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Stress Test

Terrorist Attacks Present New Challenges for Organization Devoted to Post-Traumatic Stress Disorder

By Molly Rath | Posted 10/3/2001

On Sept. 25, Esther Giller left her Towson office for lunch in Washington--and an unlikely mission.

Giller is the co-founder and executive director of the Sidran Traumatic Stress Foundation, a private, nonprofit purveyor of research, education, and advocacy regarding post-traumatic stress disorder (PTSD). Until Sept. 11, Sidran's 12 staffers stayed busy publishing self-help books for rape, accident, and combat survivors, penning guidelines for the mental-health professionals who treat them, and training the clergy who seek to comfort and heal them. In recent months, they've also worked to sensitize Baltimore City public-school personnel to the traumas many students face simply living in communities where neglect and violence are the norm.

After last month's terrorist attacks, though, Giller and company--like reams of other mental-health professionals across the country--were suddenly in huge demand. Sidran helps run an information line that usually handles 10 to 15 calls a day; since Sept. 11, it has been fielding more than 200 a day. Sales of its books and tapes have soared, and the foundation, previously known strictly in mental-health circles, has become the expert voice on PTSD for media outlets ranging from Newsweek to MSNBC.com.

The calls for help have run a gamut even the 49-year-old Giller couldn't have imagined. (Disclosure: Giller is married to Baltimore artist Craig Hankin, a City Paper staffer during the paper's first several years of operation, in the 1970s and '80s.) Case in point: Sept. 25. Giller traveled to the Health Resources and Services Administration, an arm of the U.S. Department of Health and Human Services, presumably to do what she'd done for other agencies and organizations--provide help and resources for employees. Instead, she found herself consulting on an initiative started earlier this year by President Bush to investigate church burnings. There have been 200 such incidents a year in the last three years, and officials with the initiative fear that synagogues and mosques will be targeted in the wake of the terrorist attacks.

"The fact that there really is a faith component to this crisis and people are being targeted because of their Islamic beliefs--there is a sense that we really need to be up to speed on this," Giller says. "We generally think of clergy as being the helpers, and we [at Sidran] have been working on developing materials for clergy. But this is a difficult situation because, in this situation, the clergy are the victims."

If making ready to treat potential PTSD among Islamic clerics seems a remote extension of the events of Sept. 11, it underscores the scope of the disorder and the tenets underlying its treatment. "From combat to rape to child abuse to domestic violence to community gun violence and so forth, it's all very related," Giller says. "It's about how humans respond to violence, and interpersonal violence and betrayal."

Meanwhile, the terrorist attacks have given Sidran an unprecedented platform for doing what it set out to do 15 years ago. For Giller, it is perhaps the starkest proof since the foundation was founded that a mission borne out of one person's experience can affect millions.

"On Sept. 11, the roof blew off, so to speak, and we've really been doing a lot of media and educational opportunities. Fortunately, we were positioned so that when this happened we were able to help," she says. "It's one of those terrible opportunities. When something high-profile happens, it brings a lot of attention to your issue, and you have to make it into an opportunity to educate. And that's where we find ourselves."

Sidran was founded by Giller's family in 1986, after the assault of a close family member culminated in a life-threatening medical crisis. At the time, understanding of PTSD in the mental-health field was extremely limited, and symptoms such as hallucinations and flashbacks were typically misdiagnosed as schizophrenia. Giller's relative was misdiagnosed, mismedicated, and had a physical reaction that nearly resulted in death.

"The family decided at that point that doing the research, advocacy, and education that was required to help us through the crisis gave us a unique knowledge base that we didn't have before and wasn't really available," Giller says. "We decided that we really needed to share what we had learned and create a place that people could turn."

