Tuesday, April 23, 2013

PTSD May Strike Bostonians in Bombing, Lockdown Aftermath

April 23, 2013

Less than a week after Andrew King moved to Cambridge, Mass., from Little Rock, Ark., the 26-year-old biostatistician found himself living under lockdown, along with a million or so others, as law enforcement hunted for Dzhokhar Tsarnaev, the surviving Boston Marathon bombing suspect.
With no cable hookup and his cell phone's Internet connection on the fritz, he found out about the lockdown from a friend in Atlanta.
"As soon as I read the text, I ran back in my room and literally covered my head with the sheets," he said. "It was terrifying."
For several hours, King huddled in his unpacked apartment that bordered where the suspect was eventually apprehended, peering out the window at the legions of armed police performing a slow sweep of the streets and driveways. King's friend kept texting him updated news reports, which King tried to reconcile with what he was seeing outside his door.
"It was just unbelievably surreal," he said.
Now that the subject has been apprehended, the city has no doubt breathed a collective sigh of relief. But a nagging sense of insecurity will likely linger for many, said experts.
"There is a particular sense of vulnerability to this act of violence, because these men lived among us. It is one of those traumatic events that are at the very heart of post traumatic stress," said Dr. Paul Ragan, an assistant professor of psychiatry at Vanderbilt University Medical Center in Nashville, Tenn.
After a traumatic five days that began with the marathon bombings and ended with the manhunt and lockdown, Ragan said he'd expect some percentage of Boston-area residents to experience some lingering level of anxiety, depression or fear.
Some will develop an "acute stress disorder," characterized by an emotional detachment, flashbacks, a heightened startle response, poor concentration and irritability, Ragan said. If such symptoms last for six months or longer, they could morph into full-blown post traumatic stress disorder.
"People think PTSD is a normal response to abnormal happenings, but that's not true," Ragan said. "It's classified as a severe anxiety disorder that requires treatment."
Ragan said he suspected the most deeply affected would continue to relive the events of the past week through nightmares, flashbacks and intrusive memories. He said they were also likely to develop a set of avoidance behaviors -- a marathoner might give up running, others might avoid Copley Square and other geographic reminders of the horrific events.
Although it is impossible to know how many people will be plagued by long-term psychological problems, Ragan said women, children and those with a genetic predisposition to psychological problems, including PTSD, or who lived through similar traumatic events, were at highest risk.
One of the biggest risk factors is proximity to the danger.
King's friend Taraq Abdallat was walking in Watertown to another friend's house for dinner shortly after the "shelter in place" order was lifted when he heard the gunfire exchange between the police and the alleged bomber. The pop of gunfire was so close that Abdallat feared for his life and hustled to get indoors.
Abdallat, who is originally from Jordan, described the experience as devastating.
"I can't feel secure the same way I used to before these terrible things happened. I don't feel secure in my hometown anymore," he said.
Studies find that after the 9/11 terrorist attacks on the World Trade Center in New York, the highest percentage of both short- and long-term psychological disturbances were reported by people closest to the attacks with a progressively smaller percentage of people reporting disturbances the farther away they were from the attacks.
Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York said many Boston residents might react differently because ubiquitous access to texting, Twitter and other forms of instantaneous communication might have given them a feeling of control, or "empowerment."

But Manevitz said Boston residents still needed to be vigilant in monitoring stress and other psychological symptoms. He recommended avoiding the endless news cycle and having open, honest discussions about feelings with friends, family and loved ones, especially children. And if symptoms become unmanageable, he recommended seeking professional help."Even with lockdown, people were fully engaged and aware of what was going on electronically, soothing each other, informing and also ... searching their own photos and videos to try to help the FBI. They were scared and traumatized, but there was also an informed calmness," he said.
Manevitz said he believed social media may be transforming the way we respond to catastrophic events. Social media, he said, allows people to feel less isolated. Although it can be the source of rumors and misinformation, it can also, he said, help people stay calm.
The Boston events in particular allowed the public to watch the results of the government's efforts unfold in real time, which many people found comforting, Manevitz said. Also, because the government directly appealed to the public for assistance, many people felt useful even if they weren't directly involved in the search for the bombers.
As for King, he said he felt shaky for a few days but said he must move on with his life.
"I was a little nervous on Saturday but by Sunday the streets were crowded again and people were in the park playing soccer and softball. I'm not having second thoughts about moving to Boston," he said.

