On the morning of September 11, 2001, I had just stepped onto the thirty-seventh floor of my company’s Manhattan headquarters when American Airlines Flight 11 plowed into the North Tower of the World Trade Center, less than one thousand feet away. The floor shuddered beneath my feet, and a long, metallic grinding sound rose above the babble of the waking office. I froze as my mind flipped through possible explanations like study flashcards: Not thunder; the sky is blue. Not from the building site next door; too loud and long. Instinctively turning toward the sound, I saw a thick curtain of indistinguishable stuff raining down outside the floor-to-ceiling windows of our north wall. I jogged over to investigate with a handful of colleagues.
Not far above us—just a forty-five-degree head-tilt up and right—black smoke and sporadic jets of flame erupted from a colossal maw ripped into the North Tower, edged with fangs of molten steel. We stood, dumbstruck, until a witness to the catastrophe told us what had happened. Eyes glued to the tower, I flipped open my cell phone and called my boyfriend, Marcus, an emergency room physician at a downtown hospital who was off work that day. “Hey. I’m OK, but a big plane just crashed into the World Trade Center. Some insane accident. You’re going to be needed.” He hardly needed a minute to grasp what I’d said; he encountered the incomprehensible every day. “On my way, call you later. Take care of yourself, OK?” he said, and hung up. It then occurred to me that the savaged building lacked floors and walls enough to contain all the dead and dying. Some were bound to fall, and it felt wrong to watch their last moments out of terrible curiosity. So I turned my back to the window, just as a colleague’s yelp announced the first plummeting soul.
About fifteen minutes later, we were all online searching for news about the “accident” and calling loved ones to assure them of our safety when a plane crashed into the South Tower. A colleague who put two and two together before the rest of us yelled, “It’s a terrorist attack—everybody out!” With the composure and determination of people used to overcoming challenges together, my colleagues kicked off heels, tossed off suit jackets, and hurried to the exits. I didn’t move. The ground around our building looked like earthquake ruins. What if the attack wasn’t over . . . or chunks of plane and building kept falling? Would we face more danger outside than inside? A colleague I didn’t know stepped directly in front of me and, with pale blue eyes glaring into mine, said, “Get. Out. NOW.” I snapped out of my looping threat assessment and joined thousands of building occupants thundering down the stairs. Seven minutes later I careened out of a ground-floor door onto a carpet of debris as the policewoman holding the door screamed, “GO! GO! GO! GO!” and pitched imaginary speed balls, urging us clear of the building.
The events of my slow trek home, to East Twenty-Seventh Street at the time, have solidified into a vivid capsule memory: A hulking rescue helicopter landing in the park next to our office building, defeated by impossible flying conditions around the towers. Human specks sailing down the towers’ length, when I couldn’t help stealing a backward glance. Thoughts of loved ones I couldn’t reach due to an overloaded cellular network, and of people trapped in the towers realizing that help wasn’t coming. People overflowing from neighborhood bars, drinking hard liquor and straining to hear the TV news blaring inside. A crowd of south-staring faces simultaneously contorting as one of the towers collapsed in a sickening roar, launching a tidal wave of rubble into the lower floors of our office building. And the stony feeling of my face through it all: furrowed brow, set jaw, stiff tongue against bottom front teeth. What I now know from experience is my mourning mask.
Then, five years later, I have to rescue myself when an explosion in my Brooklyn apartment blows my hand halfway off.
Born and raised in privileged circumstances, I naively once thought it extraordinary to have experienced two close encounters with death, let alone one. But exposure to traumatic events[*]—as victim, witness, emergency responder, or in a similarly intimate capacity—is utterly common. How common is “common”? The answer necessarily varies depending on how the question is asked, relative to what population, but the World Mental Health Survey Consortium offers one instructive benchmark. Surveying large samples of the general population on six continents, it found in 2015 that over 70 percent of all respondents reported exposure to one traumatic event, defined as threatened death, serious injury, or sexual violence. Over 30 percent reported exposure to four or more. Such statistics may shock, but cannot surprise, when one considers that the world supplies sufficient armed conflict, terrorist attacks, school shootings, natural disasters, interpersonal assaults, serious motor vehicle accidents, and other catastrophes to fuel a global twenty-four-hour news cycle.