Giller's maternal grandmother, Kate Sidran, tapped the fortunes of Sidran Inc., a family-owned clothing manufacturer in Dallas, to fund the foundation, and Giller quit her job at Johns Hopkins University Press to run it, drawing on the personal knowledge she'd gleaned as well as professional contacts she'd made while editing Hopkins Press works related to mental health and trauma, primarily in the field of child abuse. Initially formed as a clearinghouse for information on PTSD, Sidran has since expanded into publishing, and into creating and conducting training workshops for professionals who help people with PTSD.

The federal National Center for Post Traumatic Stress Disorder, an arm of the Department of Veterans' Affairs, defines PTSD as a "serious public-health problem in the general population" that affects more than 10 million Americans at some point in their lives. Sidran estimates that 20 percent of trauma victims overall experience PTSD; for victims of particular traumatic experiences, such as rape and child abuse, that number reaches 60 to 80 percent. According to the American Psychiatric Association, the disorder can be diagnosed when symptoms--which can include nightmares, flashbacks, fear, agitation, hypervigilance, depression, and anger--last more than a month. But for many sufferers, the onset is more delayed and can linger much longer.

Interest in--and knowledge of--PTSD swelled in the years after the Vietnam War, but until the 1980s it was considered only a disorder among veterans; trauma disorders in the realms of child abuse, domestic violence, and rape were deemed a different condition, leading to the coining of terms like "rape trauma syndrome." The notion that all these forms of post-trauma stress were related didn't really take hold until well into the 1990s, Giller says. (Sidran is one of only a handful of organizations dealing with PTSD in the country that are geared toward the general public; others focus on doctors, mental-health professionals, or specific patient groups such as veterans.)

Before this year, the Baltimore City Public School System exemplified the narrow approach to trauma that until recently dominated its treatment. Staffers knew how to perform crisis intervention--say, when a school shooting occurred--but they "really didn't have a good foundation in the impact of trauma," says Robert Hull, who trains school-system psychologists and social workers in handling crisis situations. "We have a huge percentage of our children who are exposed to violence, who are abused, who are neglected." So this past summer, Hull hired Sidran to conduct a three-day workshop for the school system's mental-health personnel.

But nothing in Sidran's relatively brief history has changed the public view of post-traumatic stress disorder like Sept. 11. "Suddenly," Giller says, "people in a much broader kind of way are interested in the whole phenomenon of PTSD."

Corporations are asking Sidran how to tend to employees affected by the terrorist attacks, and the national Office for Victims of Crime is referring Pentagon families and their children's schools to the foundation's reference materials. Sidran has also fielded reams of queries related to PTSD relapses.

"[One] thing we've been dealing with in the immediate aftermath is people who have prior histories of trauma--this [the terrorist attacks] acts like a trigger and sets something off that is more complex," Giller says. "For example, a victim of childhood abuse who later in life found him- or herself in a domestic-violence situation or a terrible car accident. When this happens, it reawakens all of those feelings of danger and loss this person may have developed as a result. It is sort of a secondary wounding."

But mostly the pleas for Sidran's help have come from people without trauma histories who are experiencing symptoms such as nightmares, depression, and fear and wondering whether they have PTSD. "And mostly what we're saying is, 'No, what you're feeling is normal. Give yourself time to feel what you're feeling, to get back into your regular routines,'" Giller says.

"Those are all symptoms of PTSD, but what they are also are normal responses to overwhelming stress. It's a physiological thing," she says. "When we're in danger, our bodies are adaptive. People who are actually directly affected by losing a family member or being one of the thousands of people who escaped, they're dealing with their own immediate acute, stressful things. It could be years before [they] start to feel symptoms or disruption in their lives."

Given the way the disorder works, the real work for the 15-year-old foundation may be just beginning. Giller says she is preparing. Any day now, she expects to hire a second full-time person to handle hotline calls, and for the first time Sidran is scheduling media appearances and working on public relations.

"I have very ambivalent feelings about it, because in a way it seems like marketing. But it is something we have to maximize," Giller says. "We've been doing this work for 15 years and we now have an opportunity to educate the public, and we have to rise to that opportunity."

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