Kentucky towns devastated during a rare December tornado outbreak will take months or longer to rebuild. Recovering from the emotional trauma could take even longer. Experts say it is important for tornado victims to be vulnerable and open to talking about the trauma they experienced. "There's no rulebook of how to manage a natural disaster," said Tara Immele, a clinical social worker with Greater Cincinnati Behavioral Health Services. "The first and foremost, you need a roof over your head and everyone acknowledges that. But the challenge is going back to address the emotional components there."Immele said PTSD is common in people who experience a traumatizing natural disaster like a tornado. "A lot of times it's a delayed response: a week, a month, six months later. You see a lot of folks enrolled in just basic counseling still addressing and responding to some of their negative experiences," she said. "Some people may withdrawal or act out, especially kiddos. But the thing is to make it a part of conversation, not force it but at the same time, don't make the tornado taboo."The American Red Cross utilizes licensed therapists to meet survivors' emotional needs in the immediate aftermath of a disaster. A spokeswoman said the teams "identify individuals who need additional support, provide short-term disaster mental health interventions and refer individuals to local resources as necessary, in order to supplement local community resources and strengthen community resilience."Tim Andreasen and his family are a handful of the tornado survivors in Mayfield who recognize they will need some kind of professional help to rebuild their minds and overcome the trauma of the storm. "I'm taking it day by day right now. It's not fully hit me yet. It will hit me when I'm alone by myself," Andreasen said last week. His 7-year-old son and 9-year-old daughter were both home when the tornado ripped their home apart."They keep hearing glass break every time they go to sleep," he said. "I keep telling him he needs to talk and get it out before it eats him up. I haven't even talked to nobody yet."

A mother and daughter from Blair, Nebraska, are in remission after their simultaneous battles with breast cancer. If you look through the branches of Amanda Nelson's family tree, you'll find a long history of breast cancer. So it was no surprise to her when she found out she carries the BRCA-2 gene, which makes her more susceptible to the disease."I knew without a doubt just from that history that the risk was very high for me," said Nelson. "There really never was a question of if I would get breast cancer, it was just always a matter of when is it going to happen," said Nelson.Nelson stayed on top of her breast health, scheduling annual mammograms and breast MRIs."So with that breast MRI, it does take a deeper dive so-to-speak out of that breast tissue, just to see what's going on," said Nelson. "It's a better picture from what you're going to get with a mammogram."Then in 2019, that MRI caught a tumor deep in her breast tissue."I believe is what saved my life," said Nelson.Things were already hard for Amanda, who was taking care of her mom, Terry Wulf, after she received a diagnosis of her own, a rarer form of breast cancer known as triple-negative. "It was scary. It was really, really scary to get hers," said Nelson.The mother and daughter's treatments were very different. Amanda underwent a double mastectomy, while her mom was put on several rounds of chemotherapy and intensive oral medications. "That was probably so hard on my body, that is when I truly thought I wasn't going to live any longer, that that was going to kill me," said Wulf. Dr. Katie Honz is a reconstructive surgeon with Methodist Health System. She followed the two on their journey and performed Amanda's reconstructive surgery. Honz and a team of doctors meet each week for a tumor conference. These experts analyze cancer masses and come up with options for each patient. "These patients need a lot of care, even down to their physical therapy and support teams," said Honz. Wulf's battle with cancer would continue. To her doctors' surprise, Wulf was diagnosed with another form of cancer in her fallopian tube. But, with her daughter by her side, they never gave up, and after long, arduous battles, they both went into remission. Now, Terry and Amanda both ask others to keep a close eye on their breast health. Amanda hopes women can find groups for support and the right doctor to make everything more manageable. "I just want to think, 'I made it through it. And now I just want to live my life,'" said Wulf.

