26 august 2918 Salam Plan (interview)

26 august 2018

Never say this to a victim of terrorism and the best ways to help

Do not give them any advice, hug them. This is one of the main tips that the psychologist Sara Bosch, with 25 years of experience attending victims of terrorism, has shared with Salam Plan.  Perhaps you can also contribute to make each day more bearable for the victims of a terrorist attack. Or maybe you are a victim yourself and you do not even know it.

Bosch is head of the Attention and Assessment Unit for People Affected by Terrorism (UAVAT) in Spain, which includes psychologists, psychiatrists and lawyers. Since it its foundation last February, they have treated around 170 people affected by the attacks in Catalonia (Spain), which occurred one year ago. All of them Spanish victims, but there were also many victims of other countries. 16 people died, more than 100 were injured and many more were hurt psychologically, according to Sara Bosch. 90% of victims are survivors and 80% of all the victims still suffer a psychological injury, she says.

On the ‘International Day of Remembrance of and Tribute to the Victims of Terrorism’ this 19^thof August her advice may be useful to all of the victims of terrorists around the world and people around those who suffer.

Are there victims of the attacks in Catalonia one year ago starting to ask you for help now?

Sure! Of course, of course. (When we started contacting last February) all the people who had gone to the emergency services of the attacks, there were people who had not yet received psychological attention. They had been holding themselves, struggling to cope with a psychological situation and waiting for time to heal them. But we are seeing people who still have a lot of psychological affectation, who have not received any treatment yet.

What needs do victims have or what problems do they face?

In the first place, when we think of victims, we all think first of the ones who were murdered, and therefore we quickly connect with the relatives of the deceased. After that, the physical wounded. Later, we began to think that there were many people there who might not have had an impact on the body, but that it is a traumatic experience and it is very likely that these people are emotionally affected.

At the beginning, we also understand that there is a lot of psychological affectation in a large number of people, but that somehow that will later heal on it own. A bit like when we get a punch. The bad thing is that sometimes we don’t recover as expected, and than we start considering: “what if there is something broken in me?”

People who receive that psychological punch, at first cannot sleep, they see the images continuously (on their minds), the sounds of the sirens, they are hypersensitive, they are afraid, have anxiety crises, they cry, they are disconnected from their day to day, they behave very strange … The (initial) psychological affectation is a chemical reaction: there is an explosion of neurotransmitters at the cerebral level, which are the ones that generate those symptoms. Therefore, it is something physical too.

That chemical explosion has to calm down, but there are people where that doesn’t happen. There is a percentage of those people, which can be perfectly 60%, that will break down (, like a sportsman). They are going to suffer some psychological injury, which is when those reactions remain: they cannot sleep -insomnia is very characteristic-, they are still very afraid, they still have a state of anxiety that doesn’t go away, they have not sit down in a terrace again to have a beer, they have not gone back to the cinema, they do not want to enter a supermarket, they have not taken the tube again…

What does the first anniversary of the attack mean to them?

They know that there is a lot of media attention and that there is also a social memory, it is a call to their memory. It is something that they are getting through with the help of professionals, trying not to be harmed more from the outside. But it still means getting through an experience that is very slow and very painful to digest and suddenly there are reminders, images … especially in the media, with that nightmare. They do not remember, they experience it (again).

Therapeutically we are always going to recommend facing that memory, so that it becomes something that can be emotionally tolerated and that instead of reviving it, it may remain a painful memory.

There are people who have done that process and are relatively capable of being exposed now to that homage and there are people who are still in a very early process and avoid seeing those images, because it would be an overdose for them. It’s each person the one who chooses

What practical advice do you give to the victims at this point, bearing in mind that each person and each circumstance is different

Basically, we make them aware that they can choose, that they do not feel obliged to anything. Sometimes, it’s a bit of giving them permission to do those things that can make them feel better.

Without that permission, do they feel guilty?

Yes, they feel guilty. Especially towards their relatives, because there are many who, when time has passed, don’t understand why you are not feeling well: “nothing happened to you, you were not injured, you are alive” (, they would tell the psychological victims, the survivors). It’s not that they do not want to forget, it’s that they cannot. They feel misunderstood.

