Today marks the fifth anniversary of the Paris attacks that took place across the city in 2015. That evening, suicide bombers and gunmen with automatic weapons carried out 6 separate attacks including one inside the Bataclan Theater where a rock concert was underway. 130 people were killed and 413 wounded. It was the deadliest assault on French soil since World War II. In the weeks and months that followed, survivors, medical workers, loved ones of the victims, and average citizens suffered from anxiety, sleep problems, and mood swings. I recently listened to a podcast that Slate.fr published a year after the attacks. Titled Assister au renversement du monde, the podcast is a first-person narrative, told by a psychiatrist who reflects on his personal reaction to the tragedy.
In coming to terms with his own emotions, the psychiatrist allowed one of his patients, documentarian Caroline Gillet, to interview him in his office. The title of the resulting podcast refers to this role reversal where the doctor became a patient and the patient became his confessor.
If you’d like to listen to the podcast, which is only available in French, you can find it here. Below is my English interpretation of this unexpected turn of events as described by the psychiatrist.
There’s Not a Moment When You’re Cured
Sometimes when I’m working in my office and don’t have a patient, I like to sit on the couch where my patients sit during a visit. I put myself in their place and see what they see, except for the fact that I can’t see myself on the other side of the desk looking back. Anxiety is a very common mental illness. For some patients, it can be extremely debilitating but paradoxically, it is usually very easy to treat.
I had a young man come to see me who was in his 30s. He had been suffering from agoraphobia for 4 or 5 years. When he was in his twenties, he had enjoyed going out with his pals to drink beer at a café terrasse. But little by little, his agoraphobia had grown to a point where it prevented him from doing many things. He no longer felt comfortable going far from his apartment. After a while, he didn’t feel at all comfortable leaving home. He minimized his outings, going only to work. Meeting with friends or going out for fun had become impossible for him.
This resulted in enough suffering that he decided to start seeing a therapist. We scheduled about ten sessions together and while this is often enough, his case was a bit more complicated. While he made progress, not all of his apprehensions went completely away. His symptoms had become bearable but still bothered him. I wasn’t expecting to totally free him from all of his anxiety and it was clear that he was able to do more and more. Riding the metro had been impossible but slowly he became comfortable with short trajectories. So, there wasn’t a moment when I could say you’re cured, but rather a series of milestones that showed he was making continued progress.
For us psychiatrists, it is extremely gratifying to see our patients reclaim their freedom. It’s idiotic to say this but perhaps he was cured too quickly because the first night that he went out to meet with friends was November 13, and he was shot and killed by one of the terrorists.
A Downward Spiral
My patient’s agoraphobia had evolved rather quickly. Sometimes you can point to an event that triggers this illness but in his case, we didn’t determine one. Things were going well for him when he was in school. After graduation, he found a job in Paris and did well at work. But he wasn’t originally from Paris and this probably played a role in him getting sick. He found life in Paris to be stressful and mass transportation particularly painful.
He didn’t like the Metro and was afraid of having a panic attack while riding even though he’d never had one. He limited all of his trips to riding the bus, or renting a bike, or traveling on foot. He was young and fit and handsome, which might seem sad to mention, but he had everything going for him except for this mental handicap. He lived and worked in the suburbs of Paris. Meanwhile, his friends lived in the center of Paris. Joining them for a drink in their neighborhood was extremely hard since he needed to take a train of some sort to get there.
So, he started to cut out visits with friends and little by little, he cut back on many other activities. Eventually, he only went to work and to his gym, both of which were located in his neighborhood. He began to lose interest in everything, even watching TV. He asked his friends to come see him but they didn’t want to make the trip. He was effectively living in hell and his mood began to plummet. He had difficulty sleeping. He was irritable. His sex drive disappeared. He was in a vicious, downward, spiral.
Eventually, his girlfriend told him that he either had to go see a counselor or she’d end the relationship which and become unbearable. I knew his girlfriend. She had been seeing me to talk about the difficulties she’d been having supporting his agoraphobia. So, the therapeutic relationship I had with this young man was bookended by his girlfriend since it started with her and ended when I last saw her after the November 13th attacks.
Where are you?
On the evening of 13th of November [which was a Friday in 2015], I was at a dinner party at the home of some friends. I had silenced my cellphone so as not to disturb the meal. But then I turned on my phone because we’d been arguing about the age of some aging actress. We were wondering if she was 80 or maybe even 90 years old. So, I turned on my phone to check her Wikipedia page. In truth, we had all turned our phones off because one of the people there was of another generation and she did not tolerate the use of cellphones at the table. Hence, we were all forbidden to have our cellphones out. Looking up the age of the actress was actually just a pretext we used to check our phones.
