The Sept. 11, terrorist attacks at the Pentagon, in New York City and Pennsylvania claimed far more than thousands of innocent lives. Some experts believe millions of Americans across the country may have been psychologically affected by the events as well.

“Post-traumatic stress disorder is a very complex syndrome that results from an individual’s experience with major life trauma,” Dr. David Tornberg, deputy assistant secretary of defense for clinical and program policy.

The doctor noted that military health professionals have dealt for decades with PTSD — more commonly known as “shell shock” or “combat fatigue” in military circles. It can lead to stress or anxiety that causes people to do things they wouldn’t normally consider — like abuse alcohol, drive drunk, road rage or even suicide.

Military medical researchers, Tornberg said, determined decades ago that shell shock was “a tremendous disabler” that pervaded among fighting men during World War I.

“We were much better prepared in World War II [to deal] with combat fatigue,” Tornberg said. Prevention and treatment methods developed by researchers between the wars, he added, enabled 60 to 80 percent of combat-fatigue-affected troops to return to duty. He said accumulated knowledge of prevention and treatment of American service members affected by PTSD has been employed during and after subsequent wars.

Routine anxiety caused by everyday stressors normally “dissipates with time,” Tornberg noted. PTSD left untreated may become chronic, he emphasized, and that’s why prompt treatment is paramount. Today, mental health teams trained to treat combat stress are embedded throughout the military, he said.

“Number 1 is assuring the individual of survival… and continued safety,” he said.

Communication with PTSD patients is key, to include “reintroducing, reorienting them to their circumstances and placing them in contact with loved ones and friends,” Tornberg said. Such treatment is often sufficient to enable PTSD patients to “go on and be productive,” he noted. Today, mental health teams trained to treat combat stress are embedded throughout the military, Tornberg said.

He noted the events of Sept. 11 “have put things into perspective” concerning the psychological effects of horrific events on affected populations.

At the onset of the attacks, he added, the military immediately mobilized mental health professionals, social workers, occupational therapists and chaplains to provide counseling for military and civilians, including family members of victims.

“We offer the opportunities for follow-up care. We try not to be obtrusive about bringing it to the individual, but to let them know that it is available and we care,” he added.

NMHAC board member Robert Boorstin of Greenberg/Quinlan Research used the word “resilient” to describe the emotional health of most Americans after the Sept. 11 attacks. However, he also pointed to a recent nationwide survey that reported as many as 8 million Americans are experiencing depression or anxiety as a direct result of the attacks.

“We’re clearly dealing with quite a large population” that may need care, he remarked. And the psychological impact of the attacks isn’t limited to people who live around the attack sites, Boorstin said.

The people who seem to be having the most difficulty dealing with the attacks — besides those who lost friends and relatives in the attacks, and police, fire, and search and rescue workers — “have experienced previous traumatic experiences in their lives,” he said. That’s why immediate and follow-on treatment for PTSD is so important, he noted, adding that people affected by PTSD may relive the traumatic event years later.

Boorstin said 7 percent of respondents in the recent survey said they’ve seen mental health professionals as a direct result of Sept. 11. Ironically, only one in five persons surveyed who said they were anxious or depressed because of the Sept. 11 attacks was seeking help, he added.

“We’ve got to continue looking for people who are in trouble,” he noted.

EDITOR’S NOTE: For more information about the warning signs of anxiety and depression and avenues of treatment, see the National Mental Health Awareness Campaign Web site at, or call (202) 207-1334.