Taking the war out of the soldier

IDF combat troops often need help readjusting to civilian life.

Ruth Pat-Horenczyk (photo credit: )
Ruth Pat-Horenczyk
(photo credit: )
Could it be that after all of Israel's wars and the hundreds of thousands of citizens who have worn the Israel Defense Forces uniform, nobody has thought about the need to smooth the psychological transition from military service to civilian life? In recent decades, the IDF has become very aware of post-traumatic stress disorder (PTSD) - a syndrome that can cause sleep disorders, difficulty concentrating, irritability, nightmares and flashbacks to the traumatic events - and sent victims for treatment. But how about the majority of demobilized combat soldiers, free of PTSD, who nevertheless experienced enough stress, fear and other negative feelings during their service to need psychological attention before resuming their lives? DR. DANNY BROM, director of the Temmy and Albert Latner Israel Center for Treatment of Psychotrauma (ICTP) at Jerusalem's Herzog Hospital, and Dr. Ruth Pat-Horenczyk, its director of child and adolescent services, have developed a model - based on short-term group therapy combined with outdoor adventure therapy - that offers hope for relief. Called "Peace of Mind," the pilot project is supported by foreign donors, with the enthusiastic cooperation of IDF units and the handful of discharged soldiers who have participated so far. The ICTP conducted the pilot project in the aftermath of the 2006 Second Lebanon War, in which thousands of soldiers participated for 33 days. Two groups from elite units participated, one group of 25 going for a retreat in Holland and the other with 10 participants to France. In the first group, soldiers from an elite rescue team were made responsible for all daily functions of the boat they traveled near the north shores of Holland. They received two daily psychotherapy sessions from a pair of professionals from the Jerusalem center. Last October, the ICTP took a group of combat soldiers who lost comrades in the war to Paris for a one-week program that combined traveling, relaxation and therapy. In August, another two groups will go abroad for such an experience. "In the psychotherapy sessions, participants are helped to review what they've gone through and come to terms with it," says Brom. "Sometimes black humor about death is expressed; if they get time out to process their feelings and experiences, they will have an outlet. They see that friends have the same issues, and that talking about it is not as frightening as they thought it would be. On the battlefield, one has no time to think. Afterwards, they will usually say they're OK. But after psychological intervention, they realize they were actually in much more distress than they realized. In the long run, it's important to build resilience." PROCESSING TRAUMATIC experiences may help soldiers during their transition between mandatory service and civilian life to expand their self-awareness and coping abilities, says Brom. "Participation in these workshops gives a soldier entering civilian life a chance to learn, experience, think and integrate his experiences to attain a feeling of completion and balance." "The soldiers in both groups built relationships, developed a sense of control and had the opportunity to express themselves in a safe atmosphere," adds Pat-Horenczyk. "Those in need of treatment for PTSD were identified and treated. The soldiers and commanders were wildly enthusiastic about the experience." The two psychologists believe that difficult military experiences may be one of the reasons that large numbers of demobilized soldiers "run away" to the Far East or South America; take drugs, drive dangerously and have problems in interpersonal (including sexual) relations and marriage. It could even play a role in the relatively high rates of emigration in this age group. "When discharged, soldiers get money and advice on job interviews, but nobody asks about their emotional state," says Brom, who himself immigrated decades ago from Holland. "From the outside, they all look fine. I'm sure that most really are fine, but some suffer in silence. Most discharged soldiers who have problems don't go for help even if they have all kinds of symptoms," says Brom - himself the father of a newly demobilized soldier son - in an interview. "You can't expect the IDF to perform the service we are suggesting; it's a luxury. But that doesn't mean it doesn't need to be done." COMPULSORY IDF service comes at an age at which young people are striving for autonomy and self actualization, the psychologists note. "Army service requires the teen who has just demanded his own territory to live in a close and demanding shared community, lacking any personal signature or individualism. Israeli youths are thus often delayed by army service, in comparison to youths from other countries." Every year, thousands of combat soldiers are discharged back to civilian life. The majority take from six months to a year to readjust. To clear their minds, many "trek" to the Far East or South America, which sometimes leads to new problems. They attempt to regroup after this rite of passage, often with great difficulty. There is an urgent need to strengthen our released combat soldiers, to help them make this adjustment more easily, they insist. RESEARCH ON discharged Israeli soldiers found that almost 75 percent didn't know what they wanted to do with themselves after their service, Brom and Pat-Horenczik report. Further investigation found that 50% were planning a trip abroad, 40% were planning to work in a temporary job or study (mainly, for completing a high-school diploma).Very few were able to commit to a clear plan. The end of army service typically results in feelings of nervousness about the newly earned freedom, as well as sadness, pressure, depression, and even mourning. When they are discharged, they suddenly need to start making decisions independently, and many post-service soldiers go back to the developmental phase they were in before the army. As an example of difficulties, Brom suggests that soldiers who spent many long hours at checkpoints in Gaza and the West Bank - examining Palestinians who might be suicide bombers - may regard everyone they meet with suspicion and develop a lower threshold for anxiety. This could seriously affect their later relationships, he says. "Our kids learn for three years to look for enemies and be very alert, and then when they return to civilian life, we're surprised that they continue this." "We had some arguments about the project," Pat-Horenczyk says, nodding at Brom. "Taking them abroad means taking them away from their usual surroundings and away from their cellphones; it is of course also very expensive." "The challenge is to do something that would attract them. You can send them to the Negev, but if they spent their military service there, it might not mean enough to get them to participate," adds Brom. "It's important that a group who served together in danger go to enjoy themselves together. We have to test it out, whether the program would be as effective if held in Israel." "The question was whether the same very positive effects would be seen if they are taken to an out-of-the-way spot in Israel," continues Pat-Horenczyk. "If there is great need for this experience among all combat soldiers, it could be run like 'birthright-Taglit,' the program that has brought many tens of thousands of Diaspora youths for short visits to Israel. There are lots of Friends of IDF organizations that I am sure would want to donate toward such a project. Perhaps all discharged combat soldiers could be offered such an experience. You wouldn't need psychiatrists to lead all the groups, as we could train others to do it. The purpose is first to acknowledge that these young people need time, space and professional guidance." ICTP psychologists questioned the participants after their return from the experience to assess the project and found that the therapeutic benefits were universal, even in soldiers who had initially said they had no emotional problems. "One woman medic whose helicopter had been targeted by missiles told us: 'My life has changed twice - the first time by the war, when I felt lucky to be alive. I came back with a lot of stress, but realized I don't have to live with it. In the retreat, I regained peace of mind and optimism.' We are hopeful that we can go on to the next step - to establish a database on five or 10 groups to show the need and respond to it," says Pat-Horenczyk. COUNTRIES USUALLY measure the "costs of war" in monetary terms, the number of casualties and lost production. But rarely do they try to measure the cost in terms of individual human suffering. Unfortunately, conclude the ICTP psychologists, "Israel is a country in which war and combat seem unavoidable, but when a society requires its youth to participate in combat, it is essential to fully comprehend the magnitude of the inevitable psychological consequences. By not addressing the increasingly evident needs of Israel's post-service soldiers with appropriate services to reintegrate them into civilian life, we are not only sending our soldiers to dangerous environments but bringing them back to ones in which they might not be able to function."