Terrorism and Fear

Examining Psychological Reactions to Terrorism and the necessity of Fear Management

“Terrorism works because of the psychological effects that can immobilize individuals and entire populations that feel vulnerable.” (Wilen)

Introduction
         The devastation brought about by the tragic events of September 11, 2001 was insurmountable. Shock and surprise were rampant emotions. Chaos and panic ensued. Not only was a nation left to recover physically and economically, but also psychologically. Mechanisms were not in place to properly handle such an attack, such a disaster, such an emergency scenario, much less the human response involved with such devastation and destruction.
         Soon after, departments and agencies organized, planned, and began the recovery process as far as the physical/structural damage and recovering from the resulting financial loss. Yet perhaps some of the most devastation occurred in the hearts and minds of citizens and more especially, emergency responders. The overwhelming emotions felt on that day, and still persisting years later, have yet to be properly addressed. Likewise, should another attack occur in the future, the psychological consequences and emotional toll of terrorism have not been properly anticipated.

         The following essay will describe some of the various emotions provoked by a terrorist event, especially fear, and how to assuage those feelings, to some extent, through fear management, education, and preparedness. The WTC bombings by al Qaeda, as well as the Aum Shinrikyo sarin gas attack will be used for specific reference.

Emotional Responses to terrorism
         After the devastating events on September 11th, the general public responded emotionally with “…widespread panic, then social withdrawal, and then widespread demand for violence against ‘enemy’”. (Gopinathan) Accordingly, emotional responses to terrorism develop, emerge, and progress through stages or on to other emotions. Emotional responses to terrorism are varied and include a wide array of non-pleasant feelings. Some of the possible reactions, as outlined by the Virginia Terrorism Preparedness Program, are as follows:

1.          Shock, numbness, and confusion….as if you are watching a movie or a bad dream that won’t end.
2.          Intense emotion…You may feel overpowered by sorrow and grief.
3.          Fear---you may feel intense fear and startle easily or become anxious.
4.          Guilt---Some people find it easier to accept what happened to loved ones if they can blame themselves in some way.
5.          Anger and resentment---You will naturally have anger for the perpetrators, but you may also have redirected anger.
6.          Depression and loneliness or feelings of isolation or abandonment.
7.          Physical symptoms such as headaches, fatigue nausea, sleeplessness, loss of sexual feelings and weight gain or weight loss.
8.          Panic.
9.          Inability to resume normal activity.

While this list includes many possible psychological reactions to terrorism, some might agree that many of these emotions may begin with fear or at least are rooted in fear. As well, fear may exist before, during, and certainly after an attack. The emotion of fear itself, along with the emotions that may arise out of fear, can be debilitating.

Examining Fear
         Fear must be considered when discussing counter-terrorism. As President Bush stated, “Freedom and fear are at war. The terrorists’ goal is not only to kill and maim and destroy but to frighten us into inaction.” (Myers)  Indeed, fear can be immobilizing. Many examples of this were seen directly after 9/11 when people refused to fly, numerous sports events were cancelled, and others were afraid to vacation in Disneyworld. As well, exaggerated fear or irrational fear can lead to exaggerated or irrational responses. After 9/11, some citizens were afraid to eat, drink, or sleep due to an exaggerated and irrational fear that no area was free from contamination and no area was safe or secure.
         It is imperative to assuage fear, not only to prevent the terrorists’ from achieving one of their ultimate goals, but also to prevent paralysis of the general public due to natural human response.
          To properly determine the best methods in which to combat fear, it is necessary to first understand the emotion, how and why people experience fear, and what other emotions fear incites. As well, it is necessary to examine how to properly prepare for and help prevent fear as best possible. The next section will provide an in depth analysis of this particular and common emotion.
         Fear can be inescapable and unavoidable. It varies in what is feared, to what extent, and why. “Psychological science has identified four influences on our intuitions about risk. First, we fear what our ancestral history has prepared us to fear…Second, we fear what we cannot control…Third, we fear what’s immediate…Fourth, we fear what’s most readily available in memory.” (Myers) This explains why people fear terrorism more than accidents---which kill nearly as many per week as did terrorism with its combined death toll in the 1990s. (Myers) Still, according to the Crime Prevention Association of Michigan, “…The fear of terrorist acts has become even greater than the fear of crime.” As well, this accounts for why “a survey in April 2004, 31 months after 9/11, found that over half of New Yorkers fear they or their families will be the victims of a terrorist attack.” (Health Politics)
         Fear is an ever-present emotion. In fact, researcher Michael Clarkson, states, “The average person has about 40,000 worrisome thoughts a day, many fueled by the media which often over-blows the threats to us with breaking new stories.” (FactorOneNews.com) However, fear can cause not only emotional distress, but also present physical symptoms of sickness. This is perhaps most commonly seen in Post Traumatic Stress Disorder or PTSD.

