Fear of Terrorism in New York After the September 11 Terrorist Attacks: Implications for Emergency Mental Health and Preparedness
Joseph A. Boscarino, Ph.D., M.P.H., Charles R. Figley, Ph.D., and Richard E. Adams, Ph.D.Author informationCopyright and License informationDisclaimerSee other articles in PMC that cite the published article.
On September 11, 2001, a terrorist attack in New York City killed 2,800 persons, caused massive destruction, and had an adverse economic impact in the region (Barry, 2001; Eaton, 2001; The New York Times, 2001). It has been noted that the use of terrorism occurs when there is an imbalance of power between two antagonists and one of these, usually the weaker, employs clandestine methods of attack to inflict casualties and fear among members of the other group (Jones & Fong, 1994). Apart from the terrorists and the terrorist act itself, the goal of the terrorist attack is to instill fear and panic in a population in order to achieve political goals (Jones & Fong, 1994; Wessely, Hyams, & Bartholomew, 2001). Furthermore, a modern society, with its dependence on sophisticated institutions and services, international trade, and mass communications, is vulnerable to such attacks (Jones & Fong, 1994). This fact—together with the spread of weapons of mass destruction (WMD)—make prevention of terrorist attacks involving significant casualties difficult.
Incidents of acquisitive panic and near panic in crowds, and their deleterious effects, have been documented (Brown, 1965; Proshansky & Seidenberg, 1965). Incidents of epidemic panic and sociogenic illnesses also have been described (Boss, 1997). In addition, the potential psychological impact of WMD deployment have not gone unnoticed (Jones, 1994). In the field of military medicine, the prevention and treatment of psychiatric casualties associated with WMD deployment is recognized to be as important as managing medical casualties (Jones, 1994). During World War I, the U.S. military learned to treat soldiers with “gas hysteria,” acute symptoms that mimicked those of gas poisoning yet were psychological in nature (Jones, 1994). Recent evidence from attacks among civilian populations provides further documentation on the psychological impact of WMD deployment. For example, of the 5,510 persons who sought medical treatment following the Tokyo sarin attack in 1995, 12 died, 17 were critically injured, and 4,000 had minor or no apparent injuries (DiGiovanni, 1999; Ohbu et al., 1997). During the 1991 Scud missile attacks in Israel during the Gulf War, it was reported that the overwhelming majority of people presenting to emergency rooms, nearly 80%, were psychiatric casualties (Karsenty et al., 1991).
While understanding how to prevent, identify and treat psychiatric casualties and control panic are imperative in military operations, from a public health point of view, managing adverse psychological reactions during WMD threats among the general population also is imperative (Glass & Schoch-Spana, 2002). A recent study related to the September 11 attacks in New York City indicated that nearly 13% of Manhattan adults suffered a peri-event panic attack during this event (Boscarino, Galea, Ahern, et al., 2003). Other studies, conducted nationally and within the New York metropolitan area following the September 11 attacks, also found psychological distress to be fairly widespread (Boscarino, Galea, Ahern, Resnick & Vlahov, 2002; Galea et al., 2002; Schlenger et al., 2002; Schuster et al., 2001; Silver, Holman, McIntosh, Poulin, & Gil-Rivas, 2002). It is reasonable to expect that an incident involving WMD in a major metropolitan area would have a considerable psychological impact (DiGiovanni, 1999). In spite of this, however, much of the recent terrorism preparedness activities in the United States have primarily focused on the technological and medical aspects (Bravata et al., 2002; Keim & Kaufmann, 1999; Khan, Levitt, & Sage, 2000). Below we present findings from a recent survey conducted in New York State during September 2002, which provide insights on the potential psychological sequelae associated with terrorism that might be useful in developing better emergency mental health plans.