The sight of that airplane deliberately striking the World Trade Center is something that will stay with us for the rest of our lives. Everyone who saw the World Trade Towers collapse has become part of the world community of trauma survivors. People who are already trauma survivors have been re-traumatized. Post-Traumatic Stress Disorder symptoms often resurface--even for people who have had successful therapy--with further trauma or incidents that remind you of some aspect of the trauma, like total complete powerlessness while you watch other people die.

During a traumatic event, people lose the freedom to choose what happens. They don't have the power to prevent the trauma. Trauma is by its very nature more powerful than you, whether it is the rapist who is simply stronger, the hurricane's powerful winds, the guy with the machine gun who is better dug-in, or self-righteous fanatical crash dummies flying airplanes into the World Trade Towers. ("Crash dummy" is a street term for the guys whom criminals use to do dangerous dumb things for them. Seems to fit. Whoever was behind the attacks didn't give his life.)

Sometimes for the rest of your life you struggle with "if-onlies" which help you avoid and deny terrible feelings of helplessness, horror and fear. Better to think "I shouldn't have worn that red dress," than to feel the terror that the rapist could have and would have killed you. Better to think, "I shouldn't have taken the trail," than feel your despair when the ambush opened up on your buddies. Better to say, "I was a bad kid and they straightened me out," than to remember that anything could bring on a beating, anything or nothing. The "if onlies" for this tragedy are infinite, but nothing any of us did made these men killers of the innocent. No one could have imagined such an event.

This attack has taken away our freedom to travel and our sense of safety. We will be worried when we travel, and when our loved ones are out of our sight. Once free thoughts will now be focused on controlling what cannot be controlled: other people, the way they think, and what they do. Moreover if we are not educated and aware, post-traumatic reactions may rule us, suppressing our feelings and distorting our lives. This loss of freedom does not have to be permanent, however. We can recover from the effects of trauma.

Why is there pain in seeing trauma even if you are not part of it? Human nature, the best part of human nature: compassion. It is what made the firemen go back into a building that was burning and could collapse. It is also what makes people who have struggled with their own PTSD feel such pain when someone else, especially an innocent party, is hurt or killed. Survivors and those of us who live with and love people who have been traumatized, don't want other people to have to go through what we and our loved ones went through back when PTSD didn't have a name and wasn't supposed to exist.

Suggestions for healing:

1. Focus on finding your own freedom from the effects of trauma. One of the rescue workers said he was digging to free any survivors, but he was also digging to find the freedom we have lost. It is the ground of our being in this country, freedom. If we become trapped in post-traumatic reactions, we are where the terrorists want us. We have to dig through our own feelings and experiences, but at our own rate, in our own time, in a safe way, and with support. Not every one develops PTSD from experiences like this.Understanding that it is normal to be affected by trauma will help free you. Denying the impact of trauma, keeping silent about it, and not having support are three things that increase the likelihood of having post-traumatic problems later.

You may have spent hours in front of the TV, hoping for news. I have found myself doing that lately, and I know it is a normal reaction, although not conducive to getting my work done. I tell myself that it is okay for me to be human and disturbed by seeing so much death and destruction. I can be kind and compassionate to myself. I can understand that this feels like a vigil to me and to many. We are not thrill seeking but trying to be there for those who have been lost. We are giving our attention and respect to what happened to them. This is not an everyday occurrence, to "get over," like a skinned knee. We will--we are--going on with our lives, but we are also marking this loss, grieving for all those people, and helping ourselves through a time of pain and loss by doing what is human.

On one broadcast, the reporter was showing cars that had been towed from the WTC parking lot. Someone had put beautiful single flowers on them. She told the reporter that she was powerless over what happened, but she was trying to respond with humanity. Human beings care. Let yourself care, and do the things that come to you as ways to contribute to the healing.

2. Talk: talk to supportive people. Not people who say, "You're alive, so what's your problem?" If you are saying that to yourself, stop. You don't have to qualify by reaching some level of personal loss to be upset by this event. We are hurting because we are human beings and care about each other. The best part of us is what hurts. People who say, "Yes, it scared me too. My life is changed too," are the ones to talk to. Let yourself cry if you can. Everyone is experiencing grief for the loss of human life.

