The Sept. 11 terrorist attacks understandably triggered a host of strong emotions, from fear to anger, and mental health providers across the country mobilized to help. But does that mean most people are going to end up on the therapist's couch?
No, said a group of 19 psychologists who urged caution in a letter circulated in the days after the attacks. Most people will rely on family and friends to cope with the tragedy, but you'd never know that from the offers of counseling and warnings being issued by psychologists and other behavioral experts, two of the psychologists said in interviews.
Nonsense, said trauma stress experts and the American Psychological Association. No one is pushing people to turn normal reactions into mental pathologies, they argued; professionals are just letting people know help is available.
James Herbert, a psychologist who specializes in anxiety disorders, wrote the letter and solicited support from other psychologists, primarily from the academic world. The letter urged counselors working with rescuers in New York to be cautious, especially in the use of critical stress debriefing.
Herbert, an associate professor in the Department of Clinical and Health Psychology at MCP Hahnemann University in Philadelphia, said some of the rhetoric coming from psychologists through the media "overpathologizes the normal reactions to such a horrible, horrible event."
"A lot of mental health professionals tend to focus so much on pathology that they just sort of assume that, given such a horrific trauma, the whole nation is going to have years of ill effects from this," Herbert said. "The data just don't suggest this. Most people feel the ill effects for a time, then recover."
"It may be good for people to see counseling as a product and notice that the people who say there is a need for counseling are people who are selling the product," said a letter signer, Gerald Rosen, who's in private practice and is an associate professor in the departments of psychology and psychiatry at the University of Washington, Seattle.
Herbert contended that some studies suggest debriefing can hurt patients.
Debriefing typically involves people who experienced a trauma from the same viewpoint, such as firefighters. The sessions shouldn't be conducted until the group is out of the trauma setting and won't be going back, said Jeffrey Mitchell, a certified trauma specialist and president of the International Critical Incident Stress Foundation, Ellicott City, Md.
Mitchell said that studies suggesting that debriefing causes harm have had flawed applications of the model. And debriefing is just one step in helping those such as rescue workers exposed closely to a tragedy, said Mitchell, a former firefighter and paramedic. After 25 years of experience with debriefings, he's convinced they are effective.
Rhea Farberman, communications director for the APA, denied that psychologists were exaggerating the effects of the tragedy on the public. "I think this truly does victimize all Americans," especially those who lost loved ones, she said. "But even if you weren't in the World Trade Center (on Sept. 11), this is scary stuff."