Irrational - Or Just Neurotic?

Miriam Kohn is a psychologist in private practice. She has lived in Washington D.C. for more than 30 years, and is old enough to remember the nuclear fears of the fifties.

Dirty bombs… Cyanide… Ricin… Briefcase devices… What should you do about terrorism fears? Are you overreacting?

You're asking me??

As a psychologist with a private practice in Washington DC, I'm used to dealing with irrational fears. But not with this – these days, who knows what's irrational and what's simply prudent?

We now face the seemingly imminent threat of terror attacks, the ambiguous, unspecified Orange Alert, the rumors that New York or Washington are the primary targets. The government is telling us to get duct tape, batteries, tuna fish, and bottled water.

Naturally, almost everyone in DC is on edge. As city dwellers, we are used to a certain amount of chaos and danger - we tend not to notice sirens when they pass. No more. Therapy sessions are now interrupted for a moment as both patient and psychologist (me) try to figure out whether that fire truck is racing uptown or downtown. Is it responding to a flaming White House, or to a cat stuck in a tree in Chevy Chase? Patient and therapist are in perfect sync, thinking about the threat.

My patients, who are vulnerable to begin with, seem more so now. One of them asks me to reassure her that her anxiety is simply neurotic – meaning, in other words, that it holds no basis in reality. I can see her disappointment when I tell her instead that everyone is anxious. She says incredulously, "You too?"

Yes, me too. When I'm sitting in my living room reading, I hear a window rattle in the wind: a draft. Should I cover it with plastic? Will I pat myself on the back later for foresight, or be embarrassed at my ridiculous fear?

With my patients, I am used to being the voice of calm and rationality. But in this case, who has any idea what a reasonable reaction should be? Should I tell them to postpone their full-blown anxiety attacks until the Red Alert? Or is it okay to panic now?

My patients seem more deeply affected by the prospect of a terrorist attack. They often think that they're going to be victims. They call and cancel appointments. They want to stay home with their water, tape and tuna fish, where they have achieved a semblance of safety. But for some, there's another reason too: these days, their problems seem less important. Who cares about that lingering tension with your parents when we're facing a smallpox outbreak.

It seems worse for the kids that I see. During the sessions, they play more aggressively, and they seem more fearful and vulnerable. But maybe they're acting the same as they did last month, and I'm simply projecting my fears onto them. In this case, their parents (and even their therapist) on whom they depend for strength and protection, are as confused as they are. That's not much consolation.

These are crazy-making times. The Washington Post reported Thursday that the Oak Ridge National Laboratory in Tennessee found that sealing up rooms with plastic and duct tape "had a very positive psychological effect. People said they really felt better doing the taping, that they weren't just sitting around waiting." But is that why we're being urged to do this? Simply so we don't flip out while we wait for an attack that we can in reality do nothing to shield ourselves from? Should I advise my patients to tape up their entire houses, as one man outside New York did, simply as a meaningless but effective coping exercise?

These days, it's difficult to get one's bearings. On one hand, I have a strong sense of hope and denial: Even if an attack occurs, my odds of being injured or killed are probably quite low, and in any case I have to live my life without giving in to fear. But then the next moment comes the recognition that the victims of other terrorist attacks probably had those same tough-minded thoughts.

I think I'll go make some Valentines calls, to my children and one-year-old grandchild (all of whom live in NYC, that other primary target…). This week, that seems particularly important.