When Crazy Is Normal

Portrait of a Grieving City

Last Friday night was the first time in a while Lauren Buchter had a good night's sleep. By Sunday, though, her sweet slumber, which had fallen victim to the terrorist attacks, was once again disrupted by anxiety-filled nightmares. The gritty video footage of bombs going off in Afghanistan made Buchter, a senior at Manhattan's La Guardia High School, sick to her stomach. But while the nausea wore off rather quickly, her emotional distress lingers on. "I have a helpless feeling," says Buchter, who's been dreaming of being trapped on planes and buses. "All these things keep happening and there's nothing I can do."

On September 11, as the financial district was cloaked in chaos, a formidable army of psychologists, social workers, and psychiatrists emerged to offer the talking cure. By 5 p.m., more than 200 had gathered at the Red Cross offices on Amsterdam Avenue in midtown, eager to counsel. There were, however, no patients at that point, so the volunteer mental health workers ended up watching CNN and comforting one another.

At Bellevue, Dr. Joseph Merlino, director of community and ambulatory psychiatry, was also preparing for a flood of traumatized patients seeking mental help. Distraught visitors did come to the crisis center set up in the hospital's chapel, but they didn't want to talk about their feelings. "They didn't even want to sit down," says Merlino. "They just wanted to know if their loved ones were there." Nor did Merlino's seriously ill patients seem to be showing much distress. In fact, he says, "They all seemed to be handling it rather well."

Illustration by Max Grafe

Trauma experts have a name for the emotional calm that overtook the city in the first few days after September 11: the honeymoon period. The shocked and bereaved summoned their resources to deal with practical matters. The usually self-obsessed rose above their personal problems. Mixed in with the raw terror and massive grief, many felt an unprecedented connectedness. Somehow, despite the overwhelming loss, it felt for a fleeting moment as if the whole city were on Ecstasy: Coworkers hugged, passersby radiated love.

Four weeks into the crisis, there is no question that the honeymoon is over. As war begins and the period of emotional clarity draws to a close, the city is bracing itself for the true psychic aftermath of the attacks. Already, pharmacies are reporting an increase in the number of new prescriptions for anti-anxiety, anti-depressant, and sleep-inducing drugs. Some psychiatrists say they have upped the doses for patients already taking these medications. LifeNet, the city's 24-hour mental health hot line, which at first held steady at its usual average of 110 calls per weekday, had roughly twice that number last week.

In a Bronx elementary school, Kari Collins has been seeing a significant jump in the number of kids arriving at her office with physical complaints. "They come in complaining of a stomachache or a headache," says Collins, who is director of mental health services for the School Based Health Program at Montefiore. "But when you talk to them a little bit more, they start talking about the World Trade Center."

A preliminary tally shows the city's suicide rate holding steady during these extraordinary last few weeks, but it's clear that emotions have taken center stage. NY1 even cut away from the president's press conference to showcase the city's volatile moods on its new call-in therapy program. But no matter—many city dwellers could identify more with callers' tears than with the forced optimism and military lingo of Bush.


Beyond Psychiatry

The old border between sanity and insanity was hardly tidy, but psychiatry did its best to distinguish between the pathologically problem-ridden and the rest of us: Before September 11, mood swings, crying jags, a change in sleep patterns, and loss of interest in pleasurable activities signaled depression. People who thought others were out to get them were paranoid. Those whose worries interfered with their daily functioning had anxiety disorders. They were sick. But what's the diagnosis now, when an entire city feels these things? What's the prescription when one passenger on a City Hall-bound bus begins to cry, and then another and another until everyone aboard—the bus driver included—is weeping?

"We know that there is not one New Yorker who isn't affected by this," says Health Commissioner Neal Cohen. What the commissioner doesn't know—what no one knows—is whether New York's surreal emotional state will balloon into a full-fledged mental health crisis. The Coalition of Voluntary Mental Health Agencies estimates that 2.3 million people in the New York City area will need counseling as a result of the World Trade Center disaster. A Pew Research Center poll reported that more than two-thirds of Americans were depressed in the weeks after the attacks.

The situation resists such numbers and definitions. Trauma experts agree that between 20 and 25 percent of people exposed to traumatic events typically develop significant psychological problems, most notably post-traumatic stress disorder (PTSD). But according to the official psychiatric manual, the disorder can only be diagnosed if the symptoms—including recurrent nightmares, heart palpitations, irritability, and difficulty concentrating—persist more than a month after the original trauma. So, though thousands of people have already had these symptoms for weeks, they technically can only begin having PTSD on October 11.

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