Post Traumatic Stress Disorder After 9/11 and Katrina


Statistics say that only 5% of those who survived 9/11 in New York City went on to experience symptoms of Post Traumatic Stress Disorder (PTSD). But in the case of Hurricane Katrina, 33% later suffered symptoms. This is a very high percentage, even for an extremely traumatizing event. So why the disparity in PTSD rates between 9/11 and Katrina?

Recently, I had the profound fortune of attending a lecture with Dr. Bessel van der Kolk on trauma, during which he compared the impact of 9/11 to Hurricane Katrina. Dr. van der Kolk is one of the world's leading research experts in the field of PTSD. He is particularly known for his work with the consequences of trauma and stress - both from a neurological standpoint and a psychological one - and has written numerous books on this topic.

Dr. van der Kolk was showing us a photograph of people on the Brooklyn Bridge on that fateful day in 2001. The burning twin towers were in the backgrounds, and all of these people were running away from them, toward their homes in Brooklyn. He pointed out that naturally, they were running in the direction of the places they perceived as safe: their own neighborhoods, where they had family, friends, and community to comfort them. We all remember 9/11 vividly. Three-quarters of Americans donated to the 9/11 relief effort. Our country rallied together to support those affected by this horrible tragedy.

As the media described, community and municipal departments acted quickly to provide healing resources to 9/11 survivors post-event.

In 2003 - two years after 9/11 happened - New York Magazine reported that "probably half the city's firefighters have gone into therapy-6,100 uniformed people have received counseling through the department. The department now has 60 full-time counselors instead of the 9 it employed before September 11." Victims of Katrina, in contrast, tended to be low-income and minority civilians without access to supportive counseling and other such resources as they tried to psychologically cope with the epic disaster they had witnessed. Governmental and FEMA resources were focused on crowd control, housing, and tangible issues.

Dr. van der Kolk talked about how, as a result of Hurricane Katrina, victims were forced to flee their homes, some of them permanently. Refugees from New Orleans numbered in the thousands. Many were displaced to other cities and even states as everything they perceived as familiar was eaten alive by the hurricane and its aftermath. And this was only if they could get out. During Katrina, those who did not or could not escape fast enough were trapped in a drowning city, without the ability to run for refuge. Their fight/flight/freeze responses were presumably on high alert for a prolonged period of time. Emergency airlifts strapped down many trapped New Orleans residents and carried them out of the city, stacking them like cordwood to fly them to safety in new and unfamiliar places. In many cases, victims never saw their homes and communities again. Additionally, while those who experienced 9/11 in New York were painted as national heroes in the press, the victims of Hurricane Katrina were labeled as just that: victims. (Of course, one has to consider the fact that one situation was a terrorist attack, the other, a natural disaster.) 

Not everyone who experiences trauma will go on to suffer from PTSD.

There are many factors that determine whether a trauma victim will develop PTSD, including their level of coping skills, resiliency, exposure, and the severity of any prior trauma. However, what has not been much talked about is the importance of community support in an individual's mental recovery from a natural disaster or terrorist event. Access to external resources, the support of others -both moral and logistical - and the media portrayal of a situation are all components on the road to healing. We rely not just on our loved ones and our immediate family, but our entire community and culture, when recovering from a major traumatic social event. The likelihood of a survivor experiencing PTSD as a result of a trigger event depends not just on the event itself, but on the ensuing circumstances and the cultural reaction to the event.

We are not simply at the mercy of our circumstances. Building up strong coping mechanisms is the first step to weathering the unknown and should be part of your natural disaster first aid kid.

I recently attended a 9/11 memorial ceremony here in California. As an imported 65-pound piece of the Twin Towers was put in place in front of our own fire department, the message "We are standing here as a unit" was the predominant theme. Survivors were remembered, and their pain was acknowledged, sending the message to all of the victims that they are not alone. I thought of the endless stories of my own clients who only wanted — despite their personal trauma — to have their pain acknowledged. What if our community felt it was a part of the solution more often. What if we had more such ceremonies?




First published on Psychology Today.