Airline Crash Survivors, Vietnam Veterans, and 9/11

Carol H. Pollard, Carl Mitchell, and Victor Daniels

Gestalt!
ISSN 1091-1766
Volume 6 ; Number 1
Spring, 2002

ABSTRACT
Two populations are examined for information relevant to working with survivors of the 9/11 tragedy. A qualitative study of fifteen flight attendants involved in airliner crashes or hijackings found informal intensive meetings and conversation by members of the flight crew involved in the disaster to be therapeutic. Psychoanalytic and other minimally directive approaches were generally viewed as frustrating and ineffective. Several more directive approaches were found to have value, and methods of applying Gestalt therapy to problems and issues reported by the flight attendants are discussed. A long-term history of group therapy and Gestalt therapy with Vietnam veterans provided a supportive milieu and forum of shared understandings for the veterans, while significant therapeutic movement was most often reported as a result of Gestalt dialogues. Insights from both groups are applied to the situation of 9/11 survivors.
.
.
In this special issue, we examine insights potentially relevant to working with 9/11 survivors in previous work with two other populations that have experienced traumatic events: Vietnam veterans and air-crew survivors of airliner crashes and hijackings. It is written as a collaborative venture among Gestalt Therapist Carl Mitchell, who for many years ran Veteran’s Administration funded therapy groups for the former group, Carol H. Pollard, who recently completed a doctoral dissertation entitled Impact: A Study of Flight Attendant Survivors of Air Disasters (2001), and Victor Daniels, the usual author of “The Working Corner.” Impact… is a phenomenological, qualitative study based on lengthy (in most cases 2 hours or more) interviews with air disaster survivors. Carol Pollard is herself a flight attendant, and Carl Mitchell is a non-combat veteran.
.
Due to space limitations, this article does not explicitly address the existing post-traumatic stress disorder literature. Its intent is simply to use these two particular kinds of traumatic experiences to shed such light as they may on working with survivors of the September 11th events. Some of the principles articulated here are also likely to be relevant to therapeutic work with Afghani refugees and other victims of war and repression in that unfortunate country, as well as other regions where similar events have occurred.
.
The Air Disaster Survivors
.
Flight attendants’ memories of events during the crashes and just prior to them are poignant, powerful, recurrent, and sometimes overwhelming. Mary, a 25-year old attendant who had been flying for three years, saw the passengers “put driver’s licenses and notes into their inner garments, so that their bodies could be identified later: ‘I saw some women that took out their licenses and put them in their bras. . . . This whole row was holding hands and someone was leading them in prayer. I just thought, Oh, my God.” After the crash, she “saw people missing their arms and their feet. I thought, I am all intact, sure I have cuts, some blood. I think I had guts on my shirt. I think I had a lot of blood from passengers too…”(2001, pp. 137-8)
.
In general, flight attendants reported that their emergency preparedness training as safety professionals served them well, so that they were able to focus on carrying out tasks that contributed to the safety of passengers and their fellow crew members rather than being overwhelmed by fear and shock. After the crash or hijacking was over and they found that they had survived, however, they felt a strong need to process the thoughts and feelings that occurred both during and after the event.
.
Many were not ready to jump into formal therapy immediately. They needed to wait for some time to pass before they were prepared to do so. One kind of event that was consistently reported as therapeutic by almost every respondent was spending time together with other members of the flight crew who were involved in the crash, comforting each other, talking about what had happened, and sharing their feelings about it. This was something that many could do and wanted to do right away. Some flight crews had a chance to do so immediately following the event, when they spent time together in the same hotel just after the crash. Others made a point of seeking each other out. Some, however, were immediately separated from other flight crew members, and subsequent events prevented them from getting together and having the benefits of any deep and moving sharing of their thoughts and feelings.
.
Here the parallel to the experience of the veterans is obvious: Many of the veterans would open up and move into significant psychological work only in the presence of others who had been through experiences like their own. Impact declares that “Southfield (1993, p. 249) found group therapy with peers to be the optimal treatment modality for war veterans. . . . Flight attendants work together as a unit, much like soldiers in combat, and it seems reasonable that both informal and formal discussion groups could benefit the survivors of air disasters.”
