More Thoughts About Thinking the Unthinkable, Part II

GUEST: Lawrence Aber, Ph.D.
VTR: 04/22/04

I’m Richard Heffner, your host on The Open Mind. And in a sense this program is still another extension of one we did just a year ago about “thinking the unthinkable, in order to do something about it”.

My guest then and really the intellectual presence behind this Open Mind and others to follow, was Dr. Ralph Gomory, the redoubtable President of the Alfred P. Sloan Foundation who has wisely insisted that “you can’t ask people to agree that the threat of terrorism is huge and leave it at that. You have to give them something concrete they can do. Because their question is going to be, ‘what can I do about it?’”

Well, here on The Open Mind, therefore that is precisely what I want to ask a number of expert guests on occasional programs over the months to come; from their respective disciplines and vantage points just what practical measures can we Americans take to protect ourselves against terrorism – biological, chemical, nuclear – and in whatever other forms sick minds can conjure up to injure us.

Today then, as last time, we start appropriately enough with concern for our children. And my guest today is Dr. Lawrence Aber, Professor of Applied Psychology at New York University’s Steinhart School of Education and a widely acclaimed student of children in stress.

When he was here on The Open Mind not long after 9/11, Dr. Aber had just participated in a symposium evocatively and cleverly titled, “When the bough breaks”. You remember, “rockabye baby in the tree top, when the wind blows the cradle will rock; when the bough breaks, the cradle will fall and down will come baby, cradle and all”.

Well in the terror of 9/11, the cradle did fall, fall a great distance, with damage of many different kinds to young Americans. And the question then, as it remains now was what practical steps can we take for our youngsters sake in order to deal with terrorism, as with the various other traumas they face at other times, poverty, abuse, debilitating diseases, parental and societal indifference or ignorance. Dr. Aber played a major role in the research with children conducted after 9/11. And I want to begin today by asking him whether we have learned anything practical and meaningful from it? Are we doing anything with what we’ve learned?

ABER: Great question, Richard, and we have begun to learn many things that have practical implications, but we’ve not driven through to succeeding in, in practice, yet.

Some of the things we’ve learned. We’ve learned that children are exposed to events like 9/11 not just at ground zero and not just in surrounding communities, but throughout the nation. There’s a phenomenon we could call “distant trauma”, where people can be traumatized through the media, children especially and that is … expands the radius of our concern. We have not, however, really worked through what that means for media and communication strategies. That’s example number one.

Example number two, we found that children’s mental health problems are elevated after events like 9/11. In the study of the effects of 9/11 on New York City’s children, which was headed up by my colleague Christina Hoven at the Mailman Center, and I was a co-investigator. What we found was that children’s … not only their post traumatic stress disorder symptoms, but also symptoms of separation anxiety, generalized anxiety, depression, substance abuse, all were elevated after 9/11.

But, of the kids who showed serious mental health symptoms, over 75% were not receiving any kinds of services in the schools or in their communities. This, with all the investments that were made after 9/11. So, we’re learning about the nature of the phenomenon and we’re learning about its impact; we’re learning where we should be targeting resources and what kind of practical things we should be doing around public education; but we haven’t worked it through yet.

HEFFNER: Public policy is your major field of interest in the psychological area, why haven’t we translated what we have discovered into public policy?

ABER: Well, I think three reasons. The first is that disasters like the events of 9/11, war, major natural disasters, technological disasters … all these are such complex phenomena, such dynamic phenomena and they move in, in complex ways, that they strain the multiple levels of the system that need to response.

We need national and Federal responses; we need State and regional and local responses. We need responses by multiple service systems; communities, neighborhoods, schools, and families. And that is a massive enterprise; that’s the bad news.

The good news is, I think, we’re becoming increasingly aware of it and there are initiatives like some of the ones Dr. Redlener spoke with you about at the last show where we are rehearsing how to collaborate and cooperate across these multiple systems. But it has to be public policy’s roles to insist on and rehearse that collaboration and cooperation.

The second, the second thing … reason why I think public policy isn’t working is that public policy is very … consensual public policy on this is very hard in the absence of consensual politics. And the events of 9/11 brought us together for a period of time, politically, in this country, but over the last two and a half years, we’ve become increasingly polarized, increasingly politicized; we are the red and blue country again. And the red and blue country has a hard time dealing with the politics of policy in this area.

HEFFNER: Consensual politics, consensual policy.

ABER: Right.

