Introduction
At 8:46 AM on the unusually crystal-clear morning of September 11, 2001, American Airlines Flight 11, hijacked by terrorists, was deliberately crashed into floors 93-99 of the North Tower of the World Trade Center in New York City. At exactly the same time, this author was serving as a Police Lieutenant in the NYPD and was just exiting the Battery Tunnel on the Manhattan side.
As I watched, shocked and mesmerized by the spewing white smoke of upper tower floors and what appeared to be glitter coming from the heavens, the nightmare began for me. Life would never be the same for any of us who were first responders on that devastating day, and the year to follow at Ground Zero.
On the afternoon of 9/11, I was deployed with five of my cops to the city morgue to assess the needs and assist victims’ families. Anticipating mass casualties, the City’s Medical Examiner had ordered refrigerated containers to accommodate the volume of remains recovered. But the anticipated amount of human remains was not to become a reality for years, as less than 300 dead bodies were recovered “intact” from Ground Zero. Since 9/11, there have been 1,642 persons identified of the 2,753 people who died.
The agency responsible for the safety, security, and coordination of service delivery in the days and weeks that followed 9/11 was the New York City Police Department’s Community Affairs Division, where I was assigned as a Police Lieutenant.
With a doctorate in the mental health field and an extensive background in crisis intervention, I was selected to coordinate the inter¬-agency mental health response, under the direction of the Mayor’s Office Community Assistance Unit. I handpicked an amazing team of officers based upon their knowledge and their crisis intervention skills.
The Recovery Work
Our work consisted of assisting hundreds of families with the preparation of the VIP Missing Persons Report, (a detailed multi page report), and helping families negotiate a traumatic and chaotic bureaucratic process. The first few days following 9/11, our work took place at the Public Administration Building auditorium at the City Morgue and then ultimately at a temporary “Family Center” set up at the Armory on Lexington Avenue in Manhattan. Later, the Family Assistance Center was permanently housed at Pier 94 to accommodate thousands of families seeking answers and services. The police mental health team, with the assistance of volunteers from the Red Cross, mental health and spiritual care providers, along with powerful therapy dogs, provided support and crisis intervention.
It was a common occurrence during these early days at the family Assistance Center to hear families pleading with us to be allowed access to Ground Zero so they could help find their loved ones; others hoped to find them wandering disoriented in lower Manhattan; still others believed that their friend, mother, lover, partner, son, or daughter, whose "missing person" photo they carried with them, was unconscious and unidentified in a hospital. One bereaved woman screamed in a rage that she wanted to go and "dig her baby brother out of the rubble." Most of all, people wanted their questions answered and none of us could offer a resolution. In most cases, as those in crisis screamed in frustration, all my officers and I could offer was empathy, and unconditional support.
No amount of education or training could have prepared me for this devastating nightmare. Those of us who were aware that the worst of fears had been realized, gently and compassionately broke the news to one person at a time, as lists of the deceased became available compiled from the names of the few whose bodies had been recovered. Because of the volume of families seeking assistance and coming through the doors of the Family Assistance Center at Pier 94 in Manhattan, approximately 200 additional Community Affairs NYPD officers were deployed to assist families.
At “Ground Zero,” Port Authority set up a special viewing stand for families, and my team would bring these families by Waterway Ferry three times a day to view the horror in person. Along with the Support Team, I briefed the families prior to these boat trips and supervised all three trips daily, totaling 4.5 hours each day of exposure at Ground Zero.
In November of 2001, a memorial service was held at Ground Zero to honor the victims and their families, and my team was again at the forefront of this service, distributing wooden memorial urns and flags to each family following the memorial. Shifts were long during this “recovery” period and it was typical for my officers to work 12 to 15 hours per day, seven days a week through October. In November, schedules were reduced to about 10 hours per day, six days a week.
In December 2001, redeployment to officers’ original assignments began and on January 30, 2002, their work with families formally ended. Approximately 20 of my officers provided security at a viewing stand for families and tourists near the WTC site until September 2002.
Many of my officers were re-traumatized by this ongoing work and particularly found it difficult to go from compassionate care with thousands of families to “tour guide” responsibilities with thousands of tourists. I continued to provide crisis intervention and stress management to all of the 200 officers assigned to this work until my retirement in 2003.
Empirical Data
Six months after the attack, a convenience sample of these officer (N = 74) was conducted and results indicated that 23% had Posttraumatic Stress Disorder (Piotrkowski & Telesco, 2011). My team, however, weren’t the only officers exposed to this traumatic event. More than 25,000 NYPD officers were deployed at the WTC site, the various morgues, and the Staten Island landfill following 9/11 (Dowling, Moynihan, Genet & Lewis, 2006). Dowling et al. (2006) analyzed data collected from 28,232 NYPD officers in 2003, finding high rates of reported psychological and related symptoms and reaching the conclusion that a majority of the “rank and file” were still suffering from symptoms of stress related to 9/11.
Lowell et al. (2018) conducted a systematic review of longitudinal studies of PTSD among highly exposed populations from October 2001 to May 2016. Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack.
