Social Impact LIVE: Ellen Lukens and Helle Thorning Reflecting on 9/11, Loss, and Resiliency
On the 18th anniversary of 9/11, Richard Hara is joined by Dr. Ellen Lukens and Dr. Helle Thorning to discuss the crisis-oriented intervention they developed to serve the needs of those affected by the destruction of the twin towers.
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Richard Hara: Hello. I’m Richard Hara and this is Social Impact LIVE, a weekly conversation with members of the Columbia University School of Social Work. I’m pleased to have here today, on the 18th anniversary of the 9/11 attacks, Dr. Ellen Lukens and Dr. Helle Thorning. Dr. Thorning is a research scientist and the director of the ACT Institute, Assertive Community Treatment, of the New York State Psychiatric Institute at Columbia University. She is also a clinical professor of psychiatric social work at the Columbia University Vagelos College of Physicians and Surgeons. Dr. Lukens is the Sylvia D. and Mose J. Firestone Centennial Professor of Professional Practice here at the Columbia School of Social Work. Dr. Lukens and Dr. Thorning, welcome.
Ellen Lukens: Thank you.
Helle Thorning: Thank you very much.
Richard Hara: After the 9/11 terrorist attacks on New York City, Dr. Lukens, Dr. Thorning, and Dr. Peggy O’Neill, a good friend and former colleague of ours, now teaching at Smith College School for Social Work, worked with a team of social work clinicians to develop and implement a psychoeducational intervention for those individuals and families directly affected, based on their prior expertise in helping people deal with trauma, mental illness, and other significant challenges. But before we turn to that intervention, I wonder if we might pause for a moment to reflect on that day, September 11th, and where we were.
Ellen Lukens: Thanks, Richard, and thanks for having us, inviting us to do this. So that morning, September 11th, I was teaching my doctoral class, which I usually do from 9 to 11 on Tuesday mornings, and it was a large class. It was the second session and we didn’t take a break during class. So we were involved in an intense discussion. So after the class was over, I walked back to my office. People in the next room were huddled around a radio, looking horrified, and one of them ran out to – and literally grabbed me, and ex- tried to explain what had happened. It was very hard to absorb and my first thoughts went to my daughter who was, fourth day of freshman year of high school, very close to the World Trade site, and my husband who had just flown from New York to Atlanta for business, uh, and, and then, just trying to figure out, in the midst of a sort of an unprecedented experience and reaction, what to do next.
Helle Thorning: I’m glad. Thank you again also for having us, and, and I think it’s a very good question to start with, because on a day like today, you know, we, all of us are sort of thinking about where we were and what happened and, and also sort of reflecting on the impact that it’s had not just on us, but on, on, on our country. So yeah, I was the director of social work at the time and at New York City Psychiatric Institute, so also heard the news sort of from a colleague. I couldn’t really absorb it either and, and started to go about my day, the business of the day, and then I realized what was going on. And then my kids also in New York City, you were thinking about where are they, where is your family. Obviously, kids and your husband is the sort of the forefront of your, of your mind, but at that moment, it was also an interesting kind of experience, because I had to kind of turn over the concern for my children to my husband, and I was lucky to get in, in touch with him. And then, I had to kind of go on and try to think about what my role was in my position at the hospital, and what was going to be expected of us. So that was kind of the day, full of sort of this having to turn off in a way what was going on with the family, to think about sort of the work piece, and, and that I was totally unprepared for.
Richard Hara: Yeah. To sort of pick up on your story, I was, I was a clinical social worker at the time at Memorial Hospital of Sloan Kettering, and like you I was with my colleagues and we were trying to get information about what was going on. And then we heard from hospital administration, from people like you, saying well, we needed to mobilize for this catastrophe, and so we tried to discharge as many patients as possible to open up beds. We were setting things up in hallways and we waited, and we waited, and, and that’s what I remember about the day. The terrible realization that the… that the tragedy was so awful that when you talk about casualties, we didn’t even have wounded to treat at our hospital. Yeah.
