The second word you use here is: naked; and with that zaftig shadayim on this Nordic Jew, plus that seriously sexy terrace---with its rather convenient...um, prospect---this apparently intelligent and evolved woman of certain class and background, who is willing to share the tapes of her therapy process with a newspaper writer as an illustrative proof that another $4.3 billion need be justifiably spent on a collective already engorged on unprecedented tax and charity dollars, is evidence that times are truly hard, and ObamaCare doomed.
For its intended audience, 9/11 had no aesthetically pleasing component, a "kind of beautiful," scrim of "pigeons and paper," although Dr. Margaret Dessau's dream doesn't overreach here, like those who say they saw paired couples on fire, holding hands, while leaping like burning birds from the upper stories, which at least could be viewed as Nijinsky-esque. The group of "sufferers" Dr. Dessau is representing doesn't "replay the disaster in their minds," as much as they are identifiable as the active agents of media who force a false-flag reality down our throats.
I don't know if it is synchronicity or complicity that brought Dr. Dessau to this perch, and a point of inherent contradiction, one where she will "avoid anything that reminds [her] of that terrible day," while she continues "listening to the tapes she made during therapy." That sounds more like trauma programming to me than recovery.
But for Dr. Dessau, a pulmonologist, to have precipitously lost her husband, who had never smoked, from lung cancer in 2009, didn't compound her existing "sense of tragedy," especially the one implanted on 9/11, as much as it awoke her to the responsibility to see what came before as unreal. That her loss occurred close to Ground Zero, the epicenter of what Paul Levy calls our cultural "field of disease," doesn't support her suspicion of physical causality in her husband's death, as much as it does the metaphysical relationship. She was on Greenwich Street for some reason, since it's unclear when they had moved there---with the Times choosing to illustrate her story for a reason too, although it's beyond me.
I've long been separating out those truly traumatized by the manipulation of 9/11 from the class of foreknowledged participants who put on the show. There is extremely little in the story, as told in the New York Times and elsewhere, which even hints at truth. Even what we think we saw on TV is proving to be an artificially manufactured deception. Whatever the private experiences this "privileged" class of participants underwent, their stories as told in the media are unreal. They are fundamentally false public constructs, emotionally unidentifiable as being our fellow human beings.
A goal of mass traumatization was accomplished on the television screen by those convecting Cumulonimbus mushroom-clouds, with dust-devil ejecta, and imaginary fumaroles of sulfur. It was a Haboob---"a tumbling black wall of sand stirred up by cold downdrafts"---where out of a liquefying Lahar came the spectral victims of Plinian eruption and pyroclastic flow. It was a saltation, a solifluction, and a storm surge; whose suction vortices turned into that wall cloud of whiteout.
For its intended audience, 9/11 had no aesthetically pleasing component, a "kind of beautiful," scrim of "pigeons and paper," although Dr. Margaret Dessau's dream doesn't overreach here, like those who say they saw paired couples on fire, holding hands, while leaping like burning birds from the upper stories, which at least could be viewed as Nijinsky-esque. The group of "sufferers" Dr. Dessau is representing doesn't "replay the disaster in their minds," as much as they are identifiable as the active agents of media who force a false-flag reality down our throats.
I don't know if it is synchronicity or complicity that brought Dr. Dessau to this perch, and a point of inherent contradiction, one where she will "avoid anything that reminds [her] of that terrible day," while she continues "listening to the tapes she made during therapy." That sounds more like trauma programming to me than recovery.
But for Dr. Dessau, a pulmonologist, to have precipitously lost her husband, who had never smoked, from lung cancer in 2009, didn't compound her existing "sense of tragedy," especially the one implanted on 9/11, as much as it awoke her to the responsibility to see what came before as unreal. That her loss occurred close to Ground Zero, the epicenter of what Paul Levy calls our cultural "field of disease," doesn't support her suspicion of physical causality in her husband's death, as much as it does the metaphysical relationship. She was on Greenwich Street for some reason, since it's unclear when they had moved there---with the Times choosing to illustrate her story for a reason too, although it's beyond me.