.
A number of the flight attendants were referred to psychotherapeutic practitioners who used either a psychoanalytic, free-association technique or another minimally directive approach. Most flight crew members who saw such practitioners voiced frustration about their experience and said they needed more active guidance. For example, “She did not feel that the abstinent, psychoanalytic style of this mental health professional was helpful. She felt uncomfortable with his silence and did not know what to say.”(2001, p. 146) Another “had sessions with three mental health professionals, and found their professional styles were quite different. She found her needs incompatible with the more abstinent, psychoanalytic style of her first therapist. She noted that the cognitive behavioral treatment helped her, in a more superficial way, be strong enough to return to work [but did not seem to] help her in terms of the deeper emotional issues that continued to trouble her.” It is no surprise that in general, those who received therapy from professionals who had specific training in working with trauma victims reported better therapeutic experiences than those who did not.
.
One respondent also found value “in hypnotherapy and in Eye Movement Desensitization and Reprocessing during a walk-through of a 747 aircraft, where they recreated the incident frame by frame, conducting the EMDR procedures.”(p. 163) From this report, it sounds as if systematic desensitization using an alternation between frames of the disaster and a comforting, safe environment, could also prove useful.
.
In the Gestalt context, one of the authors of this article has used regression and dialogues in treating survivors of motor vehicle accidents, such as the case of a young woman who at the age of ten was in the back seat of a car when her parents were killed in a collision with a Greyhound bus. In a very real sense, every Gestalt therapist who is experienced in “finishing unfinished business” by working through painful old memories such as physical and sexual abuse has at least some experience in working with trauma.
.
There were dramatic differences in airlines’ behavior toward surviving personnel. Some made every effort to provide support and comfort, while others were primarily concerned with minimizing any publicity about the crash and protecting their company image. The latter essentially said, “Keep your mouth shut and stay out of sight.” Julia was still terrified and shaking as she thought of the dead passengers and how they had died and of one of her injured crew members half-buried under debris when “the crew was taken to a room in the airport and held until the next morning. Their airline’s management representatives handed them a stack of blank forms and told them all to write down everything that happened. Julia felt that they were more concerned about the prospects of litigation than about their welfare; they were not initially offered emotional support, assistance in phoning family members, or given food or drink. . . . They answered questions for the remainder of the night and were finally released the next morning by the FBI. They were not provided transportation to their homes [even though] they were without purses, keys, or suitcases. They took taxis home” (p.163).
.
Even more poignant were flight attendants’ remarks about their guilt in following standard procedures that they themselves felt were wrong and dangerous rather than relying on their own judgment. For instance, “I knew when I was telling the passengers to put children on the floor [in accord with the Federal Aviation Administration’s recommended emergency procedures regarding infants] thinking to myself, I can’t believe I’m actually uttering such nonsense.’ (p. 145)
.
Reading the reports of intense anger toward their airlines reported by those who had been treated badly, it seemed obvious that Gestalt dialogues that placed the airline officials in the empty chair and provided the flight attendants a chance to directly voice their anger and frustration would be immensely useful. The same thing holds in regard to FAA guidelines that attendants reported led to avoidable deaths of infants and very young children, and to reporters and photographers who were perceived as insensitive and intrusive.
.
Similarly, empty-chair dialogues with colleagues and passengers who died or suffered would help in working-through and bringing closure to raw, open, unfinished feelings of survivor guilt. Such dialogues with other flight-crew members whom they had not seen since the accident would also be quite useful, such as in expressing gratitude to a pilot who managed to crash-land successfully with minimal damage and injuries in a situation which might easily have been much worse.
.
In addition, top dog-underdog dialogues would be useful in cases where attendants engaged themselves in pejorative, repetitive, “If only I had. . . ” self-talk about events where they had done the best they could but were browbeating themselves about not having done more.
.
These are a few obvious examples of ways in which a Gestalt approach would immediately give the flight-crew members a range of options for expressing and working through both conscious and repressed thoughts and feelings. Other widely-used Gestalt techniques appear prima facie appropriate to other related problems. An attendant who essentially anesthetized herself and went into a robot-like, substance-abusing existence for several years after her crash reported ongoing nightmares that would lend themselves well to Gestalt dreamwork as a way of moving through her defenses into processing her feelings. Others also reported value in working with their dreams.
