Even if people avoid the televised 10th anniversary remembrances from New York, Washington and Shanksville, Pa., the date alone will be enough to trigger memories.
Sept. 11, 2001.
"Sept. 11 marks such a deep and tragic loss for our country, there is no doubt that this year's anniversary in particular will be significant for many people not just because it is the 10th anniversary but for other reasons as well," Karen Wolford, a licensed psychologist, board certified expert in traumatic stress and professor at the State University of New York at Oswego, told UPI in an interview.
This year's anniversary of the terror attacks may also be more difficult due to recent events -- the recent earthquake and hurricane impacting the Northeast and New York, people may already be under increased stress, Wolford said.
"Proximity to the World Trade Center site, duration of exposure 10 years ago in New York and Washington and degree of loss and prior exposure can and do impact the depth of pain and loss experienced," Wolford said. "People who were physically injured may still carry not only the emotional scars that others carry but also may have residual physical pain and limitations as a result of the event."
The anniversary date could trigger memories of the attacks, but when it comes to anniversaries, some are more significant than others.
For example, a psychologist described the trauma of his own father dying. Even though he was a part of the wake and funeral, for weeks he still expected his father to call on the telephone or to drop by because he simply couldn't be dead.
He was in denial.
But at the third-month anniversary of his father's death, the psychologist said, it started to sink in -- maybe his father wasn't on a long business trip after all.
People notice months four and five, but they are not as significant, the psychologist said. Then there's the six-month mark. It all comes back and people relive the event. For the next six months the anniversary date recedes -- most forget the ninth month -- but all the memories are dredged up again at the one-year anniversary, as well as the five- and 10-year anniversaries.
Other things besides dates can trigger traumatic memories -- being near the World Trade Center site in Lower Manhattan or the cool, crisp sunny weather of that day, for instance.
"For example, two combat veterans (were) walking in the San Diego Zoo and suddenly they both became overly alert to their surroundings. They didn't know why, but as they left, they saw they had walked into the South Asian garden and the heat, the smells and the plants brought them back to Vietnam," Kathleen R. Gilbert, a professor at Indiana University Bloomington, told UPI.
Denis Leary, co-creator, writer and star of FX's "Rescue Me" told Postmedia News he did not want to commemorate the 10th anniversary of his cousin's death because it was going to be overwhelmingly sad and would dredge up all the memories of the Worcester, Mass., warehouse fire in 1999 that killed six firefighters, including cousin Jerry Lucey and childhood friend Tommy Spencer.
But, Leary said, once he was there, marking the tragedy made sense -- and the same thing applies to the 10th anniversary of the Sept. 11, 2001, attacks.
"It is helpful to participate in a ritual in public with other people who share your feelings, because it shows you are not alone -- it has a healing effect," Gilbert said. "It's also empowering because it shows you can handle the emotions."
"Rescue Me" in large part has focused on the reactions of firefighters who survived the attacks on the World Trade Center that killed 2,752 people, including 343 firefighters. The last season of "Rescue Me" -- the last episode of which airs on FX Wednesday -- focuses on how the firefighters on the show deal with the 10th anniversary.
Brett Litz of the National Center for Post-Traumatic Stress Disorder at the Veterans Affairs' Medical Center in Boston said a traumatic anniversary might be painful but it is also an opportunity to connect with people and deal with the trauma.
"Talking helps people with PTSD because it puts the problems on the table, people express their feelings, they share their feelings with others and people try to make sense out of them. It is a fundamental way of coping," Litz said.
Post-traumatic stress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma -- it may involve the threat of death or trauma that overwhelms the individual's ability to cope.
Symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma and increased arousal such as difficulty falling or staying asleep, anger and hypervigilance. Symptoms of PTSD last more than one month and cause significant impairment in social, occupational or other important areas.
However, acute stress reaction, is the result of a traumatic event in which the person experiences or witnesses an event that causes the victim/witness to experience extreme, disturbing or unexpected fear, stress or pain, and that involves or threatens serious injury, perceived serious injury or death to themselves or someone else.
Some people might experience the anniversary of a trauma more acutely than others.
"For example, in one case, a woman whose young daughter had been killed by a hit-and-run driver had been coping, but on the anniversary of her daughter's 16th birthday more than 10 years after her daughter died, the woman had a very hard time getting out of bed," Gilbert said.
"She said she woke up as if she was in a coma, she said she couldn't move, she felt exhausted and overwhelmed and she explained that when she used to shampoo her daughter's hair they would plan her 'sweet 16' birthday together and while it was 'playtime planning,' once that 16th birthday had arrived, the only future the mother had with her daughter was gone and that made that particular birthday more challenging."
People need to feel the world is predictable and controllable. Traumatic experiences, however, are unexpected and outside the normal world and it takes an adjustment, Gilbert said.
And sometimes the reaction is decades in coming.
"A combat veteran never experienced PTSD -- no dreams, no flashbacks -- but in his 80s he had a heart attack and after that he started to re-experience his ship being torpedoed," Gilbert said.
Avoidance is part of PTSD but eventually the person must face the event and move through the pain, Wolford said.
"Cognitive behavioral therapy involves guided exposure to the memories and experiencing the emotions attached to the memories, which helps people progress past avoidance," Wolford said.
Knowing an anniversary could trigger this reaction might make it easier to deal with the situation. It's a time to have one's support system nearby and for most people the memories recede. People do better, but if they don't, it might be time to talk to a therapist, Gilbert said.
"People move forward especially if they construct meaning from the loss, integrate the event into the narrative of their life and find a way to honor the memory of those they have lost," Wolford said.
Leary established The Leary Firefighters Foundation in 2000. He said working with the Fire Department of New York while producing "Rescue Me," showed him the firefighters not only look at Sept. 11, 2001, as the day they lost 343 comrades, but as a day many lives were -- the single greatest rescue effort in the history of the fire service.
"Healing is about moving ahead in spite of the pain that might always be there to some degree," Wolford said. "People learn to reach out to others, to reconnect with those who might have gone through the same or similar traumatic events."