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Depression & Suicide After September 11

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Published On: <DATE>          Updated On: December 19, 2001
© Terence T. Gorski, 2001

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Depression & Suicide After September 11

Victims at Risk Again
Counselors Scramble To Avert Depression, Suicides After Sept. 11

By Jacqueline L. Salmon and Lena H. Sun
Washington Post Staff Writers
Wednesday, December 19, 2001; Page A01

The first suicide was last week, the widow of a World Trade Center victim who shot herself at her Pennsylvania farmhouse.

It was a tragedy that relief workers had braced for -- a spike in depression, substance abuse, divorces, suicides -- the sad legacy among those touched by the Sept. 11 terrorist attacks.

Warned by a pattern that emerged after the Oklahoma City bombing, public officials and charities have taken perhaps the most aggressive stance ever in pushing mental health therapy for families and others affected by the attacks.

For New York City police employees, counseling has been declared mandatory. The American Red Cross flew in survivors of the 1995 Oklahoma bombing to talk with relatives of the Sept. 11 victims. In Washington, anyone who worked at the Pentagon is eligible for free counseling. In New York City, officials are launching a massive campaign this week urging counseling. Subway cars, bus shelters and radio ads will spread the message: "New York Needs Us Strong."

Charged with doling out an unprecedented $1.4 billion in donations, charities have become lead players in deciding what kind of help victims should get. And along with public officials, charities have been determined to emphasize self-sufficiency and mental health.

But that approach has not been uniformly welcomed. Some victim families argue that they should decide how to spend money donated in their names.

"Let's not give $40 million to this group for counseling and another $40 million to another group for counseling," said Elizabeth McLaughlin, the widow of a World Trade Center victim, who helped organize the Sept. 11th Victims' Families. "Let's give it as cash to victims."

The potential for long-term emotional repercussions from Sept. 11 was underscored last week when Pat Flounders, the widow of a money market broker who died in the World Trade Center, committed suicide at her East Stroudsburg, Pa., home. Friends say Flounders, 51, was in poor health even before the terrorist strike and became inconsolable after her husband's death. Flounders received some counseling, friends say, but refused further psychological help.

"That's why the preventative measures are so important -- we want to get to people early if they are getting symptoms out there, whether they are getting depressed or maybe becoming suicidal," said Jane Barker, an executive at Safe Horizon, one of the major charities involved in the New York relief effort.

For those who have studied the psychological impact of terrorist acts, such as Oklahoma City and the Pan Am passenger jet brought down by a bomb over Lockerbie, Scotland, Flounders's suicide fits into a grimly familiar pattern.

A study by researchers at Washington University in St. Louis and the University of Oklahoma of 182 survivors six months after the Oklahoma City bombing found that almost half had a post-disaster psychiatric disorder. And one-third of the 182 had full-blown post-traumatic stress disorder, placing them at greater risk of suicide, substance abuse, depression and other problems.

Since the bombing, Oklahoma City police have counted at least six suicides of people directly involved in the disaster -- including a bombing survivor, two police officers and a Denver federal prosecutor who participated in the Timothy McVeigh investigation.

Trauma researchers and others say it is impossible to blame the suicides directly on the bombing of the Alfred P. Murrah Federal Building, but mental health workers say they aren't taking any chances this time.

"Oklahoma City taught us that months and years later, people still need that kind of [mental health] support, so we built it in very early in our recovery process," said Sandra Mullin, a spokeswoman for New York's public health department.

This week, the city will blanket subway cars, telephone booths, bars, restaurants and drugstores with public service posters featuring various messages -- such as "Even Heroes Need to Talk" and "Feeling Anxious after 9/11 Is Normal" -- and advertising a toll-free mental health hot line available for any city resident. About 20 radio stations will also air spots describing how listeners are coping.

In the Washington area, the United Way last week awarded $2.1 million in grants to area organizations to help those affected by the September attacks, with $385,000 of that going for counseling and other mental health services.

Northern Virginia Family Service, which was appointed to coordinate aid for the Survivors' Fund, the largest area Sept. 11 charity, considers mental health issues so important that it is hiring caseworkers with experience in severe emotional trauma to work individually with the families.

Theemotional fallout from such trauma can be so profound that families need help negotiating the complex process of recovery, said Larry Shaw, chief operating officer for Northern Virginia Family Service.

"Some of them have stacks of paper that they put in a shoe box and say, 'I'm not going to answer it,' " Shaw said. "It can be a bill, it might be someone saying, 'Here's something we can offer you.' They're just overwhelmed. . . . The grief is so intense."

Recovery from such trauma can take as long as a decade for many, researchers warn, and some people might never bounce back.

