When an earthquake hit the Baltimore area recently, a familiar anxiety crept over Kimberly Anthony — not unlike her feelings after the terrorist attacks a decade ago.
Anthony, a Washington resident, still carries psychic scars from Sept. 11, 2001. She was headed to her job across the street from the Pentagon when the attacks took place, and though she now works as a data entry clerk in downtown Baltimore, her worries have led to commuting only by car.
"I just don't want to get on a train or a bus," she said. "The attacks made me a little more paranoid, a little more alert. I understand I'm more exposed to terrorism. … I was really scared during the earthquake."
Many Americans — even those who only watched the Sept. 11 attacks unfold on television — were traumatized by the events, medical experts say. And as the 10th anniversary of the attacks draws near, those feelings may resurface.
Still, researchers and observers who specialize in terrorism and disaster psychiatry say Americans learned to cope with their fears in the days, weeks and months after the attacks on the Pentagon and the World Trade Center in New York. They recovered from the trauma faster than expected.
"Most people are resilient, and that was a surprise. It was underestimated a decade ago just how resilient people are in general," said Dr. Anand Pandya, chair of the department of psychiatry at Cedars-Sinai Medical Center in Los Angeles and co-author of the textbook "Disaster Psychiatry: Readiness, Evaluation, and Treatment."
Surveys showed that in the first months after the attacks, more than half of Americans had nightmares or insomnia. They also said they were fearful and anxious.
But the issues tended to resolve quickly on their own, especially for people who weren't physically close to the targets, had suffered no previous trauma and had no underlying health conditions. Researchers found the farther from the attacks people were, the faster feelings dissipated and the less likely they were to develop post-traumatic stress disorder or major depression.
Marks on the American psyche do remain, experts say, but they largely credit strong social supports, religious beliefs, and even good political leadership for a widespread national recovery. Though Pandya expects some symptoms to resurface with the impending anniversary of the attacks, people will largely cope with those, too.
The lingering feelings of individuals, however, may be conflicted.
Anthony, for example, said she appreciates that she and her family escaped harm. She treasures more what she does have. She was able to return to work, though some co-workers never came back to the building, she said.
Such responses and opposing sets of emotions are not uncommon, said Dr. Steven S. Sharfstein, president and chief executive of Sheppard Pratt Health System, Maryland's largest behavioral health care organization.
He said feelings of shock, dismay, anger and sadness are normal after such a national trauma, but so are feelings of gratitude and fellowship. Americans had similar experiences when President John F. Kennedy was shot and when Pearl Harbor was bombed, he said.
"For Americans, in my opinion, there was always a sense of invincibility and exceptionalism and [the Sept. 11] events shattered that," he said. "People realized we can be vulnerable.
"At the same time, people really came together. They were reminded we are a community. It was something everyone across the country felt whether they were in New York, in rural areas in the Midwest, in a red state or blue state. Everyone reacted to this as Americans."
He said the anniversary may cause some people to relive the events — and the feelings. But that's normal and not a problem as long as the response doesn't involve turning to alcohol or drugs "to forget," or harming others, for example.
Dr. George Everly, an associate professor of psychiatry at Johns Hopkins University who specializes in the psychology of terrorism, said about 10 percent to 20 percent of people directly exposed to an event will develop serious aftereffects such as PTSD or depression. But even those sufferers can generally cope on their own within six months or so and adjust to a "new normal" — even one that includes security alerts or tight restrictions on airplane travelers.
Sept. 11 was different, though, because the attacks were televised live and the images repeated over and over. That may have meant fewer people emotionally insulated by their distance from New York or Washington, and more far-flung cases of distress than in past tragedies.
Everly noted that a study of flight attendants a year and a half after the attacks showed 18 percent had symptoms of PTSD, whether they were based on the West Coast or on the East Coast, where the planes were commandeered.
"Vulnerability is more than physical, it's psychological," he said. "And that now means what is 'direct exposure' is etched in Jell-O."
Still, he agreed that people are more resilient than experts had given them credit for 10 years ago. Everly even saw the same coping skills among ordinary people and the first responders in New York he treated after the 2001 attacks. (Though, for the most part, first responders' symptoms didn't surface until after their work was done.)
He also sees the same attributes in people worldwide, with the level of resilience being linked more to resources and leadership than race.
"If you're in Haiti, or even in New Orleans, you may still be dealing with tragedy, and so those impacts may be lingering," he said. "But there is a natural trajectory of recovery, even if you're getting no assistance. The human spirit is an amazing thing."
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