Big Brain Energy: The lasting mental and physical health effects of September 11th, 19 years later

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“The World Trade Center Cough.” Post-Traumatic Stress Disorder. Depression. Grief. 

19 years ago last week, Al-Qaeda hijackers flew planes into the Twin Towers, the Pentagon and attempted to fly a plane into the Capitol Building in a coordinated terrorist attack that took the lives of nearly 3,000 people and drastically altered the United States forever.  

Although the ash from the flames of 9/11 has long settled, the mental and physical scars on those left behind remain and are only beginning to be understood by doctors, psychologists and all other scientists tasked with evaluating the greater impact Sept. 11th had on American citizens.  

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For many who were caught in the soot and smoke of the fires that ensued that day, respiratory distress is now chronic. “The World Trade Center Cough,” as it has been termed by doctors, includes any of the following: “chronic rhinosinusitis, asthma, and/or bronchitis, often complicated by gastroesophageal reflux dysfunction.” Several survivors have been afflicted with the mystery illness, whose long term effects will not be measured until many years from now.  

The name for the illness was first coined by Dr. David Prezant, the medical director for the New York City Fire Department, in 2002 after several firefighters working on the relief effort at Ground Zero came down with asthma and bronchitis-like symptoms for several weeks at a time.  

“Nearly 24,000 gallons of combusting jet fuel and the burning, pulverized buildings created a massive smoke plume and dust cloud that blanketed the region,” wrote Liza Zamosky in a 2011 article for the Los Angeles Times. “Cement, glass fibers, asbestos and a host of toxic chemicals from the collapsed buildings created a mix of environmental pollutants and carcinogens such as polycyclic aromatic hydrocarbons (PAHs), dioxins and volatile organic compounds. Fires continued to burn below and above ground for months, further exposing workers to noxious chemicals.” 

In this Sept. 11, 2001, file photo, the south tower of the World Trade Center, left, begins to collapse after a terrorist attack on the landmark buildings in New York. Families impacted by the terrorist attacks say it’s important for the nation to pause and remember the hijacked-plane attacks that killed nearly 3,000 people at the World Trade Center, at the Pentagon and near Shanksville, Pa., on Sept. 11, 2001, shaping American policy, perceptions of safety and daily life in places from airports to office buildings. (AP Photo/Gulnara Samoilova, File)

Those who live in and around the World Trade Center have also been shown to be at an increased risk for several of these respiratory issues. Scientists still do not have a good understanding as to why inhalers, medication and other supportive care mechanisms are not proving effective for many of those afflicted. 

“A 2005 study of 2,812 residents living near the World Trade Center published in the journal Environmental Health Perspectives found that coughing, wheezing, chest tightness and shortness of breath were reported in three to six times greater numbers among people living within one mile of the World Trade Center site than among those who lived more than five miles away,” Kamosky wrote. “…More recent studies of patients who have sought treatment for Sept. 11-related respiratory illness suggest that years later, they still have a greater risk for abnormal lung function.” 

Among the most prominent mental health issues in first responders and those who suffered through the events of Sept.11th is PTSD, which is characterized by nightmares of unwanted trauma, avoidance of situations that remind one of trauma, depression, irritability and anxiety. However, the televised and well-known nature of 9/11 makes forms of trauma harder to diagnose in those who might not have been physically present for the tragedy.  

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“In order to meet diagnostic criteria for PTSD, an individual must have been directly exposed to a ‘traumatic event.’ Direct exposure means that an individual (or their loved one) was at or very near the site of the event,” wrote Dr. Dana Rose Garfin, a researcher in social psychology, in a 2016 article. “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.”

For some directly involved in the tragedy, the effects of trauma and trying to cope with the unimaginable have devastating effects. Marcy Borders, the woman who fled from the 81st floor of her office in the World Trade Center and survived its collapse, became known as the “Dust Lady” after a photograph was published of her covered in the debris after the towers fell. 

Borders battled severe bouts of depression and anxiety for years after the terrorist attacks and was admitted to rehab for alcohol and cocaine abuse in 2011. She began improving after the death of 9/11 mastermind Osama Bin Laden later that year. In 2014, she was diagnosed with stomach cancer, which she succumbed to the following year. It’s unclear whether her diagnosis was a direct result of exposures to toxins on 9/11 or the subsequent trauma she faced.

“It was like my soul was knocked down with those towers,” Borders told the New York Post in 2011 about her mental health struggles. “My life spiraled out of control. I didn’t do a day’s work in nearly 10 years, and I was a complete mess.” 

Other first responders have also reported dealing with mental health issues nearly a decade after the attacks—indicating the scars will likely never go away. 

“A research study looking at police officers who responded to 9/11 showed that 12.9% reported PTSD symptoms over a decade after the attacks,” Dr. Romeo Vitelli wrote in an article for Psychology Today. “Of those who had PTSD symptoms, 72.4% also reported problems with depression and anxiety.”

In this Sept. 11, 2015, file photo, victims’ family members look on during a ceremony at the World Trade Center site in New York. The coronavirus pandemic has reshaped how the U.S. is observing the anniversary of 9/11. The terror attacks’ 19th anniversary will be marked Friday, Sept. 11, 2020, by dueling ceremonies at the Sept. 11 memorial plaza and a corner nearby in New York. (AP Photo/Bryan R. Smith, File)

In February 2019, a group of researchers published a research article in which they evaluated data from the World Trade Center Health Registry (WTCHR), a database that collects information based on individuals who lived or worked in the area of the World Trade Center or were involved in the recovery efforts. The Registry focuses on evaluating long-term effects of physical ailments such as respiratory distress and PTSD.

The participants in the specific 2019 study conducted at John Jay College of Criminal Justice were adults at the time of 9/11 and were present in one of the two towers between the first tower’s impact and the subsequent collapse of the buildings.  

“Overall, 13% of the participants were still experiencing PTSD symptoms 14 years after 9/11 with 68 percent also reporting depression. Not surprisingly, all participants with PTSD had significantly greater exposure to the events of 9/11 than participants who weren’t reporting mental health symptoms or who had depression alone,” Dr. Vitelli wrote in his article regarding the research study. “Also, those participants reporting both PTSD and depression scored much lower in perceived self-efficacy than other participants. They were also significantly more likely to abuse alcohol, report a lower quality of life, as well as being less physically active compared with other participants.” 

Dr. Vitelli advised that one of the most significant predictors of resilience in those who experience traumatic events such as 9/11 is having strong social support from peers, loved ones and trusted professionals who can work with them through the wounds of that horrible day. 

“In dealing with tower survivors who experienced multiple traumatic events on 9/11, it is often as important to focus on improving self-efficacy as it is to help improve their social support networks,” Dr. Vitelli said. “This research also shows that there is no one-size-fits-all therapy for survivors and that the kind of therapy given should be based on the full range of symptoms they are showing.” 

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