Nearly 3,000 Americans died on that tragic day. And many more live with physical and psychological scars that range from serious to life-threatening — illnesses like cancer after exposure to toxic dust and debris from the collapsed towers in New York City, post-traumatic stress disorder, depression, and the loss of loved ones, according to New York City’s World Trade Center Health Registry. For many who survived or lost someone in the 9/11 attacks, the anniversary reignites memories of what they experienced that day, says the grief psychologist Heidi Horsley, PsyD, an adjunct assistant professor of social work at Columbia University in New York City, and the executive director and cofounder of Open to Hope, an organization for grief recovery. Dr. Horsley has counseled widows and children of firefighters who died in the New York City attacks. “Anniversaries can bring people back into those earlier stages of grief, which can be blindsiding for them,” Horsley explains. If you’re feeling a resurgence of grief as the anniversary of 9/11 approaches, you’re not alone, Horsley says. “It’s very normal, and I think it’s a relief to people when they find out it’s very common.” Here’s why she says anniversaries like 9/11 can reawaken grief, how you can cope, and when you should seek professional help. Everyday Health: Why can anniversaries of traumatic events like 9/11 heighten grief? Heidi Horsley: It’s completely normal to have heightened grief reactions on anniversary dates, because oftentimes, anniversaries like 9/11 retraumatize people. On each anniversary, many people have the same physical and emotional reactions they had on 9/11 itself or in the weeks, months, and years following the tragedy. EH: In what ways might that grief show up for people? HH: People might experience a range of emotions, with some people being more impacted than others. They may feel sadness, anxiety, and anger at levels they experienced on the day of the attacks. Sometimes these emotions are more intense; sometimes they are less intense. Crying, anxiety, or nightmares can also be tied to grief cropping up again. And others might notice physical reactions like stomachaches, headaches, and backaches, as well as hyperarousal symptoms (the body’s fight-or-flight response kicking into gear). This could be triggered by regular, everyday noises like cars backfiring, sirens, ambulances, and car alarms, which may be reminiscent of the sounds of that day. And some people respond by avoidance. Some people will avoid going to lower Manhattan where the attacks on the World Trade Center happened or to New York City (or the other sites related to the attacks). They might not want to go to any 9/11 memorial sites. They might want to avoid news coverage because of traumatic reminders of the events, such as footage and images. Those traumatic reminders bring back memories and intrusive thoughts about the 9/11 attacks all over again, especially for someone who experienced the events in person or lost a loved one. RELATED: What You Need to Know About Migraine and PTSD EH: Why might grief show up in new ways many years later? HH: It’s not unusual for people to put their grief on hold or not process it at a deeper level when they first experience it, because they don’t want to be totally overwhelmed by it. This may have been some people’s way of coping earlier on, but if grief comes back months or years later, they may suddenly feel it on a larger level. This could be triggered by anniversaries or even by experiencing another loss, which may remind them of the loss they had on 9/11. EH: You work directly with families of firefighters who died on 9/11. What are some feelings people have toward the upcoming 20th anniversary? HH: The common theme I’m seeing among bereaved families of firefighters who died on 9/11 is that the days leading up to the 20th anniversary date have been very difficult. One factor that makes it so hard for them is that 9/11 was a very public event, meaning there are a lot of reminders of what happened cycling through the media. But at the same time, this was a very personal loss for these families. That complicates their grief experience. The bereaved family members often feel as if they’re under a microscope. As the anniversary date approaches, their stress builds, and it’s a relief for them when they get past this very public event. That said, these families are also very resilient and have gone on to create meaning from their loss. The 9/11 community of survivors and bereaved families is very tight-knit and close, and they have all supported each other through their grief over the past 20 years. Although their lives have changed profoundly, they continue to honor the memory of their loved ones in many ways, including helping others process mass tragedies, working as grief therapists, and becoming firefighters to honor their fathers, husbands, and brothers who didn’t survive the 9/11 attacks. They choose to look at the 20th anniversary of 9/11 as a day of hope, healing, and remembrance. RELATED: What Is Resilience? Your Guide to Facing Life’s Challenges, Adversities, and Crises EH: The 9/11 attacks and subsequent events have been in the news cycle a lot lately given the conflict in Afghanistan. How does this contribute to the grief and other emotions people are feeling right now on the heels of the 20-year anniversary of 9/11? HH: The conflict in Afghanistan and the deaths of 13 U.S. service members in an attack on the Kabul airport on Thursday, August 26, serve as additional triggers of grief for people who survived or lost someone on 9/11. These events can compound the grief reaction and lead to anxiety as the anniversary of 9/11 nears, including fears that another tragedy might happen on 9/11 this year, too. EH: What advice do you have for people in terms of how to cope with all this grief? HH: First, remember that what you’re feeling is normal, and you don’t deserve to be judged, criticized, or for people to say, “Oh, you’re not over it yet?” People who lose a loved one don’t “get over” the loss. They learn to live with it, and that’s something that people around them need to understand. To help you cope, I recommend using adaptive skills that have worked best for you in the past. Some ways to do this are:
Don’t isolate yourself. Instead, talk to supportive friends and family, and talk to a therapist if needed. Tell them about thoughts and feelings you’re having around the anniversary and what it’s bringing up for you. Avoid numbing your feelings with drugs and alcohol, which are maladaptive coping mechanisms.Limit your exposure to the news. There are going to be images of the towers falling, people running, smoke, and fire — all the things that happened on 9/11 — played over and over on the anniversary, which can be really disturbing for people. Be sure to limit social media as well, because many posts about 9/11, including images that you’re not prepared to see or don’t want to see will likely surface in your news feed.Exercise. Walking or any physical activity that releases endorphins is another important adaptive coping skill. One positive activity to consider doing on the anniversary of 9/11 is go for a memorial run or engage in some kind of workout in honor and memory of those who died on the day of the attacks.Focus on remembrance. Remind yourself that 9/11 is about remembrance. It’s a day to memorialize, pay our respects, pay tribute to those who perished, and remind ourselves of how far we’ve come since the attacks happened in 2001. The trauma is not happening again. Think of it as a day of hope for moving forward.
EH: What are some things people can do or say to help loved ones experiencing 9/11-related grief? HH: First, it’s important to remember that saying nothing on the anniversary of the loss of their loved one is not helpful, and is often hurtful and isolating. For people who lost someone on 9/11, reaching out on those anniversary dates and touching base with them is very helpful. Let them know you’re thinking about them on the 20th anniversary of 9/11, and offer to talk with them, have lunch with them, or support them in some way on that day. Validate and acknowledge that they’ve lost somebody. Sit and listen to stories about the person they lost and the way that person lived. The way they died is a moment in time; how they lived is really what we want to talk about when we remember them on the anniversary of 9/11. Support your loved one without judging their grief, and don’t try to “fix” their grief, because you can’t bring back the person they lost. But you can be there to walk with them on their grief journey and to hear what they have to say. RELATED: Study: Having a Good Listener in Your Life Is Linked to Better Brain Health EH: When should you seek help for grief? HH: Remember, there’s nothing wrong with getting professional help for grief. Again, it’s normal to feel this way after traumatic losses, even 20 years later. Over time, we still miss people we lost and feel sad that they’re not here, but there can be joy and hope in your life again — and seeking professional help can help you reach that point. I recommend reaching out to a mental health professional for help if you:
Feel hopeless, helpless, or like your life is not worth livingHave a substance abuse problem, such as excessive alcohol and drug useFeel consumed by angerFeel like your relationships are being impacted or like you’re pushing loved ones awayHave a hard time reconnecting with othersFeel like you can’t function in your careerHave thoughts of or a plan for suicide
