Cover Story

Being present

Red Cross Disaster Mental Health officer Robert Hayes, EdD, guided his mental health colleagues at the Pentagon disaster site with a simple message: "Don't do something, stand there."

"Being present is one of the best things we do--that and an awful lot of listening," said Hayes, a DRN member who has trained mental health workers on behalf of the Red Cross for eight years. A professor of counseling psychology at Ball State University, Hayes flew to Washington, D.C., on Sept. 14, the first day he could get a flight out of Indiana.

The Red Cross had asked him to oversee the more than 150 mental health volunteers helping at the Pentagon and throughout Arlington, Va. Having worked his way up through the ranks of the Red Cross, Hayes is considered a "Level 5" Red Cross officer, a qualification that enables him to lead volunteers at large disaster relief sites. Hayes is also the Indiana State Lead for Disaster Mental Health for the Red Cross.

At Red Cross headquarters in Arlington, Hayes spent three weeks supervising the mental health volunteers. The groups were working at Washington's Dulles Airport with families of passengers, at the Pentagon's south parking lot with rescue workers, at a local hotel with families of missing Department of Defense workers and throughout the community with other local employees affected by the Pentagon tragedy.

Hayes's wife, psychologist Susan Spencer, EdD, joined him in Washington and volunteered at the Pentagon during his assignment.

The amount of energy and dedication generated by the volunteers was like nothing he'd seen in any other disaster site he's visited. These sites include the 1995 Oklahoma City bombing, the 1994 Los Angeles earthquake and the 1999 American Airlines plane crash in Little Rock, Ark.

Hayes was overwhelmed by "everyone's willingness to pitch in and help."

'A strange kind of stillness'

John Gualtieri, PhD, left a message with his local DRN coordinator as soon as he heard about the Pentagon attack. The Virginia private practitioner didn't expect a call back, but he got one--a page at his home.

He immediately headed over to the Arlington Red Cross chapter, waited several hours and then went to the Pentagon in a van cleared to pass barricades. At 9 p.m., he arrived near where the plane had hit and witnessed confusion, shock and exhaustion, but also, he said, "a strange kind of stillness."

"There was an unreal quality about the building--like a movie set," said Gualtieri. "It was beyond torn up, and there were fires breaking out."

There was also uncertainty and misinformation about bodies already being recovered and rescuers needing psychological support, he said. Officials directed mental health workers to counsel rescuers, but, said Gualtieri, "that never really happened."

Some psychologists talked briefly with relief workers as they rested between shifts, but there wasn't time for anything more. Gualtieri decided to cancel his Wednesday appointments and return the next morning.

Once again, he didn't provide any direct services, and a plan to counsel victims' families never materialized. But he did help distribute food and water to workers. Of the experience, Gualtieri said, "I was certainly proud to do something to help, and I think what we're all faced with is the great helplessness of the situation in a disaster like that."

Resilience and mental health

DRN member Sally Singer Horwatt, PhD, a psychology practitioner in Reston, Va., provided relief for rescue workers at the Pentagon for eight days. Arriving the first day, "I felt small and insignificant," she said. "What was I going to do with my pleasant smile alone?"

What she did, in fact, was hand out roast beef sandwiches, Gatorade, towels soaked in cold water, dry towels and hugs. And she listened.

"I listened to an emergency medical technician who drove up 20 minutes after the crash and found six live, burnt people lying on the sidewalk and had to figure out where to take them. I listened to a Pentagon worker who ran back into the burning building to shut off the computers since they were carrying top-secret information."

Though the stories were horrifying, she didn't witness the widespread grief and panic that many were expecting. "None of these people was in denial," said Horwatt. "They were appropriately sad, angry and very confused about the motives of the people who would do this. They were acting appropriately, heroically and without self-aggrandizement to get the job done."

Witnessing their reactions bolstered her belief in the idea that most people who are subjected to severe trauma remain healthy. And she was deeply touched by how grateful the rescue workers were for the support they had been given.

The experience transformed her thinking about psychology, she believes. "In a crisis, it is not our insights or theories that count," she said. "It is not feeling their pain that helps. It is not our five-step death-and-dying agendas. It isn't even our degrees. It's our support. That'll keep them from getting sick. A smile, a joke and a cup of coffee. The rest--they'll take care of the rest."

Setting up around-the-clock shifts

Rosemary Schwartzbard, PhD, learned a plane had hit the Pentagon--just a few miles away from her office in Arlington, Va.--when a patient called her to cancel a 10 a.m. appointment.

As the Virginia DRN coordinator, Schwartzbard was expecting the call that came soon after. By evening, several DRN members were deployed to the Pentagon to set up around-the-clock shifts of mental health workers at Red Cross emergency aid stations where rescue workers came for food, blankets and other necessities.

"We had mental health people at each of these emergency stations just in case anyone needed support," she explained. On several occasions, Schwartzbard also accompanied Pentagon employees on walks near the wreckage while they surveyed the damage.