Across the vast field where the plane fell out of the sky so many years ago, all is quiet.The hills around Shanksville seem to swallow sound. The plateau that Americans by the millions ascend to visit the Flight 93 National Memorial, to think of those who died in this southwestern Pennsylvania expanse, sits just above much of the landscape, creating a pocket of quiet precisely where quiet needs to be.It is a place that encourages the act of remembering.Twenty years have passed since United Flight 93 made its final descent, chaos unfolding aboard as buildings burned 300 miles to the east. Nearly one-fifth of the country is too young to remember firsthand the day that changed everything.At the edge of the memorial's overlook, a burly man in a leather Harley Davidson vest talks to two companions. He points toward the patch where the plane hit. It is an intimate conversation, and it is hard to hear what he's saying.But his first two words are clear:"I remember …"___Remembering is not merely a state of mind. As those who beseech us to never forget the Holocaust have long insisted, it is an act. And when loss and trauma are visited upon human beings, the act of remembering takes many forms.Remembering is political. Those who disagree about the fate of Confederate statues across the American South demonstrate that, as do those who dispute how much the war on terror and its toll should be part of discussions about 9/11 memories.Remembering wears many coats. It arrives in ground zero ceremonies and moments of silence and prayers upon prayers, both public and private. It shows itself in folk memorials like those erected at the sides of lonely roads to mark the sites of traffic deaths. It is embedded in the names of places, like the road that leads to the Flight 93 memorial — the Lincoln Highway. It surfaces in the retrieval of "flashbulb memories" — those where-were-you-when-this-happened moments that stick with us, sometimes accurately, sometimes not.There are personal memories and cultural memories and political memories, and the line between them often blurs.And for generations, remembering has been presented to us in monuments and memorials like Shanksville's, negotiated and constructed and fine-tuned to evoke and provoke the memories and emotions of people and moments in certain ways."Monuments are history made visible. They are shrines that celebrate the ideals, achievements and heroes that existed in one moment in time," architectural historian Judith Dupre writes in her 2007 book about them — a book she first pitched to her publisher on, of all dates, Sept. 10, 2001.Yet while monuments stand, remembering itself evolves. How 9/11 is remembered depends on when 9/11 is remembered. Remembering it on Sept. 15, 2001, or on Sept. 11, 2004 is different from remembering it on Sept 11, 2011 — or, for that matter, different from what it will be next weekend.What, then, does remembering come to mean on a 20th anniversary, or at any juncture when an event like 9/11 starts to recede into the past — starts to become history — even as its echoes are still shaking the foundations of everything?"Our present influences how we remember the past — sometimes in ways that are known and sometimes in ways that we don't realize," says Jennifer Talarico, a psychology professor at Lafayette College in Pennsylvania who studies how people form personal memories of public events.Evidence of that is obvious in the events of the past five weeks in Afghanistan, where a 20-year war waged in direct response to 9/11 ended pretty much where it began: with the repressive and violent Taliban in charge once more."If we were still in Afghanistan and things were stable, we would be remembering 9/11 in probably a very different way than how we will remember it this year," says Richard Cooper, a vice president at the nonprofit Space Foundation who worked for the Department of Homeland Security for several years after the attacks and has watched many remembrances over the years."That heartbreak and pain we felt on the morning of Sept. 12, 2001, is resurrecting itself," Cooper says, "and that impacts how we remember it today."___Even within more static forms of memory, such as the Flight 93 National Memorial, the question of how remembering changes and evolves hangs over so much.In the visitors' center, visceral, painful artifacts of the moment still bring back the past with astonishing efficiency; twisted, scarred cutlery from in-flight meals is a particularly breathtaking sight. But the variety of remembering that is presented yards away at the quiet overlook and its thoughtful memorial feels more permanent, more eternal — and now, 20 years on, more befitting of something that happened a generation ago. Paul Murdoch of Los Angeles, the lead architect on the memorial, says it was carefully calibrated to resonate across multiple stages of memory about the event and its implications."You can imagine a memorial approach that sort of freezes anger in time, or freezes fear. And that can be a very expressionistic piece of art. But I feel like for something to endure over a long period of time, I think it has to operate a