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Living in the Shadow

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Elizabeth Beautyman says that when she examines some patients who complain of symptoms like stomachaches or exhaustion, she now often discovers nothing physically wrong, and suggests they see a therapist. "People don't want to hear it," she says. "It's more frightening for them to think it might be their brains, that they're causing these severe symptoms themselves."

Children in the city have developed psychosomatic illnesses, too. "I've seen five kids who have complaints -- abdominal pain, headaches, tightness in the chest -- for which I could find nothing physically wrong," says Max Van Gilder, a West Side pediatrician. Van Gilder has a deeper worry, however, noting that March is traditionally one of the peak months for suicide. "We are now in the midwinter depression-and-suicide season," he says. "My fear is that we're going to see adolescents who were in school near ground zero having delayed psych responses. I know the schools are worried, and I'm a little terrified."

New York Psychiatrists and psychologists are well equipped to treat patients troubled by unfulfilled ambition and loneliness, but a whole population radically traumatized by a single violent event is a new kind of challenge. At Rockefeller University's campus on York Avenue, so many researchers and clinicians turned up on a recent Tuesday evening for a free seminar called "Stress in the City" that organizers had to open up a second room to accommodate the overflow crowd.

As Joseph LeDoux, a neuroscientist at NYU, showed slides of the brain's structure and explained the body's physical freeze-fight-flight reaction to a traumatic event, many people jotted down notes. Rachel Yehuda, who directs Mount Sinai's Traumatic Stress Studies Division, got a lot of knowing nods as she methodically listed the symptoms of post-traumatic-stress disorder: "distressing recollections . . . emotional numbness . . . avoidance of reminders of the event . . . "

But the biggest response came by accident. Marylene Cloitre, director of Payne Whitney Clinic's Anxiety and Traumatic Stress Program, was having trouble at the podium with her computer's PowerPoint slide presentation, silently pushing different buttons as a technician tried to help. Suddenly, a huge photo flashed on the screen of the Twin Towers on fire, and people gasped loudly, a collective moan of shock. "I was rattled; I had meant to introduce that photo before I showed it," Cloitre says three days later in her office at Payne Whitney, overlooking the 59th Street Bridge and the East River, still abashed by the presentation. "But this does show how raw people still are."

A strawberry-blonde psychologist with an empathetic manner who sounds southern ("Nobody believes I'm from Queens"), Cloitre specializes in treating PTSD patients such as rape and incest victims, and worked with family members of victims of TWA Flight 800. But dealing with the shell-shocked survivors of September 11 -- Cloitre met with numerous traumatized people right after the attack and consulted for several months for Marsh & McLennan -- has been a searing and worrisome experience.

In the early weeks, Cloitre said her goal was to offer education and reassurance, to tell people it was normal to have bad dreams or be fearful or jump at a loud sound. "Everyone wanted to know, 'What should I expect? When will it go away?' " But by March, anyone still suffering from those severe symptoms is not likely to recover without therapy or medication. "At six months, whoever is going to get better is better," she says. The problem, of course, is that no one wants to admit to being the odd person out; if everyone in your office saw the same horrors you did and seems fine, how come you can't handle it? "This is the big divide," she says. "If other people can go back to life as normal, those who are deeply affected feel abandoned."

Her program has seen a 20 percent jump in new patients in recent months, but many people don't come in complaining about reactions to the Trade Center attack, talking instead about other anxieties -- panic attacks, fear of committing to marriage, depression. "Their problems aren't obviously related to 9/11," she says. But what's happening is that people who have seemingly overcome a previous trauma -- death of a loved one, being a crime victim, a frightening illness, long-ago childhood abuse -- have been, in the clinical term, "re-traumatized" by this new shock to the system.

For all the work she does with the severely distressed, Cloitre is in many ways an optimist; she's seen a lot of people get better. But she thinks we're going to be living in a sad city for some months to come; there's no quick fix for this New York state of mind. "When I see people suffering from PTSD, I know it's just the beginning of a long journey."

Recovery comes slowly, no matter how hard people try to cope. It's not a simple take-a-pill, move-away, see-a-therapist formula: Everyone reacts differently. For those who lived closest to ground zero, it's impossible to escape, or pretend it never happened. As Sandra Harper was racing out of her TriBeCa apartment on September 11 with two daughters and a dog in tow, she took the time to roll up towels and place them on the window sills to keep out the dust. Now, although she and her husband, Hamilton Fish, the president of the Nation Institute, have been back home for many months now, the towels are still there, a mute reminder of that day.


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