Although her lengthy shifts at the Pentagon have been over for some time, she continues to work with the DRN and the Red Cross to arrange discussion sessions at community events and in workplaces--and dealing with the aftermath of the crash in her private practice.

"Many of my patients actually witnessed the plane hitting the Pentagon," she said, "or it flew over top of them when they were on the highway, or they heard the impact or smelled the smoke."

Helping at home

Mary Durham, PhD, learned of the attack on the Pentagon while in her Arlington, Va., office. After heavy traffic on the Washington-area telephone lines eased, she received several calls for assistance from the DRN.

Two days after the attack, she was assigned to assist victims' families at the Crystal City Sheraton Hotel, near the Pentagon, where families had gathered to await word of loved ones. When she arrived, officials were briefing families on the recovery operation a few miles away. After the briefing, as family members waited for news, Durham and her colleagues scattered through the lobby to assist them.

An Army chaplain introduced her to a woman who had lost her sister, and Durham spent the next few hours offering her support and advising her on how to talk with her children about the disaster.

Durham has been a DRN volunteer for 10 years, but hasn't had as many opportunities to use her training as she would like. "As practitioners, we can't just jump up and leave town," she explained. "It was gratifying to be able to do something to help here at home."

Avoiding being intrusive

Sarah Reagan, PhD, had to abruptly end her session with a newspaper editor when they received word of the terrorist attacks. Her client raced back to his office, and Reagan, a practitioner who works two miles from the Pentagon, watched out her window as people poured out of three government buildings and security vehicles blocked the entrances to area parking garages.

Patients who made it to her office later in the day reported traffic jams and crowded sidewalks. Many offered rides to stranded pedestrians.

Reagan, a DRN member, was later notified by the Red Cross to report to the Arlington chapter. Once there, she was dispatched to the Pentagon, where at 9 p.m., fires were still burning with intensity and emitting such toxic fumes that firefighters had been ordered to keep away. Many were resting on the ground, exhausted.

Reagan took note of what they and the other rescue workers needed--blankets, for example, and dry socks and bottled water--and provided the items when she could. She returned the next evening to find a heavier military presence. She continued offering support to rescue workers, but avoided being too intrusive.

"We were available to talk to those who wanted to talk, but were careful not to interfere with their work," she said.

'A stimulus to do some soul-searching'

Disaster-trained psychologist Sara Beth Bosley, PhD, of Arlington, Va., planted herself at the Pentagon food tent on the Sunday after the attacks to listen to police, military workers and other Red Cross volunteers who might need support. She also offered something somewhat unusual: having been certified as a massage therapist, she offered shoulder massages.

Though unsure of the difference she made for relief workers, she said the experience made a difference for her: "I was grateful that I was able to get out there. The appreciation of the horror gave me increased empathy for my clients and a stimulus to do some soul-searching in my own life," she said.

In the days that followed, Bosley was asked by a managed-care company to lead a support session with employees of a major department store near the Pentagon. Employees discussed the effects of the attacks on their lives: A pregnant woman wondered about the future her child would experience; a survivor of recent civil war in another nation was very shaken by seeing the plane fly into the Pentagon; an employee's son who had originally been scheduled to fly on the Pentagon-attack flight felt guilty for surviving his friend.

"It was a challenge to help people be calm in a situation where no one knew for sure if it was over," she said. "If it were a storm, at least I could say 'It's over and you know what the damage is.' I was half as scared as they were and had to be aware of myself."

As for self-care, Bosley said that she and her colleagues are "doing a great deal of mutual support. I've been asking my family for support and prayers, too. That helps a lot."

'Run, run! Incoming aircraft!'

Jackie Lapidus, PsyD, is less cynical now. "I have learned how vulnerable I am," she said. And, she added, even after the horrific events of Sept. 11, she's almost surprised by her reaction. "I am less cynical because I have witnessed so many acts of kindness and courage."

Lapidus, part of the DRN in Washington, D.C., interrupted her private practice for five days so she could work at the Pentagon. When she arrived the morning of Sept. 12, "The scene was somewhat chaotic, but also somber and purposeful," she said. "The building was still burning and the ground in front of the 'hole,' as it came to be called, was a mud pit."

Soon after she arrived, the scene became even more frenzied. "An alarm sounded and people--officials--started yelling, 'Run, run! Incoming aircraft!' Everyone who could ran away from the building. It was terrifying as the danger of continued attack seemed so real." Fortunately, the aircraft was identified and the rescue workers and volunteers returned to their duties.

Lapidus's role as a psychologist, she said, "was to be available as a person who would listen. Often, those on the front lines needed just a few minutes to take a break from the work, just to have a conversation, sometimes unrelated to the horrible task at hand."

She felt grateful and humbled by the "incredible team of workers at the Pentagon who shift after shift after shift found the courage to do unspeakable things," she said. "Perhaps their bravery also makes me a little braver."