TEL AVIV (JTA) – The talk often turned to blood at a group therapy session for Israeli soldiers suffering from post-traumatic stress disorder: salty, sweet, warm, cold, covered in your own or of the friend who did not survive.
“The smell of blood, that’s what stays with you,” Tom Shechter, 22, says matter-of-factly.
Shechter, a combat medic, was badly injured during the 2006 Lebanon war. He was setting up a field hospital in an empty school building in a Lebanese village when he was hit by a Hezbollah missile.
Like Shechter, the other men in the group were injured in combat during the war with Hezbollah, which ended two years ago this week.
This group and dozens of others like it that treat reservists and active-duty soldiers suffering from post-traumatic stress disorder, or PTSD, are a reminder of one of the least visible but most painful scars of the 2006 war.
They are also a sign of the progress Israel has made in reducing the stigma traditionally associated with PTSD in Israeli society, where military service is mandatory and everyone either has fought in a war or knows someone who did.
Even public service announcements on the radio urge war veterans who suffer from trauma symptoms – they include difficulty sleeping or concentrating and problems interacting with family and friends – to call a help hot-line.
“Today it is no longer treated as something to be ashamed of,” says Miri Shalit, who supervises the Defense Ministry’s Tel Aviv rehabilitation department and is a psychologist and social worker by training. “You can see the difference, for example, from the Yom Kippur War [in 1973] – it took people years to seek help.”
Shalit credits a new, more cognitive therapeutic approach – patients are encouraged to recount in detail the traumas they endured so they can begin to process the events and overcome them – for better success rates in treating PTSD.
The Israel Defense Forces now trains combat officers to work with their soldiers in the aftermath of attacks or difficult incidents as part of an effort to prevent cases from developing into PTSD.
The concept, based on years of research conducted in Israel and abroad, is to debrief as soon as possible after the traumatic event in a safe place away from the battlefield.
In providing a supportive framework within the soldiers’ units to discuss traumatic incidents soon after they happen, the focus is on preventing PTSD, said a senior army psychologist who serves in the military’s mental health unit and spoke to JTA on condition that his name not be used.
During the debriefing, the soldiers can review the facts of the incident together, and share their thoughts and feelings. They can understand, too, that it’s normal to have intense reactions to traumatic situations – called “acute stress reaction” – and at first suffer from symptoms such as difficulty sleeping and moodiness.
The problem occurs when the symptoms do not subside and prevent one from functioning normally.
During and immediately after the 2006 war, soldiers from the front lines were brought to vacation areas straight from battle to undergo physical and mental recuperation. When the sessions had to take place within range of Hezbollah rocket attacks, they were held in underground shelters.
There are no exact figures on how many veterans of the Second Lebanon War are suffering from PTSD or are in treatment for mental health problems, though the IDF and Defense Ministry report high rates of improvement among those they treat.
Research shows that some 10 percent of those exposed to traumatic events suffer from PTSD. Combat soldiers tend to have a lower occurrence in part because they are trained to deal with stressful battlefield situations.
But, as Shechter attests, even soldiers cannot fully be ready for the traumas of the battlefield.
“You cannot fully prepare yourself,” he says. “An incident will always come as a surprise.”
As Shechter lay wounded in an Israeli hospital with shrapnel injuries from a missile to his stomach, head and hand, he dismissed an offer of help from an army psychologist.
But two months after returning home, Shechter knew things weren’t right. He found himself waking suddenly in the middle of the night, unable to fall back asleep. He was haunted by flashbacks from the day of the attack, when a missile slammed into the wall next to him, showering his body with shrapnel.
After undergoing individual and group therapy at the Defense Ministry, Shechter says he’s starting to feel improvement.
“It was good to be able to feel like I could unburden myself, to talk,” Shechter tells JTA.
He says it was a relief to meet as a group, where he could talk with others who had undergone similar experiences.
“What we spoke about there, it was hard to talk about with other friends because they were not there and did not go through the same things,” Schechter says. “Here we could share and give each other advice.”
For Shechter’s mother, Orna, her son’s injury and subsequent trauma has been bewildering and painful.
“There is Tom before the war and Tom after the war,” she says, pausing to weep. “Before, Tom was happy, he was Tom without these dark moods.”
Rachel Gold, a social worker at the Defense Ministry, tells of one young officer she treated who was shot by a Hezbollah fighter. He came home a changed person, she said: frustrated and silent, withdrawn from his wife and children, suspicious and unable to concentrate.
“He became obsessive-compulsive,” Gold says. “As if he still had blood on his hands, he kept cleaning them.”
She worked with him on his flashbacks, his feelings of incompetence for not killing the Hezbollah gunman who shot him and his refusal to go to crowded public places like malls and restaurants because he believed it was too dangerous.
Getting the officer to recount the night he was shot was the key to his rehabilitation, Gold says. In the course of retelling his story, the soldier realized that instead of underperforming, he actually may have saved Israeli lives because he had fired back and protected his fellow soldiers.
Gold also got the officer to start going out again, giving him homework assignments to overcome his fears, like taking a trip to the mall.
“The world seemed wider again,” she says. “He could go back to living and remove the association of the trauma.”
As for Shechter, he sounds upbeat when he describes his plans to study management in college. But he acknowledges that he still struggles to overcome his war trauma.
“When a door slams too loudly, my heart leaps into the sky,” he says. “I try to calm myself down, that everything is OK – that it’s not Lebanon.”