I've long been separating out those truly traumatized by the manipulation of 9/11 from the class of foreknowledged participants who put on the show. There is extremely little in the story, as told in the New York Times and elsewhere, which even hints at truth. Even what we think we saw on TV is proving to be an artificially manufactured deception. Whatever the private experiences this "privileged" class of participants underwent, their stories as told in the media are unreal. They are fundamentally false public constructs, emotionally unidentifiable as being our fellow human beings.
A goal of mass traumatization was accomplished on the television screen by those convecting Cumulonimbus mushroom-clouds, with dust-devil ejecta, and imaginary fumaroles of sulfur. It was a Haboob---"a tumbling black wall of sand stirred up by cold downdrafts"---where out of a liquefying Lahar came the spectral victims of Plinian eruption and pyroclastic flow. It was a saltation, a solifluction, and a storm surge; whose suction vortices turned into that wall cloud of whiteout.
Do you think the English language would have an environmental glossary this rich were we not programmed to be susceptible?
contradictions, and discrepancies so deep, that it isn't honest feeling that's missing, but human beings.
Look at the avowed confirmation bias in this self-analysis:
She sees 9/11 and her husband’s death as part of a continuum, along with her parents’ escape from Nazi Germany, the suicide of a close relative and her time preparing bandages as a student in Israel during the 1967 Arab-Israeli war. “It confirms my sense of pessimism,” she said. “It’s corroboration of the evil of human beings.”
If the suicide of a "close relative" corroborates "the evil of human beings," that would mean Dr. Dessau considers her loved one evil, and the logic at base would mean herself as well. "Her parents’ escape from Nazi Germany," and "her time preparing bandages as a student in Israel," is a laughable excuse for any dark view. Her parents escaped, for heaven's sake---unlike residents of Dresden and Tokyo who were firebombed en mass in a deliberate campaign of terror. The ratio of carnage in the Israeli-Palestinian conflict is probably a hundred to one in Israel's favor, and unless one has empathy for the total picture, one probably isn't growing as a human being. The besieged paranoia of Jews leads them to secretly strike first for fun and profit. The imbalance in the law of proportionality, of "an eye for an eye" that is on display in the Middle East, can't be called overt Jewish doctrine, so what is it then?
I would submit that that is exactly what is happening now
Dr. John Howard,
“In mental health you have to treat the whole person, "
,
Ozier Muhammad / The New York Times
Dr. Margaret Dessau heard the crash of a plane into the World Trade Center from her apartment; the things she saw out her window changed her life.
Running naked from her bath, she saw pigeons and paper flying through the air. “It’s kind of beautiful in a way,” she recalls on the recording she made and listened to over and over as part of her treatment. “There’s these silver pieces just floating in the air.”
Her gaze met the hole in the tower. “The flames get worse, and then I start seeing all these people hanging out there. The guy with this white towel, and he’s waving it.”
He jumps. Children at a nearby school scream.
“How are you feeling?” her therapist, David Bricker, is heard asking on the tape.
“I start crying,” she replies.
Dr. Dessau’s husband yells at her, “Stop looking at it, stop looking at it.” But, she says, “I can’t tear myself away from it.”
One measure of the psychological impact of 9/11 is this: At least 10,000 firefighters, police officers and civilians exposed to the terrorist attack on the World Trade Center have been found to have post-traumatic stress disorder, and in a kind of mass grieving, many of them have yet to recover, according to figures compiled by New York City’s three 9/11 health programs.
In interviews over the last several months, Dr. Dessau and others revealed a wide-ranging but consistent body of symptoms. They cannot sleep. They replay the disaster in their minds, or in their nightmares. They have trouble concentrating. They are jittery and overreact to alarms or loud noises. They feel helpless, hopeless, guilty and cut off from the people who are close to them. They avoid anything that reminds them of that terrible day.
Millions of dollars will be spent treating them over the next few years through the James Zadroga 9/11 Health and Compensation Act, passed by Congress in December, which provides $4.3 billion to compensate and treat people with 9/11-related illnesses.
Some are emergency responders and others who vainly searched the debris for survivors. But some were residents, commuters and office workers caught in the dust cloud. And others were passive witnesses with no direct connection to the attack other than proximity.