I also thought it extraordinary to have ultimately emerged psychologically undamaged by these traumas. How, after all, could anyone feel safe and capable again, knowing that such things can happen and one is powerless to prevent them? How could anyone feel whole again, having been pierced to the core by the horror and grief of them . . . or bear to love or endeavor again, knowing that anything we cherish or build can be destroyed in an instant? But I did, and I am not at all unique in this respect, either.
Of course, it is true that, for all our astonishing, built-in survival capabilities, what doesn’t kill us can shake the foundations of our lives and selves—what we believe, feel, do, hope for. In clinical terms, we may feel exhausted, confused, anxious, or depressed. We may avoid people and situations that remind us of the traumatic event. We may reexperience it through intrusive thoughts and images, and hyperarousal in the form of irritability, sleeplessness, difficulty concentrating, or elevated startle response. Trauma specialists believe some of these symptoms to be caused by the failure of our built-in threat-defense program, described in chapter 2, to deactivate as soon as danger has passed. At the extreme, we may develop post-traumatic stress disorder (PTSD), in which our clinical symptoms following a traumatic event persist and intensify, significantly impairing our ability to function at work, in school, in relationships, or in other important life domains.
And yet, a large majority of people exposed to a traumatic event don’t develop PTSD. They suffer a few symptoms that resolve within several weeks or months, or even maintain psychological equilibrium and normal function throughout the experience and beyond. Manhattanites living south of 110th Street exemplified this after 9/11: A month after the attacks, 7.5 percent of surveyed residents reported symptoms consistent with a PTSD diagnosis, and 17.4 percent reported some symptoms of the disorder but below the diagnostic threshold. By six months, those figures had dropped to 0.6 percent and 4.7 percent, respectively.
What accounts for the variety in people’s responses? Some Western cultural notions attribute it to volition and courage, implicitly making heroes of those who rebound from trauma, and failures of those who suffer long and deeply from it. But like our experiences of pain, or the conscious decisions we make to escape danger, our adaptability to trauma is a unique product of event characteristics and of interacting biological (including genetic), psychological, and environmental factors, many well beyond our knowledge, let alone our control.
For instance, the nature, severity, and duration of a traumatic event influence its psychological impact. So people exposed to traumas involving violence, like combat or assault, are much more likely to develop PTSD than those exposed to impersonal events, like accidents or natural disasters. Simply being biologically female can also elevate one’s risk of developing the disorder, as can a history of trauma, or factors that may make emotional regulation and problem-solving more difficult, such as a serious mood disorder, low IQ, or lower level of education.
Conversely, people with higher levels of education tend to adapt better to trauma, as do those with financial resources and, especially, strong social networks that they can tap for practical and emotional support. Thus, the meta-tragedy in trauma: deeply entrenched social and racial inequities deprive innumerable people of such protective resources.
Research also suggests a number of inner resources that can promote healthy adaptation to traumatic events, as well as other acute stressors like the death of a loved one. An inclination to search for meaning, purpose, and opportunity in adversity is one; others include a realistic confidence in one’s ability to influence circumstances, a problem-solving mindset, a religious or spiritual practice, and belief in the instructive value of both positive and negative life experiences.
This is by no means an exhaustive list of risks and protective factors influencing individual adaptability to trauma. And because we all experience trauma differently and bring a unique complement of resources into the task of coping with it, the means by which we do so can be counterintuitive, even disturbing, to the people in our lives. We won’t rebound as quickly as some think appropriate, or grieve as long and strenuously as others think we ought. We’ll “overshare’’ difficult emotions or maintain “too stiff” an upper lip. We might feel and express joy—even use humor, God forbid!—when others believe we shouldn’t be capable of levity.
But there is no right or wrong way to feel about adversity, and there exist an infinite variety of paths through it—including positive emotion and humor, both of which have been associated with healthy adaptation. The moral of the story? It’s pointless to compare, and unfair to judge, people’s responses to trauma. We’re all just doing the best we can with what we’ve got.
