Skip to main content

Advertisement

SpringerLink
Log in

Stories Behind the Symptoms: A Qualitative Analysis of the Narratives of 9/11 Rescue and Recovery Workers

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

A qualitative study of the experiences of rescue and recovery workers/volunteers at Ground Zero following the terrorist attacks of 9/11/01 is reported. Information was extracted from a semi-structured clinical evaluation of 416 responders who were the initial participants in a large scale medical and mental health screening and treatment program for 9/11 responders. Qualitative analysis revealed themes that spanned four categories— occupational roles, exposures, attitudes/experiences, and outcomes related to the experience of Ground Zero. Themes included details regarding Ground Zero roles, grotesque experiences such as smells, the sense of the surreal nature of responding, and a turning to rituals to cope after leaving Ground Zero. These findings personalize the symptom reports and diagnoses that have resulted from the 9/11 responders’ exposure to Ground Zero, yielding richer information than would otherwise be available for addressing the psychological dimensions of disasters. This work shows that large scale qualitative surveillance of trauma-exposed populations is both relevant and feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington D.C., American Psychiatric Association, 2000

    Book  Google Scholar 

  2. Batanji R, van Ommeren M, Benedetto S: Mental and social health in disasters: relating the social science research to the Sphere standard. Social Science and Medicine 62(8):1853–1864, 2006

    Article  Google Scholar 

  3. Bracken PJ, Giller JE, Summerfield D: Psychological responses to war and atrocity: The limitations of current concepts. Social Science and Medicine 40(8):1073–1082, 1995

    Article  PubMed  CAS  Google Scholar 

  4. van der Kolk BA: The body keeps score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry 1(5):253–265, 1994

    Article  PubMed  Google Scholar 

  5. Wilson JP, Friedman MJ, Lindy JD: Treatment goals for PTSD. In: Wilson JP, Friedman MJ, Lindy JD (Eds) Treating Psychological Trauma and PTSD. New York, Guilford Press, pp. 3–27, 2001

    Google Scholar 

  6. Katz CL, Nathaniel R: Disasters, psychiatry, and psychodynamics. Journal of the American Academy of Psychoanalysis 30(4):519–530, 2002

    Article  PubMed  Google Scholar 

  7. O’Kearney R, Perrott K: Trauma narratives in posttraumatic stress disorder: A review. Journal of Traumatic Stress 19(1):81–93, 2006

    Article  PubMed  Google Scholar 

  8. Tuval-Mashiach R, Freedman S, Bargai N, Boker R, Hadar H, Shalev A: Coping with trauma: Narrative and cognitive perspectives. Psychiatry 67(3):280–293, 2004

    PubMed  Google Scholar 

  9. Ambramowitz SA: The poor have become rich, and the rich have become poor: Collective trauma in the Guinean Languette. Social Science and Medicine 61(10):2106–2118, 2005

    Article  Google Scholar 

  10. Gerson RRM, Qureshi KA, Rubin MS, Raveis VH: Factors associated with high-rise evacuation: Qualitative results from the World Trade Center evacuation study. Prehospital and Disaster Medicine 22(3):165–173, 2007

    Google Scholar 

  11. Smith RP, Katz CL, Holmes A, Herbert R, Levin S, Moline J, Landsberghis P, Stevenson L, North CS, Larkin GC, Baron S, Hurell JJ: Mental health status of World Trade Center rescue and recovery workers and volunteers – New York City, July 2002-August 2004. Morbidity and Mortality Weekly Report 53(35):812–815, 2004

    Google Scholar 

  12. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA: Psychometric properties of the PTSD Checklist (PCL). Behavioral Research and Therapeutics 34(8):669–673, 1996

    Article  CAS  Google Scholar 

  13. Kessler RC, Sonnega A, Bromet E: Post-traumatic stress disorder in the national co-morbidity survey. Archives of General Psychiatry 52(12):1048–1060, 1995

    PubMed  CAS  Google Scholar 

  14. Spitzer RL, Kroenke K, Williams JB, and the Patient Health Questionnaire Primary Care Study Group: Validation and utility of a self-report version of PRIME-MD. Journal of the American Medical Association 282(18):1737–1744, 1999

    Article  PubMed  CAS  Google Scholar 

  15. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R Psychiatric Disorders in the United States. Results of the National Comorbidity Survey. Archives of General Psychiatry 51(1):8–19, 1994

    PubMed  CAS  Google Scholar 

  16. Ewing JA: Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association 252(14):1905–1907, 1984

    Article  PubMed  CAS  Google Scholar 

  17. Leon AC, Olfson M, Portera L, Farber L, Sheehan DV: Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry and Medicine 27(2):93–105, 1997

    CAS  Google Scholar 

  18. Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R: Differences in PTSD prevalence and associated risk factors among World Trade Center rescue and recovery workers. American Journal of Psychiatry 9:1385–1394, 2007

    Article  Google Scholar 

  19. Stellman J, Smith R, Katz C, Sharma V, Charney D, Herbert R, Moline J, Luft BJ, Markowitz S, Udasin I, Harrison D, Baron S, Landrigan P, Levin S, Southwick S: Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery and cleanup workers: The psychological dimension of an environmental health disaster. Environmental Health Perspectives 116(9):1248–1253, 2008

    Article  PubMed  Google Scholar 

  20. Katz CL, Smith R, Herbert R, Levin S, Gross R: The World Trade Center worker/volunteer mental health screening program. In: Neria Y, Gross R, Marshall R, Susser E (Eds) 9/11: Public Mental Health in the Wake of a Terrorist Attack. Cambridge, Cambridge University Press, pp. 355–377, 2006

    Google Scholar 

Download references

Acknowledgements

The Department of Psychiatry, Mount Sinai School of Medicine and Disaster Psychiatry Outreach assisted in development and administration of the mental health aspects of the World Trade Center Worker and Volunteer Medical Screening Program. We are indebted to the many organizations and staff members who worked to inform WTC responders of the program and facilitate their participation. Special thanks to the Robin Hood Foundation Relief Fund, the American Red Cross Liberty Fund, The September 11th Recovery Program, The Bear Stearns Charitable Foundation, The September 11th Fund, and many others. This work was supported by the Centers for Disease Control and NIOSH, contract 200-2002-00384 and grants U1O 0H008232, U10 OH008225, U10 UOH008239, U10 OH008275, U10 OH008216 and U10 OH008223. The views expressed in this article are those of the authors and do not represent the views or policies of the Department of Health and Human Services or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Corey B. Bills

  2. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    Nancy Dodson

  3. Department of Environmental and Occupational Health Sciences, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Jeanne M. Stellman

  4. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Steven Southwick

  5. Department of Psychiatry, The Mount Sinai School of Medicine, Box 1230, One Gustave L. Levy Place, New York, NY, 10029, USA

    Vansh Sharma & Craig L. Katz

  6. Department of Community & Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Robin Herbert & Jacqueline M. Moline

Authors
  1. Corey B. Bills
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy Dodson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeanne M. Stellman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Southwick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vansh Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robin Herbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacqueline M. Moline
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Craig L. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Craig L. Katz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bills, C.B., Dodson, N., Stellman, J.M. et al. Stories Behind the Symptoms: A Qualitative Analysis of the Narratives of 9/11 Rescue and Recovery Workers. Psychiatr Q 80, 173–189 (2009). https://doi.org/10.1007/s11126-009-9105-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-009-9105-7

Keywords

Search

Navigation