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ISTSS members worldwide responded to the September 11 attacks in the United States with services to those affected by the attacks and support for colleagues in the traumatic stress community. ISTSS members continue to provide grief counseling and crisis intervention for public agencies, unions, private companies, hospitals, mental health centers, schools, and disaster relief organizations.

The following brief reports from several ISTSS members in New York and Washington provide a glimpse into the emotional and professional challenges at ground zero.

Yael Danieli
ISTSS past president and UN representative
New York

Being Israeli as well as American, terrorism does not surprise me-but I am still stunned by how diabolically the September 11 event was conceived and executed. Immediately after the attacks, phone calls and e-mails came from patients, current and (reliving their) past, trainees, colleagues and friends-especially those who "know," in Israel, Bosnia, Rwanda and Argentina, whose friendship deepened all the more. I, like many other New Yorkers, have been comforted by this embrace of solidarity, as if it helped balance somewhat the evil that assaulted us.

At the center of my own concentric circles of commitments are my patients, many of whose histories and legacies are rife with man-made massive traumata, some with individual ones. With few (diagnostic) exceptions, every conversation-in elevators, buses, restaurants, family centers, and on the streets near ground zero-was about the terrorist attacks. All became potentially healing environments. Companies too sought advice and guidance.

Being a "mensch," hanging out with people, listening, reassuring them that they are experiencing normal reactions to a horrendously abnormal and shockingly malevolent reality, I am trying to help them examine how it figures in their lives and their way of being in a world that has changed forever-what they can do despite overwhelming feelings of helplessness.

Globally, recognizing that many of the victims are not American, beyond attempting to coordinate local ISTSS members throughout the United States, I see a particular role for the ISTSS international network to coordinate efforts to help the families in their own midst who lost loved ones in the attacks.

More than ever, issues related to the time dimension emerged as paramount. First was the imperative to resist the culturally prevalent impulse to do, to find quick fixes, all too swiftly look for closures and flee "back to normal." Second, knowing that there will be long-term effects of the disaster and of the immediate interventions, recognize the need for long-term commitment, as well as examine systematically every short-term decision from a long-term perspective. To help train and support professionals, we restarted, earlier than scheduled, our biweekly seminar on countertransference and trauma. Third, we must consider the at-risk times as well as the at-risk groups. While the Jewish high holidays have been upon us, I am left concerned about how those who lost loved ones will experience upcoming family holidays such as Thanksgiving and Christmas.

Other public health, community-based psychosocial initiatives might be:
o "Adopt" your own police/fire station.
o Create legacy works: The art community, beyond traditional fundraising, can create containers for ashes, stones or pieces of metal from the site for the families, taking into account the diverse customs and cultures involved.
o Seek ways to preserve the goodness and solidarity.
The week of the attacks, my new book, Sharing the Front Line and the Back Hills, came out. Though it was published for and on behalf of the United Nations and meant for international protectors and providers (peacekeepers, humanitarian aid workers and the media), it suddenly became horribly relevant right in my own hometown.

Charles Figley
Florida State University
Kathy Regan Figley, Tallahassee Office president of the Green Cross Foundation, activated the Green Cross Projects (GCP) on September 11 and was invited to provide assistance by Local Union 32 B-J of the Service Employee International Union (SEIU), with headquarters just blocks from ground zero. Fifteen hundred members of the 32 B-J worked in the World Trade Center, and more than 7,500 members worked nearby. The host wanted the GCP to care first for the 800 union employees who witnessed the carnage from union headquarters (101 Avenue of the Americas) and then help the union with the thousands of members and their families who needed assistance.

The first week's teams began consultation and crisis intervention services September 16, starting with management. At the end of the third week of services, 38 GCP members (from the U.S., Spain, Canada and Puerto Rico), provided 1,626 hours of pro bono services to 1,400 individuals. Currently the GCP is organizing traumatologists from the local GCP Chapter of New York who will assume services on or before October 17. The American Red Cross has placed Green Cross Projects on their referral list for businesses that request crisis-oriented services. For more information, go to www.greencross.org.

Jeffrey Jay
Washington, DC
I was able to volunteer at the Pentagon through the American Red Cross and through the FBI. My thoughts have been filled with the legion of good-hearted and big-shouldered helpers who massed in front of the destruction-and the dynamics of that "camp," its professionalism, and the quality of a sacred duty that emerged. I hope we can think about this and research it, much as we have looked at the dynamics of PTSD.

I have been working with an army mortuary unit, the FBI, a U.S. marshal and DOD civilians-along with many other determined souls. In addition, I spoke with news organizations, workplace groups, and students and faculty at Gallaudet University, a university for deaf and hearing-impaired students in Washington, DC. As we move toward the next phases of this tragedy, I hope that the professional community here can form a community dedicated to high standards of care, inclusiveness, patience and respect.

