For every physical casualty of a terrorist attack there are many more victims of psychological trauma. They need their own 'first aid' too
By Chong Siow Ann, Published The Straits Times, 8 Oct 2016
The recent arrest of six Indonesians allegedly plotting to attack Singapore with a rocket to be launched from Batam has once again raised the spectre of a terrorist attack. The bleak sentiment voiced in some quarters, repeated to the point of becoming cliched, is that an attack is not a matter of whether, but when.
This time, death and mayhem did not rain from the sky, and that initial queasy feeling soon passed, with most of us resuming our complacent ways. But had we been savaged with mass destruction and loss of lives, our sense of the reassuring ordinariness of life would have been profoundly shaken. It would have - in the words of the American novelist Don DeLillo, writing after the attacks on the twin towers in 2001 - "changed the grain of the most routine moment", including "where we live, how we travel, what we think about when we look at our children".
Amid the rubble, we would have lost our innocence.
And so the Government has been urging Singaporeans to be vigilant and to sign up for emergency preparedness programmes where, among other things, participants learn basic first-aid skills and cardiopulmonary resuscitation.
The goal, according to Home Affairs and Law Minister K. Shanmugam, is to equip at least one member from each of a million households with these skills that could be potentially life-saving, since civilians and bystanders could be the first responders in the wake of any terrorist attack.
PSYCHOLOGICAL FIRST AID
But there is another form of first aid that has not been emphasised and is perhaps just as important - what is known as psychological first aid, and which is also the theme of this year's World Mental Health Day which falls on Monday.
The effects of a terrorist act reverberate beyond the epicentre of the actual physical attack, with far-reaching emotional and psychological aftershocks. For every physical casualty of a terrorist attack, it is estimated that there are between four and 50 times the number of victims of acute stress and psychological trauma, such as post-traumatic stress disorder and depression.
Until fairly recently, the accepted protocol for giving psychological help to those affected by traumatic events was to do what is called a Critical Incident Stress Debriefing, which involved getting survivors to talk about the event, to "ventilate" their feelings, and to warn them of the distressing psychological symptoms that may emerge.
By Chong Siow Ann, Published The Straits Times, 8 Oct 2016
This time, death and mayhem did not rain from the sky, and that initial queasy feeling soon passed, with most of us resuming our complacent ways. But had we been savaged with mass destruction and loss of lives, our sense of the reassuring ordinariness of life would have been profoundly shaken. It would have - in the words of the American novelist Don DeLillo, writing after the attacks on the twin towers in 2001 - "changed the grain of the most routine moment", including "where we live, how we travel, what we think about when we look at our children".
Amid the rubble, we would have lost our innocence.
And so the Government has been urging Singaporeans to be vigilant and to sign up for emergency preparedness programmes where, among other things, participants learn basic first-aid skills and cardiopulmonary resuscitation.
The goal, according to Home Affairs and Law Minister K. Shanmugam, is to equip at least one member from each of a million households with these skills that could be potentially life-saving, since civilians and bystanders could be the first responders in the wake of any terrorist attack.
PSYCHOLOGICAL FIRST AID
But there is another form of first aid that has not been emphasised and is perhaps just as important - what is known as psychological first aid, and which is also the theme of this year's World Mental Health Day which falls on Monday.
The effects of a terrorist act reverberate beyond the epicentre of the actual physical attack, with far-reaching emotional and psychological aftershocks. For every physical casualty of a terrorist attack, it is estimated that there are between four and 50 times the number of victims of acute stress and psychological trauma, such as post-traumatic stress disorder and depression.
Until fairly recently, the accepted protocol for giving psychological help to those affected by traumatic events was to do what is called a Critical Incident Stress Debriefing, which involved getting survivors to talk about the event, to "ventilate" their feelings, and to warn them of the distressing psychological symptoms that may emerge.
But there are now a convincing number of well-conducted studies which show that such reliving of the frightening traumatic event not only does not work, but could make things worse and increase the likelihood of future psychological problems.
Psychological first aid is now thought to be the more appropriate intervention in the immediate aftermath of any disaster, including terror attacks.
It is about having a common-sensical approach of calming and stabilising the victims, meeting their basic physical needs, keeping them safe from any immediate harm, giving them an empathetic hearing, providing accurate and timely information about available resources, and facilitating referrals for more specialised care for those who need it.
And it is also something that can be delivered by a trained layperson.
THE IMPORTANCE OF RESILIENCE
Equipping the community with the knowledge and skills of basic and psychological first aid has another less overt benefit: it empowers people. It is a foil against that debilitating feeling of helplessness that may follow a catastrophe, and strengthens resilience that comes from that sense of preparedness in face of unpredictable threats.
