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Outsourcing Compassion: Stress and the Brain

MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

The attacks on the World Trade towers allowed researchers to conduct a massive study of what happens when a civilian population is traumatized. Mental health and neuroscience researchers in New York quickly organized efforts to help and study the city's trauma victims. Researchers want to learn how trauma affects the brain and what can be done to heal it. Stephen Smith of American RadioWorks prepared the second of our reports.

Unidentified Woman: Tell me your name and whether you are in pain at this moment. I don't mean...

STEPHEN SMITH reporting:

Twenty people gather around a conference room table in Midtown Manhattan. Though it's been years since the World Trade Center attacks, the people in this room are still suffering.

Ms. BARBARA WILLIAMS: I'm Barbara Williams. I'm in pain physically and financially.

SMITH: Pain, physical and mental, is what this Red Cross support group is supposed to help with. All of the people here are living with psychological wounds from 9/11.

Mr. CLARENCE SINGLETON: I'm Clarence, and I always feel sad.

SMITH: Clarence Singleton is a muscular man in a denim work shirt. He's a retired fire lieutenant who pulled people from the debris at ground zero on 9/11. Singleton dislocated his shoulder that day, but it wasn't just the physical injury that caused his life to unravel.

Mr. SINGLETON: I remember when I couldn't get out of bed in the mornings, and I wasn't cleaning the house, and I don't complete anything. Like I used to paint, I used to play guitar. I'll pick it up sporadic. I just don't continue anything, which is different from the way I was before.

SMITH: In the immediate aftermath of a disaster, it's normal to be distressed. Many people have difficulty sleeping and concentrating. Some have nightmares. What's different about people who develop post-traumatic stress disorder is their symptoms don't get much better over time. Dr. Sandro Galea, an epidemiologist with the New York Academy of Medicine, did a phone survey in Manhattan five weeks after the September 2001 attacks. Many New Yorkers in the survey said they were reliving the event.

Dr. SANDRO GALEA (New York Academy of Medicine): It means you start imagining and thinking about the towers falling over and over again. You have avoidance, which means you try to avoid things that remind you of the event, so you don't want to go into tall buildings or you avoid flying on planes. And you have intrusion, where you have memories and symptoms that keep bothering you. Then you also have arousal, which is when you're jumpy and easily irritated and unhappy.

SMITH: Doctors don't diagnose post-traumatic stress disorder until at least a month has passed since the traumatic event. More than a month after 9/11, Galea's survey found 7 1/2 percent of Manhattanites had enough symptoms to suggest they might have PTSD. At six months, fewer than 1 percent had the symptoms. So most people got better. The question that interests researchers is why some people don't.

(Soundbite of brain scan equipment operating)

SMITH: In a brain scanning laboratory at Cornell University Weill Medical College, Dr. David Silbersweig is studying the circuitry of fear in the brains of people with PTSD from 9/11.

Dr. DAVID SILBERSWEIG (Cornell University Weill Medical College): And you'll also see that images flash up every few seconds in a particular pattern.

SMITH: A patient lies inside an MRI machine and watches a slide show. Some pictures are serene, like a picnic or a vacation photo. Others are scary, like the World Trade towers burning. As the patient watches the images, the scanner measures the changing levels of blood oxygen flowing to parts of the brain that control emotions. On a monitor, bright yellow patches in a part of the brain called the amygdala show where the brain is especially busy.

Dr. SILBERSWEIG: We can pinpoint precisely where the activations or abnormal activations are taking place.

SMITH: People who are suffering more--does it seem to be brighter?

Dr. SILBERSWEIG: That's exactly what this shows. In fact, this is a correlation between clinical severity and the degree to which there is increased activity in this core fear-related structure. Yes.

SMITH: In all animals, both fear and the memory of frightening events are essential for survival. But researchers say that in people with PTSD the fear system seems to get stuck in the red alert position. Silbersweig says it's not clear whether trauma alters the brain or whether people who have PTSD were somehow more vulnerable to trauma in the first place.

Dr. SILBERSWEIG: The jury's still out and it may well be that both are the case.