Many of us experience grief as anger, but grieving, though harder, is more healthy.

If you are not feeling anything, then you are probably numb, not cold and unfeeling. Have compassion for yourself. It means you have a post-traumatic symptom which is helping you cope, which means you care.

Critical Incident Stress Debriefing is a way of debriefing emergency responders (cops, firefighters, EMT's, doctors and nurses who are often traumatized by what they see) after a disaster. They are encouraged to talk, each getting a chance to talk about what happened to them: what they did, what they saw, what they smelled, what they felt, what they touched, what they hoped the outcome would be, and what actually did happen. Emotions are expressed and accepted. No one interrupts or corrects. Each person is telling it from his or her perspective. Every one shares on each topic, and then they move to the next. It doesn't prevent PTSD, but it helps people process what happened and know it is okay to get help if the need it. Using a similar pattern to talk about this event or even write about it may help you even if you were not an emergency worker.

3. Know what post-traumatic reactions are: Most people are unaware of the effects of trauma, the symptoms of PTSD, or even that such an experience--seeing the death of people you may not even know and feeling fear, horror and/or helplessness--is by definition, the kind of experience that can cause Post-Traumatic Stress Disorder. So is losing a loved one or friend in the disaster. Having survived the attack is, too, as is being a rescue worker on the scene. The human cruelty of this terrorist attack makes it more traumatic than a natural disaster. Individuals may not develop full blown PTSD but still have post-traumatic reactions. Knowing what they are can help you recover.

What are some of the effects trauma normally has on people? People commonly become numb in order to focus on survival: people were counting steps as they went down through the smoke, holding hands. Numbing their fear helped them survive. Later they may find themselves maintaining this numbness, because the emotions which are naturally evoked by such a tragedy are so painful. (This is called "professionalism" in some circles.) People may isolate. They may turn to drugs, alcohol, food, or other substances or compulsive behaviors to maintain numbness when it begins to wear off. If you find yourself doing this, it is very human, but it can be the start of a slippery slope to a life ruled by post-traumatic reactions. It is more healing to find a safe place to talk about the tragedy (and cry about it). If your life is distorted by numbing, the terrorists win again. If you have made progress in healing from some other trauma, you may slip back. Little kids may also slip back to bed-wetting or baby talk or needing a night light.

Other normal reactions are feeling like others can't understand what you are going through, and feeling like there is no future, both of which have an element of realism. You may also forget details or periods of time, a sign of how overwhelming the trauma was to you.

Avoiding painful emotions is a lot of work, so you may begin to avoid anything that reminds you of the trauma (thoughts, feelings, situations, activities). Avoiding things that remind you of the trauma may also mean you stop doing things you once loved to do. You may find yourself crying when your feelings break through, which is normal and healthy, not weak and unmanly. You may find yourself very angry, too.

Often people expect you to get over it right away. The people who are saying "get over it" make it very clear that people who have not experienced trauma can't understand, which reinforces feeling detached and estranged from other people. These are the normal numbing and avoidance symptoms. They begin when your brain focuses on survival or on helping others survive as the rescuers have. They maintain themselves because it is easier to be numb. It helps you keep on keeping on. Balancing the need to keep on with moments where you let yourself feel is important for healing.

Survivors become easily aroused, constantly watching for danger, quick to anger, unable to sleep or concentrate on everyday stuff (believe me they are concentrating on survival information), and perhaps seeing danger everywhere and being controlling and bossy. You may have been elated and feel ashamed but it was the adrenaline running through you. You may feel like you are jumping out of your skin (adrenaline again).

Finally, people also commonly re-experience the trauma through intrusive thoughts, nightmares, intense physiological (sweating, shaking) or psychological reactions to things that resemble some part of the trauma, flashbacks when it feels like it is happening again, and anniversary reactions.

Most of these symptoms begin as survival skills that help you get through the trauma. Chemicals in your brain focus your attention on how to survive and give you the energy to do so. Some of them develop as ways to survive the aftermath of trauma by avoiding triggers and unendurable pain. Some seem to be your better-safe-than-sorry brain trying to warn you it might happen again (re-experiencing). You may even act in the way you did during your trauma (re-enacting). All of these and more are normal reactions. These survival skills can become tremendous problems over time--blocking your ability to feel, to find help, to calm yourself after a trigger, and to process the pain.