I dragged a few notable risk factors into my traumatic events—two X chromosomes, a family history of serious mood disorders, and some personal history of depression and anxiety. However, I also benefited from a significant complement of protective factors, fundamentally including a strong family and social network; an advanced degree of education, mainly devoted to intellectual and practical problem-solving; and a level of professional and financial security that kept peripheral worries to a minimum and afforded me quality health care and time off for recovery. I leaned hard on these advantages, every single day, to navigate through the aftermath of my traumas, and particularly after my accident.
The tug-of-war between my risks and protective factors resulted in what I’ve concluded are my signature trauma-response symptoms: sleeping and weeping. For several weeks after 9/11, it was a Herculean effort to stay awake for more than a few hours at a stretch, and much of what I remember from that period is Marcus gently waking me to take calls or eat meals. I slept prodigiously after my accident, too—more hours than I spent awake, it seemed—certainly more than the side effects of painkillers, antibiotics, and an energy-sapping healing process alone could explain.
My weeping jags after the two traumas—always sudden, brief, and cathartic—differed only in their usual contexts: that solitary bench on the Brooklyn Promenade after my accident, and the 69th Regiment Armory near my Manhattan apartment after 9/11. Within days of the attacks, flyers covering every reachable exterior surface of the armory implored passersby to report sightings of missing loved ones last seen near the towers before the attacks. Their near-universal format: white printer paper, HAVE YOU SEEN [NAME] heading, a color photo of the missing beloved celebrating a happy life event, and a list of their identifying physical characteristics . . . scars, tattoos, birthmarks, gold-capped teeth. The colossal twin heaps burning downtown made it fantasy to believe that anyone would be found alive; their bodies would need identifying. I felt compelled to walk that path home, and to stop and read the flyers, and I was far from the only person wiping away tears as I did.
After my accident, I also had “reexperiencing” symptoms common among trauma survivors, with thoughts of 9/11 bombarding my consciousness, and prolific dreams about my feelings during recovery—fear, grief, and alienation gradually ceding to cautious optimism. I find it intriguing that my brain did not thrust gruesome accident replays on me while awake or asleep, especially given that the event resulted in devastating injury. Other people think it peculiar that I hardly worried about the real possibility of severe, permanent hand dysfunction. I am often tempted to satisfy my own and others’ cravings for certainty by explaining these curiosities away but must continue to resist the inclination. Given the innumerable and unknowable factors that produced them, I’d be choosing, rather than revealing, the truth of the matter.
Psychological coping in the aftermath of trauma is not just about managing the clinical symptoms to which it gives rise. It’s also confronting our shaken foundations, the loss of those aspects of our lives and selves that used to sustain and guide us, but cannot in our new circumstances. It’s a painful, confusing “dying while alive,” in the words of a teacher of Tibetan Buddhism I recently encountered, who likens such transitions to the bardo between bodily death and rebirth in that tradition.
The existential keystone that wobbled for me after 9/11, and took a proper pummeling after my accident, was my mistaken belief that self-sufficiency was achievable and necessary. Since toddlerhood, when I first rebuffed my mother’s help (“Becca do it BY SELF!”), I have craved the ability to explore, succeed, and fail on my own terms, and the strength to be the helper, not the helped. I also came to believe that I had to live this way. No complaints, no excuses, no second chances. I organized my young adult life accordingly, pursuing school admissions, degrees, and jobs like pieces of armor to fortify me on whatever quests I might fancy, and protect me from misfortune.
The strategy has yielded significant psychological and material benefits. But the beliefs underpinning it have caused me much unnecessary suffering and, at times, reduced my capacity to treat others the way I wanted to. I’d been challenging them in psychotherapy before the accident, slowly learning to accept our human vulnerability, and the accident accelerated that learning by dispelling my last delusions about self-sufficiency, beginning in my hallway when a fireman used his big, gloved hands to pry my left fingers off my bound wound so that he could relieve me in applying direct pressure to it.
