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The psychological trauma of the Tunisian terror attack

It is 10 years to the date that the UK experienced it's first alleged terrorist attack by Al Quaeda. As our country will no doubt take time out to reflect, we are still coming to terms with recent news from 26th June 2015, when terrorist gunman Seifiddine Reggui attacked the beach resort of Sousse in Tunisia. ISIS claimed responsibility for the attack in which 38 people - plus the gunman - were killed.

Whilst the attacks took place in different countries, with different people at their core, the resulting human experience and response is marked by it's consistency. Survivors of the London Bombings were treated for PTSD and reported feelings of shock, overwhelm, disorientation, a desperate search for meaning, disassociation, horror or need to escape. Other survivors of life threatening situations have reported feelings of extreme powerlessness, flashbacks, nightmares, and replaying the situation over and over. 

However, in amongst the unimaginable panic and resulting grief experiencing in Tunisia, the account of Angela Evans strikes me as particularly significant from a psychological point of view. 

Angela was on the beach at the time with her friend Belda Butauskiere, both of whom managed to stay laying face down in the sand for 10 minutes, effectively 'playing dead' whilst the gunman opened fire on other bathers on the beach. She has told reporters that the gunman stood over her and reloaded his weapon to “finish her off” but became distracted by noises further up the beach.

This is her account

"I looked up and there was the gunman dressed in black. He was shooting indiscriminately at people. He then approached those who were dying and shot them execution-style. We tried to run but had fallen over in a panic. I whispered to Belda to play dead and we both just lay flat, face down in the sand, as though we were corpses.

I could sense the gunman was close by. His feet were just inches from my head. Then I heard him change the magazine in his gun. At this point I began to say a prayer in my head. I thought we were next and he was going to finish us off. But at that moment we heard some commotion elsewhere and he seemed to be distracted by that and wandered off.

We played dead for about five more minutes until we heard screaming coming from the hotel lobby and we knew that’s where he had headed.

I’m still in shock. This is the last thing you expect to happen on holiday. I’m just so thankful that myself and Belda are OK, but my heart goes out to those who lost their lives."

What is the psychological price for 'playing dead'?

In the first instance, it is important to commend the incredibly bravery of Angela and her friend in their ability to remain still for what must have felt like an eternity that day. The effort involved in controlling their breathing and lying motionless during such extreme fear must have taken immeasurable amounts of energy and strength. 

Whilst their efforts garnered the best possible outcome - in terms of their survival - there is unfortunately a psychological price to pay for 'playing dead'.  

When we are in a life threatening situation (or a non life threatening situation that the brain perceives as stressful for that matter) we respond with either the fight or flight response. 

You may have witnessed this if you have ever seen a cat playing with a mouse. The mouse will initially try and fight back by standing on it's legs and trying to appear larger than it is (fight), it will attempt to run away (flight) and after a long period of doing what it can to avoid death, will eventually go into the 'freeze' position. This is an automatic bodily response rather than a choice: by playing dead it is possible that the predator may leave the scene and the mouse is able to survive. 

It is important to understand that 'freeze' is not a choice, but a bodily mechanism. Evolution takes over and everything becomes focused upon preservation of life. 

Humans have the same preservation system which kicks in to try to protect our safety when the option of fight or flight is not available to us. However, putting the body through such an arduous ordeal is likely to create significant psychological trauma, which if left untreated, could result in a lifetime of suffering. 

To explain things a little further, in both the 'fight' or 'flight' mode you are actively doing something, whereas in 'freeze' there is a surge of adrenaline within the body whilst at the same time it remains still. This experience has been likened to driving a car with your foot on the accelerator and brake at the same time. And whilst the body survives, this experience can create psychological symptoms that can be difficult (but not impossible) to shift. 

One such element of this suffering has come to be known as 'survivor syndrome' or 'survivor guilt'. This may be triggered after a traumatic event, when a person perceives themselves to have done wrong by surviving when those around them did not. It can be found among survivors of combat, terrorist attacks such as those in London or Tunisia, natural disasters, among the friends and family of those who have died by suicide, and in non-life threatening situations such as among those whose colleagues are laid off.

How can this be treated and what is the hope? 

Many people with PTSD find it incredibly reassuring to know that trauma, and any resulting survivor guilt, can be resolved. It is not something that we have to live with. 

Sometimes, simply having an understanding of the fight or flight response can be enough to make a difference in some cases, and equally important is to understand that 'freeze' is not a choice but a natural bodily mechanism. It can be easy after the event to look back and wonder what you might have done differently, however unless you are trained to deal with such mortal situations, it is unlikely you will have the ability to override the body's natural response. 

Support from a counsellor or psychotherapist who is specifically trained to help individuals who have experienced deeply traumatic events to process the memory so that they are not triggered by situations that they have come to associate with the event. In the case of Angela and her friend, examples of this might be: hearing a loud noise, going on holiday, visiting or lying on a beach, seeing a pair of boots that resemble those of the gunman. 

The list of possible triggers is numerous and will depend on what the women saw and heard at that specific time.

Of course in this article we have explored the psychological response to some extreme events, however there are likely to be many people living with untreated PSTD in the workplace or even within our families. This can be a result of being a victim of violent crime, sexual assault, abuse, road traffic accidents to name just a few.

If the information covered within this article has triggered any feelings for you and you would like to talk to us about how we might be able to support you coming to terms with a traumatic event in your life, then please do get in touch. You can call us on 01270 764003.

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