Remember, if you have been exposed to or survived other traumatic event (war, political repression, personal violence, sexual assault, or natural or man made disasters) this may re-trigger PTSD or you may develop it now for the first time (the post in PTSD). When you are triggered, if you start "recycling" your PTSD, that does not mean that your therapy and other recovery activities did not work. It means you need to do more recovery work. What helped before will help again as you to go through the process of working through the pain. Keep an open mind, and you may also find more tools to add to your recovery tool kit.

The capacity to be re-triggered can happen even if you weren't aware that you had PTSD. Most people who have it, don't know it. They don't fit the stereotype of wacko veteran with the gun. Most veterans who have PTSD don't fit that stereotype either. Most people with PTSD are invisible hard-working people with families who are struggling with reactions they don't understand. Nobody knows how nuts they feel.

4. Realize PTSD is a normal response to trauma. Normal, but not comfortable to have. It's painful. Most people with PTSD are scared. They struggle to hide their symptoms and seem normal. Not affected. Fine. John Wayne is the model for this, but John Wayne was an actor who never faced a bullet. Suppressing PTSD symptoms becomes a full time job. People wind up losing friends and even family. Unfortunately, there also is a continual search by some to figure out why some people get PTSD, as if it were some sort of failure.

PTSD is actually a success, proof of survival. Dead people don't get it. People get PTSD because they care.

Good support can help with traumatic events, but I don't care who you are, if you live through enough trauma you'll probably struggle with PTSD symptoms. It is good to be informed. Trauma survivors can look good to outsiders while their family pays a heavy price. Families are systems and they can be organized around making the survivor look good while absorbing his or her pain.

For those of you who have small children, talking to them about this in simple terms is suggested. Yes some bad men hurt all those people but we are safe here. The police will find the bad men and make sure we are safe. Let them cling. Let them have a nightlight. If they wet the bed you can say that is common for little kids when something scary has happened and after a while they will be dry at night again. Sometimes kids will misbehave when they are afraid. Be gentle and firm. Try to stick with a routine the child is used to. Read them a bedtime story. Listen. Note if they change behaviors and let them talk. Kids are by nature valuable, vulnerable, imperfect, needy and self-centered. they may worry that they caused this. They will see it as a possible danger to them. "Will someone blow us up, or blow up your office?" Fear is normal and saying things that normalize it is good. "Yes, this is scary. Anyone would be scared of an airplane hitting them, but the police are not going to let that happen again. It still scares us, but we will see over time that things are safe again." Let them be imperfect and needy. If you are feeling kind of imperfect and needy yourself, seek adult help so you can be a parent to your kids.

For parents and teachers, I recommend a book, Debra Alexander's Children Changed by Trauma which is published by New Harbinger (1-800-748-6273). If you are an adult who survived childhood trauma without help it will teach you the help any child needs.

5. It is okay to ask for help. Going for help is one of the first and best things you can do for yourself. Grief and trauma counselors are working to help people through the immediate aftermath of this tragedy, but you may need more help. If you do, be kind to yourself and get it. Normal people have problems especially with traumatic events. How do you tell if you need help? Are you numb? Are you very angry and it is coming out on family and friends? Some people experience grief as anger because anger is a powerful emotion and grief hurts. Are you thinking about it all the time, dreaming about it, feeling as if it is happening all over again? Are you drinking and drugging, using sex, TV, food, the internet to keep numb? Can you talk about it? Don't let the terrorists stop your voice. You also don't have to talk about it. Other forms of telling your story include writing about it (journal, play, poem, article, book), drawing and painting, dancing, sculpture, acting. Anything creative is healing.

Adults need to be kind to themselves. No one would say to a fireman who came out of the ruins, "Why the hell are you crying? You're alive!" Don't say it to yourself, either. This is a grievous loss. If you can cry that is healing. If you can't--yet--that is where you are at, and that is okay, too. Being numb is a survival skill given to us by God or evolution--it doesn't matter which--but we all have it. It helps us get through things. It is good to be able to be numb and also good to be able to feel your feelings when it is safe. If you don't, if as many Americans are taught, you try to tough everything out alone, you are not being fair to yourself or your family.

