Cover Story

First at the scene

New York City practitioner Bridget Amatore, PhD, was among the first mental health workers to arrive at what's now known as ground zero on Sept. 11. She and two others boarded a Red Cross supply truck, passed through National Guard checkpoints and found themselves at the rescue control center and triage center, near where the World Trade Center towers once stood.

The scene was dark and eerie--there was no electricity, phone contact or water. Dust covered everything and hampered breathing. Nevertheless, Amatore and her colleagues went to work assisting rescue workers as they steadily began visiting the triage center at about 1 a.m. The three played down their status as mental health workers, though.

"We just talked to rescue workers and calmed them down," said Amatore. "They were upset and uptight, they were dehydrated and exhausted. We encouraged them to get their eyes washed out and helped to make sure they were medically cleared."

Amatore also spoke with security officers from a nearby school, who were distressed that they'd seen people jumping off the towers earlier in the day.

"I would listen and say it must have been so terrifying, and they would ask me why people would do this," said Amatore. "I said it was probably a last-ditch effort for those people. It was a way to say, 'I will not be helpless. I will not stay here. I will not be burned to death. I will not die this way.' It was almost a flight to freedom."

'I will never be the same for it'

When Kathryn Dardeck, EdD, first arrived where the towers once stood, the firefighters there were too intensely focused on their rescue work to talk with her or her colleagues. That gradually changed as rescue workers increasingly recovered bodies from the rubble.

"It was gut-wrenching and exhausting for them and for us," said Dardeck, co-chair of the Massachusetts Disaster Response Network (DRN) and a practicing psychologist at Valley Medical Group in North-ampton, Mass. When they made a recovery, "a hush would come over the pile...all of us stood with our helmets in our hands out of respect, totally quiet, as the remains were draped in the flag and slowly transported down the street."

Not only were Dardeck and her colleagues offering support to firefighters who had lost many of their own in the disaster, they were also sharing their deep shock and pain.

"They wept with us, expressed their frustration and anger with us, and just sat, stood, walked, talked and spent time with us to relieve them of some of their horror and guilt," she said.

Dardeck was deployed to the disaster site in her capacity as clinical director of the Western Massachusetts Critical Incident Stress Management Team, which put in 12 hours at a time during the first few days. "There was nothing in my training or life to this point that could have adequately prepared me for what I saw," said Dardeck. "It was impossible for me to look at the rubble and not think of the plus-or-minus 6,000 lives that lay beneath it. I will never be the same for it."

Dardeck was touched by "the outpouring of support" mental health volunteers received from New Yorkers.

"People would thank us for coming to New York, would buy us meals, would give us rides where we needed to go," she said. "It was inspirational. I witnessed more kindness and love than I ever would've thought possible."

Offering encouragement and relief

Unable to obtain telephone service, Sharon Brennan, PhD, left her Upper East Side practice in New York City and learned of the World Trade Center and Pentagon attacks as she joined throngs of New Yorkers who were pouring "like dazed refugees" up from midtown and downtown.

"I immediately sensed that every psyche in the city was impinged by this," said Brennan, a private practitioner and senior psychologist at Brooklyn's Maimonedes Medical Center child and adolescent psychiatry department.

That evening, Brennan, a DRN member, reported to the Red Cross and went out on the first emergency response vehicle that carried mental health personnel to the attack site's command center. The area--what she could see through the thick, gray ash--was surreal. "It was as if part of our city had been amputated," she said.

Brennan worked through the night of Sept. 11 at Stuyvesant High School, located across the street from the command center, where firefighters and police came in for rest after 14 or 16 hours on the scene. She and fellow mental health volunteers did anything they could to offer support and encouragement and relieve the rescue workers' physical discomfort. Many had eye trauma and needed help finding a doctor. Others needed food, water or a place to sit down.

"People were pumped up with adrenaline and all of their energy was being put into saving as many lives as possible," she said. "But they also showed immense gratitude to someone who was offering them comforting words."