.
The events of 9/11, of course, affected not only those directly involved but also family, friends, and colleagues of those who died and those who survived. In that regard it was like an air disaster writ large. Impact states, “An air disaster . . .casts an effect on all involved in the incident. Survivors, families of survivors and victims, emergency workers, airline personnel, community members and those who watch the news at home on television all feel the effects of disasters of this magnitude (Butcher & Hatcher, 1988). Frederick (1981) pointed out that the families of the victims undergo a long and traumatizing process related to the identification of the loved one and the claiming procedures for return of the remains. Expressions of anger and hostility are not uncommon when families are frustrated at this process.”(2001, p. 109)
.
One intriguing finding is that many of the flight attendants found the near-death experience to have a positive transformative dimension. One “felt that being in the crash made her strong enough to change her life.” Another “reported that she launched a new career in both political and social activism and in public service.” Another says that her disaster experience “threw me into life because before I wasn’t living life at all, I was living everybody else’s life.” Her near-death experience “was an initiation to a powerful spiritual journey of self-discovery” (2001, p.140, 147, 170). Their experiences remind us of the principle of responsibility that runs through both existential philosophy and Gestalt therapy. Within situational limits, which the existentialists call the “thrown” condition of our lives, the value and meaning of an experience is what we make of it.
.
There are both parallels and differences between the flight attendants and the war veterans. One attendant recalls, “I remember being carried over to the triage area. . . . That was like, I think, one of the final scenes in “Platoon” where you just see bodies everywhere and that whole scene is constantly played back in slow motion. Some of the people you can’t tell whether they were luggage or whether they were —if it was a person.” (p. 152)
.
One obvious difference between the flight attendants and the war veterans is that while the former were involved in a single highly traumatic incident that lasted for a relatively brief time, the latter were in a war zone where their lives were potentially constantly threatened for as much as a full year or more. They therefore developed a hyper-vigilant arousal response in which they react to commonplace disturbances as potentially life-threatening, sending them into fight-or-flight reactions that often result in inappropriate physical aggression. In addition, they had no postwar civilian experience that was similar enough to their war experience to allow desensitization of their fears and hyper-vigilance in a similar but non-threatening environment. Most fight attendants, by contrast, sooner or later returned to the same job with the same airline, and thus had repeated opportunities to fly safely in a situation much like the emergency situation, providing an opportunity for their fears to greatly diminish through gradual extinction.
.
The Vietnam Veterans
.
The warrior who has been to the gates of hell and returned sees a different reality than the average person. I would have to say that the experience is “viscerated” or “somaticized,” so that when the veteran re-experiences a combat memory, it’s not only a memory, but also a body experience, complete with adrenalized reactions and insulin reactions, which are part of a frequent and repetitive up-and-down of being prepared for intense overwhelming experience and reactions.
.
For the Vietnam vet in particular, isolation is a strong part of his experience. He would spend 12 or 13 months in combat and then his time would be up and he would be lifted right out of the battlefield with no debriefing and no preparation for re-entry into civilian society. In one story, a vet and his group were pinned down by a machinegun and somebody had to make a move. His buddy moved. The machine-gunner hit his buddy and then they got the machine-gunner. Thirty-six hours later he was in full dress at home, his mother had just made his favorite meal and was saying, “Go wash your hands, honey, dinner’s ready.” He looked down at his fingernails and saw Vietnam mud and the images, and sounds of his buddy getting killed 36 hours previously started flashing through his mind. To go, with no transition, from a life-and-death situation in an overwhelming combat scene, to being back home has been incredibly difficult. This man had, although he didn’t know it at the time, Post-Traumatic Stress Disorder, or as they called it in World War II, Shell Shock.
.
During World War II, most men had a chance to be on a troop ship returning to the United States, talking it through over and over again with their buddies. Consequently they were able to debrief themselves to a considerable extent. But when an isolated individual is pulled out of his unit and goes abruptly home, there is no transition, and when he tries to go back into normal civilian life, the world has changed forever for him.
