Dealing with trauma

Ever since the establishment of the Jewish state, Israeli society has been contending with an unsettled struggle for its existence – fighting wars and ongoing terrorism.

After a terror attack or the end of a war, most people breath a sigh of relief and gradually return to their daily lives. A significant number of others, among them senior citizens, teenagers and children, remain traumatized. Their recollections of flying bombs and exploding Kassam rockets shatters both their physical and emotional wellbeing. Their feeling of personal security is severely damaged, resulting in fear, trauma and bitter disappointment with regard to the state’s ability to protect its citizens. Like open wounds, each flashback reinforces difficult memories, affecting all aspects of the person’s life.

Empirical research conducted by NATAL, the Israel Trauma Center for Victims of Terror and War, prior to the escalation of rocket attacks in August 2011, shows that approximately 10 percent of the Israeli population displays symptoms of post-traumatic stress disorder (PTSD). In the south, with the cities of Sderot, Ofakim, Ashkelon, Beersheba and Ashdod that for over a decade have been subject to constant bombardment, one in three residents experiences post-traumatic stress on a daily basis.

There is indeed something infectious about PTSD; it is not even necessary to be directly involved in a traumatic occurrence to develop some of the symptoms. “Dealing with terrorism as part of one’s routine through incidents that involve family members, friends or other people from one’s personal environment increases the vulnerability of individuals with lower income and education levels, who have fewer resources for coping with it,” explains NATAL’s hot-line director Sigal Haimov.

Moreover, chronic fear equally impairs people’s working conditions – almost half of Sderot’s residents have reported a loss in income due to the need to make regular life-or-death decisions as a result of living under constant fire. Those who could afford to leave the city have done so.

“Therefore, we invest in prevention. We need to be there before it happens and teach them techniques to manage their course of life under and after extreme conditions,” emphasizes NATAL’s CEO Orly Gal. “Our mobile unit visits families in their own homes and checks what practical needs these people have; how often they eat, go see their doctor, speak to their rabbi, etc.”

Gal believes that in such cases it is crucial to apply family therapy, as “NATAL’s findings have demonstrated a connection between the symptoms of children and those of their parents: The more parents suffer from PTSD, the higher the correlation with their children being affected by traumatic symptoms as well. The same principle also works the other way around: If the patient has a strong and supportive family, he or she is less likely to be afflicted with common grievances and more likely to recover faster than somebody not actively involved in family life. When we come [to visit] we also determine who the ‘gatekeepers’ are, like parents and teachers, and help them explain to others how to behave in emergencies.”

NATAL SEEMS to be the only organization that focuses exclusively on trauma caused by terror and war. Since its establishment in 1998, NATAL has provided direct psychological help to more than 130,000 people. Its various units offer immediate and in-the-field support to people directly and indirectly affected by military and terrorist aggression.

During times of emergency NATAL’s toll-free hotline is constantly publicized by news channels and on the radio. It is the only hotline in the country exclusively serving victims of national psycho-trauma.

The intensively trained volunteers offer short- and long-term psychological and emotional assistance in Hebrew, English, Arabic, Russian, French, Spanish and Amharic.

After the Second Lebanon War in 2006, children increasingly began calling the hotline and organizers perceived a strong need to establish a separate children’s hotline that has since received international acknowledgement, having been accepted as an affiliate member of Child Helpline International.

“Furthermore, we send our experts abroad to share our professionally developed methods with their international colleagues. Some of them were sent to France immediately after the terrorist attack on Otzar Hatorah school in Toulouse, where they were coaching French psychiatrists and helping to take care of the victims and their families,” Gal recalls proudly.

“For us it’s not work. We really believe in what we do. If we manage to help a victim of terror and war to overcome their problems, it is as if the person has come back to life.”

DESPITE THE recent “quiet,” NATAL has found that nearly 30 percent of adults feel threatened. Another 23% take anti-depression and anxiety drugs to facilitate living as much of a normal life as abnormal conditions will allow.

As demonstrated above, PTSD symptoms are not somatic, but rather psychological. During periods of relative calm, there is an increase in civilians seeking professional counseling as the time of tranquillity allows them to “hear” their anxious thoughts and realize that they are often related to traumatic events, leading them to seek more comprehensive psychological treatment. There are people whose symptoms awaken years after the incident, and it is impossible to predict when they will erupt.

To foster stronger social inclusion of PTSD patients, NATAL’s Clinical Unit and Social Therapeutic Club offer activity groups and workshops for art, cooking, music, dance, ceramics, etc. Other projects are aimed at treating discharged soldiers and former prisoners of war and working on their psychological health by improving their natural coping resources and body-mind connection via outdoor activities, creativity, empowerment and peer counseling. By sharing their experiences and mutually assisting one another, veterans achieve a strong basis for further successful treatment.

With the purpose to accomplish even better and faster results, the NGO collaborates very closely with other organizations. The list of NATAL’s helpers ranges from the municipalities, to Magen David Adom, to the IDF and NGOs.

About 6,400 PTSD patients receive professional supervision at the Sderot municipal mental health center. Some 3,500 children and 500 teachers and staff learn coping tools through the local schools. The Resilience Center treats about 400 people each year, most of them children and teenagers. They are taught relaxation exercises through a psychological, just-for-them puppet show and by using specially designed anti-stress balls, both of which were generously donated by the German Embassy and the Philadelphia Jewish Federation.

THE WORRISOME reality is that 12% of the children of Sderot have severe trouble functioning, 41% suffer from over-excitation and 20% display all the symptoms of post-traumatic stress. This is the result of their chronically threatening environment; most of them have been experiencing multiple direct exposures to missile attacks from Gaza for the past 11 years.

Fifty percent of Sderot’s children are emotionally exhausted and constantly relive the traumas.

“My two younger children refuse to leave the house. They have problems concentrating, they don’t want to go to school and are afraid even to go to the bathroom alone or take showers by themselves,” reports a single mother of three from Sderot.

Such children are always extremely alert, ready for danger, and every little noise shakes them up. Because of the ongoing aggression by Hamas and the Islamic Jihad, whose goals are to murder and destroy, these children are forced to spend more time in bomb shelters than in playgrounds. They don’t want to play, but rather withdraw inside themselves and refuse to maintain any contact with their existing environment.

After more than 11 years of living in the most heavily bombed city in the world, over 71% of Sderot’s children suffer from at least one symptom of PTSD, whether it’s flashbacks, bed-wetting, the feeling of constant, paralyzing fear, nightmares, etc., while in the meantime, they continue to hope that one day they can wake under a permanently rocket-free sky.