January 2002 • Volume 8 • Number 1
Session explores 'vicarious impact' of Sept. 11
BY TONI LAPP
A mericans' psychological responses to the Sept. 11 attacks have been proportional to their distance from New York City, said a speaker at a special session on dealing with fear at the Patient Education Conference held here Nov. 15 18.
But even though most Americans have not been directly affected by the attacks, "I was struck by how interconnected we all are. Even at a geographic distance, everybody had a connection with what happened," said Steven Shearer, Ph.D., a clinical psychologist at Franklin Square Hospital Center in Baltimore. He spoke about those who have been "vicariously impacted" during his talk at the conference, which was co-sponsored by the Society of Teachers of Family Medicine and the AAFP.
Cindy Barter, M.D., says she was stymied in her attempt to get a live voice when calling CDC about a postal worker with a rash.The discussion sparked heated debate when participants began talking about the public health response to the anthrax threat. Some decried the failure to detect the infection of postal workers who later died. Others said it was justified to be caught offguard, given the minimal threat of anthrax before now.
"Helping Patients -- Dealing With Fear in America" featured discussion by Shearer and Linda Prine, M.D., medical director at Sidney Hillman Family Practice in New York City. She spoke of the problems of persons directly affected by the Sept. 11 events.
Shearer addressed normal responses to vicarious trauma such as persistent re-experiencing of the attacks, be it intrusive images of mourners or of planes striking the towers. Other patients report recurring nightmares and being unduly startled by airplanes or sirens. Hyperarousal may occur, he said, causing insomnia, difficulty concentrating, irritability and anger.
Shearer originally was scheduled to speak at a conference session on an area of expertise for him: counseling patients with a fear of flying. One might think that business would have picked up for Shearer, but "most patients who were fearful before are now saying, 'Thanks, but no thanks,'" said Shearer, conceding that even he now views low-flying airplanes with trepidation.
His observation has been that outside of New York City, mental health offices have not been overrun by people seeking therapy, contrary to what he has found reported in the media. Patients who were already on edge experienced a reverb, but, for better or worse, society seems to be getting back to normal, he said.
Participants had a chance to comment, and the public health response to anthrax became the focus. Donald Bosshart, Ed.D., chair of the National Center for the Evaluation of Residency Programs in Kent, Ohio, objected to the criticism and blamed the media for negative coverage of the public health system. "When was the last case of anthrax?" he said. "We have to look at probabilities."
"I suggest that we take some time out from the news," he said.
Some FPs told of their own encounters with worried patients. FP Cindy Barter, M.D., of St. Louis said she faced uncertainty when a postal worker presented with a rash. Unsure of what tests to request, she was stymied in her attempts to reach a live voice when she made calls to the CDC. "We need to question how we communicate among ourselves to try to get answers when something comes up quickly," she said.
STFM President Denise Rodgers, M.D., of New Brunswick, N.J., said she volunteered for a state health department hot line to answer questions on anthrax. "You want to be able to reassure people, but the anxiety level is sky-high" in her area, she said. "The thing for me that is the scariest is the realization of just how unprepared as a country we really are."
FP Report is published by the AAFP News Department.
Copyright © 2002 by American Academy of Family Physicians.
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