I intuitively coped with the trauma by throwing myself into OT and studying the science behind my injury, which gave me a tenuous sense of control (to a hammer, everything looks like a nail, as the old saying goes). My dedication to OT yielded slow but steady improvement in strength, range of motion, and dexterity in my replanted hand. And just as my friend Scott had promised, learning about its anatomy helped me better recognize progress and tolerate disappointment in rehabilitation.
Very quickly, though, learning became a fascinating end in itself. With newfound appreciation for the severity of my injury, I wondered how I could have dodged fear until emergency services arrived, dodged pain until arriving at the hospital, and dodged PTSD altogether. Those questions sucked me into neuroscience, which, over the next fifteen-plus years, progressively led me to readings on human consciousness, psychology, genetics, and evolution.
I was also preoccupied by fuzzy, uncomfortable existential questions during recovery. I just hope this all comes to mean something, I wrote, almost weekly, in my journal of the first few months. I hit the books in search of answers to these questions, too, dipping into philosophy and religion, and consuming one “misery memoir” after another. Those stories of life-threatening and life-changing experiences—limb loss, cancer, addiction, brain injury, organ transplantation, severe mental illness, bereavement—offset my sense of alienation, and their endings hinted that someday, my wish to discover meaning in my trauma might come true.
For all these helpful coping mechanisms, I still needed my loose network of Samaritans—those loved ones, colleagues, neighbors, and strangers who implicitly and explicitly reassured me that I mattered to them, that I was not imagining my difficulties or my progress, and that life would improve. It was in what they said and how they listened, the meals they brought, the laundry done, doors held open without asking, tissues offered on a weepy subway ride, forgotten video-rental late fees waived, silly nicknames (“Hey, Lefty! Keep snoozing, I’ll wake you up when we’re boarding and escort you onto the plane first”), and so many other kindnesses.
They kept the virtuous circle of physical and emotional recovery turning, and me lightly tethered to their world until I could return to it. I did return, of course, when my hand had become sufficiently mobile, and my clinical symptoms of trauma response (all that sleeping and weeping) had subsided. But my experience of the trauma didn’t end there.
One night in London not long ago, I was sitting in bed reading when a surge of grief and loneliness overtook me. The sudden change in emotional state perplexed me, since the book wasn’t sad, nor was I brooding about any particular life issues at that juncture. It took a few seconds of mental exploration to realize it had been triggered by the song playing on the radio, which I had listened to a lot while recovering from the accident at home alone in Brooklyn, but not at all since. Called “Hang On Little Tomato,” it came from an album of cheery lounge tunes a friend had given me, and its reassuring “things will look better in the morning” message had often prompted cathartic tears. All these years later, instead of bringing relief from the painful aftermath of trauma, the song reminded me of what it felt like to be in the thick of it.
The experience of trauma changes us. Like spilled ink, it seeps into every aspect of our being, perceptibly and imperceptibly tinting memory, perspective, identity, and beliefs, long after clinical symptoms fade. Prompted by almost any encounter with hardship these days, I recall the loneliness and anxiety provoked by needing help during recovery but not knowing where it would come from; the burden of having to spin optimism out of uncertainty for weeks on end; or the cramped-chest sensation accompanying upsetting emotions that need venting but defy articulation or lack a ready ear. It hurts to remember myself, and recognize others, confronting such difficulties.
I also recall what I have gained from coping with trauma. My occasional periods of anxiety and despair as a young woman left a residue that accumulated into a latent dread that some massive crisis could permanently lodge me in those excruciating states. But 9/11 and my accident served up irrefutable evidence that I was psychologically stronger than I had thought, and the dread began to awkwardly coexist with an unfamiliar faith. Not the naive kind that insists, contrary to all evidence, that everything always turns out OK, but the savvy kind that, as my friend Kathryne describes it, knows it’s highly likely “you’ll still be standing when something good finally happens again.”
I’ve become much more comfortable asking for help. I’m better at recognizing others’ emotional and practical needs in a crisis, and more skilled at addressing them because of the thoughtful support I’ve received myself. And strengthened by all these developments, I’ve taken personal and professional leaps to live in closer alignment with my values.