PTSD
         Post Traumatic Stress Disorder “is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious incidents, or violent personal assaults like rape.” (National Center for PTSD) PTSD is debilitating in physical ways such as not being able to sleep, having nightmares and flashbacks, appetite changes and being easily startled. This usually leads to, or also involves, social responses such as depression, substance abuse, and problems with memory and cognition, among others. “The disorder is also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.” (National Center for PTSD) In addition, some 10-25% of people never recover from PTSD.
         “PTSD usually does not present until six months after the stressor transpires and the symptoms last longer than one month.” (Pangi, pg. 4) “A survey conducted by the New York Academy of Medicine found 1 in 10 people here were clinically depressed one or two months after Sept.11, and 7.5% were experiencing post traumatic stress disorder at that time.” (Crenson)
         While PTSD is certainly noteworthy, a more common response to terrorism is anxiety. While perhaps less severe, this emotion can significantly affect those who suffer. It is also a subset emotion of fear.

Anxiety
         According to Maccoby and Heckscher, “Anxiety implies a generalized sense of danger which we are powerless to eradicate.” As well, “Anxiety disorders---from generalized anxiety to panic attacks and full blown phobias---are the number one mental health problem in the United States, affecting as many as 1 in 10 people and costing tens of billions of dollars in treatment and lost productivity.” (When Fear Seems Overwhelming) Of course not all anxiety disorders result from a terrorist attack or fear of one. However, there was an increase of the number of people reporting anxiety after 9/11. “Experts believe that the continued threat of terrorism is contributing to anxiety and depression across the nation.” (Crenson)
         Freud’s general description of anxiety states, “Anxiety (or dread or angst) is an ‘affective condition’---a combined psychological state and mental state. Physiologically the breathing tightens, the nervous system is stimulated, and the heart palpitates. The anxious person may feel faint. She shudders. Mentally, intense apprehensiveness is experienced. The person feels unable to act; she is, in the common expression, overwhelmed by anxiety.” (www.socialknowledge.com)
         While the aforementioned emotional responses to terrorism have been examined, the question still remains, “What can be done to help alleviate or reduce some of these drastic responses, especially fear, to the threat of or an actual terrorist event?” The following sections aim to answer this question by analyzing the Aum Shinrikyo subway attacks in Japan as well as fear management implementation. Likewise, education and preparedness are methods with which to prevent fear.

Analyzing attack by Aum Shinrikyo and citizen response in Tokyo
         On March 20, 1995, members of the religious cult, Aum Shinrikyo, carried out a horrifying terrorist attack upon a crowded subway train. Members of the cult released sarin gas, a nerve agent which can cause nausea, vomiting, eye irritation, shortness of breath, and loss of muscle control. “Approximately 5,500 people went to 280 medical facilities on the day of the attack and the in the days following. In all 1,046 patients were admitted to 98 hospitals. Twelve people died as a result of the sarin attack.” (Pangi, p.2)
         The Aum Shinrikyo attacks are important to investigate since these attacks “…provide the most comprehensive and historically grounded fact set regarding the short and long term effects of WMD terrorism.” (Pangi, pg. 2)
         Of course, the most obvious resulting damage from the sarin gas attacks presented itself in a physical nature. However, the more common response was psychological. Not only those who were directly involved in the attack suffered psychological damage. In addition, the "worried well" had to be aided. The "worried well" consist of "uncontaminated and unexposed individuals who fear, despite evidence to the contrary, that they have been contaminated." (Pangi, p. 3) "...The worried well outnumbered physically affected victims by a margin of 4:1--adding a significant burden to an already overwhelmed medical system." (Pangi, p. 3) While medical facilities and first responders are surely more concerned with those who are physically injured after a disaster, the worried well and others who have been psychologically affected by the event must not be ignored.
         As well, citizens are not only affected by the trauma of the event, whether they were directly affected or not, but also by the government’s response to such an attack. Again, fear prevails in preventing the citizens from feeling a sense of security; part of the responsibility of government. “In other words, an individual may be able to handle the trauma of the actual disaster, but can be adversely affected by the federal government’s uncoordinated or unsympathetic response to the disaster.” (Pangi, pg. 8)
         While not more than twenty people died when combining the statistics from the sarin gas subway attacks and the anthrax attacks in the United States, the ‘psychological casualties’ numbered in the thousands for each incident. (Pangi, pg. 14) Psychological responses can be as devastating, if not more, than the actual physical attack. The methods with which to prevent or respond to these emotions are currently, severely inadequate. Likewise, not only the emotional needs of the population as a whole, but also those of first responders must be addressed.

