She and her son, Jamal, were in lower Manhattan on 9-11 for an ophthalmologist appointment early in the morning. Her son was looking forward to visiting Border's Books & Music store near the World Trade Center after the doctor appointment. Instead, Marshall's plans placed them at the center of the world at precisely the wrong moment in time.
In the days before 9-11, Jamal had become fascinated with the book Chicken Little, "the classic children's fable" written to teach a lesson about courage.
The story reads like this: One day Chicken Little was walking in the woods when -- KERPLUNK! -- an acorn fell on her head. "Oh my goodness!" said Chicken Little. "The sky is falling! I must go and tell the king."
Chicken Little spreads the word to her friends and convinces them to follow her to visit the king, but not before great panic ensues.
On the morning of 11 September, Jamal watched events unfold --not from the safety of his family room-- but real-time, real-life, and from yards away from where they stood. His eyes were due to be examined for glasses, but from what he clearly saw, the sky came crashing down. He pulled at his mother's skirt and cried, "The sky is falling, mommy! The sky is falling!"
The lives, dreams, and hopes of many children in New York City came into question that day. Jamal was not the only child to witness atrocities. Other school children were in the vicinity. Children across the five boroughs became obligatory observers of history in the making as they could have seen the explosions from Brooklyn, Jersey City, NJ, and from any rooftop by naked eye on such a crystal clear morning. And as horrendous as the day was for most children, it was even worse for kids already suffering mental or emotional stress.
Johanna Schneider works with children challenged by mental and emotional issues and she has helped children in New York City Public Schools since 1986. On 9-11, she was working at IS 232 where PS 36K has a three class unit for emotionally disturbed students. "I think for the most part, many of our students who already have emotional problems were pretty confused," Schneider said. They were not alone.
Jamal turned 11 in July 2005, and four years after 9-11 he is making progress with his therapist, but he still has issues with Post Traumatic Stress Disorder (PTSD) and anxiety attacks. "My son was not like this before he saw people falling from the sky," Marshall said.
PTSD has been a part of organized psychiatry for only three decades; the concept however, has been known for decades and through different names. Sigmund Freud concluded that traumatic events in childhood had a lasting effect on an individual's emotional development. Pierre Janet wrote on traumatic stress, and he was the first to describe the full syndrome of traumatic stress disorders.
During WWI, PTSD was called "shell shock," and during WWII, it was referred to as "combat fatigue." PTSD evolved more mainstream after the Vietnam War, as it was often mistakenly called the Post Vietnam Syndrome.
The New England Journal of Medicine reported that on a national level after 9-11, nearly 50 percent of children worried about their own safety; 35 percent exhibited more than one symptom of PTSD; and 90 percent of adults had at least one stress-related symptom. Results for residents of New York City however where higher across the board and greatly enhanced by loss of life; whether it have been a neighborhood resident or firefighter, or the death of someone close to the family.
Traumatic stress is determined by the trauma itself and by the person's ability to respond to the trauma. Someone who has experienced, witnessed, or been confronted with an event (assault/rape) will respond in different ways reflecting their own fear, helplessness, and horror.
While reaction to a traumatic event is very normal, the range in which the person manifests that event --depending upon his/her ability and past exposure to trauma-- will play out the symptoms in different ways, but most of which can be treated and cured.
For children, with no prior experience in witnessing true horror, their behaviors can become highly disorganized, unfocused, and agitated.
Franz Phillips, a psychologist in private practice in New York City says, "There are three categories of specific symptom clusters: 'intrusive' symptoms [trauma is re-experienced,] 'avoidant' symptoms [people purposely avoid triggers, which negatively impact their routines,] and 'arousal' symptoms [sleep disorders, irritability, anger outbursts, attention deficit, easily startled.]"
A mental health professional will diagnose PTSD by the number of symptoms within each category, and by the way in which the patient reacts to those symptoms.
By all accounts, Jamal had experienced many root causes of PTSD. He witnessed an airplane crash into a building --by itself a horrific event even upon accidental fate-- but add to that: Intention of attack by terrorists, a second plane crash, people fall through the air and hitting the ground, building debris, and towers' collapse.
"Jamal will not leave my side. He's 11-years old and he is still very much like the 7-year old he was that day in September. It's very frustrating, because at times we feel as though he's stuck in 9-11," Marshall said.
For people living and working in New York City, psychoanalysts say, Jamal is hardly alone. Even though thousands of adults witnessed the same events on 9-11; they were not much more advanced than Jamal at rationalizing what had happened. Some adults experienced temporary changes in response to psychological stress of that day, others may be more biologically vulnerable, or had a history of more trauma, or are more directly and/or deeply affected by the trauma. 9-11 specifically resulted in a small percentage of chronic PTSD, where as some patients developed associated psychiatric disturbances that complicate the clinical picture of recovery.
Marshall said her son refuses to ride a subway and he won't get involved in after-school activities, "because he feels that something bad is going to happen. It's as if he's waiting for another terrorist attack to occur."
"How do you sit by and watch your son's childhood waste away like this?" Marshall asked. "We don't let him watch TV unless we know exactly what's on. And it's never the news, I'll tell you that much!"
Phillips said that by watching repeated news footage of planes crashing into the World Trade Center is an unsettling experience for anyone, but for children the replays had a lasting, adverse effect on their psyche. Phillips says, "For very young children (under age six and some cases children a little older) the amount of time the parents/caregivers watched the television that day...has been quite problematic, because really little kids think it happened over and over again. Developmentally, they can't grasp that they are seeing repeated pictures of something that only happened once."
Children rationalize trauma differently and 9-11 becomes their only association with terrorism, thus with the mention of terror in the news 9-11 happens over and over again. It happens in their minds when they're envisioning terrorist attacks and it happens in their sleep through nightmares.
Schneider, who is now the Principal of PS 36 in East New York, Brooklyn says, "Sometimes I feel afraid that something will happen and I won't be able to protect the students in my care, or the adults. I'm responsible for over 350 students and almost as many staff. Will I be able to keep myself together? I'm pretty good in a crisis, so I'm sure I'd do okay."
After 9-11, adults too have reported higher instances of anxiety, depression, PTSD, and the avoidance of certain patterns that might trap them during a terrorist attack.
In most cases PTSD can be cured. The treatment includes early management (intervention,) supportive critical incident stress debriefing, group and peer rapport, targeted psychotherapy (for most patients, exposure therapy, anxiety reduction, and cognitive therapy,) and in some cases medications can be useful. Each step of the healing process helps a patient put a little control back into his or her life.
Schneider, 48, said that in the days immediately following 9-11, "Some of the older students wanted to go to war to get the people who planned the attacks, while others were just very introverted and asked questions about being safe and why people are so mean to each other, out of the mouths of babes."
Marshall asks, "How do I teach Jamal to have courage in world filled with cowards who cause so much pain and suffering? The sky did fall that day.
"It fell down in piles of twisted steel, smoke, dust, and body parts. And after it fell, it chased my son and me for blocks. Chicken Little was teaching him about being courageous, but it couldn't prepare him for something like 9-11."
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