Jewish World Review June 7, 2002 / 27 Sivan 5762

Psychological fallout in
the shadow of terrorism

By Dr. Abraham Twerski, M.D. | We live in an era of suicide bombers and anthrax threats. The few cataclysmic moments of 9-11 have changed our lives forever. Thousands of families were devastated by the loss of spouses, parents, children and loved ones. People lost sincere friends and employers lost devoted employees. The ripple effects on the economy have jeopardized the livelihoods of millions. But if there is anything more destructive than the horrible attack itself it is the long range trauma that can continue to affect survivors and the country as a whole for decades to come.

Surrender to despair would be giving the terrorists the triumph they seek. Life will and must go on. Not only must we help those who have suffered personal losses to rebuild their lives, but the emotional and mental well being of the entire population must be protected. In order to understand this and find ways of coping with the new reality, we must understand the various types of reactions to terror.

Parents ask, "What do we say to our children?". Teachers ask: "What do we say to our students?" Youngsters have been repeatedly exposed to the graphic atrocity. They have met children who have been orphaned. They hear the daily news, which is so often foreboding. Is there any way we can help them feel safe? Can they grow up to be mentally healthy if they fear that by touching a piece of mail they or their parents may be injured from anthrax?

Let me begin with a principle of parenting. The most effective way of reducing fear and anxiety among children is for parents to find ways of reducing their own fear and anxiety. Our non verbal communication to our children must be reassuring. This does not mean that you must stifle your emotions. Children should know that their parents are sentient human beings. The circumstances do arouse fear and anxiety. What is important is that we keep the fear and anxiety levels at a normal, non-disabling level.

What then can we do for ourselves?

Psychological trauma is defined as a feeling of "intense fear, helplessness, loss of control and threat of annihilation". This is true whether one is the victim of violence or one witnesses it. Here are some possible fear reactions that people may experience:

Fear of death: It has been said that one cannot fear that which one has not experienced. Fear of death, really, is the fear of abandonment and the fear of absolute isolation.

Fear of annihilation: While we have not experienced personal annihilation everyone has experienced, at some point in life, helplessness and loss of control over one's life. These feelings may have occurred being trapped in an elevator or being in a car accident. Experiencing or witnessing violence recalls these feelings.

Fear of abandonment: Infants may feel abandoned if a parent is away only a few hours. As children grow, they come to understand that if mommy or daddy leaves for a few hours, he/she does return. However the first time parents go away on a vacation for a longer period of time, they may feel abandoned. As they mature, experience teaches them that parents do return even after longer absences, and they are able to tolerate these with little or no anxiety. If there is a prolonged absence, or if the child is temporarily placed with family or friends there may be abandonment anxiety. Living in the fear of a terrorist activity may cause juvenile feelings of abandonment anxiety to recur.

Human beings are endowed with adaptive capacities for coping with life stressors. Here are some coping mechanisms:

Fight or flight: This enables a person to escape from an attacker or to defend oneself. As a result of an attack the victim's heart rate increases sharply, respiration increases and the blood supply shifts to the muscles where it is most needed. The liver discharges its glucose to the muscles. Blood pressure rises as adrenaline and cortisone-like hormones are secreted into the blood stream.

These physiologic reactions are very effective in responding to an acute assault and last a few moments to allow the victim to defend himself. The fear of a terrorist attack may evoke many of the changes of the flight of flight reaction. But in this situation they are not effective. There is no safe haven to which one can escape, and there is nothing one can do to fight off the anticipated assailant. Furthermore, in contrast to an acute attack, the anxiety is not over in a few moments. To the contrary, it may persist throughout the day and night, for weeks and months. These persistent bodily changes, which in these circumstances are not adaptive, may exert great stress on the body and may result in physical as well as psychological disorders.

Fear vs. Anxiety: Fear occurs when one is confronted by an actual danger. The object of the fear is known and one can implement safety measures to deal with a known danger. Anxiety occurs when one has the same sensation as fear, but the object of the fear is not apparent to the senses. The fight or flight reaction is well suited for fear but not anxiety.

