Floral tributes outside the Bataclan Theatre in memory of the victims of the Paris attacks
On Friday, November 13 2015, a series of terror attacks erupted in Paris. They were mercilessly launched on people gathered at various social outlets and events in order to maximise the carnage. A football match was the first target in this co-ordinated killing spree. This was followed by shootings at restaurants and cafes and finally a metal concert in the Bataclan Theatre. Hostages were taken there also. A total of 130 lost their lives and over 4,000 were injured, almost 100 seriously. These were the most serious attacks on the city since WWII. Isis claimed responsibility.
It is no surprise that the impact of these attacks on the psyche of those involved, both directly as victims and less directly as observers, has been studied in depth by psychiatrists and psychologists, as have attacks in other locations. The London bombing and 9/11 attacks in New York have both generated large volumes of research information. In the April issue of the British Journal of Psychiatry, a paper exploring the impact of the Paris attacks, headed by Dr Stephanie Vandentorren, of the French Public Health Agency, has been published.
Two groups were studied. First responders were fire officers, rescue workers and so on exposed during the first 12 hours after the events. The second group were witnesses – those who were themselves under threat of being killed, held hostage or injured or had seen somebody in that position, or heard of a close relative in that predicament. These could be either directly exposed or have witnessed them from their homes. Seeing these events only on the media did not constitute exposure. Various face-to-face structured interviews were administered and over 400 people were interviewed.
Among rescue workers, post-traumatic stress disorder (PTSD) was diagnosed in 3pc and an anxiety disorder in 14pc. Among civilian witnesses, more than 15pc were significantly distressed, 25pc had possible PTSD, while 18pc were diagnosed definitively with it, and 10pc had depression. As expected, those indirectly threatened had lower levels than close relatives of victims, and the highest rates of mental health problems was in those directly threatened.
Almost half of civilians had more than six months treatment for a mental health problem, compared with a third of first responders. However, most had returned to work six months after the attack. These results show that first responders had lower rates of mental health problems than civilians and they required less professional help.
This study shows that people witnessing traumatic events are more vulnerable to mental health problems than are first responders. It may be that the training those in rescue and first response teams receive helps them withstand the distress of their direct involvement. It is also likely that if they had concerns about mental health difficulties developing after the attacks, they pro-actively sought help as a preventative measure and needed it for a shorter period.
During their training, they will have been made aware of the help that it available should they ever require it. Civilians on the other hand may feel less entitlement to such help and may defer seeking it until their distress is much more incapacitating.
The positive finding, that all but 6pc returned to work, shows the power of healing. Similar results were described following the 9/11 bombings and the London attacks. Either time or therapy seems to have benefited those who were suffering in the aftermath. This surely proves the resilience that human beings are endowed with, enabling them to deal with major traumas and to emerge from the quagmire of distress that engulfed them.
Resilience is determined by several factors. The personality of each individual is probably the single most important element, while the presence of support from family, friends and the community is next. Having a person to talk to is undoubtedly beneficial. The scientific literature on resilience has been developing in recent years and it also describes the value of positive coping, religious coping, having a sense of purpose in life, and altruism.
It is comforting to know we are not long-term victims of the events that befall us. Rather, we are strong and can emerge from the suffering of terrible events with more compassion and a better understanding of life.