When Ground Zero Is All In Your Mind: A Psychiatrist's Story

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The Wall of Prayers at New York's Bellevue Hospital

Diana Graham, M.D., is a third year resident in the psychiatry program at New York University in Manhattan. Since the September 11th terrorist attacks, Dr. Graham has observed, from her remarkable vantage point, a range of human reactions to tragedy — some predictable, some wholly unexpected.

About ten days after the attack, we moved the Bellevue Hospital crisis center to smaller quarters, and canceled the special support sessions because no one showed up. Families wanted information or their loved ones back, not counseling.

Even some of firefighters and police who were visiting the Medical Examinerís office nearby or colleagues in our hospital told me they were refusing any counseling because they were afraid they would be labeled as having "psych problems," and lose their positions. So we get back into normal routines at the clinic — appointments, prescriptions, officious memos chastising us for being behind on record keeping. At first it was hard to imagine sitting with my old patients, until I actually did and heard their stories. I was as amazed by the stories of resilience as I was by those from people who are falling apart.

A man with schizo-affective disorder, whose cousin hacked her way out of the first floor of the Trade Center with an ax, calmly tells me he is glad sheís okay. "Thatís my only story," he says, and asks for his prescription for Haldol, an anti-psychotic medication. A man with an almost crippling fear of leaving his apartment comes to his appointment. He is reorganizing his closets, "to do something normal." My ten-year-old patient recites the plot of every horror movie she has ever seen, complete with severed body parts. She acts out a puppet show in which scary monsters eat her, and then me. She wonders if kids can get drafted. My gentle Buddhist patient from China comes, sits quietly, says, "I never in my life heard of such a thing happening." I fight back tears because her simple observation captures our common experience.

Slowly we doctors realize that the real fallout is just beginning. The most vulnerable people in our population, those with chronic psychiatric illnesses who donít function well, start to show up in the emergency rooms. As the third week begins, no more waiting for people to turn up — we are busy. Over and over, patientsí family members tell me the same thing, "She was doing okay, just barely, but then the Trade Center...." I think about how those of us who think of ourselves as stable feel — terrified, disbelieving, stressed to the limit — and try to imagine what itís like to be paranoid already, and then have this happen.

We are also experiencing a mini-epidemic of manic patients who feel compelled to come to New York City from great distances for various World Trade Center-related reasons. Some believe they are essential to the relief effort ("Iím the lead firefighter!" says one); others have to document the wounded city with expensive, newly bought video cameras.

One day when the families of victims were still searching for information at the Armory on Lexington Avenue, an ambulance was called to come get a guy who was there offering his services to resurrect the dead. I have heard of a whole lot of people showing up in emergency rooms claiming that their wife or husband is missing in the towers, only to have it turn out that the person was never married, and has not lost anyone. My fellow trainees and I are exhausted, numb, bewildered. We are doing too much. We are not doing enough. I have a speech that I give — Itís okay to feel this way (insert symptom X: Sleepless, anxious, jumpy, wonít ride the subway, wants to move to Canada, convinced there will be a nuclear bomb, guilty about having seen a movie, experiencing ceaseless diarrhea). You are having a normal reaction to an abnormal event.

I say this to my patients, my friends, the superintendent in my building as he repaints apartment 4D (whose tenant never came home), strangers in the street. I am surprised when people start saying it to me. I price gas masks on the Internet, consider prescribing myself emergency antibiotics. I wonder, horrified and hopeful, whether Club Med has dropped their prices, and can I go tomorrow? Suddenly, the escapism of my favorite television show, "Buffy the Vampire Slayer," is not so escapist. But I love it even more, because now I know what itís like to have evil nearby.

Back at the clinic, I find itís almost impossible to find an inpatient bed for a psychiatric hospitalizationóthere are no openings. I make midnight phone calls looking for open spots, reaching out to residents at St Vincentís, Beth Israel, Columbia Presbyterian. They laugh, "Donít even ask. No beds." Suddenly every night is a full moon.

Three weeks later, itís all becoming even more surreal, if thatís possible. I am having urges to watch the original attack footage again, or look at photos of the towers burning, because I need to be reminded of what actually happened, now that this has become a fact of my life. I walk past that wall of Missing photos and messages outside Bellevue Hospital where I work every day, and am disturbed by having become almost immune to it. I wonder who decides whether to take it down, and how, and when that will happen.