HEFFNER: Do you see a point at which we will have consensual politics relating to public policy in the area of protecting our children?

ABER: It will require a willingness to meet at the middle that has been increasingly eroded in Congress and in our national discourse. It will require forms of leadership where citizens ask their elected officials not to fall back on ideological standards and to get practical in the middle. And, and it will require voters disciplining their elected officials who don’t do that. That means showing them the door.

HEFFNER: No, euphemisms. Let’s talk turkey. What do you mean about a “middle ground”? How could there be a middle ground as you’ve participated in the study of the impact upon our children of 9/11 and I know you’ve devoted so much of your life to dealing with children in stress, generally. Do you feel that there is “middle ground”?

ABER: I do believe there can be “middle ground” and the strategies that … national and state and local strategies that we need to adopt have to meet three criteria. They have to be consistent with American values, they have to be within our economic means to be able to provide and they have to be known to be able to have practical impact.

And working from the back, “known to have practical impact” … we have some evidence of effective strategies to meet kids and families mental health needs in these situations. We know some things that don’t work … psychological debriefing doesn’t work and it was the most popular approach to it. We have hints of some things the could work, cognitive behavioral therapy for anxiety could work … short, powerful. And we need more evidence based practice and a consensual middle is to support the science and research to do that.

On the other issues there are ways of preparing communities and states that involve enhancing the service structures to deal with the problems that children have now and by reducing their burden now and making them more effective now, they’re more prepared to help in the future in the face of disasters.

HEFFNER: Now, what could a parent watching take away in terms of what you’ve learned and what you think needs to be done.

ABER: Dr. Redlener suggested on your last program that parents ask their pediatricians how they should prepare for terrorism and preparedness for other kinds of disasters. Parents should be asking their schools, their children’s school principals as well. Parents have to advocate in the basic systems that affect their children and schools is the biggest. But not only schools, parents should be asking the local City Council representative, the local State legislature, “what are you doing to help our community prepare for the mental health needs of our children in the face of violence and disaster?”

HEFFNER: Let me ask a very direct question …

ABER: Yeah.

HEFFNER: … will my son in California asking his pediatrician about his children get the same response that my son in New York asking his pediatrician about his children get?

ABER: There’s enormous diversity in professionals preparedness to interact with their patients, their customers, their clients on these kinds of issues. There are big state differences in how service systems are prepared. But, no they won’t get the exact same response. But through accumulated requests over and over again, they can raise their service providers consciousness of this and insist on something different.

HEFFNER: Yes, but you’re saying “they” should raise their provider’s consciousness in this.

ABER: Right. Right.

HEFFNER: And what role is your community …

ABER: Well …

HEFFNER: … taking.

ABER: … you asked me what parents should do.

HEFFNER: Okay.

ABER: So I, I … my response was what parents should do. But I think you’re appropriately asking, with this second question, “Do we leave preparedness up to parents?” And the answer is “Absolutely not”.

I, I began by saying that I think that only national government can take a perspective on the cooperation and collaboration across the multiple levels that are required to prepare our nation to respond to terrorism and other kinds of disasters as they affect children. So I’m … I go back to the political process and understanding how that’s going to be a part of it.

You know that on the day of September 11th … one point two million New York City children were in school. And 750,000 of them got to school via public transportation … they went on a road, over a bridge, through a tunnel and we focused enormously on bridges and tunnels and protecting physical plant. We have not made anything like the national investment in the mental health preparedness, even though we recognize that the purpose of terrorism is to have a psychological effect, to increase the fear and insecurity of people, that they become immobilized and not able to protect themselves.

HEFFNER: And terror did increase the fear and anxiety of our children.

ABER: Absolutely. Quite significantly. And we’ve known that for a long time. There’s now very good studies of over 60,000 disaster victims in over 100 different disasters … technological disasters like industrial accidents, natural disasters like earthquakes and floods and disasters like mass violence.

And we are accumulating a base of knowledge about that that we have to mine … we have to mine that every bit as much as we mine knowledge about causes of and effective treatments for cancer.

HEFFNER: You say, “We have to mine it”. Haven’t we?

ABER: Ahmmm … we, we have begun to. But I don’t believe the softer side of human life has the same respect from the national community in terms of a focus research as the harder side.

HEFFNER: Larry, why do you say “the softer side”?

ABER: Because it is very hard to come up with the exact, concrete hard, biological mechanisms by which terror affects the human heart and human soul. And it, it’s …there are some people who are skeptical about our ability to learn about that. And that skepticism leads them to be unwilling to support research in that area.