Someone is bound to label my personal evolution “post-traumatic growth” (PTG). Coined by trauma researchers in the 1990s, the term refers to positive psychological changes that some people report experiencing as a result of struggling through a severe crisis. However, I’m not convinced that it applies to me, as the authors’ definition of growth requires a reshaping of beliefs that I did not experience, at least not to the degree implied. Rather, I attribute much of the positive change in my post-trauma life to a process of nurturing helpful perspectives, and starving harmful ones, that began long before 9/11 and my accident (and continues today). This assessment aligns with some trauma researchers’ critique that instances of PTG are often simply a manifestation of an individual’s pre-trauma traits and capabilities.
My primary concern with post-traumatic growth, though, is the tantalizing term itself. Belying the subtleties of the theory behind it, it implies that life’s ups and downs can be distinguished and accounted for as neatly as debits and credits to a bank account. Interpreted through the lens of my national culture of origin—which detests unhappy endings and insists that anyone who works hard enough can achieve whatever they want—people could therefore misconstrue the theory as suggesting that traumatic experiences hold the possibility of unequivocally positive outcomes, and that those who don’t experience them have only themselves to blame. That’s an easy recipe for misery and callousness.
Whether inapplicable diagnosis, unsupported theory, or just bad branding, then, I reject the PTG label for my own development, much preferring a Brooklyn neighbor’s take on how we change when we live through trauma. “Welcome to the Death Club,” she said in a chance hallway conversation a few months after my accident and her father’s death in hospice. “We’ve seen death up close, and we’ll never look at anything the same way again.”
The work of this figurative Death Club is to integrate death into life, before it inevitably consumes us. That means surrendering to paradox, learning to carry a belief in possibility alongside the visceral knowledge of profound and permanent loss, so that loss does not become the chief architect of our lives, causing us to shrink from what is enriching or necessary for fear of it. And it means learning to embrace the strange kind of happiness (there’s no better English word for it, alas) that only travels with sorrow—like what my best friend, Jen, and I feel, knowing we can tell each other our scariest inner shit without scaring each other off; or what my siblings and I feel when we can address my father’s frequent health emergencies with slick teamwork and gallows humor, despite our concern for him and the worries about our own futures that his situation prompts.
We members of the Death Club often recognize each other, sensing vulnerability that others do not, or noticing a particular ease with, and insight into, upsetting subjects that can only come from rigorous grappling with them. And we often seek out and support each other, knowing we share a familiarity with what is difficult to describe or bear, and a kinship that can reassure, without promising the perpetual safety we crave but know we cannot have.
In real life, that dynamic looks like this: In the summer of 2020, between pandemic lockdowns, I met up with members of my London running club for a trot around Hyde Park, and ended up doing the loop with a new one—a twenty-five-year-old guy who was stuck with me because he showed up too late to run with the fast boys and didn’t know the route well enough to catch up with them.
“What do you do for work?” he’d asked.
“I’m writing a book,” I replied, and within fifteen minutes, we’d offered each other the intimate stories of my accident and his father’s recent, sudden death. We spent the next thirty minutes relating and witnessing the impact of our experiences, and parted with the warmth of good friends.
I can see the Death Club dynamic in my interactions with Dr. Vargas, too. Examining my wound for the first time, he’d said, “Do you think you can look?” not, “I need you to look,” subtly acknowledging the appalling nature of my condition, which I struggled to convey to other people in my life. And his enthusiastic support of my science studies suggested he understood that I needed to push my intellect to be sure that some recognizable part of “me” had survived.
There is freedom in this work of integrating death into life—freedom from the gnawing, depleting pain of resisting what we know to be true, and the squandered opportunity that results from not seeing the facts of our lives as they are. But it’s beastly hard. Much harder, apparently, than I could admit to myself, until one morning on my way to work nearly a year after I’d recovered, when I tripped while galloping down the stairs of a footbridge over the West Side Highway. As my body flew out from under me, I felt that hot punch in the chest you get at the top of a big roller coaster drop, and only just managed to grab the handrail with both my hands and pull on it with all my strength, so that I could keep my skull from cracking on the step behind me. As my body stilled, I surprised myself by thinking, Next time, I hope I just die.