On September 11, 2001, Dario Gonzalez, MD, helicoptered to lower Manhattan landing near the World Trade Center just as the second tower collapsed. Gonzalez, an expert in collapsed structure disasters and, at the time, the Medical Director for Clinical Affairs of the City of New York Fire Department and Medical Director of Urban Search and Rescue, New York Task Force One, bolted out of the copter and ran towards the dust and debris.

He set up a command post and for the next three weeks, he camped out in tents with other rescue workers, ministering to firefighters and first responders and on one occasion, stitching up the paw of a search and rescue dog.

"Disaster

Dr. Gonzales, left, at Ground Zero

During that first week, Gonzalez and everyone on “the pile” clung to the hope that they would find survivors in crawl spaces formed by the debris. “Thousands of people were missing and we all kept scratching our heads, wondering, ‘Where are they hidden?’” But, after days of climbing over razor-sharp pieces of metal and contorted steel, the devastating realization hit: “We weren’t going to find anyone alive,” he told me back in 2002 when I first interviewed him for the alumni magazine of Stony Brook University on Long Island, NY, his alma mater.

Gonzalez, now 75, is a tough guy with a tender heart. He’s not one to easily display emotions. He doesn’t much like talking about himself or his feelings. As his wife, Pearl, a psychotherapist, told me back then, “Dario is a very quiet person who needs his own space to process his feelings,” she said.

Still, his feelings, 20 years on, is what I wanted to talk to him about when I called him in August. I asked him if this upcoming anniversary was on his mind more so than past anniversaries. “This one feels kind of weird,” he concedes, “It’s been a long time and now there are firefighters who were babies in 2001 and who have no memories of that day. Yeah, I’m thinking about it.”

He’s been to the 9/11 Memorial twice but prefers to mark anniversaries at an FDNY-EMS Training Academy. “They have a little ceremony that’s very nice. It’s not a lot of people and very private,” he says.

In his years as a disaster doc, Dario Gonzalez has dealt with “so many traumatic events that I’m not sure which trauma I’m thinking about at any time,” he says, only half-joking.

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Before September 11, he was in Oklahoma City searching for survivors after the 1995 bombing. In 2005, after Hurricane Katrina, he was part of the FEMA Urban Search and Rescue emergency response teams in New Orleans. In 2010, after the devastating earthquake hit Haiti, he was on the scene. In 2014, he spent three months doctoring patients in an Ebola treatment unit in Liberia, West Africa. This year, he crawled through the wreckage of the Champlain Towers condo collapse in Surfside, Florida staying with a victim as the remnants of the building shifted and groaned. And on August 30, he was on standby to help victims of Hurricane Ida.

The man whose calmness in a crisis is legendary among his colleagues doesn’t often voice his fears. Still, when pressed, he acknowledges that recent events and the situation in Afghanistan has him worried about what might happen next. And that brings to mind this 20th anniversary of 9/11. “I’ll feel better after enough time has passed,” he says, “maybe around Christmas.”

A Not So Happy Anniversary

We humans love to mark milestones: birthdays, wedding anniversaries, baby’s first step, the first day of school, college graduation, Mother’s Day, and every significant event and holiday in between. Those are the good milestones and anniversaries.

And then there are the bad ones, the traumatic or tragic emotional landmarks—the loss of a loved one, a terrorist attack, a mass shooting, a hurricane, or an earthquake. It’s these heartbreaking events and the days they happened that can cause the “heightened emotional and psychological response that is the ‘anniversary effect’,” says Kenneth Yeager, PhD, director of The Stress, Trauma and Resilience (STAR) Program at The Ohio State University Wexner Medical Center.

And “it’s a very real psychological phenomenon,” says Dr. Yeager.

Attacks of the Anniversary Effect

Sometimes the feelings sneak up on you, the psychological equivalent of a stalker. You’re walking around on an ordinary day and out of the blue, you recognize that you’re feeling off and unsure why. And then it hits you: it’s been a month, a year, or five or 10 since your best friend died or your cousin was injured in a car crash or that terrorist attack forever changed the way you thought about the world.

