I WOKE UP THIS MORNING WITH STRESS REACTION THAT OCURRED TEN YEARS AGO: THE TERRORIST ATTACK TO THE UNITED STATES ON 9/11/2001
Joseph O. Prewitt Diaz[1], PhD
September 9, 2011
Cayey, Puerto Rico
In the morning I was awakened by a dog barking in the distance. I had a slight headache, stiff neck, was shaky and hyper-vigilant. The first thing I did was make coffee and check whether the tanks were full of the generator, then I looked at the cuvert where I keep the emergency equipment. As I sat down to take my blood pressure, I realized it was a sunny day and the weather forecast, was not calling for bad weather today or the rest of the weekend. After deep breathing seeveral times I was relaxed enough to reflect on my actions this morning.
I realized that my actions were consistent with traumatic stress reactions, these reactions were due to an event that happened ten years ago. The terrorist attacks of September 11, 2001. Around that time of the year, I always get up experiencing the transitory experience.
My name is Dr. Joseph O. Prewitt Diaz, born in Cayey, Puerto Rico. I am a psychologist specializing in humanitarian assistance. I spent most of my life working on the Disaster Services American Red Cross (ARC). The night before the attack I had returned to my daughter’s in State College, PA for a two weeks leave from my current position as an International Delegate serving as ARC Regional Coordinator for recovery for Central America after Hurricane Mitch.
In my role as Coordinator of Disaster Mental Health within the Disaster Services Human Resources (DSHR) , I was part of the National Team that responded air transportation events. The decade of 1990-1999 I served in many of the traumatic events that would change the way the nation prepares and responds to natural and manmade disasters. Some of these events were Hurricane Andrew, the attack on Murray Federal Building in Oklahoma City, several plane crashes, floods, storms, hurricanes and tornadoes. I felt sure that with the level of theoretical and practical experience I could phase any disaster, do my job and move on.
That night (Sept 10th) my daughter and I sat down to plan my days. The next day I had to drive her to work, pick up a prescription, take the car to change two tires and meet for lunch. I took her to work, and when I arrived at the pharmacy I saw on a TV a plane hitting one of the Twin Towers in New York. I remember I told the pharmacist “this movie is very realistic what it is called” the man looked at me with a dull expression, and said “that not a movie it is an accident: a plane crashed into the twin towers” and continued to fill the prescription, a few moments after the second plane crashed. Not sure of what I had seen, I called the Headquarters of the Red Cross in Washington to ask what was going on, the voice at the other side answered, “seems to have been a fatal plane crash in New York, give me your phone number in case we need you.” I called my boss in International Services and I he told me “this is an accident, do not think you need, just relax on your holiday, thanks for checking in.”
When I reached the garage, I noticed a commotion in the waiting room. No one was attending the reception desk, all customers and employees were glued to the television. No sooner had the door open when I received a call from my daughter, she said “Dad, America is under attack, a plane just crashed into the Pentagon and I can not find Joito and Jerry.” I told her not to worry that I would get in tuch with them, I commented that maybe this was a drill. Several days later I learned that my son and brother had gone unscathed from such ominous event.
Not a minute had passed when I received a call, the voice on the other side had a serious tone “we are under attack, two planes crashed in New York, one in the Pentagon, and they are tracking a fourth plane to somewhere over Pennsylvania, report to your nearest Chapter and call me back.” I understood intellectually that it was a real issue. Pancho de la Roche was not a hype man, his ability to communicate in times of crisis was accurate. This was the real thing a thousand thoughts ran through my mind and I felt an adrenalin rush.
When I reached the chapter in State College, PA. I checked in and immediately called Washington. Fred forwarded my call to the Emergency Operations Center. I heard the familiar voice of Dr. Susan Hamilton who greeted me cordially and efficiently. She explained what was happening and wanted me to prepare to leave for New York immediately. At the moment I heard from the other side “Oh my God”,” Jose hold one.” Within seconds, the voice said, “José report to emergency management in Somerset, Pennsylvania, a plane just crashed there. By now you’re in charge of mounting the mental health services in disasters, we will send staff when we can. ” I asked how many hours” and she said, “In two or three days”.
When they arrived, I found that I was the only person from National”. I proceeded with the help of local volunteers, and the guidance from Washington to set up the DMH services that would be offered for the next four weeks, a clearinghouse for the rescuers, coordinating mental health services for the morgue, open the Family Reception Center and reported to the Center Federal Command. The next day Dr. John Weaver arrived and took over the operation, on day two Dr. Margaret Pepe who was in charge of the operation, John was in charge of dealing with the Family Center, and I was in charge of assigning the 27 volunteers.
