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PTSD & Cockroaches

by Yeshara Gold

Straight From Jerusalem

Aviva was just a block from the bookstore with her daughter's new school list in her pocket, when without warning, intense emotions welled up within her. "It wasn't fear that gripped me" she later explained, "but an overwhelming sadness as I walked on Jerusalem's Ben Yehuda Street. Tears flowed down my face as I passed my intended destination and found myself, instead standing outside the Ramon Cafe, a popular restaurant that had recently become once more the scene of violent death for Israelis." Aviva was never in a terrorist attack, nor was any member of her immediate family. But this young mother can be counted as one of the walking wounded, a Post Traumatic Stress Disorder (PTSD) casualty of this war.

A recent American study shows that between 25 to 33% of people exposed to community disasters develop PTSD. Israel with its closely connected communities, has been repeatedly subject to violent disaster on a prolonged basis. Shouldn't that percentage rise far higher in this small country?

From aggressive road rage, to a store clerk's numbness, to the bank clerk's bark, I suspect that many are suffering from either a full-blown case of PTSD or at least a partial one. Some time ago I mentioned to a woman my belief that the majority of our children were, in a sense, victims of this war, terrorized in what should be their own unique safe haven. She looked at me, horrified, insisting her daughter couldn't possibly be a 'victim' and could in no way be adversely affected from the terrorist attacks exploding on all home fronts. Her refusal to even momentarily entertain such a notion is possible evidence of her immovable residence in the State of Denial.

If you don't acknowledge there are cockroaches in the belfry, you can't call the exterminator. The species of cockroach we are infested with here is PTSD. In the Israeli "ye'ya b'seder" ('everything will be ok') society, it's an embarrassment of the nth-degree to admit something might be 'lo b'seder' (not ok) for fear of showing weakness. But PTSD is a normal reaction to an abnormal situation.

The citizens of New York and throughout America who, each in their own unique way, experienced the horrors of the Twin Towers, understood immediately the implications of PTSD. Before the week was out, tables, manned with volunteer therapists were on the city's sidewalks with makeshift art therapy projects and other therapeutic interventions.

We now know of reports of PTSD going back as far as the ancient Greeks. During the battle in Marathon, 490 B.C.E., an Athenian soldier, who suffered no physical wounds, became permanently blind after witnessing the death of the soldier next to him. There is also the 17th century account of the great London fire of 1666 by one of the survivors, "A most horrid, malicious, blood fire.. so great was our fear, it was enough to put us out of our wits." For weeks following the disaster, the writer, along with other survivors, suffered symptoms of PTSD including insomnia, anger, and depression.

It is unfortunate that many people still believe that cases of anxiety, depression, anger, and other difficulties are always due to internal psychological discord, rather than the possibility of external causes and events. It is misguided and dangerous to discount or minimize the effects of social and collective stresses on the individual.

Without any previous psychological problems, a trauma, due to a single powerful event or a series of catastrophic happenings, can cause a wide range of PTSD symptoms. In the Diagnostic and Statistical Manual of Mental Disorder (DMS-IV), the authoritative guide to psychiatric problems, PTSD is the only diagnosis that is attributed to the origin of the disorder which is outside of the individual rather than the individual's personality.

This understanding could reassure the average Israeli that PTSD does not neccessarily come from a weakness of character. Obviously, the pre-trauma personality will have some affect on the response to a traumatic event, but it is clear that personality does not affect the impact of the traumatic event, but rather, the trauma impacts the personality.

According to the DMS-IV, to qualify as someone suffering from PTSD, some of the conditions are:

* Criterion A - Exposure to a traumatic event involving actual or threatened death or injury, during which one responds with panic, horror, and feelings of helplessness.

Who in Israel has not been exposed either first-hand or via radio, newspapers, and television, to the sight of death and injury by murderers and homicidal-bombers? Who does not feel threatened today when Arafat has instructed his people to kill Jews no matter who or where they are?

