The Second Wave
Physicians brace for the coming siege on body and mind
What would have been a simple diagnosis for doctors at Boston's Massachusetts General Hospital has suddenly become murky. Are the fatigue, respiratory distress, and insomnia symptoms of a viral infection that has been sending Bostonians to bed? That's what physicians would have assumed a month ago. But now it's equally plausible that these same symptoms are signs of the profound psychological stress people are feeling after the recent terrorist attacks--attacks that involved flights out of nearby Logan Airport. Both virus and stress are going around. It's unclear which is more virulent.
The terrorist acts at the World Trade Center and the Pentagon are already resulting in a wave of physical and psychological complaints among Americans. For some people, the events, combined with ongoing fears about physical security, may lead to disorders ranging from ulcers and hypertension to irritable bowel syndrome, gum disease, and psoriasis. And those who are more emotionally vulnerable to begin with, says Randall Marshall, director of trauma studies at the New York State Psychiatric Institute, "are having powerful and disabling problems. We are seeing a relapse--in panic, in depression, in psychosis."
These relapses, whether physical or emotional, appear to begin with the brain's response to serious life stress, a response that researchers are only beginning to unravel. Danger signals coming into the body are fed into the limbic system, the brain's emotional center, which in turn activates regions involved in the body's fight-or-flight response. In some cases, when all systems are responding in healthy proportion, this can result in quick responses and saved lives. But the body is wired to sustain this physiological reaction for only a brief time. It's ideal for a bear attack, or even a hurricane, but not, says James Griffith, professor of psychiatry and neurology at the George Washington University Medical Center, for this kind of threat. Because many people aren't yet confident of their own safety, "they are in a chronic state of hypervigilance."
Years of stress. The combination of trauma and persistent stress could lead to the exacerbation of many existing conditions, both physical and emotional. Patients suffering from rheumatoid arthritis may experience more pain; asthmatics may start wheezing more. Blood pressure is also highly sensitive to chronic stress. Studies show that people who lived through traumatizing events--from World War II bombardments to the Three Mile Island nuclear accident--had higher blood pressure and elevated levels of some stress-related hormones for several years after the danger passed.
In many cases, the physical and psychological responses are inextricably tied together. For example, a study of teenagers who experienced the worst of Hurricane Hugo in 1989 showed that they perceived both their physical and mental health as declining, and in direct proportion to how severely their communities were damaged by the storm. Other research has shown that veterans with post-traumatic stress disorder had twice as many physical ailments, such as gastrointestinal problems, as other veterans. Researchers now believe that PTSD may be a risk factor for physical disorders.
Mike McLeer is a case in point. The rap singer used to show up in the ER 10 times a week feeling dizzy, breathless, and nauseous, as if he were having a heart attack. And 10 times a week he would be told that he was fine. In fact he was suffering from PTSD, the consequence of his mother's and little sister's killings by a hit-and-run driver four years before. With counseling, drugs, and ongoing support, McLeer no longer needs to race to the emergency room. Still, when he saw the World Trade Center collapse, his haunting memories returned in force.
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