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September 11

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Above, responders to the attacks of 9/11 at Ground Zero included professionals and volunteers. Photo by John Bombace

By Daniel Dunaief

Volunteers at the World Trade Center site on 9/11 have had more significant post traumatic stress disorder than police officers, firefighters, and other trained professionals, according to a recent Stony Brook University study.

This was among a host of findings in research published in the journal Nature Mental Health about the mental health consequences for those on site after the attacks in downtown Manhattan.

“Being a volunteer responder was a significant risk factor, compared to being a trained professional responder,” explained Frank Mann, lead author and Senior Research Scientist in the Department of Medicine and Program in Public Health at the Renaissance School of Medicine at Stony Brook University.

Mann and his colleagues studied PTSD symptoms over 20 years, from 2002 to 2022, to understand the impact of this national tragedy on the mental health of those who arrived at the site to offer their help.

The higher risk for volunteers likely reflects some combination of self-selection based on resilience, professional screening, past experience coping with trauma and, maybe most importantly, the training professional first responders receive, Mann said.

“The relative contributions of these factors, however, remains unknown because these factors ‘jumble together’ when testing occupational differences” he  explained.

The researchers found that symptoms can change over time, showing signs of improvement and then worsening before another recovery.

The median time before symptoms improved consistently was between eight to ten years for confirmed PTSD cases, with most patients experiencing improvement a decade after enrolling in care through the Stony Brook WTC Health and Wellness Program.

The top 10 percent of those who had the poorest prognosis incurred about half of the total mental health care costs, which includes talk therapy with a psychiatrist, clinical psychologist or social worker.

Heterogeneity 

Responders varied greatly in the severity and course of their symptoms over time.

“There is a substantial heterogeneity both between individuals and within individuals,” Mann explained. “Individual differences are the norm, not the exception.”

This suggests that mental health professionals need to remain vigilant with patients whose overall health may appear to improve, only to see it decline. Although specific triggers were not identified, the Stony Brook team recently published another study in Psychological Medicine that sheds light on stress-related dynamics and how they contribute to PTSD symptom severity over time.

While the study is not well-suited to speak to the efficacy of treatment to create an enduring remission from PTSD, the experience of the participants who received screenings and free treatment over the course of years suggests that time-limited interventions are unlikely to produce lasting changes.

“Continuous monitoring is so important,” Mann added. “If individuals exposed to trauma are only monitored once, shortly after their exposure, this will inevitably miss many late-onset and relapsing cases. So repeated monitoring is needed to ensure nobody ‘falls between the crack,’ and everyone gets the attention and treatment they need.”

For politicians and health care leaders, this study suggests that the mental health consequences for first responders who assisted after a significant event with extensive trauma can require ongoing attention for years.

“Politicians, clinicians and public health officials should anticipate the effects of trauma to reverberate for many years, even decades, after the traumatic experience,” Mann said.

Previous studies have also demonstrated that the battle with PTSD tends to be more severe with events where the trauma is man made, compared with devastation from natural disasters such as tornadoes, hurricanes, or earthquakes.

Additionally, female first responders, who represented about 10 percent of the total population, showed slightly elevated, but statistically significant, differences from their male counterparts in developing PTSD. That could partially be a by-product of the higher level of comfort among women in sharing the effect of their trauma with the health care community.

“This supposition remains speculative because it was not measured or tested in our study,” Mann explained.

To be sure, the observational study is not sufficiently broad to apply across the board to first responders.

“WTC responders do not represent the full diversity of people with PTSD,” Mann said. “Consequently, the generalizability of findings to other populations, especially those with more women, greater racial diversity and exposure to nonintentional trauma, such as natural disasters, should be examined further in future studies.”

Future studies

In the search to find an underlying biological mechanism for PTSD, the Stony Brook researchers are measuring nearly 10,000 differentially expressed proteins and then are using statistical methods to reduce this large pool of target proteins to a smaller, more plausible set of candidates. Of these differentially expressed proteins, they anticipate that anywhere from a couple of dozen to nearly 1,500 could emerge as candidates.

In a 2023 review of the search for biomarkers for mental health problems such as PTSD published in the journal World Psychiatry, Anissa Abi-Dargham, Professor and Chair in the Department of Psychiatry and Behavioral Health at Stony Brook, described neuroimaging, genetic, molecular and peripheral assay efforts to determine susceptibility of or presence of illness and predict treatment response or safety.

