ABSTRACT. The terrorist attacks of September 11, 2001 have had a profound impact upon all Americans. This essay reports on some professional responses immediately following the disaster, and illustrates a variety of ways those events particularly affect gay men and lesbians psychologically and emotionally.
KEY WORDS. Terrorist attacks, September 11, 2001, World Trade Center, gay men, lesbians, therapy, counseling, trauma, crisis
In the time it took three airplanes to slam into the Pentagon and Twin Towers of the World Trade Center, life changed for all Americans. Our previous concepts of what had been normal were immediately and permanently obliterated. As one client of mine expressed the day after the attack, "I don't even have a vocabulary for what I and we are just beginning to wrestle with." The terrorist attacks of September 11, 2001 have resulted in most Americans losing their emotional equilibrium. For queer Americans this is not a new sensation. For the past two decades, until the onset of combination therapies changed AIDS into more of a chronic, as opposed to a terminal illness, living with the ever present reality of having too many young loved ones become critically ill and die caused a constant and profound social and emotional crisis for all gay and lesbian people. In the earliest days of the epidemic, prior to the HIV test, none of us felt safe or immune from the plague, as we lived with the ever present fear that we ourselves would be diagnosed next.
Prior to the onset of AIDS, middle class and affluent gay men and women had begun to revel in the progress made politically and socially. Many had begun to become complacent regarding a growing sense of the inevitability of the gains gay people were making. This often led to a fragile, but increasing sense of personal and communal safety. Many of us had erroneously assumed that medical science could cure any of the sexually transmitted diseases we contracted during the days of sexual Camelot. This sense of safety and trust was demolished as HIV and AIDS confronted the hubris which too many had, regarding the invincibility of medicine to keep us healthy and prolong our lives. Just as individuals who are victims of anti-gay harassment and violence have their sense of personal safety shattered, the terrorists attacks on New York and The Pentagon destroyed all traces of the complacency with which Americans took our sense of safety for granted. In the aftermath of September 11, it is clear that for all Americans our sense of safety was an all too fragile privilege, just as the promise of good health had been for middle class gay men prior to the onset of AIDS.
In the days immediately following September 11, I was asked whether the collective history of gay men in view of the tragedies faced of the early AIDS Crisis, and the brutal hate-related murders of Matthew Shepard, Barry Winchell, and Fred Martinez to name just a few, has made us better prepared to handle the current crisis. Prior to the terrorist attacks I would have answered that after coping with the community wide decimation that AIDS has wrought in our community for over twenty years, and the onslaught of hate crimes, that we as a community were better prepared to face tragedy. Gay and lesbian Americans have always lived with numerous instances of being in the position of having to redefine "normal" differently than the majority of non-gay Americans. Examples of this include living with the kind of bereavement overload that results from burying too many friends and lovers from AIDS. Additionally, many gay and lesbian parents live in states where custody and visitation of children are restricted or can suddenly be changed, solely because of their sexual orientation. The many closeted gay and lesbian individuals routinely struggle to adapt to the toll that needing to hide takes on them psychologically, emotionally, physically, and spiritually. It has become commonplace for same sex couples publicly expressing affection to be alert to hostile reactions or physical attacks. Indeed members of our queer tribe have all needed to learn to adjust to daily adversity that stems exclusively from being perceived to be a member of a sexual minority, and all the accompanying innumerable examples of homophobia and heterosexual bias.
Just as people of color living in America who grow into well adjusted and self-actualized adults learn to become emotionally resilient in the face of racism, so too do well adjusted gay men and lesbians develop into emotionally strong and adaptive adults with the propensity for being better able to respond to crisis and emergencies. I hope that as members of sexual minority communities who have always lived with enormous adversity and been intimately affected by HIV and AIDS, that how we have learned to cope, survive, and thrive in the midst of these ongoing realities has caused us to develop the emotional stamina and resilience to give us the emotional, psychological, and spiritual muscle to cope with the aftermath of the September attacks.
In New York City, at the Gay, Lesbian, Bisexual and Transgender community services center there is a grief counseling program called CenterBridge. Immediately following the World Trade Center tragedy, they began to offer drop in counseling and groups for anyone in the community who was affected by the events of September 11. I assume that any city that has a gay and lesbian center will also offer a grief counseling program. I know that gay and lesbian specific grief programs exist in Washington, D.C., San Francisco, Los Angeles, and Boston. All mental health professionals who have worked closely with lesbian and gay people are by now experienced grief counselors with years of practice working with those who have lost loved ones to AIDS, breast cancer, Hepatitis, other life threatening illnesses, drug addiction, violence, or suicide. Additionally these same clinicians have socially known and/or most likely worked with individuals who have died, thus preparing them to work therapeutically with individuals in a crisis that very likely they themselves are living through. The emotional and clinical skills and coping mechanisms learned during the darkest days of the AIDS crisis were useful and sorely tested in the days following the terrorist attacks on the United States.
