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America At War:
Health Talk: Normal, Yet?
Hosted by Abigail Trafford
Washington Post columnist
Tuesday, Oct. 23, 2001; 2 p.m. EDT
Join Post Health columnist Abigail Trafford on Tuesday, Oct. 23 at 2 p.m. EDT for an interactive reader discussion about dealing with life in the aftermath of Sept. 11 -- from
changes in your daily routine or moods to big questions about changing
values and priorities.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests
and hosts; guests and hosts can decline to answer questions.
Abigail Trafford: Hello everybody. How are you doing? These are difficult times. Two postal workers died, probably because they inhaled anthrax spores. They were postal workers at the Brentwood mail center in Washington. The deaths have heightened anxiety across the country. But it's still not proven who are the ones responsible for these attacks. And for some of the scares that turn out to be false alarms. In the wake of the September 11 attacks, we're all looking for the new normalcy. Tell us what the new normal is for you. Send in your comments and questions.
Washington, D.C.:
Hi Abigail --
I just wanted to thank you for the excellent article this morning, and for mentioning the National Depressive and Manic Depressive Association, an organization I hadn't heard of before but plan to research. Organizations such as this are such an important factor in educating those of us who are afflicted with these diseases, as well as the general public.
Abigail Trafford: I think people with mental illness who are managing their disorder are heroes for the rest of us. They show us how to live--and live well--with fear. How to manage in the face of confusion and uncertainty. How to deal with trauma and move on. An official for the National Mental Health Association put it this way: "Now a whole nation knows what trauma is all about. It's a hard lesson. There's no simple medication that will make you not be fearful. People need to feel safe and secure. People with serious mental illness haven't had that for a long time. Now the rest of society is joining us." The message is that we can recover.
College Park, Md/:
I feel like my life is beginning to get back to normal after Sept 11. I no longer cringe at the sound of a siren or worry about planes overheard. I have even made a concerted effort not to watch so much news because it was upsetting me. However, I have now started to have nightmares about the events of Sept 11. Is this normal at this point?
Abigail Trafford: We have to throw out our old definitions of normal. These are abnormal times. What you describe seems very normal. A woman told me today that she feels worse now that she did right after the attacks. She said she was numb for a while. Now her feelings are coming out. Everybody heals at a different pace. The immediate question for you is this: are the nightmares interfering with your life--interrupting your work and family life? Are you not getting any sleep? If so, that's a sign to consult a physician or counselor. I am not a doctor or a therapist, so I can't give you personal advice. But from what others have told me, there is no single script for finding the new normal. It's great you are feeling better about life and no longer worry about sirens and planes overhead. What a relief.
Staunton, Va.:
In light of recent events, I have a friend who is becoming increasingly paranoid, due to his heritage. He is of Cuban descent. He is very concerned that people will mistake him for a terrorist. He is wearing American Flag t-shirts and has a flag on his car - doing what every other American seems to be doing- yet he is very worried about being singled out. Especially in a very small town such as ours. We have tried to reassure him, however, he is still very nervous. Ms. Trafford, do you have any words of wisdom or insight for my friend?
Abigail Trafford: You are a wonderful friend. Talk it through. There are lots of Americans who look like him. Lots of Americans of Cuban heritage. Has he ever been singled out before? Has he experienced discrimination on account of his looks? This is a time of alert and everyone is wary that abuses will occur. Vigilence, friendship--these are good shields against discrimination and abuse. If these feelings start overwhelming your friend, he might walk to consult a professional. Is there a group or society of people with similar backgrounds where he could also find support? Meanwhile. Be his friend and show him it just ain't so. He's no terrorist.
Arlington, Va.:
My friends say that I am repressing my feelings about the current terrorist activities because I try to avoid the news coverage and I don't like to talk about it. I say that if I talk and read about it I get depressed and scared. How do you reach a balance between these extremes?
Abigail Trafford: Welcome to the news dilemma. You find a balance by trial and error. It's good not to overdose on news. See what it's like without television! then you may want to know what going on! You can pick and choose when and where you get your news. I'm partial to newspapers. I feel I'm in control when I pick up the paper. And I can skip a lot. Yes, I do. I don't read it all. . . . I'm searching for balance too.
