It happens dozens of times a day, everywhere in the country, every day of the
year – car crashes in which the metal is dented, glass shattered and driver and
passengers shaken up. Obviously, when someone – a pedestrian or occupant of a
vehicle – is maimed or killed, road accidents can cause severe and long-term
emotional trauma for those involved, but experts are finding that even minor
accidents can damage psyches.
As the number of people wounded in terror
attacks has fortunately dwindled in the past few years, Jerusalem’s Metiv
walk-in crisis clinic – established by Herzog Hospital’s Israel Center for the
Treatment of Psychotrauma (ICTP) – has found itself less and less busy with
people who were shot at, stabbed or had buses or restaurants blown up around
them. Only about 10 percent of clients today, according to Metiv’s clinical
services director Joel Wardi, are the victims of Palestinian terror attacks,
most of which occurred some time ago. A graduate of Bar-Ilan University who did
his internship as a psychologist in the IDF and treated terror victims during
the second intifada, Wardi says that working with road accident survivors is
just as challenging.
The term “trauma” comes from the Greek word for
wound, but it has in recent decades been used to describe damage to the psyche
as well. “There has been growing awareness of the fact that people exposed to
events such as terrorist attacks or car accidents are often not injured only
physically, but mentally hurt as well,” says Prof. Danny Brom, an immigrant from
Holland who established ICTP 21 years ago and has become a world-recognized
innovator in its research and training of professionals to deal with emotional
trauma. Other examples of traumatic events are natural disasters, sexual assault
or serious disease.
Of all those involved in a motor-vehicle accident –
serious or not – about 10 percent will develop posttraumatic stress disorder
(PTSD), in which the symptoms interfere with daily living and don’t go away
without treatment. The American Psychological Association has found such
accidents to be the number-one cause of PTSD in men and number two in
PTSD can occur when victims – or their loved ones or even
strangers – are exposed to a situation that could end in death or serious
injury. As the event could not have been predicted or prevented, it may shatter
one’s sense of security and leave the victim feeling vulnerable. Victims should
not regard themselves as “crazy” or abnormal, as PTSD is a normal response to an
abnormal event. For example, if an individual suffers only minor physical
injuries in a major car crash that killed relatives or friends, he may start
having nightmares about it. He may jump at the sound of a siren or the sight of
an ambulance or avoid even going near the site of the accident.
says a growing number of clients are referred to the center at 59 Rehov
Shmaryahu Levin in the capital’s Kiryat Hayovel neighborhood after being
involved in a relatively minor road accident. Some are feeling psychological
symptoms, such as depression, feelings of helplessness, guilt and being
emotionally numb, irritability, lack of joy in life, excessive alertness, fear
of driving or even getting into a car again, sleeplessness, anxiety and lack of
concentration. In the extreme, symptoms may also include flashbacks in which
survivors feel or even act as if the incident is recurring; feelings of great
distress when reminded of the trauma; intense physical complaints such as
headache, stomach ache or chest pains; and even suicidal thoughts.
a 51-year-old clinical psychologist who was born in Denmark, came on aliya at 18
and has spent the last decade at Metiv, said many of these clients are
recommended by lawyers suing insurance companies for compensation for damages.
“They have an incentive to prove that the accident victim suffered not only
physical harm to himself or his vehicle but also psychological distress,” said
Wardi in an interview last week at the clinic. But most of these people are
genuinely suffering; they don’t go through the motions to make a better case for
the lawsuit, he says.
In addition, there are many people who survived a
road accident and suffer but are unaware of Metiv’s services; Wardi wants to
spread the word.
“Even if the terror attack occurred long ago, drive-by
shootings and even sad family events can open old wounds. Road accidents too can
open old wounds,” adds Wardi, who along with four other staffers and 15
freelance therapists handle about 300 clients a year.
“At any one time,
we have about 100 people coming here for treatment.”
Some of those who
seek help themselves survived an accident and were hurt or permanently disabled
or others died or were seriously injured; they may have had the accident because
they spoke on their cellphone, sent an SMS or were drinking while
They, he says, need even more intensive psychological help. “If
our client clearly caused the accident, I don’t ignore that. The question is
whether he wants to live.