.
He couldn’t take the life his mind and body knew in Vietnam back into, for example, Santa Rosa, California. One vet had been in a situation where his unit and the enemy were dug in on opposite sides of a field. The enemy strapped explosives onto the backs of children and made the children run toward his unit. He and his buddies had two choices: shoot the children or get blown up. After returning home, experiences like this expressed themselves as nightmares and intense flashbacks. An incident that occurred in the course of daily life might trigger 5 or 7 days of nightmares and intrusive thoughts, and a somatic state of being hyper-alert, and not able to sleep. He went back into “combat sleep–2 or at most 4 hours at a time–and these mental pictures were close at hand in the back of his mind. In some sense, the horror of those experiences has something in common with the horror of the 9/11 experience. For a policeman or a fireman, for example, memories of members of one’s unit and other people dying, and of the heat and the sounds, and of the smells of burning flesh, must surely trigger a complete mind-body reaction that has something in common with those of the combat vet.
.
The ideal way for treating a group of such vets is that, in memory and conversation, the whole group moves from civilian life through recruitment and training and into combat, and discusses the situations and fears that they dealt with. That would be the strongest way of moving therapeutically. Although that doesn’t usually happen, the territories of their experience do get covered and re-covered time and time again. In working with survivors of 9/11 and other disasters, a similar strategy would have great therapeutic power.
.
Another element in Vietnam was rejection by, in many cases, the Veteran’s Administration and the veterans’ service organizations. These organizations rejected many of the Vietnam vets because the United States lost the war. The VA had no comprehension of PTSD back in 1972. They would prescribe medication and say “These are problems that they had in adolescence that just surfaced in the war,” and the men went untreated. When the veterans went to college and there were political discussions in their classes about the wrongness of being in Vietnam, what they learned to do was shut up. No one wanted to hear their experience. Other veterans were the only people with whom they could feel understood. In therapy they have been told, “Do not expect other people to understand how you feel and how you see life.” As they themselves have said, “Nobody’s going to know what it was like..” Unless they’ve been there, they don’t, and won’t, understand.
.
There may be elements of that reality in 9/ll as well. People need to express their feelings and talk about their existential reality in the war or disaster situation to work it through. If there’s not psychological space for that to happen in their daily lives, then it can occur in therapy through understanding and caring, as someone, or some group, hears and accepts their expression of their experience and thereby validates it.
.
Gestalt dialogues can be very useful in this respect. One vet was raised to believe that he should never ever attack a woman. One of his nightmares was the woman he killed in Vietnam. In his Gestalt work, when he had the sniper on the pillow and was changing places in a Gestalt dialogue, he realized that she was the enemy, that she had picked up a weapon and chosen to put him in her sights, and that he had to get her before she got him. When he could transfer, “I could never attack a woman” to “I defended myself against a warrior,” the intensity of the nightmare decreased markedly. At times he would still have the nightmare, but would stress himself less about it, because the meaning had changed, and he had come to view the memory on more acceptable terms.
.
In Gestalt groups, when a group member goes into an experience, almost everybody in the room feels it along with him. It’s an experience that goes through the body, so that the group as a unit goes through the situation with the combat veteran. When he comes out of it and reintegrates it, people realize that something has changed. Ever since the original events took place he has always been alone with his experience of them, this time, in the group, he has not been alone. People have been with him. Therefore he has experienced feeling accepted, understood, and supported, which changes the isolated way in which he carries that experience into the future.
.
A difficult thing for the combat veteran is that reactions to stress like that experienced in combat are hardwired. The VA has done some work to check that out and has found, “Yes, there are chemical changes that happen to combat veterans.” It’s also the case that in children and adults who have been physically or sexually assaulted, there are chemical changes that take place. After experiences of physical or sexual violence, victims’ body chemistry is slightly different. According to the VA, what has happened is that the reflex to stay alive skipped through the brain, did not go to higher cortical centers, and went directly to the amygdala pons on the old brain stem. This is the most primitive area in the brain, the area of the fight/flight reaction. Usually we have higher mediating processes in the cortical lobes where we weigh and sift through the data and then make our decision to act or not to act. A person who has been in severe stress may not have that opportunity. Input can skip directly into the old brain and into reaction. Consequently, taken by surprise, it is sometimes nearly
impossible to control. Daniel Goleman describes all this in detail in Emotional Intelligence (1997).
