Psychotrauma: Beyond War’s Headlines
The machine on the Israeli neurosurgery ward that kept the 18-year-old boy with shrapnel in his brain alive made a constant, low-pitched hissing sound. I listened to it, watched the boy’s chest rise and fall as the machine breathed for him. The shrapnel was lodged in his brainstem, the vital area that controls our breathing and circulation. Surgery could not be performed in this key area; he would not recover.
Would he die while on the mechanical ventilation, or would his parents, when they understood that his condition was hopeless, agree to pull the plug?
I’m getting flashbacks like this. They’re memories from when I went to Israel during the Yom Kippur War as a medical volunteer. Just before the current Israel-Hamas war broke out, I wrote a newspaper opinion piece about that experience: The Faces of War: My Time as a Doctor in the Yom Kippur War Left Me With Haunting Questions.1
And now, since October 7, the vivid images of the Hamas massacre are invading my sleep.
Were you ever in an accident or a near-death situation, that left you on edge, traumatized? Or perhaps you witnessed a sudden and frightening event happen to somebody else? What happened to you afterwards?
Did you have flashbacks, and replay images of the harrowing scene? Or did you have trouble sleeping, nightmares? A feeling of being on edge, that something bad was going to happen?
Many of us have experienced this kind of acute stress reaction at some point in our lives. When it lasts longer than a month, it’s labelled as post-traumatic stress disorder (PTSD). Whatever the duration, we need support. At a minimum, it helps to talk with friends or family about what happened, and what we’re experiencing. But when symptoms don’t go away, and interfere with our daily lives, professional counselling is recommended.
In my previous post, The Faces of War, I touched on the long-term psychological trauma that war brings to non-combatants. While we naturally focus on the daily headlines about loss of life, we overlook the more hidden consequences: the emotional stress and psychotrauma of war.
“Trauma”, 2023. Graphite on paper by César Rodríguez, student in Visual Arts, Universidad de Guanajuato, Guanajuato, Mexico
The Children
In Israel, children have been showing the signs of psychological trauma since the massacre by Hamas on October 7. “We’re witnessing a tsunami of anxiety symptoms among children,” said the chair of the Israeli Pediatric Association.2
In Gaza, about half the population of 2.3 million are children. Not surprisingly, kids in Gaza are reacting to the near constant bombing. They become more anxious, and have sleep disturbances, nightmares, night terrors. Overwhelmed by fears and worries, behaviours may regress: many of these children become hyperactive, go back to bedwetting, cling to their parents all the time.3
The Evacuees
We can only imagine the mental trauma suffered by survivors of the Gaza nightmare. About 1.8 million Gazans have been forced to leave their homes. Many are packed into temporary shelters, yet remain unsafe from attack. What kind of support can they be receiving?4 We know more about the emotional-trauma support available in Israel, to the 200,000 people evacuated from the south and north of the country. Psychologists, psychiatrists, and other therapists are volunteering their services.
Fear, and Memory
They are certainly needed. During the October 7 horrors, Hamas terrorists mercilessly gunned down elderly, women, and children hiding in safe rooms. They set homes afire with helpless, terrified people still inside. Children, some tied up, were forced into a room and slaughtered.
For many Israelis and Jews around the world, the Hamas onslaught is triggering the most excruciating memory of all, the worst slaughter ever to occur on the planet: the Holocaust.
There were haunting resemblances: scenes of armed men going door to door to hunt and kill Jews; scenes of families hiding from them, of parents trying to keep their young children silent so as not to give away their location.
Following the national shock, there has been nationwide grief, and a collective psychological burden. Dr Michel Thieren, WHO Special Representative in Israel, described what he found 2 weeks after the massacre.5 “The fact that so many Israelis are still being held hostage by Hamas,” he said, “means that there is no chance for the wider public to begin the healing process. It is on their minds 24 hours a day. It has added to the burden… triggering an acute need for mental health services.”
First responders are particularly exposed to stress. Pity, too, the overwhelmed forensic scientists who had to identify 1,200 bodies—many of them mutilated. And those who helped collect the remains of Hamas’ victims. They have witnessed the gruesome evidence of rape, and mutilation of sexual organs.6
How does one deal with such images, such memories?