We try to help people who admit to having been
to blame for the accident. People cry quite a lot in these cases,” notes
Metiv was originally funded with seed money by the UJA-Federation
of New York to help people shaken by terrorist attacks during the second
intifada. The service was available free for two or three years, but as the
federation moved on to other projects, Metiv has had to charge NIS 80 to NIS 300
per session, depending on the client’s financial ability and the nature and
length of care. In accident cases, the center allows the people who come in for
counselling to pay later, when they receive compensation from the insurance
Thus people in distress can get care immediately even if they
can’t afford it after the accident occurred.
Metiv services only those
who come to Jerusalem, as there is only one branch; Wardi is not aware of any
other Israeli center with expertise in psychological trauma from accidents. It
also treats mostly adults, but it will give focused help to children and teens
Few Arabs who don’t speak Hebrew come to the center, as no
Arabic-speaking psychologist is available.
Aside from serious accidents
that lead to injury and even serious disability or someone else was killed, the
bulk consists of the common “little ones,” in which there was little or no
physical harm, but those involved suffered psychological trauma. Their
functioning declines, not because of physical trauma to their bodies. Some,
Wardi adds, may not even be aware of it or connect their symptoms with the
The fact that these small accidents are so common, even banal –
like someone going abroad and showing friends their photos and video footage –
can make it even more difficult for survivors to handle.
“People who hear
them would say: ‘Say thank God you’re alive and forget it.’ But they can’t.”
These, says Wardi, are the “transparent victims” of car crashes.
they have to admit that something happened to them. “People hurt by a car
suddenly feel weak. A vehicle is made of steel and glass. Our bodies are much
weaker. We are soft. An accident,” says Wardi, “puts driver and passengers into
survival mode. This is necessary in nature, as it can keep you alive in the face
of danger; it’s fight or flight. But if this is not possible in an accident,
many people react by freezing.
After that, they are oversensitive and
They become stuck in survival mode. They constantly look
right and left. In many cases, they fear driving again and will even fear
touching a steering wheel.
Some will avoid going to the place where the
accident occurred, as if only that spot is dangerous. When they take the bus,
they will sit behind the driver and constantly keep an eye on him.”
overreaction is so ironic, says Wardi, as “cars make us feel more attractive and
protected and strong.
A vehicle expands your personal boundaries. If you
have a car, you are regarded as having a certain status, of being more
successful in life. And then, BANG, an accident occurs, and being around cars
make you feel so weak, small and susceptible. It is a very traumatic experience
to lose control.”
He compares such an experience to the dramatic contrast
between people going to attend a joyous wedding at the Versailles hall in
Jerusalem nine years ago and then crashing down with the ballroom floor as it
collapsed, leaving many dead and injured.
Metiv has a psychiatrist
consultant who can prescribe psychotropic medications to those who need them.
“They sometimes need antidepressants and to be stabilized,” explains Wardi. “But
the main thing is psychological help. We explain what happened to him, the logic
in his symptoms. We don’t want him to think he’s crazy. This would set off a
“Clients are given the tools to relax. They learn to pay
attention to the way their bodies react to stimuli related to the accident. They
pay attention to arousal and learn what to do to cope. We try to expand the way
they look at the event and not to concentrate on one thought.”
is eased if those who were involved in the accident were respectfully and
considerately treated at the site or in the hospital, says Wardi. “If not, it
can only add to the trauma. The talk therapy usually focuses on harmful thoughts
and may include behavioral therapy that desensitizes clients to stimuli. If they
fear driving, we ask them to stand near their car; then they sit in it and then
turn on the motor. Later, they are usually able to drive.”
some modern Orthodox who survive an accident bring an additional perspective –
that a bad event comes as punishment for some sin they committed.
who is modern Orthodox, tries to put things into perspective and minimize their
feeling of guilt.”
Teenagers after an accident must also be handled
carefully, as learning to drive is considered an initiation rite for adulthood,
suggests the Metiv psychologist, and parents must pay special attention to them
to ensure they observe the laws and don’t drink and drive.
survivors gain – or lose – weight due to the psychological trauma. “Some don’t
take care of themselves. We recommend exercise to fight passivity and promote
good health as well as a balanced diet.
Exercises for relaxation can be