LATimes

Anxiety: the Only Certainty

People are shopping for a Mercedes, but not a home. Trips are canceled but weddings aren't. 'Don't be worried just because you're worried,' expert says.

By TERENCE MONMANEY, Times Staff Writer

Bridal shops say the weddings are on, but real estate agents say their phones aren't ringing. Thousands of workers nationwide are being laid off, but Mercedes-Benz dealers in Southern California report strong sales. People with no history of depression are feeling low, therapists say, while some patients with diagnosed anxiety disorders are actually doing better than before.

More than two weeks after the terrorist attacks, Americans are responding in a spectrum of ways, some seemingly paradoxical, to the uncertainty now settling on the land like an autumn mist.

Recovering from the shock of this previously unthinkable devastation, the nation faces wide-open questions as U.S. troops mass overseas and the prospect of further terror at home sinks in: What's next? And when will it happen?

"There's a real sense of, 'When is the other shoe going to drop?' " said Jerilyn Ross, president of the Anxiety Disorders Assn. of America and a therapist in Washington. "It's very unsettling."

Generally, the disaster's effects on Americans' personal plans might be described as partial, with big commitments going forward while major decisions are being put off. That view was summed up by Valerie Largin, relocation coordinator for the Transition Connection in Sacramento.

None of the firm's clients has backed out of a planned move, she said, though inquiries about future moves have dropped off. "People who had planned to come are coming, and people who needed to go are going," she said.

Of all catastrophes, a terrorist strike is perhaps the most difficult to put into perspective, tougher to absorb than conventional war or natural disaster or disease, according to experts in risk analysis, which attempts to explain how people make choices in the face of uncertainty. And the nagging worry about future terrorist killings, which military authorities have said are possible, is not easy to shake.

"This is the kind of hazard that's hard to get a handle on because it comes from the intentions of other people, and those are hard to understand," said Paul Slovic, director of the Eugene, Ore., firm Decision Research and a pioneering risk scholar.

Many researchers and therapists have emphasized that the frustration, fear and sadness that many Americans still feel are healthy emotions. As Boston University psychologist Curtis Hsia put it: "Don't be worried just because you're worried."

To be sure, people whose loved ones died aboard the hijacked planes or in the World Trade Center or Pentagon have only entered grief's long tunnel. And notwithstanding the outbreak of red, white and blue, a black mourning pall continues to hang over much of the nation.

In New York City, poles and walls remain covered with the impossibly poignant wallpaper of fliers bearing the faces of loved ones lost on Sept. 11.

"People are saying the world is different now," said Harold Pass, director of the outpatient psychiatry clinic at the Stony Brook campus of the State University of New York.

There, only 55 miles from the attack site, people are "postponing major decisions like buying houses and cars and traveling," he said. "They want to be with their families. They're hunkering down."

One family he knows had been planning a trip to Florida but canceled "because they're frightened about what might happen in the next few weeks."

Patients he's seeing are experiencing serious anxiety, he said, with disturbed sleep, stomachaches and difficulty concentrating. Yet many who did not lose a loved one don't feel entitled to their grief, he said.

But the "worried well are hurting," he said, and their pain is just as real as anyone's. "You don't have to be embarrassed or ashamed you didn't lose someone."

Around Washington, the great charred section of the supposedly unassailable headquarters of the U.S. military is only the most obvious wound. The mood in the capital is somber, Ross said, with otherwise well-adjusted people dogged by "a sort of low-level depression and malaise."

Hsia, at Boston's Center for Anxiety and Related Disorders, said people around the city, where the two flights that were crashed into the World Trade Center towers originated, "are more anxious, really nervous, and they're unsure of what happens next."

Several therapists said they have observed a phenomenon that may surprise the nonexpert: Some patients long disturbed by free-floating anxiety or self-doubt say they are less troubled.

Gary Emery, a Los Angeles-based cognitive therapist who espouses swift treatments of depression and other disorders, said some of his clients have suddenly improved. "It put everything into perspective and their own problems seemed less serious," he said. "The cause of many emotional problems is patients turning inward, and these events forced people to turn outward."

Also, the devastation and terrible losses have probably awakened in many people an often dormant appreciation for life. "People may actually have some gratitude that they didn't have before," he said.

Ross, in Washington, said she has had fewer new patients in the last two weeks, presumably because "people who are fearful now feel it's normal to be afraid." But among some clients in their 20s and 30s, she's observed for the first time signs of a despair that once marked an earlier generation worried about nuclear annihilation.

