The PANY Bulletin

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

President's Column
Robert Chalfin, M.D.

Six weeks after the World Trade Center tragedy and its aftermath, we are in the midst of a growing Anthrax scare. The future is more than ever unclear, and unpredictable. Fear and anxiety in the face of unknowable dangers can only mount. This, of course, after the unimaginable devastation and deaths from the attacks on the World Trade Center with its catastrophic loss of life and suffering. That this has happened--that these buildings no longer exist--that space is empty, that so many are dead--is apocalyptic in its impact.

To write about P.A.N.Y.'s response and activities seems an exercise in impotence and helplessness mitigated by the knowledge that helplessness, sadness and anger is shared by most everyone. Certainly almost all health personnel, including mental health professionals, have to some degree felt helpless and passive. Those able to be more immediately usefully involved seem drained, but somewhat energised--seemingly heroic to us, within themselves also dealing with guilt, helplessness and despair. Survivor guilt over not being there, not doing more, seems to have been endemic in the first weeks, along with our own stress reactions. Our invulnerability and omnipotence have been pierced. America--New York--we--have been invaded and attacked--overwhelmed to an extent. Denial, avoidance, despair, anger and anxiety are certainly noticeable. In this second month, as the recognition of our enormous loss sinks in mourning, grief, depressive responses seem to be coming to the fore admixed with efforts to cope, gain mastery, turn passive into active, retaliate, meet aggression with aggression, get them who got us, revenge against our enemies, these killers--the terrorists and their accomplices.

At the same time it is necessary, despite these feelings, maybe even because of them, to keep going, to actively cope with our fears and our denials, our guilt. As individuals we first responded in our private worlds--self, family, friends in our personal communities, to recapture whatever sense of safety and reassuring familiarity we could. As professionals we respond in our continuing and mutually useful efforts to assist our patients to deal with the seemingly undealable and its effects on their psyches. Maintaining our professional functioning is essential for our patients and ourselves. Continuity and identity are essential but feelings of weakness, impotence, guilt can be admixed with our adherence to our professional and life roles and also can become denial in action. That it is a role, an aspect of our identity, crucially important, but not the totality of our individuality have certainly been vividly demonstrated and continues to be demonstrated to us in terms of our vulnerability.

As psychoanalysts we are only first finding our way through the rubble of the destruction--of myths as well as lives and buildings. In the first days at PANY. we sought to find a role by volunteering the services of our group to the NYU Medical Center as well as informing our members of disaster response groups being formed. Individual members found their way to Ground Zero, fire houses, to decimated corporations to offer debriefing, bereavement counseling, to simply be there to lend support, lend a hand or in our case an ear to listen and hear. Perhaps some of us began to discern outlines of coping mechanisms, defenses, adaptive and non-adaptive, in relationship to the loss, sorrow, guilt and helplessness. We saw the banding and bonding together most clearly in the "brotherhoods" of the firemen and corporate families of those missing, the survivors, but also in our own families and groups. Group cohesion in response to disaster can certainly serve sustaining functions, regressive and adaptive at the same time--meetings of staffs of hospitals, the banding together of professionals, etc.

A meeting to form a P.A.N.Y./NYU Psychoanalytic Institute response group drew 35 people the first Saturday after the disaster on 24 hours notice. It included graduates, candidates, psychotherapy associates under the aegis of the Association, set up in this way in part to minimise interference with the analytic dyads which form the core of the training functions of the NYU Psychoanalytic Institute. Out of the meeting came a response group chaired by Dr. Charles Goodstein and soon coordinated by Robert Miller, a very capable executive husband of one of our members. Over the next several days he (we) developed a roster of almost 100 members volunteering their time and services in a wide variety of ways not immediately psychoanalytic. But as we are psychoanalysts, little that we do is not filtered through that perspective.

As our availability become known through the active efforts of many we began to provide consultations and assistance to New York Law School, NYU Downtown Hospital, and then individual referrals began to emerge. We participated in disaster planning meetings at Bellevue chaired by their Associate Director of Psychiatry Mike Garrett (a PANY member) and were in contact with the medical school and the medical center leadership. David Frank and Mike Singer participated in the initial clinical conference at the medical center sharing their experiences along with others and their analytic perspective. New York City, unlike other places, is rich not only in psychoanalysts and psychoanalytic organizations, but has an enormous number of mental health professionals most of whom wanted and needed to help in this crisis. A concern about the mental health needs of survivors, families, organizations is clearly felt. Pre-existing outreach programs of P.A.N.Y. and in the larger mental health community were utilized to build a response system. The Disaster Psychiatry Outreach Group, originally set up in the mid-1990's organized the initial delivery of services at Pier 94 where evaluations, triage and urgent treatment was given.

Yet despite all our connections with various organizations set up to provide treatment there is a feeling of under-utilization. In the past weeks there has been a decrease in requests for active interventions with a dozen or so individual referral requests to our response group. There will be more over the next weeks and months I think. In our practices we are seeing decompensations and regressions in patients along the lines of their vulnerabilities along with stress and traumatic reactions in those closer to the catastrophe. Those involved in teaching and supervision are able to tie into more cases and people

A series of conferences have been planned. The first by the South Asian Forum led by Mimi Ismi brought Robert J. Lifton speaking of Apocalyptic Reactions and Forms of Violence. With one-week notice it was attended by about 200 people and reported upon in at least one major newspaper. The South Asian Forum has set up a group of seminars open to the public utilizing psychoanalytic along with historical and political perspectives. This should be highly useful, as will our other efforts to bring a psychoanalytic point of view to understanding and dealing with these horrific situations. Two more conferences are in the offing. A five-society conference on this tragedy and its aftermath from an analytic point of view is in the early stages of planning. A second conference on the apocalyptic imagination, really trauma and creativity, is being organized by Sandy Leong for February 2002. These offer an opportunity to think through and about these events from a psychoanalytic position.

The bio-terror threats of anthrax only further compromise us and increases our sense of vulnerability. Children and their parents are especially vulnerable. This is one area where our efforts should be more sharply focused. How this will unfold, including in the mental health field is uncertain and unknown. We have gone from a horrific, acute, catastrophic trauma with its tremendous loss and destruction to now this continuingly frightening, upsetting destablizing bio-terror of anthrax. By the time you read this undoubtedly more, and we can hardly imagine what, will have occurred. The need to maintain ourselves, to find a base of security in order to function, is obvious and vital.

Other activities and issues reflecting our continuity need to be mentioned. These include our continuing scientific meetings, website development, an internal survey and development of a directory, a 50th anniversary planning committee, reorganization of our standing committees, responding to issues in the American Psychoanalytic Association on certification, membership, training analyst selection, IPA issues, increasing the usefulness and perhaps the scope of our practice initiatives and maintaining our PANY-Faculty educational seminars.

I hope when you read this our world will be a safer and more predictable place.

Robert M. Chalfin, MD