9/11: Twenty Years Later

For those of us who lived to experience that day, 9/11 is one that will forever be embedded in our memories.

Ask anyone and they will tell you exactly what they were doing when we all thought it was an accident that a plane had hit the North Tower of the World Trade Center, where they were when the second plane hit the South Tower, and who was with them as we saw the Pentagon on fire and found out about flight 93 going down near Shanksville, Pennsylvania. Some of us may even remember what we were eating that morning and can even smell and taste that breakfast when we think of that day. Personally, I was in my microbiology class during my second year of medical school. We all huddled to watch the news coverage in our student lounge and saw the second plane hit.

The trauma that we collectively experienced on 9/11 was unprecedented in magnitude. It was about massive loss of life… Mothers, fathers, sisters, brothers, daughters, sons. But it was also about the loss of security, the loss of some of our freedoms, the loss of trust, and, overall, the loss of our innocence.

In the aftermath of 9/11, as a psychiatry resident and forensic psychiatry fellow at St Vincent’s Medical Center in New York City’s Greenwich Village, I treated WTC survivors, victims’ families, and first responders. I also completed evaluations of psychiatric disabilities for the NYC Fire Department Medical Board’s WTC Fund. I have seen the whole gamut of psychological sequelae. Depression, anxiety, substance use disorders, post-traumatic stress disorder (PTSD), and beyond. Some individuals were able to recover with brief therapeutic interventions. Others have required long-term treatment for persistent symptoms to this day.

Those who continue to experience depression and PTSD may have disturbing thoughts, flashbacks and nightmares that lead them to relive the events of that fateful day. They may estrange themselves from others and experience a myriad of feelings: sadness, guilt, shame, fear, and anger. That anger can manifest itself in many ways. It could be directed at other family members, the government, the terrorists, and even themselves and their lost loved ones. It could range from mild irritability to severe outbursts that can lead to further estrangement from friends and family members.

Survivors and families of victims may place — or displace – their blame at several targets, depending on their perception of their involvement in the events leading to and on 9/11. They may blame the government for not having protected us. They may inappropriately displace blame towards an ethnic or religious group that fits the general profile of the terrorists. For families of victims, they may blame their lost loved ones for having gone to work on that day or for not getting out. They may blame themselves for not having stopped their lost loved one from going out the door or for not delaying their departure. Similarly, survivors may blame themselves for having gone to work that day or for not having done enough to help a co-worker escape. They may have a degree of survivor’s guilt. Overall, there may be a lot of “what ifs” and a circular way of thinking that can further complicate the survivors’ psychological wellness.

The old adage tells us that “Time heals all wounds.” This is not entirely accurate. To those people who say 9/11 was 20 years ago and that it is time to put it behind us, I would tell them that while it does take time to heal, time itself is not a healer. For some of us, healing takes longer than for others. Some of us will continue to deal with the burden of the loss that we sustained on that day. Part of that healing process may include remembering those whom we lost. While annual commemorative events serve towards that healing for some, the same memorials may reopen partially closed wounds for others.

Remember 9/11 and Remember to take care of yourself and your loved ones!

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

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