SMITH: Researchers say a person who has been traumatized before is more likely to develop PTSD after a new event. Clarence, the firefighter injured on 9/11, felt the cumulative weight of his traumatic experiences.

Mr. SINGLETON: I have post-traumatic stress already from Vietnam, but I was unaware of it. And after 9/11, it got worse, and I still didn't know what was happening with me so I checked into a VA hospital. Sometimes I wonder--I always get sad when I talk about this stuff--but sometimes I wonder if there is any hope.

SMITH: Mental health experts say there is hope. A drug called propranolol may blunt the formation of traumatic memories if it's used right after the trauma. Anti-depressants and anti-anxiety medications can ease some of the symptoms of the disorder. But the most tested treatment for PTSD is cognitive behavioral therapy. Psychologist JoAnn Difede directs the Anxiety and Traumatic Stress Program at Cornell University. She says CBT leads a patient back through the traumatic memory to organize the disturbing fragments into a coherent story.

Ms. JOANN DIFEDE (Cornell University): They gain a sense of mastery and control over their experience and it's not terrifying in the present anymore. They can distinguish--it's a memory now; it's not happening again.

SMITH: But Difede says some people with PTSD may not be able to recall the details of the trauma, at least not well enough to put it to rest. So she's experimenting with a virtual reality therapy.

Ms. DIFEDE: So what I'm trying to do now is to use the mouse to get us to the view of the World Trade Center.

SMITH: Difede's patients pull on a set of goggles and find themselves in New York City.

Ms. DIFEDE: Lower Manhattan as it might have been on September 11th: clear, crisp, blue skies, like any September day. And then the next step would be to a plane fly overhead--a commercial airliner.

(Soundbite of computer-generated scenes)

SMITH: The sound and images get more intense and build from plane crash to explosion to the horrific sight of people jumping to their deaths and the towers collapsing. Difede talks the patients through what they're seeing. The idea is to get them to confront memories they've been afraid of and then to organize the thoughts into a less debilitating story. One of Difede's patients after 9/11 was Long Island fire chief Steven King.

Mr. STEVEN KING: All right, sweetie pie.

Unidentified Girl: Yeah.

Mr. KING: You going home with Daddy?

Unidentified Girl: Yeah.

Mr. KING: Yeah.

SMITH: King sits on his front porch waving goodbye to his granddaughter. He's a burly guy who still wears a New York Fire Department shirt, although he's now retired. King says on September 11th, he got a career's worth of trauma in one day. The fire chief was used to being in control of dangerous situations. But after 9/11, he felt overwhelmed by new fears. He used to love to go to Broadway shows, but now he stayed home because he was afraid to cross the Brooklyn Bridge.

Mr. KING: I felt vulnerable--you know, like somewhere out of the sky a plane was going to come and hit that bridge or whatever.

SMITH: A year and a half of talk therapy and anti-anxiety medication helped King make it across the bridge. But there were still disturbing blank spots in his memory. So Difede suggested he try the experimental virtual reality goggles. King was skeptical.

Mr. KING: When I first watched it I said, `How could this possibly help me?' But the reality is that as I watched it, she had me again talk about my experiences. You watch a plane hit the north tower. You know, where were you, etc. And the net result is that it allowed us to continue on. It really did work.

SMITH: King says he feels better, thanks to the therapy, but he's still not back to normal. Difede says that's to be expected.

Ms. DIFEDE: The very nature of going through a terrifying life event is going to change a person. What the treatment does is it cures the PTSD, if you will; it treats the symptoms. But it doesn't address the existential issues, and I think that's what a lot of people are left with: How should I live my life? What's meaningful? Am I living my life the way I want to live it?

SMITH: Psychologist JoAnn Difede says no therapy can give patients back the lives they had before September 11th. For NPR News and American RadioWorks, I'm Stephen Smith.

SIEGEL: Our reports were produced by Sasha Aslanian of American RadioWorks, the documentary unit of American Public Media. You can hear part one of this report at npr.org.

BLOCK: You're listening to ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.

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