18 Wednesday, September 10, 2008 smh.com.

au The Sydney Morning Herald

Insight
Survivors
confront
the terror in
their heads
Scientists are using virtual reality to help
those still traumatised by the attacks of
September 11, 2001, writes Jane Lyons.

F
or Andrew*, a sufferer of post-
traumatic stress disorder since the
World Trade Centre attacks, watch-
ing again as two people jumped to
their deaths was a pivotal moment
in his recovery.
An office worker in downtown Manhattan,
he witnessed it all on September 11, 2001: the
planes, the explosions and the collapse of the
twin towers.
He had also watched in horror as people
began to jump from the 110-storey building.
The problem was that he had no memory of it.
He became progressively housebound,
shying away from social events and inter-
acting less and less with his wife and child-
ren. No longer able to work, he had to rely
on a disability pension to support himself
and his family.
But, while September 11, 2001, was his
undoing, going back has proved his salvation.
Andrew is one of about 50 survivors who have
re-experienced the sights, sounds and smells
of that day with the help of a virtual reality
program being trialled by Cornell University
in New York.
The 12- to 14-week treatment is based on
the concept of exposure therapy, which asks
patients to repeatedly and incrementally
visualise the original trauma while in a safe
and controlled environment. Patients can
then process the emotions surrounding the
‘‘The traumas are so intense that you can’t
just file them away in your memory like every
other memory,’’ says Dr Judith Cukor, the
program’s co-ordinator.
‘‘So they need to reprocess it over and
over until they can break it down and file it
away and be able to move on and live their
life not in the shadow of it but with the
memory of it.’’
But getting people to reimagine their
traumas can be difficult. Virtual reality has
proved a powerful tool, which helps sufferers
of post-traumatic stress disorder to re-engage
with their memories and process them.
At the Weill Cornell Medical College’s
department of psychiatry, where the
program is under clinical trial, participants
wear virtual-reality goggles that allow
them to move through a three-dimensional
replica of downtown Manhattan before the
terrorist attacks. The software allows
patients to view the scene from different
angles and distances.
In the beginning there are only the build-
ings towering above; then a plane flies
silently behind them. ‘‘If you have [post-
traumatic stress disorder] and you see the
planes flying past, that’s usually enough to
get anyone to have a jump [in distress levels],’’
Cukor says.
The treating psychologist monitors the
patient’s progress by asking them every five
Exposed to the horror all over again ... but in a controlled environment where traumatic memories can be safely drawn out. Photo: Jared Cohee
100. The psychologist will not move to the
next scene until the score comes down to
about 40.
Once the patient has become used to the
opening scenes, the drama amplifies. The
plane hits the first building and explodes
silently; then sound is introduced and the
whine of the plane, its impact and the ex-
‘They need to reprocess it over and over until
they can break it down and file it away.’
DR JUDITH CUKOR, program co-ordinator
plosion can be heard. The second plane
crashes and then there is a deep rumbling as
the buildings start to collapse. People scream,
sirens wail and there is confusion everywhere.
All the sounds are real, collated from me-
dia recordings of that day. Loudspeakers be-
concussive force of the explosion, while a
machine reproduces odours such as cologne,
coffee and burning.
‘‘A lot of people talk about the smell, this
constant type of burning smell. A lot of
people associate it with burnt bodies . . .
They associate it with the smell of death,’’
Cukor says.
The shadows of people jumping are the
last cue to be introduced and one of the
most potent. It was a turning point in
Andrew’s recovery.
‘‘It was stuff that was there but it was so
awful he had somehow blocked that out,’’
to him, that was really important because that
was something he hadn’t dealt with.
‘‘He was able to remember two people
holding their hands and why he thought that
How numbers
was so awful, and the thoughts that were
going through his mind at that time, and
what they were wearing and who they
stacked up
reminded him of.’’
Each session is taped and the patient must
listen to their recorded thoughts and feelings 19 terrorists hijacked the four
passenger jets that crashed on
the day: two into the World Trade
at home, as well as keeping a log of reactions.
‘‘The idea is that they need to habituate to Centre in New York, one into the
these memories. Once a week is not enough,’’
Cukor says.
Pentagon in Washington and one into
a field in Pennsylvania.
Last year New York’s World Trade Centre
Health Registry, which monitors the health of
70,000 survivors, found that one in eight
emergency workers were suffering post-
2974 people were confirmed
dead in the attacks, apart
from the hijackers.
traumatic stress disorder in 2004. In 2006 the
registry found that 11 per cent of evacuees
from damaged or destroyed buildings near
Ground Zero screened positive for probable
24 people were declared missing,
presumed dead.

