November 30, 2015
In Blog News
Over the last few weeks, hundreds of security forces, paramedics and civilians have responded to severe terror attacks. Some of them are likely to develop post-traumatic reactions. What do mental health officers do and how can these problems be tackled?
Rotem Elizera, Yoav Zitun, Roi Yanovsky
IDF soldiers, Border Policemen, and other rescue personnel who arrive at scenes of terror attacks are all dealing with traumatic events and difficult situations. When the adrenaline finally dies down, they are forced to mentally deal with the experiences from these violent incidents.
The IDF and the Border Police have set up a system of support for those who might develop post-traumatic reactions, and nowadays the military’s mental health officers are more available to troops who have been exposed to terror attacks in the current wave of violence. The mental health officer joins the commander out in the field for every terror attack, contacts the soldiers, and visits the wounded at the hospital. As part of the lessons learned from Operation Protective Edge, all new recruits for combat positions, starting in August, have been trained to provide initial treatment on the scene to any mental and emotional reactions of their comrades in arms.
First Sergeant (res.) Itay (a pseudonym) was a fighter in an elite unit of the IDF during Operation Protective Edge and killed a terrorist in the Gaza Strip.
“I remember seeing the terrorist and it was clear to me that if I don’t kill him – he could kill me or one of the other fighters,” he says. “I remember unlocking the safety, pulling the trigger, and firing a burst. He fell to the ground and didn’t move.”
Itay can still recount that moment, to the very last detail. “The images from this incident haunt me at night sometimes. As much as I try to repress the memory of this incident, it won’t let go. I think it will stay with me throughout every important and meaningful moment in my life. Even though I know this terrorist needed to die, the knowledge that I killed him won’t let me rest.”
Itay is one of the many soldiers who experienced trauma during their army service. “After that incident, we had conversations with commanders and mental health officers and I even went to therapy. I don’t think the incident left me with post-traumatic stress, but that was thanks to the therapy.”
According to him, many fighters who go through similar situations won’t talk about how they feel and the experiences they went through, and some keep things bottled up. “You can’t describe to someone else what goes through your head when you pull the trigger and the bullet hits a person, rather than a cardboard target,” Itay says.
Over 70 terrorists have been shot dead by IDF and Border Police troops since the beginning of the current wave of violence. Alongside the operational success, the IDF is aware of the fact that the mental strain soldiers are under at the scenes of the attacks might lead to issues that won’t necessarily manifest themselves in the immediate future. Military officials say that so far, there have only been a handful of cases in which soldiers who were wounded in an attack, or whose friends were wounded, sought mental help. So far, there have been no instances in which soldiers asked for a break from operational duty because of an incident they experienced.
Much as during Operation Protective Edge, when dozens of mental health officers offered rapid initial help to the fighters on the frontlines who witnessed horrible sights, the Judea and Samaria Division also received reinforcements of mental health officers.
“You have to remember that the fighter learns mental strength in his initial training, where he undergoes workshops to enable him to deal with mental difficulties that could arise during fighting. These are not new recruits who just joined up,” a senior officer told Ynet.
“We’re working with the commanders to help their fighters. Mental health officers in the Central Command are now busy 24/7 throughout Judea and Samaria. In every battalion, before starting its operational activity, the mental health officers help commanders and battalion medical teams brush up on instructions on what to do if they encounter a stressful situation, what reactions they might expect from their soldiers, and how to deal with such reactions. The mental health officers are working as they go along in order to prevent distress from arising.”
“Fighters are not the only ones to deal with difficult situations. Paramedics, rescue teams and even ZAKA personnel deal with complex situations,” says Dr. Gila Shen, the head of the Body-Mind Clinic at the Geha Mental Health Center and a former psychiatrist at the Air Force. “You have to give them the legitimacy to express their feelings, and recognize the fact they’re experiencing a kind of trauma. We explain to them that what they went through is something normal in a reality that is a bit abnormal. Even my daughter, who was a paramedic in the army, was involved a few years ago in a terror attack and was exposed to difficult sights along with others. We, her parents, taught a workshop on processing trauma. In the past, no one would have paid this any mind, but today there is a lot more awareness of this issue.”
The origin of the word “trauma” is Greek, and it means “wound.” Post-trauma is a reaction caused by exposure to a traumatic incident such as a terror attack, murder and sometimes rape.
“Not everyone who is exposed to trauma will necessarily develop post-traumatic reactions,” says Dr. Shen. “If someone is suffering from post-traumatic symptoms a month after the event, it’s normal. If it’s more than that, it needs to be taken care of.”
A senior professional in the field of mental health says that “Symptoms of post-trauma appear after a minimum of three months, and the symptoms are generalized. Those of a soldier in situations such as these could be identical to those of a woman who was sexually assaulted and suffers from post-trauma.
