Letters to the Editor
The World Trade Center Disaster
The psychological impact of the World Trade Center disaster was more significant than similar previous incidents, partly because of the live television coverage. I report 3 cases of patients affected by this trauma.
On September 20, 2001, a 36-year-old man who is an assembly worker at a local factory was admitted through the emergency department of our general hospital. He was in a psychotic state, suffering from confusion and paranoia. Apparently, around September 11, a fellow worker of East Indian origin left the factory abruptly, and from that point on the patient was constantly worrying, assuming the worker to be in some way connected to the disaster. Although that particular worker returned to work after a few days, the patient continued to worry. He did not sleep adequately and ultimately became confused and needed hospitalization.
The patient had a history of 2 psychotic episodes, both precipitated by stress, that resolved completely within a week of treatment. There was no history of alcohol or drug abuse or any significant family history of mental illness. He has a stable marriage and has been functioning quite well at his workplace for the last 15 years. He stabilized within 24 hours of admission and was discharged after 3 days, with a prescription of quetiapine 100 mg, to be taken at bedtime.
A 52-year-old female outpatient suffering from dysthymic disorder and chronic anxiety, with a history of sexual abuse, was mentally stable prior to the disaster. Subsequently, she became increasingly depressed, anxious, and agitated. She suffered from insomnia and complained of nightmares in which her abusive ex-husband was the pilot of one of the planes involved in the disaster. This patient stabilized quickly with reassurance and the adjustment of her medications.
A 44-year old female outpatient suffering from major depression, chronic
anxiety disorder, and fibromyalgia, without a history of any phobias,
said she was housebound for 2 entire weeks after the disaster. She said
she was frightened and suspicious that if she left home she
would meet with some catastrophe. The patient also said that she had always
been tolerant toward different races, but after the disaster she developed
hostile and bitter feelings toward Arabs and felt guilty about it. The
patient responded to reassurance alone.
Lal Fernando, MD, DPM, MMed Sc, MRCPsych, FRCPC