Over 3,000 IDF veterans have been recognized by the Defense Ministry as sufferers from chronic combat stress, but the actual number is unknown.
By LARRY DERFNERidf 88(photo credit: )
Walking through Sadnat Gal, the main rehabilitation center for IDF victims of combat stress - what used to be called "shell shock" - you get an idea of the price this country has paid for a history of war. The outpatients here in a section of Tel Hashomer's Sheba Medical Center are mainly in their 50s - quiet men whose expressions, seen up close, tell you something is wrong with them.
In the lunch room, Roni Yarkoni, 53, grips the napkin holder, squeezing the napkins in and out, as he tells his story. When he gets to the especially difficult parts, he lets out a little nervous laugh through a cockeyed grin.
His memories of battle go back to the Yom Kippur War. "But I don't think any of that stayed with me," he says. His problems began with the Lebanon War. "We were going on missions into villages in 'Fatahland' every night for about four months. Once we were surrounded for 24 hours - about 100 RPGs were fired at us. I saw children burned. There were a few other situations that I really don't want to talk about - things I was forced to do that change your moral character."
One morning in 1994, he was having a cup of coffee at work on Tel Aviv's Rehov Dizengoff when a bus exploded nearby - a suicide bombing that took 22 lives. "I went down to see," he recalls, "and then I went home. I didn't leave my room again for a year and a half."
He was thrown into violent rages and paralyzing fears. "I was afraid to cross the street. I was afraid to go into open areas where there were tall buildings around - it reminded me of the cities in Lebanon where I fought. Once I went to the Tel Aviv Museum and it took me five hours to get out of there. I went from being a paratrooper to being afraid to take an elevator past the fifth floor."
His wife left him, taking his two children. Luckily, a friend gave him a form to sign to apply for psychological help from the Defense Ministry. After going through what experts in the field describe as the "Via Dolorosa" that the Defense Ministry puts combat stress victims through before recognizing their condition - Yarkoni began treatments. That was in 1998.
Today, he is in close touch with his children, but lives alone in Ramat Gan. For the last seven years, he has been spending every day at Sadnat Gal, passing the hours mainly by creating huge, colorful paintings and sculptures. Several of them hang in the lobby of Sheba's auditorium, others at a branch of Bank Hapoalim and at Bar-Ilan University, still others have been bought by collectors including Shari Arison, Aviv Geffen and Ofer Nimrodi. He also donates some of his works to charity auctions.
"This is really what saved me - being able to create," he says. Yarkoni could be called Sadnat Gal's showcase outpatient - the most accomplished, the most demonstrably improved. But like all the 115 outpatients here - whose psychic wounds go back as early as the Six Day War - Yarkoni stays heavily medicated. "God forbid if I fall asleep without taking my medication, I wake up in a panic," he says.
Like 90 percent of the inpatients, he suffers from insomnia. "The only good sleep I usually get is for about two hours around sundown," he says. "But this is already a part of life. You get used to living with your limitations."
People who know Yarkoni's story are often surprised at how bright and optimistic his paintings look. "I lie when I paint," he explains. "I force myself to see things that are good, comforting, sympathetic, and I paint that. I don't want to show all the poison inside me - I want to create a world that's better than the one I'm in."
OVER 3,000 IDF veterans have been recognized by the Defense Ministry as sufferers from chronic combat stress, but the actual number is unknown because many victims live with their insomnia, nightmares, bouts of rage, extreme anxiety, flashbacks and such without seeking treatment. Many others wait years, or decades, until they get help.
Psychiatric treatment can lessen the effects of combat stress, make it more "manageable." But for all except a small minority of victims, the affliction never completely goes away.
"It's as if a person's spiritual spinal cord has been severely damaged. It may take him a long time to recover, he may never recover, but the thing is to try to hold him up," says Dr. Michael Polliack, head of Sheba's treatment clinic for post-traumatic stress syndrome. (PTSD may develop in someone exposed to life-threatening danger and violence, but in about 80% of such cases, the symptoms disappear shortly. If they persist, however, over the course of several months, the condition becomes chronic and usually requires indefinite treatment. PTSD that results from war experience is called combat stress.)
As for the best approach to treating battle stress, Polliack says there is "no consensus" among psychiatrists. There are several new methods, including "prolonged exposure," which seeks to desensitize the patient to the traumatic incident, and EMDR (eye movement desensitization and reprocessing), which aims to drive away debilitating memories.
