The Recovery Work
The work of the mental health response team consisted of assisting hundreds of families with the preparation of the VIP Missing Persons Report, (a detailed multi-page report) and helping the families negotiate a traumatic and chaotic bureaucratic process. The first few days following 9/11, this 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 professionals, and spiritual care providers, along with 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 to be allowed access to Ground Zero so they could help find their loved ones; others hoped to find their missing loved one wandering disoriented in lower Manhattan; still others believed that their friend, mother, lover, partner, son, or daughter, whose 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 no one could offer a resolution. In most cases, as those in crisis screamed in frustration, all the officers could offer was empathy and unconditional support.
No amount of education or training could have prepared the team members for this devastating nightmare. Those who were aware that the worst of fears had been realized, gently and compassionately broke the news to one person at a time, as the names of the few whose bodies had been recovered were released. 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 the team would bring families by Waterway Ferry three times a day to view the horror in person. The support team briefed the families prior to these boat trips and supervised three trips daily.
“No amount of education or training could have prepared the team members for this devastating nightmare.”
In November 2001, a memorial service was held at Ground Zero to honor the victims and their families, and the support 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 the officers to work 12 to 15 hours per day, 7 days a week through October. In November, schedules were reduced to about 10 hours per day, 6 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 the officers provided security at a viewing stand for families and tourists near the WTC site until September 2002.
Many of the 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.
Empirical Data
Six months after the attack, a convenience sample of these officers (N = 74) was conducted and results indicated that 23 percent had posttraumatic stress disorder (PTSD).2 The support team members, 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. An analysis of data collected from 28,232 NYPD officers in 2003 found high rates of reported psychological and related symptoms, reaching the conclusion that a majority of the “rank and file” were still suffering from symptoms of stress related to 9/11 two years later.3
A systematic review of longitudinal studies of PTSD among highly exposed populations from October 2001 to May 2016suggested a substantial proportion of 9/11-related PTSD among those highly exposed to the attack.4
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 appeared 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; this is particularly true for first responders.4
Another 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 9/11.5 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.
Summary & Interpretation
These studies provide validation and confirmation for those 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 responders would prefer to be less plagued by the memories. As the 20 =-year anniversary of 9/11 passes, responders continue to be haunted by the memories of the, and their recovery work that is too often forgotten by those who watched the events from their television sets at a distance.
Psychologists 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.6
Of the three core techniques used in this treatment, an emphasis on meaning making resonated most for the author. Addressing the numerous layers of meaning that 9/11 and it has helped in the author’s and others’ treatment and recovery.
First responders have benefited from this work, and many anecdotally describe their 9/11 experience as the most painful and yet most meaningful work of their lives. Support team officers were instruments of support and safety for thousands of people who could deposit their shock and grief into the vessels of the officers. This is the meaning of the work, and the psychological recovery efforts continue for those impacted. The phrase “Never Forget” might be replaced with “Never Forget, Sometimes Forgotten, and Often Haunted,” especially 20 years later.
Notes:
1Corey Kilgannon, “‘Reopening Old Wounds’: When 9/11 Remains Are Identified, 20 Years Later,” New York Times, September 6, 2021.
2Chaya S. Piotrkowski and Grace A. Telesco, “Officers in Crisis: New York City Police Officers Who Assisted the Families of Victims of the World Trade Center Terrorist Attack, Journal of Police Crisis Negotiations 11, no. 1 (2011): 40–56.
3Frank G. Dowling et al., “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, no. 1 (January 2006): 151–153.
4Ari Lowell et al., “9/11-Related PTSD Among Highly Exposed Populations: A Systematic Review 15 Years After the Attack,” Psychological Medicine 48, no. 4 (March 2018): 537–553.
5Shane W. Adams et al., “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, no. 2 (February 2019): 156–164; Jeihue Li et al., “Comorbidity Amplifies the Effects of Post-9/11 Posttraumatic Stress Disorder Trajectories on Health-Related Quality of Life,” Quality of Life Research 27, no. 3 (March 2018): 651–660; Raif Schwarzer et al., “A PTSD Symptoms Trajectory Mediates Between Exposure Levels and Emotional Support in Police Responders to 9/11: A Growth Curve Analysis,” BMC Psychiatry 16, no. 1 (July 2016): 201; Kimberly Caramanica, K. et al., “Comorbidity of 9/11-Related PTSD and Depression in the World Trade Center Health Registry 10–11 Years Post-disaster,” Journal of Traumatic Stress 27, no. 6 (December 2015): 680–688.
5Evelyn J. Bromet et al., “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, no. 4, 771–783.
6Peter T. Haugen et al., “Integrative Approach for the Treatment of Posttraumatic Stress Disorder in 9/11 First Responders: Three Core Techniques,” Psychotherapy 50, no. 3 (September 2013): 336–340.
Please cite as
Grace A. Telesco, “Never Forget, Sometimes Forgotten, Often Haunted,” Police Chief Online, September 22, 2021.
