Mental Health The Future of Traumatic Memories
Notes on surviving a terrorist bombing.
I do not remember the bomb exploding. I remember a soft whisper in my right ear. I remember the sound of my right eardrum bursting as something very soft, tender. I remember a silence thick and dense, one that I can hear in my bones. I do not remember falling to the ground. I do not remember choosing a fetal position. I do not remember the weight of the two little girls who fell on top of me. I do not remember how long I lay unconscious. I remember elbows and knees and wrists of little girls gently trampling my back as they wake up and flee. I remember that they look like two sisters with beautiful long black silky hair and I have a memory, that perhaps is made-up, of what their hair smells like, a mixture of sunshine and warm sand. I remember David saying Lucie but his voice sounds weird, as if he is talking from behind a thick glass door. I do not remember being covered in concrete dust.
I do not remember regaining consciousness. Everybody has fled. I do not see the exploded concrete staircase, though it is right in front of me. I see David, but do not see that he is covered in dust, nor that his pupils are unusually large and black. His voice sounds as if I am underwater. I have no memory of what he is saying. The dancers of the religious ceremony in their bright yellow costumes are still dancing, facing the Ganges. The air is saturated with incense, concrete dust, something burned, and fear. I remember thinking that was a very little bomb.
The New York Times , Tuesday, December 7, 2010: India on Alert as Bomb Hits Hindu Holy City . “Indian authorities issued security alerts in several major cities on Tuesday evening after a bomb detonated in the Hindu holy city of Varanasi. The police said the explosion and ensuing panic of pilgrims left a toddler dead and at least 20 other people injured.”
In French, my native language, two words exist for memory: la mémoire and le souvenir . La mémoire designates the function of the brain that stores information. Le souvenir is a fragment of scene remembered. Paradoxically, one of the main functions of memory is to forget. A healthy memory evolves both with the passage of time and through contact with other people’s narratives. A memory becomes traumatic when it stops evolving and remains as if preserved in ice.
Two words for trauma also coexist: Le trauma refers to what happened (i.e. a bombing) and le traumatisme refers to the representation of what happened. So when we suffer a trauma, we suffer twice. As the French neurologist Boris Cyrulnik wrote in Mémoire et Traumatisme: l’individu et la fabrique des grands récits , traumatic memory functions as a type of hypnosis, where some aspects of what happened are imprinted with a profusion of sensorial details that partake of a sort of hyperrealism. Everything else around the scene is vague and foggy, dream-like. Cyrulnik says that within the foggy territory that surrounds a traumatic memory, a process of reshaping or reshuffling the information and images that construct the souvenir is possible. The process demands time and is directly dependent upon the victim’s environment.
The day after the bomb, I am expecting other bombs, other explosions. On our way to the airport in the taxi, warm salty water leaks slowly from my eyes. Because I have no tissues, I use the sleeve of my red sweater so I can stare peacefully at the streets, the cars, the sacred cows, the dogs sleeping in the middle of traffic, the military men in their crisp olive green outfits. Why is the world not exploding today? A world without bombs is now a world in between two bombs. Perhaps the next one is now . . . or now . . . or now . . . I do not understand the absence of destruction, fear, concrete dust on people’s faces. Sounds come and go, muffled. I do not know where they are in relation to me. When someone addresses me I do not know if the voice comes from behind me, next to me, or inside me.
Six years have now passed since the bombing and I am somewhat surprised to realize that my rewriting of the event today bears very few significant differences with the diary entry I wrote just a few hours after the event. One main reason for this is that the only other person with whom I share this memory is my husband David, who was standing right next to me when the bomb exploded and our two narratives were fused into one.
But what happens to someone’s traumatic memory when it is shared with hundreds, thousands of other people? Is it possible to map the connections between individual and collective memories? How do they feed each other, influence each other? Eventually, do they fuse and become one coherent narrative or do they remain plural, fragmented, possibly contradicting each other?
