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This article by Kathleen McGinn Spring was prepared for the September 18, 2002 edition of U.S. 1 Newspaper. All rights reserved.

Post-Trauma Stress: A Stiff Upper Lip Is Not Always Best

Olga Vilko, age 81, a student at Hunter College, was in class on September 11 when Manhattan was attacked. In school to catch up on subjects she missed as a younger woman -- art history, and music, for example -- Vilko made her way home calmly.

"She was able to get home. She didn't get all upset," says Dr. Naomi Vilko, a Princeton psychiatrist and Olga Vilko's daughter. Olga Vilko is an Auschwitz survivor, as was her husband. Her behavior on September 11 "shows how she survived intact," according to her daughter, who reports that her mother's attitude since September 11 has been "well, this happened. I'll deal with it."

Not everyone has been able to cope as well. In her practice, with offices at 419 North Harrison Street and in Manhattan, and through the many volunteer lectures and counseling sessions she has given during the past year, Vilko has met many of these people. On Friday, September 20, at 8:30 a.m., she takes part in a free panel discussion of "The Aftermath of 9/11: How to Cope with Medical, Psychological, and Substance Abuse Issues," which takes place at the New Jersey Hospital Association at 760 Alexander Road. Other panelists are Arnold Washton, an alcohol and substance abuse specialist; and Mary Guardino, founder of Freedom from Fear, a support group for individuals suffering from anxiety. Call 609-924-3225.

Reactions to the 9/11 attacks vary by proximity, but the nearness of the loss or the terror is not the only factor governing how the attacks affect different individuals. Vilko brings personal perspective to understanding this issue. Her parents survived the Holocaust and were forced to flee their homeland, yet neither suffered major depression or fell into substance abuse.

"I was lucky," she says. While her parents were able to nurture her, she saw that "many of their friends were not able to parent." The difference is not a matter of strength of character, but rather a matter of biology. Presented with unimaginable horror, some people develop heart disease or cancer, others are possessed by anxiety or depression, and a lucky few continue pretty much as before. When the reaction is acute anxiety or depression, the circle of suffering can go on and on.

"I worry about the parents," Vilko says. "They can become so dysfunctional. Maybe they are able to function better at work than at home. They are not able to give their children what they need." More than 50 years after the Holocaust, she sees the effects of post-traumatic stress syndrome in parents reflected in their children -- and in their grandchildren. The same cycle could begin again, she says, if victims of the September 11 attacks who are still not functioning well a year later do not get help.

Vilko, who is married to Princeton urologist Dr. Sidney Goldfarb, is the mother of three children, age 18 to 22. When her youngest child went off to school, she began giving talks on mental health. "I don't bake," she says, "so I thought I might as well do something I can do." Now she is considerably busier, teaching at Robert Wood Johnson University Hospital, and running a new business, Vilko Corporate Consulting, in addition to attending to her private practice. Yet she still gives substantial time to informing groups about the help available for post-traumatic stress syndrome and other psychological disorders.

Urging people to get help is an easier sell now than it was in the years after her parents made their way to this country. Holocaust survivors did not talk much about what they had been through, she says. A consequence, she says, is that fully 65 percent of them still suffer from post-traumatic stress syndrome more than 50 years later. In the Inwood section of New York City, where she grew up, Vilko saw that stoicism was not limited to those who had lived through the Holocaust. Many neighbors were fire fighters and police men. "The culture is stiff upper lip," she says. It's "I'll help other people. If I'm not feeling well, I'll take a drink."

There has been a change, but perhaps not enough change. Depression and anxiety still often are seen as signs of weakness. With September 11 there are other forces at work as well, says Vilko. Those who are alive because they were late for work or because they found a way out of the burning buildings may suffer from survivor's guilt, and may feel that their sleeplessness or fear of travel is minor and not worthy of treatment.

"There are 25,000 people who escaped," says Vilko. "I don't think enough are getting help."

A woman Vilko treated was in the south tower when the planes hit. Her husband was in the north tower. Both survived. Under Vilko's treatment, the wife took medication and had several counseling sessions. After a month, "she was back to herself," says Vilko. Her husband refused treatment and after a year, she says, "still has a lot of symptoms."

While anyone who was in New York during the attacks -- let alone anyone who lost a relative or escaped from the World Trade Center -- could be expected to show some signs of post-traumatic stress disorder, the circle is larger still. In central New Jersey there are thousands of people who travel to the city every working day, and many more people who spend time there for business or pleasure. Vilko, for example, who delivered mail at the World Trade Center when she was in college, attended a meeting there shortly before September 11.

In central New Jersey, perhaps more than any place other than Manhattan itself, last fall was uniquely traumatic for nearly everyone. "We had anthrax," explains Vilko. Some of her friends and patients had maintained emotional distance from the attacks on New York. They were living suburban lives, she says, never venturing into Manhattan or Philadelphia. But when it became known that the anthrax-laced letters were sent from the Hamilton post office, any sense of invulnerability fell away.

"It was like AIDS when it first happened," Vilko says. "People were very suspicious. It could be anywhere."

Enduring two types of terrorism -- and numerous alerts from Washington that more trouble could well be imminent -- took a toll on many. For some, the effects linger. Here are some thoughts on what to do next.