For the next few weeks, Brennan got involved with the disaster relief effort in various ways. She counseled people at a grief center set up at Pier 94 by the Red Cross, the mayor's office, the New York Police Department, the Federal Emergency Management Agency and other organizations to help people searching for lost loved ones. Through the Maimonedes Medical Center, she talked to schoolchildren about the attacks and helped schools identify children who were particularly vulnerable to feelings of distress, fear and anxiety. She also participated in a multidisciplinary effort to assist business owners who lost their businesses or employees.

"The process of working through this is going to be long-term," said Brennan. "Many people are coming out of the stage of being stunned, and there will be emotional repercussions that will be with us for a long time, in various ways and in various degrees."

'I'll do whatever they want me to do'

As New York City coordinator for the New York State Psychological Association Disaster Response Network (NYSPA­DRN), Lisa Jill Kaplan's primary responsibilities have included calling those who are referred for psychological services.

"I speak with them about what is going on and tell them what services NYSPA is able to provide," she said. "If they are interested in getting the name of a pro-bono clinician, I call clinicians until I find one who is able to help....Some-times these people already have therapists and I am really doing phone crisis intervention until they see their clinicians."

Kaplan's responsibilities also included calling victims' families and friends to gather more information on them.

"We needed to know what they were wearing, whether they had tattoos, jewelry, scars, where their dental records might be, whether they'd ever had X-rays," she said.

The hardest part about making those calls, she said, was hearing the hopes it raised on the other end of the phone.

"Of course, the families' immediate response was 'Did you find him?'"

Acts of closure

A client late for his 9:20 a.m. appointment told Sandra Haber, PhD, about the planes crashing into the World Trade Center. Haber, an independent practitioner in upper midtown Manhattan, cancelled her appointments for the rest of the week and began volunteering for the Red Cross the next day. She performed a variety of tasks, from roaming the streets near ground zero listening to anyone who needed to talk, to answering phones on the missing-persons hotline.

Her most difficult but worthwhile day was Friday, Sept. 21, when she was sent to work at the fire station at the Brooklyn Navy Yard, from where families, friends and co-workers of missing firemen were taken by boat to ground zero.

"As I boarded the boat, I wondered if I could hold it together," Haber said. "At one point, we went by the Statue of Liberty....Seeing the statue in the midst of this war zone was inspirational and helped me get through the rest of the day."

The families' visits to the site were an important act of closure for many people, said Haber. "Upon seeing the site, many said, 'It would be impossible to get out of there.' 'There's just too much metal and too much damage,'" she explained. "My job was to meet the families in the fire station, talk to them on the boat, escort them to the viewing site and be there for them on the boat trip back. We made three trips that day."

'We're all very, very close to this tragedy'

On the morning of Sept. 11, New York City corporate psychologist Paul Ofman, PhD, dropped his daughter off at school, voted in the mayoral primaries and came home to find a message on his answering machine urging him to look out his window. That's when he saw smoke billowing from the World Trade Center towers.

After the father of two made sure his family was safe, he headed to the Red Cross, where he is chair of emergency services.

In subsequent days, he advised the New York City mayor's office and the commissioner of health and mental health services on how to create psychologically helpful messages for the public and the media, and about laying the groundwork for community recovery over the longer term.

"While we've been touching thousands, millions of people out there are affected," he explained. "It was important to work with the media to get messages out that are informative," such as strategies citizens could use to cope with trauma and advice on how to meet children's needs.

Ofman counts himself among the affected. "My family used to see the World Trade Center towers from our windows," he said. "While my family is safe, we're all learning that if we didn't know somebody personally, somebody close to someone we know was in the World Trade Center. We're all very, very close to this tragedy."

Windows on the World

On the Sunday after the attacks, NYSPA and Red Cross DRN volunteer Paul Greene, PhD, was called into the city to meet with the management of Windows on the World and Wild Blue, restaurants located on the 106th and 107th floors of Tower One. Out of about 450 employees, the 78 who were in the restaurants on Sept. 11 were confirmed dead or missing. The company had lost all of its personnel records, making it difficult to track missing employees and contact victims' family members.

