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This article by Kathleen McGinn Spring was prepared for the September 18, 2002 edition of U.S. 1 Newspaper. All rights reserved.

Post-Trauma Stress: A Stiff Upper Lip Is Not Always Best

Olga Vilko, age 81, a student at Hunter College, was

in class on September 11 when Manhattan was attacked. In school to

catch up on subjects she missed as a younger woman — art history,

and music, for example — Vilko made her way home calmly.

"She was able to get home. She didn’t get all upset," says

Dr. Naomi Vilko, a Princeton psychiatrist and Olga Vilko’s daughter.

Olga Vilko is an Auschwitz survivor, as was her husband. Her behavior

on September 11 "shows how she survived intact," according

to her daughter, who reports that her mother’s attitude since September

11 has been "well, this happened. I’ll deal with it."

Not everyone has been able to cope as well. In her practice, with

offices at 419 North Harrison Street and in Manhattan, and through

the many volunteer lectures and counseling sessions she has given

during the past year, Vilko has met many of these people. On Friday,

September 20, at 8:30 a.m., she takes part in a free panel discussion

of "The Aftermath of 9/11: How to Cope with Medical, Psychological,

and Substance Abuse Issues," which takes place at the New Jersey

Hospital Association at 760 Alexander Road. Other panelists are Arnold

Washton, an alcohol and substance abuse specialist; and Mary

Guardino, founder of Freedom from Fear, a support group for individuals

suffering from anxiety. Call 609-924-3225.

Reactions to the 9/11 attacks vary by proximity, but the nearness

of the loss or the terror is not the only factor governing how the

attacks affect different individuals. Vilko brings personal perspective

to understanding this issue. Her parents survived the Holocaust and

were forced to flee their homeland, yet neither suffered major depression

or fell into substance abuse.

"I was lucky," she says. While her parents were able to nurture

her, she saw that "many of their friends were not able to parent."

The difference is not a matter of strength of character, but rather

a matter of biology. Presented with unimaginable horror, some people

develop heart disease or cancer, others are possessed by anxiety or

depression, and a lucky few continue pretty much as before. When the

reaction is acute anxiety or depression, the circle of suffering can

go on and on.

"I worry about the parents," Vilko says. "They can become

so dysfunctional. Maybe they are able to function better at work than

at home. They are not able to give their children what they need."

More than 50 years after the Holocaust, she sees the effects of post-traumatic

stress syndrome in parents reflected in their children — and in

their grandchildren. The same cycle could begin again, she says, if

victims of the September 11 attacks who are still not functioning

well a year later do not get help.

Vilko, who is married to Princeton urologist Dr. Sidney Goldfarb,

is the mother of three children, age 18 to 22. When her youngest child

went off to school, she began giving talks on mental health. "I

don’t bake," she says, "so I thought I might as well do something

I can do." Now she is considerably busier, teaching at Robert

Wood Johnson University Hospital, and running a new business, Vilko

Corporate Consulting, in addition to attending to her private practice.

Yet she still gives substantial time to informing groups about the

help available for post-traumatic stress syndrome and other psychological

disorders.

Urging people to get help is an easier sell now than it was in the

years after her parents made their way to this country. Holocaust

survivors did not talk much about what they had been through, she

says. A consequence, she says, is that fully 65 percent of them still

suffer from post-traumatic stress syndrome more than 50 years later.

In the Inwood section of New York City, where she grew up, Vilko saw

that stoicism was not limited to those who had lived through the Holocaust.

Many neighbors were fire fighters and police men. "The culture

is stiff upper lip," she says. It’s "I’ll help other people.

If I’m not feeling well, I’ll take a drink."

There has been a change, but perhaps not enough change.

Depression and anxiety still often are seen as signs of weakness.

With September 11 there are other forces at work as well, says Vilko.

Those who are alive because they were late for work or because they

found a way out of the burning buildings may suffer from survivor’s

guilt, and may feel that their sleeplessness or fear of travel is

minor and not worthy of treatment.

"There are 25,000 people who escaped," says Vilko. "I

don’t think enough are getting help."

A woman Vilko treated was in the south tower when the planes hit.

Her husband was in the north tower. Both survived. Under Vilko’s treatment,

the wife took medication and had several counseling sessions. After

a month, "she was back to herself," says Vilko. Her husband

refused treatment and after a year, she says, "still has a lot

of symptoms."

While anyone who was in New York during the attacks — let alone

anyone who lost a relative or escaped from the World Trade Center

— could be expected to show some signs of post-traumatic stress

disorder, the circle is larger still. In central New Jersey there

are thousands of people who travel to the city every working day,

and many more people who spend time there for business or pleasure.

Vilko, for example, who delivered mail at the World Trade Center when

she was in college, attended a meeting there shortly before September

11.

In central New Jersey, perhaps more than any place other than Manhattan

itself, last fall was uniquely traumatic for nearly everyone. "We

had anthrax," explains Vilko. Some of her friends and patients

had maintained emotional distance from the attacks on New York. They

were living suburban lives, she says, never venturing into Manhattan

or Philadelphia. But when it became known that the anthrax-laced letters

were sent from the Hamilton post office, any sense of invulnerability

fell away.

"It was like AIDS when it first happened," Vilko says. "People

were very suspicious. It could be anywhere."

Enduring two types of terrorism — and numerous alerts from Washington

that more trouble could well be imminent — took a toll on many.

For some, the effects linger. Here are some thoughts on what to do

next.

Get help. Psychological pain is not all that much different

from physical pain. It comes in all degrees of intensity. Comparing

it to arthritis, Vilko says one person might need a little medicine

for joint soreness while another might need a hip replacement. Likewise,

people are who suffering mild symptoms of anxiety a year after September

11 would benefit from group counseling or a few sessions with a social

worker. Anyone with more severe symptoms needs to see a psychiatrist.

In most cases, says Vilko, a combination of medication and counseling

— – combined with the passage of time — will return those with

post-traumatic stress disorder to normal, or at least to an ability

to cope.

"If you don’t do it for yourself, do it for your children,"

Vilko urges.

Give help. There are few things that work as well to dispel

grief and anger as helping those who suffered the most. "Especially

now, after the first anniversary," says Vilko.

Stop the warnings. Of Washington’s code yellows and code

oranges, Vilko says, "It’s ridiculous! And very upsetting to children."

Warnings that mail may be contaminated with anthrax are helpful and

necessary, in her view. Warnings that something bad may happen some

place at some time are not. Tune them out, and, if possible, keep

them from children.

One source of comfort is that the first anniversary is behind

us. The concept of an "anniversary effect," says Vilko, is

real. She suspects that humans are hard-wired to bring up memories

as anniversaries and major holidays approach. Her father died 40 years

ago, when she was 10, and she becomes sad each year in June, around

the date of his death. The good news is that the sadness is less acute

as the years roll along.


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