Because of lingering questions about the bounds of the PTSD diagnosis, which is only three decades old, people with mental problems are eligible only for treatment assistance, whereas people with physical ailments, in most cases breathing difficulties, qualify for both treatment and compensation. And money available to treat patients with the stress disorder might decline if the government concludes there is a link between certain cancers and 9/11, which would give cancer patients access to the same pool of money. Doctors are expecting a surge in PTSD patients with the coming 10th anniversary, as they have on each Sept. 11.
Charles Figley, professor of disaster mental health at Tulane University’s School of Social Work and a former Marine, advanced the concept of PTSD in a 1978 book on Vietnam War veterans. He said one reason the trauma had been so hard to shake was that it ripped at the most ordinary fabric of daily life.
The landmark is not a distant hill in Afghanistan that one will never see again. “It’s the places you see every day, where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played,” Dr. Figley said.
“You go into a combat zone and then you leave,” he added. “You don’t leave home. You return all the time.”
Ancient but Evolving Illness
“The Iliad” described warriors consumed by feelings of guilt, rage and grief. World War I had “shell shock,” and World War II had “combat fatigue.” PTSD has been found in survivors of Nazi concentration camps, fires and railway accidents. But it was not until 1980, after the Vietnam War, that post-traumatic stress disorder was added to the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders.
The current manual, the DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it. Almost no other psychiatric diagnosis has generated as much controversy, according to Dr. Robert L. Spitzer, a retired psychiatry professor from Columbia University and an expert in mental disorder classifications. It has become so vague that stressed-out college students and people who watched horror movies could fit the profile, he and two other experts wrote in a professional journal article.
“It’s a way of saying something terrible has happened to me and I’ve been damaged in some way, but that doesn’t necessarily mean it’s an illness,” Dr. Spitzer, who advocates tightening the criteria, said in an interview.
Some experts have been skeptical of studies finding that people suffered the disorder from watching television coverage of the Sept. 11 attacks. (Congress effectively excluded TV watchers from its treatment program by requiring that victims had lived or worked within certain geographic boundaries.)
Amy Cushing-Savvi, a social worker at Mount Sinai Medical Center, which runs the largest program, said a frequent topic at staff meetings was, “What’s 9/11 and what isn’t?” — in other words, the exquisitely vexing question of how to separate the effects of 9/11 from the traumas of everyday life.
“Taxpayers could end up paying for psychotherapy for Woody Allen and half of Manhattan,” Theodore H. Frank, a fellow at the Manhattan Institute, testified before the House Judiciary Committee in April 2008, when he was a fellow at the conservative American Enterprise Institute.
Ultimately, federal financing for PTSD treatment was limited to firefighters, police officers, employees of the New York City medical examiner’s office who handled body parts, and other rescue, recovery, cleanup and support workers at ground zero, on the barges that carried debris and at the Staten Island landfill where the twin towers rubble was entombed; responders at the attack sites at the Pentagon and Shanksville, Pa.; and people exposed to 9/11 dust when the buildings collapsed or who lived, worked or attended school south of Houston Street in Manhattan and in parts of Downtown Brooklyn where the dust may have extended.
Family members of New York City firefighters who died are covered as a continuation of an existing Fire Department counseling program, but family members of other victims are not. Representative Carolyn B. Maloney, Democrat of New York and the lead sponsor of the Zadroga Act in the House, said that since victims’ families had been covered by the original 9/11 compensation fund, which paid an average of $2.1 million to each family, the goal was to look after others who suffered. “We were focusing on covering the people who did not die on 9/11, but those who were dying and sick because of 9/11,” she said.
The law was named after a New York police detective who took part in the rescue efforts and later developed breathing complications. The cause of his death in 2006 became a source of debate.
Dr. John Howard, who oversees 9/11 programs as the director of the National Institute for Occupational Safety and Health, said in an interview that he was willing to give people the benefit of the doubt about PTSD, even if they had other stresses. “Collapsing 220 stories of a lot of material in one of the most densely populated cities in the world is a very unique event,” Dr. Howard said.
“In mental health you have to treat the whole person, and you can’t really separate out some of these other influences, personal stressors, economic issues. People are living their lives.”
“It sounds squishy,” he added, “but it really isn’t squishy.”