Even they themselves do not understand why they are not OK and consider it a sign of weakness, for example. And it is not a sign of weakness, nor is it stubbornness of not wanting to overcome something.

There is a lot of incomprehension, as much as of the victims towards themselves, as of the relatives, the close friends, the bosses … We tell them: do not force yourself to feel well, understand if you are not OK, respect that you are not OK. This is a slow process. Look for what can make it as easier as possible to feel calm and, above all, if you have not yet started a treatment, go to a professional – basically a psychologist – to help you go through this whole process, because it is a psychological injury. It has nothing to do with being weak or not wanting to get over it.

And what can the people who love them do to stop messing up when they are trying to help?

Accompany them in their feeling, the same way we tell the relatives of the deceased that we join with them in their grief. We need to do the same with those who got injured. Therefore, if they prefer not to talk, then we do not speak. If they feel bad, we do not have to tell them anything, hugging them is enough.

Let us remind them that we are there, that we are in a safe place, and we do not need any special phrase. And try to be available to what they may need, without asking them how they are all the time. Supporting them with empathy.

Do not question them, do not to judge them, and do not give them advice. It is simply being there, at their disposal, and not looking for the magic phrase, because the advice does not help. They advise themselves.

And the media and politicians, who perhaps are the ones who treat this issue the most in the public sphere? What can we or they do to not make it more painful and help as much as possible?

Media, on the one hand, have the need of giving information and therefore it is true that these images of the van (at the attack in Barcelona) … is a repeated image. But it is true that if we consider respecting the victims or not hurting them, we should not issue them.

There are victims (for whom) talking about their experience (helps them) or they have a message to give us. I would ask media to say the full message of those affected, just as the victim wants to express it. Because what has been happening is that many of them do the interview, (that) has been an extra effort for them but they had the expectation that it would serve something. And when they see it later, they tell you: “They have not said that; I told them it was very important to me.” Then: “They have only put my drama, they have only published the gruesome part.”

I believe that on the one hand it is true that it is very difficult not to give that message that they will see as morbid, but as we talk to the victims, allow them to give another message that they need to tell us.

And politicians … Errrrr, wow, how much time do we have? In a terrorist attack, unlike other crimes, a message of solidarity is generated with incredible speed and impressive magnitude. They are continuously told by politicians and everyone: “We are with you, for whatever you need …”. That generates both an expectation of support, and when it is not there later, after months, or when they begin to process their needs with the Administration… that solidarity does not disappear, it is directly the opposite: denials, denials.

What type of refusals? Of treatment, or information …?

Yes, right. Denial of treatment, fundamentally, and denial of recognition as a victim. For example, when there is an attack which has the power to grant recognition of victims of terrorism, the Ministry of the Interior in Spain will have a list of people, which will be collected from the wounded and deceased (…). For the Ministry all these people are the victims of the attack, they will be able to see exercised their rights of compensation for injuries, they can go to a psychologist if they need it … there will be no problem.

The ones that worry us are those that are not in that list, because many psychological wounded do not go to the doctor. Many go to their homes and after three, four, five or six months those people cannot take it anymore, they break.

What should we never tell a victim of terrorism and what is most likely to help?

When it is about someone who has lost a beloved one, I think you should especially not give them any advice. You have to be there for what they need and offer help in practical things.

Like solving paperwork or buying food, if they do not feel strong enough.

Exactly. And allow them to feel their pain, even if we do not like to see it.

And in the case of psychological victims, the survivors?

Do not remind them that “fortunately nothing has happened” to them. Do not ask them to make efforts, because when a person has a psychological injury she does many more efforts than we think.

Also, you need to understand that they can be very fluctuating. Maybe there are days that are worse than others. Let them know that if one day they are not feeling well, you are there to complement them. And do not try to make them explain how they feel or stop conferring them attributions that hurt them even more: “you are so and so”, “you don’t do whatever”, “don’t take it that way” … Try not to make attributions of that type, because they tend to blame themselves very easily.

Listen to them when they want and do not force them to talk.

I suppose that in the end these tips for people who are psychologically wounded are equally valid for everyone, also the physically wounded.

Sure. And something important as well about people who have a psychological affectation: it is important to help them to get back to a (certain) routine, because many of them can be in a somewhat chaotic state.