Dr. Rakefet Rodriguez, a psychiatrist at Be'er Ya'acov Hospital, says experiments are being conducted with psychedelic drugs; she and her colleagues are administering the drug Ecstasy to combat stress victims in psychotherapy.
Michael Hershkowitz, an activist on behalf of combat stress sufferers who developed the malady after the horrific Chinese Farm battle of the Yom Kippur War, says, "Prozac is the mildest medication I've taken."
Not too surprisingly, Israel is a world leader in the treatment of combat stress, says Polliack. Since the Second Lebanon War, he says, the military has been trying to "catch" the disease early by keeping tabs on that war's fighters. But this is no guarantee of prevention. I ask Polliack if even immediate psychological treatment on the battlefield for combat stress victims could prevent the disease from becoming chronic, and he replies, "Not necessarily. We're not even sure about the best Emergency Room treatment for trauma victims. In some cases, the best thing to do for battle stress may be to just leave them alone for awhile and make sure they have a lot of family and friends for support." In some cases, psychotherapy not only doesn't help, it hurts.
"Without question, I was doing better before I started seeing a psychiatrist," says Hershkowitz. "I suffered, sure, but it came and went, it wasn't so close to the surface like it is now, I could push it down, it wasn't in front of me. I could work full-time. Now, since I started bringing up all those memories, it's with me all day. I can't work anymore.
"But on the other hand," he adds, "I don't know what would have happened by now if I didn't start seeing a psychiatrist. Maybe sooner or later I would have exploded. You can't know."
HERSHKOWITZ, 56, was recognized by the Defense Ministry for combat stress and began seeing a psychiatrist in 2000 - for a disability that dates back at least to the Yom Kippur War, but which, in his opinion, really began a year earlier in the army, then was worsened by his experiences in some of the most savage fighting of the October 1973 war - the battle at the Chinese Farm.
Since coming to grips with his problem, he has written a book, A Broken Mirror, about his struggle with combat stress, and has founded an organization, Matzdi'im (We Salute), on behalf of sufferers like himself.
Sitting one evening at the kitchen table of his Rosh Ha'ayin home, Hershkowitz says he came from a "fighting family" - his father was an Irgun man who fought the IDF during the battle over the Altalena arms ship. After reading heroic stories about tank battles in the Six Day War, he enlisted as an IDF tank driver. But about two years after he joined the army, he was stripped of his rank for what he considered a negligible infraction at worst.
"In a room on the base in front of all the officers," he says, "the commander took scissors and cut off my stripes."
Afterward, Hershkowitz went back to his room and shot himself in the side; he pulls up his shirt to show the scars from the bullet's entry and exit. Eventually he was released from the army with a low medical profile. But a few months later the Yom Kippur War broke out and he wheedled an IDF medical panel into raising his profile back to combat-ready level. In the near anarchy of those first days of the war, he joined up with a tank unit going into the Sinai.
"For me it was a suicide mission," he says. "I wanted to come back in a plastic bag as a way of getting back at that commander who humiliated me."
He ended up at the Chinese Farm. "It was a killing ground," he says. "On one side was hills, on the other side was the Suez Canal, and we were on the plateau in the middle, fully exposed."
While describing the battle, Hershkowitz's gaze becomes distant, his words are broken by long silences, his face contorts, and shivers run through him.
"The Egyptians started firing missiles at us. There were two Egyptians with Kalachnikovs shooting at us - I ran them over. The Egyptians were firing [rifles] from 20 meters away. We got out of the tank and ran for cover with the paratroopers. We were hiding in the irrigation ditches... They were shelling us for seven, eight hours... There were missiles falling all around."
Hershkowitz cries quietly, but gathers himself together and continues. "We called for help. Help came in the afternoon. I saw paratroopers wandering around barefoot, their uniforms were in shreds. We were the last to be rescued."
Later, on a winter night at a base back in Israel, he first realized something was wrong when a crash of thunder sent him diving to the ground, scurrying for cover. From then on, sudden loud noises would jolt him back to the Chinese Farm. Once, while giving a talk about the battle, he broke down completely. He became manic-depressive, and his business fortunes reflected his moods - from boom to bust.
Hershkowitz says he's luckier than most combat stress victims in that his wife and three children have stuck close by him through the unending ordeal. His daughter became an IDF tank instructor and she's now studying to become a psychologist to treat veterans like her father. I ask him if this compensates somewhat for his suffering, if he's able to take some satisfaction from his family's devotion. Hershkowitz sort of shrugs. He says he doesn't have the emotional capacity. "I can smile, but it's fake. Since the army, I've basically stopped living."
