Whether they have been obsessing over the possibility of another terrorist attack for the past 365 days or have pushed images of the falling towers to the back of their minds, most Americans have no doubt been grappling psychologically with the events of Sept. 11.
"The biggest thing that happened after September 11 is that we realized that we are vulnerable, and there are some people in the world that would like to harm us," Penn Psychiatry and School of Medicine Instructor Sheila Rauch said. We are "finding ways to deal with that reality while still enjoying our lives and moving on with our lives."
According to the National Opinion Research Center at the University of Chicago, as of March 2002, 42.5 percent of Americans were still angry about the attacks and the war on terrorism, 16 percent were still worried about flying and 11 percent were still concerned about the threat of anthrax and bioterrorism.
Clinical specialists have observed that some people have had more trouble than others coping with the aftermath of the attacks, ranging from thinking twice before using public transportation to not being able to go to work because of Post-Traumatic Stress Disorder.
According to Rauch, this psychiatric disorder, also experienced by some victims of rape, childhood sexual abuse and car accidents, involves symptoms such as nightmares, flashbacks, avoidance of activities related to the trauma and problems with sleeping, concentrating and controlling anger.
However, she said that some of these symptoms may manifest themselves in ways that are specifically related to the attacks.
"A rape victim may avoid talking to men or may avoid going on dates, while a person [a year after the attacks] is more likely to be avoiding the news, air travel and other things that are related to September 11," Rauch said.
Experts say that PTSD is not the only disorder that has plagued people who have had trouble coming to terms with Sept. 11.
"We have learned through a number of disasters that psychological reactions are prominent and people automatically think about Post-Traumatic Stress Disorder, but it's also depression, anxiety, substance abuse and, for children, you can have delays in development," said Lieutenant Colonel and psychiatrist Cameron Ritchie, who worked on a report with the National Institute of Mental Health that proposed early intervention for people suffering from PTSD as a result of Sept. 11.
Dean Kilpatrick of the Medical University of South Carolina said that studies in New York and nationwide have shown that incidences of PTSD and depression are more common among those who watched graphic images of the attacks on television, but there is controversy over whether the relationship between these phenomena is causal.
Since a year ago when television sets were stationed around campus, Penn students have had to deal with the aftermath of the images they saw.
According to Ilene Rosenstein, director of Counseling and Psychological Services at Penn, while students have coped over the past year in many different ways, their reaction to the events has gone through a natural transition.
"We're moving from a shocked phase to a how-to-grapple-with-this phase," Rosenstein said.
"In terms of actual reactions to things, last year it was very emotional," College sophomore Susie Flood said. "This year, I think everyone can think of things much more intellectually."
Rosenstein also said that undergraduates, because of where they are in the stages of development, are often less globally concerned than graduate and professional students.
Rosenstein also stressed that, one year later, there may be some students who are feeling vulnerable and fearful while others may not be affected by the attacks at all.
According to Rauch, who works at Penn's Center for Treatment and Study of Anxiety, college students, and especially last year's freshmen, may be taking longer to cope with Sept. 11 because they are in a less comfortable environment.
"Some college students do not have the same support structure," Rauch said. "If they've moved away from home, they probably didn't have a friend support structure here at school. They didn't have their family here. That put them at a little bit more of a risk of having trouble adjusting to it."
Similarly, since Penn is located in a large city, Rauch said that students may feel additional anxiety over the possibility that terrorists would target Philadelphia.
"I think Philadelphians might feel more vulnerable than people in a small town," she said.
However, Penn Psychiatry Professor Edna Foa, who is also the director of Penn's Center for Treatment of Anxiety Studies, said that her office has not received many calls from students seeking help because of Sept. 11.
"There were some who called with problems with images and symptoms associated with the World Trade Center, but very few," Foa said.
While experts say that people have suffered in various ways since Sept. 11, there has also been a general resiliency amongst Americans.
"I think that at this point, a lot of people have adjusted," Kilpatrick said. "We see the world in a different way and reconcile that and still find value in the things that we're doing in our daily lives and in our families."
At the same time, as terrorists may have intended, the attacks caused a change in the American psyche.
"It also made a fundamental shift for a lot of people," Rauch said. "Previously, a lot of Americans felt that nothing was going to happen on our block. Now that has really changed for a lot of people. We know that there is a possibility that something like this can happen."
