Transparent victims on the road

Road accidents in which no one was physically hurt are so common that those who nevertheless suffer emotional trauma get little sympathy.

By
October 24, 2010 03:06
CLINICAL PSYCHOLOGIST Joel Wardi:

Joel Wardi 311. (photo credit: Judy Siegel-Itzkovich)

 
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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.

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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 women.

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.

Wardi 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.

Wardi, 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.

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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 driving.

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 Wardi.

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 company.

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 if necessary.

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 accident.

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.

First, 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 overprepared.

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.”

This 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 vicious cycle.

“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.”

The trauma 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.”

Haredim and some modern Orthodox who survive an accident bring an additional perspective – that a bad event comes as punishment for some sin they committed.

Wardi, 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.

Some accident 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 very helpful.”

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