Why is it that, although terrorism and war are not infrequent in Israel, the number of IDF soldiers suffering from post-traumatic stress disorder (PTSD) is actually amongst the lowest in militaries around the world?
In 2013 the Israel Defense Forces Medical Corps Mental Health Department released a study on PTSD with staggering statistics. For example, following the 2006 Second Lebanon War, 1.5 percent of Israeli soldiers in mandatory service and in the reserves were diagnosed with PTSD. Some 2.9% of the IDF servicemen who took part in the military campaign sought psychological help after the war, but were not diagnosed as suffering from PTSD. In contrast, a U.S. Army Medical Corps study done in approximately the same time period, found that about 8% of U.S. soldiers who served in Iraq and Afghanistan had been diagnosed as suffering from PTSD.
According to the IDF study, PTSD diagnoses in other militaries worldwide ranged from 2% to 17% of troops who participated in combat.
How can this be? Is it special training received in the IDF? Or is it something else?
Israel has developed world class expertise in the treatment of trauma but it is not some special prevention regimen that makes the difference. It isn’t something different in Israeli soldiers. Our soldiers are people from all backgrounds, from countries around the world. Yes, their training is not the same as in other armies but much of it is very similar and the differences are not enough to account for the statistics.
Israeli soldiers aren’t different. It is Israel itself that is different.
Unlike in the US, there is no person in Israel who is untouched by terrorism or war and soldiers are an integral part of Israeli society.
The IDF is a citizens’ army, consisting of our fathers, brothers, husbands, friends, sisters and daughters. Almost every household has a soldier, if not a number of soldiers, many of whom have fought in multiple wars. Those who don’t have a soldier in their own family live next to a household with a soldier. Virtually every person does reserve duty and /or has colleagues who take leave from work to go to reserve duty. Israelis pass soldiers on the bus, in the train and in the store. Even those portions of society that do not enlist (such as Orthodox Jews) have seen soldiers and had interactions with soldiers. This means that many Israelis who have not themselves been on a battlefield have secondary experience with those that have – they have dealt with injuries and death of friends and family, brothers and sisters.
The prevalence of terrorism means that there is little separation between the soldier on the battlefield and the mother in her home, the child walking to school or the father driving to work. Many Israeli civilians have found themselves under attack by terrorists with rocks, knives, guns and suicide bombs. Others have witnessed attacks or seen their aftermath. Others are related or connected with those who have been in these situations.
The average Israeli knows or can imagine what a soldier or a victim of terrorism has experienced. Personal experience creates understanding and compassion for the pain of others.
Israel’s current generation of 40 to 60 year-olds grew up with Holocaust survivors. They didn’t understand the survivors or their sometimes-strange behaviors. Some survivors picked up half-eaten sandwiches that other people had thrown away and put them in their pockets, just in case. Others were terrified of dogs. Some clung to their children. Others almost never touched their children. Some were perfectly normal in the day but screamed in their sleep.
It took many years for people to understand that these behaviors developed as a result of the extreme trauma the survivors had experienced. Later on, it was discovered that trauma could be passed on - that the second generation, the children of the survivors had developed their own form of trauma related behaviors.
The average Israeli knows that terrible experiences alter the psyche and effect behavior.
“What doesn’t kill you, makes you stronger.”
Israelis have developed an attitude of “What doesn’t kill you, makes you stronger.” Although this expression is often said jokingly, regarding small uncomfortable situations like going to the dentist or telling a child to do something he or she doesn’t don’t like, it is indicative of a societal mindset. Israeli’s experiences as individuals and as a nation have taught that terrible things will happen. Some people will die as a result but those who survive will be stronger because of it. This is the mindset of resilience.
“Maybe it’s because of something he experienced.”
A lawyer I once met was obviously brilliant but also obsessive and prone to temperamental fits. I was told about him: “Oh yeah, he’s nuts. But maybe it’s because of something he went through [as a soldier]”. In a single breath, there was a swift judgement, forgiveness and understanding.
