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Post-Traumatic Stress Disorder
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Coping With Terrorism and War

Mark Dombeck, Ph.D.

The article below was originally written in response to the attacks on September 11th, 2001.  However, the feelings described and the stages of grief, anger, and resolution remain true today regardless of the actual event that be responding to whether it is a recent plane downing, migrant and asylum-seeking refugees leaving their homes and horrible circumstances around the world, or a recent terrorist group claming a horrible bombing or other attack.


Human beings waking up on this day after and the many days after to come will need to find ways to cope with this awful event. Here then, are some suggestions for how to accomplish this task.

People reacting to losses and traumas tend to go through a set of 'stages of grief' which are usually listed as denial, outrage/anger, working through, and resolution. Although these 'stages' don't always occur in this order, they are experiences that many people will go through as they come to terms with this event. Although a verbal description is not the same as experience, it is nevertheless a good idea to know what you and others are likely to feel.


You can't believe that this is happening, has happened. It seems unreal, like a dream. The world may even seem unreal and you may go about your day in a sort of fog. In the more serious scenarios, true dissociation can occur where there is distorted memory for the event. Just this morning on the news, I saw an interview with the parents of one of the Pennsylvania victim's parents. It seems that this brave man was able to call his parents after the hijacking, tell them he loved them, and also tell them about the hijacking events. The parents noted that he "is a proactive sort of person" and would be someone who would try to take action against the hijackers. Maybe, they wondered out loud, maybe he helped crash that plane into the ground rather than allow it to hit a target. I noted the parent's use of the present tense in describing their son - the reality of the son's murder hasn't quite sunk in yet.

You are angry, furious, outraged at the event, at being victimized, at the scope of the tragedy, at the death toll of thousands of innocents, at the vulnerability that has been forcibly brought to your attention, at your own vulnerability. You are hurt, you may even find yourself crying. You are both sad and angry. You want revenge. You want blood. You want to take the eye of the perpetrator (who at this point is not known), for having taken your own eye. In the more severe scenarios, you will not wait to know who did this, will not limit your anger to those who legitimately deserve it, will not allow the government and military to do their jobs, but rather will race out to harm others who, in your own mind are associated with the perpetrators.

If these are your feelings, please do not act on them. Feel them, talk about them even, but do not act on them. The people you as an individual could harm are not to blame for this tragedy. They were not the perpetrators. Instead, they are as much victims as you are. Allow the United States government to "hunt down and punish" (in the words of President Bush) the true perpetrators.

Working Through

Working through happens over time. It is the process through which one ends up sorting all the many feelings out and weaving them into the fabric of ones life so that, as it were, things return to 'normal'. Many different feelings may be felt during this sorting out process: anger and outrage may alternate with periods of relative detachment, fatigue, sadness, bursts of tears, even numbness at times. You may find yourself not wanting to feel anything, and then later find yourself overwhelmed by feeling. It is as though you have swallowed an emotional meal that your body and soul are not quite able to digest all at once. Eventually, over time, most will find a way to digest it all, and life will return to 'normal'


Resolution is a relative term. Mostly what it means is that the acute emotional mess of working through is resolved enough so that life has returned to a regular rhythm, and once again, worry about paying the bills and holding and keeping a job, and keeping your relationships on an even track become the day to day worries. Some people will resist resolution in the belief that to resolve and be over this tragedy means that the horror has been forgotten and that the meaning of the attack has been forgotten. Others will find solace in spiritual teachings of forgiveness and confidence in the ultimate ability for eternal judgment to sort out things better than any human being could. For many people, resolution will be hard to achieve until there has been some satisfactory response by the United States government.


The intensity of this process of grieving and working through will likely be in relationship to how closely you have been impacted. Those who have lost loved ones will be hardest hit, as will those who do the actual rescue and emergency work. Those who know people who were lost, but are not related to them will be hit to a lesser degree. Those who only saw this on the television and heard it on the radio will have an easier time.

Trauma Disorders

Those people most directly impacted by the violence and death are at heightened risk for experiencing trauma disorders. A trauma disorder occurs (in the broadest sense) when a person is not able to follow a normal process of grief through to resolution, and instead gets stuck in it, reliving the emotions and memories associated with the trauma over and over. There are two forms of trauma disorders: Acute Stress Disorder and Posttraumatic Stress Disorder. As the names suggest, the big difference between these two disorders is that Acute Stress Disorder happens directly in the aftermath of a trauma, while PTSD by definition cannot occur until six months after the occurrence of the trauma. Trauma disorders are characterized by: 1) heightened startle responses, arousal, and anxiety reactions, 2) avoidance of trauma related people, places, things and memories, and 3) intrusive re-experiencing of the trauma in the form of nightmares, waking dreams and memories, and sometimes even hallucinations.

See Your Doctor

If you have been traumatized, it isn't a bad idea to see your doctor, or even better, a Psychiatrist with an understanding of trauma. Doctors may be able to prescribe a treatment plan for you that will help address and help you work through your traumatic circumstances. Such a plan will likely include medication and psychotherapy.

Encourage But Do Not Force Talking

It is most important that people exposed to a trauma be encouraged, but not forced to talk about what they have experienced. Traumatized persons are very vulnerable to being flooded with the emotion of what they have experienced - it is quite important that they be able to speak about what they have witnessed in a safe environment in front of people who will have the strength to witness what they have to say and feel without themselves becoming overwhelmed, angry, etc.. Many lay people will have a difficult time doing this and so, in many cases the task of encouraging traumatized people to talk will be best left to trained mental health professionals. If you are a traumatized person, consider seeking psychotherapy at this time. If you know of people who have been traumatized, encourage them to participate in psychotherapy sessions. Both individual psychotherapy and group psychotherapy sessions with other persons who have experienced similar or the same traumas can be very helpful to trauma victims. In some cases, therapy may be the thing that prevents trauma victims from crossing the line from Acute Stress into Posttraumatic Stress Disorders.

Combating Helplessness

Most all people are on edge in the aftermath of a national trauma like that we have just experienced. Don't be surprised if there is an increase in the number of household arguments you have. Don't be surprised if you find that fears and phobias you had a handle on before (fears of flying in an airplane, of being in a tall building, etc.) become exacerbated. Chalk this up to the normal process of working through and trust that in most cases these will recede as this event becomes resolved (and if they don't that there is effective therapy that can help). In the mean time, there are a few things you can do to combat feelings of helplessness:

1) Give Blood. The Red Cross and hospitals are always in need of blood. Be part of those who help the victims get the blood that they need by donating some to your local Red Cross or Blood Bank. Call 1-800-GIVE-LIFE (1-800-448-3543) or try the Red Cross' website.

2) Talk About It. If this tragedy is bothering you, talk about it with others who also want to talk about it. This sort of talk could happen anywhere, at home, work, with a therapist, with a religious leader, etc. It doesn't have to be formal. Just watch out for expressions of violence and anger. It's really okay to talk about being angry, hurt, devastated, etc. but it is not okay to threaten others with violence (see my plea above under Outrage/Anger). Let the government handle that part.