A French Psychiatrist Explains the Psychological Toll of the Paris Terror Attacks

One week after a wave of terror attacks killed 130 people in Paris, VICE News spoke with psychiatrist Christian Navarre to try and understand the psychological toll of the attacks on survivors, their families and friends, and the French nation as a whole.

Navarre works at Rouvray Hospital in the northern French city of Rouen and has written a book about his experiences with trauma. He helped set up some of the first emergency psychological support units in the country after the attacks.

VICE News: In the immediate aftermath of Friday's attacks, some of the witnesses who survived appeared extremely calm when speaking to the media. Some of them were even smiling. How do you explain that?

Christian Navarre: These individuals are experiencing acute stress and something known as "dissociative disorder," which is sort of like lucid dreaming. In the context of something as traumatic as a terror attack, the state of confusion and shock is such that a neurophysiological phenomenon triggers this dreamlike state. It acts as a defense mechanism.

Emergency psychological support units were set up on Friday night. What is their purpose?

After the 1995 Paris terror attacks [subway and train bombings], psychological support units were set up to help the victims. Up until then, we only took care of physical wounds. Historically, these units first emerged within the army, to support soldiers returning to civilian life. These units act as a "buffer" between the horror the patient has had to face, unprepared, and "normal life." Like they do in the army— since these attacks are comparable to wartime experiences — these psychological support units help diminish the risk of post-traumatic stress.

During the night of Friday into Saturday, these crisis cells helped survivors verbalize what they had just experienced. Talking can sometimes help [victims] come out of the dissociative state by helping them realize what has happened. Psychiatrists, psychologists, and psychiatric nurses can often relieve the psychological tension and emotions of survivors — sometimes, just by helping them cry. The worst thing in a situation like this is to find oneself alone. The units are sort of like a reception center: You need to let survivors know that they're not alone, that they are surrounded by empathy, that [healthcare] professionals are in a way "suffering with them."

How do you rebuild yourself after such an ordeal?

Survivors can sometimes spend several days, weeks, or months not realizing what actually happened to them. Once they are out of this phase, they will enter a phase of anger and revolt — especially those who will have to deal with serious physical scars, particularly since the weapons used against them were actual weapons of war. After a phase of depression, they will have to accept the situation and move on despite their injuries — be they psychological, physical, or both.

What about the families and friends of the victims – how do they cope with this kind of a tragedy?

It's a different situation than the one faced by the survivors. Obviously, there is a dominant feeling of injustice, which is characteristic of terror attacks. Families and friends wonder what their loved ones did to deserve this, they see it as a "massacre of innocents." In the case of a natural catastrophe, you can always blame the tragedy on an unlucky coincidence.

Friday's experience was extremely brutal — unlike old age or sickness, where you can "prepare for death" — particularly given the fact that the bodies are not always recognizable and that some families only received confirmation of the death after several days of waiting.

For friends and families, the mourning rituals are very important, including tributes paid by the country and politicians, and the funerals and religious ceremonies. The minute of silence is, in a way, a secular prayer, but for many families, religion can play a therapeutic role in their bereavement.

Then comes the resilience phase, which is necessary to move on. In the case of Friday's attacks, many of the victims are very young, and a lot of parents have lost their children and will have to carry that burden their whole lives. But you never heal from the loss of a child.

From a collective point of view, the country is on edge and we've seen many reactions of panic. Is that to be expected?

We're grieving collectively, as a nation, and we're experiencing a mixture of horror (from the trauma), fear (which can be controlled in the long term), and anxiety (over the possibility of another attack).

It's partly the role of politicians to reassure the nation and to try and quell fear — which is what they've been doing with the recent announcements that were made over the last few days. I'm not judging the political merit of these announcements, but, psychologically speaking, it can help reassure people.

What do you make of [Prime Minister] Manuel Valls warning that France is at risk of a chemical attack? Is that meant to reassure the country, too?

In France, we don't really have such a thing as a "risk culture," so Valls elected to tell the truth, since today the government is taking preventive health measures to prepare for this type of attack. It's probably better for the prime minister to announce that the government is taking this risk into account, rather than a newspaper revealing that emergency services have been equipped with antidotes. In that case, the French might think they'd been lied to or that information was kept hidden from them.

In a way, this type of announcement spells the end of our collective naivety — which was nice while it lasted. Sadly, we are confronted with a sense of reality, which can be just as therapeutic and allows us to show greater solidarity. We've already lived through other waves of attacks, in 1985 and 1995, where we saw the same latent collective panic. But we managed to emerge from it in the end and return to a state of less concern.

Follow Pierre Longeray on Twitter: @PLongeray