By Patrick Donges
http://stream.publicbroadcasting.net/production/mp3/wamc/local-wamc-985511.mp3
Pittsfield, MA – Al Whelan, who moved from New York City to the Berkshires about 30 years ago, went back to New York be with family on Sept. 12, 2001, after learning in the early morning hours of that day that his brother Eugene, a New York City Firefighter with Engine 230, was among the missing.
Whelan was a civilian among those first responders from across the country who rushed to Manhattan to assist in recovery and clean-up at ground zero. He described the scene at the site in the days immediately following the attacks.
"It was hell, it was hell. It was a war zone; everything was burning and it was hot, it was smoky. Everybody was not hopeful at that point."
From ground zero, he went on to attend several memorials for firefighters from the Rockaway Beach neighborhood of Queens, one of the areas hardest hit in terms of casualties.
"It was one service after another, after another. It was just, it was numbing after a while."
That "numbing" is one of the symptoms of post-traumatic stress disorder, or PTSD, the severe anxiety disorder commonly associated with soldiers returning from war, which Whelan was diagnosed with and received treatment for in the months after 9/11.
It's impossible to know exactly how many Americans experienced symptoms of PTSD following 9/11; the New York Times estimated that least 10,000 first responders and civilians close to the attack on the World Trade Center have been diagnosed with the disorder.
Dr. Jennifer Michaels, medical director at the Brien Center, which provides mental health and substance abuse services in the Berkshires, said most of her patients felt a need to discuss their feelings immediately following the attacks, which she said was healthy after such an extreme event.
"The vast majority of people who experienced 9/11 did not end up with PTSD. They were traumatized, but they worked through it and they were able to move forward."
"Probably about 10 or 11 percent of people ended up with more persistent, pervasive symptoms that were quite hobbling sometimes. What they experienced was a difficulty removing themselves from the thoughts (and) the events that occurred on 9/11."
While ushering in a new era of heightened national security, the attacks also gave mental health professionals insight into the nature of PTSD at a time when debate on the definition of the disorder was looming.
The American Psychiatric Association, or APA, began planning for the drafting and publication of the fifth and latest edition of their Diagnostic and Statistic Manual of Mental Disorders, commonly known as the DSM, in 1999; Dr. Benjamin Wood is a psychology professor at Massachusetts College of Liberal Arts.
"9/11 was a huge moment in the history of our country. The world watched as it happened, and that brought on a lot of questions in terms of PTSD regarding witnessing the event."
"As it stands right now the PTSD diagnosis requires that a person be present at an event that involves actual or threatened death or serious injury. The revisions proposed are really trying to flesh that out. I think a lot of that is related to people being more versed in the idea of what trauma is; there used to be 'Trauma' with a 'T,' now there's a lot of traumas with a 't.'"
Wood and Michaels said those working on the DSM-5, which is expected to be published in 2013, have had to revise their focus from the etiology, or origin, of traumas to those symptoms felt after an initial experience, if a specific event could be traced as the cause of the symptoms at all; here's Wood.
"The DSM really focuses on specific symptoms to fit the diagnosis, but other folks would argue that you could have more of a continuum of experience; you might start off with a stress response that could develop into more of a full-blown PTSD."
That could be an issue of concern for those most vulnerable to the disorder as the media ramps up coverage of remembrances on the tenth anniversary of the attacks.
Michaels said those who have experienced PTSD symptoms related to 9/11 might find relief in avoiding that type of stimulus in the days leading up to the anniversary.
"It's important for PTSD patients to make sure they feel safe that day, to feel supported. Sometimes it's very good to avoid all of the events if it feels like it will be too much."
In the years since 2001, Whelan has met with family on 9/11 in Dutchess County for a day of food and togetherness during which he said the attacks are not typically brought up in conversation.
This year he will be attending services at the National September 11 Memorial and Museum in Manhattan, but as in years past, will also be avoiding the barrage of anniversary coverage.
"It's going to be tough this year, but the memorial is going to be a good thing. I've seen it online a couple of times already and it looks like a beautiful tribute."
Michaels said the Brien Center recognizes that the anniversary is a time of increased emotional stress across the country, and that their mobile crisis team is prepared 24/7 to help with mental health issues.
A CNN poll released this week shows that while fewer residents across the country are still dealing with the mental effects of the attacks, they have left a lasting impression; 17 percent of those polled this year said they thought about 9/11 at least once a week, down from two-thirds of those polled in 2002.