I was sitting in the Command Center when the personnel from United Airlines put the names of the passengers of United 93. One of those passengers was a Puerto Rican professional who worked at the Census Bureau in Philadelphia, and happened to be on the plane on her way to California. In my previous trip, had the opportunity to make a presentation in Harrisburg, Pa on migration patterns of Puerto Ricans in Pennsylvania, a member of the panel had been that person.
Needless to say how difficult it was to receive this family and make notification of what happened and what we expected to happen in the coming days. The mom had a heart condition and the Red Cross made arrangements to bring a Puerto Rican cardiologist Scranton, who happened to be a volunteer, to be with family during the four days they were in Somerset.
The commemoration ceremony was very moving. Family members were driven in a bus to the place where the plane crashed. There was not much to see, only men dressed in white uniforms and a large crater in the ground in the distance. Personalities like representing the United States, such as Congressman John Bertha, members of the Executive Branch, the President of the Red Cross, Laura Bush, President Bush’s wife were present and offered the condolences to each family on behalf of the Nation. Then we went to a place where there was a prayer meeting, and informal visits with each family. Each family received a little crystal box with soil from where their dear one’s had come in contact with the earth. That night I met the Puerto Rican family and had a meeting to give closure to this part of the process and make sure that all formalities had been fulfilled.
Three weeks after returning to State College, I returned to meet with my children, and that afternoon I went back to Guatemala. I stayed in touch with my collegues, at both formally and informally with the recovery process in New York and Washington. One year later, in August 2002 I returned to Washington for an official visit of “debriefing” with peers who worked in the early days of the response. I still had not realized my traumatic response to that operation until this morning—when 9/11 came to life in my awareness.
[1] Dr. Joseph O. Prewitt Diaz is the recipient of the APA International Humanitarian Award and the Government of India Certificate of Distinguished Service (Silver Award). He is Adjunct Professor and Director of the Disaster Law Center, School of Law, University of Puerto Rico. He continues to be an active volunteer with the Puerto Rico Chapter American Red Cross
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read moreSUPPORT FOR THOSE LEFT BEHIND
Joseph O. Prewitt Diaz[1]
We take great pride in sending or younger man and woman on combat missions to different parts of the world. We have welcomed back troops from Iraq and Afghanistan. The injured are handled differently, and the psychosocial support for the next of kin and extended family are not clearly articulated. At times we have had to receive the remains of fallen heroes. On at least twenty occasions in the last three years, I have witnessed how the rites of mourning are at times not culturally, linguistically or psychosocially appropriate. There are at least three basic moments that support is needed: (1) the mechanics of handling the notification, (2) the funeral, and (3) the support received by the next of kin and extended family after the event.
The notification is frequently handled in two segments; first a warrior shows up to the home of record, gives the news of the loss and leaves. The second part is the arrival of a chaplain, and a liaison to assist the family in preparing the funeral services. In that very first private moment where “shock” sets in, the television cameras show up and begin a process of intrusive inquiry. The respect paid to the grieving next of kin is a “camera on you face”. The format is that they show the next of kin crying, they show someone reading a recent email, and that ends the appreciation of a grateful nation for the sacrifice of one of its hero’s.
The funeral services come out of the “standard book” and culminate with a folded flag handed to the next of kin. That folded flag signifies the sacrifice of the fallen warrior, and the beginning of a new life of loneliness and despair for the next of kin and the extended family.
The support phase because of its length and complexity needs to be carefully planned. The official support system is located in a military installation, the Veterans Administration, and the Office of the member of Congress. The focus is on how the insurance monies are invested on behalf of the survivor. There are no visits to the home. Veterans Administration is located in the capitol city and there are limited outreach services. Local government doesn’t have the wherewithal for serving the survivors needs and rely on Veteran’s organizations for support. On all cases the focus is survival, the spiritual and psychosocial support needed available to the survivors is limited or non-existent. I was told by a government official recently “we are well prepared to handle the funeral, but can’t assist the survivors for an extended period of time that is the role of the family and the church”.
