Fear isn't the only thing we have to fear

Commentary: Americans' reactions to terrorist acts are well within the norm, psychiatrists say.

October 23, 2001|By Michael Ollove | Michael Ollove,SUN STAFF

We are all living under a death threat.

That is the new reality of America. If we believe al-Qaida's pronouncements - and we'd be crazy not to - they'd love to kill every one of us. Men, women, children. If we didn't know that before Sept. 11, we know it now.

You don't have to be in the offices of a television network or on Capitol Hill to feel apprehensive. Out in Oakland, which might qualify as the middle of nowhere, the police chief has started locking his doors. "Everyone is paranoid," said John Sines.

Everyone is jumpy. Confetti spills from a greeting card on an airliner and passengers get quarantined for three hours. A package with no return address is delivered to a data processing company in California and all 400 employees are evacuated.

Americans are afraid. They are buying Cipro and trying to lay hands on gas masks. They are spooked by anything powdery. They are staying out of airplanes and are in no rush to enter the Magic Kingdom. Collectively, they are popping anti-anxiety drugs like never before.

The America today was unimaginable only six weeks ago. Are we overreacting? It's hard to make that case after watching the Twin Towers vanish before our eyes. If such horror is possible, how can we rule any dangers out?

The president tells us to go about life as usual, but his administration issues a warning that the chance of another terrorist attack is 100 percent and puts us on "full alert" for a weekend. Stay calm the government tells us while also making plans to stockpile enough smallpox vaccine for the entire nation. The messages are contradictory, but what's the choice? Suspend our lives? Forget that someone out there wants us dead?

The line between reasonable and unreasonable fears shifted dramatically on Sept. 11. The anthrax exposures have only moved the dividing line farther from the norm.

"It's difficult to say whether people's fears are legitimate or not, because it's hard to know what the reality is right now," said Neil Warres, chief of psychiatry at Maryland Shock Trauma Centerand Kernan Hospital. What he does know is "more of my patients than usual have needed to be hospitalized, and my colleagues have noticed the same thing."

Terrorism is not like calamities such as natural disasters or chemical explosions. These lend themselves to risk management. Based on probabilities, it is possible to take steps to decrease risks, for example, by building safer housing in areas prone to earthquakes or by storing inventory more carefully in the case of chemical plants.

But terrorists defy risk management because they are purposely trying to take their targets by surprise. "It's very, very hard to know what actions to take in dealing with terrorists," says Howard Kunreuther, a professor of operations and information management at the University of Pennsylvania. "You can decide to stay out of tall buildings, but the next time, they may go after short buildings or stadiums. That makes terrorism qualitatively different from other disasters."

It is difficult now to say whether a perceived danger is realistic or not. Before Sept. 11., there was generally a consensus about what constituted real danger. "Under normal circumstances, it is fairly easy to distinguish between what is reasonable fear and what is unreasonable fear," says Rudolf Hoehn-Saric, professor of psychiatry at the Johns Hopkins School of Medicine. "We have a general sense of what is dangerous and what is not dangerous, and fairly large public agreement about that."

For example, we generally accept that elevators are safe and ride them without a second thought. But there is a small subset of people who understand elevators are safe but are nonetheless afraid to use them. Those people are considered phobic. They realize their apprehensions are unfounded, but still experience fear.

Paranoia is another matter. Paranoiacs have faulty beliefs about persecution that cannot be corrected by reasoning. They are delusional, or nearly so. "For instance, they might be convinced someone is sabotaging the elevator," says Hoehn-Saric. "You can show them that it is perfectly safe, that the mechanics are all intact, but you cannot persuade them."

As the saying goes, just because you're paranoid doesn't mean someone isn't out to get you. Someone is out to get us. When our nightmares become the reality, it's not so easy to dismiss the avoidance of malls and airplanes as craziness.

Information, where it exists, is the great antidote to fearfulness. U.S. Sen. Tom Carper's office in the Hart Senate Office Building is 30 feet from that of Sen. Tom Daschle's where anthrax was found. Yet, Brian Selander, Carper's press secretary, said staffers were not unduly worried, as they had been on Sept. 11 when they were evacuated. "We didn't know who was attacking or what might be coming next," Selander said, "But, here, we knew what the problem was, and we knew the steps to take to solve it. To get tested and take your medication. So there is no nervousness."

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