Anie Kalayjian
President, ISTSS New York Chapter
New York

As chair of the United Nations 54th Annual DPI/NGO Conference, I was leading the speakers in the conference room at the UN when we heard that the World Trade Center was hit by terrorists, and an hour later we had to evacuate. The scenes on CNN took me back to my childhood in Syria, where my grandparents had fled during the Ottoman Turkish Genocide of the Armenians in Asia Minor. I remembered the Syrian-Israeli conflict, and how the Israeli planes came so low on our residential housing that our windows shattered, as we hid in the subbasements.

After those flashbacks, I felt a sense of helplessness, which I channeled into helping others. Many attendees of the UN were stranded in New York, their hotel reservations having ended. I housed three guests and found friends to house others. Ironically the theme of the conference this year was "volunteerism." The next several days we all witnessed a sense of solidarity and collective volunteerism around the globe.

I received more than 200 requests a day from people wanting to help. The majority of the requests were from mental health professionals in the tri-state area, but some came as far as California, Pakistan, Sweden, Taiwan and Armenia. I began sending them e-mail handouts regarding how to cope with terrorism.

I organized an urgent meeting for mental health professionals (MHP) in the tri-state area to provide a therapeutic, safe and nonjudgmental environment for professionals to express their own feelings, share their individual and community resources, and provide recommendations. The meeting was very fruitful and empowering, as MHP were able to express their feelings of frustrations, anger, fear and helplessness. The need to help people channel their anger in a healthy way became apparent. The need for more training also surfaced, as all the attendees decided to meet again in two weeks. Therefore we will offer a variety of workshops, self-help groups and pastoral counseling.

I also organized and delivered training material for Fordham University faculty and counselors to help guide them in their attempts to talk with students after the devastation. In addition, I prepared a list of resources (physical, psychosocial and spiritual) for survivors, involving needs. I was interviewed by several television stations.
I urge members to engage in some form of outreach to prevent complications in the postterrorism phase. These preventive workshops can be conducted in churches, temples, mosques, police and fire stations, community centers, universities, schools, counseling centers, etc. My motto is the Swedish Proverb: When one helps another, both are strengthened.

Sylvia Mendel
ISTSS UN representative
New York

The morning of the terrorist attacks, I flash back to World War II and the London blitz-long nights, exhausted people creeping from shelters after the "all-clear" siren. No transportation September 11, so I walk 14 blocks to be with a friend.

The day after the attacks, I deliver supplies to the local firehouse for rescue workers and I volunteer at the Red Cross. But when Red Cross staff and volunteers are set up at the Lexington Avenue Armory, there seems to be little need for counseling at the moment. Families wait for information on missing relatives. A staggering number of "missing" posters plaster the walls of the massive armory, store windows, phone booths, lampposts-and candles burn in hope.

The first self-care activity comes at a local hangout, where I have dinner and talk to a police sergeant, who recounts the details of his 26-hour shift at ground zero. I can barely stand to hear, but I listen to what he desperately needs to tell. I listen for two hours before leaving. I buy myself roses on my way home.

On September 14, I begin to talk with frightened people and respond to calls from child welfare, education and mental health agencies. There are calls from friends whose grown children worked close to the site. One woman calls about her husband who worked in Building 7-he has seen things unimaginable to most of us. She puts him on the phone, and he agrees to see me. Today I buy smoked oysters and wine-soul-restorative diversions.

I begin to disseminate informational materials, write proposals for planned responses to requests for trauma training and consultation. I have many informal encounters on the street, in stores, elevators and taxis, which I call "serendipitous street work." Again I make a connection to the London blitz, when people in the streets comforted each other.
A little book from 1923, What Is Professional Social Work? by L.A.S. Halbert, gives a definition of social work that remains relevant for me: "Social workers are continually originating certain activities and vindicating them and making them standard and permanent, but after they have reached that stage they are not rated as social work." I think that trauma work is always social work no matter what the discipline.

Ann Norwood
Washington, DC
From our department at the Uniformed Services University of the Health Sciences (USUHS), Captain (Sel) Tom Grieger served on the National Naval Medical Center's SPRINT team, which helped at the Pentagon and the Navy Annex. LCDR Lisa McCurry assisted in the Family Support Center for the Pentagon. LTC Mark Chapin, DSW, of the Family Medicine Department has assisted in providing support to the Pentagon. Carol Fullerton, PhD, the center's scientific director, and center scientists James E. McCarroll, PhD, and John Newby, DSW, have distilled key points for fact sheets targeted to many topics. The department also has played a consultant role in many other activities.

Along with me, Robert J. Ursano, MD, and members of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disaster have been active in the wake of the terrorist attacks. The committee has updated its Web site to provide timely fact sheets and reference articles on disaster psychiatry. Committee members also have been active in providing direct care, testifying before Congress, providing funding, and educating the public.

I have confined my remarks to mental health activities of USUHS faculty. However, the military mental health providers and VA personnel have performed in exemplary fashion, assisting at the Pentagon and in New York City.