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Dr. Marc Siegel
Confronting Iraq Special Report
"Vague Fears, Real Concerns," Post, Feb. 13, 2003
Talk: World Message Boards
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Coping With War
With Marc Siegel, MD
Associate Professor of Medicine
New York University

Thursday, Feb. 13, 1:30 p.m. ET

Last Friday the government raised the threat warning level to reflect "high risk" that al Qaeda will attack U.S. targets here or overseas. The designation is second only to "red," which indicates an imminent or ongoing attack. Businesses, institutions and individuals are preparing for the worst in light of heightened concerns about terrorist attacks.

"People are more vulnerable since 9-11 and that vulnerability leads to fear and the fear is a terrorist tool," said Dr. Marc Siegel, associate professor of medicine at New York University, in an interview with washingtonpost.com. "The treatment for their fear is realizing that the risks and the probability of anything happening to an individual are relatively low."

Siegel was online Thursday, Feb. 13 at 1:30 p.m. ET, to discuss the effects of the stress brought on by the terrorist alerts, what people may be feeling and how they can cope.

Siegel is a regular contributor to The New York Times, the Los Angeles Times, the Chicago Tribune, the New York Daily News, Diversion magazine and the Nation. On television he is a regular medical correspondent on CNN.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Washington, D.C.: How can the average person do to control anxiety about the war when that's all you hear about. The media's flooded with it. Should it be ignored and if so, how would one do that?

Dr. Marc Siegel: It shouldn't be ignored but it needs to be seen in perspective. For example, do not spend all your time watching the 24-hour news channels. If you did that, you would think that was all that was going on, but believe it or not, real life is continuing.

Arlington, Va.: How does the time we live in compare to other generations? Are there now added reasons and conditions for feeling more stressed out in than previous times?

Dr. Marc Siegel: Conditions that existed in previous times have just become too remote. I certainly remember growing up in the Cold War with air raids, siren, emergency alert systems and drills where I hid under my desk at school.

Arlington, Va.: What kind of medical supplies should folks stock up on? Tylenol? Cipro? Surgical masks?

Dr. Marc Siegel: For fear of chemical weapons, plastic sheets and duct tape have been mentioned. I am not for the stockpiling of antibiotics since the use of them may be unnecessary and require a prescription besides. Putting away a few days of food and water is not unreasonable, but put it away and forget about it and go on with you life.

Harrisburg, Pa.: You teach at NYU in lower Manhattan, which is not too far from the financial district. How are residents in lower Manhattan taking to the heightened security alerts?

Dr. Marc Siegel: Good question. People that are in proximity to Ground Zero are more susceptible to flashbacks and/or stress, but for them too, it must be business as usual.

Intern Desk, Capitol Hill: How are soldiers treated for prewar stress? Is there any danger in overmedicating our troops?

Dr. Marc Siegel: You're right. The use of anxiolytics (Valium, etc.) could make a soldier groggy when he/she might be going into combat, which is problematic. Therefore, the treatment is not likely to be medicine but emotional support. I realize the military may be short on emotional supoport. This area obviously needs work in the military.

Arlington, Va.: How should parents address the fears of their children about possible terrorist actions?

Dr. Marc Siegel: My own opinion is that children do not have to be told the details of this situation. Children as always should be treated with love and role modeling. If you don't want your kids to panic, don't panic yourself.

Washington, D.C.: Thanks for this chat. I love living and working in Washington and don't want to leave. But at what point does staying in a terrorist target become irrational and foolhardy? How do we balance the desire to live our lives and "not let the terrorists win" with common sense?

Dr. Marc Siegel: Not yet. Nnot even close. We don't let the terrorists win by not giving in to the fear. The terrorist's tool is terror. The risks of something happening to you as an individual are low.

Springfield, Va.: How would you compare the stress impact of the Cold War era, Cuban Missile Crisis, etc., with the fears we have faced currently, i.e., 9-11, the sniper, the current situation? Was it more stressful back then or now? Thanks.

Dr. Marc Siegel: Good question. More stressful now, because we're not used to it. Then we were desensitized over years. We had time to adjust. I would guess that the risks of a megaton hydrogen bomb being pointed down our throats was greater than what we are experiencing now (in terms of actual risk on a large scale).

Kensington, Md.: I feel very angry about the irresponsibility of our government leaders towards the public in their movement towards war. What do you suggest is a constuctive way to deal with this anger?

Dr. Marc Siegel: By going on with your daily activities and not letting the news get to you. The public has never dictated policy, except perhaps in the voting booth.

Somewhere, USA: I agree. The probabilty of one being killed in a terrorist attack is quite unlikely. A person has more chance of being killed by lightning than a terrorist.

However, I am still quite upset with Bush and the media. They are blowing this latest terror warning way out of proportion.

Bush and his friends in the media are trying to scare people into a war with Iraq and that is shameless.

Thank you for allowing my say.

Dr. Marc Siegel: You're welcome. Nnot sure what the government's motivation is entirely.

