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Case Study 9-11 Tragedy Pictures

The Sept. 11, 2001 terrorist attacks were the worst acts of terrorism on American soil to date. Designed to instill panic and fear, the attacks were unprecedented in terms of their scope, magnitude and impact on the American psyche.

The vast majority (over 60 percent) of Americans watched these attacks occur live on television or saw them replayed over and over again in the days, weeks and years following the attacks.

As we reflect on the anniversary of this tragic event, a question to consider is: How has this event impacted those individuals who are too young to remember a world before 9/11?

As an applied social psychologist, I study responses to natural and human-caused adversities that impact large segments of the population – also called “collective trauma.” My research group at the University of California, Irvine (UCI) has found that such exposures have compounding effects over the course of one’s lifespan. This is particularly relevant for children who have grown up in a post-9/11 society.

PTSD and Ground Zero

Many of the outcomes on which my team and I focus involve mental health, such as post-traumatic stress symptoms (PTS) and post-traumatic stress disorder (PTSD).

Post-traumatic stress symptoms include feeling the event is happening again (e.g., flashbacks, nightmares), avoiding situations that remind individuals of the event (e.g., public places, movies about an event), negative feelings and beliefs (e.g., the world is dangerous) or feeling “keyed up” (e.g., difficulty sleeping or concentrating).

In order to meet diagnostic criteria for PTSD, an individual must have been directly exposed to a “traumatic event” (e.g., assault, violence, accidental injury). Direct exposure means that an individual (or their loved one) was at or very near the site of the event. It might be somewhat obvious that people directly exposed to a collective trauma like 9/11 might suffer from associated physical and mental health problems. What is less obvious is how people geographically distant from the epicenter or “Ground Zero” might have been impacted.

This is particularly relevant when considering the impact of 9/11 on children and youth across America: Many reside far from the location of the actual attacks and were too young to have experienced or seen the attacks as they occurred. The point is people can experience collective trauma solely through the media and report symptoms that resemble those typically associated with direct trauma exposure.

Impact on physical and mental health

The events of 9/11 ushered in a new era of media coverage of collective trauma, where terrorism and other forms of large-scale violence are transmitted into the daily lives of children and Americans families.

I have been exploring these issues with my collaborators Roxane Cohen Silver and E. Alison Holman. My colleagues surveyed a nationally representative sample of over 3,400 Americans shortly after 9/11 and then followed them for three years after the attacks.

In the weeks and months following the 9/11 attacks, media-based exposure was associated with psychological distress. This included acute stress (which is similar to PTS but must be experienced in the first month of exposure), post-traumatic stress and ongoing fears and worries about future acts of terrorism (in the months following the attacks).

These harmful effects persisted in the years following 9/11. For example, the team found measurable impact on the mental and physical health (such as increased risk of heart diseases) of the sample three years after the attacks. Importantly, those who responded with distress in the immediate aftermath were more likely to report subsequent problems as well.

These findings bear close resemblance to research led by psychologist William Schlenger, whose team found that Americans who reported watching more hours of 9/11 television in the immediate aftermath of 9/11 were more likely to report symptoms resembling PTSD. For example, those who reported watching four to seven hours were almost four times as likely to report such symptoms compared to those who watched less.

These findings were echoed in work conducted by Michael W. Otto, who also found that more hours of 9/11-related television watching was associated with higher post-traumatic stress symptoms in children under 10 in the first year following the attacks.

9/11’s impact on children

However, it is also the case that studies have found the number of children who reported longer-term distress symptoms to be relatively low. Among other factors, children whose parents had low coping abilities or themselves had learning disabilities tended to report higher distress.

For example, my collaborator Virginia Gil-Rivas, who studied American adolescents exposed to 9/11 only through the media, found that symptoms of post-traumatic distress decreased in most adolescents at the one-year mark. An important finding of her study was how parental coping abilities and parental availability to discuss the attacks made a difference.

Furthermore, children who had prior mental health problems or learning disabilities tended to be at higher risk for distress symptoms. That could be because children prone to anxiety in general experienced increased feelings of vulnerability.

Despite the number of studies that have followed children over the course of several years, no studies have comprehensively examined the long-term impact of 9/11 on children’s development and adjustment. That is because it is difficult to compare American children who lived through 9/11 with those who did not, since almost every American child was exposed to images of 9/11 at some point in time.

This limits the ability of researchers to examine how children’s lives might have changed over time.

However, some researchers believe that even media-based exposure to collective trauma could likely have a longer-term impact on the attitudes and beliefs of those who grew up in a post-9/11 world. It is possible, for example, that exposure to 9/11 and other acts of terrorism has led to fears of perceived threats, political intolerance, prejudice and xenophobia in some American children.

How 9/11 trauma impacts people today

Fifteen years later, a bigger question is: How does the collective trauma of 9/11 affect people today?

Over the past several years, my team and I have sought to address many of the issues that remained unanswered in the scientific literature after 9/11. We sought to replicate and extend the findings initially produced after 9/11 through an examination of responses to the 2013 Boston Marathon bombing, the worst act of terrorism in America since 9/11.

To this end, we surveyed 4,675 Americans. Our sample was demographically representative, meaning that our sample proportionally matched the U.S. Census data on key indicators such as ethnicity, income, gender and marital status.

This allowed us to make stronger inferences about how “Americans” responded. Within the first two to four weeks of the Boston Marathon bombings, we surveyed our sample about their direct and media-based exposure to the 2013 Boston Marathon bombing and their subsequent psychological responses.

Our study found that as media exposure (a sum of daily hours of Boston Marathon bombing-related television, radio, print, online news and social media coverage) increased, so did respondents’ acute stress symptoms. This was even after statistically accounting for other variables typically associated with distress responses (such as mental health).