Videos of the Atrocities: Watch at Your Peril
Some Israelis can’t stop watching videos of the Hamas atrocities and are developing symptoms of PTSD.7 8 These videos have been disseminated via social media and text messages. How can one forget such brutal images? They include videos of gunmen at a music festival shooting the dead bodies of civilians in cars. Another shows the terrorists beheading a body with a hoe.9
You can’t “unsee” such images. Watching videos of people being murdered, of dehumanisation, does nobody any good. It’s disaster voyeurism. The images replay in our minds, prevent sleep, upend our mental health.
Psychological First Aid: Therapy on the Street
Early intervention in PTSD can help people stay resilient. Therapy includes support through bereavement and grief; it must also address family and social supports. Early intervention can prevent PTSD from becoming chronic and a way of life.
In Israel, the survivors and the evacuated civilians receive emotional support from social workers, psychologists and psychiatrists, many of whom are volunteers. Other civilians must search for emotional aid in other places. Some contact ERAN, the Emotional Support First Aid Initiative, that provides mental health services by phone and online.
There is also a team of 80 psychologists and social workers providing free outdoor mental health services to Israelis. They sit in public spaces throughout the country and offer twenty-minute sessions for emotional support. Sitting under prominent signs, and wearing distinctive shirts to make themselves visible, they encourage as many people as possible to approach.
They are also in Tel Aviv’s “Hostages Square”, where many families of the kidnapped civilians reside while waiting for news of their children, brothers and sisters, parents. There is a music therapist, and an “expression wall” where people can write or draw their emotions. But the talks are the primary activity.
I recently attended a Zoom session with the leaders, Dr. Ortal Shimon Raz, clinical psychologist; Prof. Boaz Ben David, psychology researcher at Reichman University; and Tchelet Bressler, psychology student. I asked them how, after listening to the distraught families of the hostages in Gaza, they manage to deal with their own emotions. They meet regularly, Prof. Ben David told me, to air out their experiences, support each other.
Prof. Boaz Ben David and “emotional first aid” in Hostages Square, Tel Aviv. Photo: Orel Cohen
First, put on your own oxygen mask
Prolonged exposure to other people's trauma can be exhausting. Doctors, nurses and others treating the wounded find their mental health is affected by the stories they hear from survivors.10
To be able to help others, professionals need to take care of themselves first. And part of that is leaning on each other for support. The risk of not doing so, even for the most caring professionals, is to become overwhelmed by the needs of others. Sadly, that can lead to “compassion fatigue”, a loss of empathy.
In therapy, as in an airplane, you need to put on your own oxygen mask first.
What next?
Israel clearly cannot tolerate a messianic Hamas on its border whose aim is to annihilate the country, and that perpetrates horrendous, meticulously planned, terrorist atrocities.
Palestinians cannot be expected to tolerate forever their loss of human rights, whether in the occupied West Bank or at the hands of Hamas in Gaza.
In marked contrast to Israelis, Gazan civilians continue to live under daily bombing, with no reliable sanctuary. Their current struggle is for basic existence. Professional mental health support would be an unimaginable luxury; the psychological consequences for the survivors are frightening.
Beyond physical harm, vast numbers of children and adults on both sides are being left with emotional and psychological traumas. These will have long-term consequences. These traumas, the inner wounds that do not make the headlines, will—sadly—be a lasting effect of this war.
Researching for this piece has left me with vivid images that interfere with my sleep. I came across horrific details that I’ve chosen not to include here. I’ve no wish to traumatize you, my readers, with them. They don’t easily go away.
Beyond politics, beyond ideology, we are human under our skins. Can we not look into each other’s eyes, recognize each other’s suffering? Those who can feel no compassion for the innocent victims on the other side have lost their humanity.
Endnotes
Thank you for this Peter. On both sides of this war will be inter-generational trauma. No one wins.
My friend sent me a video of a post-bombing scene in Gaza. It was degrees above shocking, but provided a necessary corrective toy perception of war and its aftermath. We are, in the main, removed from the reality. For my part, all non-graphic reporting has allowed me to keep the horror as an abstraction. You're right, the images can't be unseen, but like mass shootings. If not seen at least once, their reality is less than vague. The powers that be do not want us to see the suffering and get closer to the pain. Because when we do we cry, Stop!