You flip on the TV to see the twin towers of the World Trade Center, both with massive plumes of smoke funneling out in front of the bright blue New York morning. Matt Lauer narrates, telegraphing both concern and, somehow, calm. The date is Sept. 11. The year: 2015. Or 2014. Or 2013. It could be any year since 2006, really. This is MSNBC’s annual tradition: The network replays the complete 3½ hours of unedited, uninterrupted, untouched live footage of NBC’s Today Show coverage of the attacks of Sept. 11, 2001.
“Ugh. Ugh,” says Bradley Kaufman, first deputy medical director for the New York City Fire Department, who had been unaware of MSNBC’s yearly replay. (Like many other first responders and survivors who were at ground zero, Kaufman spends the 9/11 anniversary at a memorial ceremony organized by FDNY, which lost 343 members on that day.) “People must want to see it. I know I wouldn’t.”
The problem with the replay is that viewers are likely to stumble on images they simply don’t want to see. Those images, including people jumping from burning buildings and replays of United Airlines Flight 175 detonating the south tower, are difficult to shake. At the 9/11 memorial museum, the sparse number of such images are displayed behind signs warning potential viewers of the graphic nature of their content but receive no such treatment when replayed on MSNBC.
Kaufman says he has not even visited the 9/11 museum. He’s still dealing with the ramifications of that day in 2001: “If there’s a fire in a tall building and I see a skyscraper with smoke coming out, or an airplane flying low, that’s completely a trigger for me,” he says, though he noted that he has not been diagnosed with post-traumatic stress disorder.
The events of 9/11 were traumatic for many: An estimated 11 percent of Americans and 16.6 percent of New Yorkers suffered clinically significant psychological distress following 9/11, including an estimated 530,000 cases of PTSD. Over the past 15 years, a small but valuable body of psychiatric research has revealed that watching these events play out on television seems to have played a role in the presence of clinically significant psychological distress related to 9/11. Those directly affected by the attacks (having a family member killed; witnessing the events in person; experiencing post-event job loss, loss of possessions, or displacement from one’s home; or participating in the rescue efforts) are known to be far more likely to have PTSD and depression if they saw certain disturbing televised images repeatedly. And children, even those with no direct 9/11 exposure, appear to have been at a higher risk of being traumatized by such imagery, too. Research suggests that children who already suffered from—or even merely had parents who suffered from—anxiety disorders or depression had up to a 24.1 percent chance of developing PTSD or PTSD-like symptoms after watching about three hours of 9/11 footage on television, according to interviews conducted with children or their parents following the 2001 attacks.
The directionality of how television affects trauma remains unclear (and 9/11 is not the only example). Do those who repeatedly watched images of bodies falling from burning buildings develop PTSD because of the repeat exposures, or were the most PTSD-prone simply more likely to, for whatever reason, flock toward those images and obsessively watch them? Social scientists still aren’t sure, but it seems that the televised nature of the attacks certainly didn’t help. Of course, in 2001 it was news that needed to be reported. In 2016, it’s a different story.
But it seems people can’t look away. The footage is unsettlingly captivating and sickeningly compelling television, which MSNBC’s ratings clearly reflect (though the replay is presented commercial-free). Between 2002 and 2005, 9/11 anniversary coverage typically resulted in a 7 percent boost in viewership. But since instating the replay tradition in 2006, ratings jump an average of 37 percent above MSNBC’s normal daily numbers, according to Nielsen data.
Anniversaries of tragic events are known triggers for people with PTSD and depression. One study showed that PTSD symptoms are exacerbated for some 9/11 survivors and rescue workers on and around the anniversary, precisely when clips of replay footage are most likely to be broadcast by all media, not just MSNBC. Unfortunately, some people may feel the need to actually seek this out. “There’s this feeling that seeing it one more time, or reading yet another article, will somehow help them reach an understanding,” says Barbara Kamholz, associate director of outpatient mental health services at Boston’s VA and assistant professor of psychiatry at Boston University, who co-authored the study.
