Monday Morning Crisis Quarterback

All week I've been writing about how American society matches the symptom profile for Post Traumatic Stress Disorder. This morning, I took the first of those pieces to my writer's group, a small circle of women writers who share and respond to each other's work every Friday mornings. I knew it was not my best work, and I wanted feedback.

As usual, the group was very helpful, but one of their reactions caught me by surprise. Members felt that my writing was distressing (not in terms of quality, but in terms of topic), and that I needed to give information on how to deal with that distress. So I'm taking a detour from the exploration of PTSD in a post 9-11 society to help all you Quarterbackers out there as we head into the 10th anniversary of the attacks.

Perhaps the most important thing you should know is that, if you're feeling blah this week, or sad, or anxious, or irritable, or having trouble sleeping, or anything else that makes you feel "off," even if you do not consciously connect those feelings to this anniversary, you're normal. Anniversaries are very powerful, and quite often people who don't even realize that it is an anniversary have negative reactions nonetheless. This isn't helped by the terrorism alert for New York and Washington. What might be somewhat distressing anyway only feels magnified given the time of year.

You also aren't crazy if you are sick and tired of the anniversary coverage (although chances are you aren't reading this, so I may be wasting my breath). The extra coverage is draining because it prevents us from getting away from the intense memories and the feelings they evoke.

Whichever of these two groups you most identify with, you're normal. Don't waste one minute worrying that your reaction is too much or not enough or inappropriate, any more than you would criticize yourself for feeling pain when you stub your toe. You couldn't control those feelings if you wanted to, so don't bother trying.

But what can you do? If the coverage or the date or the blogging about our messed-up society is bothering you, what is the solution? You may not like the answer, because here's what it isn't. Turning off the TV, avoiding reading my blog, doing something completely non-9-11 related on Sunday and generally trying to get your mind off it may feel good for the moment, but it is a quick fix for a longer term problem. That's because problem isn't the reminders of the attack, it's how upsetting they are to you. Avoiding the reminders won't solve the underlying issue, it will just push it back underground.

What I suggest is completely counter-intuitive. When you find yourself having negative feelings -- sadness, fear, hurt, anger, guilt, shame or whatever -- don't try to turn away from them. Turn towards them. Identify what you are feeling and what caused it. Label them consciously. Don't try to explain it rationally, because emotions are not rational -- they're, well, emotional. Whatever you're feeling just is, so you might as well feel it.

The reason this is a good idea is that, when you turn and face your negative emotions, they stop feeling so overwhelming. Feelings, by themselves, do not hurt us. What we tell ourselves about those feelings and the events that trigger them can. No one likes to feel sad or afraid, but you can tolerate it. Your negative emotion loses its power when you acknowledge it and face it head on.

Does this mean you should glue yourself to the TV and watch as much coverage as you can this weekend? No. Just as avoiding reminders isn't healthy, seeking them out to excess isn't, either. Watch, read and hear what interests and moves you or is meaningful to you. Consider for yourself what type of commemoration, if any, you believe is appropriate for you to participate in. Just monitor yourself and be careful when you find yourself saying things like, "I can't watch that," "I want to get my mind off it," or "I won't be able to handle that." Those are signs you're avoiding, and you're not turning into the wind.

For me, this Sunday is about reclaiming September 11th as a day of grief and fear -- yes, I'm reclaiming fear -- and as a day of unity, service and collective support. I am allowing myself to feel the sadness and, as hard as it is, some of the horror of that day. And I'm patting myself on the back for doing it, because it isn't easy. I hope you'll join me.

Yesterday I shared the idea that America, as a society, is manifesting symptoms of PTSD. There are three sets of these symptoms, and today we'll be looking at symptoms of numbing. People with PTSD go to great lengths to avoid and/or numb themselves to feelings and experiences related to the trauma.

Specifically, to be diagnosed with PTSD, there must be at least three of the following symptoms present:

Efforts to avoid thoughts, feelings, or conversations associated with the trauma. Traumatized people often come across as angry. It's not that they don't have a right to be angry at the people who traumatized them. But they're often just angry all the time at everyone. Anger is a very effective defense mechanism against other, more uncomfortable feelings.

If there's one thing Americans are, it's angry. You need look no further than Capitol Hill. We don't just disagree, we think the other side is a threat and evil. We are locked and loaded. And we're rude.

So, what feelings are we avoiding? Fear. If you think back to how you felt on September 11, you weren't mad. You were horrified, and you were scared. Pretty quickly, you were sad. If someone had asked you if you were mad at the people who did this you would have said yes, but anger was not the primary emotion.

The thing is that fear doesn't feel good. It feels weak. So does sadness. Anger feels strong. So we stick with anger -- at each other, at other countries, at whomever. Do you remember that feeling of togetherness we all had right after the attacks? Have you wondered why we can't seem to get it back? Because we came together in fear and in grief, and as much as we might like togetherness, we don't want to go back and feel those things again.

Efforts to avoid activities, places, or people that arouse recollections of the trauma. There was a contingent of people who got mad at President Obama for visiting Ground Zero after bin Laden was killed. They said he was politicizing September 11th (and I would argue that ship sailed a long time ago, but let's put that aside).  But Obama didn't go there to give a speech or do a victory lap. He went to lay a wreath. He went to acknowledge grief. That's a no-no.