The review highlighted a critical gap in the biomarker validation process, suggesting that the overwhelming majority of candidate biomarkers has not proven sufficiently reliable, valid and useful for clinical benefit.

Mann is hoping to develop a reliable, replicable signal for poor long term course that can translate into a formal blood test and the development of pharmacological intervention.

From Maine to Rochester

Frank Mann with his family.

Born in Maine, where he spent his childhood, Mann moved to the suburbs of Rochester, New York, close to where he currently lives.

A gardening hobbyist, Mann enjoys spending time with his wife Aubrey, who is a registered nurse, and their sons Leland, 3 years old, and Cambden, 3 months old. He also appreciates the opportunity to grab lunch with high school friends.

Mann believes parenting has enriched his perspective and practice as a scientist.

“Witnessing my toddler’s resilience after every stumble reminds me that the same adaptive processes we study in PTSD recovery are not abstract — they are embodied in real human development,” he explained. “The empathy I gain through daily caregiving brings an even greater sense of urgency and responsibility to my work.”

Each protein or pathway he maps is not just a point on a graph, but, more importantly, is a potential lever to improve lives, Mann suggested. 

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World Trade Center worker. Photo courtesy Steven Spak

By Daniel Dunaief

Sean Clouston takes some time to reflect each year around this time.

Sean Clouston

 

A professor in the Department of Family, Population and Preventive Medicine in the Program in Public Health at Stony Brook University, Clouston studies the long term implications of the exposure and experiences of first responders after the attacks on the World Trade Center.

Clouston, who published research this summer that chronicled the higher rates of dementia among first responders in the years after the attack, spoke exclusively with the Times Beacon Record Newspapers about the work he does and the interactions he’s had with people who were in harm’s way in the days and weeks after the terrorist attacks.

Each September 11th is a “quiet day,” Clouston said, as he takes time to remember those lost  and reflect on those who are continuing to deal with the health consequences of being there.

Clouston recalls thinking about how the attacks shaped the way he thought about what he should be doing with his life.

In the work he’s done in monitoring the role of long-duration exposures at the World Trade Center on neurological health of responders to the events following the Sept. 11 attacks, Clouston has interacted with survivors, spouses, and families, receiving regular updates.

“It’s a pretty big part of my everyday social network,” Clouston said.

He’s heard numerous stories from a day in which the comfortable, clear air provided an incongruous backdrop for the mass murders. He has heard about people who were blown out of the buiding amid a combustible blast and about how difficult it is to put out a cesium fire.

“There were definitelly so many different stories that speak to me,” Clouston said.

As someone who studies the outcomes of severe or early life challenges, Clouston is aware of how the traumatic events of that day reoccur for so many people, as they reexperience the moments that sometimes haunt their dreams and that can continue to affect them physically and cognitively.

People generally consider post traumatic stress as a “fairly short condition” where someone has it “immediately after an event and it kind of goes away,” Clouston said.

For first responders, however, “that’s not true. They are dealing with it for years or decades after the traumatic event.”

Indeed, first responders not only feel the effects of the physical and emotional trauma, but the experience affects their body chemistry and “changes how their immune system reacts.”

Researchers can see how it “wears away at the body over the years and over the decades,’ Clouston added.

The study of post traumatic stress allows him to focus on and understand the link between the mind and the body.

How can people help?

Clouston suggested that people who want to help first responders need to start by recognizing the specific challenges each person may be facing.

“What you do depends a lot on who the person is and what they remember and what they’re struggling with,” said Clouston.

Sept. 11th each year can be a hard time, as people confront painful memories.

People can help others by “being available to listen,” he suggested. Try to understand “why it affects them and how.”

Therapists can help, as can doctor-prescribed medications.

First responders may feel angry, which people don’t always anticipate feeling.

In his research, Clouston focuses less on day-to-day changes and more on how their exposure and experience affects them in the longer term.

First responders can become physically weaker and slower, as they are less able to lift weights.

Cognitively, the effect of the experience has also been significant.

Earlier this year, Clouston published a paper in which he found an “enormous difference” between people with minimal exposure to dust and other particulates at the World Trade Center site compared to those who were more heavily exposed, he said.