To continue to expand and fine-tune psychosocial support programs for the survivors of heroes I suggest that we study the words of a great Soldier and Statesman called Pericles. He teaches us in his Funeral Oration after the Peloponnesian War (Thucydides (c.460/455-c.399 BCE): Peloponnesian War, Book 2.34-46):
“Comfort, is what I have to offer to the parents of the dead who may be here. Numberless are the chances to which, as they know, the life of man is subject; but fortunate indeed are they who draw for their lot a death so glorious as that which has caused your mourning, and to whom life has been so exactly measured as to terminate in the happiness in which it has been passed. Turning to the sons or brothers of the dead, I see an arduous struggle before you. When a man is gone, all are wont to praise him, and should your merit be ever so transcendent, you will still find it difficult not merely to overtake, but even to approach their renown. If I must say anything on the subject of female excellence to those of you who will now be in widowhood, it will be all comprised in this brief exhortation. Great will be your glory in not falling short of your natural character; and greatest will be hers who is least talked of among the men, whether for good or for bad”.
[1] Dr. Prewitt Diaz is a Visiting Professor in the School of Law of the University of Puerto Rico, and Director of the Disaster Law Center. He was awarded the 2008 APA International Humanitarian Award. He is a trainer for disaster mental health professionals and chaplains in Puerto Rico.
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CRISIS COMMUNICATION, PSYCHOSOCIAL SUPPORT AND THE AMERICAN WAY
Crisis Communications is a required subject to achieve a “Certificate in Emergency/ Crisis Management”. Most bureaucrats and politicians are trained in the subject. I became increasingly interested in the subject when the Director of FEMA had to resign in the high of the Katrina response. As I recall the TV clip, he was more interested in the color of shirt that he was going to wear for the interview, and spent precious hours with previous appointments that had nothing to do with the thousands of people displaced from New Orleans in the aftermath of Katrina.
The last week has been a time of crisis in the United States, and very little crisis communication has taken place between those that created the crisis that has sent millions of Americans on the road to despair. We began with the approval of laws regarding the external debt of the United States, continued with a down turn in the market, leading to a decrease S&P credit rating the rating of the United States to AA+. The politicians decided that they needed a rest, and so Washington closed down for a five-week rest, where members of Congress went back to their District or on junkets so that they could conjure new ways to continue to take money out of the common man’s pocket. Thank you God!!! Between the rightist from the Tea Party, the Moderates from both parties and the populist from the left only God knows what now measures they would have concocted to “save the country” that would have resulted in greater calamity for the American people.
While politicians covered or scratched each other’s back, the real Americans, the patriots were at work. Yesterday morning we woke up to the news that 30 Americans had lost their life in the battlefield. All the President could offer to those American families that have been sacrificing so much was an a acknowledgement that their dear ones had fallen in the battlefield. I wonder if, whether or when the Nation will honor those heroes with the same intensity as that wasted to make a political point in the Halls of Government the last few weeks. You see most of those men were “Navy Seals”, heroes only known to God!
Crisis communications suggest that in spite of great odds and difficulties the interlocutor has to provide accurate and timely information. It also recommends that for the well-being of all communication has to be such as to create an environment that fosters safety, connectedness, and has a calming effects on the individual and the community as a whole. It further suggests that a small group of people will be so affected that they may need to be referred for psycho-education and/or professional assistance.
Well the time has come to acknowledge that crisis communications have failed; there is a perception that government has failed its people (except the rich and power brokers). There is no longer a feeling of safety in our country. Those who can defend us are deployed half way around the world, and they too have been led down by the chain of command. There is no calmness, joblessness is on the rise, the economic measures suggested by the President have not worked, State governments are shutting down, elected politician are running away to other States so that they don’t have to make hard choices, the blame game is being played all over. How can we be calm? To boot, the programs that are being earmarked for cuts are the community mobilization, community clinics, and community mental health. What are the elements of psychosocial support needed in such a sick environment?
Fortunately tomorrow is Monday, a new week begins with people in the corners of little towns and cities and freeway exits with cardboard sign saying “Handiman, busco trabajo!”. Farmers will be cited for providing employment to children. And yet, another committee will be formed to offer solution to the psychosocial support needs of our population.
All the while politicians and CNN, will continue, under the guise of transparency, to inflame the psyche of the common man/woman, probably increasing the symptoms of high blood pressure, heart conditions and strokes, while the politicians in Washington continue to fund raise for the next election and reduce the funds for physical and behavioral health programs, and many of our heroes die in the battle field to preserve freedom, safety and our rights of free speech. This is the American Way!!!
