Analyzing our search to retrieve normalcy

By Joseph B. Verrengia
Associated Press

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E-counseling chat line A Web site that provides e-counseling, liveperson.com, is offering free help to people suffering from the effects of the Sept. 11 terrorist attack. Get Well (getwell.com) and LivePerson have opened up a Live Chat Counseling line so that people can chat in real time with therapists. For more information call (212) 918-2524. Some other sites offer similar services. And at aboutourkids.org, New York University's Child Study Center is providing information on child mental health geared to the terrorist attacks.

Same as it ever was? Not quite.

"We were witnesses to mass murder," said Chicago psychiatrist Stevan Weine, who counsels refugees from Bosnia. "History crashed into our lives."

This unexpected vulnerability is "completely new for Americans," he said. "I think it is an illusion to think that life gets back to normal."

The 20th century pulsed with inspiring examples of how everyday people followed their habits and rituals in the face of overwhelming destruction or barbarism.

While it may appear futile, psychologists say it's a basic instinct to demonstrate that you're still standing, however monstrous the circumstances.

During the London blitz, housewives hung laundry to dry as bombs leveled their neighborhoods.

In genocidal Rwanda, schoolteachers scratched the ABCs in the dirt for orphaned refuges.

In besieged Sarajevo, women put on makeup to stand in bread lines. Couples dressed in evening attire to attend the symphony in a bombed-out concert hall. A lone cellist played day after day in Sniper Alley, exposed.

"When you are being treated like a rat, playing the cello in public is a way to assert your humanity," psychiatrist Weine said.

The difference between then and now is that those acts of defiance occurred during long sieges when societies — and people's minds — were smoldering ruins.

In this 21st century war on terrorism, it's early still.

Even Weine and other experts aren't certain how people should behave or feel now.

So audacious and violent were the Sept. 11 attacks that claimed more than 6,000 lives that psychiatrists say lessons learned from conventional war, natural disasters and other terrorist incidents, such as the Oklahoma City bombing, do not neatly apply.

Complicating matters is the persistent dread of more violence, when and where uncertain. Feeling safe, both as a nation and personally, has been shattered. Even everyday errands like going to the grocery store or dropping the kids off at school can be unsettling or seem pointless.

Therapists have a name for it.

"Acute stress reaction," said New York Presbyterian Hospital psychiatrist Alan Manevitz. "Right now New York — and the entire country — is undergoing it."

Acute stress disorder is a clinical description category for a reaction to a traumatic situation that can be physically dangerous or emotionally distressing.

The symptoms are varied. You can feel anxious or dazed. You can be irritable. Or numb. You can sleep for hours, or you can walk the floor at night.

What you don't feel like is yourself. ASD can last days or weeks, depending on your exposure to trauma.

The lengthy rescue and cleanup, round-the-clock news coverage and the threat of more terrorist attacks just extends the recovery period, therapists say.

"This is an ongoing disaster," Manevitz said. "People want some structure and they want to reconnect."

For some people, the terrorist attacks will result in a more debilitating condition: post-traumatic stress disorder, a severe, delayed reaction to violence or abuse.

Without therapy, sufferers relive terrifying incidents, sometimes years later. Flashbacks can occur on anniversaries of the incident or be triggered by a random reminder, such as a whiff of smoke.

It's more than just "feelings." Among post-traumatic stress patients, imaging experiments show that certain brain structures, such as the hippocampus, can shrink. Brain chemistry also alters after experiencing trauma.

Survivors who escaped the disasters at the World Trade Center and the Pentagon, as well as the first rescuers who watched their companions perish, are the most likely to develop post-traumatic stress, researchers said.

So how can we feel better? When will we feel better?

Professional counseling may be appropriate for some. In severe cases, drug therapy also relieves anxiety, depression and other symptoms about half the time, according to Columbia University psychiatrist Randall Marshall.

But for most of us, therapists say, Freud offered the right prescription when he identified his twin towers of happiness a century ago: Love and work.

Enjoying the company of others — family, neighbors, church, even a ballgame or a concert — is therapeutic, they said.

Talking about the attacks — where you were, what you saw, and most importantly, how you feel — also helps raise the curtain on your spirits.

"Converting these experiences into language puts them into a context that we can cope with so that they are not relived," said C. Donald Williams, a Yakima, Wash., therapist and president of the Academy of Organizational and Occupational Psychiatry.

Work is another way to get a grip, whether it means returning to your desk or resuming your household schedule. "Work lends structure in chaos," Williams said.