When we looked at our phones, we saw that each of us had received 50 or 60 text messages, many asking, “Where are you?” So we knew something was going on and that many people were spending their evening exactly the same way—sending and receiving messages to check on loved ones. I wanted to contact my doctor at the hospital to let them know that I was available to help in any way I could. But, in fact, I had no way to get there at that moment because traffic was shut down throughout Paris as people braced for further attacks. I found the remainder of the evening entirely agonizing as I was unable to exercise my profession and go to the places that needed me. We ended up staying put and sleeping there overnight.
The next morning I headed to my office, which is located close to one of the bars where an attack took place. As I passed, I saw the marked-off crime scene which was extremely painful. That same Saturday, some of my clients that had not canceled came to see me. These were largely patients suffering from anxiety or agoraphobia. The neighborhood was surrounded by police vehicles. There were TV trucks stationed everywhere. Outside my office, it looked like the set of an American television series. And yet, these people were willing to cross through all that in order to reach a psychiatrist with whom they could talk about their anxiety on that morning of November 14th.
My Saint Bernard Side
She had found his planner and knew that her partner was receiving therapy, that he wasn’t yet cured but was only seeing a psychiatrist in order to deal with minor troubles. She called to cancel his appointment. In talking to her, I began to choke up a bit. It was a shock. There I was, sitting where he had sat. I had this woman on the telephone who was remarkably calm, even serene, who was telling me about his death. I’m ashamed to say that I felt almost more pain than she did. I don’t think that I showed it but my emotional response was extremely violent.
I offered to help her because that’s all I know how to do. It was my Saint Bernard side that was proposing help, saying that I couldn’t follow her permanently since that would be inappropriate but that I could see her two or three times while she looked for another therapist. There was chaos in my head, chaos in my heart. I’m not afraid to use that word. My head was messed up. I don’t know much more to say about it. I was a doctor, I was sad. I replayed the previous evening. I imagined him and his friends, seated at that terrace that I’ve been to. I put myself in his shoes. That’s it. Those are the thoughts that went through my head as I was speaking to her.
The force of my emotions surprised me. You don’t feel the same way for all of your patients. At the beginning of each new therapy, I say that therapy is a relationship. Both sides have rights and responsibilities. And the relationship is asymmetrical. The patient has more rights, the psychiatrist has more responsibilities. But it’s a true relationship. In the case of this patient, because of the way our relationship had ended, he stayed with me. His girlfriend also had a special place in my life’s experience. I mourned their loss with deep sadness.
We all know of lives that are cut short. At that age, it’s a waste. But when you can put a face with the victim, when you can remember someone’s way of being, their chemistry, see them in front of you, the tragedy becomes concrete. Even if it’s not as intense as the loss of a loved one, which is much worse, still my grief lingered while months passed—months where people talked about the loss of 130 young lives. Yes, 130 were killed but for me it was 129 plus 1. In the Place de la République, they posted the first names of the 130 people that lost their lives around the base of the statue. I knew exactly where his name was located.
Cured Too Rapidly
You might think that I believed I had cured him too rapidly, that it was my fault. But I didn’t really have those kinds of thoughts at all. Yes, I understood this kind of reasoning—because I’d helped him he was dead—but I immediately rejected it. Factually speaking, it’s true. But what was I to do about it? Search for evidence, a series of unintentional causes and effects? Perhaps leaving my office at a certain time had caused this, then that, then this, to occur and could have indirectly lead to someone getting killed. Possibly true, but it’s the kind of thing you can’t do anything about. I told myself these kinds of stories but they didn’t affect me adversely. I took tons of notes, writing down all of my thoughts and feelings about the situation, almost as if I was paranoid. But doing so was simply an exercise to prove to myself that I’d handled his case properly.
It’s like when a patient commits suicide. You ask yourself if there’s something you might have done differently to prevent his death. But in this case, he hadn’t killed himself. With suicides, one feels a certain amount of guilt or at least strong self-doubt. But in the end, you tell yourself that as a doctor, you’re more likely to have clients that die than if you’re a baker.
Overall, psychiatry has been a beautiful experience. When patients die, yes, I’ve played a role in the events that led to their death. But the world is a marvelous place. I also get to play a role in events that lead to children being born. Children that will thrive without a need for my services.