Stamford, Conn.:
I've been treated once before, a few years ago, for clinical depression. We are situated very close to NYC and lost many people from our county to the disaster. I feel very lethargic and just want to stay home... though I have to venture out to go to work. Do you think this is still a normal reaction to the disaster, or should I seek medical help and, perhaps, antidepressants again? I took them for about nine months a couple of years ago but did not want to be on pills all my life.
Until this all happened, I felt reasonably OK. Do you have any thoughts?
Abigail Trafford: This requires an expert opinion. What about contacting the folks who helped you before? You are obviously very wise about yourself and your mood. You have suffered a terrible blow and are directly affected by the losses. Mental health experts tell us that a trauma like this can rekindle depression in people who have had it before. You'd get some reassurance and support.
Temple Hills, Md.:
Can anthrax be transmitted from one person to another by touching or kissing?
Abigail Trafford: Since the anthrax deaths in the postal workers, many people have been wondering if spores could be spread by shaking hands or touching. At this point there's no definitive answer from the Centers for Disease Control, the federal agency that is investigating these cases. But contagion is very unlikely. Health officials tell us that a certain concentration of spores are required. It's not like bushing dust off your coat. Another point. You can reduce your risk of contagion by washing your hands.
Arlington, Va.:
Hi Abigail,
I am a 26 year-old working in D.C. at a health care facility. Last night, when I opened a catalogue in my mail, white flakes presumably of paper (shreddings from the catalogue being shoved in my mailbox-- guess) fell in my lap. I immediately it threw away. I logically know it is not anthrax, yet I could not sleep last night and have been panicked about this since it happened. How do I get a grip?
Abigail Trafford: You are getting a grip. You saw white flakes that looked like shreddings of paper. You know anthrax particles are tiny like powder. White paper flakes do not resemble anthrax spores. You are logical and logic will win out. . . it just takes a little time. You're not alone. Everyone is a little on edge about mail.
Dover, New Hampshire:
I have grappled with anxiety problems for years and have managed to do so with minimal medication (a Xanax before flying, basically). Since 9/11 I have felt the anxiety ramping up -- claustrophobia, heart racing, problems sleeping, nervous stomach. Would it be appropriate for me to explore the possibility of being put on Paxil or some other anxiety treatment? I've always been proud of the fact that I managed the problem myself, but am really experiencing a compromised quality of life now.
Abigail Trafford: Again, you need an expert opinion. I am not an expert. You have such knowledge about yourself, I think you've already answered your question. It's not right to feel anxiety ramping up. You know what to do. And my feeling about medication? If you need a prescription for anxiety or depression--or for diabetes, or high blood pressure, thyroid problems, then take the medicine. It's part of managing the condition and having a good quality of life.
Alexandria, Va.:
Two points:
For the person with depression problems who did not want to be on pills all their life, it is useful to consider that the pills attempt to make you who you are, not something different. If you look at it that way, taking pills does not seem as invasive.
About the new normal--I realized a couple of weeks after 9/11 I had to find a place to "put" the events. I could not, and did not want to, go back to feeling like I did on 9/10. But I also could not go on being distraught. I wanted to watch "Friends" once in a while, for example. So for now I have "put" 9/11 with other events in my life that won't go away--the deaths of my parents and nephew, and my handsome, dashing uncle who killed himself two years before I was born. For now, this works for me.
Abigail Trafford: Great advice. I like the idea of putting the bad stuff in a place so it won't affect the other parts of your life. That's called having control and exerting control is a way to gain a feeling of security. Bravo.
Arlington, Va.:
I can't shake the feeling that the 9/11 attack and the anthrax incidents are just the tip of the iceberg. What is your advice for living with fear -- especially given the constant media reports that we are unprepared for biological/chemical attacks?
Abigail Trafford: Here's what I do. I reduce the huge overwhelming fear of a terrorist catastrophe into little bits that I can manage. What is my immediate risk when I get into bed at night? It's virutally zero, and I get a good night's sleep. What is today's threat when I get up in the morning and go to work? I'm uneasy because I've just read the headlines. Still, the risk of anything beyond the usual dangers of urban living is virtually zero. So I walk down the the street with the fallen leaves and the warm autumn sun and think: this is beautiful. Thank you God. As the day goes on, it gets more complicated. How to protect yourself against anthrax? We've actually learned quite a lot. The risk is still low. The procedures for testing and treatment have become more standard. (Personally with the mail, this is a good excuse to throw it all out. So much is junk, junk, junk.) All in all I try to scale down the scope of personal risk and get the threat to a manageable level. There are also some catastrophes you can't protect yourself from. I accept that. Is it easy. No. But there's no alternative.