People who reported more than three hours of media exposure had higher probability of reporting high acute stress symptoms than were people who were directly exposed to the bombing.

Then, last year, we sought to explore whether the accumulation of exposure to events like 9/11 and other collective trauma might influence responses to subsequent events like the Boston Marathon bombing.

Once again, we used data from demographically representative samples of people who lived in the New York and Boston metropolitan areas. We assessed people who lived in the New York and Boston areas to facilitate a stronger comparison of direct and media-based exposure to 9/11 and the Boston Marathon bombing: people who lived in New York or Boston were more likely to meet criteria for “trauma exposure.”

This study had two primary, congruent findings. First, people who experienced greater numbers of direct exposure to prior collective trauma (e.g., 9/11, the Sandy Hook Elementary School shooting, Superstorm Sandy) reported higher acute stress symptoms after the Boston Marathon bombings.

Second, greater amounts of media-based live exposure (i.e., people watched or listened to the event as it occurred on live television, radio, or online streaming) to prior collective trauma were also associated with higher acute stress symptoms after the Boston Marathon bombing.

So greater direct and media-based exposure to prior collective trauma was linked with greater acute stress responses (e.g., anxiety, nightmares, trouble concentrating) after a subsequent event.

Stay informed, but limit exposure

Overall, our research indicates that the impact on children growing up post-9/11 likely extends well beyond the physical and mental health effects of exposure – be it direct or media-based. Each tragic incident that individuals witness, even if only through the media, likely has a cumulative effect.

Nevertheless, the positive finding is that most people are resilient in the face of tragedy. In the early years following 9/11, several studies examined how 9/11 impacted children nationally. Like adults, children exposed both directly and through the media tended to be resilient in the early years following the attacks and symptoms generally decreased over time.

Even so, being aware of the potential for distress through media exposure is important. Even small percentages can have large implications for our nation’s physical and mental health. For example, in the case of 9/11, 10 percent of a nationally-representative sample reporting post-traumatic stress represents 32,443,375 Americans with similar symptoms.

So, people should stay informed, but limit repeated exposure to disturbing images, which can elicit post-traumatic stress and lead to negative psychological and physical health outcomes.

The lawyers handling the 9/11 case still in pretrial hearings at Guantanamo Bay were arguing this week about how much information the government has to turn over to defense counsel about the secret CIA prisons where the men were held and tortured. How much to reveal and how to handle that evidence, which mostly remains classified at various levels of secrecy, has been the subject of countless hearings and thousands of pages of paper submitted in the case so far.

Earlier in the week, lawyers argued over whether it's possible for defense lawyers to effectively represent their clients in the military commissions system, where prison camp rules and government surveillance practices lead to regular violations of attorney-client confidentiality, an ethical requirement for attorneys representing a criminal defendant.

What's striking in the case against the five alleged plotters of the September 11 terrorist attacks is not only that more than 14 years after the worst terrorist attack ever against the United States, which killed nearly 3,000 people and spawned at least two wars, no one has been held accountable. Equally remarkable is that it's now been four years since the charges in this commission were filed, and the case so far has centered largely on the government's own misconduct. Although the 2001 attack on the World Trade Center and the Pentagon was a mass murder of astronomic proportions, all we've heard about so far in the case is how the government mistreated the accused and has repeatedly hampered their ability to get a fair trial. What happened to the victims of those attacks, and the ongoing suffering of their families and loved ones, seems to have no place in the Guantanamo courtroom.

There is no trial date set and lawyers involved have estimated the case won't get to trial before 2025. That's not surprising, given that just this week prosecutors were speaking of having to turn over tens of thousands of classified documents to the court about the CIA "black sites" and interrogations, along with summaries of their contents, so the judge can determine what the accused and their lawyers are allowed to see. Aware of the monumental task, prosecutor Clayton Trivett told the court on Thursday: "We hope to get the case done during the lives of living men."

Watching the procedural details getting worked out can get pretty boring, which is why you won't hear many news reports about it. But underlying this dragged-out ho-hum process is a critical fact: The government could have avoided putting itself on trial and instead focused on seeking accountability for the mass murder that took place simply by conceding its mistakes from the beginning and working out an accommodation in an experienced federal civilian court. That probably would have meant foregoing the death penalty, but the men convicted would most certainly have spent the rest of their lives in prison. As important, it would have demonstrated publicly exactly how the attacks came to take place, holding up for public scrutiny the monstrous tactics used and the barbaric indifference to the lives of innocent people, including many Muslims. It would have dealt a blow to not only the individuals involved, but to the entire organization of al Qaeda that supported them. And it would have demonstrated how a society that's committed its own bad acts can take responsibility for them, and still bring criminals to justice through a fair trial in a respected court of law.

Instead, because the U.S. government fought every step of the way against releasing information about CIA activities and interrogation tactics, and because it insisted on seeking the death penalty notwithstanding its own missteps, the U.S. government has made its own post-9/11 conduct the central issue of the case. The defendants, understandably eager to avoid concluding the case at all, are happy to take full advantage of that.

What we see happening at Guantanamo, then, is a spectacle of tragic proportions. To be sure, it often seems comic, given the frequent outbursts of the accused, the Keystone Cops tactics of the various branches of government, and the bewildered look on the judge's face when he's repeatedly faced with novel issues that the newly-created military commissions are wholly unprepared to resolve. But viewed with some perspective, it's not very funny at all.

The government could still salvage this mess by transferring the case to a civilian court if it could only concede that years ago, it took the wrong path. The tragedy is that the United States still seems not to have learned that lesson.

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