September 11, 2001, was a momentous and traumatic day for all Americans. Not surprisingly, we each handled it in our own way based on our history, defensive styles, and actual and psychological proximity to the events. In addition, we analysts had to process it repeatedly with our patients. Many of us helped others deal with the effects without spending enough time tending to ourselves.
At the December 2001 meetings, APsaA president Dick Fox and Stuart Twemlow, head of the Committee on Psychoanalysis and the Community, responded to members' requests by scheduling four group discussions about what the events of September 11 had meant to us. Leaders with experience in the field of trauma facilitated each discussion.
Attendees included New Yorkers (some of whom had witnessed the disaster), immigrants who had experienced war or civil disorder, foreign visitors who were trying to assimilate the events into their understanding of Americans, and analysts from across the country. The groups were respectful, with only an occasional interpretation of a political or social comment as “really” defending against a psychological concern. The participants talked about their concerns for personal safety and the safety of their loved ones. We talked about how the attacks affected our sense of America as powerful and invulnerable. We worried together about what this would do to civil liberties and the values that make America the country it is.
A tense moment occurred when a Canadian member accused Americans of being naïve, saying that we should have realized that we couldn't be an open country without serious risks. There were complicated feelings when we talked about our patients acknowledging disavowed parts of themselves, such as their appreciation of racial profiling at airports, and then shamefully acknowledged that we shared this position.
Although September 11 may have had very different meanings to our patients and to us, this was shared trauma. To what extent did different clinicians give credence to this? To what extent did they think or say “we” or “all of us” and not “you”? How much did individual analysts disclose to their patients about where they had been when the events took place or how the events affected them personally? What did sharing affect or information mean to the treatment in subsequent weeks?
Some analysts who practiced in lower Manhattan had to leave their offices on September 11 without notifying patients. Many people could not get to their appointments because of travel restrictions, the need to return home, or anxiety. Some participants talked about income lost because they couldn't use their offices and their patients who lived or worked in lower Manhattan had been relocated. They feared their decimated practices would not be easily revived and worried about their capacities to energize their practices. Their patients who had lost apartments, possessions, and possibly jobs shared the same concerns. The group talked about how much of these joint realities one should share with patients.
“For many of the participants, listening to patients tell their stories and experiences of September 11 is a re-traumatization.”
We discussed trauma and re-traumatization. Do we encourage someone who has escaped from a collapsing building to tell his story? What about those who witnessed people jumping from buildings and saw body parts scattered on the streets, or watched dead firefighters being carried out of the buildings? As psychoanalysts we assume that telling one's story and making sense of it is useful and brings mastery. The groups painfully realized we don't know for sure when doing this with acutely traumatized people is therapeutic.
Some group members treated people who had lived under civil disorder or torture in other countries and had come to America to find peaceful safety, then were re-traumatized by the events of September 11. This was also true for some analysts. For many of the participants, listening to patients tell their stories and experiences of September 11 is a retraumatization. Our struggle to achieve some sense of meaning and mastery has been repeatedly undermined by listening to our patients' struggles.
We talked of counter-transference responses to the different ways our patients coped with the events of September 11. Some patients were so narcissistically self-involved that they could talk only about inconveniences, which seemed minor compared to the death and major disruption to thousands of people. Some analysts were challenged by patients who were so defended that they almost trivialized the events because they could not allow themselves to feel their own responses. Some acknowledged experiencing parental concern about their patients, accompanied by parental annoyance, with feelings of “Why didn't you call me, didn't you know I would be worried abut you?”
Some New York analysts talked about their activities immediately after September 11. Some went to the piers where volunteers were triaging, feeding, and clothing survivors, neighbors, and relatives. Analysts made themselves available to anyone who wanted to talk. As the days went on and family and friends searched for victims and survivors, the analysts continued to be available. One analyst came from Milwaukee to volunteer his time. The New York Psychoanalytic Society collected names of analysts who would donate ongoing time. [See page 16 for more on APsaA volunteers' activities.]
Some analysts walked into their local fire or police station, drank coffee, and talked to staff. They attempted, by their continued presence, to be useful to surviving firefighters and police officers. Analysts appeared at bookstores at advertised times to talk with anyone who needed to talk about the attacks. The New York analysts who had volunteered in these programs all felt better for doing something. They felt that activity helped them feel less impotent; bearing their own impotence was overwhelming. Action was necessary for a group that is more used to listening than acting. In December we attempted to meet the need to talk, and thus to provide care for our members, so used to being care-givers.
There are plans for follow-up groups at the Annual Meeting.
Caryle Perlman, M.A., is on the faculties of the Chicago Institute for Psychoanalysis and the Institute for Clinical Social Work.