The 9/11 terror attacks killed nearly 3,000 people and injured thousands of others. The coordinated assault left tens of thousands of grieving parents, children, spouses, siblings, cousins and loved ones.
The attack – and other high-profile, traumatic events, like the COVID-19 pandemic – also affected the long-term health of countless others who watched the assaults or their aftermath on television, listened to radio accounts and read news reports, according to mental health clinicians. Many of these people likely relived the trauma of that shocking day during recent ceremonies commemorating the 20-year anniversary of the attacks.
“You don’t have to be directly affected, such as losing a loved one, to experience long-term health effects (associated with a national traumatic event),” says Kai-Rai M. Prewitt, a psychologist at Cleveland Clinic’s Center for Adult Behavioral Health. “We know that people who are witness to tragedy or constantly exposed to hearing about and/or responding to traumatic situations can be impacted. Because of the internet and the media we have access to others’ tragedies. When someone experiences trauma or witnesses it, there’s a chance of being impacted mentally, physically and spiritually.”
Reactions to Trauma
It’s normal for people to feel emotional distress after incidents of mass violence, such as shootings with multiple victims and terrorism, according to the Substance Abuse and Mental Health Services Administration.
In the wake of such incidents, people may exhibit these signs of distress:
- Trouble sleeping.
- Feeling numb or like nothing matters.
- Worrying a lot of the time; feeling guilty but not sure why.
- Feeling like you have to stay busy.
- Excessive smoking, drinking or using drugs, including prescription medication.
The last two years in particular have exposed tens of millions of people to a series of nationally publicized traumatic events that can lead to long-term health issues, says David Fingerhut, director of mental health services at Everside Health, which provides direct primary care for employer groups, including unions, municipalities and public school systems. Fingerhut’s based in Indianapolis, Everside has more than 300 clinics in 33 states.
“The (collective) American psyche is really in a vulnerable state right now,” Fingerhut says.
Fingerhut recited some of the major traumatic events of the past two years:
- The COVID-19 pandemic.
- Hurricane Ida.
- Catastrophic wildfires in the western part of the U.S.
- Increased concerns about climate change, in light of severe weather like Hurricane Ida and the massive wildfires in the western part of the country.
- Domestic political violence, such as the January 6 assault on the Capitol by supporters of former President Donald Trump.
- Mass shootings, like the assault in March 2021 in Boulder, Colorado, in which a gunman killed 10 people in a supermarket.
Reactions to major traumatic events vary widely, Fingerhut says. “Some people can shrug it off and there’s no effect.” Other people, though, will react by isolating from their social groups and using alcohol or other substances to cope with the tragedy. “A lot of times, you see maladaptive behaviors.”
Some people experiencing trauma fall into maladaptive behaviors as coping strategies. Maladaptive behaviors can include:
- Misusing alcohol, drugs or tobacco.
- Sleeping too much.
- Binge-watching TV shows.
- Spending an inordinate of time on social media or playing video games.
Maladaptive behaviors often are used to avoiding thinking about or emotionally dealing with trauma. These avoidant strategies can also appear to be “positive” such as immersing oneself in professional work, but are done with the end goal of avoiding thinking about or feeling about the trauma.
Long-Term Effects of Trauma
In the short term, trauma associated with such events can lead to conditions such as gastrointestinal distress, headaches and insomnia. Such trauma can also lead to spikes of cortisol, which is widely known as the body’s primary stress hormone. Cortisol is important in regulating the immune, digestive and reproductive systems and growth.
Cortisol spikes make the body more susceptible to chronic conditions, Fingerhut says.
These chronic conditions may include:
- Cardiovascular disease.
- Concentration and memory problems.
- Sleep problems.
- Weight gain.
In the wake of mass shootings, most survivors are resilient, according to the American Psychological Association. However, some – particularly individuals who believed their lives or those of their loved ones were in danger or who lack adequate social support – experience ongoing mental health problems.
These problems can include:
- Post-traumatic stress.
- Substance abuse.
Research suggests that stress and trauma associated with 9/11 can affect not just the health of people who witnessed it, but their income.
For example, a study published in the International Journal of Environmental Research and Public Health in 2019 assessed the attack’s impact on employment among people who lived and worked near the World Trade Center at the time. Researchers studied the association between 9/11-related health conditions on early retirement and post-retirement income loss on 6,377 residents who took completed health surveys.
“We found that 9/11-related health conditions were significantly associated with the likelihood of early retirement,” researchers wrote. “Residents and/or area workers with more physical health conditions, especially when co-morbid with post-traumatic stress disorder were more likely to retire before age 60 than those with no conditions.”
Study participants who suffered from PTSD or PTSD with another comorbid health issue “increased the odds of reporting substantial post-retirement income loss,” the study says. “Having PTSD alone was not associated with early retirement; however, PTSD was the driving factor out of all 9/11-related health conditions that was linked to substantial income loss post-retirement.”
The New York City Health Department created the World Trade Center Health Registry in November 2001 to track the health of people who lived, worked and went to school near the World Trade Center at the time of the attacks. Initially, officials estimated 400,000 people were eligible to voluntarily register for the initiative.
Post-Traumatic Stress Disorder Symptoms
PTSD symptoms are the most common health effect of the 9/11 attacks, according to the registry’s website. As many as 20% of adults who were “directly exposed to the disaster or injured in the attack had PTSD symptoms 5 to 6 years after the attack,” according to the registry. That’s four times the rate in the general population.
Among those people, risk factors for PTSD include:
- Witnessing horror.
- Event-related job loss.
- Having little social support.
- Knowing someone who was killed in the attack.
Ten years after the attack, 15% of registry enrollees had PTSD symptoms. “PTSD was more likely to persist or get worse in people who were unable to get mental health treatment, had high 9/11-related exposure, were unemployed, or had little social support,” according to the registry.
PTSD, in turn, is associated with early death, research published in 2019 in JAMA Network Open suggests. The study suggests that PTSD related to 9/11 is associated with a higher mortality risk for both responders and civilians.
Unless managed, the immense chronic stress experienced over 9/11, the pandemic or any other major trauma – extended or acute – will be experienced by the mind and processed into the brain in a toxic way, says Caroline Leaf, a Dallas-based communication pathologist and cognitive and clinical neuroscientist.
“Trauma, especially the more severe and extended it is, can cause a ‘tsunami’ type reaction in the brain and body, upsetting our mental energy and health,” Leaf says. “This, in turn, can affect cognition in different ways, from losing perspective to mental exhaustion and brain fog. If left unmanaged, trauma like this can progress to varying levels of ill-health and cognitive issues.”
What to Do When a Traumatic Event Occurs
While there’s nothing anyone can do about major traumatic events, individuals can take certain steps to protect your health in the short- and long-term when experiencing direct or vicarious trauma, says Moe Gelbart, director of behavioral health at Torrance Memorial Medical Center in Torrance, California.
When a major traumatic event occurs, Gelbart recommends taking these steps:
- Acknowledge your feelings, don’t minimize, trivialize or dismiss them.
- Find a trusted person to share your feelings with. This could be a relative, friend or mental health professional.
- Avoid numbing your responses with alcohol or other substances.
- Don’t catastrophize about the future. Stay rooted in the moment, where solutions lie.
- Don’t dive into avoidant activity, such as immersing yourself in work, overeating or binge eating, or seeking out inappropriate relationships.
- Control the things you can and let go what’s out of your control.
- Make sure you get enough sleep, eat properly and try to exercise.
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