William Hirst is a professor of psychology at the New School for Social Research in New York. During our phone interview, he warned me that it is important to distinguish between traumatic memories, flashbulb memories, and event memories (terms commonly used among researchers). A traumatic memory relates to an event that directly happened to me (i.e.: losing an eardrum in a bombing). A flashbulb memory is remembering the circumstances in which I heard of a traumatic event, but I had no direct experience of it. For instance where I was and with whom, what I was doing, when I first learned about the 9/11 attacks. An event memory is a recollection of the details of the event itself. How many planes were involved in the attack? At what time did it happen? Though flashbulb memories are from an indirect experience—something I saw on television or something I heard about on the radio—the epidemiological studies show that people can show signs of Post Traumatic Stress Disorder from them as well.
Flashbulb memories are community specific. French people have a clear flashbulb memory of the day President Mitterrand died (though it’s highly unlikely anyone developed PTSD from that memory), but almost no Belgian people do. Flashbulb memories are autobiographical memories that bind a community together.
I do not remember very well what happened in Paris on November 13, 2015 . I do not remember how many shooters started firing on the café’s terrace. I do not remember whether it happened in the tenth or the eleventh arrondissement. I do not remember if a bomb exploded. I remember the ordeal of the people who were kept hostage in the Bataclan, but I do not remember how many died, how many survived. I do not remember what exactly happened simultaneously during the soccer game. My event memory is very blurry.
Yet, my flashbulb memory is quite vivid. I remember it was a Friday. I was at work, teaching French at the Alliance Française in Portland. It was my lunch break when I first learned of the attack. The radio was on in the staff room. I remember thinking it was too loud and my colleagues were too quiet. I remember making a spontaneous effort not to make sense of the words coming out of the radio. I left. Perhaps I made photocopies, perhaps I just left. I mostly remember trying not to learn and the mental efforts required not to understand things, and eventually failing. I remember my colleague Pascaline’s rivulets of tears mixed with black eyeliner on her flushed cheeks. I knew all her friends lived in the tenth and the eleventh arrondissements. Many of mine did too. Then some journalists from a local TV channel came and we both hid because we did not want to speak to them.
The fact that so much energy on my part was geared toward not knowing exactly what took place in Paris is very telling about the way a person living with trauma chooses to cope and finds new strategies to avoid remembering painful events. Associations take shape in the brain that I cannot control and need to be careful about. In my case, the memory of the bombing is associated with big gatherings, outdoor festivities. But other things too, like fireworks, because they sound exactly like bombs, are forever dreaded.
It’s possible that the 13th of November marked a shift for me in my post-bombing life because it was the first event that I failed to ignore. It was too close to me. My father was born and grew up in Paris. My grandmother, my uncle, my cousins, my friends live there. I have an emotional connection to this city similar to one with a person. On the day the city was attacked, together with millions of others, I felt wounded. Simultaneously the defenses I had constructed after the Varanasi bombing partially collapsed.
My forgetting of the event itself ties in to William Hirst’s findings in his ten-year follow-up of a study of memory for the attack of September 11, 2001 . Hirst collected and compared some three thousand accounts over time: “There was rapid forgetting of both flashbulb and event memories within the first year, but the forgetting curves leveled off after that, not significantly changing even after a 10-year delay.”
In France, historian Denis Peschanski and neuropsychologist Francis Eustache were directly inspired by Hirst’s work when, just a few days after the November attack, they decided to create the 13-Novembre program: “We felt that we owed it to the victims to mobilize our tools and skills for a project that would give meaning to the whole thing and make sense of it over time,” Eustache explains.
This transdisciplinary program will run for twelve years and will follow one thousand people who were direct or indirect witnesses of the attack. The first filmed interviews started last May; three others will follow in 2018, 2021, and 2026. Those dates are directly modeled after Hirst’s study so as to track over time how the victims’ memories evolve and perhaps transform. Historians, sociologists, psychologists, psychopathologists, and neuroscientists designed the guidelines for the interviews together so that the material collected could be used by each discipline. This has never been done before.