“The incidence of dementia is building on prior work showing that the longer you were on site, the more likely responders were to have slowed down cognitive function in general,” he added.

Future questions

Clouston and his colleagues are hoping to understand what disease is affecting first responders. They are unsure whether it’s a form of dementia related to other conditions or whether it’s unique to this group and this exposure.

They are hoping to explore whether people who were on site have anything in their blood that is a measure of exposure, such as chemicals or metals.

First responders don’t all need care now, but one of the goals of the research is to make sure scientists and doctors are “on top of what is really happening” as they prepare to provide any necessary help in future years.

People develop diseases when three things occur: a noxious or toxic element or viral particle exists, they are exposed to it, and people are vulnerable to its effects.

Researchers are working to understand the level of exposure and different levels of vulnerability.

Clouston also highlighted the connection between the immune system and tau proteins, which can trigger dementia in Alzheimer’s and which can spread throughout the brain.

Researchers have been exploring how some immune systems might spread these proteins, while other immune systems trigger a slower spread and, potentially, fewer and less severe symptoms.

In theory, scientists could learn from the immune system that causes a slower spread, although “we’re years away from doing anything like that,” he said.

Alternatiely, researchers and pharmaceutical companies are working on ways to remove these proteins.

“You can fight fires in two ways,” he said.

Stony Brook has been considering “those ideas. To get there, we have to first understand excatly where are we and what is the problem,” he said. “That’s where we really are for the next couple of years.”

As for his interaction with first responders, Clouston has been inspired by the way the first responder community has rallied around people who are struggling with physical and cognitive challenges.

He recalled a firefighter who was struggling with age-related conditions.

“His fellow firefighters came together and built in some lifts and ramps to help him and his spouse get around the house and use the bathroom,” he said. “Moments like that are really touching.”

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File photo

Written by a member of Gen Z

When this editorial appears in our newspapers, it will be one day after the 23rd anniversary of 9/11. A day of which our young adults have no memory.

Members of Gen Z — those in their late teens and early twenties, mostly — were not alive for the terrorist attacks on the Twin Towers, the Pentagon and those on Flight 93, which killed nearly 3,000 people in total, and continue to claim the lives of countless more as a result of 9/11-related illnesses. 

Not long after that solemn day, officials started to use the phrase “Never Forget,” as a sort of chant and message of solidarity, used in speeches, at memorials and in everyday life. Just one glance at Instagram or Facebook will show streams of different variations of that phrase, written over pictures, graphics and even just written out.

Many say 9/11 was our modern-day Pearl Harbor, but let’s face it: Who’s left that remembers Pearl Harbor? At least in a way that strikes a personal chord, worth keeping in ongoing conversation.

So, when every student who just graduated college has no recollection of a day in which we have been implored to “Never Forget,” what do we do to rectify that?

Perhaps, make 9/11 a national holiday. The conversation has been in the air for quite a while, but the compromise seemed to be regarding it as the National Day of Service and Remembrance.

Maybe, teach about how those tragic events unfolded in schools. Yes, it is already taught, but perhaps in more detail.

We’ve all heard the stories of horror from our family members who were in the City on that day. Whether our families lost loved ones that day or simply remember the pit in their stomachs as they watched the second plane hit on television, the testimonies are out there.

The answers are not known to this dilemma. Who knows how many members of Gen Z feel personally connected to the day enough to go to a memorial service or watch the names being read on television. In all honesty, who knows for how many more decades the names will be read on television.

All we can hope for is that no matter how many years go by, and how the iterations of national 9/11 celebrations change, as a people we keep 9/11 sacred. Yes, different people have different interactions with 9/11, but together we can all ensure that this day does not fade into the pages of our history shelves, if we don’t want it to.

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Fire departments from Wading River to Mount Sinai came to the 9/11 Community Memorial in Shoreham Sept. 11, 2019 to commemorate that fateful day. Photo by Kyle Barr

By Daniel Dunaief

Daniel Dunaief

September 11th is not just another day.

The country, and the world, stood still for hours, horrified and stunned by the mass murder committed by terrorists in Manhattan, Washington DC and in a field in Western Pennsylvania.

We can focus on the bravery of the first responders that day, on the remarkable effort by the passengers aboard Flight 93 to retake the plane, the loss of 2,977 people, and the passage of time since that horrible day.