event and decondition their responses. minutes to rate their distress on a scale of 0 to neath the patient’s chair re-create the Cukor says. ‘‘Having that cue brought it back serious psychological distress in 2004.
The protracted nature of the disaster was
particularly traumatic for emergency workers
200 or more people jumped to
their deaths from the World
Trade Centre’s burning towers.
and civilians, who faced a 10-month recovery
operation, Cukor says. ‘‘You had civilians
come back after their buildings were cleaned
. . . You’re talking about somebody like an
10,000 unidentified bone and
tissue fragments were
collected by New York’s medical
accountant who knows they are finding body examiner’s office but were unmatched
parts every few hours.’’ to the dead.
Even seven years after the attack there will
still be many people seeking treatment for
post-traumatic stress disorder, she says.
‘‘There is a peak of interest in the program
91,000 litres of jet fuel fed the
tower fires.

around the anniversary because there is a peak

in symptoms,’’ Cukor says. ‘‘The anniversary
also reminds people how long it has been. We
1.4 the number of trillion US
dollars in American stock
values that were lost in the week after
are talking about very strong people [disaster the attacks.
workers] who are not used to calling for help.
‘‘Sometimes it takes five or six years for Sources: Wikipedia, BBC
them to say, ‘This isn’t really working; my
marriage is falling apart. Maybe I should
reach out for help.’ ’’
The term post-traumatic stress disorder was
coined in 1980. Sufferers relive the original
trauma over and over through nightmares and
flashbacks, while a heightened state of anxiety
keeps them primed for ‘‘flight or fight’’. Worlds
become smaller as they avoid both the fam-
iliar and unfamiliar, while dissociation from
feelings can be so extreme that sufferers may
act without memory. Relationships falter, jobs
are lost and the oblivion of drug addiction is a
common escape route.
But Cukor believes help is on the way.
‘‘Clinically we think that it [virtual reality
treatment] will be helpful for people who
don’t respond to other treatments, but the
next step is to prove that with research.’’
The first part of the research was published
last November in the Journal Of Clinical
Psychiatry. As for Andrew, he is still doing
well: socialising more, spending time with
his children and running a small business
from his home. ‘‘It’s not just a matter of deal-
ing with your memories but being able to
change your life,’’ Cukor says. 78th-floor survivor ... Edward Fine got
out just in time. Photo: AFP/Stan Honda

FREE Italian CD this Sunday * Not his real name.

■ CONSPIRACY THEORY

European Language CD Collection Arab view of terrorist plot

SEVEN years later it remains conventional
wisdom that Osama bin Laden and al-Qaeda
could not have been solely responsible for the
Don’t miss the second CD in the Essential European Languages Collection. Essential Italian attacks of September 11, 2001 and that the US
covers everything from basic expressions and numbers to telling the time and eating out. and Israel had to have been involved in their
planning, if not the execution, too.
This is not the conclusion of a scientific
You’ll be speaking basic Italian in no time with this hour-long audio lesson. survey, but it is what routinely comes up in
Ask your retailer. While stocks last.
Mushairy al-Thaidy, a columnist in the
Saudi-owned regional newspaper Asharq al
Awsat, said that unless the US could convince
Muslims of the terrorism argument, they
would not help in the battle against it. And
this, he said, ‘‘is not the kind of battle you can
fight on your own; it is a collective battle’’.
Zein al-Abdin, 42, an electrician in Cairo,

conversations around the region – in a
Don’t miss your Essential Italian Language CD only with The Sun-Herald this Sunday. shopping centre in Dubai, in a park in Algiers,
in a cafe in Riyadh and all over Cairo.
‘‘Look, I don’t believe what your
governments and press say. It just can’t be
true,’’ Ahmed Issab, 26, a Syrian engineer
who lives and works in the United Arab
Emirates, said. ‘‘Why would they tell the
truth? I think the US organised this so that
Travel with they had an excuse to invade Iraq for the oil.’’
That such ideas persist represents the first
failure in the fight against terrorism – the
inability to convince people in the Arab world
that the US is not crusading against Muslims.
TBA 018
questions the evidence against Arabs. ‘‘Why is
it that they never caught him, bin Laden?
How can they not know where he is when
they know everything? They don’t catch him
because he hasn’t done it. What happened in
Iraq confirms that it has nothing to do with
bin Laden or Qaeda. They went against Arabs
and against Islam to serve Israel, that’s why.’’
The broad view here is that the US
capitalised on the attacks to buttress Israel
and undermine the Muslim Arab world.
The single greatest proof, in most people’s
eyes, was the invasion of Iraq.
The New York Times.