My patients often seek help in the darkest of times: job loss, medical illness, and the loss of a loved one are just a few of the challenges that can be extremely daunting.
But what happens when several of these tragedies happen at once, in one day, in one moment, unexpectedly and so tragically? This was the reality many faced on September 11, 2001 in New York City.
As a young psychiatrist in training, I never imagined that I would be working with survivors of such a catastrophic event.
Suddenly, as an intern at a New York City hospital, I found myself responsible for providing mental health care to rescue, recovery and relief workers, as well as grieving families and ordinary New Yorkers, as we all struggled to make sense of life after the largest terrorist attack on American soil.
Dr. Sue Varma directs the World Trade Center Mental Health Program at NYU Langone
Dr. Varma's training could never have prepared her for work with 9/11 survivors
Through her work with first responders and survivors of the September 11th terrorist attack, Dr. Varma to know some of the most important tools a person can have in the face of trauma and adversity
A few years later, I was selected as the first medical director of the World Trade Center Mental Health Program (WTC MHP), part of what is now NYU Langone Medical Center, one of seven centers in the United States founded after the tragedy to provide ongoing evaluations, treatment and support for WTC responders.
Little did I know that this experience would lay the foundation for what would become my philosophy for dealing with life's challenges: something I like to call practical optimism.
I discovered that optimism played a critical role in building the resilience that I saw in many of the patients I encountered.
At first I thought of optimism as something that was either innate or not. However, over time, I realized that while genetics played a role, the rest was up to us.
I wanted to learn and teach skills that can help individuals recover from and thrive in the face of adversity.
And from the many amazing people I met after 9/11, I learned some of the most important tools a person can have in the face of trauma and adversity—and it is through that guidance that I live my own life.
Here are the five strategies I practice every day that help me keep going, even in the worst of times.
Optimism plays a crucial role in building resilience, and while genetics play a role, the rest is up to us
Altruism, giving back to the community and helping others, can shift our focus from internal rumination to external connection
FIND A BRIGHT SIDE (EVEN IF IT'S REALLY HARD)
Even in the midst of tragedy, our perspective is a choice. Tragic events often lead us to both the depths of depravity and the heights of humanity. Which aspect we focus on determines our attitude towards life.
When I can't change a situation that upsets me, I try to find a way to change my attitude towards it. This change in perspective allows me to redefine an otherwise unpleasant situation for me and transform it into a more bearable (and perhaps even more pleasant!) experience.
Try to see things from another person's perspective, or look for a positive insight – a bright spot, a lesson learned, a bullet dodged, a crisis averted.
HELP OTHERS…AND SHARE YOUR PAIN
When we change “I” to “We,” even illness becomes well-being. Altruism, giving back to the community and helping others, can shift our focus from internal rumination to external connection. Even small acts of kindness can have a significant impact on your mental and physical health.
Turn your pain into meaning by sharing your insights with others. I know people whose extreme life experiences required them to deal with loss, trauma, and hardship—and sharing what they learned became an important part of their own healing journeys.
We also know that altruism can be therapeutic for those who have suffered from severe stress. Several of my patients have expressed interest in the areas of grief counseling, rehabilitation and therapy based on their own experiences, losses, trials and successes – from helping others with physical injuries to substance use disorders.
Don't store anything in bottles
It takes more mental resources to suppress emotions than to express them. Unexpressed emotions often manifest as physical symptoms. Keeping a journal to express emotions, worries, fears, and anxieties can be liberating and therapeutic.
Voluntary work for meaning and purpose
In his book “Man's Search for Meaning,” Austrian psychiatrist Viktor Frankl talks about what he learned as a survivor of the Auschwitz concentration camp: “Woe to the one who no longer saw meaning in his life, no longer saw any goal, no longer saw any meaning in moving on. “He was soon lost.”
And in a study published in The Lancet, participants who expressed meaning and purpose were 30 percent less likely to die during the average follow-up period of eight and a half years than participants who lived the least healthy lives. Be
So it's clear that developing a sense of meaning in life can protect us from stress and help us stay afloat in difficult times. Even small volunteer activities or helping others can create a sense of self-worth and purpose.
Even small volunteer activities or helping others can create a sense of self-worth and purpose
It can be as subtle as parents volunteering at their child's school to become more involved in their child's life and including a parents' evening after the meetings.
I experienced this purpose-pleasure combination in the form of a fundraising practice session followed by dinner together. Or someone whose work takes up their nights and weekends decides to reclaim their time and give back by volunteering at a community garden on Saturdays.
The effort doesn't have to be big. Many of my patients in the WTC Mental Health Program simply accompanied others to their medical appointments. Her presence was the greatest gift to those around her.
NEVER SUFFER IN SILENCE
Don't suffer in silence. Get support if needed. Resources such as the National Suicide Prevention Hotline (988) are available for those who need them.
Dr. Sue Varma is a board-certified psychiatrist and author of Practical Optimism: The Art, Science, and Practice of Exceptional Well-Being. You can stay in touch with her (IG, Twitter, FB @doctorsuevarma)
TERESA'S STORY
Teresa is just one example of the incredibly resilient people I have met during my time at WTC MHP, and she is a poignant example of how optimism and determination can shine through even in the darkest of times.
At the time, Teresa was a 68-year-old woman. The native of Venezuela had worked as an accountant at a small auditing firm for 20 years. On September 11th, she was caught in the chaos and narrowly escaped just minutes before the North Tower collapsed.
She witnessed the unimaginable sight of people jumping out of the building covered in blood, dust and debris.
As part of the medical program, Teresa was evaluated for physical and mental health symptoms. Surprisingly, despite the traumatic experiences she endured, she never developed mental health problems.
Throughout her life, Teresa faced various hardships, including those of 9/11, but she demonstrated exceptional resilience. It seemed like she was immune to stress-related symptoms.
What set Teresa apart even more was her willingness to share her strength with others.
Teresa volunteered her time and joined community organizations to help those affected by the tragedy. She accompanied fellow patients who suffered from panic disorder, agoraphobia, and fear of public transportation and crowds, which were common reactions to the trauma of September 11th.
When I asked Teresa what her secret was, she just smiled and said, “Mi proposito,” which means “my goal” in Spanish.
She firmly believed that when we give back to others, we gain even more. Teresa's actions illustrated the power of altruism in the healing process. She understood that helping others not only benefits the recipient, but also fills our own cups and ensures we have the strength to continue investing in the lives of those around us.
This powerful lesson from Teresa reinforced the idea that optimism in unusual places often involves looking beyond ourselves and actively seeking ways to contribute to the well-being of others, even in the midst of our own grief and struggles.
This does not mean that you neglect your own needs, but rather that you are open to sharing your strength with others when you are able.