Tag Archives: psychotherapy

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

Emotional Impact of the Separation of Children and Parents at the US Border

On June 20, 2018, the American Psychiatric Association (of which I am an Assembly Member) and 17 other mental health organizations joined forces in a letter to the Departments of Justice, of Homeland Security and of Health and Human Services, urging the administration of President Donald Trump to end its policy of separation of children from their parents at the United States border.

The letter states that “children are dependent on their parents for safety and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder (PTSD). In addition, the longer that children and parents are separated, the greater the reported symptoms of anxiety and depression for the children.”1

The separation and detention of minors is a human rights crisis

The United Nations Convention on the Rights of the Child emphasizes the importance of considering “the best interests of the child.”2 These interests include:

  • Protection against discrimination
  • Safety
  • Wellbeing
  • Health
  • Ensuring to the maximum extent possible the child’s survival and development
  • Preservation of the child’s identity
  • Family integrity
  • Protection against the separation from parents against the child’s will
  • Free expression of ideas
  • Freedom
  • Education

The separation of children from their families and their detention under inhumane and deplorable conditions are in direct opposition to all these interests.

The emotional impact of the separation

The negative effects, both physical and emotional, on the children separated from their parents may not be apparent for many years and some may be irreversible.

The short-term emotional effects include:

  • Post-traumatic stress disorder
  • Anxiety
  • Depression
  • Low self-esteem
  • Feelings of helplessness and hopelessness
  • Behavioral problems
  • Irritability
  • Sleeping problems
  • Changes in appetite
  • Loss of interest in pleasurable activities
  • Poor self-care
  • Feelings of guilt
  • Suicidal thoughts or behaviors

The long-term emotional sequelae can be reflected in:

  • Developmental delay
  • Poor psychological adjustment
  • Poor school performance
  • Regressive behavior
  • Aggression
  • Increased vulnerability to physical illness
  • Alcohol and drug use

Studies show that no matter how brief the detention, it may cause severe and long-term psychological trauma and increase the risk of mental disorders.3

Parents may also be affected due to the uncertainty of what may be happening to their child, which may manifest itself in:

  • Increase in physical and emotional problems
  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Difficulty in their relationships
  • Suicidal thoughts or behaviors

What is Attachment?

Attachment is the bond between the child and his parents, which plays a fundamental role in the social and emotional development of the child. Adequate attachment fosters feelings of security in the child. Poor attachment can make the child grow insecure, with separation anxiety, self-esteem problems, trust issues, behavioral problems, and even extreme dependence on others.

The relationship between parents and children can continue to be affected even after being reunited, which may be manifested in:

  • Attachment problems
  • Reduction in parental authority
  • Poor parent-child relationship
  • Difficulties in child rearing

How can we prevent these negative effects?

  • Putting a stop to the separation of families and to the inhumane conditions in the detention centers. The separation of a parent from a child should never occur, unless there are concerns for the safety of the child at the hands of his/her parent.
  • Early detection of symptoms through mental health assessments and periodic reevaluations (especially when symptoms may arise later as the separation or detention persists).
  • Coordination of services:
      o Physical health
      o Mental health
      o Legal
      o Interpretation in the child’s primary language
  • Psychotherapy and counseling can help the children and their parents to deal with their feelings or negative thoughts, identify stressors, and strengthen coping skills. Therapy can assist in processing emotions and offer support and hope.
  • Psychiatric medications may also control symptoms of depression, anxiety, post-traumatic stress disorder, or any other mental health condition.
  • Finally, there should be no shame in seeking help, which can improve the lives of the child and his/her family.

Remember…

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

Until next time!

Dr. Felix

References:

1American Psychiatric Association. (2018, June 20). Mental health organizations urge administration to halt policy separating children and parents at U.S. border. Retrieved from https://www.psychiatry.org/newsroom/news-releases/mental-health-organizations-urge-administration-to-halt-policy-separating-children-and-parents-at-u-s-border/

2United Nations. Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx/

3Linton, J.M., Griffin, M., Shapiro, A.J. (2017, March). Detention of immigrant children. American Academy of Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2017/03/09/peds.2017-0483.full.pdf