Terror attacks threaten the human soul

Survivors and observers must not allow fear to destroy them or their communities
By Chong Siow Ann, Published The Straits Times, 15 Dec 2015

Seated on a wooden bench in a small, quiet park on Saturday, Nov 14 , with an open book on my lap, I was distracted by a couple with two small children. They took their time to carefully spread a mat on the grass for a picnic, with the children excitedly noisy beside them.

It was a fine, balmy, haze-free morning. As I was about to return to my book, a friend texted me. Soon, I was receiving news on my cellphone of yet another terrorist attack in Paris where, a few hours earlier, black-clad Islamic State in Iraq and Syria (ISIS) militants attacked a concert hall, a sports stadium and cafes, killing 130 and wounding hundreds more.

ISIS claimed that the attacks were a retaliation against France's campaign against its fighters in Syria. They had chosen to target Paris - the City of Lights and Ernest Hemingway's A Moveable Feast - because it is, for them, "the capital of prostitution and obscenity".

Whatever its twisted reasons for the massacre, ISIS has - which is probably one of its aims - inflicted a deep, wounding fear and a festering anxiety.

Fear is that elemental response, with its roots in evolution, and which has ensured the survival of humans to this day. When the brain of a person senses danger, it triggers the body to activate various reactions, including the release of stress hormones like adrenaline: The heart rate accelerates, blood pressure rises and the breath quickens as the person is readied to either fight or flee. When the immediate danger passes, that surge of fear may trail into a state of anxiety, with its chronic apprehension and heightened vigilance for future and unpredictable dangers.

Fear and anxiety can become pathological following a traumatic event. The more unexpected and brutal the trauma, the more pathogenic it is - particularly when it is a deliberate act of man rather than an act of nature or, if you like, of God.

From the almost unimaginable accounts given by the survivors of the carnage in Paris (as reported in The New Yorker) - "A body fell on me - it emptied blood on my legs… My neighbour, a man of about 50, was shot right in the face, in the head. Bits of brain and flesh fell on my glasses. I tried to keep my eyes on the floor, it was an immense flood of blood" - it would not only be the physical wounds of these survivors that need healing, but the mental wounds as well.

Post-traumatic stress disorder (PTSD) is the prototypic disorder where pathological fear and anxiety are melded together. It can follow in the wake of an exposure to a life-threatening situation, either as a victim or a witness. The disorder is a constellation of symptoms: sleep disturbance, nightmares, flashbacks, difficulty in controlling anger, hypervigilance, marked avoidance of any reminders of the trauma, emotional numbness, guilt and hopelessness.

Watching images of death and destruction on television and social media may even give rise - in certain vulnerable persons who have not directly experienced the traumatic event - to what is called vicarious PTSD.

In the months following the Sept 11, 2001, terrorist attacks, or 9/11, a widely observed condition was one which extended to those not directly involved.

A study published in 2002 in The Journal Of The American Medical Association found that 17 per cent of the population who lived outside of New York City had reported symptoms of PTSD two months after the attack, and 5.8 per cent continued to do so even six months later. The likelihood of PTSD correlated with the amount of television coverage of the attacks watched.

It is hard to say how many of the people exposed to the attacks in Paris will develop PTSD, but given the magnitude and form of the attacks, the random and indiscriminate targets and the continued threat (a subsequent ISIS communique threatened that the attacks were "the first of the storm"), the psychological effect would most certainly emanate beyond the direct victims.

As Mr Pascal Bruckner, one of France's foremost philosophers, admitted grimly: "We are scared and filled with hate at the same time."

With our imagination - fuelled by the flood of images and reports that were broadcast - we identify with the victims: We feel their distress and outrage, and share that sense of vulnerability and uneasiness of the capriciousness of our fragile existence.

We feel too that frisson of fear that militant terrorism might reach our shores. "These attacks show that no country is immune," said Home Affairs and Law Minister K. Shanmugam a day after the attack.

He then went on: "We have stepped up security measures, border checks and vigilance We encourage everyone to remain vigilant and report any suspicious activities or persons to authorities."

Perhaps no country other than Israel has that sustained experience of living daily in the shadow of terrorism. For over 60 years, it has been buffeted by multiple wars and weathered numerous terrorist attacks. One of its distinguished authors, Mr David Grossman, has written on what it is like to live in country where fear has "spread everywhere like a flesh-eating bacterium".

Mr Grossman describes the terror as humiliating and life-embittering. To protect itself, the country lays out a web of security systems and apparatus, deploys heavily armed police and soldiers to patrol its streets and guard its public places, and allows secret agents to "invade every private, intimate area".

Private telephone calls and e-mails are monitored, along with other curtailment of personal freedom and rights - all with the willing collusion of the citizenry. (If it comes down to it, a great number of us would readily sacrifice a few civil rights for our physical safety and to stop the terrorists dead in their tracks).

But these multifarious measures, which are meant to protect, often make the populace "feel more upset and less secure", and inevitably, living in this "unending state of military stress" would take its toll.

This year, researchers from the Hebrew University of Jerusalem published a study in the Proceedings Of The National Academy Of Sciences.

The study, which involved over 17,000 Israelis, found that long-term exposure to the threat of terrorism elevated resting heart rate, which increases the risk of dying from heart disease.

The fear of terrorism also led to a decline in a neurotransmitter called acetylcholine, which diminishes the body's ability to ward off a heart attack.

Mr Grossman points to another insidious and pernicious effect: The "individual soul, the soul of each individual human being" is coarsened by paranoia and riddled with suspicion of every unfamiliar person. It leads to stigmatising and stereotyping people along racial, national and religious lines. In such a xenophobic climate, "the political parties that feed off hatred of foreigners and racism will flourish".

In spite of its electoral setback this week, there is expectation that the French far-right National Front will continue to make gains in the aftermath of the Paris attacks. And throughout Western Europe and the US, there is a growing animus towards refugees and immigrants.

"Maybe that's the worst thing of all," Mr Grossman writes. "The person who lives for a time in the shadow of terror no longer knows how enslaved he has become to the struggle for survival, and how much he is, even now, a victim of terror."

Salman Rushdie, who, since 1989, has lived under a fatwa calling for his assassination following his book The Satanic Verses, once posed this question: "How to defeat terrorism?" His answer: "Don't be terrorised. Don't let fear rule your life. Even if you are scared."

Should the unthinkable happen to us, we will have to try to do that and to do it, somehow, without letting that fear corrupt our individual and collective soul.

There is a coda to my morning in the park. While I was still reading the stream of news on my cellphone of the Paris attacks, a knot of young men had gathered under the shade of a tall tree.

There were about 10 of them, and each wore a military-looking backpack and carried a toy submachine gun. They proceeded to form two groups, which then peeled away. Running away from each other, they started shooting at each other. The guns emitted a tinny, but unmistakable, simulation of automatic gunfire, which broke the quiet of the park.

The young men darted from tree to tree, moving closer to my bench and the family picnicking on the grass. At that point, I stood up and left - I didn't want to be caught in the crossfire.

The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.