Helle Thorning: That was… So, that’s interesting. We were both sort of uptown, and I think the people that were sort of coming out from the, from the site and needing treatment, they had St. Vincent’s, and they got the people that needed the treatment, but us, from the rest of the city, uptown, we were just waiting.
Richard Hara: Yeah. So, the events of that day reverberate to the present, and there was an interesting article in the New York Times, I don’t know if you saw it, about a woman who fled the towers that day and dealing with PTSD now, 18 years later. So, it just underscores the importance, right, of trying to intervene early, as early as possible, at the time of these kinds of events, which you were in a position to do back then. You developed this intervention to help people directly affected. I believe, was the program called HOPE New York?
Ellen Lukens: Yeah. So the program-, so we named the program HOPE New York, and that stood for “Healing and Outreach through Psychoeducation,” but hope felt like a very critical component of the work at that point, because nationally, people felt quite hopeless. So, figuring out how to build on resilience in, in the context, became really important. And then, the name seemed, for us, symbolized that. So, yeah, but you talk about the reverberations of the trauma 18 years later, it’s gone very deep in terms of physical and psychological impact, and the fact that people are still experiencing the aftermath. So, it hasn’t, and I think days like today bring that up for a lot of people. So…
Richard Hara: Yeah, yeah. So, at that time, what did HOPE New York try to do to kind of lessen the impact of the trauma that day and on the people affected? I mean, how did the… how was the program set up and how did it work?
Ellen Lukens: And how did it start?
Richard Hara: Yeah.
Ellen Lukens: Well, I think, Helle, actually, you called, soon after the event, you called me and said, “You know, we’ve been doing psychoeducation with people with severe mental illness for many years, and it seems like this would be a really good approach for this event, and clearly, it would require some adaptation as well.” So, the idea was to use the premise of psychoeducation, which is really a learning exchange between participants and facilitators to … and to work with very, very diverse communities across the city. So…
Helle Thorning: And I think, we were saying directly affected. So, so I just want to kind of think about that a little bit.
Ellen Lukens: Okay, that’s true. That’s true.
Helle Thorning: Because in the first day of, or the first period of time after traumatic events like we saw at 9/11, is that the first thing really that needs to happen is that the first responders have to step in, and I think… and that’s what we learned too. We were both reminiscing about that the first couple of days after the event, after we knew our kids and the family were safe, we were also then trying to think about well what is our role, what do we do? And we did different things, went down to the Red Cross, but really couldn’t find this space where, you know, we were, we could be helpful. So, so the first, in any kind of traumatic expe- or event, or when that happens – safety, of course, is first for people. We know that people need shelter, they need food. They need to be safe, and that’s, that’s the first responders’ kind of job. What we start seeing is that the sort of, the next wave of things, that people were needing to figure out a way, as we, ourselves, to understand what was going on, and how the impact it has, and to understand our reactions and to help. So to use this idea or use psychoeducation as a way of explain, kind of helping people understand and help them make meaning out of this event for themselves.
So this is kind of… so this is not a model for first responders, but this is a model for sort of the immediate aftermath for people who have had, who are in the community, close to the events but really sort of impacted and significantly impacted, just like with the woman you talked about who has, still has, suffers from PTSD to this day. But that helping people to understand that the reactions that they had or they were having or that emerge after an event like that are very common reactions in very unusual events. And that’s what we wanted to kind of get at, because that’s what the… People got concerned about that they would have these problems or reactions for, for a long, long time, but it’s actually very common that you have those kinds of stress reactions, and what can you do?
Richard Hara: Okay. So, the intervention was basically group meetings that were organized in different communities, consisting of what, four sessions, I believe? Is that correct?
Ellen Lukens: No. So, yes. So, so as you said, and as you introduced us, we started… Peggy O’Neill, Helle and I developed this initially, but it seemed quite disingenuous of us to attempt this work in communities around the city without involving the communities.
Richard Hara: Okay.
