Covid-19 trauma complicates the 9/11 ‘anniversary effect’

Trauma caused by violence or tragic events can have a huge impact on individuals’ lives. And though their responses to trauma may fade away, it can reemerge or be heightened by anniversaries. That the 20th anniversary of the horrific attacks on the United States on September 11, 2001, is taking place amid the ongoing collective tragedy of the Covid-19 pandemic is bound to make this year’s remembrances of 9/11 extra difficult for some Americans.

When two hijacked commercial airliners plowed into the World Trade Center’s Twin Towers, a third crashed into the Pentagon, and a fourth plunged into a field near Shanksville, Pennsylvania — diverted by the plane’s passengers from its intended target — life in the U.S. came to a halt. The events of that day traumatized tens of thousands of people and forced many to rethink America’s place in the world.

Covid-19 is doing something similar, albeit spread out over months.

Though these two generation-defining occurrences are, on the surface, quite different and have different timelines, their aftermaths share some similarities.

There are several normal and common responses to a traumatic event. These include hypervigilance (feeling on edge), avoiding triggers related to the trauma, trying to maintain control of people or situations around you, not knowing who or what to trust, and difficulty knowing who you can safely share your thoughts and emotions with.

It’s important to understand that these responses are different from those caused by grief or bereavement. They are the result of experiencing vicarious trauma (things no one should have see); of traumatic stress (doing things no one should ever have to do); of moral distress (having to make decisions that are less than optimal); and more.

And though these responses lessen for some people with distance from the traumatic event, they can reemerge as part of what’s called the anniversary effect.

The 9/11 anniversary effect comes at a particularly difficult time. Results from the national Household Pulse Survey, conducted by the National Center for Health Statistics in partnership with the Census Bureau, show that 32% of Americans reported symptoms of depression or anxiety in August 2021. That’s two to three times higher than in pre-pandemic years.

What many people do around the time of an anniversary is measure what’s happened in their lives since the trauma. But that’s hard to do in the midst of a pandemic. We’re in phase four of the pandemic, and don’t know what phase five will be. We don’t know what other variants will emerge, and if they might be even worse than Delta. And the country is in the midst of a disastrous polarization that is making things worse.

People who have experienced trauma generally follow one of three paths: a gradual return to pre-trauma life, a life shaped by post-traumatic stress, and one changed by post-traumatic growth. Helping people achieve the latter is something I have tried do over the course of a 30-year career studying trauma and working with traumatized individuals.

Following a traumatic event, there’s a strong pull to focus on the negative. Humans are hard wired to see the negative as part of our fight or flight survival mechanism. While the negative screams at you, the positive only whispers. It is very hard to not be pulled down by the inertia of the negative.

Yet some people harness their feelings and channel them in ways that change the trajectories of their lives. I recall a student of mine who had lost a child to sudden infant death syndrome. Inspired by a social worker who helped her come to grips with this tragedy, she threw herself into learning about crisis intervention and went on to help other mothers who had lost young children. It changed her entire life.

The concept of healing from trauma by trying to move beyond one’s circumstance in order to help others isn’t new. A mainstay of Alcoholics Anonymous since the mid-1930s is that one person helps another and in so doing helps himself or herself.

Recovery is also aided by a sense of shared experience, something that my colleagues and I have been seeing with our efforts on behalf of health care workers, many of whom are traumatized — sometimes daily — by the pandemic. Our Stress Trauma and Resilience (STAR) program has trained close to 900 people to do peer support for their colleagues in the form of brief emotional support teams. This support is a framework of some psychological first aid, a bit of cognitive reframing, and motivational interviewing stitched together. Over the past 10 years, this program has helped create a common framework and language for addressing the impact of traumatic stress, vicarious trauma, and moral distress. It literally gives people permission to check in with peers who are distressed and a framework for processing this distress.

Today what we are working toward is giving people a common language to talk about working in a time of coronavirus, a time when so many health care workers have felt that the organizations they work for don’t care about them or have their backs — and many rightfully so. In addition, because health care professionals are trained to think critically, many say to themselves, “It’s all my fault” or “I should have made a different decision.”

But when you have peers trained to say “I know how you are feeling” and “Wait a minute, you weren’t caring for that patient alone but are part of a team,” it turns what can be traumatic memories into common understanding. It is empowering for the people who offer help and healing for the people who need to hear it.

In our Stress, Trauma, and Resilience Trauma Recovery Center, we hold group orientations for victims of crime. These sessions help individuals who have felt isolated by their experience know from the get-go they aren’t alone. This is especially important for individuals dealing with intimate partner abuse, which is an isolating and shaming situation to begin with.

Working against recovery or healing is what I call community betrayal. We saw it after 9/11 from the deniers and the conspiracy theorists. We’re seeing much the same thing during this pandemic. A colleague of mine who is an emergency physician described it to me like this: For three months, as she cared for people with Covid-19, many of whom died, she stayed in a hotel rather than go home and bring the virus to her children. She recalls how difficult it was for her to go outside the hospital during that time and see people not wearing masks or hear people on the news or on social media deny that Covid was real. The death of a colleague who contracted Covid and died three days later made this community betrayal even more enormous.

After 9/11, Americans generally pulled together. We need that today, though sadly it appears we are headed in the opposite direction. Another thing that could help people cope with Covid-19 is getting out and interacting with others, and ideally helping others. But therein lies a challenge with Covid-19: People are being advised to lock down for periods and avoid everyone not in their “bubble.” What they do instead is watch TV or be on social media, which can be harmful.

Just as many people were traumatized by watching the Twin Towers burn and collapse over and over again on television, the health care catastrophe wrought by Covid-19 and the deaths from it are causing secondary trauma that’s almost impossible to escape. Descriptions, often with vivid video, of the wildfires in the West and the hurricane damage in the South only compound the problem.

For people concerned about their mental health, I offer a simple suggestion: Turn off the television and eschew social media. Take care of your children or parents or elderly neighbors or friends. Get out of your head and into the life of someone who needs you.

Ken Yeager is the director of the Stress, Trauma and Resilience (STAR) Program at The Ohio State University Wexner Medical Center and professor of psychiatry and behavioral health at The Ohio State University College of Medicine.