There are some things at which Israel excels. Sport is not one of them. When it comes to agriculture, for example, we have considerable know-how to export. Yet that is not all. In a country beleaguered by wars, you would expect the percentage of shell shocked victims to be particularly high. But the opposite is true. As it turns out, the IDF is highly adept at coping with this phenomenon. Forty years of experience cannot be lightly dismissed.
In the past few years, the United States has had to grapple with millions returning or about to return from the battlefields of Iraq and Afghanistan. And it is Israel's experience and success in this field that has attracted the attention of a large number of American academics. A forty-strong delegation of professors and senior lecturers headed by Prof. Marilyn Flynn, dean of the School of Social Work at the University of Southern California, has come to Israel seeking to learn from the IDF how to better treat soldiers with post-traumatic stress disorder (PTSD).
"Close to 1.5 million military personnel will soon return to the US," says Flynn. "From our own experience, between one-fifth to one-quarter of them suffer, or will suffer from PTSD, what you Israelis call 'shell shock'. Approximately a tenth of them will suffer from chronic manifestations, some of which could last for decades."
These soldiers, says Flynn, suffer from sleep disorders and depression, finding it hard to keep a steady job or function in society. "And they are not the only casualties; their wives and children are secondary victims who also need treatment. What we’ve discovered is that the suicide rate of soldiers in Afghanistan or those who have already returned from battle is relatively high compared to the general American population."
It did not take long for researchers in Israel, Britain and Canada to realize that the number of soldiers with PTSD in their own countries is relatively low. Says Flynn, "In these three armies, only one-fifth to 10% of combat soldiers suffer from shell shock, compared to 20-25% among American troops. We also discovered that Israel is better able to cope with this phenomenon, so we’ve come to learn from the IDF how to do this."
Surprisingly or not, one of the factors contributing to the relatively low percentage of PTSD in Israel is a phenomenon commonly known as 'the buddies' or 'the guys'. “In Israel, some 60% of the population serves in the military, and combat soldiers enjoy a high social standing. When they go back to civilian life, everyone understands what they had endured," says Flynn, who for the last fifteen years has headed the School for Social Work at USC where she oversees a $19 million research budget. "In the US, only 1% of the population serves in the military. When a soldier is discharged and goes back home, only a handful of people can relate to what he has been through. He is expected to put his experience in the past and fit in. He has no one to share his experiences with."
"The soldiers sent to Afghanistan or Iraq," she explains, "could be career soldiers, the National Guard or reservists. In recent years, it is mainly the last two groups that have been dispatched. But once they return home, it's hard for them because they don't return to a structured military base; rather, they are thrown back to where they came from, with no support whatsoever."
Flynn brings up another factor, namely the fact that Israeli troops usually understand the justification for the wars they fight. "Israelis share a very strong bond, and everyone knows what they are fighting for," she observes. "In the US, soldiers are motivated to be in the military, but the reasons for war are not as clear to them, thus making them emotionally more vulnerable. When something tragic or violent happens, they're less able to muster the emotional resources to cope with it."
Another major difference stems from the conditions under which American troops serve. Says Flynn: "IDF soldiers get to visit their families every couple of weeks. An American soldier in Afghanistan or Iraq serves under combat conditions for several months. It is also important to bear in mind that the war in Afghanistan has been the longest ongoing war in US history, almost ten years. Some soldiers have already had four of five deployments to Afghanistan or Iraq. This is something we were unaccustomed to."
But American Soldiers were away from home for long periods of time also in World War II and Vietnam?
"There's a big difference between those wars and what's going on today in Afghanistan and Iraq. In the old wars, the battlefront was clear. Soldiers fought there, and every week or two would pull back to recoup in the rear. Today, soldiers encounter many risks, such as improvised explosive devices, suicide bombers and other dangers even in the so-called 'rear' of Afghanistan and Iraq. The tension never lets up."
There are two US government departments that oversee veterans. The first one is the Department of Veteran Affairs, one of the largest departments with a $139 billion annual budget and 150 large VA hospitals. Responsible for the lifetime treatment of veterans, it is the largest hospital network in the world. There is also a large system that is responsible for education, vocational training and veterans' pensions. In addition, the treatment of post-traumatic soldiers is among the responsibilities of the Department of Defense.
"The USC School of Social Work has landed a DoD contract to draw up a plan for American military psychologists," explains Colonel Dr. Eyal Fruchter, chief IDF Psychologist. "Going back to the Yom Kippur War, we have nearly forty years of experience coping with this phenomenon."
The IDF model for treating PTSD takes place on three levels, Dr. Fruchter explains. “The first one is prevention. This can be compared to getting a flu shot -- preventative medicine. We spend time with commanders before they go to battle, teaching them how to better prepare the troops in order to avert future psychological damage,” he says.
Do the military psychologists prepare all commanders in combat units?
“We have plans tailored to each unit based on its specific needs. To prevent emotional trauma, a paramedic or an airborne technician, for example, will be exposed to gruesome photos of wounded people and bodily injuries to prepare them for what they will have to encounter. In contrast, infantrymen will undergo a different kind of preparation, without exposing them to pictures of wounded people. The overall objective is to prevent post-traumatic stress disorder well before battle.”
The second level is early intervention, occurring immediately after an incident. “To use the flu example again, this is like immediate treatment after the patient has been exposed to the virus and contracted the disease. Immediately after an incident – a skirmish or battle -- the psychologist will meet with the commanders and guide them on how to properly hold a talk with the soldiers. It's very much like debriefing. Talking about the experience is needed in order to reduce the risk of someone developing PTSD. This allows the soldiers to vent anger, frustration, grief and other emotions. If the commander feels that some soldiers are particularly vulnerable, he will refer them to the military psychologist already at this point.”
The third level is treating those who are already hurt. An enlisted or career soldier will be treated by the military, while a reservist will be treated by the Defense Ministry's rehabilitation unit.
“For purposes of comparison, until recently when an American soldier had emotional problems, the only person in the unit he could go to was the chaplain or the rabbi,” says Dr. Fruchter. ”In Israel, military psychologists have been well integrated in all combat units for the last thirty years.”
Dr. Fruchter also notes the overriding importance of the supportive social network of Israeli soldiers in reducing the number of people with PTSD. He agrees with Flynn, who says that the difficulties of American soldiers are also related to the fact that society doesn't understand what they have been through. "The closest comparison to what they're experiencing is Israel's War of Attrition. Soldiers were deployed in outposts on the banks of the Suez Canal and came under constant shelling. Then they got leave and met people partying in Tel Aviv who were clueless about what they were talking about. This also conjures up the early days of the First Lebanon War, when I served as a battalion physician in Lebanon, when I returned from hell to normalcy and peacefulness."
Dr. Fruchter emphasizes that when it comes to combat soldiers, 95% of the people around them are usually familiar with military life and have shared similar experiences. "Normally, a discharged combat soldier does not come in contact with populations that have not served, such as ultra-orthodox Jews or Arab Israelis. Almost everyone in his immediate surroundings has served in the military and understands his feelings. Our soldiers undoubtedly have more support, so the chances of developing shell shock decline."