Arlington, Va:
In response to Alexandria, VA's second point. What is the difference between putting things in a separate place to have control and putting them there because they are beyond our control? It seems to me that that is what people are doing, and it is hard to see whether that is control or denial.
Abigail Trafford: Control or denial. . . Good point. I'd say, whatever works, whatever keeps you safe.
Alexandria, Va.:
I have suffered from chronic anxiety for six years, and have taken a variety of medications (alprazolam, clonazepam, diazapam). Since the Sept. 11 attacks, I feel LESS anxious and more normal. Isn't that odd? I think it's because everyone else now seems to be feeling as (justifiably) jumpy and nervous as I always have -- thus I now feel less out-of-place. Do you think this theory has any validity?
Abigail Trafford: Yes I do. As I said before, you and others who have experienced clinical anxiety are leaders for the rest of us who are new to this kind of anguish. You know what to do. You have worked through the fear. You have managed the nervous jumpy feelings. You've created your "normal." That's what we all have to do.
Oakton, Va.:
On the subject of mental illnesses and living with stress, I think too much emphasis is being put on COPING with and ACCEPTING stress in ones'life when the real attention should be put on the root CAUSE of stress and ELIMINATING that root cause. For instance, many people are stressed out by the behavior of their fellow co-workers, but all too often, that person is "counseled" into "acceptance" of the behavior and speech of these co-workers when in reality it is the co-workers who should change their behavior so that they don't CAUSE the stress that they do. Same with commuting, a major cause of stress fo so many. It is the fault of our local and state governments who have let the situation get completely out of control by allowing excessive growth and overcrowded roads and subways. They are the ones who should have to shoulder the blame and change THEIR policies, not the poor commuters who are stressed out and have to go to "counseling" sessions. I could go on and on, but I think you get the picture.
So many times the cause of stress is idiotic policies and actions by people in power or by those who should know better and never have to answer for it.
Abigail Trafford: I'm with you, Oakton. This is not about accepting what shouldn't be accepted. It's it's possible to get to the cause of the problem, then eliminate it. Yes, yes. And often that means political activism and being sure to vote. I'm with you there. But I guess it's like the Serenity prayer. . . having the serenity to accept the things you cannot change, the courage to change the things you can, and the wisdom to know the difference. The current "war" is new and complex for all of us civilians. Some things we can't change. The overal threat, for example. That's up to the government to find and destroy our enemies. But we can change how we behave in response to the threat. That takes a combination of acceptance and pro-active fight.
Silver Spring, Md.:
My feelings have been in reverse. After September 11th I was numb, it seemed surreal, sleep was not a problem. As I read and watched reports of death and suffering I seemed to thaw and it became real. My senses are heightened to my surroundings. Airplanes, sirens, and other loud noises once backgound sound now in the forefront. And as Anthrax enters the picture I now worry and sleep comes but later after much reflection and concern for the future.
Abigail Trafford: You're not alone. I've heard this over and over again.
Baltimore, Md.:
I lost my husband on American Flight 77 on Sept. 11. I feel so afraid all the time. I miss him terribly and am so angry. I don't care that innocent people are dying from our bombing and that is not like me. Will things ever get better?
Abigail Trafford: My heart goes out to you. You have all my sympathy--and all the world's. Of course you are angry and afraid and filled with grief. This is a time of mourning. You ask: will things ever get better? The answer is yes. Grief is its own journey. The key is that you are not alone. I hope you are surrounded by those you love and who love you.
New York, N.Y.:
I was very upset by the WTC attack, though not directly hurt, now having major stomach problems for first time in my life (Dr. says probably ulcer from stress). There is pressure here to 'not be affected'. I think this is an exercise in 'codependent denial' i.e. "we are all pretending to be ok, how dare you not be ok". Agree we can "heal and move on", but how does one deal with this attitude in light of the fact that there is little I can do over physical manifestation of stress? I have heard "post tramatic stress" shows up a month later.
