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Are Americans Really Living in Fear and Trembling?

By Susan Sample

It's invisible, intangible and highly contagious, and it can't be detected by the most sophisticated technology available. The newest weapon of mass destruction unleashed throughout America is fear.

Since 9/11, the nation has been seized with an overwhelming, paralyzing fear--if we're to believe headlines in news magazines, special in-depth television reports, even call-in shows on public radio. Old, young, rural, urban, Americans are said to be suffering psychiatric repercussions, ranging from anxiety disorders to depression to post-traumatic stress disorder (PTSD), like never before.

"This is no surprise. With each new traumatic event, we attempt to make it into the gold standard, when, in fact, an increase in psychopathology, especially in those personally connected to a trauma, goes back to the days of Mesopotamia," said David A. Tomb, M.D., professor of psychiatry in the School of Medicine. "It's been around forever under different names."

"9/11 had unique features, but if we look at the big picture, is it different from other traumas? No. What we're noticing is that it's not the average person who is having a tough time. They're troubled by it, concerned that it may escalate into something worse, but it hasn't affected them on a daily basis to the point where they can't sleep or go to work."

People suffering the most from 9/11, excluding individuals directly exposed to the World Trade Center and Pentagon bombings, are those with a biological predisposition to anxiety and/or depression, or those who have experienced traumatic events in the past.

"The nervous system is altered by trauma," explained Tomb. "The anatomy of the brain changes. It becomes wired differently, so it will pick up events and manifest as a relapse. For the practice of psychiatry, this means we look more carefully at people who fall in the categories of having a predisposition to depression or having a past experience of trauma. We ask more questions, because these people are at risk."

The U of U psychiatrist, who has been studying responses to traumatic events for 15 years, has found that "as long as people thought of the effects of trauma as associated only with war, terrorism, and torture, they neglected the majority of psychiatric repercussions." Even PTSD, recognized in response to the suffering of Vietnam war veterans, is still undergoing revision in terms of understanding its specific criteria and official diagnosis.

"We are gradually learning, a caveat I'd put in caps, that there is a new nomenclature. What we've discovered over time is that people who've seen combat in war are different from people who have suffered other traumas, such as losing a limb or child in a car accident, being raped or severely burned, or surviving a hurricane or flood. There may be a close clinical association, but they are experiencing different kinds of trauma in terms of duration, post-accident support, and treatment."

The most common response to 9/11 hasn't been PTSD, but depression. A New England Journal of Medicine survey of residents in Manhattan, conducted 5-7 weeks after the Twin Towers collapsed, found that 7.6 percent of the population met the criteria for PTSD, compared to 10 percent for depression. That's what psychiatrists would expect, according to Tomb. Every year, 4-4.5 percent of Americans will experience major depression; the percentage of people traumatized will be twice that, but most will not develop PTSD.

Although several professional groups are devoted to studying how best to treat victims of trauma, "unfortunately, they're not of one mind," said Tomb. "The conditions are so individualized. It's incredibly complex to develop a set way of dealing with bad things that occur. It's definitely a major issue for psychiatry and psychology."

The threat of bioterrorism seems to bring with it another kind of crippling fear. "If a population is being terrorized by what might happen, they may display mass hysteria," said Tomb. "Mass hysteria, in a way, is like hypnotizing a large group of people who all come to believe the same thing. That kind of phenomenon is real, but it occurs in a subset of the population: the highly suggestible group."

About 10 percent of people fit into this category. "They avoid the nightly news on TV, because they might hear of a shooting. They'll have difficulty sleeping for two to three days after an incident, due to fear. These are very bright, intelligent, rational adults," said Tomb. "They're just very suggestible."

They're also very "hypnotizable." Yet, as Tomb explained, "a clinical hypnotist or a good stage hypnotist can make nine out of 10 people temporarily suggestible. By using all the tricks, we can get them to hypnotize themselves.

"This is not magic. Lightning bolts don't come out of our fingers into the core of their brains. They are encouraged to enter a state that is quite unfamiliar to them. They feel as though they have entered a different kind of consciousness, which they have."

Repeated exposure to threats and implied danger can affect people in ways similar to hypnosis, increasing their suggestibility. "Repeated trauma will move the bar to the lower 30 percent of the population, maybe even to half of all people, depending upon how close they are to the trauma, how many stimuli or reminders are surrounding them, and the amount of grief they've been exposed to.

"Given the right conditions, mass hysteria can be induced. Basically, if people are exposed and re-exposed, they will develop a sense of imminent danger. If anthrax had kept coming in letters, it could have been a nightmare. Large numbers of people could have become desperate to have been made safe."

But just as mass hysteria can be induced, it can be prevented. "You do it through something as simple and matter-of-fact as education: describing the phenomenon of mass hysteria. If you educate people well, you can quiet the tendency to become overly suggestible in the majority of people."

Although the mass media in recent months has reported epidemics of anxiety in America, a study published in the December 2001 issue of Military Medicine reported that "disorganized flight" in the presence of real or perceived danger (i.e., mass panic) is rare. On the other hand, in a real or perceived WMD scenario, outbreaks of multiple unexplained symptoms may be prevalent. Many of the symptoms (fatigue, nausea, vomiting, headache, dizziness/lightheadedness, and anorexia) are common in combat and after toxic chemical exposure, chemical weapon exposure, prodromal infectious illness, and acute radiation sickness."

"You're not likely to quiet the most suggestible 5 percent of people. They'll still feel short of breath and have anxious and hysteric kinds of responses," said Tomb. "But you can help 95 percent of folks with repeated, sensible, matter-of-fact education. When you're talking about mass hysteria, the media can be the devil and the cure."

We always welcome your comments about the magazine. Address letters to: Editor, Health Sciences Report, Office of Public Affairs, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132. FAX: (801) 585-5188. E-mail: Susan.Sample@hsc.utah.edu.

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