The mental health crisis that wasn't: how the trauma industry exploited 9/11

Reason, August-Sept, 2005 by Sally Satel, Christina Hoff Sommers

How can debriefings make things worse? First, venting emotions and reviewing experiences repeatedly in the immediate aftermath of a crisis can interfere with victims' natural adaptive instinct to distance themselves emotionally. They may start ruminating about the event--fixating on why it happened, how life is now ruined, whether revenge is possible--thus intensifying intrusive memories and overall distress.

Second, debriefing might lead people to believe that they have now received "treatment" for distress and no longer need to, or should, disclose their anxieties to family and friends. This deprives victims of the comfort and reassurance that are usually best supplied through established, intimate relationships. Paradoxically, knowing that professional debriefers are involved may even cause family and friends to hang back.

Third, by warning participants of the kinds of reactions that could develop over the coming weeks, debriefers might inadvertently prime victims to interpret otherwise normal reactions as pathological or as the beginning stages of PTSD. As the psychiatrist Simon Wessely has remarked, "The toxic effect of counseling is that some people begin to see themselves as having a mental health problem when they do not."

Where Are All the Patients?

In October 2001 Sharon Kahn, a senior psychologist at Coney Island Hospital, manned the phones at a televised call-in show sponsored by PBS and called Reach Out to Heal. Experts described the symptoms of traumatic stress, and viewers were urged to phone in with questions and to get referrals for help.

Kahn took calls all evening. She referred a grand total of two people for therapy. The vast bulk of the calls were queries about the resumption of regularly scheduled programming.

Across the country, mental health professionals braced for epic caseloads after September 11. Yet in the end, the demand for their services was modest. According to the New York Academy of Medicine, which conducted numerous surveys after the terrorist attacks, roughly 19 percent of New Yorkers said they saw a mental health professional within the eight weeks after the event--but this was little more than the 17 percent who did so eight weeks before the attack. "Existing therapeutic relationships and informal sources of support were the primary mental health resources for most people within the first few months," according to Dr. Sandro Galea of the Academy.

According to an Academy study published in 2004, there was no evidence that the predicted waves of delayed PTSD were surfacing, at least within the first five months after the attacks. Mental health service use declined steadily within the first five months after attacks to virtually pre-9/11 levels. "The increase was not clinically significant," Dr. Joseph A. Boscarino, the study's lead author, told The New York Times, "We expected higher use rates."

For about a year after the attacks, star-studded public service announcements were ubiquitous in subways, buses, and newspapers around New York City. "Whatever you are struggling with, you are not alone," the actor Alan Alda intoned on radio stations serving New York City. "Now is the time to feel free to feel better." The ads were sponsored by Project Liberty, the name given to the crisis counseling program in New York City funded by the Federal Emergency Management Agency (FEMA) and run by the New York State Office of Mental Health.