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Can We Influence the Trajectory of Psychological Consequences to Terrorism?

This article makes two significant contributions to the field of disaster and emergency mental health. First, it contributes to the existing knowledge regarding response to, and recovery from, events involving large-scale trauma. It does so by confirming previous findings as well as adding new information. Second, the findings of the study raise both puzzling and intriguing challenges to the profession and the country as we struggle to expand our knowledge and come to grips with the “new normal” faced by the United States. In a field where research is not nearly as extensive and complete as it needs to be and where we are far too dependent on extrapolation from other types of traumatic events, any and all research directly on disasters and terrorism is welcome. Longitudinal studies, even with rather short periods between samples, are especially needed. This study contributes by replication earlier findings regarding such factors as exposure, the impact of status factors such as gender, and the importance of social support. Other findings are tantalizing in both what they tell us and what they do not. We learn for example that a significant number of people turn to alcohol, medications, or drugs to feel better. What we cannot know from the study is the extent to which this coping strategy is nonproblematic use or abuse. To what extent is the drug use licit or illicit? These distinctions are important not only from a scientific and intervention perspective but also from a public policy, program development, and funding perspective. The study also demonstrates a significant gap in the existing models of understanding and intervening with the largest of catastrophic events. The science, practice, and appreciation for the importance of emergency and disaster mental health response has, and continues, to grow. However, most of our models are based on events that are far more limited in scope than the psychosocial sequelae that this study tells us attend the events of September 11, 2001. We have models for natural disaster. We have models for smaller-scale violent events. We do not have models for understanding and providing response and recovery from national disasters. This study documents the national nature of fear, distress, and changed behavior brought on by these types of events. While we may Psychiatry 67(2) Summer 2004 164