Those who have prohibitions against getting help often take out their emotional problems on family members and then forbid them to get help. It becomes a vicious cycle. Feelings that are stuffed eventually come out. Grief and sadness stuffed may erupt into yelling at the kids. Fear stuffed may make you over controlling, as I was. Despair stuffed can make you verbally destroy the dreams of your kids. And while you are stuffing away bad feelings you will not be able to have good ones either. Happiness, joy, love, serenity will all elude you if you avoid sorrow, pain, fear, and despair. Remember feelings are not logical. They are feelings. You can't control them with logic without paying a high price.

Finding a safe place to express your feelings can be difficult. People often feel it is weak to ask for help, but I think it is a true measure of strength. It takes courage to say you need help. It takes courage to accept help.

If you cannot bring yourself--yet--to ask for help, one thing you can do is research. Look on the web for information on PTSD. There are lots of websites on the subject, as well as many books and articles.

My website, http://www.patiencepress.com, looks at the symptoms of Post -Traumatic Stress disorder as survival skills which later become big problems. Many people find this helpful. To me trauma is the problem and PTSD symptoms are solutions to the immediate problem of trauma, and to some of the problems that grow out of being traumatized. Post-traumatic symptoms develop for a reason, survival, and they can be lessened by seeing what needs they met, and slowly figuring out how to meet those needs in your present circumstances. If you have PTSD it means you survived. The survival skills worked. A number of issues of the Post-Traumatic Gazette and some other articles can be downloaded from my website. I hope you will read them. I hope they help.

Other books I recommend: I Can't Get Over It, Trust After Trauma, and Survivor Guilt, all by Aphrodite Matsakis, Ph.D. PTSD: A Complete Treatment Guide is her excellent book for therapists. Also available from New Harbinger.

Growing Beyond Survival: A Self-Help Tool kit for Managing Traumatic Stress by Elizabeth Vermilyea is full of healing ideas. Journaling is one way of dealing with trauma. The Way of the Journal: A Journal Therapy Workbook for Healing, by Kathleen Adams, is designed specifically for trauma survivors. So is Managing Traumatic Stress Through Art: Drawing from the Center, Barry M Cohen, Mary-Michola Barnes and Anita B. Rankin. Art is one of the ways you can help yourself express the inexpressible and speak the unspeakable. Unspeakable Truths and Happy Endings: Human Cruelty and the New Trauma Therapy by Rebecca Coffey, is another outstanding book for reading about the process of recovery. All from The Sidran Foundation (www.sid-ran.org,1-888-825-8249).

6. Find good help: People are different and have different needs. Find someone you are comfortable with who provides you with a variety of tools and who listens to your story. If you have to do what they say when they say it, it is not therapy.

You have a right to talk, draw, journal, to be upset, to grieve. It doesn't matter if you were in the Towers and got out or saw it on TV. This is upsetting. Working through the pain and loss, the helplessness and horror, will free you from the grip of the terrorists.

Don't "get over it." Get through it. People who work through the pain of trauma become beacons of hope and teachers for the next generation of trauma survivors. There is always a next generation. If you can get through the grief and pain, they can, too.

To me, the most valuable thing we can do for ourselves and our country today is to take action against the destruction that has been visited upon us. We go out and light candles so the dead and missing are not alone in the dark. We sing to support the living and the dead. We donate stuff to help the rescuers and those who lost loved ones. We can also acknowledge that this trauma has effects on all of us and talk about it, feel our pain, and slowly heal.

In the past we have forgotten the effects of trauma from one generation to the next. As soon as the war was over or the camps closed, the massacres ended, society dived into denial. Denial is not just a river in Egypt. But we are not living in Egypt. We live here. Today we have the opportunity to heal ourselves and free ourselves and our country from the claws of terrorists. Each of us can resist their efforts to make us soldiers in the armies of denial. Working through the pain will only make us stronger.

You can subscribe to the PTG on the website or by mail for $12 per year.


Patience Mason, Editor and Publisher
The Post-Traumatic Gazette
P O Box 2757
High Springs, FL 32655-2757