.
What a veteran does is learn to recognize when he’s having a good day and when he’s having a bad day, when he can stand crowds and when he can’t, when he needs to isolate and when he can be with his family. He develops an early-warning system about his state of being, and then calibrates his response based on what he knows about his present state of being. For example, he may be feeling the loss of a friend around an anniversary, and if he goes to his job at the post office and someone slights him, he’ll immediately drop into a rage. In that state of mind/body, he may not be able to be at the post office for fear that he will attack someone, because he can hardly control his reaction when he feels violated.
.
Part of what’s hardwired in such situations is being taken by surprise. The postal worker who is a vet may be casing his mail when another worker drops a big box of mail behind him. He jumps. What his body heard was the explosions of a mortar round landing nearby. That reflexes his body into adrenalization, and he wants to strangle the guy who did it, and after that he’s going to be pumped up all day. He won’t be able to settle down for a long time. And we can predict that he’s going to have five to seven nights of nightmares and flashbacks as a result of just that one event. These veterans may even die of somatic tension and physical diseases, because they cannot sufficiently de-stress from the combat. They’re hyper-tense. Sudden anxiety attacks are also common The first wave of breaking down comes from somatic tension of the organs. For some vets it’s extremely useful to guide them through a relaxation technique and teach them how to calm their minds and relax their bodies.
.
Control is another issue that may or may not apply to survivors of a given disaster situation. It’s likely to be an issue if higher authorities had some role in triggering the disaster that occurred, or in causing avoidable injury or loss of life by those involved in it. Most veterans from Vietnam absolutely will not be pushed or controlled. They want to be in charge of themselves and their own lives. They develop trust only if the facilitator does not push and lets them move totally at their own pace. Consequently, when periodically they do a piece of gestalt work, their resistance tends to be very high and the intensity of their feelings is also very high. They don’t want to go back into those feelings. Nonetheless, when group members were asked “When has significant change taken place for you?” each person who raised his hand said, “Change took place when I did Gestalt work.” That’s critically important, because the client is allowed to re-experience a particular situation that happened in combat, but with support and guidance that helps him find a more effective way to handle it.
.
The resistance to being controlled by anyone else, and consequent difficulties with authority, occurred because officers were characteristically in combat for only six months, and therefore in order to make their show and get their medals, some were willing to press the men in dire situations to achieve a victory or make a gain so their personal record would look good. As a result, the men felt like targets or cannon-fodder. The tank was more important than the tank-driver. The tank-driver was easier to replace. That makes it very difficult for the combat veteran to accept authority because he learned that there was a good chance that authority was going to get him killed.
.
One therapeutic approach is to ask vets to draw a situation, like a particular ambush in which a captain and a squad leader and a radio man got killed. Although for the most part these are stick figure drawings and rough mapping on paper, the other veterans can smell the jungle, and picture what the shrubbery and trees look like. They look at that black and white sketch on paper and fill in the rest with their experience. They sense how much danger and how much protection there is in that situation. They share a knowing that they each understand. So in therapy as in daily ife, you want to be absolutely careful never to take control from them and never to slight them.
.
One man in the group had been a sergeant in but he almost always “walked point” at the head of his column, because he didn’t trust anyone else to do it. One day he saw a wire across the path and shadows moving in the brush and he signaled his men, “Down!”
The captain said, “How come you’re not going down the road?”
He replied, “Well sir, anybody who goes down that road today is going to get killed.”
The captain said, “Move your squad down the road.”
He said, “No sir, I’m not doing that.”
The captain said, “Fine, I’ll take care of you later, you’ll be court-martialed.” Then the captain called his buddy, the leader of the second squad, up. The sergeant looked at his buddy and shook his head “No,” signaling “Don’t go there.” His buddy understood what he was saying but was caught between that and the captain’s order. And the captain and his buddy and the radio man all moved out on point down the road. As members of the second squad went past this guy, he grabbed them and pulled them down to the ground, saying, “Get down.”