“There is no uniqueness to the trauma of a soldier that killed a terrorist, but it is a very significant incident, therefore we work with him and don’t make do with telling him ‘everything is fine, everything is fine.’ This way we can make sure that in another seven months he won’t wake up from nightmares and develop a post-traumatic response. Every soldier has the phone number of the mental health officer and will turn to them as needed.”
“We know today that 90 percent of people who undergo traumatic experiences will not need to undergo therapy, so around 10 percent will need to be treated by professionals,” says Dr. Micky Pollack, a psychiatrist at Sheba Medical Center in Tel Hashomer.
“Usually it is expressed in dreams and difficulty sleeping,” he continues. In most cases, the army tries to resolve these issues through its own services, and only in cases that develop into something more complex will soldiers go to a psychiatric department in a hospital.
Psychologists and psychiatrists have in the past recommended “questioning” following trauma, but not anymore. “They used to take the soldier who had killed the terrorist immediately after the attack, and they would ask him how he feels,” says Dr. Shen. “Research has shown that in fact immediate questioning such as this, usually with someone who has no desire to talk about it, can sometimes cause even greater damage.”
Psychologists arrived at this conclusion following a trial with soldiers who had fought in Operation Protective Edge. “It’s not always in the soldiers’ heads at that moment. Give them water, let them get some air – that’s absolutely advisable. Questioning them – not so much,” adds Shen.
If so, what should be done? According to mental health professionals, commanders and colleagues of soldiers exposed to traumatic events should hold an open dialogue with them.
The soldier needs to talk about his experiences with the people close to him. Only if unusual behavior is identified is it worth involving mental health professionals. “There is great importance in having a group,” adds Dr. Shen. “Of course this can change from person to person and from situation to situation.”
Border Police officers and soldiers are not always keen on sharing their experiences and feelings. Some of them see it as damaging to their male ego and reject the need for therapy. “For fighters, there is only partial responsiveness. In many cases, only the appearance of post-traumatic symptoms that cause depression and dysfunction will make them seek out a professional,” says Dr. Shen. “Commanders have a very important role, which is to try and identify which soldiers are likely post-traumatic – and they need to encourage them to turn to a professional for treatment.”
The worry over soldiers’ and Border Police officers’ negative mental reactions to seeing their friends wounded or seeing the bodies of terrorists that they shot has led to some new policies. Over the last few weeks, mental health professionals have been advising the IDF’s Central Command to send a mental health officer immediately to the scene of any attack or attempted attack, to become involved straight away, and not to wait until they have been requested by the security forces.
“The mental health officer will touch base with the commanders after every event which has resulted in injuries. Every mental health officer visits the wounded soldiers in hospital with the aim of developing a personal connection. This way, if the soldier wants help, he will know who to turn to,” Dr. Shen continues. “The mental health officers have already arrived at the scene in the middle of the night and walked around giving out the guidebooks for involvement. There are also soldiers who have contacted a mental health officer in light of the tensions and complexities on the ground, but we still have not had any soldiers who have said ‘I don’t want to fight anymore,’ and that is a testament to the strength and independence of the soldiers.”
“It’s not just mental health professionals who have an important role, but also the family,” says Dr. Micky Pollack. “The soldier comes home less understood, he’s less patient, prone to tantrums, frustrated and has great difficulty organizing help for himself. So the family needs to learn to deal with the change as well as stepping up to help him get out of this situation.”
Chief Superintendent Idit Michael, who oversees mental health management in the police, explains one of the ways to tackle possible post-traumatic symptoms from terror incidents. “We work very hard on a routine in order to prepare them. We go into every course in the national police academy. A resilience workshop is held over two days, which gives them responses and tools. We also do weekly classes, exercises and we talk about tools for tackling different situations.
“We have special training for commanders. The commander is the one on the ground who can respond immediately. After an event we have a dialogue with whoever took down the terrorist, a type of emotional investigation, ‘how did you respond, what did you feel, what did you see, what did it do to you?’ Additionally, everyone who has been in a situation like this – whether it’s a Border Police officer or a regular police officer, will get a phone call from the mental health officer for the unit in order to see how he is, what we can offer him, whether he wants an appointment,” Michael continues.
Chief Superintendent Michael says that during the terror wave there have been two significant referrals to the unit mental health officer. “Everyone went back to work, no one refused to respond or to be called up. This stems from a sense of mission and also from a sense of being in the midst of a somehow mobilizing activity. Policemen get feedback from the population and when the home front is behind them, the motivation of police officers and soldiers increases. They are at the heart of a consensus. They feel lifted.
“One of the ingredients of resilience is the feeling that you are efficient and that you have a necessary role to play. That is at the heart of the matter.”