So research on children’s mental health, partly because children are little, partly because it’s complex and soft, doesn’t get the same play as physical illness of all sorts.

HEFFNER: Now you said, you said in practical terms we did mine two things; one had to do with the ineffectiveness of a certain kind of therapy and one had to do with the effectiveness of another kind. Would you explain that?

ABER: Yes. There has been a form of response to terror and disaster … a psychological protocol called “psychological briefing” that involves going over the event and, and it’s in response, in part, to the fact that people who go through trauma events, in order to construct meaning, go over it over and over again until they can assimilate it.

But that creates the intrusion into thoughts of those events and the avoidance that’s very characteristic of post traumatic stress disorder. It was a good thing to think about and design … people seemed to like it going through it and rigorous studies show that it doesn’t help. It doesn’t in any way affect long-term psychological health.

On the other hand, there’s another form of treatment … cognitive behavioral therapy, that involves slow exposure to the anxious making thoughts and events again and learning how to master and manage them in a certain way, using a different protocol, the current evidence suggests that that can be effective in reducing symptoms of PTSD.

And the larger point is that there are only these two flavors that we know much about through rigorous studies. We would like to have in our toolbox ten, twelve, thirteen, for the lucky number, of different approaches. And, and that’s a role that science has to play.

HEFFNER: Do we know anything from other societies’ experiences, whether we go back to the Blitz in London or to contemporary acts of terror and their impact upon children?

ABER: We do. There’s been a lot of knowledge exchange, particularly in Israel. All Americans virtually know the degree to which Israelis have lived with terror over decades. And there is a very, very active scientific community and clinical community in Israel learning about these things, and there is scientific exchange between Israeli scientists and clinicians and American scientists and clinicians. We, we have learned about that.

Taking an even broader perspective, though, this database of hundreds of studies on hundreds of disasters tells us things like disasters have more of an effect when the malicious intent to harm or the belief that it was caused by callousness and carelessness are part of people’s experience of the event.

So mass violence is worse because the malicious intent to harm is a part of it. Technological disasters are worse than natural disasters because people assume a level of callousness and carelessness that caused it. So human intentionality is a very, very big part of people’s psychological response to, to these kinds of disasters.

HEFFNER: Now, we’ve just talked about psychological response …

ABER: Yeah.

HEFFNER: Can you elaborate upon the nature of the response, particularly when you talked just now about intentionality …

ABER: Right.

HEFFNER: Are we producing more cynical, more bitter, more, more nastiness … in response to the nastiness of our society?

ABER: Well, I’ve just concluded editing a special issue of a scientific journal on the effects of 9/11 on children. And one of the studies in the journal … actually one done by several colleagues of mine and I … we have tested the effects of exposure to the events of 9/11, not only on children’s mental health, but on their social mistrust; their xenophobia and their tendency to feel paranoid in a variety of way. And prejudiced in a variety of ways.

And once you do kind of fancy statistics in a way and try to tease this apart … yes … there is evidence that exposure to the events of 9/11 increased children’s social mistrust, but curiously enough not their prejudice against other ethnic groups. Here in New York City, I don’t know how generalizable that is, but here in New York City, there is a level of social mistrust that was increased by the events of 9/11, but not racial, ethnic prejudice which a lot of people were quite concerned about and appropriately so.

HEFFNER: And then the question of distancing … the further away a child was from “the spot” … ahhh, what do you find?

ABER: There have been studies now of children in North Carolina, of children in Colorado and of several national surveys; children have learned about the events of 9/11 through the media and media is a vehicle by which children become aware of it, feel helpless, potentially, and can be traumatized.

So that, nonetheless, the greatest risk is for people, including children, who experience life-threatening danger themselves. Who experience the life threatening danger or loss of a loved one, who were in the, the disaster itself. That’s the biggest effect. But it does … there is an increment in risk that radiates through communications mechanism that we have to think about as a public health issue and a media policy issue in 21st century America.

HEFFNER: Tell me … media policy … what do you mean? Do you mean about the, the degree in which the news media impact? Or are you talking about, let’s say, violence in entertainment?

ABER: In that particular instance, I was talking primarily about the news media. And there … one of the things that I would love the news media itself … the broadcast media to do … is to have before a next disaster, a confab among itself … I’m not interested in the government policing the media on this issue, and I am completely committed to citizens knowing the truth.