different way," says Murdoch, who co-designed the memorial with his wife, Milena."Now we have a generation of people who weren't even alive on 9/11," Murdoch says. "So how do you talk to people of this new generation — or of future generations?"That question is particularly potent on this 20th anniversary. Society tends to mark generations in two-decade packages, so there's an entire one that has been born and come of age since the attacks. That hardly means they haven't been paying attention, though: They "remember" too, even if they weren't around. Krystine Batcho, a psychology professor at Le Moyne College in Syracuse, New York, studies how nostalgia works. She found something interesting a couple years ago when she was researching how young people encountered stories that resonated with them — both personally and through the news.Even those who lacked living memories of 9/11, Batcho says, responded with stories about the event. It was remembering as shared experience.And no wonder. So many first encounters with 9/11 on the day it happened were, in the tradition of an information age, both separate and communal. People in different parts of the country and world, under vastly different circumstances, watched the same live camera angles on the same few feeds and saw the same, now-indelible views of the destruction in the same way. They experienced it apart, but together.That formed a communal memory of sorts, even if sometimes people who saw the same things didn't remember them the same way — a specific camera angle or vantage point, a key figure's comments, the exact sequence of events. Remembering can be like that, experts like Talarico say, particularly with intense flashbulb memories like 9/11 that carve deep grooves but aren't necessarily accurate in the details."We reconstruct the event through our own lens, and part of that lens is very social," Batcho says. "You would think that the memories would be more cohesive and homogeneous. It turns out that it's much more complicated than that."___May 31, 2002, less than a year afterward. former New York Mayor Rudy Giuliani tells high school students in Shanksville at their commencement: "A hundred years from now, people are going to come and want to see it. And they are going to want to know what happened."Sept. 11, 2016, the 15th anniversary. President Barack Obama says: "Fifteen years may seem like a long time. But for the families who lost a piece of their heart that day, I imagine it can seem like just yesterday."That fundamental tension — it feels like yesterday, yes, but it is also becoming part of history for the long haul — is what confronts us in the coming days as many revisit and consider 9/11 and commit their own acts of remembering.For those who were not at the nucleus of 9/11's horror and its pain but experienced it as part of the culture in which they live, it can somehow manage to feel like both yesterday and a long time ago all at once. And as with so many acts of remembering, it is still being debated and contested — and will be for a long time to come."Sober ceremonies should not mislead us into thinking the public remembrance of this horrific event is a settled matter," 9/11 historian John Bodnar wrote in a Washington Post opinion piece in May.At a hinge point like a major anniversary, particularly with something as tectonic as 9/11, it's easy to fall back on an aphorism like this one from William Faulkner: "The past is never dead. It's not even past." But the saying has endured for a reason.Memory becomes history. And history — shared history — is held onto tightly, sometimes rabidly. It's why so many people grasp tightly to comforting, nostalgic historical narratives — even when they're shown to have been as destructive as they were productive.The act of remembering something like 9/11 involves exactly that delicate balance. When memory does become history, it can become more remote, like a Revolutionary War memorial for people whose passions and sacrifices have been sanded down by time. With distance, it can calcify.That's not going to happen with 9/11 for a long time, of course. Its politics are still roiling. The arguments that it produced — and the ways they sent society hurtling in a different direction — are just as intense as in those early days.And when a nation pauses to remember the morning 20 years ago when it was attacked, it is not only looking over its shoulder. It is also looking around and wondering: What does this mean to us now?"What is important in making a memorial, in what you remember and in how you remember it?" J. William Thompson wondered in his elegant 2017 book, "From Memory to Memorial: Shanksville, America and Flight 93."Any answers to that are, understandably, complex. But behind all the formal words and ways to commemorate a day that upended the world, something more fundamental lurks: a simple imperative to hold onto a sense of what changed things, and how.On the cover of Thompson's book, a man stands looking at the Shanksville crash site, his right arm raised. In his left he holds a hand-painted sign etched with four words, one declarative sentence: "I did not forget."