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Psychosocial Support in the aftermath of the Oslo Bombings
Joseph O. Prewitt Diaz[1], PhD
I was astounded and saddened with the news of the bombing and shooting incident in a campground in Oslo yesterday. Our sincere and deepest condolences, to all the citizens of Norway.
Terrorism, whether from the right or the left, as a way to shake world order, seems to be on the increase. The message to the world was “loud and clear” – terrorist will attack soft targets, to make themselves heard. The question for the world to ponder is what are the appropriate actions to reduce violence against the vulnerable civilian populace. Certainly peaceful actions will lead in-kind to peaceful results.
At prima-facia the bombing and shooting will certainly have an effect on the affected population, and on the Norwegian nation as a whole. The affected people are (1) the family and friends of those that lost their life or were injured, and (2) those that are watching the drama unfold on TV or through other media sources, without enough information wondering about their safety and well being.
Three common reactions that will emerge are
- Hatred, prejudices, animosity and distrust may increase due to person-blame behaviors.
- Some will unable to yet comprehend the tragedy that had struck them and will be numb and silent. Certain incidents might trigger off hidden fears and expressions of violent behavior.
- As the survivors return to their places many will feel psychological safety. A small group will feel uncertain and hopeless about their future. They will begin looking for a new place that they perceive as ‘safe”.
Psychosocial strategies:
As the first responders and mental health professionals approach the event-affected people. There are three needs that they may have. (1) Develop faith and trust. (2) An understanding that while most of the youth may recover, in the next few days, much stronger and more resilient. Others may not recover as quickly and will need grief counseling, and/or consultation with mental health professionals. (3) Potential short term response may include psycho-education, adequate and timely information, active participation in grieving rites, and an opportunity to share their feelings will lead to a feeling of comfort, well being, and an emerged hope for a safer future.
As the first responders and mental health professionals approach the event-affected people. There are three needs that they may have. (1) Develop faith and trust. (2) An understanding that while most of the youth may recover, in the next few days, much stronger and more resilient. Others may not recover as quickly and will need grief counseling, and/or consultation with mental health professionals. (3) Potential short term response may include psycho-education, adequate and timely information, active participation in grieving rites, and an opportunity to share their feelings will lead to a feeling of comfort, well being, and an emerged hope for a safer future.
[1] Dr. Prewitt Diaz is a humanitarian Psychologist who serves as a Visiting Professor and Director of the Disaster Law Center, School of Law, University of Puerto Rico. Her served with the American Red Cross as a Disaster Mental Health officer during the Oklahoma City Bombing and the 9/11 response in Somerset, PA. He was the recipient of the APA International Humanitarian Award in 2008.
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Top 10 Articles Published in Community Based Psychosocial Support since 2008
Prewitt Diaz JO: Integrating psychosocial programs in multi-sector responses to international disasters. Am Psychol; 2008 Nov;63(8):820-7.
North CS: A tale of two studies of two disasters: comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees. Rehabil Psychol; 2010 Aug;55(3):241-6.
Henley R, Marshall R, Vetter S: Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: a case study. J Behav Health Serv Res; 2011 Jan;38(1):132-41.
Williams R, Alexander DA, Bolsover D, Bakke FK: Children, resilience and disasters: recent evidence that should influence a model of psychosocial care. Curr Opin Psychiatry; 2008 Jul;21(4):338-44.
Te Brake H, Dückers M, De Vries M, Van Duin D, Rooze M, Spreeuwenberg C: Early psychosocial interventions after disasters, terrorism, and other shocking events: guideline development. Nurs Health Sci; 2009 Dec;11(4):336-43.
Udomratn P: Mental health and the psychosocial consequences of natural disasters in Asia. Int Rev Psychiatry; 2008 Oct;20(5):441-4.
Smith E, Wasiak J, Sen A, Archer F, Burkle FM Jr: Three decades of disasters: a review of disaster-specific literature from 1977-2009. Prehosp Disaster Med; 2009 Jul-Aug;24(4):306-11.
Walsh DS: Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: an integrative review. Int J Nurs Pract; 2009 Aug;15(4):231-40.
Ray-Bennett NS: The role of microcredit in reducing women’s vulnerabilities to multiple disasters. Disasters; 2010 Jan;34(1):240-60.
Findley SE, Sanchez M, Mejia M, Ferreira R, Pena O, Matos S, Stockwell MS, Irigoyen M: Effective strategies for integrating immunization promotion into community programs. Health Promot Pract; 2009 Apr;10(2 Suppl):128S-137S.
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