They made me a new eardrum out of cartilage that they cut from somewhere inside my ear. The day after the operation, I constantly hear something like an old washer-dryer that seems to be lodged inside my right ear. It takes me a while to understand that it’s the sound of my own heart. It has a gurgling squishy quality the first two days. My ear is stuffed with cotton and wrapped with bandages that fill with blood. It looks like I’m wearing just one large white headphone made of polystyrene. I choose green and red glittering stickers in the shape of small five-point stars to decorate my fake headphone. David has the same fake headphone. He lost both eardrums, but they operated on the right one for now. I give him pink and yellow smiley faces for his. He accepts. We leak blood onto our pillowcases at night. We can never sleep.
On November 13, 2016, France commemorated the Paris attacks. On France Culture radio, they ran a program that presented three of the fifty-seven scientific projects that were started as a direct response to the attacks. On November 18, 2015, Alain Fuchs, President of the CNRS (Centre National de Recherche Scientifique – National Center for Scientific Research), wrote an open letter to the scientific community that started with these words: “The scope of the trauma caused by the attacks tends to make any action that would not have an immediate effect derisory.”
“Remember,” a biomedical study launched by the INSERM (Institut National de la Santé et de la recherche médicale – National Institute for Health and Medical Research), was one of the three projects chosen. “Remember” is part of the 13-Novembre program and takes place in Caen, in the North of France. The 13-Novembre program in its entirety includes one thousand participants that are divided into four groups: Circle 1 consists of those directly exposed to the violence; Circle 2 includes residents of the areas targeted by the terrorists; Circle 3 comprises Parisians of other neighborhoods; and Circle 4, inhabitants from other French cities.
“Remember” selected 110 people from Circle 1 and seventy people from Circle 4. Brain MRI scans are conducted while they are being interviewed so as to identify markers associated with cerebral resilience to trauma and to better understand, predict, and prevent the development of PTSD. A biochemical marker is defined as “any hormone, enzyme, antibody, or other substance that is detected in the urine, blood, or other body fluids or tissues that may serve as a sign of a disease or other abnormality.”
At Caen, the interviews take place over two days. First, interviewees take a sort of entry test with a psychiatrist so as to learn about their emotional background, and whether they had a pre-existing psychiatric condition prior to the attack on the 13th of November. Then they are given a series of psychological tests that last an entire day. Those tests aim at learning how their specific memory works, how they deal with emotions, how they typically react in specific situations. Some questionnaires are about memories in general. Finally, the last questionnaires are about their memories of the 13th of November in particular.
Eustache told me that all the questionnaires are kept confidential so as not to thwart the study. When I ask Eustache on the phone what exactly a cerebral marker is he explains that it is a sign that allows scientists to detect a syndrome or a pathology. The cerebral marker can correspond to three sorts of modifications: a structural modification in a specific area of the brain, or a functional modification—a change in the way connections occur in the brain—or a modification of cerebral reactions towards a specific stimulus. “Remember” aims at showing that there are cerebral modifications that are specific to PTSD.
Sophie is one of the volunteers for “Remember.” She is a forty-one-year-old Parisian who was at the Bataclan concert on the night of the 13th of November, celebrating her birthday with a friend. She was right near the stage when the shooting started. She fell onto the floor and played dead. She told the France Culture journalist that she used techniques she had learned in her training as a freediver to slow down her heartbeats and control her panic. She said she was sure she was going to die. The only question was how. She said she chose to die running. So at some point when the shooting intensified, she quickly got up and rushed to the front door. Miraculously, she escaped.
Shortly after my eardrum operation, I start hearing ghost sounds. First I recreate, out of love and nostalgia, the beloved sounds that I can no longer hear: the rain, the music of Ravel and Debussy, the purring of the cat, the whispering of tea water about to boil, footsteps in rain puddles. But then other sounds come at night and I do not know where they come from nor what they truly are. Tinnitus. Whispers. Vibrations. Suggestions of words in languages I don’t recognize.
One night, during the ghost sounds phase, I have a dream. I dream of music. A piano piece that sounds so familiar, yet I cannot remember what the piece is called. I think I might have studied it as a child, but my memory is failing me. I walk aimlessly on the streets of the dream asking people if they know what the music is. Some turn their heads away in silence. Others pretend not to hear. Eventually one stranger approaches me and says: Image .