We can also consider the incredible generosity and sensitivity of the country in the days, weeks and months afterwards. I know that didn’t apply to everyone and I remember how taxi drivers from mostly Muslim countries put bumper stickers on their cars indicating they were proud Americans. I also recall the unfair and horrific questioning of people who looked different or who might have originally come from Saudi Arabia or any neighboring countries.

Still, in the wake of a day that also lives in infamy, people gave of themselves and their time.

My family, which included our then three-month old daughter and my wife, walked to an upper east side fire station that lost several members when the World Trade Center collapsed.

There, we saw other people in our community who were bringing toys, pies, gifts and money to the department. The members of the fire station, whom we thanked, forced appreciative smiles on their faces and, more often than not, comforted many community members who choked out heartfelt words of thanks to the station’s survivors.

Outside the station, a car from one of those killed that day was barely visible under an enormous collection of flowers.

Prior to 9/11, I had spent considerable time writing about banks and financial services companies. I had a particular and lasting connection with several members of the boutique firm Keefe, Bruyette & Woods.

KBW provided research and investment banking services for a range of banks. In the months after the attack and the loss of lives, banks made sure to include KBW on investment banking deals, trying to help the survivors and the firm stay in business.

On Long Island, a range of companies donated construction materials to create lasting memorials to the people lost on that day, while offering families a place to go to reflect on the people they were fortunate enough to know.

The frenetic city that never sleeps entered a grieving cycle in which people implicitly knew the rules. A collection of cars passing by with their lights on behind a hearse required people always in a hurry to make way.

Despite the need to do things yesterday, to get somewhere faster than everyone else and to beat people’s own records in traveling from one place to another, people stood by, slowed down and made supportive eye contact with those who were putting up pictures of lost loved ones.

As we drove along the roads around New York City, we saw the efficient removal of debris from the World Trade Center site, with twisted metal and concrete sitting on passing flat bed trucks. Cars made room on highways for these huge trucks and turned on their lights in support and sympathy.

In a more insular way, many of us checked on our friends and family, setting aside ongoing familial disagreements.

I remember watching the video of President George W. Bush (41), who had lost the popular vote in 2000 to Al Gore but had won the election on the strength of the final recount in Florida. He was sitting in a classroom when the secret service whispered in his ear about the attacks. He seemed to take a long time to process what he heard.

Yes, people wondered where he went and what was happening with the center of government power and yes, some criticized him even as they flocked to the Churchillian resolve of Mayor Rudy Giuliani, who somehow symbolized the combination of pain and determination in the days after the attack.

People wanted to help each other, donating, volunteering and coalescing around the notion of a country in need of healing and recovery.

Many of the most helpful and supportive moments reflected the strength of a unified nation with a readiness to set aside political squabbles to defend the country. In our darkest moment, we gave flowers, food, support and respect.

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Students and staff across the Three Village Central School District honored Patriot Day on Sept. 11. Through in-class lessons and activities, students reflected on the tragic events of 9/11 by remembering the lives lost, those who were impacted and the many heroes who made sacrifices.

At several elementary schools across the district, students planted American flags on the front lawn of their buildings. Meanwhile, the perimeter of the Ward Melville High School property was lined with flags as a display of remembrance. 

Along with the flag tributes, many students and staff dressed in red, white and blue as a show of unity.

R.C. Murphy Junior High School social studies teacher Kristin Stelfox participated in an invaluable experience this summer to learn new strategies to effectively teach Three Village students about 9/11. Stelfox was selected for the inaugural Institute for Educators at the 9/11 Memorial & Museum in New York City, spending five days learning from first responders, museum directors and curators and leaders in their fields of study on terrorism about how to teach the history of 9/11 and ensure this fateful day may never be forgotten. 

Stelfox presented what she learned to her department so that her experience and knowledge gained could be shared with a greater audience of Three Village students.

“This experience was incredibly impactful, not only because of the level of access to and caliber of presenters over five days, but because our commitment to never forgetting means we dedicate the time to teaching the next generation of students about the sacrifices and heroism of the day,” she said.