ON HIS WAY into the Sadnat Gal rehab center, Gabi Kait, who deals with combat stress sufferers for the Disabled IDF Veterans Organization, exchanges a few words of survivor's humor with every outpatient he passes. He hugs one of the two women at the center - ex-policewomen who developed combat stress from dealing with intifada terror attacks.
"How am I?" the woman says. "I got out of bed this morning, so I guess I'm all right."
Kait, who developed combat stress in the Yom Kippur War, goes into the outpatients' greenhouse where a veteran about 60 years old is tending to the plants. The man takes a small orange off a branch and starts eating it, peel and all. "Isn't that bitter?" Kait asks him. "I've tasted things more bitter," the man replies in a slurred voice, and Kait smiles and nods his head on the way past.
Sadnat Gal, one of eight Israeli rehab centers for combat stress victims, is for hard cases - men (and two women) who had been too withdrawn, anxiety-ridden and out-of-control to fit into any other rehabilitation routine they'd tried.
"Before they came here, they were either sitting at home staring at the four walls, or they were on the street," says Niza Regev, director of the center. Some combat stress victims are homeless to this day; Regev knows of one who lives in a Rishon Lezion park, and Kait knows another - a former colonel - who lives on the street in Jerusalem.
When Sadnat Gal opens at 7 a.m., many outpatients are already waiting outside the door. "Insomnia," explains Regev. Besides getting psychiatric counseling, they can paint, play snooker, sing in a choir, work at the computer or learn English. Occasionally an outpatient will be overcome by memories and begin to sob, but usually it's enough for one or two of his fellows to come talk to him and bring him out of it.
"Sometimes we have to call a psychiatrist, and in rare cases we have to send them to the ER. When we first opened the center 11 years ago, those sorts of crises were happening just about every day. Now it's an unusual thing," says Regev.
On days when there's bloodshed in Israel, the atmosphere inside Sadnat Gal changes. "During the intifada, you could feel the tension in here. We would try to keep the television off," she says.
Several of the outpatients here have improved dramatically. Regev tells of a Six Day War veteran who spent 15 years alone in his room, going out only to see his psychiatrist for counseling and medications. "Now he's writing his life story here on the computer. He drives a car, he's traveled overseas. He helped build the synagogue in his neighborhood," Regev says. A Yom Kippur War veteran who suffered violent rages before coming to the center is now a reflexologist treating expectant mothers.
"Some of the younger men here have gotten married and had children," Regev says happily. On the other end of the scale, two Sadnat Gal outpatients have committed suicide.
I ask if the center was getting a lot of veterans from the Second Lebanon War, and she says it is still too early. "It takes time for soldiers, who are usually so macho, you know, to admit they've got a problem, and then it takes a long time for them to go through all the procedures and evaluations by the Defense Ministry before they're recognized as disabled. The combat stress victims from the last war in Lebanon still haven't really surfaced."
LIRON NIR-LASHOVITZ is an exception among veterans of that war, but then he had a head start, so to speak: He first developed combat stress in 2002 in Hebron, then four years later volunteered to go back into battle in the Second Lebanon War, where the disease struck him a second time, only much worse than before.
At 26, Nir-Lashovitz looks like a young Brad Pitt. In an interview at his Jaffa apartment, he was fidgety, absently squeezing a pillow, tapping a pen, although such excess energy might be natural for him; his hobby is playing drums. His drum-playing ability, though, has been hampered by the mild neurological damage he suffered when a bullet grazed his skull in Lebanon. Earlier, in Hebron, he had been wounded in the leg by shrapnel. But from the way he tells it, his combat stress didn't result from his own brushes with death, but rather with the deaths of his comrades.
He was a combat medic. "My father was a colonel, my mother was a major, my older brother was a paratrooper - for me, there was no other option except going into a combat unit," he says.
Six years ago, Nir-Lashovitz was the first medic on the scene in Hebron where 12 Israeli soldiers and civilians were killed and 15 wounded in an ambush.
"I treated a lot of the wounded that night. I carried the corpses of soldiers on stretchers," he says. "The feelings I had of seeing my friends killed, the sights, the sounds, the smells - all that stayed with me for a long time." He had flashbacks and nightmares, and "every little noise made me jump," he says.
After getting out of the hospital, he began seeing a psychiatrist at Sheba Medical Center's Combat Stress Treatment Unit. Still in the army but allowed to stay at home, he could have just sat it out until his enlistment duty was over, but his conscience was bothering him.