Her World Collapses
For Dr. Dessau, who is now 64, listening to the tapes she made during therapy conquered her fears for a while, “like cod liver oil,” she said. But in 2009, her sense of tragedy was compounded when her husband, Bob Wheeler, died just four months after being told he had lung cancer.
Dr. Dessau, a youthful, athletic blonde with blue-rimmed green eyes, still lives in the same airy loft on Greenwich Street, decorated with souvenirs of 35 years of travel with Mr. Wheeler — shells arranged in bowls, a child-size winged Hermes, a many-limb stone goddess, a terra cotta Chinese statue of a man. There is also a green plastic box containing her husband’s ashes.
Mr. Wheeler, a lawyer, never smoked, so Dr. Dessau, a pulmonologist, suspected that his disease was related to his exposure to the falling buildings. His quick death revived the sense of helplessness she had felt watching people jump from the towers. “As a doctor you always think you can fix it,” she said.
She lost 20 pounds. She stopped seeing friends. She was “on red alert,” sure that something bad would happen at any second. She avoids looking at the skyline outside her window, though her reaction is not as bad since buildings have begun to fill in the space where the World Trade Center used to be.
A city fund set up before the Zadroga Act was enacted provided $9,000 to Dr. Dessau to cover therapy expenses not handled by her insurance. The city sent a letter encouraging her to seek further treatment through a public program that would allow the Zadroga money to cover her out-of-pocket expenses, but she prefers her own therapist.
She sees 9/11 and her husband’s death as part of a continuum, along with her parents’ escape from Nazi Germany, the suicide of a close relative and her time preparing bandages as a student in Israel during the 1967 Arab-Israeli war. “It confirms my sense of pessimism,” she said. “It’s corroboration of the evil of human beings.”
That sense of 9/11 as a catalyst is common. In June, Stanley Mieses, 58, a freelance writer and editor, lined up with other psychiatric patients at the city-run Elmhurst Hospital Center under a sign that said, as if testing his sanity: New atient Registrati n.
During a screening, he circled the maximum, “nearly every day,” to a question about how often he had been “feeling bad about yourself — or that you are a failure or have let yourself or your family down.”
Mr. Mieses, who is receiving treatment under the Zadroga Act, lived six and a half blocks from the trade center and watched the buildings collapse. The police evacuated him, but he returned every few days to feed his cats. “Dead people were blowing into my apartment off the windowsills,” he said, remembering the ash, “because the landlord was too cheap to clean it.”
For a while he sublimated his anxiety, filing reports for NPR from his stunned neighborhood. But in short order, his mother, a World War II German refugee with what he said were her own PTSD issues, died; his girlfriend left him; work dried up; and he was forced by his finances to move to Jackson Heights, Queens.
These psychic blows led, he said, to “a change in my attitude, a change in my — I don’t know — joie de vivre.”
His pulmonologist at Elmhurst says his shortness of breath could be from the dust, or the 20 years he smoked. The origins of his mental wounds are also ambiguous. “I tend to think of 9/11 as the trapdoor that opened up,” Mr. Mieses said. “Whatever else I’m doing past that, is climbing back up.”
A Number Unknown
It is impossible to say how many people have 9/11-related PTSD. The city’s three official programs do not count people, like Dr. Dessau, who use private physicians — or those who have not been treated at all.
According to figures provided by the programs, run by the Fire Department, which treats its own employees; a consortium of hospitals led by Mount Sinai Medical Center, which treats police officers and other rescue and recovery workers; and the city’s public hospital system, which treats civilians, at least 10,000 patients have met the criteria over the last decade, and at least 3,600 of them still have symptoms. But even those rounded numbers have an asterisk: 3,000 of the 10,000 patients were treated by the public hospitals, whose statistics do not differentiate among PTSD, depression and anxiety. The Zadroga program covers all three, along with panic disorder, substance abuse and a few other conditions.
Extrapolating from a registry of people exposed to the attack, the city’s health department has estimated that 61,000 of the 409,000 in the disaster area experienced “probable” PTSD within six years of 9/11. But these numbers were produced by institutions and a city government with two main goals: to make as many people as possible feel better, and to try to persuade Congress to provide a steady stream of treatment money. The city’s 9/11 health programs have created a huge intake system that screens every patient for mental as well as physical illness, and the public hospitals reached out to New Yorkers with subway advertisements that said: “Lived there? Worked there? You deserve care.”