The Happiest People Pursue the Most Difficult Problems

The Happiest People Pursue the Most Difficult Problems

The happiest people I know are dedicated to dealing with the most difficult problems. Turning around inner city schools. Finding solutions to homelessness or unsafe drinking water. Supporting children with terminal illnesses. They face the seemingly worst of the world with a conviction that they can do something about it and serve others.
Ellen Goodman, a Pulitzer Prize-winning journalist (and long-time friend), has turned grief to social purpose. She was distraught over the treatment of her dying mother. After leaving her job as a syndicated columnist, she founded The Conversation Project, a campaign to get every family to face the difficult task of talking about death and end-of-life care.
Gilberto Dimenstein, another writer-turned-activist in Brazil, spreads happiness through social entrepreneurship. When famous Brazilian pianist Joao Carlos Martins lost the use of most of his fingers and almost gave into deepest despair, Dimenstein urged him to teach music to disadvantaged young people. A few years later, Martins, now a conductor, exudes happiness. He has nurtured musical talent throughout Brazil, brought his youth orchestras to play at Carnegie Hall and Lincoln Center in New York, and has even regained some use of his fingers.
For many social entrepreneurs, happiness comes from the feeling they are making a difference.
I see that same spirit in business teams creating new initiatives that they believe in. Gillette's Himalayan project team took on the challenge of changing the way men shave in India, where the common practice of barbers using rusty blades broken in two caused bloody infections. A team member who initially didn't want to leave Boston for India found it his most inspiring assignment. Similarly, Procter & Gamble's Pampers team in Nigeria find happiness facing the problem of infant mortality and devising solutions, such as mobile clinics that sent a physician and two nurses to areas lacking access to health care.
In research for my book Evolve!, I identified three primary sources of motivation in high-innovation companies: mastery, membership, and meaning. Another M, money, turned out to be a distant fourth. Money acted as a scorecard, but it did not get people up-and-at 'em for the daily work, nor did it help people go home every day with a feeling of fulfillment.
People can be inspired to meet stretch goals and tackle impossible challenges if they care about the outcome. I'll never forget the story of how a new general manager of the Daimler Benz operations in South Africa raised productivity and quality at the end of the apartheid era by giving the workers something to do that they valued: make a car for Nelson Mandela, just released from prison. A plant plagued by lost days, sluggish workers, and high rates of defects produced the car in record time with close to zero defects. The pride in giving Mandela the Mercedes, plus the feeling of achievement, helped the workers maintain a new level of performance. People stuck in boring, rote jobs will spring into action for causes they care about.
Heart-wrenching emotion also helps cultivate a human connection. It is hard to feel alone, or to whine about small things, when faced with really big matters of deprivation, poverty, and life or death. Social bonds and a feeling of membership augment the meaning that comes from values-based work.
Of course, daunting challenges can be demoralizing at times. City Year corps members working with at-risk middle school students with failing grades from dysfunctional homes see improvement one day, only to have new problems arise the next. Progress isn't linear; it might not be apparent until after many long days of hard work have accumulated. It may show up in small victories, like a D student suddenly raising his hand in class because he understands the math principle. (I see this from service on the City Year board. You can find dozens of these stories on Twitter under#makebetterhappen.)
It's now common to say that purpose is at the heart of leadership, and people should find their purpose and passion. I'd like to go a step further and urge that everyone regardless of their work situation, have a sense of responsibility for at least one aspect of changing the world. It's as though we all have two jobs: our immediate tasks and the chance to make a difference.
Leaders everywhere should remember the M's of motivation: mastery, membership, and meaning. Tapping these non-monetary rewards (while paying fairly) are central to engagement and happiness. And they are also likely to produce innovative solutions to difficult problems.
More blog posts by Rosabeth Moss Kanter
Rosabeth Moss Kanter


Rosabeth Moss Kanter is a professor at Harvard Business School and the
author of Confidence and SuperCorp. Her 2011 HBR article, "How Great Companies Think Differently," won a McKinsey Award for best article. Connect with her
on Facebook or at Twitter.com/RosabethKanter.