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The tragedy of 9/11 will long live in our emotional memories. Thousands died. Tens of thousands were affected by deaths of friends and relatives, Injuries, narrow escapes and economic reversals. Fear, anger and despair over-whelmed countless others.

Much attention has been paid to the psychological needs of those suffering the aftereffects. Reminders of 9/11, they are an ongoing focus of those who recognize the practical and emotional signifi-cance of the attacks.

While most people are returning to normal, others still live with daily distress. Who are the most affected? Some are among the most directly harmed: it takes a long time to recover from the death of a loved one. Some were already enduring a significant stress at the time of the attack: a divorce, a new child, a promotion or a financial setback. Some had few social supports to draw on: fewer now if they no longer have their office social network. Still others have a predisposition to depression, panic disorder or alco-holism: the attacks made their symptoms worse.

Many have some combination of these factors. Likewise, ongoing post-traumatic stress disorder (PTSD) is typically caused by a combination of such causes, By itself, a single event doesn't often trigger lasting emotional harm. PTSD is not an inevitable consequence of one emotionally traumatic experience: it is far more likely to be the proverbial straw that breaks the camel's back. Nor Is PTSD necessarily a chronic illness that must or should be tolerated for a long time. Just because someone has endured a tragic event doesn't mean they should have to keep on suffering,

Treating the Problem
Unfortunately, many of those still suffering have not found effective treatment, or even treatment at all, With all the attention to the psychological care of 9/11 victims, the importance of quality mental health care often gets lost in the shuffle. Media accounts of those with enduring pain make some of this clinical need clear. While depression and panic disorder are often hidden, even people whose symptoms seem obvious in a news-paper story have not been offered the specific medication and skilled psychotherapy that they need. Just as important, where hidden family and work problems may be major causes of distress, they can remain hidden unless addressed by a skilled clinician.

Merely labeling all symptoms after 9/11 as part of PTSD is not accurate or helpful. The label can obscure helpful solutions, or even lead to the notion that treatment would be of little value. And it is always dif-ficult for someone in distress to realize when better help is needed. Finding effective treatment starts with a thoughtful psychiatric interview, which looks carefully at all of the traumatic, symptomatic, spiritual, personal, family, work and medical issues. These issues may have started before, during or even after the attacks.

When patients find their way to the right treatment, their lives can get better swiftly. Therapy can untangle the complex interactions of traumatic events, personal concerns, family interactions and so many other issues. When the right medications keep painful and intrusive symptoms under control, people can feel better, make far more progress in therapy and more effectively seek real solutions to the practical problems in their lives. The tragedy will always be there, and many losses can never be compensated. But emotional lives can recover, and the business of life can go on.

Dr. Kahn is president of Manhattan-based WorkPsych Associates (WorkPsych@aol.com; www.WorkPsychCorp.com) providing executive assessment, development and treatment services, as well as management consultation. He is past president of the Academy of Organizational and Occupational Psychiatry and teaches at the Weill Medical College of Cornell University. He is also co-editor of the forthcoming Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians (Jossey-Bass: Fall 2002).

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