Nancy Anthony, executive director of the Oklahoma City Community Foundation, which operated a $40 million recovery fund for victims and rescue workers, said that six years after the disaster, the organization has dozens of open cases, individuals who are still emotionally or physically disabled by the bombing.

"I guess we originally thought that we would be out of the emergency assistance business within the first year," Anthony said. "But you're dealing with a grieving process, and some people get through it and go on, and other people don't. And then some people think that they're doing just fine, and then the holidays hit . . . or somebody's birthday or the first anniversary of the event comes along, and then all of a sudden they become unable to function."

Looking back at Oklahoma City, Anthony and the Red Cross said they eventually realized that rescue workers were among the hardest hit but among the last to seek help. About three months after the bombing, Anthony said, some firefighters, police officers and emergency medical personnel who had worked at the site began showing up with substance abuse problems. Domestic violence complaints also increased. Months later, the workers were struggling to sleep or having emotional difficulties on the job.

With that in mind, Arlington County's fire department is holding private "all-hands" meetings this week to praise members and reinforce the message about counseling, said Assistant Fire Chief Jim Schwartz.

"When we look back at Oklahoma City, we look at the people who left public safety services or had adverse results, such as suicides. We are trying to be more proactive in staving off those kinds of results," Schwartz said.

The New York City police department announced last month that it was ordering all 55,000 employees to attend educational sessions about the psychological distress they might experience. The fire department, which lost 343 members in the attacks, is requiring mandatory physical examinations for firefighters that include psychological assessments.

A team of Red Cross mental health workers is on duty 24 hours a day to help firefighters and others at the huge respite tent set up by the city and charities about a half-block from ground zero. Their job is to listen to the rescue and construction workers and engineers during breaks from their recovery work.

"Every day, they find human remains, they're listening to the pounding of the machines, they're constantly in danger, they're inhaling things that may be toxic," said Jill Hofmann, coordinator of the Red Cross team. "All of that is potential for stress, not to mention looking for their family members, friends, brothers or civilians."

The counseling is informal, often at the table as workers eat. The Red Cross also uses pet therapy, in the form of a 120-pound golden retriever named Nike. The specially trained dog is taken to the respite tent, especially during night shifts, to comfort workers.

"They pet him, they hug him. Nike rolls over, and they scratch him and pull his ears. And a lot of times, he's doing the most work when it looks like he's not doing any work," said Nike's owner, Frank Shane, head of K-9 Disaster Relief Organization, a nonprofit agency formed after Sept. 11 to coordinate pet therapy for disaster victims.

The Red Cross is delivering another kind of comfort through its national hot line, 1-866-GET-INFO, which opened 10 days after the attacks. Based in Fairfax County, the call center operates out of a warehouse-size former furniture store just off the Capitol Beltway. Thousands of calls come in each day to phone banks lining the windowless hallways. When a caller seems in particular distress, which often happens more than 50 a day, front-line operators wave for mental health "rovers" to step in and take the call.

One caller last week was a distraught grandmother who had taken in her four young grandchildren after her daughter, a single mother, was killed at the World Trade Center. She was receiving counseling, the weeping woman told the volunteer therapist, but she refused financial assistance, saying she felt guilty about taking money.

Another call came from a World Trade Center restaurant worker who said he was feeling depressed and sad. He had lost his job and many friends in the attacks, and now, he told a mental health worker, neither his family nor his surviving friends wanted to talk about the disaster.

For many callers, the numbness of the past three months has worn off, exposing them to the full brunt of their pain and loss.

Listening intently and probing gently, the volunteers look for signs of post-traumatic stress disorder -- including constant crying, insomnia or an inability to leave the house or go to work.

Among those devastated by the attacks was Pat Flounders.

She and her husband, Joseph, had recently moved from Brooklyn Heights to the New York suburb of East Stroudsburg. Friends say that Pat Flounders had health problems: She was a breast cancer survivor who had recently had a pacemaker implanted. But she had looked forward to her husband's retirement in a few years. They were renovating their dream house in the Poconos and doted on their two dogs.

After Joseph died in the collapse of the second tower of the World Trade Center, Pat was in despair. A neighbor, fearing that Pat would take her own life, hid her husband's gun from her, according to Rep. Kelly Lewis, a state delegate who represents that part of Monroe County, Pa. The neighbor told her where it was after she convinced him that she was feeling fine.

Flounders spoke with a number of community mental health counselors, but "the bottom line was that Pat didn't like people fussing over her," said Lewis, who befriended her after the attacks. Lewis and his wife set up more appointments, but "Pat never went to them," he said. She would cancel them, or she just wouldn't go, he recalled.

"I don't know why people kill themselves," he said. "I know her health was definitely not good. I know Pat Flounders was heartbroken."

© 2001 The Washington Post Company

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