Abstract and Keywords
Following the terrorist attacks of September 11, 2001, in the United States, social workers assumed a major role in providing services for people who were severely affected. A new literature was developed, relating to serving these individuals, families, organizations, and communities; responses of agencies and organizations to the needs of staff working with traumatized clients; and policy practice in response to restrictive government policies. Work with people affected by mass violence has emerged as a new field of practice within the profession.
Keywords: communal bereavement, human rights violations, mass violence, organizational compassion, policy practice, September 11, 2001, attacks, social justice, social worker self-care, terrorism, trauma
Deriving from the word “terror,” which in Latin refers to fear, “terrorism” is defined as “the systematic use of terror especially as a means of coercion” (Merriam-Webster Collegiate Dictionary, 2003). Terrorist acts are targeted against specific population groups and national symbols with the intention of creating fear and intimidation, as well as personal and environmental destruction (Kastenbaum, 2007). Fear of recurrent attacks causes hypervigilance and a heightened sense of vulnerability among potential targets (Miller, 2004; Webb, 2004). Terrorist acts often reflect a battle of political or religious ideologies; a group's terror actions may represent its own struggle for liberation or may be a reaction to the liberation tactics of another group. State-sponsored terrorism may result in the development of insurgent groups committed to conflicting ideologies (DiNitto, 2007; Holody, 2004).
While terrorism has a long history throughout the world, within the United States the first mass terrorist attack occurred in 1993 at the World Trade Center in New York City, followed by an attack on the Alfred Murrah federal building in Oklahoma City in 1996. However, it was not until the September 11, 2001, attacks on the World Trade Center and the Pentagon, and the plane crash in rural Pennsylvania, that there was public recognition, both nationally and worldwide, of terrorism in the United States. At this juncture, the social work profession was called on by both public and voluntary organizations to participate in providing services to those severely affected by the attacks. Agencies, particularly the American Red Cross, recruited hundreds of social workers to assist those affected by loss, psychological and physical trauma, and the social and economic dislocations created by what for many were life-changing events. In fact, social workers constituted the largest single group of mental health professionals responding to the events of September 11, 2001 (http://www.nasw.org).
With this new and urgent role, social workers turned to the literature for theoretical understanding, intervention strategies, and research approaches related to helping people impacted by terrorism. While the social work literature in the United States included related topics such as crisis intervention, trauma, and work with people affected by natural disasters, only the interdisciplinary and international literature addressed terrorism and mass violence in depth (Quota et al., 1995; Weine et al., 2001). During the ensuing years an expanded social work literature on terrorism, mass violence, and trauma was published in the United States. Social work with people affected by mass violence emerged as a new field of practice as schools of social work developed courses and specializations in this area. The new social work literature focused on the areas of direct client practice with people affected by terrorism and war; the impact of this practice on agencies and social workers, including the responses of social service agencies and organizations to the needs of staff and policy practice, was aimed at promoting social justice in times of repressive government policies.
Direct Client Practice
In the aftermath of the terrorist attacks of September 11, 2001, the incidence of depression and posttraumatic stress disorder (PTSD) increased dramatically (National Center for Posttraumatic Stress Disorder); in Manhattan, home of the World Trade Center, it doubled (Galea et al., 2002). With the nation's attention on the psychological effects of the attacks, there was a shift in the attitude of the public toward mental health services, leading to new funding from federal, state, city, and voluntary sources, and a destigmatization of services. The importance of providing services not only to individuals but also to families, organizations, and communities of those who lost their lives and those who were deeply affected by the events was broadly recognized (Rosenfeld et al., 2005). Extensive media coverage enlarged the affected group, and some proclaimed that “protecting the public's mental health must be a component of the national defense” (Susser et al., 2002, p. 70).
“First responders,” including police, fire, medical and other personnel, were recognized as a new client group needing immediate clinical intervention. The public learned clinical terms and concepts important for social workers and other mental health professionals were brought to the public's attention. For example, the diagnosis of PTSD was broadly recognized in those severely affected by the attacks, including first responders (Danieli & Dingman, 2005).