Peschanski and Eustache are asking how a traumatic event can modify the structures of the brain. Can you predict the development of PTSD and resilience thanks to cerebral markers? For the conducting of the brain MRI scans, Eustache wants to study the power of the brain to block or keep at bay traumatic images. It is obviously not an option to ask volunteers to be exposed again to traumatic images. So another design for the experiment has been developed by Pierre Gagnepain, a researcher working with Francis Eustache in Caen on neuropsychology and the functional neuroanatomy of human memory.
At first, volunteers are asked to learn by heart a series of roughly twenty-five word-image pairs. For instance the word pen associated with an image of a pair of glasses. This process of memorization takes approximately ninety minutes. At the end of this process, volunteers automatically associate the word with the image for each pair so that when they are shown the word pen , an image of glasses comes automatically to mind.
After that, volunteers are put inside the MRI so as to measure their brain activity while they are given a specific task: The subjects are presented with some of the words they have just learned in association with images, but this time the word alone is presented to them. Some of those words appear in green. When such is the case the subjects are asked to bring to mind the image that is associated with that word. On the MRI, you then see all the activated zones of memory that start to work in coordination to bring the image back. Some of the words then appear in red. In that case, the subject must do everything in her power not to think of the image associated with it. What you can see on the MRI in that moment is called a réseau de contrôle (control network) that emerges in the brain and this network comes to suppress the zones where memory is at work. The observed consequence of this task of not thinking of an image is that the memory of the image is not only put aside, but in the long term the memory fades, deteriorates.
Sophie says that this task of not thinking is exhausting. Yet, even though the aim of the biomedical study “Remember” is purely for scientific research, she says that it has had a direct therapeutic effect on her. After the attacks, she started to associate freediving with her ordeal in the Bataclan. She started to have panic attacks when she was practicing diving. Thanks to “Remember,” she learned what exactly was happening in her brain when she was panicking and this new knowledge is helping her on a regular basis to deal with her panic. It has not erased the panic attacks but it has helped her to weather them better.
I have no image associated with the bombing. I do not know how long I remained unconscious, curled up like a cat napping, among exploded concrete, covered in concrete dust. The only image I associate with the word bomb is the red sun-like motif that the little girl was busy painting in the hollow of my right wrist just before everything ended. It was precisely as she painted a red dot at the center of the red circle on my wrist that the bomb exploded. But this image does not trigger fear or panic. For reasons I cannot justify, it brings up nostalgia.
When I told Eustache on the phone that in my case there was no image linked with PTSD, he said that with bombs, if you’ve been blown off your feet and have lost consciousness, there is no image, but sounds, smells.
Eustache insists on the importance of the word “network” to understand how the brain functions. In the past, neuroscience used to be more focused on studying the structures of the brain but nowadays, thanks also to new technologies such as the MRI, scientists study cerebral activity in the way it is linked to the activity of cerebral networks that synchronize themselves with each other and that can complement or sometimes antagonize each other.
One thing that particularly puzzled me was to learn that memory and imagination cohabitate in the same region of the brain. I asked Eustache whether this relatively new discovery was important in the research on PTSD. Eustache said that when you project yourself into the future and you try to imagine what you will do in a few days from now, even if it’s very uncertain, you create images that are partially fed by images of your past. What has been shown, in a famous study by the experimental psychologist Endel Tulving, is that people suffering from severe amnesia struggle to project themselves in the future. Their struggle to imagine what could plausibly happen to them in three or four days from now mirrors perfectly their impossibility to narrate what happened to them three or four days ago. In both cases, the activated cerebral networks are relatively similar.
But when it comes to PTSD and whether a person suffering from trauma would have the same difficulties projecting into the future, no study has been done so far. Eustache is hoping that “Remember” will answer this question.
In my dream, during the ghost sounds phase, my aimless wandering in unfamiliar streets echoes both the sense of mourning for a past I cannot recreate—for me it is music I can no longer hear—but also the pain of having no path, no direction, no future and feeling lost in a sort of small labyrinth. Perhaps writing offers the brain the impossible opportunity to simultaneously remember and forget, to dig into an exploded, irretrievable past in search of fragments of possible futures.