Addressing the need for fear management
         “History teaches us that the greatest numbers of victims or casualties arise from the indirect psychological consequence---FEAR.” (Pangi, pg. 14) Yet, there is no governmental plan or response in place to appropriately deal with these consequences for that of the general public or first responders, specifically.
         A delay in providing psychiatric treatment can significantly affect the emotional recovery of some victims and their families. (Pangi, pg. 6) Likewise, there is no proactive approach being taken in terms of mental treatment. “…Patients typically had to seek psychiatric care themselves.” (Pangi, pg. 6) This can be devastating in the sense that there may be those who will not seek psychiatric treatment because of the stigma sometimes associated with mental ills. With a proactive approach in addressing the issue, more people may likely seek treatment. Most would likely recognize they are not alone in feeling these extreme emotional responses and not be further frightened by the prospect of stigmatization for seeking mental help.
         In addition, while public and private medical facilities will help in aiding victims of a terrorist attack, “few hospitals and fewer communities have disaster plans to minimize posttraumatic psychological sequelae.” (Pangi, pg.7)
         In the end, Pangi summarizes it best when addressing the following areas of weakness in being able to respond psychologically to a terrorist attack.
“…Few first responders have received training specific to traumas involving weapons of mass destruction. Second, the mental health needs of victims are underestimated. Third, the structure overemphasizes the federal role in disaster management and ignores the immediate mental health care role of first responders, particularly emergency medical workers. Fourth, there is a tendency among mental health organizations in America, unlike in Japan, to focus on the needs of emergency workers instead of victims, whereas both populations will require assistance. Fifth, even when victims are given due consideration, the net is cast narrowly and does not always include family, friends, witnesses, and others who are emotionally affected by the disaster. Finally, intervention tends to be tailored to the short-term needs of victims rather than to long-term recovery.” For these numerous, well described areas in need of attention, fear management provides somewhat of a panacea.

Fear Management
         Fear management is a relatively new branch of consequence management, aimed at “reducing the incidence of adverse psychological effects following a disaster.” (Pangi, p.1) The actual definition of fear management is "the mitigation of panic and the management of public response following a WMD or other mass casualty incident." (Pangi, p.1)
         In some ways, fear management is risk management. When people feel ‘at risk’, this is when they begin experiencing the emotion of fear. “Uncertainty in the form of non-observable, new, unknown, delayed or increasing threats, and dread of catastrophic, fatal, random, involuntary, and uncontrollable events trigger fear.” (Health Politics) Fear management aims to reduce this fear by incorporating fields of public health, psychology, sociology, philosophy, political science, and medicine.
         Due to the fact that fear management is a relatively new concept under the larger heading of consequence management, most academics, emergency response practitioners, and policymakers are not as familiar with this topic as necessary. In the end, this topic has received inadequate attention and “translates to a lack of preparedness on the part of federal, state, and local governments.” (Pangi, pg. 6) And, as mentioned before, “an individual may be able to handle the trauma of the actual disaster, but can be adversely affected by the federal government’s uncoordinated or unsympathetic response to the disaster.” (Pangi, pg. 8)
         America is finding itself under prepared in many aspects of the counter-terrorism effort. Fear management is one of those arenas. While the need has recently been recognized, there is dispute over how fear management programs should be funded. While Presidential Decision Directive 39 relegated domestic terror response to the federal level, “…the Federal government does not have primary responsibility for consequence management but supports state and local governments in domestic incidents.” (Pangi, pg. 8) In essence, “The federal government has the responsibility for, but neither the institutional investment in nor the capability to pursue, a comprehensive mental health response plan.” (Pangi, pg. 8) If the federal government cannot help fund efforts in such an important area of counter-terrorism, it is also unlikely that states have the funding for such a large task. Nonetheless, this issue must be addressed because of the severity of its impacts, emotionally and financially.