Ellen Lukens: And because there was significant funding available through Project Liberty and the September 11th Fund, we were able to have the dollars to hire people from the communities that we were working with. That included the Arab-American community, the Chinese-American community, the Dominican-American community, and the American-Indian community, as well as rescue workers, and to adapt our model for each of these communities, working in conjunction with people from the communities, because trauma is understood very, very differently in different cultures. So it was a bit of a daunting task, because as Helle said, this was not something we could do immediately after September 11th, because people were dealing with the crisis and it took a lot of collaboration with the communities to be able to develop the model. So…
Richard Hara: So this provided you an opportunity to get some feedback from the very communities that were affected and to build a… to collaborate on, on developing this intervention in a way that gave them agency, gave them a sense of a role in, in how it would be put together and how it would be delivered, I guess.
Helle Thorning: Right, and I think, to add to that that as we started working with people in these four, five communities that we worked in, it was with the people who were helping people. So, we also became keenly aware of the importance of understanding impact on the helpers who were helping in a traumatic situ- after a community trauma, who had also been impacted themselves. So the whole idea of vicarious trauma, secondary trauma, really sort of rose to the surface and that I think one of the really big lessons of what we’ve learned from, from the project of the importance for us, as social workers or helpers, to pay attention to how we are experiencing what we hear, because it might resonate with our own fears or worries for ourselves and our families. So the, so the distance between the helper and the people being helped, also that distance really, it didn’t exist, and I think that was one of the big lessons from that we learned, I think – wouldn’t you say? – of what impact of community trauma has for everybody in the community.
Ellen Lukens: So we were really, it was really a process of not only healing in the work that we were doing, but healing ourselves, in turn, because this was so hard to grasp. It’s still very difficult to understand that that really happened, and there are many other kinds of traumas that are not dissimilar happening around the world. So…
Richard Hara: Well I think it’s a wonderful approach, you know, to sort of, I don’t want to say, you know, shift from an individual focus, but to look at it in more collective terms, right, and, and, and sort of a group response and that, you know, would promote and foster resilience, right, and, and is more strength-based. Certainly, as we like to talk about in social work, you know, as a response. So just to… What were some of the topics that came up in actual discussions?
Ellen Lukens: It is such a great question. I mean, some, some of the topics that came up in discussions were the most mundane things having to do with everyday rituals and how one’s life was disrupted because of what had happened. What was expected in daily life was no longer … you couldn’t exp-, you didn’t know what to think would happen next. And then other, some of the other discussions were much deeper, focused on, you know, the, the grief associated with losing a husband so suddenly, or a child, an adult child. So, it ran the gamut in terms of … And actually, I think, moving from the mundane to the more really deeply upsetting aspects within the groups was, was healing in its own way for people. So…
Helle Thorning: Yeah, and then it was very… but we also were, kind of, it was kind of an honor to be part of the communities that had very different kinds of reactions and it meant different for, for them. So, for example, the Native American community now, not many people know that there is a Native- very vital community in New York City and they have a community house, and we were invited in to participate in their kind of… as they were figuring out what to do for their members. But they had… so, for many of… there was a… historically, the Native American community were actually the iron workers who built the World Trade Center. So, they had a very strong connection to the World Trade Center itself. They were very proud of it and it became, you know, that was sort of very proud, because they were part of making it, or building it, and then… But at the same time, they were also experiencing, “Wait a minute, you know, this is, you know, a tragedy, a community trauma for New York City, but what happened with our historical trauma as Native American people?” And so, as Ellen said, it touched on many different levels, because it was “nobody paid attention to our trauma when were…” In particular, I remember one man talking about his trauma of being removed from his tribe to, you know, go to a Catholic school and you know, being, his culture being sort of, him being stripped off his culture. And so that, so for that community, it brought up, you know, a number of different… In particular, when they thought about the historical trauma, and then thinking about, learning about how people think about that in that community, in terms of the way they make meaning. So, it was, it was a very sort of privileged position for us, in a way. Very honored to be able to, to, to hear and understand, and get that perspective as we were participating with them.