Whenever an individual experiences any form of trauma, it is normal that earlier traumas are reawakened. Like many therapists, after the collapse of the World Trade Center I began to observe examples of this in my own practice, and not just from people who had been in the buildings and managed to escape or who had loved ones who were killed. In the aftermath of collapse of the Twin Towers, most people in New York City experienced some kind of intense emotional response to the trauma. People who were victims of hate crimes years ago, and who had largely regained their emotional equilibrium, found themselves tormented by dreams and memories of being attacked. Viet Nam veterans suffering from Post Traumatic Stress Disorder frequently found themselves thrown back to memories and dreams of the long ago battle fields. People who had buried close friends or lovers in years past, reported experiencing emotional states reminiscent of what they felt in the days of their acute early mourning. Survivors of early childhood sexual abuse or sexual assaults reported feelings that had long been quiescent, reemerge powerfully in the wake of the attacks. I observed a significant amount of relapse into active drug and alcohol use by people who had been sober prior to September 11. Physical and emotional safety have always been precarious entities for the majority of lesbian and gay people. Living in a city and country that instantaneously became no longer as safe as it once was, or at least appeared to be, has taken a major toll on the psyches of Americans, including queer people.
Gay and lesbian mental health professionals are a terrifically skilled and valuable resource, not only for our queer tribe, but for all survivors. I know of at least one very prominent gay psychologist who, in the hours immediately following the attack on the World Trade Center, was at ground zero using his expertise to provide emotional support to rescue workers. He reported that in addition to listening to their stories about finding bodies and body parts and feeling helpless, often what he had to do was give them permission to go home, rest, and stop for a few hours so that they would be able to return to the disaster site and resume their efforts. He was even driven home in a police car after fourteen hours there. It was not important that he was gay, but only that he was well skilled in offering the kind of services that the heroes of the fire, police, Emergency Medical Technician, and search and rescue departments needed.
On the Friday and Saturday following the attacks I volunteered at the Armory in lower Manhattan where people went to try and find information about loved ones who were missing. I entered that building fighting back tears as I passed hundreds of pictures of missing people glued to the walls outside. It was with great trepidation and humility that I offered my services. I had never before been part of a disaster relief effort, nor did I have any training in this area. So I felt ill prepared and unsure of how, and even whether, I might be able to help. Like Americans everywhere, I was in shock, numb, and depressed. This left me feeling vulnerable and unsure of my ability to muster the emotional and professional reserves necessary to be of assistance to people who were more directly affected than I.
I was sent down stairs to one of the rooms where scores of volunteers sat at tables with lists of the known dead and hospitalized. People with a missing loved one came to search, all too often in vain, for concrete information. My assignment was to walk individuals and families to the table and gently ask who they were seeking information about and to let them know that trained mental health counselors were available if they wanted to speak with one on their way out. Additionally I and numerous other therapists escorted people out of the rooms and asked, "Did you find out anything about your loved one?" Most of the time the only response was a sad shake of the head. We also inquired if they wanted someone to walk out with them. Almost always this offer was met with: "No thank you. I (or we) are fine." To this I always responded softly, "No you're not. You don't need to pretend that you're fine. None of us is fine just now." Often this elicited a moment of genuine connection and eye contact as it seemed to be a welcome acknowledgment of the enormity of what they were struggling to come to grips with. Sometimes then, people would begin sobbing or shaking, and I would encourage them to let themselves cry. A few people or families did ask if there was somewhere we could go to sit down for a few minutes and talk.
I have rarely felt so inadequate both personally and professionally as in those conversations. People needed to be given permission to hold on to their fragile hopes that their loved one had not yet been located or was one of the "John or Jane Does" unidentified in a hospital. This was obviously not a time for confronting anyone's denial. It was only men who apologized for breaking down and had to be told that they had nothing to apologize for. Walking back from speaking to one family I noticed a young police officer sobbing by himself in a corner. I approached him and identified myself as a therapist and asked if I could sit with him. He shared that his best friend, someone he had grown up with as a brother, was one of the firemen who had been killed on Tuesday. The previous day he had spent with his friend's wife and children. This was his first day back to work, and he was overwhelmed being in the armory and felt ashamed that he did not think that he could last a full day at this location. I empathized with him, normalized his feelings, and suggested that he ask his supervisor for a transfer to a different duty assignment. He repeatedly asked if I thought it would be alright if he did that. After a lot of reassurance, he declined my offer to accompany him as he left to speak with his supervisor ,feeling that he could still work, but not at this location.
