I'm the psychiatrist who helped the 9/11 first responders overcome their trauma - here's what they taught me about staying resilience

My patients often seek help during the darkest of times: job loss, medical illness, and the loss of a loved one are just some of the challenges that can feel tremendously daunting. 

But what happens when several of these tragedies happen all at once, in one day, in one moment unexpectedly and so tragically? This was the reality faced by many on September 11, 2001, in New York City. 

As a young psychiatrist in training, I had never imagined that I would be working with survivors of such a catastrophic event. 

Suddenly, as a trainee at a New York City hospital, I was responsible for the mental health care of rescue, recovery, and support workers, as well as grieving families and ordinary New Yorkers, as we all struggled to make sense of life after the largest terrorist attack on American soil.

Dr Sue Varma heads up the World Trade Center Mental Health Program at NYU Langone

Dr Varma's training could never have prepared her to work with the survivors of 9/11

Through her work with first responders and survivors of the terrorist attack on 9/11, Dr Varma learned some of the most essential tools a person can have in the face of trauma and adversity

A few years later, I was selected as the first medical director of the World Trade Center Mental Health Program (WTC MHP), part of what is now NYU Langone Medical Center, one of seven centers across the US established in the wake of the tragedy to provide ongoing screening, treatment, and support to WTC responders.

Little did I know that this experience would plant the seeds for what would become my philosophy when it comes to coping with life's challenges: something I like to call practical optimism. 

I discovered that optimism played a pivotal role in building the resilience I saw in many of the patients I'd encountered.

Initially, I had thought of optimism as something one was either born with or not. However, over time, I realized that while genetics did play a role, the rest was up to us. 

I wanted to learn and teach skills that could help individuals bounce back from adversity and thrive in the face of it.

And from the many amazing people I met in the aftermath of 9/11, I learned some of the most essential tools a person can have in the face of trauma and adversity - and it is by this guidance that I live my own life.

Here are the five strategies that I practice everyday, and help to keep me going, even in the worst of times.

Optimism plays a pivotal role in building resilience, and while genetics do play a role, the rest is up to us

Altruism, giving back to the community, and helping others can shift our focus from inward rumination to outward connection 

FIND A BRIGHT SIDE (EVEN IF IT'S REALLY HARD) 

Even in the midst of tragedy, our perspective is a choice. Tragic events often expose us both to the depths of depravity and the heights of humanity. Which aspect we choose to focus on will determine our outlook on life. 

When I'm unable to change a situation that is causing me upset, I try to find a way to change my attitude toward it. This shift in perspective allows me to reframe what would’ve been an otherwise unpleasant situation for me and turn it into a more tolerable (and maybe even pleasant!) experience.

Try to see things from another person's perspective, or seek a positive takeaway - a silver lining, a lesson learned, a bullet dodged, a crisis averted.

HELP OTHERS...AND SHARE YOUR PAIN 

When we change 'I' to 'we,' even illness becomes wellness. Altruism, giving back to the community, and helping others can shift our focus from inward rumination to outward connection. Even small gestures of kindness can make a significant impact to your own mental and physical health.

Turn your pain into purpose by sharing with others any insights you have. I know people whose extreme life experiences have required them to cope with loss, trauma and hardship - and sharing what they learned became an important part of their own healing journey.

We also know that altruism can be therapeutic for those who've experienced severe stress. Several of my patients have expressed interest in the areas of grief counseling, rehabilitation and therapy - from helping others with physical injuries to substance use disorders - as a result of their own experiences, losses, trials, and triumphs.

KEEP NOTHING BOTTLED UP 

It takes more mental resources to stifle emotions than to express them. Unexpressed emotions often manifest as physical symptoms. Keeping a journal to express emotions, worries, fears, and concerns can be liberating and therapeutic.

VOLUNTEER FOR A SENSE OF PURPOSE 

In his book Man’s Search for Meaning, Austrian psychiatrist Viktor Frankl talks about what he learned as a survivor of the Auschwitz concentration camps: 'Woe to him who saw no more sense in his life, no aim, no purpose in carrying on. He was soon lost.'

And in a study published in The Lancet, participants who’d expressed a sense of meaning and purpose were 30 percent less likely to die during the average eight-and-a-half-year follow-up period than those with the least well-being

So it's clear that developing a sense of purpose in life can buffer us from stress and help us stay afloat during challenging times. Even small acts of volunteering or helping others can create a sense of self-worth and purpose.

Even small acts of volunteering or helping others can create a sense of self-worth and purpose 

It might be as subtle as parents volunteering at their child’s school as a way to be more involved in their child’s life, plus adding a parents' night out after the meetings. 

I’ve seen this purpose/pleasure combo take the form of a fundraising exercise session followed by a communal dinner. Or someone whose work is consuming their nights and weekends deciding to reclaim their time and give back by volunteering in a community garden on Saturdays. 

The effort doesn’t have to be big. Many of my patients in the WTC Mental Health Program simply accompanied others to their medical appointments. Their presence was the greatest gift to their fellow humans.

NEVER SUFFER IN SILENCE 

Don't suffer in silence. Reach out for support when needed. There are resources like the national suicide prevention hotline (988) available for those who need them.

Dr. Sue Varma is a board-certified psychiatrist and author of Practical Optimism: The Art, Science, and Practice of Exceptional Well-Being. You can stay in touch with her (IG, Twitter, FB @doctorsuevarma)