Anxiety After 9/11

Such changes are coming to pass, but the altered American landscape includes more than security measures and ID cards. On September 11, terrorists did more than destroy buildings; they scarred the American psyche. The details are telling: Pharmacists report an increased demand for anti-anxiety drugs and the antibiotic Cipro, and some HMOs have seen a 25 percent increase in calls.

We are having difficulty grappling with our sudden loss of security. In the weeks immediately after the attacks, a survey of 668 Americans by the Institute of Social Research in Ann Arbor, Michigan, reported that 49 percent of participants felt their sense of safety and security had been shaken. And some 62 percent of respondents said they had difficulty sleeping. In another poll of 1,015 Americans conducted by the Harvard School of Public Health and the Robert Wood Johnson Foundation, 57 percent had taken steps to protect themselves—such as taking precautions when opening mail and avoiding public events.

In place of invulnerability, many people now harbor a small and disquieting fear—a fear of attack by unseen agents at unexpected times using unthinkable weapons. The most common objects or occurrences have now assumed horrific resonance. A plastic knife is no longer a utensil packed for a picnic, but a means to mass murder.

Psychologists study many kinds of fear. There are common phobias, such as the fear of spiders, and post-traumatic stress—the fears that spring from memories of dramatic, sometimes life-threatening events. But because most Americans are far removed from New York City and Washington, D.C., other sorts of fears are probably at work. In particular, psychologists will look for symptoms of generalized anxiety disorder, which creates an exaggerated fear response in people who have been emotionally scarred.

Over time, the general level of anxiety should ease. But some long-lasting effects will remain, and a few things will never be the same.

A man on a flight to San Jose, California, opens an envelope and a powdery substance spills out. A fellow passenger alerts the flight attendant, reporting that he had dispersed the powder into the ventilation system. Once the plane lands, it is held on the tarmac for three hours and the FBI is called to investigate. The "powdery substance" was confetti enclosed in a greeting card.

Such an overreaction shows just how fearful ordinary people are. But there is nothing wrong with feeling fear: We all do at some point. Fear is one of the most basic emotions and is not, in itself, dangerous; it is part of a natural alarm system designed to react to or anticipate danger. And though that system was first employed to avoid natural predators—a lion on the prowl, say—it has been adapted over time to deal with abstract threats or even social situations. For some, a letter filled with a powdery substance or the sight of a man wearing a gas mask would create a distinct sensation of fear, even panic, though it would be hard to explain the exact threat to someone who lived just one hundred years ago.

Although the reaction to fear is perfectly natural, it can be unpleasant. Fear begins in the amygdala, a cluster of cells deep in the most primitive part of the brain that weighs information for emotional content and possible threat. If a threat is sensed, the amygdala sends out immediate signals. Simple reflexes are set off: a jump or a shout. And the adrenal glands in the kidneys begin pumping adrenaline and noradrenaline, two chemicals that act as messengers to trigger reactions all over the body. A rush of adrenaline and noradrenaline causes the heart to race, breathing to quicken, pupils to widen and saliva to dry up. In the extreme, it is common to experience hyperventilation, dizziness, trembling and even nausea.

Another physical reaction is a change in the blood's circulation pattern—the vessels close to the skin constrict so that more blood is available to the large muscles. This redistribution is important because muscles in the arms and legs might be needed to run from or fight off an attacker. But it creates a distinct physical sensation—the blood running cold or a chill down the spine.

As an outgrowth of this ancient alarm system, fear also weakens the ability to concentrate. People who are anxious often complain that they are easily distracted from daily chores. That's a normal part of the fear response: One of the most important aspects of dealing with danger is finding out where it is coming from. Instead of focusing on small tasks, the brain cries out to scan the environment and find the threat. In the distant past, the threat might have been a predator in the bushes. With the current threats coming not from tigers but from terrorists, people most often study the newspaper looking for clues to potential danger.