Ellen Lukens: In the very first meeting with the Arab-American community, I remember we presented our ideas and then we wanted to have an exchange with the group, which was probably some spiritual leaders and community members in Brooklyn, and somebody raised their hand and said, “Are you from the FBI?”
Helle Thorning: Yeah.
Ellen Lukens: And I remember, my, sort of my blood running cold and thinking, of course they would think that. Of course they would think that. So, there was a lot of need for, you know, bridging the distrust and the fear, and…
Richard Hara: Yeah, so obviously, you know, the effects of these kinds of events differs according to…
Ellen Lukens: The community.
Richard Hara: The community, being considered, and I just wonder, you know, if, if we can draw any lessons from your work after 9/11 to what seems like an almost weekly, right, event here in our country, whether it’s a mass shooting or you know, devastation from a hurricane or some kind of extreme… things that we might draw from that work that that might help people foster resilience? You know, manage what are potentially traumatic experiences?
Ellen Lukens: It’s such a good question. I mean, one of the things that we learned is that people don’t initially have the words to describe what happens to them, and helping, which is an important part of moving on, is if you can begin to describe and make meaning out of an experience. And given the kinds of experiences that people are dealing with that’s a… that’s something that we would have to carefully attend to as we adapt this for other circumstances. I mean, it’s a great question.
Helle Thorning: Yeah, and I would just add, you know, to what you’re saying that it’s, you know, that putting words to and understanding that what you experience now may, may have a longer history.
Ellen Lukens: Yes.
Helle Thorning: Depending on who you are and what you are, sort of what your other life, your own life, sort of, trajectory has been, and where you’ve come from. So if you’re a recent immigrant or if you are, you know, and also what community means, you know, because it acts as not just location. It has… many of the people that we work with, including… You know, I am from Denmark. So, my family was very significantly affected, even though they were in Denmark, by the events of 9/11 too. So, having that, having a very sort of open understanding of both what the events means, what it, what it builds on, where it may be triggering for other experiences from the past, and so being very cog-, cognizant of that as a person trying to help put words to what happens, is all I’m saying.
Richard Hara: Yeah. So, it enables people to kind of process, right, the experience, and, and then, hopefully, move to that next stage. So, with regard to trauma, the first stage is safety, right? And then, moving to healing and processing, and then?
Ellen Lukens: Moving, being able to move on to, you know, to move along in one’s life, as opposed to being stuck, which is I think a lot of what happens with people who get very stuck with grieving and, and it’s difficult to move beyond that, and I know people are still dealing with this.
Richard Hara: Yeah.
Helle Thorning: Just also getting to the resiliency, as you were talking about that that we thought a lot about with people was around sort of this whole idea of self-care. What we learned from our communities or the communities that we worked with that it actually, it’s not just taking care of yourself, but it’s also taking care of your community. And, and so we, we tried to think about what, what do you to do both, right? For many people, it’s helping others help themselves, for people. So, there is a lot of different meaning around what does care mean, how do you build resiliency within your community, and strengthening the community to be able to, you know, know what to do if something should happen again in the future to keep yourself and your community and the family safe.
Richard Hara: So, receiving care but also providing care.
Helle Thorning: Right.
Richard Hara: Right?
Ellen Lukens: And allowing oneself to receive and give.
Richard Hara: Okay. Other sources of strength and hope that people can tap into that you can think of?
Helle Thorning: Well, I think the, the other piece that I think was so significant, and I mentioned that before, was around really being very observant or reflective of your own experience as a helper, or participating in the help in that process. And I think that was really one of the big takeaway lessons. So now, we teach that in social work school, right? Self-care, we call it, you know. We tell people how to be mindful, you know. So, a lot of the things that I think we learned then, we didn’t, we didn’t do that then as social workers. You know, we, we, we just… we worked. We didn’t really think so much about the impact. We didn’t have that… We had… it was the people that we helped, and then that was us, but it really became a “we” experience, right. So that is where the community kind of meets, yeah.
