Stress Pós-Traumático: 10 anos e um diagnóstico tardio, lembranças do 11 de setembro assombram milhares (10 Years and a Diagnosis Later, 9/11 Demons Haunt Thousands)

In the safety of her therapist’s office in late 2001, Dr. Margaret Dessau made a tape reliving what it was like to look out her living room window after she heard the boom of a hijacked plane eight blocks away.

Running naked from her bath, she saw pigeons and paper flying through the air. “It’s kind of beautiful in a way,” she recalls on the recording she made and listened to over and over as part of her treatment. “There’s these silver pieces just floating in the air.”

Her gaze met the hole in the tower. “The flames get worse, and then I start seeing all these people hanging out there. The guy with this white towel, and he’s waving it.”

He jumps. Children at a nearby school scream.

“How are you feeling?” her therapist, David Bricker, is heard asking on the tape.

“I start crying,” she replies.

Dr. Dessau’s husband yells at her, “Stop looking at it, stop looking at it.” But, she says, “I can’t tear myself away from it.”

One measure of the psychological impact of 9/11 is this: At least 10,000 firefighters, police officers and civilians exposed to the terrorist attack on the World Trade Center have been found to have post-traumatic stress disorder, and in a kind of mass grieving, many of them have yet to recover, according to figures compiled by New York City’s three 9/11 health programs.

In interviews over the last several months, Dr. Dessau and others revealed a wide-ranging but consistent body of symptoms. They cannot sleep. They replay the disaster in their minds, or in their nightmares. They have trouble concentrating. They are jittery and overreact to alarms or loud noises. They feel helpless, hopeless, guilty and cut off from the people who are close to them. They avoid anything that reminds them of that terrible day.

Millions of dollars will be spent treating them over the next few years through the James Zadroga 9/11 Health and Compensation Act, passed by Congress in December, which provides $4.3 billion to compensate and treat people with 9/11-related illnesses.

Some are emergency responders and others who vainly searched the debris for survivors. But some were residents, commuters and office workers caught in the dust cloud. And others were passive witnesses with no direct connection to the attack other than proximity.

Because of lingering questions about the bounds of the PTSD diagnosis, which is only three decades old, people with mental problems are eligible only for treatment assistance, whereas people with physical ailments, in most cases breathing difficulties, qualify for both treatment and compensation. And money available to treat patients with the stress disorder might decline if the government concludes there is a link between certain cancers and 9/11, which would give cancer patients access to the same pool of money. Doctors are expecting a surge in PTSD patients with the coming 10th anniversary, as they have on each Sept. 11.

Charles Figley, professor of disaster mental health at Tulane University’s School of Social Work and a former Marine, advanced the concept of PTSD in a 1978 book on Vietnam War veterans. He said one reason the trauma had been so hard to shake was that it ripped at the most ordinary fabric of daily life.

The landmark is not a distant hill in Afghanistan that one will never see again. “It’s the places you see every day, where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played,” Dr. Figley said.

“You go into a combat zone and then you leave,” he added. “You don’t leave home. You return all the time.”

Ancient but Evolving Illness

“The Iliad” described warriors consumed by feelings of guilt, rage and grief. World War I had “shell shock,” and World War II had “combat fatigue.” PTSD has been found in survivors of Nazi concentration camps, fires and railway accidents. But it was not until 1980, after the Vietnam War, that post-traumatic stress disorder was added to the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders.

The current manual, the DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it. Almost no other psychiatric diagnosis has generated as much controversy, according to Dr. Robert L. Spitzer, a retired psychiatry professor from Columbia University and an expert in mental disorder classifications. It has become so vague that stressed-out college students and people who watched horror movies could fit the profile, he and two other experts wrote in a professional journal article.

“It’s a way of saying something terrible has happened to me and I’ve been damaged in some way, but that doesn’t necessarily mean it’s an illness,” Dr. Spitzer, who advocates tightening the criteria, said in an interview.

Some experts have been skeptical of studies finding that people suffered the disorder from watching television coverage of the Sept. 11 attacks. (Congress effectively excluded TV watchers from its treatment program by requiring that victims had lived or worked within certain geographic boundaries.)

Fonte: New York Times