No one can say exactly how many people were exposed to the attack, and how many will eventually become physically or mentally sick. The federal government will allow the Mount Sinai and public hospitals programs to grow by 25,000 patients each over the next five years. It will be up to each program to decide who qualifies for treatment, but they will have to use uniform criteria approved by the government. Therapy can cost $135 for a 45-minute weekly session with a psychologist or $165 with a psychiatrist.
If the government finds a link between 9/11 dust and cancer, there is some concern about running out of money, though the Zadroga fund is to be a secondary payment source, covering what insurance and workers’ compensation do not.
Dr. Howard, the federal 9/11 health administrator, said the government “will treat people as they come in to the extent possible.”
Alarms, Over and Over
Patients at Mount Sinai find a busy warren of rooms where they are divided into three categories: green (no further assessment needed), yellow (potentially symptomatic) and red (symptoms so severe that they might be suicidal). They begin the screening at home, filling out an 11-page questionnaire that asks about their level of energy, how often they feel “calm and peaceful,” and about recent life experiences like losing a job or having a relationship break up. In a section called “Reminders of 9/11,” they are asked whether they have recurring thoughts of the disaster and whether they feel emotionally cut off from those close to them.
In an interview with a clinician, they are asked whether “you often believe it would be better if you were dead,” “you feel worthless” or “you feel guilty even though you didn’t deserve to feel that way.”
If they have PTSD, patients are usually given a combination of psychotherapy and pills, typically antidepressants, and sometimes sleeping pills. Many patients are encouraged to make recordings of their memories, as Dr. Dessau did, or to write about them until the memories lose their power. This is called exposure therapy.
Once a month, Earl Holland drives from his home in Flatlands, Brooklyn, to Mount Sinai for meditation classes. “You get in a room, the chimes are going, it’s fantastic,” Mr. Holland said. He also takes Wellbutrin, an antidepressant, and Ambien, a sleeping pill.
Mr. Holland, 48, was a paramedic supervisor for North Shore-Long Island Jewish Health System when he responded to the disaster after the second tower collapsed. In his dreams, he still hears the alarms — attached to each firefighter’s mask — that signal that a firefighter has stopped moving. “There were hundreds of alarms going off,” he said, grabbing a tissue to wipe away the tears as he sat in his kitchen, remembering.
“I kept the list” of the missing, he said.
Two months after the attacks, he responded to the crash of American Airlines Flight 587 in Belle Harbor, Queens.
He started shutting himself in his bedroom, refusing to talk to his wife and children. He spent hours staring at photographs of the burning rubble and had flashbacks of responding to murders during the 1980s crack epidemic.
“Toward the end, I didn’t want to do my calls,” he said. “It was like, enough. I actually thought it was burnout, but it wasn’t burnout.”
Mr. Holland’s diagnosis of PTSD was made in 2009 through a Mount Sinai outreach program, and his costs will be covered by the Zadroga Act.
He has recovered enough that he hopes to return to work, but not on the front lines. “I don’t know if I’ll go to the memorial any time soon,” he said. “I look at that kind of as closure, if I’m able to do that.”
Alain Delaquérière contributed research.
Her gaze met the hole in the tower. “The flames get worse, and then I start seeing all these people hanging out there. The guy with this white towel, and he’s waving it.”
He jumps. Children at a nearby school scream.
“How are you feeling?” her therapist, David Bricker, is heard asking on the tape.
“I start crying,” she replies.
Dr. Dessau’s husband yells at her, “Stop looking at it, stop looking at it.” But, she says, “I can’t tear myself away from it.”
One measure of the psychological impact of 9/11 is this: At least 10,000 firefighters, police officers and civilians exposed to the terrorist attack on the World Trade Center have been found to have post-traumatic stress disorder, and in a kind of mass grieving, many of them have yet to recover, according to figures compiled by New York City’s three 9/11 health programs.
