The 9/11 terror attack on American soil resulted in a collective trauma to the western world. The world learned many hard lessons, and it has started moving in a different trajectory since then. And, one good thing that happened is that in the last 20 years, there have been dramatic innovations in the treatment of trauma and post-traumatic stress disorder (PTSD).
PTSD is a disorder characterised by the difficulty to recover after being a witness to a terrifying incident. The condition may last months or years, with triggers that would bring back the memories of the trauma. Nightmares or flashbacks, heightened reactivity to stimuli, avoidance of situations that bring back traumatic memories, anxiety and depression are the common symptoms of PTSD.
In the aftermath of 9/11, the World Trade Center Health Registry that tracks the health effects of the attacks found in a study that 16 per cent of its respondents—who lived, worked or studied close to the attack sites—experienced probable PTSD five to six years after the incident. A study of low-income people seven to 16 months after the terror attack found that those suffering a 9/11-related loss were “twice as likely to be diagnosed with a mental health condition, such as depression, anxiety or PTSD”. It was found that a substantial number of people not directly affected also met the criteria for probable PTSD.
Mental health experts point out that before 9/11, the public understanding of PTSD and trauma was limited. They were earlier considered as conditions that would arise only for war veterans. However, 9/11 proved that trauma could happen to anyone, and this changed the mental health specialists’ thinking about care for trauma victims. They also found that some existing treatments were doing more harm than good to trauma victims. For instance, there was a treatment method called critical incident stress briefing in which the victims were asked to talk about their experiences. It was found that this method was activating high emotional arousal that would lead to PTSD and depression.
Post 9/11, there has been a significant advancement in studying the role of genetic factors in the development of PTSD. There has also been a huge growth in imaging, biomarkers and brain-related research. Many biomarkers, like an increase in certain hormones or inflammation, are known to be associated with PTSD, and now there is increased emphasis on targeting the right ones, in the right combinations, for diagnosing and treating the mental disorder.
The terror unleashed on 9/11 made several institutions prepare protocols that could be used in a crisis, and psychological first aid—psychological treatment to be given in the immediate aftermath of a traumatic event—became an important part of these protocols.
In the last 20 years, the world learned a lot about the links between disasters and mental health. And this paved the way for a better and quicker response to mental health concerns during the Covid-19 pandemic, at least in the developed countries.