Then fire erupted on the point and the captain and the radio man and his buddy were all killed. His reading of danger had been accurate. It was illogical for the captain, who was green and did not have combat savvy, to go blindly into an ambush like that. When they got back to camp, the top sergeant said, “You did the right thing and the captain did the wrong thing and you’re not going to be court-martialed.” However, he cannot forgive himself for his buddy’s death.
.
The vets have difficulty accepting men in the group who do not share the same knowing. One grunt who became an officer left the group because he had been an officer, and the distrust for authority was so strong in the men that they could not work when he was present in the group. Two other men were helicopter door gunners, and one day one of them made the statement, “In a free-fire zone at so many hundred feet, everybody looks like a target, and we just opened up on anything that moved.”
As it happened, one of the men in the group had been wounded seven times in a firefight, and he and one other man were the only two left in the squad, and they decided to try to make a run for it. The gunner in a chopper killed the other man and put a 50-calibre machinegun round through this individual. For that reason the group expelled the two door gunners, because they had made a light statement about “friendly fire,” which could be absolutely deadly for combatants on the ground.
.
In the group the men had a chance to talk about such events, and to get some very specific help by means of Gestalt work-throughs. Every time a person did Gestalt work, he came closer to resolving a conflict. It seems to be a law of nature of Gestalt that contradiction cannot remain as long as both sides of a polarity are kept in proximity. When the antagonists and protagonists are brought together, such as the veteran and the sniper, and are held in containment, as in the two chairs dialoguing with each other, then as long as the veteran stays with his feelings and the present action of that experience, his mind-body organism will seek resolution, trying to find a way to resolve the conflict.
Some people have patterns. For example, one individual will come upon a psycho-emotional event that’s touching him. He’ll touch it, open it up, and then be gone for five or six weeks, out of the group, as he avoids it and tries to get away from it because of the feelings involved. He’s a circler. That’s the way he approaches his therapy. He keeps returning, because he can make some advancement in group. But allowance has to be made for him to have control. It’s equivalent to life or death for him.
.
Back to New York City
.
Obviously, the experiences and feelings of those involved in 9/11 will not be the same as those of either the flight disaster survivors or the veterans. Our colleague Mary Fitzpatrick, who lives in lower Manhattan and has spent most of her career in psychological work with special-needs children, reports that “Since 9/11, I’ve been working nonstop every day with young children who were in school near the Trade Center. Some saw people jumping out of windows and falling to their deaths” (2002). Every person who watched the television coverage recognizes that the event was unique.
.
Indeed, the differences between the two groups described here help remind us to be sensitive to the special elements of this particular situation, and also to how it differs for each person involved. At the same time, we hope that there is something useful in our descriptions of how Gestalt therapy and related approaches have been used and can be used with these two populations.
.
In no way do we wish to suggest that there is any quick and simple formula for working with survivors of the disaster, or those who were close to the victims. We merely suggest that a combination of training in Gestalt therapy and in the post-traumatic stress methodologies and literature may be a very valuable combination.
.
References
Butcher, J. & Hatcher, C. (1988). The neglected entity in air disaster planning. American Psychologist, 43:9, 724-729.
Fitzpatrick, M. (2001) Personal communication.
Frederick, C., Ed. (1981) Aircraft accidents: Emergency mental health problems. Rockville, MD: National Institutes of Mental Health.
Goleman, D. (1997) Emotional Intelligence: Why it can matter more than I.Q.
Pollard, C.H. Impact: A Study of Flight Attendant Survivors of Air Disasters. A dissertation presented to the faculty of California Institute of Integral Studies. Ann Arbor, Michigan: UMI Dissertation Services, 2001.

Carol Pollard received her Ph.D. from the California Institute of Integral Studies and is a senior flight attendant for United Air Lines. Carl Mitchell is a Marriage and Family Therapist who also treats domestic violence offendersn in Santa Rosa, California. Victor Daniels is Emeritus Professor of Psychology at Sonoma State University.