THE IMPORTANCE OF RESILIENCE
Equipping the community with the knowledge and skills of basic and psychological first aid has another less overt benefit: it empowers people. It is a foil against that debilitating feeling of helplessness that may follow a catastrophe, and strengthens resilience that comes from that sense of preparedness in face of unpredictable threats.
Resilience is something much-talked about in discourse about terrorism, and stressed in anti-terror strategies. Among its various dimensions is the capacity to withstand and face down violent extremist ideologies without allowing them to tear the community apart.
People do come together after a terrorist attack, often with a mixture of fear and defiance.
In the flood of Facebook posts, tweets, and makeshift shrines with affectingly-innocent offerings of flowers, pictures, cards, candles and teddy bears, we also see a profound need to express that sense of unity and community.
But it is also something fragile. Repeated attacks on a community can have a corrosive effect on its social cohesion. France's show of national unity after the 2015 attacks in Paris with the coming together of citizenry, both Muslims and non-Muslims, fell apart following the recent Nice attack.
Fear, which can foster helplessness, can in turn engender resentment and anger which can be distorting and in want of an easy scapegoat. Acts of terrorism tug at the threads of the social fabric of a community, with the danger of unravelling its closely-knit segments.
Witness the spike in hate crimes against British Muslims following the 2005 London bombings; the repeated murderous attacks in France that have created a toxic climate of Islamophobia; and United States presidential-hopeful Donald Trump's anti-Muslim rhetoric which has tapped into a seam of suppressed resentment among certain groups in the American population.
KEEPING THE SOCIAL FABRIC INTACT
There is a perception that "a homogeneous country is more peaceful and stable and, in a very deep sense, more satisfying than one with a complex and mingled population", novelist and essayist Marilynne Robinson writes.
Implicit is the notion that "people who differ from oneself are therefore enemies who have either ruined everything or are about to", and as that idea takes hold, the community "becomes violently exclusive and defensive".
"When definitions of 'us' and 'them' begin to contract, there seems to be no limit to how narrow these definitions can become. As they shrink and narrow, they are increasingly inflamed, more dangerous and inhumane," says Robinson. "They present themselves as movements towards (a) truer and purer community, but ... they are the destruction of community."
Destruction of a community is what terrorists seek through the sowing of fear, mistrust, discord and hatred.
It would be naive not to anticipate and expect some of these divisive feelings should there be a militant terrorist attack here, particularly if the perpetrator is one of us: a home-grown radicalised terrorist.
It would be difficult, too, not to hate when we have lost much, but we should at least try not to nurse that kind of cowering hatred that will blind us and lead us to scapegoating and bigotry, and poison our existence.
KEEPING THE SOCIAL FABRIC INTACT
There is a perception that "a homogeneous country is more peaceful and stable and, in a very deep sense, more satisfying than one with a complex and mingled population", novelist and essayist Marilynne Robinson writes.
Implicit is the notion that "people who differ from oneself are therefore enemies who have either ruined everything or are about to", and as that idea takes hold, the community "becomes violently exclusive and defensive".
"When definitions of 'us' and 'them' begin to contract, there seems to be no limit to how narrow these definitions can become. As they shrink and narrow, they are increasingly inflamed, more dangerous and inhumane," says Robinson. "They present themselves as movements towards (a) truer and purer community, but ... they are the destruction of community."
Destruction of a community is what terrorists seek through the sowing of fear, mistrust, discord and hatred.
It would be naive not to anticipate and expect some of these divisive feelings should there be a militant terrorist attack here, particularly if the perpetrator is one of us: a home-grown radicalised terrorist.
It would be difficult, too, not to hate when we have lost much, but we should at least try not to nurse that kind of cowering hatred that will blind us and lead us to scapegoating and bigotry, and poison our existence.
When the wife of French journalist Antoine Leiris was among the 90 people killed in the attack at the Bataclan theatre in Paris last November, Leiris wrote an open letter posted on Facebook to the terrorists.
"I will not give you the satisfaction of hating you. You want it, but to respond to hatred with anger would be to give in to the same ignorance that made you what you are... You would like me to be scared, for me to look at my fellow citizens with a suspicious eye, for me to sacrifice my liberty for security. You have lost," he wrote.
"I cannot waste any more time on you as I must go back to (my son) who has just woken from his sleep. He is just 17 months old, he is going to eat his snack just like every other day, then we are going to play like every other day and all his life this little boy will be happy and free. Because you will never have his hatred, either."
The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.
"I cannot waste any more time on you as I must go back to (my son) who has just woken from his sleep. He is just 17 months old, he is going to eat his snack just like every other day, then we are going to play like every other day and all his life this little boy will be happy and free. Because you will never have his hatred, either."
The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.
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