But a five or six second … this show will contain news material which we suggest children watch with their parents … could dramatically change children’s responses to, to news stories related to this. We, we are concerned that children are watching television alone, they don’t have adults to process things with and there are things media can do within their Constitutionally protected right to report the truth, that nonetheless help buffer the awesomeness of the truth to children.

Second thing they can do, is during the acute reporting of events like this, refer people to places that if they have concerns, or their children have concerns, to talk about it. So, there are very, very brief things that the media could do to reduce the public health impact of their reporting on children.

HEFFNER: Why are you so fast to talk about the Constitutionally protected …

ABER: Because in talking to the media immediately after the events of 9/11 when I raised this, some members of the media said, “That’s not our job. Our job is to tell the truth. We’re not going to accept any government intrusion into that.” I’m with them.

And I said, “Your job is to tell the truth, but couldn’t you also piggyback onto that some concern about the form you tell the truth’s impact on the community and especially children when you’re doing it?” And it’s a dialogue that, I think, an important part of preparedness.

HEFFNER: A dialogue that might be an important part of preparedness if it got them to do something.

ABER: That’s right. That’s right.

HEFFNER: And do you think that it will get them to do something?

ABER: I think you have a better chance of having that happen than me. So, I think it has to happen within the community, the media community. I think that most of the other ways that it could happen are less likely to succeed.

HEFFNER: Isn’t that funny. As one who’s been around this table for almost a half century and the media generally, for even longer, my answer is that it ain’t gonna happen that way.

ABER: Ain’t gonna happen that way.

HEFFNER: Because it’s going to interfere with the competitive instinct …

ABER: Yes.

HEFFNER: … of the news media. And you know that.

ABER: I do know that, but it’s why in other areas you can lift the, the playing field of everybody and they compete on a different playing field. So, if it became a bit of a pariah to not do that, media companies could socialize themselves into it. And it’s … I don’t think, I don’t think there are big constraints to this. Do you know how easy it would be to do the two things I just described?

I’m not talking about gag orders or terribly expensive things; I’m talking about thinking things through enough … that is there are five seconds you say before a news program and five seconds you say afterwards, that frames it in a way to reduce the risk to children.

HEFFNER: But, Larry, by definition if you say “Look how simple, how easy it would be, five seconds”, how effective would five seconds be?

ABER: Repeated as often as news stories about this occur; quite effective. Part of the negative effects of the media is the repetition of the traumatic visions over and over again. So, and you wouldn’t apply it to all of that … see, you’d have an industry standard that says you show certain kinds of things; you do the five seconds before and after. It’s exactly the kinds of things that are repeated over and over again that are the things I’m concerned …

You show it once, I don’t need a notice. Show it over and over again, 24 hours a day …I’d like a notice.

HEFFNER: How could you live this long and be … remain so naïve, or hopeful?

ABER: I ….

HEFFNER: That’s a nasty question, asked by a nasty guy.

ABER: No, no. Well, you are a nasty guy, but it’s not a nasty question, it’s a completely fair question. I, I think hope is reasonably practical in this. And hope is mobilizing. Naiveté is not. So, you’ll tell me off the camera, or right now, what you find naïve about my comments. Hopefully, I agree with you. I … and I think I’m hopeful because I find it a practical sentiment.

HEFFNER: A practical sentiment.

ABER: Absolutely.

HEFFNER: You think it’s the only way in which we’re going to get anything done.

ABER: Oh, yes, yes. And I think that there’s a lot of work that we can do, and a feeling of helplessness is really one of the worst ways to prepare for the next disaster.

We cannot be hopeless. We cannot be helpless, we need to be hopeful and we need to be in the practice of engaging citizens and parents at multiple levels in the active forms of decision making for preparedness. Public policy, the government takes a role; but unless it is communities and citizens who are actively involved in this, we’re not going to be prepared.

HEFFNER: Well, I, I … I’m sure you’re right about that. But the public policy, the dictate, which I guess I’m cynically more prone to say, I’ve been around too long to think that the voluntarism that you suggest will work … just as simply as that. Would I want it to? Yes.

ABER: Yeah. I want to combine citizen and community voluntarism with public leadership and there are reasons to worry about whether we’re going to do both. But to the extent that we want to be prepared, we need to do those. Strengthening the basic mental health serving systems; strengthening the basic electoral and political processes are all part of preparedness.

HEFFNER: Dr. Larry Aber, thank you so much for joining me today on The Open Mind.

ABER: Thank you.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time, and if you would like a transcript of today’s program, please send $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.

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