While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Overall prevalence of PTSD following 9/11 appears to be relatively high in the period directly following the attacks, particularly for those with the greatest levels of traumatic exposure. While these rates appear to decline over time for the majority, first responders and rescue/recovery workers show substantial increase in prevalence as time goes on.
The WTC Health Registry has followed up on a large number of individuals, including police officers, at various waves of data collection from 2003 to 2012. Results indicate elevated prevalence of posttraumatic stress disorder (PTSD) and physical and mental health burdens among 9/11-exposed individuals years after exposure. The data suggest that high trauma exposure levels have a long-term effect on those with chronic PTSD symptoms and that this is particularly true for first responders (Adams, et al., 2018; Li, et al., 2018; Schwarzer, et al., 2016; Caramanica, Brackbill, Liao, & Stellman, 2014).
Bromet et al., (2016) in their study of World Trade Center responders more than a decade following 9/11, found WTC exposure remained strongly predictive of PTSD, particularly for police officers who indicated long-term impact of 9/11 exposures. Similar to combat experiences in military cohorts, the data suggest that the substantial percentage of those with PTSD continue to suffer more than a decade after 9/11. Responders experienced multiple exposures simultaneously and, like other rescue/recovery workers, were at increased risk by virtue of the combination of proximity to the disaster site, duration of work and intensity of the exposures.
Strong associations with physical health, psychosocial well-being and reduced satisfaction with life (Adams, et al., 2018; Li, et al., 2018; Schwarzer, et al., 2016; Bromet et al., 2016; Caramanica, Brackbill, Liao, & Stellman, 2014).
Summary & Interpretation
These studies provide validation and confirmation for those of us still struggling with PTSD symptomology and demonstrate that despite the passage of time, the severity of PTSD continues. The phrase “Never Forget” seems paradoxical in that many of us who were responders would prefer to be less plagued by the memories. In conducting this literature review, it was comforting in some ways to have the empirical findings reflect my own personal experience. As I look in the rear view mirror, approaching the 18th year anniversary, I continue to be haunted by the memories of the families, the disturbing images I was exposed to, and our recovery work that is too often forgotten by those who watched the events from their television sets at a distance. Eighteen years later and fifteen years into my retirement as a Police Lieutenant with the NYPD, when I stand in front of my undergraduate students in my criminal justice class, my attempts at relaying the events of 9/11 fall ineffectively on the ears of young people who were 3 years old at the time. When I see and hear the bulldozers working in front of my home in sunny Florida or pour a bag of cement and see the cloud of grey dust, I am reminded of the trauma and I certainly have “never forgotten” the sounds, the sights and the smells of 9/11.
Haugen, Splaun, Evces, & Weiss, (2013) describe an integrative psychotherapy for first responders to the September 11, 2001 terrorist attack, including those who continue to be psychologically impacted by these events, most of whom meet criteria for a diagnosis of posttraumatic stress disorder.
Of the three core techniques used in this treatment, an emphasis on meaning making resonated most for me. Addressing the numerous layers of meaning that 9/11 and its work had, and continues to have for me, has helped me in my own treatment and recovery.
My officers and I benefited greatly from this work and most of us anecdotally describe our 9/11 experience as the most painful and yet most meaningful work of our lives. We were instruments of support and safety for thousands of people who could deposit their shock and grief into the vessels of our beings as we held that space for them. This is the meaning of the work and the psychological recovery efforts continue for those of us impacted. The phrase “Never Forget” might be replaced with “ Never Forget, Sometimes Forgotten, and Often Haunted”.
References
Adams, Shane & Bowler, Rosemarie & Russell, Katherine & Brackbill, Robert & Li, Jiehui & Cone, James. (2018). PTSD and Comorbid Depression: Social Support and Self-Efficacy in World Trade Center Tower Survivors 14-15 Years After 9/11. Psychological Trauma: Theory, Research, Practice, and Policy. 11, 10.
Bromet, E. J., Hobbs, M. J., Clouston, S. A., Gonzalez, A., Kotov, R., & Luft, B. J. (2016). DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11). Psychological medicine, 46(4), 771–783.
Caramanica, K. , Brackbill, R. M., Liao, T. and Stellman, S. D. (2014), Comorbidity of 9/11related PTSD and depression in the World Trade Center Health Registry 10–11 years post disaster. Journal of Traumatic Stress, 27: 680-688.
Dowling, F.G., Moyihan, G., Genet, B., & Lewis, J. (2006). A peer-based assistance program for officers with the New York City Police Department: Report of the effects of Sept. 11, 2001. American Journal of Psychiatry, 163, 151-153.
Haugen, P. T., Splaun, A. K., Evces, M. R., & Weiss, D. S. (2013). Integrative approach for the treatment of posttraumatic stress disorder in 9/11 first responders: Three core techniques. Psychotherapy, 50(3), 336-340.
Li, J., Zweig, K. C., Brackbill, R. M., Farfel, M. R., & Cone, J. E. (2018). Comorbidity amplifies the effects of post-9/11 posttraumatic stress disorder trajectories on health-related quality of life. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation, 27(3), 651–660.
