As the U.S. Department of Homeland Security raises security levels, Americans frantically take extraordinary precautions to prepare themselves for disaster. How is the public affected by the media and what can mental health care professionals and the government do to help minimize this anxiety?
There are real dangers out there, and some of them yield actual tragedies--the terrorist bombings at resorts in Bali and Kenya among the more recent instances. So in February, when the U.S. Department of Homeland Security upgraded its security alert from yellow to orange (elevated to high; the next to highest stage), many people took the warning of impending violence seriously. (The alert was briefly downgraded to yellow until the war with Iraq seemed imminent--Ed.)
Responding to government alarms, duct tape and plastic sheeting disappeared from store shelves as people rushed to build safe rooms secure from chemical, radiological or biological attacks. Supplies of bottled water dried up as worried consumers also hoarded canned goods, batteries, flashlights and transistor radios in a last-minute effort to set aside the self-protective stashes recommended by public officials. At the same time, law-enforcement agencies heightened their readiness, and some people, depending on their levels of anxiety, changed their daily routines in an effort to elude a surprise attack.
And then, just as suddenly, the message changed. In response to what seemed an overreaction, officials in the Bush administration sought to calm fears, telling the public it needed to store emergency supplies, but need not use them--yet. At the same time that they sought to soothe jittery nerves, however, they continued to urge vigilance, further mixing up a by now confused public. New York Times columnist Thomas L. Friedman, in a Feb. 23 op-ed piece, asked, "Are we going to drive ourselves crazy long before Osama bin Laden ever does?"
That question is on many minds as the nation struggles to distinguish between legitimate concern and hasty panic. The range of answers, according to experts, varies from apathy to fear, with the entire population affected in some way. For those already suffering from mild-to-severe mental illnesses, practitioners will need to factor in the additional burdens created by terrorist alerts as people trigger coping mechanisms to deal with new anxieties.
"It is a stressor, but in the face of all stressors some will respond with positive coping, others by withdrawal, some by discovering new parts of life they had forgotten, and some by feeling frightened and overwhelmed," Robert J. Ursano, M.D., chair of the department of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and director of its Center for the Study of Traumatic Stress, told Psychiatric Times. "For some, it may reassure us that what we've been most frightened about is actually true. For others, it's an additional burden added on to a world that already seems overly frightening. And to others, it may be an opportunity to join with other people, where before they've stayed withdrawn and not had a way to discuss [their fears]."
According to Ursano, part of the problem is that the media chooses to report on updated and revised instructions as contradictions, a practice that heightens confusion and worry. "The confusion is a part of these settings, and we can all work together to help clarify, rather than point at, confusion and say something is going wrong," said Ursano.
However, Lee Wilkins, Ph.D., a professor at the University of Missouri School of Journalism in Columbia who consults and conducts research on topics relating to risk communications, explained to PT that there were problems with the way the Homeland Security Department handled the latest alerts. While Wilkins agreed that there will be a certain amount of uncertainty during alerts, media reports that the latest government warnings were distorted were accurate. Other agencies more experienced in disaster responses have exhibited better communication skills during past crises.
"Certainly the message about the terror threat, the one involving plastic and duct tape, was, from a risk-communication point of view, particularly ill done," Wilkins said. "It told people that they should do something, and it gave them only a very general idea as to why. It didn't provide any cues as to when it may be appropriate to do this ... [and] it was, in many ways, overly broad. ... The notion that we have this one-size-fits-all response when the threat is something airborne--could be chemical or could be biologic--is certainly ill-done and certainly doesn't follow any of the recommendations of the Environmental Protection Agency or anyone else that works with this sort of stuff on a systematic basis."
Acknowledging that Code Orange precautions lacked clarity in the early stages, Ann E. Norwood, M.D., chair of the American Psychiatric Association's committee on psychiatric dimensions of disaster, said that later official communiqu,s helped demystify the recommendations so people could act more appropriately. Depending on the region of the country, however, people perceived the level of risk differently--and so reactions ranged widely.
For mental health care clinicians working under myriad circumstances and influences, Norwood explained that it is important to watch patients to see if they become unduly anxious and to help them put things in perspective. "On the other hand, I don't think one can offer the false reassurance that nothing terrible is going to happen, because it very well might."
For Frank Ochberg, M.D., clinical professor of psychiatry and adjunct professor of journalism at Michigan State University, who also chairs the executive committee of the Dart Center for Journalism & Trauma, focusing on any single aspect of the message or the messenger is not what is key. "It's about whether in general we have the kinds of conversation between the government and the governed," said Ochberg in an interview with PT. "It's a two-way conversation that either leaves us all feeling as truly informed participants, or has us feeling manipulated and patronized, or has us feeling bewildered, confused and demoralized because there's an appearance that our government leaders are confused or confusing."
The whole population, therefore, is affected to varying degrees, Ochberg said, making the message sent by the government and the way that message is communicated by the media critically important.
"Part of what is going on is some people are legitimately frightened, while others get lulled into complacency or denial and are not as frightened," Ochberg said. "When your coping mechanisms work, they keep your anxiety within tolerable limits while you attend to the task ahead and you maintain your morale and maintain your relationships with significant others. When your coping mechanisms fail, you're not effective; you're alienated from the very people who could support you, understand you, and help you; you are demoralized; and you're anxious."