Another assignment I rotated through was to walk around the main floor and whenever I saw an individual sitting alone ask if he or she wanted to talk. My experience was that very little counseling was called for or actually occurred. Mostly what mental health workers did was validate and normalize all the feelings that people were expressing and try to offer whatever small degree of comfort was possible. What was most difficult for both families and workers to cope with was the anxiety produced by the numerous uncertainties about who might have survived as the situation unfolded. I observed all mental health professionals being very cautious in how we approached people with our offers of help. We gave them a lot of space and respected their needs to be left alone when that was what they communicated. Whenever an individual was breaking down, one of the mental health professionals or chaplains would offer to sit with, talk with, or just hold the person. This was obviously not traditional crisis intervention. There would be no helping the individual return to his or her state of functioning prior to that day. For all Americans, but mostly for all of us directly affected by these attacks, our previous standards of what had previously been normal were now forever obsolete. During those days I worked with numerous other queer mental health professionals, offering whatever small comfort we were able to provide. We counseled several gay and lesbian individuals whose lovers or family members were among the missing. Again, this was not a time where sexual orientation was or should have been the paramount concern. It was just people reaching out to others in their time of dire need.
In the aftermath of the attacks, there was an increased utilization of mental health services as firemen, police officers, Emergency Medical workers, FBI agents, and search and rescue workers were offered trauma and grief counseling. Many large corporations in Manhattan also hired therapists to run groups for their employees. Numerous individuals sought out crisis and grief counseling to help them cope with the impact of these tragic events. Mental health professionals of all disciplines who were on the front lines of working with the survivors themselves required a great deal of supportive emotional feeding and nurturance to cope with the stress produced by depression, exhaustion, depletion, and inadequacy. In addition to dealing with our own shock, grief, and other emotional reactions, we have been and will continue to be called upon to listen to how the recent events affected clients. This has the potential to increase our own stress and potential for professional burn out if we do not utilize various forms of supervision as well as therapy, and our own personal and professional networks.
Even though I am fortunate to not have known anyone personally who was killed, I am working with several people who were intimately touched by the disaster. A client described feeling bewildered by the fact that his boss had replaced him at a meeting that fateful morning at Windows on The World, the restaurant on the top floor of one of the twin towers, and had been killed. Another told of being evacuated from his office building next to The Twin Towers and being inundated in the dust cloud as he helped fellow workers to safety. He has a brother who is a police officer who is safe and at the time of this writing was still working in the disaster area. But one of his childhood friends, with whom he remains close, was a fire fighter who is among those known dead. He described the difficulty he experienced returning to work in the neighborhood. A third client was also evacuated from a nearby office building. A fourth lived so close to the site of the blast that he has been homeless since the disaster and does not know when he will be allowed to return to his apartment. A fifth client has a friend from high school who he had been at the theater with two nights before the disaster whose husband was killed. A flight attendant who had always loved his work, spoke of the trepidation that accompanied him as he returned to flying.
In the weeks following the attacks, each of my supervisees expressed distress and feelings of being overwhelmed at managing their own feelings as well as listening to their clients' feelings and experiences. They each required a great deal of additional support that included phone calls between regularly scheduled supervision sessions. I think that in the wake of these disasters there is a strong need for special support and supervision groups for therapists who live in affected areas and whose clients include large numbers of individuals who were directly affected.
In the weeks following these events, a majority of New Yorkers and Washingtonians grappled with shock, sadness,
depression, and grief, as well as a sense of fragility and precariousness. Clients, as well as therapists, needed constant
reassurance that the variety of feelings and reactions were for the most part a normal response to the trauma and crisis, and
only if they did not lessen over time were they symptomatic of emotional or psychological disorders that could benefit from
professional help. All of the issues that clients and therapists had been dealing with prior to September 11 are now filtered
through the lens of trying to make sense of this unimaginable horror and its impact upon us as individuals and as a
community and country. It is normal and understandable that the tragedy and resulting emergency heightened our own
personal sense of vulnerability. Many of us gained solace and strength from sharing our feelings and vulnerability, at times
with complete strangers as well as with our loved ones. The safety of therapeutic distance and neutrality was at least
temporarily abandoned while working as mental health professionals in the immediate aftermath of a communal catastrophe.
The kind of shared authenticity this horrendous reality allowed for was an essential part of the therapeutic process of healing
for both clinician and client. We all have a lot of grieving to do, both for the individuals lost in the attack, as well as for a
way of living that can never return to how it was before the attacks. The challenge is for us to develop the means of
wrestling adaptively with the unfolding meanings of surviving these events, both within our queer communities, as well as
part of the broader American and international communities.