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Paris, Boston, and the unbreakable power of resilience

There’s hope in the way people and cities recover from terror attacks.

People gather for a vigil outside Notre Dame Cathedral in Paris the day after the terrorist attacks.David Ramos/Getty Images

There's nothing I can say to console those who are suffering in Bamako or Yola or Paris or Beirut or any of the other cities recently stricken by violence in what has become a dramatically rising trend of terrorist attacks worldwide. While the scale of catastrophe in these cities is measured in casualties and grievous injuries to victims, there is also a less visible collective trauma: the threat of violence leading residents of the afflicted city to lose their sense of security in the days and weeks after the attack.

We experienced this ourselves in the surreal weeks following the Boston Marathon bombings. Dr. David Gitlin, vice chairman of clinical psychiatry at Brigham and Women's Hospital, saw victims — but also families, first responders, and hospital staff — arriving with symptoms of debilitating sleeplessness, anxiety, and hypervigilance. "Roughly 40 to 50 percent of those close to the event had some evidence of early post-traumatic stress disorder," Gitlin tells me. "People asked me: 'Am I ever going to be able to go back to that place again?' Runners asked me, '[Will] I ever be able to run again?' " His department saw that psychiatric symptoms did not abate immediately. In the months following the April 2013 attack, Gitlin's group noted an increase among patients seeking care for persistent traumatic symptoms.

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Terrorism can create psychological trauma inside the hearts of individuals and cities, more so than natural disasters or accidents, even months or years after the event. Following 9/11, the New York City Health Department assembled the World Trade Center Health Registry, at more than 40,000 adults the largest post-disaster exposure group in United States history. About 13 percent of them — around 5,000 people — had probable post-traumatic stress disorder even five to six years after the attack.

Similar rates of long-term psychiatric trauma were reported following the Oklahoma City bombing, the explosion of Pan Am Flight 103 over Scotland in 1988, and the 1995 bombings of the Paris Metro in France. And as a consequence of individual trauma, cities struck by terrorist attacks face the potential for a collective trauma: conflicts among ethnic and socioeconomic groups, job loss, empty streets, and an outlook mired in paranoia and despair.

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Yet again and again we see individuals and cities pull themselves from the smoke of tragedy inflicted by terrorism. In the years after 9/11, researchers who followed the World Trade Center Health Registry found, wondrously, that the most commonly observed reaction — even among those very close to the attack — was eventual recovery, among nearly 8 out of 10 participants.

Other cities around the world have described patterns of resilience after terrorism, as with the train bombings in Madrid in 2004 and London in 2005. Even reports from areas plagued by continuous terrorist attacks — such as in Israel, Karachi, and Iraq — said that the majority of affected individuals functionally recovered. "A lot of us will face something terrible in life," George Bonnano, a professor of clinical psychology at Columbia University, tells me. "But for the majority of us, the distress we face becomes ultimately adaptive — it propels us forward."

We cannot deny the tremendous pain and suffering brought on by malevolent acts. Lives are lost and families shattered. Distress from tragedy is an expected human response. But resilience appears to be our default trajectory, and, for the most part, the narrative terrorists wish for — that the psyche of targeted people and cities will be crushed — never becomes reality.

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Instead, the very on- and offline networks terrorists count on to spread fear are the ones we can use to share resilience, says Bonnano, a reaction that repeatedly proves to be the more powerful countering force within human behavior.

"As a larger community, even as cities around the world, we can buoy those who are suffering," Gitlin adds. "We can hold vigils. We can memorialize. If the majority of people are able to be resilient, we can hold those who are still hurting."

On the day of the attacks in Paris, Alexandre Palagi, a doctoral candidate in a joint program between his university in Nice and Harvard Medical School, telephoned his family in Cannes as well as friends and relatives in Paris (who were all OK). "It was horrible," he tells me, "being on another continent while this was happening. I felt all I could do was call people."

But that evening, at the French Consulate in downtown Boston, Palagi began to help plan a vigil for Paris, setting up a Facebook page and connecting people on social media. The ceremony was held on Boston Common on November 15, with hundreds of people in attendance. "It was good to see people show up, all kinds of people, American people, French people, offering condolences, shaking hands," he says. "An old lady gave me a hug."

Palagi tells me he's watched a news program in which Paris was inaccurately described as a city that's long contained neighborhoods full of "no-go zones," where non-Muslims aren't allowed to enter. But he is not interested in promoting a narrative of fear. While he recognizes that people might be afraid right now, he has great hope for a recovery of the city's spirit, just as he hopes for cities throughout the world.

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I have always felt you can walk anywhere in Paris, Palagi tells me. It's a beautiful and open city — it will always be so.

Dr. Sushrut Jangi is an internist and instructor in medicine at Beth Israel Deaconess Medical Center. Send comments to magazine@globe.com.