Antidotes for Sept. 11 anxiety

January 09, 2002|By Dan Buccino

WE REMAIN alert to even more unsettling threats in the aftermath of Sept. 11.

We are assaulted by things that are both near and well-known (the mail, hollowed-out sneakers) and yet unknown and unfamiliar (invisible microbes, plastic explosives). The war is not just over there happening to them, it's here happening to us, and it can make anyone anxious and hyper-vigilant.

Though many are worried, allowing our worries to incapacitate us is neither helpful nor healthy.

Freud observed that neurotics seem to do better during times of war and catastrophe. In an unscientific sample, that observation appears to be holding true in my practice and those of colleagues. As we hear from the pollsters, a mood of "defiant optimism" is establishing itself in our offices and around the country. Certainly many patients have required treatment, but for most, Franklin Roosevelt's "warm courage of national unity" appears to have taken hold.

Regardless of how one defines anxiety - as a product of errant biology, irrational cognitions or childhood trauma, as a realistic response to real danger, as an unrealistic response to perceived danger, or as a combination of these - excessive worry is debilitating. Sleep and concentration can be disturbed, and phobic paralysis can leave one homebound. An overstressed immune system leaves one more susceptible to the very toxins that cause concern in the first place. Though we may gain insight into what caused our anxiety, inevitably the question arises: What are you going to do about it?

One strategy is not to fight it. We must acknowledge and respect our worry and ride it like waves at the seashore rather than allowing our fear to override our reason and pull us into the undertow. An ability to tolerate a certain level of anxiety while resuming normal activities is evidence of separating oneself from worry.

Another approach is to prepare as best as possible for a worst-case scenario. Assembling emergency supplies or compiling important documents are useful actions for some. Yet undoubtedly we will face an unanticipated challenge; we cannot prepare for every possible event, and trying to do so will only instill more worry and paranoia.

Anxious people tend to worry about unpredictable catastrophes in the future, whereas depressives tend to dwell on the losses and traumas of the past. In either case, another useful practice is to focus on the present, to be in the moment, to pay attention to the things we would like to continue to have happen rather than to what hasn't happened or what might go wrong. We must imagine a preferred future in terms of the presence of things, not just their absence.

Mental health professionals are "hope-mongers" and re-moralizers more than anything. We ask our patients what virtues (courage, love, honor, forgiveness, resilience, country, family?) they truly value. We coach them to embody the traits they hold dear, to draw on the lessons of strength, not just of disorder and defect they have inherited, and to consider the legacy they wish to pass to the next generation.

Some struggle with how their tombstone might read: "Here lies a man paralyzed by fear" or "Here lies a man who tried to do things differently." The heroes of Flight 93 clearly chose the latter.

A final antidote to worry is civility - not always easy because it requires living by the Golden Rule. There are some with whom this is not possible or desirable.

Although our war on terrorism is taking place far away and very near, against enemies known, unknown and invisible, Gandhi taught, "The way of truth and love has always won." Cynics cry, "You can't believe that! History is full of oppression and tyranny!" But on the most local level, in our families and workplaces and neighborhoods, how else would we want to live?

Can we trust civility and courageously answer a call to service and community, or do we retreat anxiously to our fortresses and risk annihilation in isolation?

What some hate most about the United States, beyond any foreign policy specifics or attempts at drawing moral equivalencies, is our civil society: our democratic freedoms, our separation of church and state, our economic prowess, our tolerance of diversity and dissent, our liberated women and our scientific advances.

We must redouble our efforts to sustain these beacons of America. It is in an active, connected citizenship that we find the best treatment for worry.

Of course we're worried, but what are you going to do about it?

Dan Buccino, a Baltimore psychotherapist, is on the clinical faculties of the Johns Hopkins University School of Medicine and the University of Maryland School of Social Work.

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