Treating the terrorized: Practising on the front line: CrossCurrents Summer 2003
CrossCurrents
Toronto student Rebecca Kirsh was in Israel working on a kibbutz last year. The bus she was on had stopped for a short break
in the city of Afula. As she contemplated getting a drink, she heard what she describes as an "innately terrifying" noise.
Gunfire. She found herself lying on the floor, holding on to another passenger. "I would hear footsteps and picture the barrel
of an M16 staring me in the face," recalls Kirsch. "I assumed I was going to die and that I would never see my family again."
When the shooting stopped, Kirsch got off the bus, stepping over the body of a man in a soldier's uniform. Her instincts told
her to run as fast and as far from the scene as possible. She later found out that the "soldier" whose body she had climbed
over was in fact the man who had killed three people and injured 16 in just a few, terrifying minutes.
Dr. Danny Brom sees people suffering the aftermath of events like this every working day. A Dutch-Israeli psychologist and
director of the Israel Center for the Treatment of Psychotrauma in Jerusalem, Israel, Brom says that 60 per cent of his clients
are victims of traumatic events such as shootings and suicide bombings. They may fit the criteria for several diagnoses: post-traumatic
stress disorder (PTSD), acute stress disorder, dissociative disorders, depression and anxiety.
Brom was recently in Toronto, delivering a talk at Mount Sinai Hospital, in which he raised an interesting question: What
happens at the community level when trauma happens over and over? Brom argues that when trauma occurs frequently and in public,
its effects are cultural as well as medical, social as well as individual. He believes, for example, that Israel is currently
functioning as a "survival society," one whose members operate purely on a present-moment basis, and where many behave in
a fatalistic or sensation-seeking manner, as testified by the extraordinarily high rate of traffic accidents in Israel.
Another sociocultural effect of mass trauma is that in many societies, including the United States, mass horror tends to cause
a "honeymoon" reaction, during which victims and observers feel an almost euphoric sense of togetherness. Brom witnessed this
traumatic bonding after the September 11 attacks in New York City.
Another observation: The Diagnostic and Statistical Manual of Mental Disorders states that the acute phase of PTSD generally lasts up to one month; yet 9/11 victims stayed in this phase, responding as
though the attack were very recent, far longer than is the pattern for trauma victims in Israel. Brom speculates that this
cultural difference could reflect better support networks in Israel, or simply the fact that people living in Israel are more
used to witnessing traumatic events than are Americans.
Many complex factors, beyond the purely biological, shape the disorders of trauma: Because cultures vary, so will mass reactions
to shock. Brom argues that because of these wider, socially transmitted effects of trauma, there is much more to say about
the suffering than indicated by immediate pathologies such as PTSD and anxiety disorders. For example, Brom works with adult
children of holocaust victims, some of whom live an outwardly successful life but who inwardly feel "in hiding." Trauma, in
these cases, lasts longer than a lifetime, and is passed through generations.
The majority of those seeking help for post-traumatic difficulties in Canada have experienced non-malicious events such as
natural disasters and accidents, but the effects may be equally painful.
Dr. Clare Pain, a psychiatrist specializing in psychological trauma at Mount Sinai Hospital, sums up the agony of her clients:
"They always feel too much or too little." Many clients report that they rarely enjoy even a few seconds of mental peace and
quiet. When Pain asks them to rate their degree of anxiety from one to 10, as they sit in her quiet, comfortable office, they
tell her they are at number eight - close to pure terror, right here, right now. "People who don't recover from trauma have
a chronic pattern," says Pain. "They have a hard time at work and in intimate social relationships; they are depressed, anxious
and panicky. They may also have addictions."
Reports from societies such as Israel, which are afflicted by frequent traumatic events, have much to teach specialists here.
"This is where the knowledge is coming from", says Pain. She believes that the work of Brom and his colleagues can teach Canadian
clinicians subtle lessons about "who, how and when to treat," based on cultural insights, as well as biomedical ones.
Back home in Toronto, Rebecca Kirsch still experiences hyperarousal, frequent nightmares, sleeplessness, loss of concentration
and flashbacks, all symptoms of PTSD. "I was lucky, not only because I was physically unharmed, but because afterwards I had
the choice to come home to Canada where I feel safe and need not worry about similar events happening," says Kirsch. "But
the other people in that bus station have to live with this nightmare and the very real fear that this could happen to them
again. I don't know how they cope."
Abigail Pugh
Centre for Addiction
