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Book Review   |    
Curtis N. Adams
Psychiatric Services 2009; doi: 10.1176/appi.ps.60.4.559
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by Karen M. Seeley; New York, Cambridge University Press, 2008, 252 pages, $35

Dr. Adams is assistant professor of psychiatry, University of Maryland, Baltimore.

The book Therapy After Terror asks many very good questions about trauma and treatment in New York City after the 9/11 attacks. Karen M. Seeley adds to her narrative the first-person accounts of 35 therapists, including physicians, to underscore her conclusion that therapists were not well prepared for an attack of this magnitude and behaved in ways that were at times helpful and at other times questionable. She also suggests that the mental health care apparatus that was constructed to handle the needs of those affected might have overloaded local citizens with information about trauma and enticed some who were having normal reactions to the attacks into believing that they were trauma victims in need of treatment. Once people sought care, who was most qualified to treat them? Using what techniques? For how long?Was it proper to charge for therapy? Was it improper to not charge?Seeley doesn't pretend to have the answers to these questions, but answering them is vital before the next large-scale disaster.

Lack of access to care is a frequent concern for those who provide mental health services, but in post-9/11 New York, there were unprecedented levels of funding, and there was an apparent reduction in stigma associated with seeking mental health care. Still, Seeley highlights the difficulties that some therapists had in reaching those who might be in need, showing that some therapists could not reach first responders who would not admit therapists into their fraternity. Also, the author recounts that a few therapists who were from racial or ethnic minority groups felt excluded from much of the work at Ground Zero.

We are offered a view of the treatment of trauma and how the rapists reacted to their clients' trauma and their own trauma as direct or vicarious victims of 9/11. We see that some therapists were slow to diagnose posttraumatic stress disorder (PTSD),others were quick to do so, and some did not diagnose it at all, but all were using (or not using) the same DSM criteria.Later, we are shown how PTSD was used to confer political advantage to those so diagnosed, at times turning them into unalloyed innocent victims deserving of compensation, a potentially disempowering outcome.

One might conclude that there is little here if one counts only the 196 pages of text.Not so.There is plenty here that will have the reader thinking long past the end of the book.There are some omissions, however. For example, physicians are included in Seeley's group of interviewees, but there is no mention of medications or whether the physicians struggled with deciding to whom or whether to offer medication. Still, for those who regularly treat people experiencing trauma, this book will expand ongoing debates in the field with the extraordinary backdrop of 9/11 in view. For those who don't treat trauma survivors but who are tempted to help with the next disaster, this book will cause them to consider whether they have relevant training to be helpful as a therapist in a disaster.

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