The following article is reprinted with permission from the October 2001 issue of the Psychology Newsletter, a publication of the Lehman College Psychology Department and the Lehman College chapter of Psi Chi, the national honor society in psychology.   PTSD (Post-Traumatic Stress Disorder) In Relation to the September 11 Tragedy by Aaron C. Velez Psi Chi First Vice-President, 2001-02 Prof. David Manier is in his second year as a psychology professor here at Lehman and teaches General Psychology and Theories of Personality. He received his bachelor's degree from the University of Chicago, master's from Harvard University, and Ph.D. from The New School University, and held a postdoctoral fellowship at the Department of Veterans Affairs' National Center for Post Traumatic Stress Disorder (PTSD) in Honolulu, Hawaii. During his postdoctoral studies, he specialized in sociocultural approaches to memory and psychopathology, with an emphasis on issues related to traumatic stress. I talked with him about the relation between PTSD and the WTC/Pentagon attacks. Q: Dr. Manier, what causes PTSD? A: By definition, PTSD is caused by a traumatic event. What is traumatic depends on how an event is experienced by an individual, and can vary from one individual to another. With that in mind, PTSD is a disorder in which people try to assimilate or mentally digest an event that is indigestible. Human beings, in general, try to make sense of things that happen to us in our lives, and when something happens that is too horrible to comprehend or make sense of, the cognitive and emotional symptoms related to PTSD can result. In addition to this more cognitive perspective, PTSD can be viewed biologically as being caused by a disorder in the levels of hormones the body produces in response to stress, such as cortisol. Q: What are the symptoms manifested in PTSD? A: The symptoms are divided into three main categories: Re-experiencing. This includes everything from nightmares to intrusive thoughts. "Flashbacks," which are rarer, basically involve reliving the event. With intrusive thoughts, you cannot stop thinking about the event, or having feelings about it, despite your efforts not to think about it. Arousal Symptoms. This includes nervousness, agitation, being easily startled, and sleeplessness due to thoughts or feelings about the event. Numbness and Avoidance. When people go through something so terrible, in order to protect themselves from it, they try to avoid any reminders of what happened and avoid emotional interactions with other people that may recreate the strong emotions they felt in that traumatic situation. You must have all three categories of symptoms for at least three months after the stressful event to be diagnosed with PTSD. These symptoms must also be severe enough to interfere with your normal functioning in life. Q: Aside from personally experiencing the tragedy, do you think that by experiencing a tragic event unfold on TV, as many of us did on September 11th, that some people can be distressed enough to suffer from PTSD? A: From a strict diagnostic perspective, a person would not get the diagnosis of PTSD from watching a tragic event on TV. I do think, however, that those people who did watch it on TV were very affected by what they saw and certainly may experience sleeplessness, can be easily startled, afraid to go outside, into a tall building, get on an elevator, and so on. Nevertheless, they would not get an official diagnosis of PTSD. Once again, though, this may not be uniform for all people who witnessed the event on TV. The biggest problem is answering the question, what constitutes a traumatic event? Since its introduction in the DSM III through the current edition of the DSM IV, the definition of PTSD has gone through different descriptions of what is a traumatic event. These definitions rule out something seen on TV, instead focusing on threats that affected you directly or someone close to you. I do think that people experience events that are tough to concretely pinpoint as traumatic or stressful, because the line between determining what is not stressful at all, more stressful, extremely stressful, or traumatic can be quite fuzzy. I do not believe it to be wrong to say that most New Yorkers have been in some sense traumatized by the September 11th tragedy, but it would be inaccurate to use the label of PTSD, because psychiatrists do not want to see the definition diluted in any way. Q: What is the best remedy to treat PTSD? A: I think that one of the best things a therapist can do is to teach clients how to relax. A big part of what happens in response to traumatic events is that people are so keyed up or aroused that it is important for them to learn to relax themselves. Then, when they are exposed to something that reminds them of the stressful event, they can use those techniques to calm themselves down. The relaxation techniques can include deep breathing, progressive muscle relaxation, biofeedback, yoga, or meditation, depending on the individual. Time is also a great healer. Even when you experience a terrible loss of someone very close to you, if you can get through that first year you should be okay psychologically, so time is very important. Also, talking about how you feel is important. It will be very helpful if you have someone to whom you can talk or write and convey your feelings in reaction to what happened. Since September 11th, we have been talking a lot about what happened, but those conversations tend to be about the political situation or what our military response should be, and that is not the same thing as talking about how the events affect what you are feeling. Q: But how do people go about talking about their feelings when it is something they have never felt or imagined before? A: I think that it is very difficult to discuss our feelings because many of us have probably never felt emotions like this before. The entire Lehman campus has been directly affected because some may have lost someone close to them and because we have lost one of our own, Yvette Moreno. She was a student in one of my classes who was in the World Trade Center at the time of the attack. To even go on with the class after someone has been taken from us in that way is very, very hard. We must recognize, though, that the human spirit is very resilient and although we are initially overwhelmed by what happened, people do show the ability to bounce back, often in a very impressive way. Although we can never put into words, understand, or make sense of the horror of September 11th, for us to recognize and accept that inability is to begin the healing process. We will never forget the day, the victims, or the heroes for that matter, but it is important that we stop trying to make sense out of the senselessness and realize that there is no sense to be made. We have to move on and one thing that can be very helpful in doing so is to look at the bravery and generosity in spirit that you see in the firefighters, police, and emergency medical services. They are the ones who rushed toward the danger to help others escape from it. If we can try to emulate their generosity of spirit and use it to assist those who need our help now, we will begin to overcome what happened in a healthy and positive way.   << BACK