THE BLOG
12/19/2010 03:20 am ET Updated Nov 17, 2011

September 11 and the Effects of Trauma

I wrote this article exactly nine years ago in December 2001, for the American Airlines flight attendant union publication Skyword, in hopes of reaching out to those flight attendants who were suffering in silence and wouldn't ask for help with their traumatic reactions after the terrorist attacks of 9/11. American Airlines experienced the loss of two airplanes and flight crews on September 11, and tragically, in November, lost another airplane and crew in a crash that exacerbated employees' fears. This was my first published article on trauma and PTSD, and I'm posting this as a blog now in hopes that you as the reader will be able to substitute any form of trauma that you might have experienced; the information remains the same.

In this essay, I am speaking directly to the American Airlines flight attendant employees. It begins:

Many of you have been suffering since the terrorist attacks of September 11. Indeed, the crash of Flight 587 seems overwhelming to think about. Having been a Pan Am flight attendant for 20 years, and a psychotherapist for 15, I feel compelled to reach out through this article to help you understand the nature of trauma, for trauma is what these attacks have been for all of you. Perhaps if you just pretend that we're sitting on a jumpseat together, doing what flight attendants do best -- jumpseat therapy -- I can offer some ideas about what you might be feeling and why.

Most people are not aware that Pan Am employees endured continuing terrorist attacks since the 1970s, and that we had to live with constant threats as well as the loss of friends. Add to that the pressure of management problems, financial turmoil, airplane crashes, layoffs, Lockerbie and finally the fall of Pan Am, and it adds up to a traumatized work force. Aware of the turmoil that my beloved fellow employees endured, I decided to study trauma through the eyes and hearts of former Pan Am employees. I then wrote my doctoral dissertation on what I learned and titled it "A Psychoanalytic Exploration of the Fall of Pan Am." I hope that it might be of some benefit to you in these uncertain and scary times.

Trauma is any event outside the usual, expectable realm of human experience that causes a reaction of intense fear, helplessness or horror. The events of September 11 certainly fall within this definition. The experience of trauma can produce post-traumatic stress disorder, or PTSD. There are three hallmarks of PTSD. The first one is intrusive memories, which are recurring thoughts and dreams that elicit the same terror as the experience. Have you been having disturbing dreams or nightmares? Do frightening images come into your mind over and over? The second is hypervigilance, in which you stay on red alert, and any sudden noise may trigger panic or aggression. Are you worrying about "going off" on passengers, or even worse, your children and loved ones? Is your patience level markedly different since September 11? The third hallmark of PTSD is withdrawal, through which shying away from situations that stimulate painful memories isolates the sufferer. Have you been avoiding friends or family or conversations with them? Are you disappointed with their lack of empathy for you?

The symptoms of trauma can sneak up on you in subtle ways, until you finally feel overwhelmed and don't know what hit you. Symptoms vary widely from individual to individual and can include feelings of hopelessness, indifference and isolation. Insomnia is common, or the feeling of just wanting to stay in bed under the covers where it's safe. A loss of appetite or the inability to stop eating everything in sight can be experienced, as well as headaches, chest pains, feelings of intense fear when recollecting the overwhelming event, putting yourselves in the terrifying place of those who lost their lives, or imagining exactly what it was like for them. And, of course, wondering how you would have handled the same situation yourself. Persistent anxiety, jumpiness, fear, feeling out of control and excessive worry over loved ones' safety can be present.

Fundamental to the experience of trauma can be a devastating sense of helplessness. In my study of Pan Am employees, this feeling of powerlessness was a common theme. Sometimes this led to feelings of betrayal and painful disillusionment with Pan Am's management, who were seen as parental figures. However, such anger was not usually felt toward the Pan Am "family" as a whole. I can see many parallels between the feelings and behaviors of Pan Am employees and those of American Airlines employees now. Are you feeling angry about not having been protected? Some employees turn to unusual behaviors to counteract their helpless feelings. For example, they may become obsessed with gaining as much knowledge as possible about what is happening. Or they may keep their lives "orderly," cleaning out and straightening every nook and cranny in their homes. There are some flight attendants who have not even been able to unpack their bags since September 11. Others deal with the emotional trauma by a cutting off of emotion, and sometimes pushing those close to them away. Are you feeling numb or not very loving? A particularly traumatizing aspect of September 11 was the inability of so many flight attendants to get home. Many people state that they are less afraid of dying than of being helplessly stranded so far from home. They are more terrified of feeling those feelings again than they are of actually dying.