"I'm seeing some existential anxiety among my younger patients, who are asking themselves, 'What kind of a world am I bringing my children into?' "

She said a woman she counsels has begun wondering if she should back out of her engagement to be married. "I said, 'This is not the time to decide.' People who are worn down mentally and physically shouldn't be making a decision now that will affect them permanently."

A crude measure of the atrocity's inroads into the American psyche is how people think about big decisions such as getting married or buying a house. The evidence on that front is mixed.

Though an uncounted number of weddings were postponed because of travel restrictions immediately after the attacks, future brides appear to be on track. "Nobody's changed their plans," said an assistant at Cinderella's Bridal Salon in Topeka, Kan. "Nothing's changed so far," said the Condon Bridal Boutique in Charleston, S.C.

Contrary to predictions that the attacks and the slumping economy might steer consumers away from substantial purchases, some Mercedes dealers, for instance, are thriving. "We're having a good month," said sales manager Sam Haidar at Calstar Motors in Glendale.

At Fletcher Jones Motor Cars in Newport Beach, sales manager Chriz Lanza also said business was very good last weekend. "Life goes on," he said when asked why.

In real estate circles, brokers say deals in escrow aren't falling through, but few customers are starting a housing search. "We haven't lost any transactions," said Stanley Shapiro, president of the Century 21 office in Beverlywood, "but we haven't opened any new ones either."

A more sober view was expressed by Fred Saenz, manager of a Remax office in the mid-Wilshire district. "Nobody wants to purchase a big-ticket item during this situation," he said.

Making major decisions in this tumultuous time is greatly complicated by the difficulty of evaluating current dangers and predicting trends, experts agree. "Risk assessment doesn't do that well when the hazard is new and we don't have much information to go on," Slovic said.

In the best of times, people aren't necessarily good at evaluating hazards, researchers say. Studies by Slovic and others have shown that Americans consistently underestimate the risk of some dangerous activities, such as smoking cigarettes, and dramatically overestimate others, such as living near a nuclear power plant.

Among the reasons for such skewed perceptions, researchers say, is that people tend to go easy on serious risks that are known, voluntary and optional. By contrast, they have strong emotional reactions against involuntary risks with possibly serious consequences even if the odds of harm are exceedingly small.

In that context, researchers say, the new risk that the public is now concerned about--hijacked aircraft used as missiles--is off the charts. That may help explain why many people are avoiding airline travel, even though analysts suggest that the overall odds of dying in an airline crash remain at roughly 1 in several million.

Similarly, psychotherapists and decision researchers caution against dwelling on news coverage of the attacks, especially images of the fiery crashes into the World Trade Center towers. Mentally replaying those images may make a recurrence of the atrocity seem more likely than it really is because of the so-called exemplar effect, said decision researcher Jay Koehler of the University of Texas.

That is like first-year medical students suddenly fearing that they will contract the exotic diseases they are studying, even though their chances of doing so are negligible.

Another factor adding to anxiety, Koehler said, is embedded in the notion that trusted airline security systems failed, triggering sensations that researchers say are part of feeling betrayed.

To Koehler, that helps explain why Americans appear to be driving more, even though driving is more hazardous than flying. Studies by Koehler and others have found that people willingly take on an added risk from the environment if they believe that the device supposedly protecting them won't backfire.

In one recent study, researchers gave people a hypothetical choice of a vaccine that was perfectly safe but offered less protection or another one that offered maximum protection but also carried an extremely small risk of causing injury.

They found that people overwhelmingly favored the safer vaccine, even though the choice meant that they were more likely to become ill from the targeted disease.

Koehler is optimistic that as memories of the attacks fade, anxieties will dissipate and behavior will become more rational. "We're all thinking now about terrorists and hijacking," he said, "but in a few years this will recede into the background and we'll go back to something closely resembling our regular lives."

He spoke not only as a researcher but as a witness to the earthquake that devastated the Bay Area in 1989, when he was a Stanford graduate student. He recalls being afraid to drive across the Bay Bridge--a common fear at the time.

"I was obsessed by that," he said. "But nobody worries about driving across the bridge now."

Others are not as sanguine about the future--or remain wary of making predictions in the turmoil of the moment. For them, the attacks are too fresh for them to be comfortable with old routines or plans made before Sept. 11.

Hilaire Dallo, controller of the Mayflower moving company's Los Angeles office, said he just canceled a mid-October vacation in France--and lost his $250 deposit.

"It's just too unstable for me," he said. "We don't know what the government is going to be doing. Everything is in limbo right now. It's too uncertain for me to get on a plane for 12 hours."

-- Anonymous, September 29, 2001