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In Both United States and Israel, Post-traumatic Stress Takes Hold

July 11, 2002
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Do you find yourself waking up in a deep sweat in the middle of the night? How about that fissure of fear running down your neck when you walk down the street, wondering if the approaching bus could contain a suicide bomber?

Whether you’re in Jerusalem or New York, you may be suffering from post-traumatic stress disorder and in times like these, it’s about as simple to solve as the Middle East conflict.

A significant number of Israeli and American adults and children are suffering from post-traumatic stress disorder, following the harrowing events of the last 10 months in the United States and in Israel, according to a number of American and Israeli psychologists, psychiatrists and social workers gathered for a recent conference here on the effects of terror on children,

It is estimated that in Israel, around 75,000 people suffer from the disorder, while another 190,000 suffer from some form of the syndrome.

In New York, a survey taken by the Board of Education six months after the attacks on the World Trade Center found that out of 8,266 students in grades 4 through 12, 10 percent of the students had symptoms of the syndrome.

“In these situations, everyone is affected,” Claude Chemtob, a psychologist specializing in trauma and disaster at the Mount Sinai School of Medicine in New York, said, referring to the events of Sept. 11 as well as the ongoing terrorist attacks in Israel.

“The biggest problem in trauma treatment is that no one wants to see or tell.”

It is difficult to tell when someone is suffering from this trauma. Among children, it isn’t necessarily the students who normally act out, experts say.

And it is more often girls, who in general tend to be extra sensitive, than boys who are overwhelmed by the events taking place around them.

As a result, specialists, “traumologists,” have to create new models of detecting psychological trauma.

“Instead of waiting for people to come to us,” Chemtob said in his keynote speech, “we have to be proactive and detect them.”

The conference was organized by the Israel Center for the Treatment of Psychotrauma of Herzog Hospital, in collaboration with the Israel Trauma Coalition, a network of organizations providing trauma-related services. It was initiated and sponsored by the UJA-Federation of New York.

Held at Schneider Children’s Medical Center in Petach Tikva, the conference brought together mental health professionals from Israel and the United States to examine the effects of trauma, especially trauma induced by terror, on children and adolescents.

“We need more collaboration and sharing of know-how,” said Shelley Horowitz, a UJA-Federation professional attending the conference. “With these kinds of situations, we need to deal with this.”

In Israel, much of the trauma treatment begins with the care-givers — the parents, teachers, social workers and psychologists or psychiatrists who work with the affected children.

Part of the problem is that the adults themselves are often traumatized by the events taking place.

Ruth Pat-Horenczyk, a psychologist and conference organizer, worked with teachers in Israel and then in New York, helping teachers to cope with the issues raised by terror attacks. She found a lot of anger and frustration, as well as guilt about reactions to terror, among the teachers she was treating.

Many said they react to the ongoing terror attacks by disassociating themselves. If there are fewer than 20 victims in an attack, the Israelis said, they don’t follow the attack in the papers, on the radio or on television.

That dissociation, however, brings about guilt and frustration. Guilt at separating oneself from someone else’s tragedy. Frustration at the situation, at being tense all the time, at the need to be hyper-vigilant in the face of possible danger.

“These are all legitimate responses,” Pat-Horenczyk said.

If the care-givers aren’t treated, and don’t take responsibility for their own feelings and reactions, they can’t treat the children they are watching.

“Our children are exposed to countless terror stories,” said Naomi Baum, who specializes in treating children living in the West Bank, and is now a director at the Israel Center for Psychotrauma.

“Most parents are confused and looking for guidance. They’re looking for direction.”

Parents wonder whether they should talk to their children about recent attacks, hide the news from them or talk about their own fears and confusion.

Kids often don’t understand or know about the details of an event. If they do, they may confuse the details. Terrorist and suicide bomber are terms that are often confusing to most children.

“Safety is a wish,” Baum said. “It’s something we need, but certainly don’t have.”

The best method, said the psychologists, is to develop an axis of behavior. In practical terms, they offered the following to-do list for dealing with traumatic situations:

Pay attention to the television. Where are your kids when the television is blaring news of the latest suicide bombing? Assume the kids are there and that they are absorbing what they’re hearing, said Baum.

“Take charge of the remote,” she advised. “Or view with the kids or shut it off completely.”

Focus on stability, routine, expressions of emotions. “Talk with your kids, but don’t ram it down their throats,” Baum said. Ask them if they heard about the day’s terrorist attack. What did the teacher say? If there’s no interest in the subject, then let it go.

There are different needs with regard to talking about one’s emotions, said Nicky Lachs, a clinical psychologist in Jerusalem. “Some people need to talk it all out, and others don’t,” she said. “And those needs can change.”

Develop personal safety zones. Find the places and activities that make you feel safe and comfortable. One therapeutic technique that Lachs uses is somatic experiencing, which refers to the body’s physical reaction to the memory of a traumatic experience.

A person may be jumpy, nervous, in a constant state of alert. The key to the technique is to heal that part of the body by focusing on a person or place that helps calms one’s thoughts and then that area.

“You work in small doses to treat the trauma, to give yourself a sense of safety,” Lachs said.

Focus on relaxation habits. Make sure to exercise, and find an exercise or sport that also serves as a relaxation technique. Yoga is one good option.

Model your own behavior. Be honest about your emotions. Tell your peers/partner/children that you’re upset, that you can’t ignore it. Let them know you’re willing to talk.

Children in trauma need to be asked direct, specific questions. Chemtob advised asking, “How did you sleep last night,” as opposed to the more generic, “How are you?”

None of the treatments used to treat trauma are rocket science, Chemtob said.

But they do require starting small, building up the relationship between patient and care-giver — whether between parent and child, student and teacher or patient and therapist.

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