prof Chemtob Brom298.88.
(photo credit: Judy Siegel-Itzkovich)
While the loss of any loved one is a tragedy, parents having to bury their children - at whatever age - is probably the most devastating.
It is something for which no one can prepare, and unnatural, since the deceased were those they gave life to and who were supposed to have carried on their name to the next generation. Yet, especially in Israel, it is quite common due to terror attacks (130 children 18 and under killed in the past five years), war and, of course, accidents at home and on the roads.
Mental health professionals have found that individual therapy for such parents is not usually very successful, so they suffer for the rest of their lives; sometimes there is such anger, resentment and blame for the death (whether justified or not) that one tragedy triggers another - divorce.
Now Prof. Claude Chemtob - a veteran psychiatrist, pediatrician and psychologist at Mount Sinai Medical Center in Manhattan - has come to Israel to collaborate on how best to treat bereaved parents with one of Israel's leading experts on psychotrauma, clinical psychologist Dr. Danny Brom.
Chemtob, a Jew born in Alexandria, Egypt, left with his family for France in 1961 and then moved on to the US. He first met Brom (then a recent immigrant to Israel from Holland) at a US conference about 15 years ago. As director of Jerusalem's Israel Center for the Treatment of Psychotrauma at Herzog Hospital, Brom has collaborated with Chemtob to develop trauma treatment programs for pre-school children and their parents in Sderot - the southern development town that has been the target of Kassam rockets from Gaza.
While after the September 11, 2001 attacks on New York's World Trade Center, Chemtob became especially interested in relieving the suffering of survivors, Brom was busy coping with the endless patient load created by the second intifada.
"America can learn a lot from Israel and how its professionals have coped with terror victims," Chemtob says in an interview with The Jerusalem Post at METIV, the psychotrauma facility's walk-in crisis center in Jerusalem's Kiryat Hayovel quarter.
Chemtob poignantly recalls his mother's funeral when he was a grown man about two decades ago. His grandmother, who survived her daughter, wailed: "But I was supposed to die before her!" The Mount Sinai psychiatrist became interested specifically in bereaved parents who didn't know how to recover. "The literature on help for parents who had lost a child reveals a very grey picture until now. Individual therapy doesn't help enough," he says.
Brom discloses that when he was seven, his own brother died of an illness. "My parents initially coped quite well, but 30 years later they suddenly told their three remaining children that 'it gets more difficult every year.' So we arranged a study evening in his memory every year, and it helped."
BEREAVED PARENTS are very vulnerable. An American researcher who studied parents whose children between the ages of 12 and 28 died a violent death found that five years after their loss, the prevalence of post-traumatic stress disorder (PTSD) was 27.7 percent in mothers and 12.5% in fathers; at the same time, PTSD rates in the general US population were 9.5% and 6.3% respectively. Bereaved parents are also more likely than others who lose loved ones to commit or consider suicide, and are at greater risk for psychiatric hospitalization compared to their non-bereaved counterparts.
Sheldon and Arlene Bearman of Baltimore, who run a philanthropic foundation and lost a child of their own, gave Chemtob $200,000 to provide treatment for such parents, and as Brom's research papers on trauma - even those written years ago - remain seminal, Chemtob decided to collaborate with him and base the project in Jerusalem.
With this generous funding, the two have spent a year training a team of 10 psychologists, psychiatrists and social workers to offer free treatment to parents who lost children suddenly from infancy up to the age of 25. The death must have occurred at least six months before inclusion in the project, and the circumstances can involve terror, accidents, suicide, homicide and other causes of unexpected death; after our interview, the researchers decided also to include parents of small children under five who succumb to illness.
Although several couples have already been registered (some through the Koby Mandell Foundation), the project is open to more, mostly from the Jerusalem area. Applicants should apply to coordinator Talia Engelhart at firstname.lastname@example.org, call (02) 644-9666 or fax (02) 644-9777. The METIV clinic is at Rehov Shmaryahu Levine 59 (enter from a side street called Rehov Meir Avner).
MOURNING FOR a dead child is particularly difficult to recover from, says Brom. Longitudinal studies show bereaved parents to be at greater risk for physical and emotional difficulties, more likely to have impaired relationships with spouses and surviving children and be impaired at work. These effects persist for many years. But, adds Chemtob, "despite the public health consequences of parental bereavement, there are very few studies of the efficacy of treatment for the bereaved. Only one empirical study has specifically examined the treatment of bereaved parents, and it was found to have little efficacy. The limitations in existing treatment argue for the need to develop a specific treatment for parental loss resulting in persistent symptoms."
Dedicated to evidence-based treatment, the two decided to develop a treatment for parental bereavement, including the writing of a treatment manual and training aids, pretesting of the treatment manual with bereaved parents; and adapting the therapy if needed.
Forty couples will be included in the program - half of them randomly asked to wait 14 weeks for therapy (to see if they improve without it), while the rest will be treated immediately. "We are speaking about time-limited therapy for couples - 12 to 16 sessions of 60 to 75 minutes each. Being together is very important, as losing children can be especially hard on married life," Chemtob stresses. "Looking at your wife or husband, who is likely to resemble the child, you are constantly reminded of the loss."
Couples may tend to blame each other for the death, Chemtob adds. If the child died in a motorcycle accident, for example, one may accuse the other of allowing the child to drive such a dangerous vehicle. "Even couples who had a good marriage before their loss may find that their interaction is suddenly hurtful."
The inclusion of spouses, including those who do not show symptoms, to provide support is a unique aspect of the treatment METIV will now offer.
The program includes cognitive behavior therapy, and teaching couples that losing a child is different from anything else. "We will examine how the couple communicated before the tragedy and after. We will teach them about what reactions people can have, and give them coping skills," explains Chemtob. Breathing exercises and relaxation will be included. The final portion of the treatment focuses on revitalizing the couple's future even in the absence of the child, introducing hope and optimism without trivializing the loss. Another important task is to identify possible points of vulnerability, such as birthdays, anniversaries and other reminders of the death, and prepare the couple for these. "We will teach them to soothe and calm each other," says Chemtob. "If they have other children, especially younger ones, we will remind them not to let their bereavement get in the way of caring for their living children."
The project is unusual not only because it focuses on couples who have lost children, but also because it is a study in motion.
"We are not certain that the therapy we offer will work; we have done a lot of preparatory work," Brom notes, "but it isn't guaranteed. We will learn from experience. But we want to do it because we know that existing therapies have not been successful."
"We have not come out of nowhere; we have already successfully treated three cases in New York using these methods," Chemtob says. An independent team that doesn't know who has been treated and who has been made to wait 14 weeks will examine the pre- and post-study questionnaires to assess the effects in an objective way. They will also conduct followup to see whether beneficial results last.
If the project succeeds as they hope, other groups of bereaved people, including grandparents and siblings, parents of soldiers killed in action, or even parents whose children were murdered in the Holocaust could be included. They will start with Jewish couples, but as the need for help among Israeli Arab and Palestinian couples also exists, it could serve as a model for helping them as well.
Brom does not have exact statistics on how many of the thousands of clients who have come to METIV had lost a child. "But we know that about 8% came for counselling because they had suffered the loss of a loved one. At least some of them were in mourning for a child."
Chemtob concludes that five years after the World Trade Center disaster, "New Yorkers are nervous but somehow able to cope with daily life. But it was, we hope, a one-time thing there. In Israel, it's an ongoing threat, but Israelis nevertheless display amazing resilience."