The PANY Bulletin

Psychoanalytic Association of New York
Volume 39, Number 3 Fall 2001

On a Personal Note ...
by Herbert H. Stein, M.D.

I was in my office at the VA Hospital in Brooklyn on the morning of September 11. When someone told me that a plane had run into one of the Trade Towers, I was able to look out my window and see smoke coming from the tower. I later discovered that an enormous number of people in the city had a view of the Towers. Like everyone else, I knew it wasn't an accident when the second plane hit, and like everyone else I listened with anxiety to hear what other targets might be hit.

But it was when I saw the towers crumble down, seemingly dissolve, that I felt an odd sensation, a sinking feeling in my stomach, a sense of unreality. I have to confess that it wasn't the loss of lives that initially shocked me, although I knew many lives would inevitably be lost. It was the loss of permanence. I had learned as a child to distrust a sense of permanence. I tend to focus my memory of that epiphany on the time when the Dodgers left Brooklyn, but, of course, there were the births and deaths, moves and changes that taught me not to rely on a child's static view of the world. The expectation of change is built into modern life. I remember as a resident seeing an interview of a young boy who said he rooted for the Mets. When asked if he wanted to be a Met when he grew up, he said he didn't know if there would be Mets when he grew up.

Nevertheless, when those towers came down I suddenly realized that I had unknowingly clung to that belief in permanence. It was a more sophisticated, adult belief, easily disguised in my day to day world, but it was there and there enough to make me vulnerable. I had assumed that the buildings would always be there, would outlive me. In what seemed an odd reaction, I found myself disoriented by the fact that these landmarks were permanently gone--disoriented in the sense that I did not know how I would react to it. I had, for instance, some general idea of how I might react to events in my personal life, but this was so much more unexpected.

That afternoon, I waited in the hospital emergency room along with a host of other doctors, nurses and other staff for an anticipated ferry load of casualties. Patients were sent home, stretchers were lined up, rubber gloves were given out--and we waited. At one point, someone came from some central place to get body bags--and we waited. Finally, one man was walked in, a soldier who lived on the nearby base and had been involved in the evacuation of the buildings. I did speak with him. He had had a near death experience, but was at that point doing well both psychologically and physically and was mostly concerned about his partner, whom he'd lost track of during the collapse of the towers. I tried to help him call for information. (I learned the next day that his partner made it to our emergency room that night before he'd left, so that they'd had a chance to talk about it.) I am not sure that he didn't do more for me than I for him. Although I did virtually nothing that day, I was exhausted long before it was over.

Over the next few days, while I found innovative ways to get to and from the hospital, my e-mail box was filling with appeals from psychiatric and psychoanalytic groups for volunteers. At the hospital, too, there were meetings and discussions about responses to the needs of anticipated traumatized and bereaved patients. I signed on, but there was not a pressing need for psychiatric help. Both at the medical center and in my private office, it was relatively quiet as patients found it difficult and risky to travel. On one hand, I was relieved since the emotional strain and the adventurous traveling were tiring. On the other hand, I was feeling depressed about my inability to help.

It wasn't guilt, primarily. I have had plenty of experience dealing with guilt, my own and my patients', and have gotten fairly good at handling it. I'm sure it had something to do with seeing the enormous casualties and hearing the stories on television. I was also aware that my mood was affected by a personal loss--a close friend of many years was in the terminal stages of cancer at that time. It was difficult to separate the losses in terms of my reactions.

But there was something else going on, and I know I was not alone in this. All over the city, psychoanalysts and other mental health workers were trying to find their place in the relief effort. Residents reported some disappointment that when they did go to the relief centers, they were called upon more for help with concrete services, particularly trying to help with the sadly futile efforts to find evidence of loved ones in a hospital. I had the image that we were a like a troop of boyscouts descending upon one old lady who may or may not have wanted to cross the street. That Sunday, I walked over to the nearest firehouse--others had reportedly been of some help at firehouses during the week--to find a large crowd of well wishers leaving money and flowers and talking to each other and the firemen. I felt superfluous. I could suddenly understand more fully the stories I'd heard as a child about men who tried desperately to get into the army during World War II. Like me, they did not want be left out in the face of such monumental events.

I was experiencing a narcissistic injury at a time when good conscience and decency made even that awareness a further narcissistic blow. One thing was very clear about what was going on--it was not and should not be about me. My bemoaning my helplessness to myself was particularly petty under the circumstances.

My point in writing this is not to elicit sympathy. My "depression" was short lived and dealt with through some inner work and outer circumstances. I realized that at the very least I could help the healing process by being part of it. When an entire society is wounded, we contribute by continuing to play our role, however big or small that role might be. It was just about that time, in fact, that patients began to return, particularly at the VA facility, where I suddenly found myself too busy with combat veterans suffering increased flashbacks and nightmares as well as a few who suffered deep personal losses and some who were directly traumatized at the area of the World Trade Center on September 11. My ghoulish need to help was more than satisfied as I had to sit with a family with such intense grief that I felt the pain in the pit of my stomach or had to listen to a first hand description of people jumping from the buildings.

The point is that I was clearly not alone in my reaction of those first few days. One of my patients, a young woman, told me that she was feeling that her work was superfluous and meaningless in the face of the enormous tragedy. We heard this publicly over and over as people in the public eye spoke of their own work as unimportant in the face of life and death issues. My patient commented that it was different for me, since I could help people at such a time. I thought to myself that that was only partially true.

In the face of the loss of permanence, the witnessing of mass tragedy, the helplessness as we saw and heard about terrible things happening, many of us, I suspect, experienced a narcissistic blow, a reminder of how small we are, how helpless and unimportant we seem, how insignificant our work feels in comparison to mass tragedy. During those first few days, I had the thought that my work, the treatment of internal conflicts, was petty in the face of enormous external damage. It is a vivid reminder to us of our helplessness and the small role we play when a great tragedy occurs in our own back yard and we feel that we have no significant role to play.

Trauma has a tendency to remind us of important truths that we can either deny or learn to accept. I have long felt that people who have experienced trauma know something that the rest of us are able to avoid. They know that we are never fully safe. They have lost the illusion of invincibility that most people carry most of the time. It is a knowledge that does not serve them well, since it generally does not protect them but rather causes debilitating anxiety with all its attendant physical problems. This tragedy was a reminder to us of our vulnerability and our relative helplessness to personally affect events that are on a mass scale. The good news is that we can each be effective in our personal sphere and can all be effective collectively as a part of.