* Criterion B - Re-experiencing the trauma in the form of dreams, flashbacks, intrusive memories; or unrest when in situations that are reminiscent of the original trauma. Who can forget the images we have seen of the carnage in our streets, the blood in the cafes, the body bags and the burnings of our buses and homes? Who among us does not give a thought to the guard at a restaurant door, or ponder the safest place to sit and eat our meal?

* Criterion C - Showing evidence of avoidance behavior ..

Who hasn't thought twice about going somewhere? How many Tel Avivians avoid Jerusalem and how many Gilo residents avoid HaNafa Street (across from Beit Jala)? Another symptom might be hyperarousal, evident as insomnia, agitation, irritability, or outbursts of anger.

Everyone has experienced trying and stressful points in life, but for an event to be defined as a Trauma, it must be conceived as a threat to life, limb, and to render one powerless. These events induce feelings of intense horror, defenselessness, fear and can strain anyone's powers to cope. If one knows or believes that their life or the lives of others are at stake, this is defined as a traumatic crisis.

During these incidences, one not only gets in touch with their own mortality, but also those of loved ones with a deep feeling of helplessness. Depersonalization and feelings of being a mere pawn in a larger political game intensifies the trauma.

A Trauma is either a catastrophe brought on by natural or man-induced means. For our Jewish characters, integrating the fact that these current catastrophes are man-made shakes the very foundation of our perception of humanity and morality.

PTSD can develop in the thousands of Israelis who happened to be in the area during or directly after a terrorist attack, witnessing the devastation first hand.

Down to the youngest, the masses are exposed to the horrors of terrorism on a continual basis. There are multiple attacks at frequent intervals, and thousands of Israelis repeatedly view televised footage of murder sites over and over, from every possible angle. Unsolicited radio reports blare in taxis, buses, and the local shops. Photos and headlines visually scream out from neighborhood newsstand. These non-stop replays cause a constant re-experiencing of the initial trauma.

Without the necessary awareness, insight, and support, a PTSD sufferer will misunderstand himself and his situation, causing self-blame and guilt. Symptoms, which could be explained with a proper diagnosis, can cause even greater upheaval when left misinterpreted and self-hidden. For instance, nightmares depicting dreadful images can cause insomnia and sleep deprivation. Perhaps even worse is when the content of a dream cannot be recalled yet the feelings of nondescript fear, anxiety, anger, helplessness, and grief continue throughout the waking day.

Flashbacks, intensely clear recollections of an event, can also occur. Visual images, sounds, smells or feelings can all rush back when least expected. Flashbacks are not signs of insanity, but rather, the healthy mind yearning for the trauma to be healed by revealing itself on the conscious level, waiting to be dealt with.

Most thorny of the problems are the subtle, misunderstood eruptions of seemingly misplaced feelings like those of Aviva who casually went to town for her daughter's books. Episodes of re-experiencing trauma can manifest itself with unexplained irritability, panic attacks, rage, or, as in Aviva's case, sudden sadness with no conscious thought of the traumatic event itself.

While this current Terrorist War rages, KIDS FOR KIDS, a twenty-two month old Youth Organization for the Recovery of Young Victims of Terrorism, has furthered one of its goals of raising public awareness on the subject of trauma. By working diligently through the media, one-to-one contacts, and public forums, K4K has helped to educate citizens to identify and effectively intervene in matters of trauma and possible cases of PTSD.

Breaking through the deeply engrained cultural mindset of "ye'ya, b'seder" will be a tremendous accomplishment. But in the meantime, the greater triumph goes to K4K's staff of therapists, social workers, and counselors who deal hands-on with individuals, of all ages, reaching out for recovery from the pain of trauma. In terms of PTSD, with the help of timely intervention and skillful treatment, there can someday be a semblance of "ye'ya, b'seder".

Yeshara Gold, author and journalist, is founder and Director of KIDS FOR KIDS, Youth Organization for the Recovery of Young Victims of Terrorism, dedicated to the Jewish children who have been left orphaned, maimed and traumatized by the recent violence in Israel. Visit their Web site at www.kidsforkids.net