In interviews over the last several months, Dr. Dessau and others revealed a wide-ranging but consistent body of symptoms. They cannot sleep. They replay the disaster in their minds, or in their nightmares. They have trouble concentrating. They are jittery and overreact to alarms or loud noises. They feel helpless, hopeless, guilty and cut off from the people who are close to them. They avoid anything that reminds them of that terrible day.
Millions of dollars will be spent treating them over the next few years through the James Zadroga 9/11 Health and Compensation Act, passed by Congress in December, which provides $4.3 billion to compensate and treat people with 9/11-related illnesses.
Some are emergency responders and others who vainly searched the debris for survivors. But some were residents, commuters and office workers caught in the dust cloud. And others were passive witnesses with no direct connection to the attack other than proximity.
Because of lingering questions about the bounds of the PTSD diagnosis, which is only three decades old, people with mental problems are eligible only for treatment assistance, whereas people with physical ailments, in most cases breathing difficulties, qualify for both treatment and compensation. And money available to treat patients with the stress disorder might decline if the government concludes there is a link between certain cancers and 9/11, which would give cancer patients access to the same pool of money. Doctors are expecting a surge in PTSD patients with the coming 10th anniversary, as they have on each Sept. 11.
Charles Figley, professor of disaster mental health at Tulane University’s School of Social Work and a former Marine, advanced the concept of PTSD in a 1978 book on Vietnam War veterans. He said one reason the trauma had been so hard to shake was that it ripped at the most ordinary fabric of daily life.
The landmark is not a distant hill in Afghanistan that one will never see again. “It’s the places you see every day, where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played,” Dr. Figley said.
“You go into a combat zone and then you leave,” he added. “You don’t leave home. You return all the time.”
Ancient but Evolving Illness
“The Iliad” described warriors consumed by feelings of guilt, rage and grief. World War I had “shell shock,” and World War II had “combat fatigue.” PTSD has been found in survivors of Nazi concentration camps, fires and railway accidents. But it was not until 1980, after the Vietnam War, that post-traumatic stress disorder was added to the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders.
The current manual, the DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it. Almost no other psychiatric diagnosis has generated as much controversy, according to Dr. Robert L. Spitzer, a retired psychiatry professor from Columbia University and an expert in mental disorder classifications. It has become so vague that stressed-out college students and people who watched horror movies could fit the profile, he and two other experts wrote in a professional journal article.
“It’s a way of saying something terrible has happened to me and I’ve been damaged in some way, but that doesn’t necessarily mean it’s an illness,” Dr. Spitzer, who advocates tightening the criteria, said in an interview.
Some experts have been skeptical of studies finding that people suffered the disorder from watching television coverage of the Sept. 11 attacks. (Congress effectively excluded TV watchers from its treatment program by requiring that victims had lived or worked within certain geographic boundaries.)
Amy Cushing-Savvi, a social worker at Mount Sinai Medical Center, which runs the largest program, said a frequent topic at staff meetings was, “What’s 9/11 and what isn’t?” — in other words, the exquisitely vexing question of how to separate the effects of 9/11 from the traumas of everyday life.
“Taxpayers could end up paying for psychotherapy for Woody Allen and half of Manhattan,” Theodore H. Frank, a fellow at the Manhattan Institute, testified before the House Judiciary Committee in April 2008, when he was a fellow at the conservative American Enterprise Institute.
Ultimately, federal financing for PTSD treatment was limited to firefighters, police officers, employees of the New York City medical examiner’s office who handled body parts, and other rescue, recovery, cleanup and support workers at ground zero, on the barges that carried debris and at the Staten Island landfill where the twin towers rubble was entombed; responders at the attack sites at the Pentagon and Shanksville, Pa.; and people exposed to 9/11 dust when the buildings collapsed or who lived, worked or attended school south of Houston Street in Manhattan and in parts of Downtown Brooklyn where the dust may have extended.
Family members of New York City firefighters who died are covered as a continuation of an existing Fire Department counseling program, but family members of other victims are not. Representative Carolyn B. Maloney, Democrat of New York and the lead sponsor of the Zadroga Act in the House, said that since victims’ families had been covered by the original 9/11 compensation fund, which paid an average of $2.1 million to each family, the goal was to look after others who suffered. “We were focusing on covering the people who did not die on 9/11, but those who were dying and sick because of 9/11,” she said.