Inability to recall an important aspect of the trauma. There are certainly things about 9-11 that none of us will ever forget, but here's a test question: Following the September 11th attacks, what was the stated motivation of Al Qaeda for attacking the U.S.? If you said something like, "They hate us for our freedoms," you're not alone -- that is our dominant societal narrative. It was started by President Bush the same week as the attacks. And, if I may be so bold, it's wrong. At the time of the attacks, Al Qaeda wanted the U.S. to withdraw its troops from bases in Saudi Arabia, which it considers sacred ground. We forgot the motivation for the attack almost as soon as it happened.

Markedly diminished interest or participation in significant activities. This is a tough one. "Significant activities" for individuals are easier to define. However, I'm struggling to remember the last time it seemed like everyone was having a joint experience -- like the last episode of M*A*S*H, or even the Superbowl. Is it me, or is it just harder for us to all decide that something, other than a disaster or trauma, is important these days?

Feeling of detachment or estrangement from others. We know who our allies are in official terms. But what foreign country do we as Americans truly respect as partners these days? I can think of no one. We have become a very lonely country in a lot of significant ways. You can blame politics or policies for this, but it's also the manifestation of a gut feeling that no one really understands us.

Restricted range of affect (e.g., unable to have loving feelings). As discussed above, our primary societal emotion is anger. We don't feel joint happiness or pride anymore. We don't "put aside politics" for any common purpose. We want Congress to compromise, as long as they don't compromise on the things we want. We have lost the ability to have mixed emotions, and changing one's mind about something is weak. This is what a restricted range of emotions looks like -- anger and black and white thinking with no nuance.

Sense of foreshortened future. There is a conventional wisdom in America that the United States is no longer a superpower, or that we won't be one for much longer. Polls show we believe America is headed in the wrong direction. Every new law or policy (passed or just proposed) on both sides of the aisle is met with doomsday scenarios about how it will mean the end of America as we know it. It's one thing to say you don't like an idea, and quite another to think we can't survive it. We don't, as a country, feel very confident about our future.

Tomorrow I'll look at the third cluster of symptoms -- hyper-arousal. Later in the week, we'll examine why 9-11 impacted us this way when other things didn't, and at what kind of "treatment" we might recommend for our traumatized society.

I took my first Critical Incident Stress Management training class in 2003.  It was offered through my school district and taught by two social workers from the county department of Community Mental Health.  One of them was Gary Logan.  Gary was, among other things, the coordinator of the county community CISM team, called the Traumatic Events Response Network (TERN).  At the end of the class, he solicited volunteers who wanted to join the team.  I signed up.

I'm not sure that Gary knew what to do with me at first.  There are two categories of CISM responders:  mental health professionals and peers (some would argue that there's also a third -- clergy).  TERN, at that point, was entirely made up of mental health professionals because there was no one population it served.  Where a team assisting police officers would have cops on it as peers, a team assisting all kinds of people doesn't know what kind of peers it needs.  For the first few years, I was only tapped to respond when there was a crisis involving children or schools. 

Gary and I consulted and worked with each other more frequently when he came to assist our district team -- which needed lots of school personnel as peers -- with crises in our schools.  He was very interesting to watch and work with.  He had a calm about him in everything he did, and it put people at ease.  I learned from him how to explain complex psychological processes in language people could understand, how to grasp themes from what people were saying, and how to firmly state what you think is the right thing to do and accept that sometimes those in charge are not going to listen to you.  I never saw him sweat.

A few years ago, when I decided to pursue a Certificate of Specialized Training in schools and children crisis response, I asked Gary to please include me on more critical incident stress debriefings, and he did.  He started assigning me to respond as a peer outside of schools -- in community settings, businesses, and even responding to a group of mental health professionals from his agency following the murder of a client.  When I floated the idea of becoming a CISM instructor, Gary wrote my recommendation and told me he thought I'd be great.

Over the last couple of years, Gary has invited me to substitute for him as the coordinator on call for the county team and even allowed me to coordinate a couple of responses myself, something I do as a peer in a school setting all the time but a rarity out in the "real world."  He has expressed faith in me at every turn, strongly encouraging me to take on whatever I could, expand my consulting and, most recently, start considering earning a mental health degree myself.  His confidence in me has been astounding, and it has increased my confidence in myself.

Over the years I have needed assistance more than once with crises in which I was affected myself.  Gary was always my first call.  Watching him from the "other side" of a response was amazing, and his support was so helpful to all of us.  Whether I was responding or being responded too, Gary always reminded me to take good care of myself, and knew that I wasn't always so good at it without his reminders.

Gary retired when his department was cut at the end of last year.  He continued to coordinate TERN as a contractor.  Yesterday, he died suddenly during treatment for heart disease.  He was 63.  I doubt there will ever be anyone with as much faith in my crisis response skills as Gary.  I also doubt there will be anybody I so readily call on in my own time of need.  In fact, this morning, after I heard that he had died, I found myself wishing more than anything that I could talk it over with my friend and mentor, Gary Logan.