Monday 19 February 2018

Natural healing is often best remedy for terror victims

Floral tributes line a memorial site at the Place de la Bourse in Brussels (AP)
Floral tributes line a memorial site at the Place de la Bourse in Brussels (AP)

Patricia Casey

The terrorist attacks on the people of Brussels is one in a list that is becoming a litany. Since last October such tragedies have included the downing of the Russian jet in the Sinai desert, killing all on board, an explosion in Beirut in early November in which more than 40 lost their lives, and the Paris attacks on November 13 which robbed 130 people of their lives and injured hundreds.

And the culmination of these was the explosions last Tuesday at Brussels airport and a metro station. The symbolism of striking a metro station near the European Parliament, the heart of the EU, should not be lost on anybody.

More than 500 people have lost their lives in three continents as a result of terrorist actions since October 2015. Even more disconcerting is that prior to this attack, Brussels was on its second highest level of security alert - grave. It was here that the leader of the Paris massacre was hiding after he fled Paris and where he was shot dead just a few days before the terrorists struck again.

According to a CNN report, more than 500 young Belgians have been radicalised and have left to fight in Syria and Iraq since 2012, making this the highest number of foreign fighters per capita from Europe. It is regarded as a hotbed of jihadist ideology.

We may use myriad expressions of revulsion, horror and condemnation, but to what effect? Greg Gutfeld, the American political satirist and TV host said after the Paris attack: "Save the solemn pronouncements, we're long past lit candles."

To some extent he is right, but to ignore these acts of violence would result in governments and their spokespersons being accused of indifference. These condemnations act as a kind of reassurance and comfort for the public rather than as a deterrent to the terrorists.

A grieving population must know that their sorrow is recognised by those with the power to act against the attackers and that the national confidence will not be cowered into passiveness, hopelessness and withdrawal by bombs.

The emotional responses of those affected change during and after the attack, as circumstances and information alters. For those not injured, intense anxiety that often lasts for days is one of the dominant emotions.

However, as the facts become known, the disbelief and shock dissipates. An unusual but recognised phenomenon is 'vicarious rehearsal' (vicariously participating in a crisis which they have not actually experienced), where people present themselves to emergency departments as if they too were injured and demand treatment. This was a particular problem in Japan after the subway gas attacks when more 'armchair victims' presented to emergency services than did injured parties.

Once the acute phase of the emergency has passed, some people feel angry, understandably, at the perpetrators but also at the authorities and what they should have done to prevent it.

Blame and scapegoating are common and a desire for revenge may follow. Some feel stigmatised and believe that they will be forever marked as an inexplicable survivor. They do not see this as a positive outcome but as a mark against them. Guilt that their actions led to them escaping injury or death against the odds makes them question if they could have done more for others.

Consumed by guilt and by fear of another attack, many withdraw physically and emotionally.

But most people are resilient and even those who experience these short-term responses reintegrate into society and are relieved of their distress, anger and guilt. Those who are supported by family are in a very good position to make a full recovery.

In addition, the bonds that a community tragedy creates help people through the early stage of trauma. Indeed, the belief that events such as the Paris or Brussels attacks lead to high levels of post-traumatic stress disorder is now know to be mistaken, particularly as a result of studies post-9/11. That is not to deny the distress that those directly involved experience, nor to minimise the sadness of those who are bereaved, but to understand that people have greater inner strength than our therapy-infused culture gives credit for.

So too with those involved in the rescue procedure - firefighters, ambulance crews, emergency department staff. They will experience acute distress and fear but few become psychological victims.

There is a temptation to rush to offer therapies or medications in the early days after such an incident but psychiatrists and psychologists now know from a raft of studies that intervening too early may interfere with the natural healing within all of us.

So watchful waiting will allow the processing of what has happened and will enable people to attempt to make sense of it. Hopefully, the people of Brussels too will be allowed this psychological space.

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