"I joined the army because I wanted to make a contribution, and I didn't feel I was doing it, so I lied to my psychiatrist - I told him I was recovered, that I was okay. He wrote a letter to the army saying I was fit to go back to my unit, and they took me back." Two months later, Nir-Lashovitz was demobilized.
Over the next couple of years his symptoms worsened - nightmares, anxiety, crying jags. He began seeing the psychiatrist again and started taking medication. Then, in July 2006, he received an emergency call-up notice to report to his base for duty, and five days later he was in Lebanon. He thought he could tough it out during the fighting. "I treated a lot of wounded soldiers. I was cool. I was trying to be, anyway," he recalls with a wry grin.
He wasn't having any flashbacks to Hebron. He was actually all right until the last, bloodiest day of the 33-day war, when his unit was waiting outside a village and Hizbullah guerrillas spotted them and fired a missile into their midst, killing one soldier and wounding five others.
"I decided to move the wounded soldiers over behind a house about 150 meters away. But Hizbullah was watching us all the time, and they fired another missile at us when we got there. This time three soldiers were killed. Fifteen other soldiers were wounded, including me and the other medics."
He was bleeding heavily from the head, and had to bandage himself because his fellow medics were so badly wounded. "I don't know how I remained conscious," he says. He remembers being taken by helicopter to the hospital in Haifa. He had just seen three of his comrades killed, and then, after undergoing a lengthy surgery, he woke up and saw a picture on TV of a fourth soldier who had died meanwhile of his wounds.
"These weren't just acquaintances. These guys had been my friends for 10 years," he says.
After returning home, his combat stress escalated. "Not always, but sometimes, when I'd be walking on the street, I'd feel that someone was chasing me. I dreaded being in crowds, so I stayed away from them. I couldn't handle loud, sudden noises - the winter storms drove me crazy. Mainly what I felt was fear."
At home with his long-term girlfriend, he was having crying jags, and he'd wake up at night and turn on all the lights in the apartment because he thought an intruder was there. He had outbursts of rage. "I never became physically violent, thank God, but I wasn't very far from it." After a while, his girlfriend left. "I can't blame her. I wasn't easy to live with," he says.
He'd studied Chinese medicine for nearly four years, but decided he had to give it up. "I'd be treating somebody lying down on the table in front of me, and I'd feel like I was handling the corpse of one of my friends."
That was about a year ago. Today Nir-Lashovitz takes medication to help ward off insomnia, anxiety and depression. He sees a psychiatrist once a week. He's studying photography four days a week, from 9 a.m. to 6 p.m - a major accomplishment for someone with combat stress, which tends to disrupt concentration.
From his sessions with the psychiatrist, he's learned to gain a measure of mental control over his symptoms. "If I'm standing in a room and somebody comes in and shuts the door behind me, I'll react, but at the same time I'll tell myself: Take it easy. It's just a door."
He stays in touch with the families of his comrades killed in Lebanon. "I had a camera with me during the war, and I took the last photos of those soldiers about 10 minutes before the missiles hit, and their families have put those photos up in their homes. It's very important to me that I was able to give those pictures to them."
He has a new girlfriend. "My ex-girlfriend was always comparing me to the 'old Lior,' the guy I was before I got hurt. My girlfriend today only knows me for who I am now - with her, I'm starting off with a clean slate." For all his hardship, he prefers the new Lior to the old one.
"I'm a more thoughtful person. Things have more meaning to me now. Most of my friends these days tend to be quite a few years older than me, and some of them are going through the same thing I am. The friends I used to have - I'd have nothing to talk about with them now. We used to talk about parties, and girls, and drinking - and I'll still go to parties now, but that's not what's important to me anymore."
He says he still has anxiety attacks, but much less frequently and severely than before. "I'm a lot better than I used to be. My psychiatrist says I'm on the high road."
Laughing and shaking his head, Nir-Lashovitz says there will be no third time for him in the army. He realizes he made a terrible misjudgment going back after his trauma in Hebron. But even now, there are moments when he'd like to be a soldier again.
"Sometimes I'll be watching the news and I'll see our soldiers in the field, and I'll think: I wish I was back out there. In some part of me, I miss it - not the fighting, but the feeling of making a contribution. But then, after a couple of seconds, I'll say - no, no more for me. I've done enough." n
Thanks to Koby Yitzhak, head of the Tel Aviv branch of the Disabled IDF Veterans Organization, for facilitating most of the interviews for this article.
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