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Anthony Rotoli Jr., left, and Larry Johnston, right, holding a piece of steel recovered from Ground Zero. Photo by Raymond Janis

The Order Sons and Daughters of Italy in America Vigiano Brothers Lodge 3436 held a memorial service at Harborfront Park on Sunday, Sept. 11, to honor two brothers who lost their lives on 9/11.

The Sons and Daughters of Italy is a nationwide Italian American fraternal organization. Lodge 3436 comprises nearly 90 members from communities throughout the area, such as Port Jefferson, Mount Sinai, Miller Place and Stony Brook. 

Anthony Rotoli Jr., president of the lodge, explained the intent of the memorial service. For lodge members, it is an annual reminder of the sacrifices and heroism of first responders who risked their lives in the line of duty. It is also a way to honor the many lost on that fateful occasion.  

“Every year, we do this memorial and it’s uplifting,” he said. “It’s something that we look forward to every year, though with a heavy heart.”

The lodge was instituted in 2008 and named in honor of two brothers killed on 9/11: John and Joseph Vigiano. Rotoli considers the example of the Vigiano brothers a source of pride and inspiration for the members.

“We take that name with pride — pride to us because they sacrificed for this country,” the lodge president said. He added, referring to the memorial service, “It’s an uplifting [event] because we’re giving something back to the brothers.”

Larry Johnston, one of the attendees, served with Joseph Vigiano as a patrol officer. He remembers Joseph’s dedication to his profession and his commitment to public service.

“The guy was a cop’s cop,” Johnston said. “He was shot on three separate occasions and could have easily gone out on a disability. He decided that he didn’t want to do that and just wanted to continue on as a police officer.” He added, “Anything that he could put service into, he did. … His legacy is a legacy of service.”

Given the Vigiano family’s example of duty and sacrifice, Johnston believes the naming of the lodge is a fitting tribute. “It’s a great way to remember Joe and who he was, what he represented, what he brought down to his family and how they represent him,” he said. Brother John Vigiano was an FDNY firefighter.

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Photo courtesy Elliot Perry/MSFD
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The Mount Sinai Fire Department held a memorial service on Sunday, Sept 11, in honor of the lives lost on 9/11.

Community members gathered at the fire department’s memorial. There, various members of MSFD delivered speeches commemorating the fallen. Following these statements, the department performed a ceremonial bell ringing, recognizing those who died in the line of duty. 

In an interview, Chief Randy Nelson discussed the ceremony’s purpose. For him, this annual custom preserves the memory of first responders who risked it all in the name of duty. It also recognizes the many civilians who died during the attacks.

“It’s a way to honor those who were lost on that day and, unfortunately, those that were lost since then battling diseases that stemmed from their work at Ground Zero in the months after,” he said. “It’s a way to honor, remember and — like it’s always said — to never forget. It is important to always have their memory at the top of our minds, especially on this day, but every day.”

— Photos courtesy Elliot Perry/MSFD

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By Daniel Palumbo

To mark the 21st anniversary of the 9/11 terrorist attacks, the Rocky Point Fire Department held a commemorative ceremony at its dedicated 9/11 Memorial Garden on the evening of Sept. 11. 

The fire department invited community members, firefighters from neighboring towns and Rocky Point High School student-musicians for an evening of solemn remembrance of the lives lost 21 years ago. 

Throughout the evening RPFD firefighters, including Chief of Department Fred Hess, took to the podium to thank the attendees for their support. In their speeches, they expressed gratitude and admiration for the many servicemen, servicewomen and civilians who made the ultimate sacrifice on that tragic day in history.

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This Sunday, Sept. 11, marks 21 years since of one of the darkest episodes in U.S. history. Pixabay photo

“You can be sure that the American spirit will prevail over this tragedy.” — Colin Powell 

Those were the words of the former U.S. secretary of state who passed away last year. As a prominent military and political figure, Powell understood the terrible impact that the attacks of Sept. 11, 2001, would have on the nation. 

Though the 9/11 attacks were 21 years ago, the American public was and remains forever changed. Yet Powell was confident that America could overcome this tragedy.

This year marks the first time that the U.S. has not had a major military force in Afghanistan since the weeks after 9/11. A year ago, President Joe Biden (D) ordered the final withdrawal of soldiers from this war-torn nation. After the withdrawal, Afghanistan was quickly overrun by the Taliban. 

