A stream of patients has filed into doctors' offices and hospitals for about a month now, complaining about an inability to sleep, an indefinable uneasiness, an enveloping sadness.

The Sept. 11 terrorist attacks were such a national tragedy, it was inevitable that people would be affected mentally, counselors and physicians say. Even before the attacks, some individuals were challenged by a faltering economy and the stress that puts on families and relationships. Now a fear of bioterrorists exists, experts point out.

``I'm hearing from people who are having a lot of unusual dreams having to do with anxiety about the terrorist attacks,'' said Robin Hall, a Colleyville doctor. ``A lot of people are telling me that they are handling it OK in front of their children and their co-workers, but in private they are afraid. ... The most anxiety is over the uncertainty of the situation. It's not fear that they or a family member will be killed, but it's a fear of the unknown.''

Officials at Harris Methodist Springwood report that 10-15 percent of its patients have complained that they have been affected by events related to the terrorist attacks on New York and at the Pentagon, said Geary Goldsmith, Springwood's manager of clinical services.

Some who had previously received diagnoses of mental conditions, such as depression and social anxiety, had relapses. Others who suffer from psychoses have talked about being stalked by the FBI or the CIA.

``We had people coming in believing they were terrorists or relating to the attacks in ways that were not based in reality,'' Goldsmith said.

But doctors said that most complaints are from those having trouble sleeping, eating or focusing on their jobs or interests. Others are concerned about losing their jobs.

``I've seen more people with just a generalized anxiety,'' said Dan Handel, medical director of pain management and palliative care for Harris Methodist Fort Worth. ``I've had a couple of my patients who say, `I know what this is, and I'm just trying to work through this.'''

The threat of bioterrorism is not as pronounced in North Texas as it is in other parts of the country where cases have been confirmed, Handel said. But the fear spawned by bioterrorism may be disproportionately large in relationship to the threat it represents, physicians say.

Perhaps that is because biological and chemical weapons are an unseen threat, and people see the conditions they cause as untreatable, leaving many with a doomsday outlook, Handel said.

Some people think that ``you walk into a subway like people did in Japan and you never come out,'' Handel said.

Eventually, most people will return to a normal outlook, but it may take a few more weeks to reach that point. The military and the government must assert their ability to protect the population before normalcy will return, said R. Reid Wilson, an associate clinical professor of psychiatry in the School of Medicine at the University of North Carolina at Chapel Hill.

But events following Sept. 11 have kept the country from returning to normalcy: a bus driver had his throat cut by a passenger, anthrax has killed one and frightened many, bad economic news has dissipated but not disappeared, airline crews have been threatened by passengers, and the bombing of Afghanistan intensifies.

``We noticed another spike in patients coming in with the attacks on Afghanistan,'' Goldsmith said. ``In the last two or three days, we've seen a number of people coming in for assessment alluding to the attacks.''

Carl Chelette, a counselor at Harris Methodist Springwood, recommends the following coping techniques and activities for those seeking to reduce stress before it reaches a critical level. The better someone can reduce the background stress in their lives from job, family and economic concerns, the better they are at dealing with catastrophic events such as the Sept. 11 attacks.

Physical - Maintain proper nutrition, exercise, and sleep at least 8.25 hours each day.

Community - Maintain relationships with friends and family and get involved with church, school and social service organizations, such as the food banks.

Recreation - Take up a hobby and relax. The most important thing is to talk through your feelings.

From Healthy.net