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Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 8 million residents--roughly 2 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

Coping With 9/11

Some 500,000 people are believed to have developed post-traumatic stress disorder in New York following the fall of the World Trade Center, according to the Journal of the American Medical Association. This rate is nearly three times the national rate per capita. Thousands were directly affected - either having fled the building or the immediate vicinity or having lost a loved one or worked on recovery efforts.

So what are the best ways to cope with the anniversary? Whether you have been severely or moderately affected, experts agree that there are several key considerations to keep in mind in order to reduce stress and maintain optimal mental health. The entire month of September this year will be filled with reminders of the attack, so it is important to pay close attention to how you and those close to you are coping not just on the date itself, but during the weeks surrounding it. As the anniversary approaches, calls to 1-800-LIFENET, the helpline for mental health services which people can call to access Project Liberty, a free counseling and referral service for New Yorkers affected by the attacks, have steadily increased. "We've had a hundred additional calls a week for at least three weeks," statewide director April Naturale said in late August, when there were about 500 calls a week. "And it's climbing every day."

On the anniversary itself, experts say that there is no single best way to spend the day, whether you stay at home or participate in any of the planned ceremonies or events. "Trust your gut," says Dr. Richard Shadick, assistant director of Pace University's Counseling Center. "If you are already feeling very nervous, it might be good to have quiet reflection. But if you are craving information and connection with your community, it makes sense to find a way to participate." Shadick, who witnessed the attack and has provided pro-bono 9/11 therapy throughout the year, agreed to participate in Gotham Gazette's live chats on the day of the anniversary to counsel readers about how to cope. Naturale recommends keeping things "low key, because the emotions themselves may be overwhelming." Small community memorial ceremonies, private rituals like saying prayers or lighting candles, religious services, or just spending time with loved ones and friends can help. "We don't recommend isolating yourself," she adds.

Media attention to the anniversary, in this world capitol of media, will be nonstop and hard to escape entirely. "If you have been traumatized," says Naturale, "We recommend avoiding the images of the planes flying into the towers." For Project Liberty's tips on viewing 9/11 related TV, click here.

Dr. Nancy Smyth, Associate Professor at the University of Buffalo School of Social Work, is an expert on psychological trauma. "We have reason to suspect that the more people watch the images on TV, the more likely they are to have psychological symptoms of post-traumatic stress disorder including anxiety and depression." she says.

Smyth says the research can't determine whether people who are more traumatized are more likely to seek to watch the replays or whether the replays themselves are producing extra stress -- and some experts believe that repeated viewing could lead to desensitization, which might help in some cases. But, Smyth adds, "I have informally collected a lot of anecdotal data and people who have experienced a great deal of sleep disruption report that when they turn off the TV, they feel better."

Smyth advises minimizing exposure to the images of the disaster on television, particularly those which are most gruesome and explicit. She stresses particularly that people should not feel obligated to watch. "Many people felt they had to watch to show that they cared, and felt guilty turning it off. They felt relieved to have permission to stop watching." she says.

New Yorkers seem to be doing more of everything in their attempts to cope: While drinking, smoking and drug use have increased, so have gym memberships. Equinox is reporting a 25 percent increase in profits since 9/11 and New York Health and Racquet Club is also seeing increased demand, according to Crain's New York Business.

Exercise is one thing all the experts agree on as an excellent way of dealing with stress, and the time surrounding the anniversary is no exception. Whatever type of activity appeals to you - from rollerblading, rock climbing and running to dancing, swimming or even just walking -- moving your body can help you feel better.

One reason this is true is because focusing on your physical experience in the moment helps shift attention away from disturbing memories. Smyth cites research showing that traumatic memories seem to be stored in the brain differently from other memories; unlike ordinary recall, traumatic memories seem to involve an actual physical replay of previous events as experienced emotionally through sensations like elevated heart rate and heightened anxiety.

If you can calm those sensations from the past with physical activity now and focus on the current physical activity instead, this can help you overcome them. Therapy for traumatic stress often involves this kind of refocusing -- as well as trying to translate the memories from being disconnected physical and emotional snapshots into a coherent story, like normal memory.

"If you find yourself coming across images that are upsetting or intrusive, take time to sit down and write out what you feel and then go do something soothing." says Smyth. Both writing and talking with others can help people make sense of the traumatic experience and integrate it into normal memory. If you have intrusive memories, trying to put them out of your mind without giving them this kind of context tends only to produce more flashbacks and increased symptoms.

It's kind of like those thought experiments where people are told not to think of a certain subject, for example, white cats, say experts. Trying not to do so almost always fills your head with thoughts of pale felines; similarly, trying to suppress memories of an event that has upset you often calls up more of them until you can make sense of it and it no longer stands out so much.

Both Smyth and Naturale emphasize doing something that is meaningful to you personally to mark the anniversary, whether it be as short as observing a moment of silence, or whether you want to attend a memorial or plan a get-together with people close to you.

Finally, if you feel you need help, don't be afraid to seek it. Smyth says that the time to seek help is when talking to friends or taking other self-support measures aren't working and you continually feel low or have flashbacks. Project Liberty's hotline offers access to free, licensed mental health care services through 1-800-LIFENET, and the hotline can be accessed 24/7.

On the day of the anniversary, Gotham Gazette will be conducting online chats with psychologists at 11:00 AM and 6:00 PM. The psychologists have experience in crisis counseling and will be available to answer your questions, and discuss your feelings and reactions to September 11 one year later.

Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.

Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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