A common theme in the trauma literature, one that lies at the heart of psychological trauma and is related to a sense of helplessness, is of a sense of alienation and aloneness, and a profound despair about the improbability of ever having one's experience understood. A traumatized person can feel as if he or she is an alien to the "normal" people around them, a conviction that leads to a sense of alienation and aloneness, that an unbridgeable gulf separates him or her from the understanding of others. Anxiety slips into panic when it has to be borne in isolation. Hence, there needs to be a place where painful feelings can be shared. I know that many of you feel that family and loved ones have a hard time understanding what you're going through since September 11, and perhaps you might even feel estranged from your fellow flight attendants, especially if they are not expressing feelings of fear.

Dr. Robert Stolorow has written about the concept of trauma and the absolutism of everyday life. By "absolutism," he is referring to beliefs and assumptions whose validity are not open for discussion and that unconsciously play a role in the normality of everyday life. For example, you might say to a friend, "Have a safe trip," or, "I'll see you when you get home." These are statements whose validity isn't questioned. Such assumptions are the basis for a kind of naïve optimism that allows one to function in the world believed to be stable and predictable. It is the essence of psychological trauma that it shatters these absolutisms, a catastrophic loss of innocence that alters one's sense of safety in the world. When one can no longer believe in the absolutism of everyday life, the universe becomes random and unpredictable. The traumatized person perceives the world differently from others, and an anguished sense of estrangement and solitude takes form.

As if this sense of estrangement and isolation were not enough to bear, another aspect of traumatization makes a difficult situation even more painful: it isn't just the shattering of illusions, or the loss, or the injury, but also the intense shame and self-loathing because of one's reaction to that trauma. Flight attendants, in my experience, seem to have a feeling that they should be emotionally invincible, impervious to fears having to do with flying. Many flight attendants have expressed feelings of humiliation to me about such fears, and this shame seems to be as painful as the fear itself. Several flight attendants have expressed thoughts such as "if I were strong or spiritually grounded, I wouldn't be feeling depressed or anxious." Thus, ordinary feelings that many people in a similar situation would experience are felt to be somehow shameful.

Some flight attendants may be feeling more traumatized than others, and this seems important to understand. Just because some people are frightened and unable to fly right now doesn't mean that they are weak or don't have strong character. The situation is made worse for some people because it represents a "retraumatization," a feeling of repetition of a childhood history of trauma, which leaves them more vulnerable. That childhood trauma can be anything, including the early death of a parent or family member, early separation from loved ones through divorce or tragedy, or any form of abuse or extreme disillusionment. "Retraumatization" happens most often when there is a close replication of the original trauma, such as a loss of the way of life as one knew it, loss of a sense of power, loss of a sense of safety, loss of a sense of innocence, loss of a sense of control or brings back a state such as fear, horror, shock, panic or helplessness. For example, what happened on September 11 could be experienced as much worse by someone who early on in life has already experienced a shattering loss.

People who have already had an experience with trauma while flying are more likely to be "retraumatized" by the events of September 11. Such trauma can take the form of a major illness onboard the aircraft, an aircraft evacuation, an assault on a passenger or crew member, the death of a passenger, an airplane crash or any perception of serious threat to self, other crew members or passengers. Many of you may have "gotten right back on the horse" after other incidents, and never really understood its impact on you. So, September 11 may have just compounded an already existing but unrecognized traumatic state. For example, a dangerous experience with turbulence could easily disturb one's sense of safety, and revive old feelings about an earlier loss of a sense of control in life, such as the divorce of one's parents. Also, one might expect that any disaster that happens subsequent to September 11 will have a similar "retraumatizing" impact, as did the crash of Flight 587.

Your most important function at work besides safety has always been to provide passengers with a sense of comfort and reassurance, and a denial of the possibility of death. I am imaging you offering "coffee, tea or immortality," and that's an extremely difficult task when you're feeling at risk yourself. It's important that each one of you be able to find a place within a relationship for your disturbing experiences and feelings, rather than having to bear them alone, and to recognize that there's nothing inherently shameful about these painful experiences and fears. Shame only contributes to keeping feelings hidden and makes you emotionally isolated. I urge you to tell each other how you're really feeling. Getting together in small groups to talk can be extremely helpful. Leaning on your religious or spiritual faith can be of great comfort. Symptoms of trauma do improve with time and talking about it. If, however, you continue to experience symptoms after reaching out to family or friends or faith, then it's time to seek out the help of a professional therapist.