The Future of Resilience in Paris - An Interview with Prof. Mooli Lahad
Prof. Mooli Lahad, president of CSPC and member of ITC, went to France in October 2015 as part of a joint effort of ITC-OSE and JDC to create a resilience center in Paris. Following the November 13 terrorist attacks in Paris, a French reporter reached out to interview Prof. Lahad.
See the original article in French.
"We must not get used to the threat of terrorism.”
Israeli psychology professor Mooli Lahad is a specialist in post-traumatic stress related to terrorist acts. He trains clinicians throughout the world. In October, he stopped in Paris to provide advice after trips to Madrid and London.
This is the first time France has had a suicide attack in its territory. Is there an extreme psychological shock expected for the population?
Terrorist attacks incur a different trauma than an earthquake or a tsunami. One’s confidence in his fellow human beings builds an overall sense of security. The idea that someone would risk his life to kill a perfect stranger is not a plausible hypothesis in normal times. Even less so if the result is suicide for the killer. The event is devastating to the individual’s psychic defense system. Hence the fear reflex and the desire not to leave one’s house.
Is staying in one’s home a sign of trauma?
For someone to limit his movements or avoid crowded places such as stations or cinemas is a natural attitude when adopted for a few days or weeks. But these behaviors may indicate post-traumatic stress disorder, which requires counseling. Often those affected are not even aware of what they are experiencing.
Who may be affected?
Our experience worldwide shows that 7-10% of the population retains that sense of fear several months after the events. The risk is greatest for people, wounded or not, who were directly confronted by the terrorists. Until 2013, only this type of victim could be classified as having post-traumatic stress disorder (PTSD) by the American Psychiatric Association. Now this diagnosis may also be applied to their loved ones, such as spouses, children or co-workers. The Paris attacks caused some 400 deaths and injuries. Extrapolating to those around them, about 4000 people are seriously exposed to the risk of PTSD.
In May and October, you came to France to work with fifty doctors and psychologists in the management of PTSD injuries. What did you teach them?
I have a long history of experience. I started to intervene with victims in 1975 and in 1982 I extended my actions to the community around them. We know that the survivors of attacks will be better off if their families and friends understand their reactions and help them rebuild.
What are your methods?
We defined two circles of intervention that take into account the vulnerability of individuals. The first, direct victims, require individual support, face to face with a therapist. The problem is different for the second circle, the indirect victims, innocent bystanders, firefighters or rescue services. For them, participation in discussion groups facilitated by a professional is the right therapy. To hear stories similar to their own, to find that their feelings are shared, is the best treatment possible. Direct victims, on the contrary, must be protected from testimonies and images of the attacks, which aggravate the trauma.
Should one debrief victims immediately after the attacks? This practice, adopted by the French medical-psychological emergency units, is controversial ...
The international research community has not managed to determine whether it is good or not for victims to retell their experiences. I think for those who speak spontaneously, we should let them. Often it is impossible to stop the flood of words ... But I do not believe that the debriefing should be systematic. Approved methods include giving victims factual information about what happened, to help prevent their passing through shock before experiencing immense anger, and to teach them to focus on simple activities - like going to buy bread, for example - in order to facilitate the return to everyday life .
Many victims do not seek psychologists ...
Indeed. To go through the door of a doctor’s office or to a hospital is associated with mental illness. This is wrong. Post-traumatic stress disorder can affect anyone. In Israel, where we are constantly confronted with this problem, we rely heavily on the schools to help people take the plunge. We open care centers in schools; parents go there on the pretext of finding help for their children, and they end up talking about their own feelings.
Support methods also depend on the culture of each country. In your opinion, which may prove effective in France?
In the United States, the Church has played an important role after the attacks of Sept. 11. The recourse to religion seems less evident in France. At home, this support should be provided by entities outside hospitals, such as crisis hotlines or social networks on the Internet.
Can a country learn to live with the threat of terrorism?
I do not want the French to get used to this danger. After a period of intensive terrorist attacks, as in Northern Ireland in the 1980s or in Israel, there is a form of acceptance, making the situation more bearable collectively. The problem is that the sensitivity to violence diminishes in the same proportion. Citizens tolerate more suffering. The price is so high.
Do medical teams in France seem ready to deal with future attacks?
Your country is not helpless. Post-traumatic stress is not unknown; you have suffered train accidents, plane crashes and terrorist acts. But simultaneous attacks like those on Friday in Paris spread fear on a much larger scale. The anxiety affects the victims, but also the viewers sitting in front of their television or computer connected to YouTube. This change of scale implies new methods of care. The system will take one, two or five years to adapt but the know-how already exists elsewhere in the world, and France will soon provide quick and effective responses.
It is therefore possible, according to you, to rebuild after such tragedies?
The human being is the most resilient animal that there is. Routine reinstitutes itself, and most people will resume normal life soon enough. We must be attentive to the small minority of the more fragile, knowing that the pace of psychological reconstruction can be very different from person to person. For some it is a matter of two days. For others, it may take several months. But the trauma is not eternal.