Even Psychiatrists Mourn
Like everyone else, psychiatrists must face the loss of loved ones. Almost exactly two years ago, my father died. [This testimony took place in May of 2016.] I loved the man dearly. Three months passed between the announcement of his illness and his death. During that intense time, we became closer, talked a lot, and made the most of our remaining days together. His death, which came on May 12 , was practically planned out. That morning his hospital called to say that things weren’t going well. My father lived in Rouen so I drove there to find him in a coma. I was with him during his last hours.
I had left home without my computer or my planner but I knew that I had two patients coming that day. I didn’t have their contact information so couldn’t cancel their appointments. I decided to return to my office and see them. I can’t clearly describe what happened next. I have no idea how they were feeling that day. I reminded them that when they’d started therapy, they’d entered into a relationship between two human beings. I told them that I needed to be transparent and let them know that I’d just lost my father. I explained that I hadn’t been able to cancel because I didn’t have their contact information.
They were both totally cool about it and immediately offered to stop the session. But, I said that as long as we were all there, we might as well continue and see how things unfolded. So we did and a strange sort of inhibition came over me where I told them things that I would not have been able to say otherwise. That’s not a very French thing to say but on a normal day, I wouldn’t have been able to expose such things about myself. That day, however, I felt as if I had the right to do so.
What’s great is that the following week, one of these patients came to see me and brought with her a letter. She said, “Doctor, I have something to tell you and I didn’t know how to say it to you directly so I wrote to you.” I was thinking, “OK, after that last session she probably wants to tell me that she’s moving on.” In fact, I have the letter and you can read it.
[He leaves to get the letter and returns, handing it over to Caroline Gillet to read aloud.]
“Monsieur, I am writing you this letter. However, you will never read it. You will never read it because we have never met and will never meet. Yet, I feel the need to write it because I’ve just lived through a remarkable week and in a way, you have too. You have left our terrestrial surroundings and no longer belong to this world. Because of your death, like you, I have experienced something extraordinary. Your son has been guiding me for some time so that I can feel better about myself, better about other people, so that I come to accept myself. Because he was unable to reschedule the appointment we had made, because he had wished to see me despite your death, we had an exceptional session together—stirring, sensitive, touching, full of life, full of hope, full of empathy, full of generosity. My oldest son who works in a hospital says that when he witnesses a patient’s death he feels it his duty to tell family members that a new life has begun. I had the impression last week that I’d lived through something similar. I wanted to write to tell you about it.”
So, that was a beautiful gift—having a patient’s acceptance and acknowledgment that her doctor is also a son.
Once on Stage
You become a doctor to not be sick. You become a psychiatrist to not be sad or to not go crazy. You are paid for your empathy. An image that I always think about is that of an actor that takes the stage and makes the room laugh despite his personal troubles. Once on stage, you do your job. That doesn’t mean you’re forbidden to show your vulnerability. This is just to say that I was shaken on that 12th day of May, 2014. Yet, the fact that I’d just seen my father die, that my patients had had to do my job with me, it was sad but it didn’t prevent me from working. I’m comfortable with the way I handled things. You have to prepare the living to live and let the dead be dead.
Why did I tell you this story? I felt the need to tell it from a therapeutic point of view. It’s been liberating to do so, extremely comforting even. It has allowed me to validate my lack of guilt, to tell myself that I’m not a coldhearted monster, to go over these events without feeling culpable. It’s also helped me to understand my own emotional reaction. Shortly after the attacks, my friends were surprised to see how I behaved. Perhaps, I needed an alibi to help me understand why I had been affected more than others and to validate my right to be so deeply moved.
When you asked me to meet with you in order to share my story with the public at large, I thought about the question of confidentiality. I contacted my patient’s partner to get her opinion. She was surprised but also touched by the fact that I was willing to do this. For her, it seemed like a way to pay homage to her boyfriend. She also spoke to his family who felt similarly. They knew their son’s story, that he had undergone therapy and they found it nice to have an opportunity to learn about an aspect of their son’s life that they hadn’t directly experienced. For them, it was an important moment.
As far as his wishes are concerned, I think he would have found it rather amusing because he was capable of talking about his problems with people that were close to him. But, he’s not here to tell me if I’m right or wrong about that.
I hope that I’ve done justice to this man’s story. There were moments on the recording where I had difficulty making out his exact words. In places, for simplicity, I’ve paraphrased. But, I think overall, I’ve captured the essence of his very touching testimonial.