And sometimes, you’re painfully aware the date is approaching.

Trauma Anniversary Effect Symptoms

While the anniversary effect may come as a “surprise”, the symptoms of the psychological and emotional fallout are predictable:

  • Anxiety

  • Depression

  • Sadness

  • Avoidance (friends, family, the world)

  • Anger

  • Panic Attacks

  • Fear (avoiding places or things pertaining to the trauma, i.e., high-rise buildings, airplanes, schools, swimming pools, the beach, etc.)

  • Hyperarousal (irritability, difficulty sleeping)

  • Hypervigilance (guarding, patrolling)

Unsettling as these symptoms are, there is an evolutionary back story. For our cave-dwelling ancestors, alertness to danger was a matter of life and death. Our brains store the bad stuff for easier access—like a desktop shortcut—so that we can access the memories more easily and potentially avoid dangerous situations. At least that’s the theory.

Why Getting Through the Pain Is Harder Now

As devastating as the anniversary effect can be to some—and it’s important to emphasize that this effect is not inevitable—it is transient. “Depending upon the individual’s emotional proximity to the event the intensity usually diminishes over time,” says Susan Silk, PhD, a psychologist in Southfield, Michigan and a disaster mental health volunteer and trainer for the American Red Cross. “However, there are factors that might alter this trajectory,” she adds. “For example, if I am now the age at which my father died; if I am celebrating a major milestone—graduation marriage, childbirth without my loved one; if I’ve suffered other significant losses or setbacks—the impact of even a distant anniversary may become more salient.”

And there’s another factor at play now: The turmoil and stress of the pandemic have had a measurable impact on the incidence of anxiety and depression in the US. From August 2020–February 2021, the percentage of adults with recent symptoms of anxiety or a depressive disorder increased from 36.4% to 41.5%, a significant increase according to a CDC report based on online, self-reported responses—meaning the data was not confirmed by health professionals.

“We are absolutely more vulnerable to anxiety, stress, and fear,” says Dr. Yeager. Last summer the National Center for Statistics partnered with the Census Bureau to conduct the “Pulse Survey”. This online, self-reported survey, posed two questions for anxiety and two for depression. The survey is updated every 7 days to 2 weeks.

For the period ending August 16, 2021, 26.6% of adults 18 and older reported symptoms of an anxiety disorder, and slightly over 21% reported symptoms of depression. For comparison, in the 2019 National Center for Health Statistics, National Health Interview Survey, an in-person survey, less than 14% of those surveyed reported symptoms of anxiety disorder and/or depressive disorder.

Anniversary Effect Self-Care

If the 9/11 Anniversary or any thorny date coming up is worrying you, here are some self-care strategies to help you cope:

  • Prepare yourself especially if you’ve already experienced the anniversary effect, by making plans to be with friends or loved ones who can support you.
  • Think about doing something both distracting and fulfilling on the day. Consider volunteering, working in a community garden, cook a meal for someone in need or lend a hand at an animal shelter where you can take a dog for a walk or cuddle a kitten.
  • Take care of and be kind to yourself. Do something you enjoy whether it’s going for a bike ride, a hike, or getting a massage or manicure, take a yoga class.
  • Don’t isolate yourself or hideout for the day. If you can’t be out in the world, plan a phone call or Face Time, or Zoom.
  • Find a support group where you can voice your feelings and face the trauma or talk about the loss.
  • Honor the person or people you’re missing. You may feel better if you visit the cemetery or a memorial commemorating an event. Or sign up for a fund-raising walk in honor of the person or a cause that they supported.
  • Limit exposure to media coverage: Collective traumas such as 9/11, mass shooting incidents, natural disasters, mean wall to wall media attention. You may want to watch a documentary about a national tragedy but don’t fall down the rabbit hole.

And if you can’t think of what to do, just stand still and feel what you’re feeling, says Dr. Yeager.

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Last Updated: Sep 10, 2021