In addition to traditional intervention strategies, “Critical Incident Stress Debriefing (CISD),” a first-step intervention to prevent and limit trauma symptoms, was found to be important immediately following the traumatic events (Mitchell, 1983). “Organizational bereavement” and “communal bereavement” were recognized as part of the healing process, as groups of people, whether in firehouses, police precincts, corporations, or other places of employment, and in schools, parks, or on the streets of affected communities, gathered to mourn together (Talbot, 2001; Zinner & Williams, 1999). Social workers also noted the role of spirituality and religious belief in the healing process for some clients (Gellman & Dane, 2004).
Intervention included response to “retraumatization,” as repressed memories of earlier traumatic events were revived. “Survivors' guilt,” common when one survives a tragedy in which family members, peers, colleagues, or others perish or are severely injured, affected all client groups (Castex, 2004). Other processes, such as “physiological responses to traumatic events” and “intergenerational transmission of trauma” also required the attention of the social work profession (Auerhahn & Laub, 1998; Elbert & Schauer, 2002).
These issues also apply to the military serving in unconventional warfare, such as in Iraq, where terrorism is common. Embedded and on-site journalists are also affected. In the light of the growing acknowledgment of the emotional toll of terrorism, mental health issues of military personnel and their families received increased media recognition. Social workers assumed a leadership role, both in battle areas and in military and veterans' hospitals (Hardaway, 2004). The need for intervention with veterans and their families became more pronounced with the ongoing war in Iraq, and military social work received more attention from the profession (DeAngelis, 2007).
Social Work within Agencies and Organizations
When there are numerous agencies involved in recovery, a coordinated effort among agencies and federations is essential to establish an effective service network, both for individuals and families affected by the traumatic event and for rebuilding communities (Krauskopf, 2005). Policies reflecting organizational compassion are critical in agencies and organizations responding to the aftermath of terrorist attacks (Dutton et al., 2002). Social workers with ongoing exposure to traumatized clients are at risk for developing trauma-related responses. Among these are compassion fatigue, a consequence of continuous work with traumatized clients that leaves workers drained emotionally and susceptible to depression and exhaustion; secondary trauma, resulting from an indirect exposure to a traumatic event that produces symptoms in the helper similar to the clients'; and shared trauma, which can occur when the client and social worker have experienced the same traumatic event (Cunningham, 2003; Tosone & Bialkin, 2004). Social workers, as clients, are also vulnerable to retraumatization.
Agency administrators and supervisors can introduce innovative strategies reflecting organizational compassion. Strategies that can be useful in protecting and supporting individual staff members and staff morale include staff debriefings, balanced caseloads so that clients assigned to a worker are not all experiencing similarly high degrees and symptoms of trauma, an open-door policy for supervision, and specialized trainings and consultations. Social worker self-care is an important concern as it can minimize the risks of developing trauma-related responses that may arise when working with traumatized clients. Agency administrators and supervisors can provide opportunities for rest, recreation, and leisure activities for staff members, particularly during times of crisis.
Social Welfare Policy and Advocacy
Terrorism leads to drastic national policy measures with far-reaching effects. Of great importance to social workers since the terrorist acts of September 11, 2001, has been the diversion of government funds from traditional domestic social welfare programs for populations-at-risk, not only to new services for people affected by the terrorist acts, but to antiterrorism and national security efforts. Restrictive government policies emerged following the development of the federal Department of Homeland Security and the USA PATRIOT Act (an acronym for Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism) as well as highly controversial government policies related to racial profiling, detentions, immigration, domestic surveillance, and involvements in war, which many social workers see as violations of the profession's core value of social justice. As a result, social workers and social work organizations have mobilized and taken action to combat policies challenging human rights and civil liberties (Mizrahi, 2003; Stoesen, 2004, 2007). The profession will continue to face serious challenges in the future as the nation struggles with controversial issues such as balancing security with privacy and other individual freedoms.
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