The emotion that currently prevails in America is a mixture of fear and anxiety. Fear may be constructive because it may lead top self preservation maneuvers. Anxiety is rarely, if ever, constructive. Anxiety can:
1. Impair functioning and even be paralytic.
2. Decrease powers of concentration.
3. Divert attention and impair reactions while driving.
4. Decrease ability to show affection due to the perceived danger.
5. Negatively affect sleep patterns and appetite.
6. Cause memory impairment.
7. Cause irritability, causing one to react with unwarranted hostility to minor provocations.
8. Lead one to turn to alcohol or drugs to alleviate the anxiety.


Let me share with you a personal experience. One morning my father received a phone call that my brother had been in a severe car accident in a distant town. The ambulance driver in that town was also the mortician, and introduced himself as such when he told my father, "Your son was in an accident." My father promptly fainted.

My mother grabbed the phone and found out that my brother was severely injured and in a local hospital. She revived my father, who speeded to the town. I went there the next day, and could hardly recognize my brother. I was stunned by my father's behavior. He was a doting father, who would react with anxiety if any of us had a common cold. Here my brother was severly injured, and my father was all smiles, almost euphoric! I did not recognize my father. Was he elated because he was grateful that my brother had survived?

Several days later, my brother's condition had sufficiently stabilized that he could be transported to the hospital in our home town. Abruptly, my father's demeanor changed to one of severe depression.

The reason for this phenomenon was that as long as my brother's condition was precarious, my father was in denial. It was impossible for him to lose a child. The accident never happened. He simply did not see what I saw. When it became evident that my brother was going to survive, the denial ceased, and depression struck.

The overwhelming anxiety of the World Trade Center attack, a biochemcial threat or the reports of the inevitability of further attacks on American soil, may result in denial. Just as my father could sit in my brother's hospital room and be oblivious that anything had happened to him, so one can look at the destruction of the World Trade Center or hear about deaths due to anthrax and behave as though nothing happened. One can even talk about these events, yet not feel their impact because one may be in denial.

Whereas denial may spare a person emotional pain, it is a maladaptive defense. We cannot adapt optimally to reality if we do not see reality as it is. On the other hand, the awareness of an overwhelming threat may result in panic. A rather insignificant fire in a crowded theater may result in many deaths if people panic. People may react to a terrorist threat with denial or panic.

We must be able to steer a middle course, recognizing the reality of a danger without losing our ability to make sound judgments.


The optimum reaction to the anxiety elicited by the threat of terrorism is to recognize the reality of the danger without losing our ability to make sound judgments. We can do this by making an informed and logical assessment of the danger. For example: Determine how safe is air travel? How safe is to enter a tall building? How safe is it to enter a tunnel or drive through a bridge? What is anthrax and how does a person become infected? What are the signs of infection and what are the reasonable precautions to avoid infection? What treatment is available?

One month after the World Trade Center attack, the chief consultant for a risk management firm canceled a meeting because he refused to fly. He admitted that statistically, the likelihood of his being killed in a car accident on the way to the supermarket was many times greater than that of flying in a plane."I know that in my head," he said, "but the fear is in my heart."

We should try to use logic rather than emotions in making decisions. We need to have factual information in relating to children. Children fantasize very easily, and can distort information. If adults lack proper information which they can convey to a child, the child's imagination may magnify the danger. Children should be able to feel that their parents know what they are talking about. Children may detect parental ignorance and uncertainty, and this may compound their anxiety.


Self-esteem in the face of world terrorism

Abraham J. Twerski, M.D. is a psychiatrist and ordained rabbi. He is the founder of the Gateway Rehabilitation Center in Pittsburgh, a leading center for addiction treatment. An Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, he is a prolific author, with some 30 books to his credit. He has recently launched a new 12 step program for self esteem development Send your comments by clicking here.

© 2002, Abraham J. Twerski, M.D.