There is no doubt that 9/11 changed the way many Americans viewed the security of our nation. What editors Bruce Bongar, Lisa M. Brown, Larry E. Beutler, James N. Breckenridge and Philip G. Zimbardo do in their book, Psychology of Terrorism, is question the psychological, rather than the physical, legacy of terrorism. They present the newest findings on treatment of and clinical responses to terrorism along with their respective underlying theories. They attempt to answer one of life’s toughest questions: How can we confront fear itself? Below we have excerpted a piece from the opening chapter by Bruce Bongar, “Defining the Need and Describing the Goals.”
It is impossible to say anything that is able to give a true idea of it to those who did not see it, other than this, that it was indeed very, very, very dreadful, and such as no tongue can express. Daniel Defoe, Journal of the Plague Year.
The heinous events of September 11, 2001, have forever changed our awareness of the impact of mass casualty terrorism. Ariel Merari (personal communication, January 30, 2003) has stated that the only factors constraining the terrorists who seek to destroy us are practical and technical, not political or moral. Among the lessons learned by Merari and others on the front lines is that the strategic intent of modern terrorists is to create huge numbers of secondary psychological casualties by means of large scale physical attacks. In the 1970s it was often repeated that terrorists ‘‘want a lot of people watching, not a lot of people dead’’; today it is more accurate to say that terrorists want a lot of people dead—and even more people crippled by fear and grief.
Government and military officials acknowledge that we are currently unprepared to care for the large numbers of medical and psychological casualties that would result from an attack involving weapons of
mass destruction (WMD) and or bioterrorism. National authorities such as Leon E. Moores, a physician at the Walter Reed Army Medical Center, have calculated that the number of casualties from a WMD attack would be in the thousands but that the long-lasting psychological consequences would have a devastating affect on millions of people.
Military psychologists have long known that fear, stress, and exhaustion cause more casualties than do bombs and bullets. The ratios of psychological to physical casualties can be enormous; for every one death directly caused by an Iraqi Scud missile attack on Israel during the Gulf War, there were 272 hospital admissions resulting from clinical psychological emergencies. The March 20, 1995, sarin attack in the Tokyo subway killed 12 people and caused more than 4,000 nonaffected individuals to go to area hospitals, often with psychogenic symptoms of chemical injury (World Health Organization, 2001).
Clearly, the impact on society can be much greater than initial casualty rates might imply. The long-term psychological impact of the use or even threat of WMD is difficult to predict. Changes in daily activity, depression and suicide rates, and economic impact can last for years or even decades, and current disaster experts have no models to predict the ultimate need for psychological assessment or treatment services. Many experts contend, based on the Israeli experience and other similar venues (e.g., Northern Ireland) that the strain on the medical resources and psychological strength of a society could potentially be crippling. (Moores, 2002)
At present, the psychological science needed to provide proper and effective treatment for victims of horrendous events such as September 11 and for future potential terrorist events (including the use of WMD) simply does not exist. Despite a wealth of information about psychological assessment and intervention following severe individual trauma (e.g., combat, rape), natural disasters, and airplane crashes, for example, there is no widespread scientific or clinical consensus regarding the efficacy of these treatment interventions with people who are directly affected by a terrorist attack. A similar scarcity of scientific data exists regarding appropriate treatments specifically designed for people not directly exposed to, but struggling to cope with, actual or threatened terrorist acts. Obviously, such effects are magnified by the 24/7 news cycle and the widespread availability of Internet connectivity.