That instinct is based in truth: Exposure therapy is a cognitive behavioral technique aimed at helping people overcome certain fears and emotional strain by training their minds to accept certain images. People with intense arachnophobia, for example, might be asked to intentionally look at pictures of spiders as a first step towards overcoming their fear. This approach appears to be effective in treating some disorders and clinicians have even used related ideas (such as writing down and recording personal memories) to therapeutic effect in 9/11 survivors. But does repeatedly viewing the 9/11 televised footage actually qualify as a form of exposure therapy? No, says Barbara Rothbaum, professor of psychiatry at Emory University School of Medicine. “I’ve treated 9/11 survivors. I’ve never yet assigned looking at that footage,” she says. Sandro Galea, dean of the Boston University School of Public Health, agrees. Exposure therapies “only have utility in a controlled highly manipulated settings. Repeat viewing is not therapy and poses some danger.”
Instead, in those who have been previously traumatized by an event, seeing images of the inciting event, even many years later, can retraumatize patients, says Galea, who has investigated the relationship of television exposure to PTSD and depression, especially in those exposed to or directly affected by 9/11. Can that effect persist 15 years later? Yes. “There’s no reason to believe it’s any different. There is reason for caution,” Galea says of MSNBC’s annual replay. It’s a sentiment Rothbaum echoed: “I don’t see a population good for looking at disturbing images over and over.”
Most experts emphasize that the harms of viewing MSNBC’s replay are most likely to occur in the approximately 409,000 people directly exposed to the events of 9/11, those people who were particularly traumatized by the event while watching it unfold from afar, and at-risk children, whether exposed or directly affected or not. (Children in general are known to exhibit higher rates of PTSD after emotionally traumatic exposures, both those experienced in-person or merely via television, the Challenger accident being one well-known example of the latter.) It’s these groups, and especially the roughly 15 to 20 percent of 9/11 survivors who screened positive for PTSD in the years following 9/11, who should particularly avoid graphic replays.
So the MSNBC replay may indeed harm certain vulnerable populations. Others may be able to view it without clinically significant traumatic results. But who, if anyone, does the replay help? No one seems to know for certain.
Dan Abrams, the MSNBC executive who made the initial decision to run the replay in 2006, defends the practice even in the face of accusations that the replay is “death porn.” Abrams argues that watching the footage may be an appropriate way to ensure that we “never forget.” And while most experts and witnesses I spoke to feel that most everyone should watch it once (now-college students would have been toddlers when the attacks occurred), they also sense a line between viewing the footage as part of an educational exercise and accidentally landing on it without preparation. Some claim to find the yearly viewing cathartic. However, experts express concern. “Somewhere, it seems to me, that we’ve lost the point and that we are going for ratings, impact, and horror in our viewers and that does not seem to be a helpful thing for anyone, whether you have PTSD or don’t,” Kamholz says.
So what is the best way to remember—or to “never forget”? Networks other than MSNBC tend to broadcast memorial services, often at the sites of the events, pausing for poignant bell-ringing at particularly tragic moments in the 9/11 timeline. In recent years, former press secretary for George W. Bush Ari Fleischer has made a tradition of live-tweeting his minute-by-minute recollections of the day. Sensationalistic to some, many find Fleischer’s tweets captivating without resubjecting people to the gruesome imagery.
There are also other ways to commemorate the day without re-engaging with the traumatic events themselves. Some therapists suggest that those who found themselves particularly negatively affected by the events of 9/11 might actually be best served by seeking ways to be kind to themselves on the anniversary, consciously engaging in nurturing activities, such as taking a peaceful walk or spending time with loved ones.
For others, watching memorial services in person, or even viewing television coverage of such events, may be appropriate. “I applaud the annual memorials to this event. I think it’s incredibly important for people to come together as a community to honor those who we lost,” says Kamholz. “But running it moment by moment on screen for hours on end misses the mark.”
Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.