Generally Israeli society is willing to give people the benefit of the doubt and forgive unpleasant behaviors if and when they are a result of previously experienced trauma.
4) It’s different when you are fighting for your home
One of the reasons traumatic events can be scarring is that they often seem completely random, creating a feeling of helplessness. The soldier may question why his friend was killed and not him, after all, seconds before, he was standing exactly where his friend stood when the bomb exploded. The person riding the earlier bus might question why she left the house earlier that day and wasn’t on the bus that was blown up in the terror attack – the bus she normally rides to work. The lack of control over traumatic events that occurred or could occur in the future is frightening. In Israel, this is tempered with a collective purpose. Everyone goes to the army for the same reason. Everyone suffers from terror attacks for the same reason. The individual cannot control what is happening but at least they know why it’s happening.
It’s one thing to be a soldier fighting in a far-off land because your government decided it’s necessary. It’s very different when you can stand on a hill and see the homes of the people you are defending, possibly even your own home. This doesn’t make the traumatic experience easier but it gives the psyche a way to process it. There is a goal and a purpose, it’s not random - it’s personal.
While Americans might honor or respect their soldiers, Israelis love their soldiers passionately. Honor is something you do from far away. Love is up close and personal.
To Israelis, soldiers aren’t heroic figures you throw parades for and give medals. Soldiers are our boys, our girls, our family. You feed them, make sure they are warm and comfortable. You let them sleep on your shoulder if they fall asleep next to you on the bus. It doesn’t matter if you never saw them before and don’t know their name. It doesn’t matter if they come from a different background than you or have a personality you don’t like. The minute they put on the uniform they belong to you and you belong to them. Each soldier could be anyone’s soldier so you do for someone else’s son or daughter exactly what you would hope someone would do for yours. Our heroes are soldiers that go home and their mother tells them to take out the trash. No one calls them “Sir.” Rarely will anyone thank them for their service but everyone will love them.
Relevant to people everywhere…
My grandmother always said: “You can learn from anyone. From some you learn what to do, from others you learn what not to do.” I’m writing this because the Israeli example is relevant to people everywhere. From it, I hope that others will learn how to empower themselves.
Today, with the rise in terrorism worldwide, there is added impetus to understand trauma and PTSD. While one might be more likely to discover PTSD in soldiers, security forces or rescue workers, anyone who has been exposed to highly traumatic situations (such as a terror attack) could also be afflicted with PTSD. Just ask the people who worked next to the Twin Towers, the children of Beslan, the Bastille Day revelers in Nice, or pretty much any Israeli citizen.
We don’t have to go even as far as terrorism and war. Sexual abuse survivors for example, also belong in this category.
Not everyone who experiences trauma, even extreme trauma, will later be afflicted with PTSD. In fact, most people will not. Even so it behooves us all, no matter what our station in life, position or nationality, to have at least some understanding of trauma and PTSD. Sadly, this information could suddenly become very relevant.
The magic words
What can you do to help someone suffering from trauma or PTSD? You don’t have to have any special qualifications to help. Amazingly there are magic words that you can say that, if you mean them, can work wonders. Can you guess what they are?
Trauma manifests itself differently in different people. One of the most insidious ways that traumatic experiences can affect the psyche is in alienating the individual from those who care about him or her. The feeling that “no one can understand me” (which is often true because only those who have had similar experiences can really understand) leads to the feeling that “I am alone”.
A person who is suffering needs to find a way to release their pain. This needs to be done in a way that suites that individual and needs to happen in a way that they don’t feel judged. Often times successful therapeutic methods have to do with activities and/or with animals (who don’t demand explanations). There are many effective methods, as a bystander you can help someone suffering find the method that suites them but otherwise that healing is their private journey.
Here’s what you can do:
Address the lie of, “I am alone.” This thought is poison to the soul and can lead even the strongest individuals on a downward spiral. The key to the prison this thought creates is astonishingly simple. All you have to do is mean it.
Use the magic words: “You are not alone.”
Understanding, being there without judging, love… these don’t fix the problem but they go a long way to making it less severe.