The Mental Health Crisis That Wasn't

How the trauma industry exploited 9/11.

Sally Satel & Christina Hoff Sommers from the August/September 2005 issue

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This money was pouring forth even as evidence consistently showed that most people were improving with time. Polls taken by the Pew Research Center, the Marist Institute for Public Opinion, ABC/Washington Post, and RAND within six months of the attacks all showed declines in problems such as sleeplessness, trouble concentrating, and intense worry about future attacks. Volumes of data on traumatic response confirm that rates of stress and PTSD decline with time.

Why did the money keep flowing? Partly because mental health planners, lacking data on nonpathological responses to terrorist attacks, relied on models that were inappropriate--chiefly from the Oklahoma City bombing and other mass disasters where death or injury was widespread. The victims of such events bore little resemblance to the vast majority of New Yorkers, who, while deeply shaken, even devastated, were never in mortal peril.

In addition, officials believed more people would use trauma services in the future. "Based on our experience, we know that thousands more need these services but have not come forward," the administrator of the American Red Cross's September 11 Recovery Program announced. Once they recognized that they needed help or got over their fear of being criticized for seeking it, the assumption was, many more New Yorkers would be getting therapy. Fully three years after the attacks, the Mental Health Association of New York City was still advertising counseling services for reactions to 9/11.

Continued funding was also justified by the expectation that symptoms had yet to manifest themselves. Joshua Gotbaum, the chief executive of the September 11th Fund, informed the public that "many people affected by September 11 will need some form of counseling and that many of them will not realize it for months or even for years." Dr. Paul Ofman, chairman of emergency services at the Red Cross in Greater New York, also expected to see delayed reactions: "While for some people, the impact on their mental health is evident right away," he told The New York Times, "for a noteworthy minority of individuals, the impact won't become evident until months or even years after the disaster."

Finally, money flowed because service providers were eager to take it. Daryl Regier of the American Psychiatric Association issued a canny prediction when he told the Times, "There are going to be people coming out of the woodwork to capitalize on this large amount of money that's available, some of whom will be completely legitimate." And, Regier added, some of whom will not be. As Reuters reported, "A whole new era of mental health services could be opening up for longer-term care [for stress relating to the terrorist attacks] in what could be a boon for individual counselors and the companies who act as industry middlemen."

Ending an Ethos of Therapism

In New York City on September 11 there was a strong, spontaneous show of collective resolve and organization. Near Ground Zero, members of one tenant association helped direct the streams of people running from the World Trade Center; they formed an "urgent needs" team to check on homebound residents; they acted as volunteer cashiers in stores when paid employees could not get to the area. The calm and orderly behavior of workers evacuating the World Trade Center towers themselves surely kept the death and injury tolls from rising. In the largest waterborne evacuation in our history, half a million people left lower Manhattan. Barges, sailboats, and ferries, with no instructions, put into the port as the towers burned. "If you're out in the water in a pleasure craft and you see those buildings on fire," the Rutgers sociologist Lee Clarke said to The New York Times, "in a strictly rational sense, you should head to New Jersey. Instead people went into potential danger and rescued strangers."

According to the sociologist Henry Quarantelli, a pioneer in the field of disaster research, such constructive responses are typical. "Mythical beliefs to the contrary," he writes, "disaster victims do not panic, they are not passive, they do not become caught up in [selfish and] antisocial behavior, and they are not behaviorally traumatized." Monica Schoch-Spana, a medical anthropologist with the Johns Hopkins Center for Civilian Biodefense Strategies, laments the predominance of the "pathological model." So often, she says, officials and mental health planners neglect the positive human elements that crisis elicits, such as "reasoned caution, resourcefulness, adaptability, resiliency, hopefulness, and humanitarianism."

In our trauma-conscious society, many mental health professionals seem eager to take charge of managing the collective anxiety surrounding terrorism and its aftermath. But perhaps one of the lessons from September 11 is that the clinician's role in a shocked and heartbroken world is actually quite limited.

Consider what we know about human response to crisis. Under threat, citizens are ravenous for information and require practical resources. They need a social scaffolding in the form of civic order and some minimal infrastructure to support the bedrock institutions and relationships--families, communities, and houses of worship--that have always served them in times of uncertainty and immense sorrow.

One of the lessons of 9/11 is that therapists must find a balance between offering their services and promoting them too eagerly, between letting people know help is available and suggesting that they need help when they do not. On September 11 the helpers toiled in good faith, powered by genuine concern. But they also endorsed one of the mistaken tenets of therapism: that people are fragile. In their zeal to help, they underestimated our natural fortitude.