The long-term fighting in Afghanistan contributed to the increase in post-traumatic stress disorder among American servicemen with many other soldiers who were severely wounded fighting in this conflict. For almost two decades, Americans tied yellow ribbons around their trees and kept stars in their windows to represent the military service of their loved ones who served in Afghanistan.  

On May 1, 2011, Americans learned during a New York Mets game against the Philadelphia Phillies that Osama bin Laden was finally killed. Flying from military bases in Afghanistan, members of SEAL Team 6 were transported by helicopters to Abbottabad, Pakistan, where they cornered bin Laden in his compound. Chants of “USA” were heard throughout Shea Stadium once baseball fans learned of the death of this al-Qaida leader. The demise of the coordinator of the terrorist plot on 9/11 provided a sense of justice to the victims on that day and their families.

Despite ongoing political polarization domestically, many can still recall the moments of national solidarity in the wake of the attacks. After 9/11, citizens put their political differences aside for the good of the nation, just as they had done after the attack on Pearl Harbor in 1941. Americans in 2001 rallied around the importance of helping local rescue workers and first responders who worked around the clock in Lower Manhattan.  

New Yorkers lined the streets with American flags and handed out food and water to the police officers, firefighters, demolition workers and medical personnel who heroically sifted through the debris at Ground Zero. A plume of smoke hung in the air, blocking visibility of downtown Manhattan. Yet within this cloud, rescue workers operated 24/7.

At Shea Stadium, the New York Mets organized supplies that were sent to the rescue workers. Prominent members of the New York Yankees — Derek Jeter, Bernie Williams and Tino Martinez — visited firehouses near the World Trade Center and thanked these public servants for their efforts. Both the New York Giants and Jets invited military and rescue workers to spread flags across their football fields. With tears in their eyes, football fans nationwide watched fighter planes soar through the skies above the stadiums. Rival fans who rooted against New York teams wore “NY” on their hats, showing support for the residents of the City.

Here on Long Island, locals need not look far to see patriotism that stirred from that day of infamy. Countless memorials depict the importance of this date. Pieces of steel that were collected by the NY/NJ Port Authority was given to towns across Brookhaven and Suffolk County that were placed at post offices, schools, libraries, and police and fire stations. 

This past spring, the Rocky Point VFW organized the first annual 5K race to support War on Terror veterans as they work to better handle post-traumatic stress disorder.

And so 21 years ago, politics was put aside for the good of the nation. Americans from every corner of this country sent rescue, salvage and fire crews to help the search, and later recovery efforts at Ground Zero.  

In a moment of profound despair, our nation came together. Through shared tragedy, people from diverse economic, social and ethnic backgrounds illustrated the meaning of national unity. 

America today is a deeply divided nation. In the face of unlikely odds, the American people should never doubt their power to resolve their differences and overcome adversity. 

Rich Acritelli is a history teacher at Rocky Point High School and adjunct professor at Suffolk County Community College.

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Photo by Kimberly Brown

Middle Country Central School District honored 9/11 with a performance by their fifth grade class, who sign languaged to the song “God Bless America.”

Music teacher Rebecca Schaarschmidt overcame the digital divide that was created due to digital learning. The students have been practicing their sign language since the end of last year and were very excited to perform for their peers in the first, second, third and fourth grade on Friday, Sept. 10 at Oxhead Road School.

“It took them about three or four practices to really get it down,” Schaarschmidt said. “Then we picked it up again when school started, and really only had two days to pull the whole thing together.”

Making sure that all fifth graders were able to participate, Schaarschmidt combined students who were in person last year as well as the students who attended school virtually. She was able to teach the sign language both virtually and in-person. 

“The students were very restricted last year, we had to be six-feet a part in order to sing together and we just didn’t have the space for that,” she said. “So, I was trying to think of a creative way to have the students be able to make music without using their voices which is why I decided to go ahead and teach them the sign language.”

Growing up in the Middle Country School District herself, Schaarschmidt remembers performing a 9/11 memorial with her choir during high school every year. Wanting to translate that tradition into the elementary school, she decided to teach the fifth graders how to perform.

“I think learning about 9/11 in schools is really important because it’s a part of our history,” she said. “These kids were not alive when it happened, so I wanted them to know what happened on that day and who the heroes were as well as who was able to help protect our country.”

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