"There's nothing wrong with consulting your primary-care physician for something like a brief trial of something to help you sleep. There are appropriate medications to use for two to four weeks."

Malarik said the first step to healing is simply talking things out with friends or family. That will do a lot to resolve grief. It's important not to try to escape the feelings, he said. "Work through the grief. Don't use medication to stop normal grieving."

For those who need more assistance talking things through, the National Depression Screening Day scheduled annually for Oct. 11, will provide mental health professionals nationwide to help people handle lingering depression or post traumatic stress.

"The earlier we can intervene the less likely we're going to see the chronic effects," said Dr. Cathy Bell, a psychiatrist and specialist in adolescent mental health, who will be screening for depression at Waimanalo Health Center. "Just in the last two weeks there have been a lot of crises come into the office. Whatever mental illness a person has is escalating. For instance, if you're bi-polar, you're already impulsive, so the symptoms are becoming worse. We urge the public to go through the grieving process, but if it's lasting more than two weeks, to see a counselor or therapist."

	More suggestions for those who are having trouble:
•	Do something that helped relax you in the past, such as going to the movies, the beach, getting together with friends, reading a book, plunging into crafts projects.
•	Don't keep watching the upsetting TV images over and over. Limit input of distressing material. Malarik said reading the newspaper about the tragedy was easier for him than seeing the images constantly on TV.
•	Take action, such as donating blood, writing out your feelings in a journal, writing a letter to a friend, starting or joining a project to raise money for relief efforts, offering your help to someone else who is suffering even more.
•	Malarik is offering to be a contact person to start a grief support group in Hawai'i or help initiate town hall meetings to come together and talk. Leave a message at 942-7815.

Mental health professionals are also worrying that substance abuse will rise in the wake of the tragedies as people turn to personal crutches.

"Drug use will be up. We'll see increases in alcohol consumption," said Gloria Neumann, a psychologist with the Honolulu Police Department. And she worries that crime related to anxiety or anger also will rise, including domestic violence.

Those most at risk, she said, are people who already have poor coping skills. This could stretch them to the limit. Finding ways to nurture yourself is very important. What may help for some is watching children at play. "Children remind us how to play," she said.

It also helps to get back to as normal a schedule as possible. "People are feeling out of control, like the world is out of control." So the more you can do to put your life in order, to have a sense of accomplishment, the more you feel in control, she said.

Chronic pain may also increase during times of intense stress, and those who suffer it may want to check with their physicians.

Psychologist Sunny Massad, owner of the Hawai'i Wellness Institute, said that this time of crisis can actually offer a tremendous opportunity for people to tap into personal resources and strengths they might not normally find. She said people can begin to see this crisis not as a disaster but as an opportunity to meet new challenges and clarify or realign their values of what is important in life.

She works with people to help them "evolve" their feelings, she said, so that they can be in control of the only two things in their power: their thoughts and their actions.

"In a crisis like this we can use the adrenaline that we're calling 'fear' and 'danger' as 'excitement' and 'anticipation' for creating a better world," said Massad. "We can either go into depression or we can come to action and take control over our response."

Massad said that so many people think you have to have confidence before you take action, but it's the other way around. "You don't get comfortable with anything until you do it," she said. "You feel the fear, but you do it anyway and then confidence is built."

As part of staying both emotionally and physically balanced during these difficult days, Neumann suggests staying away from high-sugar and high-starch foods, excessive caffeine, and trying to eat a balanced and nutritious diet while drinking lots of water and continuing an exercise regime, which helps reduce stress.

Malarik said it's important to get the message out that this process of grief may not end quickly or easily. If you're waiting to wake up and feel fine, that may not be in the cards in the foreseeable future.

"This is going to be a continuing process that's going to be very, very difficult to get over with," he said. "Other things will happen to reactivate this. The unknown is one of the greatest fears. Change and the unknown are what most people fear the most."

The stages of grieving — denial, anger, depression, bargaining, and acceptance — don't necessarily fall in that order, and have no standard time lengths. Anger and sadness, for instance, can return repeatedly, and so can depression.

"Some people are like ostriches," agreed Neumann. "They'll stay in denial longer. It depends on your normal style of relating to the world. It also depends on personal loss. If your emotional immune system is depressed, you're going to be hit harder."

Malarik said that part of our shock and denial has to do with our tremendous belief as a nation that nothing could happen to us. "Now our bubble has been broken. We're not impermeable anymore. We're just like a lot of other countries in the world. This can happen at any time, the threat to family security."

Correction: A previous version of this story listed an incorrect date for walk-in counseling at the Hawai'i Clinical Research Center.