Conclusions
         “Terrorism works because of the psychological effects that can immobilize individuals and entire populations that feel vulnerable.” (Wilen) Fear is perhaps the most immobilizing of the many psychological responses to terrorism or even the threat of terrorism.          
The U.S. strategy for combating terrorism consists of three main ideals:

1.          “Reduce vulnerabilities and prevent and deter terrorist acts before they occur;
2.          Respond to terrorist acts that do occur, including managing crises and apprehending and punishing terrorist perpetrators; and
3.          Manage the consequences of terrorist attacks.” (GAO/NSIAD-97-254 Combating Terrorism)

However, as noted above, fear management has not been properly addressed. Fear management addresses the three main ideals for combating terrorism listed above, at least, psychologically. Likewise, with the massive restructuring and reorganization of the Federal government, it is uncertain when fear management may indeed, be properly researched, addressed, and implemented with success. In the meantime, there are methods with which citizens and emergency responders alike can somewhat assuage their fears of terrorism.
         Education and preparedness help alleviate fear. Emergency responders are now involved in disaster training exercises, some of which contain elements of disaster psychology and how to best aide traumatized victims. As well, tabletop exercises provide a sense of preparedness which helps to lessen fear in some ways.
         Likewise, citizens are becoming more involved in the counter-terrorism efforts and thus, learning how to be properly prepared for a terrorist attack or emergency event, should either occur. In fact, Stephen Cox of the National Anxiety Foundation states that combating the fear of terrorism is actually the duty of the citizens. “Combating this fear is not just desirable. Combating this fear is the duty of each and every citizen. And helping other citizens to fight this fear is the duty of every citizen. Mitigating your fear and fear in others is your obligation.”
         When warned that it is not a matter of ‘if’ but ‘when’ another terrorist attack will occur, addressing counter-terrorism has become an all encompassing effort for the federal government as well as local area law enforcement. Citizens, despite involvement or lack thereof, in the counter-terrorism effort, are living in fear. Some are still reeling from the events of 9/11. Others are living in fear due to the seemingly constant threat of terrorism.
         Many lessons were learned on how to help prevent fear or alleviate it in the wake of two devastating terrorist attacks; those of the WTC bombings by al Qaeda as well as the sarin gas subway attacks by the Aum Shinrikyo in Japan. These two events caused psychological suffering in thousands of citizens. Fear management could aid in reducing these devastating psychological effects and must be addressed to provide a more resolved counter-terrorism effort.
         While no matter the amount of education and preparedness, or implementation of fear management programs; the widespread fear, panic, chaos, and destruction in response to a terrorist attack will always occur. Fear will also breed emotions of anxiety perhaps resulting in PTSD or Acute Stress Disorders. However, these emotions resulting from the threat of an attack or an actual attack can be better managed. As well, the more education and preparedness that fear management programs may provide, will help expedite the recovery and recuperation process in the aftermath of a terrorist attack.          
         While not only is general public health, physically and psychologically, important to take into consideration for proper counter as well as anti-terrorism measures, it prevents the terrorists from achieving one of their ultimate goals; inciting mass fear, resulting in immobilization and vulnerability of a mass population.



Works Cited
“Are we doomed: Do we think we are?”. Postelate.Volume 3. Number 5. June 2003. Retrieved from http://www.socialknowledge.com/postelate/v3n5/postelate35.html

Cox, Dr. Stephen. “Terrorism Fear: What you can do to alleviate it” National Anxiety Foundation. October 2001. Retrieved from http://www.healthyplace.com/Communities/anxiety/terrorism.asp

Crenson, Matt. “Psychological fallout, anxiety over terrorism linger a year after attacks”. SouthCoast Today. September 2002. Retrieved from
http://www.s-t.com/daily/09-02/09-06-02/b02li102.htm

Crime Prevention Association of Michigan. “Terrorism and Crime”. Retrieved from http://www.preventcrime.net/Terrorism.htm

Gopinathan, T. “Terrorists, Terrorism, and Violence” Social Human. Retrieved from http://www.socialhuman.com/archive/terrorism.html

Maccoby, Michael & Heckscher, Charles. “Overcoming the Anxiety of Terrorism”. Retrieved from http://www.maccoby.com/Articles/AnxietyofTerrorism.html

Magee, Dr. Mike. “Fear Management: Post 9/11” Health Politics. Retrieved from http://www.healthpolitics.com

Myers, David G. “Do We Fear the Right Things?” American Psychological Society Observer. December 2001. Retrieved from http://www.davidmyers.org/fears/

Pangi, Robin. “After the Attack: The Psychological Consequences of Terrorism”. John F. Kennedy School of Government. Harvard University. August 2002.

“Terrorism Information—The Facts—How to Prepare—How to Respond”. Virginia Terrorism Preparedness. Retrieved from http://www.vdes.state.va.us/prepare/terrorismtoolkit/terrguide/intro/prepare.htm...

“What is Post Traumatic Stress Disorder?”. National Center for PTSD. Department of Veteran Affairs. Retrieved from http://www.ncptsd.va.gov/facts/general/fs_what_is_ptsd.html

Wilen, Saul. “The Essence of Terrorism: Using Information, Education, and Communications as Weapons of Prevention and Defense.” International Horizons Unlimited.