Richard Hara: Well, again, putting the social in social work, right?
Helle Thorning: Yeah.
Richard Hara: So, I’d like to see if we’ve got any questions from the audience. Okay. Working with local communities is one of the strongest and greatest things I’ve done in my life. How can someone back here in Africa partner with you to do research and implementation of these interventions? Okay.
Ellen Lukens: Wow, that’s a great question and I, I agree with, what is – what was the first part? Working with local communities is one of the strongest and greatest things I’ve done in my life. I would underline that. I mean, we would be happy to talk to you about it. I don’t know where you are in Africa, but um… yeah, I’ve, there are many ways to use psychoeducation cross-culturally.
Helle Thorning: And working with, I suppose, how you think about what that means for your culture and, and thinking about how you might be able to adapt that. So, yeah.
Richard Hara: And drawing from your experience, working with community partners, right, and how that could… yeah.
Helle Thorning: It’s a really participatory process and it takes some time, but it’s, but it’s a wonderful knowledge exchange, as we mentioned before.
Richard Hara: Wonderful. Thank you. Next question: was there a greater sense of community in New York City after 9/11, and did this help your intervention?
Ellen Lukens: The sense of community after September 11th was, was overwhelmingly positive. People… The buses were free. People were giving each other rides. Families taking other families into their apartments. I mean, it was, it was striking. And you know, people were making millions, literally millions, I think, of sandwiches for the rescue workers. There was a great sense of community, and initially a lot of chaos as well. So…
Helle Thorning: I think the… and I think also the, the experience of… having this experience as a, as a community, you know, brought people together. And I think there was a lot of hope in those initial months afterwards, and I think for the country to come kind of coming together, and the world kind of looking to help us, you know, that was really what, what was striking to me – is how much people reached out to us. One thing I remember particularly is that from Holland they sent all these tulip bulbs that were planted in various parks, and you know, so you’ve got a bag of tulips and you… So you planted them as a community and that was sort of a wonderful kind of, sense of that we were not alone, that people listened to, heard what had happened, and they reached out to try to help us too.
Richard Hara: Mm-hm, yeah. I’ve got one last question. I was very moved by what you said about how people are still working through these issues 18 years after the event. Is help still available for them, or are they on their own?
Ellen Lukens: That’s a great question. I mean, it happens that my daughter is one of those people. So it’s now 18 years later. She was 14 at the time and she’s, she’s really struggled, both with physical symptoms and emotional symptoms. She’s been in therapy. She’s done a lot of body work and very interested in, and has become very committed to, trauma work on her – as a result of her own healing process. But that’s just one person. I mean, many people are also affected in very serious ways by the physical aftermath of being rescue workers, and I know Jon Stewart has advocated on their behalf. So, yeah.
Helle Thorning: So, it has a lot of, I think, effects, sort of, that reverberates, I think, throughout and I think, in a day like today, I think, I’m sort of glad, so glad that we’re doing this because it reminds us that we probably still have a lot of work to do, and to think about. And as people have other traumas sort of roll in, and we all are witnessed to that, so, almost every day, either physically, you know, any kind of natural disasters or other disasters in communities, you know, it just behooves us to keep thinking about how we can kind of help people or think about this with people so that we can be stronger as communities, or as a community, yeah.
Richard Hara: Absolutely, and again, you know, while we wouldn’t want to take anything away from people who are dealing with the various medical conditions as a result of being first responders, I think we need to draw attention to some of the psychological sequelae of 9/11 and how best to support those people.
Ellen Lukens: And many other tragedies that are occurring here and around the world in terms of the sequelae that last for many, many years.
Richard Hara: Absolutely. Absolutely. So, I’d like to thank you both, Dr. Lukens and Dr. Thorning, for joining me here today at Social Impact LIVE. Thank you all for tuning in. We will be joined next week by Zach Parolin, a postdoc at the School of Social Work’s Poverty Center, to discuss the US welfare system and racial inequality. So I hope to see you then, all right? Thanks and good-bye.
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