The law was named after a New York police detective who took part in the rescue efforts and later developed breathing complications. The cause of his death in 2006 became a source of debate.
Dr. John Howard, who oversees 9/11 programs as the director of the National Institute for Occupational Safety and Health, said in an interview that he was willing to give people the benefit of the doubt about PTSD, even if they had other stresses. “Collapsing 220 stories of a lot of material in one of the most densely populated cities in the world is a very unique event,” Dr. Howard said.
“In mental health you have to treat the whole person, and you can’t really separate out some of these other influences, personal stressors, economic issues. People are living their lives.”
“It sounds squishy,” he added, “but it really isn’t squishy.”
Her World Collapses
For Dr. Dessau, who is now 64, listening to the tapes she made during therapy conquered her fears for a while, “like cod liver oil,” she said. But in 2009, her sense of tragedy was compounded when her husband, Bob Wheeler, died just four months after being told he had lung cancer.
Dr. Dessau, a youthful, athletic blonde with blue-rimmed green eyes, still lives in the same airy loft on Greenwich Street, decorated with souvenirs of 35 years of travel with Mr. Wheeler — shells arranged in bowls, a child-size winged Hermes, a many-limb stone goddess, a terra cotta Chinese statue of a man. There is also a green plastic box containing her husband’s ashes.
Mr. Wheeler, a lawyer, never smoked, so Dr. Dessau, a pulmonologist, suspected that his disease was related to his exposure to the falling buildings. His quick death revived the sense of helplessness she had felt watching people jump from the towers. “As a doctor you always think you can fix it,” she said.
She lost 20 pounds. She stopped seeing friends. She was “on red alert,” sure that something bad would happen at any second. She avoids looking at the skyline outside her window, though her reaction is not as bad since buildings have begun to fill in the space where the World Trade Center used to be.
A city fund set up before the Zadroga Act was enacted provided $9,000 to Dr. Dessau to cover therapy expenses not handled by her insurance. The city sent a letter encouraging her to seek further treatment through a public program that would allow the Zadroga money to cover her out-of-pocket expenses, but she prefers her own therapist.
She sees 9/11 and her husband’s death as part of a continuum, along with her parents’ escape from Nazi Germany, the suicide of a close relative and her time preparing bandages as a student in Israel during the 1967 Arab-Israeli war. “It confirms my sense of pessimism,” she said. “It’s corroboration of the evil of human beings.”
That sense of 9/11 as a catalyst is common. In June, Stanley Mieses, 58, a freelance writer and editor, lined up with other psychiatric patients at the city-run Elmhurst Hospital Center under a sign that said, as if testing his sanity: New atient Registrati n.
During a screening, he circled the maximum, “nearly every day,” to a question about how often he had been “feeling bad about yourself — or that you are a failure or have let yourself or your family down.”
Mr. Mieses, who is receiving treatment under the Zadroga Act, lived six and a half blocks from the trade center and watched the buildings collapse. The police evacuated him, but he returned every few days to feed his cats. “Dead people were blowing into my apartment off the windowsills,” he said, remembering the ash, “because the landlord was too cheap to clean it.”
For a while he sublimated his anxiety, filing reports for NPR from his stunned neighborhood. But in short order, his mother, a World War II German refugee with what he said were her own PTSD issues, died; his girlfriend left him; work dried up; and he was forced by his finances to move to Jackson Heights, Queens.
These psychic blows led, he said, to “a change in my attitude, a change in my — I don’t know — joie de vivre.”
His pulmonologist at Elmhurst says his shortness of breath could be from the dust, or the 20 years he smoked. The origins of his mental wounds are also ambiguous. “I tend to think of 9/11 as the trapdoor that opened up,” Mr. Mieses said. “Whatever else I’m doing past that, is climbing back up.”
A Number Unknown
It is impossible to say how many people have 9/11-related PTSD. The city’s three official programs do not count people, like Dr. Dessau, who use private physicians — or those who have not been treated at all.