Abigail Trafford: If you have an ulcer, it's probably caused by a bacteria and can be treated with antibiotics. .. . . I agree we're in this bind: go about as if nothing is happening and then be alert because everything has changed in the war on terrorism. That mixed message creates a lot of anxiety.
Washington, D.C.:
Just a note- "putting bad things in a different place" is functional- but it sounds a little bit like dissociation, which is also functional- separating from "icky" or threatening things.
Abigail Trafford: Sometimes you have to practice your own version of cognitive defense. To keep yourself from being overwhelmed by feelings and events you can't control, you put boundaries around them. You put them in a deposit box in you mind. That doesn't mean that you go to the other extreme of complete denial or put yourself into a disassociated state. That could be dangerous too.
Vienna, Va. :
Abi, I am offended by this idea of just "putting off" what happened on Sept. 11, as if it were just another "stressful" event in one's life. We are at WAR here. These people were (and are) trying to KILL us and all we hear is "just go on with your life" as if nothing happened. What would happen if our troops, sailors, and pilots took this attitude? How much would have been accomplished in Afghanistan in the last month? I am also offended by the nonsensical use of the word "tragedy" to describe what happened that day, tragedy, my foot. We are talking WAR here. This was an act of WAR, and we have an ENEMY to deal with here, not a medical "counseling" session.
Abigail Trafford: Yes, we are at war. But our troops have a specific mission and clear guidelines about what to do. We civilians do not. That's why each individual has to find a way to deal with the threat and the fear. I agree with you. This is about war, not a medical counseling session. But the public has gotten a lot of mixed messages in this war about how we're supposed to respond.
Washington, D.C.:
I wanted to share that I finally decided to get help and called my doctor -- when I was treated before years ago for depression. Ha ha. The next appointment is Nov. 26. I guess the mental health system is overwhelmed. I will persist.
Abigail Trafford: You've just pointed up another national disgrace: the lack of mental health services in this country.
Chantilly, Va.:
Doctors and the media have been quick to announce that anthrax cannot be transmitted person to person, i.e., the disease is not contagious. Can the spores be transmitted person to person, i.e., shaking hands or from someones clothes, hair, etc.? Also, could our currency be at risk of contamination?
Looking forward to your response. Thank you.
Abigail Trafford: I answered this before. We don't yet have a lot of information on this. I expect the officials at CDC will address this question very soon.
Arlington, Va.:
My grandmother, who was 92, just passed away last week and I find myself with a bundle of conflicted emotions, from relief, to grief to a sense of release or a need to celebrate life. Is that a common reaction? Thanks.
Abigail Trafford: Yes it is. Your grandmother had a long full life.
Cleveland, Ohio:
I like to practice what Dr. Andrew Weil calls "news fasts" (turning off all news no matter what media for a week). I just don't think this will work in the current situation. How do we stay informed and stay sane at the same time? Literally, there is NO sense of security left and I feel this everytime I turn on CNN.
Abigail Trafford: Again, treat the news like a menu in the restaurant. Pick and choose. You have to eat. . . so you want to be informed. But you don't want to be overfed.
Washington, D.C.:
Since Sept. 11, I have stopped going to the library and the movies. How do I restart these formerly enjoyable activities again without feeling anxious?
Abigail Trafford: You can start doing your favorite things again. . . and enjoy them. After a while, you won't feel so anxious.
Arlington, Va.:
What kinds of things can a person do to reduce physical aniexty due to the recent attacks?
Abigail Trafford: Physical anxiety. . . do you mean a physical sense of fear in the chest and increased heart rate? If you think you're having panic attacks, that is a good reason to consult a physician. Generally for anxiety, I follow my own personal stress management approach. I (try to) exercise regularly. I make time every morning when I wake up to write in my journal. I cut back on eating one day a week--a kind of modified fast. I make sure I've had a good talk with a friend every day. I do this in times of national and personal stress. What you do to reduce is very individualistic. This routine works for me.
Abigail Trafford: Hello. I'm afraid our time is up. Thank you all for joining in. We'll meet again, same time, same place, next week.
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