"While we supported the companies in general, it was really the managers who rose to the occasion," said Greene, who chairs Iona College's psychology department. "They were caring, smart leaders who were doing everything possible for their people."

In addition to working with the restaurant employees' union to ensure employees would receive mental health and other services, the company set up a hotline for family and friends to call for word of loved ones. Greene and two colleagues, Deborah Freed, PhD, and Lee Shain, PhD, talked with the restaurant employees staffing the hotline and offered advice and support on staying mentally healthy. They also provided one-on-one counseling with employees and made sure management had the option to ask for follow-up by psychologists in the weeks to come. "They needed us to be available to them as unobtrusively as we could be," said Greene. "We supported what they were doing already, which was so remarkable to see."

Overcoming preconceptions

As soon as they heard about the attacks, Stanford Singer, PhD, a faculty member at New York University and Mt. Sinai School of Medicine, and his wife, a clinical social worker, walked to the American Red Cross building to offer help. "We couldn't do much more than have casual conversations with rescue workers," said Singer. Some police and paramedics wanted to talk, but the firefighters did not, he said. "They had lost half their people or more. They were on autopilot."

Several days later, coordinators from NYSPA asked him and his wife to assist the police officers and detectives sorting through body parts at the morgue. "It was pretty heavy," said Singer. One detective, he said, told him she had to try to think of the parts as plastic.

"When the remains of an officer were brought in, they'd come in an ambulance with a motorcycle escort," said Singer. "Everyone would come to attention and salute. It was very emotional."

He says his experiences forced him to overcome the preconceptions of what his role as a psychologist is in some situations. "We were serving hot chocolate in some cases. Was that therapeutic? Definitely."

'Bringing order out of chaos'

When Jerry Jacobs, PhD, got the Red Cross deployment call after the attacks, he was told to drive. No planes were flying into New York, so Jacobs and his team from the University of South Dakota Disaster Mental Health Institute took to the road.

The group of three institute faculty members and two graduate students arrived in the city a day and half later. Immediately, they went to work doing what they'd been training to do for years: what Jacobs calls "bringing order out of chaos."

To do that, they took on various tasks: Jacobs, the Institute's director and one of the founders of APA's Disaster Response Network, managed an effort to set up shelters for displaced New Yorkers and helped establish two respite centers for rescue workers. His colleague, Randy Quevillon, PhD--head of the university's psychology department--saw to the opening of the first respite center, helped coordinate memorial services and created and led support teams.

Meanwhile, Beth Todd-Bazemore, PhD, also from the institute, offered mental health support to rescue workers at ground zero and a landfill where workers deposited and sifted through debris from the towers. Doctoral students Sean Stephens and Kim Douchis divided their time among the three professors, who supervised their work.

By the time the team left more than a week later, "There was better control over who was accessing ground zero and getting services to those needing help," said Jacobs.

He largely credits New York's disaster-response professionals for the team's success.

"Having this happen in a city where psychologists and other mental health professionals--the greater New York Red Cross chapter and Paul Ofman's chapter--have so much preparation and training made this much easier to respond to," said Jacobs. "It's important to recognize the work that goes into this. You go in there and it looks like all these people know what they're doing, but it's taken years of thankless blood, sweat and tears for them to get there."

From across the country

Richard Heaps, PhD, a counseling psychology professor at Brigham Young University and the Utah state DRN coordinator, was also among the psychologists from other states called in to New York. On Sept. 15, he arrived at ground zero, where he stayed for 12 days. "The first thing to strike me was the reality of it," said Heaps. "The rubble was smoking and there was a metallic smell and taste in the air."

Stationed at a respite center near where the twin towers once stood, Heaps spent more than 12 hours each day listening to rescue workers' concerns about their need to work quickly to find survivors and to parents' fears about how their children had interpreted the events. He cautioned parents to understand that "children's worlds were turned upside down" and advised them to use kids' language to help them feel safe again."

He also explained to adults that their stress, fear and inability to sleep were normal reactions. "Many people thought something was wrong with them for having feelings of depression or anxiety," Heaps said.