According to figures provided by the programs, run by the Fire Department, which treats its own employees; a consortium of hospitals led by Mount Sinai Medical Center, which treats police officers and other rescue and recovery workers; and the city’s public hospital system, which treats civilians, at least 10,000 patients have met the criteria over the last decade, and at least 3,600 of them still have symptoms. But even those rounded numbers have an asterisk: 3,000 of the 10,000 patients were treated by the public hospitals, whose statistics do not differentiate among PTSD, depression and anxiety. The Zadroga program covers all three, along with panic disorder, substance abuse and a few other conditions.
Extrapolating from a registry of people exposed to the attack, the city’s health department has estimated that 61,000 of the 409,000 in the disaster area experienced “probable” PTSD within six years of 9/11. But these numbers were produced by institutions and a city government with two main goals: to make as many people as possible feel better, and to try to persuade Congress to provide a steady stream of treatment money. The city’s 9/11 health programs have created a huge intake system that screens every patient for mental as well as physical illness, and the public hospitals reached out to New Yorkers with subway advertisements that said: “Lived there? Worked there? You deserve care.”
No one can say exactly how many people were exposed to the attack, and how many will eventually become physically or mentally sick. The federal government will allow the Mount Sinai and public hospitals programs to grow by 25,000 patients each over the next five years. It will be up to each program to decide who qualifies for treatment, but they will have to use uniform criteria approved by the government. Therapy can cost $135 for a 45-minute weekly session with a psychologist or $165 with a psychiatrist.
If the government finds a link between 9/11 dust and cancer, there is some concern about running out of money, though the Zadroga fund is to be a secondary payment source, covering what insurance and workers’ compensation do not.
Dr. Howard, the federal 9/11 health administrator, said the government “will treat people as they come in to the extent possible.”
Alarms, Over and Over
Patients at Mount Sinai find a busy warren of rooms where they are divided into three categories: green (no further assessment needed), yellow (potentially symptomatic) and red (symptoms so severe that they might be suicidal). They begin the screening at home, filling out an 11-page questionnaire that asks about their level of energy, how often they feel “calm and peaceful,” and about recent life experiences like losing a job or having a relationship break up. In a section called “Reminders of 9/11,” they are asked whether they have recurring thoughts of the disaster and whether they feel emotionally cut off from those close to them.
In an interview with a clinician, they are asked whether “you often believe it would be better if you were dead,” “you feel worthless” or “you feel guilty even though you didn’t deserve to feel that way.”
If they have PTSD, patients are usually given a combination of psychotherapy and pills, typically antidepressants, and sometimes sleeping pills. Many patients are encouraged to make recordings of their memories, as Dr. Dessau did, or to write about them until the memories lose their power. This is called exposure therapy.
Once a month, Earl Holland drives from his home in Flatlands, Brooklyn, to Mount Sinai for meditation classes. “You get in a room, the chimes are going, it’s fantastic,” Mr. Holland said. He also takes Wellbutrin, an antidepressant, and Ambien, a sleeping pill.
Mr. Holland, 48, was a paramedic supervisor for North Shore-Long Island Jewish Health System when he responded to the disaster after the second tower collapsed. In his dreams, he still hears the alarms — attached to each firefighter’s mask — that signal that a firefighter has stopped moving. “There were hundreds of alarms going off,” he said, grabbing a tissue to wipe away the tears as he sat in his kitchen, remembering.
“I kept the list” of the missing, he said.
Two months after the attacks, he responded to the crash of American Airlines Flight 587 in Belle Harbor, Queens.
He started shutting himself in his bedroom, refusing to talk to his wife and children. He spent hours staring at photographs of the burning rubble and had flashbacks of responding to murders during the 1980s crack epidemic.
“Toward the end, I didn’t want to do my calls,” he said. “It was like, enough. I actually thought it was burnout, but it wasn’t burnout.”
Mr. Holland’s diagnosis of PTSD was made in 2009 through a Mount Sinai outreach program, and his costs will be covered by the Zadroga Act.
He has recovered enough that he hopes to return to work, but not on the front lines. “I don’t know if I’ll go to the memorial any time soon,” he said. “I look at that kind of as closure, if I’m able to do that.”
Alain Delaquérière contributed research.
No comments:
Post a Comment