Washington, D.C.: I am SICK of it and it hasn't even started. I work across from the White House -- they are making plans for the demise of our building -- I am TENSE TENSE TENSE. I don't want to be here ....

Dr. Marc Siegel: Relax -- easy to say I know. The risks of something happening on a grand scale seem to be quite low, still. An ocean separates us from other continents. We used to be isolationist, remember. Now we are not, but we are still pretty well protected over here, in my opinion.

New York, N.Y.: Dear Dr. Sigel,

Is it normal to swing from extreme emotion to extreme emotion these days? Sometimes I think there's nothing I can do, and based on where I live and work in the city chances are that I won't be personally affected by many of the things people are talking about (though you never know) so I'm trying just to live my life day to day. Sometimes, though, I get so overwhelmed and freaked out that I can't eat, sleep or work, and I just sit around on the verge of tears, wishing I could get the courage to leave my job and graduate school and move somewhere else.

What is a "normal" reaction to all that's going on? How can I tell if I'm making the right decisions about how prepared to get? And why is it that I, who work in the design industry and have almost nothing to do with news at all, am all freaked out, while my husband, a cable news producer, seems to be able to accept that things are going to be tough and strange but he can go on living his life?

Thank you so much for your help.

Dr. Marc Siegel: Your emotional swings are normal under the circumstances, but I wouldn't suggest spending your time getting prepared. I think you should go about your daily activities, and gradually accommodate to the increased risks. The increase in risk is slight, in my opinion, and that knowledge should hopefully comfort you, help you to cope.

Washington, D.C.: Should people who can't control their nervousness about an impending war get medical prescriptions from their doctors to control the anxiety?

Dr. Marc Siegel: I'm glad you asked that question. Yes, you should see your physician if the stress is getting to you, and yes, he or she should consider an anti-anxiety medicine if you can't stop thinking about these things. I would also suggest sublimating your fears in other activities not related to this.

Glenmont, Md.: Why will it be therapeutic at this time for us to navel gaze into our inner child? Won't this indulgence in the weak pathetic parakeet male make us even more vulnerable to al Qaeda?

Dr. Marc Siegel: Get real.

Dr. Marc Siegel: If anyone out there is stressed over the terror alert -- please submit me your questions -- I'll be here another fifeteen minutes.

Washington, D.C.: How does one know that they're having an adverse reaction to the stress of thinking about an impending war?

Dr. Marc Siegel: You may not know. But if you are focusing on the news, find yourself increasingly fearful, irritable, disagreeable, with no other explanation, than this is a possibility that should be considered. Ways of defending yourself against these feelings include engaging in normal behavior (sublimation), and putting it out of mind (suppression).

Adelphi, Md.: Do I need to worry about making my own safe room?

Dr. Marc Siegel: No -- have a safe cache of survival supplies like the plastic, tape and food that everyone's talking about might be okay if you can put it away and not think about it in the meantime. The risk to individuals right now remains small.

McLean, Va.: Should you hide your true feelings when you're very upset at times like this?

Dr. Marc Siegel: No -- do not hide your feelings. Be honest about your feelings. By exploring them you can figure out what's bothering you, whether it's related to the threats or not. Hiding or ignoring your feelings is never healthy, especially at a time like this. In Israel, for example, where people have been on alert for decades, people tend to be open about their feelings.

Washington, D.C.: How many people have actually come to you in recent days or weeks and had problems with coping with the war? Have there been a lot of them? Should people seek the help of support groups if things get really bad?

Dr. Marc Siegel: Yes to both. In NYC, I'm hearing about this from most of my patients. Support groups are a good idea, as long as they don't put more attention on this problem than is already there.

Dr. Marc Siegel: This is a difficult time, mainly because we haven't made the transition yet from a country, surrounded by ocean, feeling invulnerable, to one that feels threatened. But the change doesn't mean that the threat is grave. We mustn't panic. We must live with a slightly increased risk, but not blow it out of proportion. Translate the uncertainty we feel into a sense of some small risk, with a low probability of something happening to us on an individual basis. Go about our daily business, become desensitized slowly to the threat. If we panic, we are giving the terrorists a greater impact -- it's what they want.

McLean, Va.: Thanks for the chat, I think your responses are informative and helpful. I suggest the "parakeet male" comment was maybe a subconscious reaction to stress in the form of sheer idiocy. What is the quickest and most effective way to calm oneself during these tense times?

Dr. Marc Siegel: You're probably right on that. Maybe I could have been more sensitive to the metaphor. Calm yourself using what has always worked for you the best -- and I don't mean to be cliched -- a vacation, a walk in the park, a glass of fine wine, a soak in a hot tub, etc.

Washington D.C.: Dr. Mark, I'm necessarily stressed (or am I?) by the alerts. But going back to the news images of 9/11. They were played over and over on TV and later in anniversary documentaries. And I can't get the orange ball images out of my mind. I've never seen fire so orange before and knowing that people were in those planes and buildings.

Dr. Marc Siegel: Over time, being exposed to images more usual and mundane than these will help them to abate. In the meantime, I would divert your attention with pleasurable activities

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