As diplomats, politicians and activists try to curb the injury and death tolls on both sides of the Gaza-Israel border, a Jewish psychiatrist is trying to heal the wounds that can’t necessarily be seen: those related to mental health.
It’s not often that a Jewish psychiatrist is spotted in the Gaza Strip. In the narrow territory home to more than 1.6 million people, psychiatrists and psychologists are rare and the public is wary of the mental-health professions even if the practitioners are local.
But a professor of psychiatry from Georgetown University medical school has won acceptance there. On Dr. James Gordon’s 18th visit to Gaza from his native Washington, D.C., as hostilities were starting to escalate in September, he was greeted warmly, he said, by high-school girls in hijabs, women in wheelchairs and groups of unemployed men.
They share a problem that is exceedingly common in Gaza: post-traumatic stress disorder. More than 50 percent of the local children and adults suffer from it, Gordon says.
For years, even before this month when the violence became a full-fledged war, Gazans have heard weekly and sometimes daily echoes of Israeli drones and air strikes against suspected Palestinian fighters.
Next door in Israel, communities near the border have also suffered years of unpredictable rocket fire from Gaza militant factions. On both sides, hundreds of thousands of children have witnessed explosions, destruction, and in some cases, casualties.
Treating the silent casualties of war is an urgent need that transcends politics, Gordon, 71, told Haaretz. “Mental health is neglected, even in very good relief efforts,” he said.
An expert on psychological trauma and its treatments, Gordon has been working in conflict and disaster zones since 1995 with his Washington-based nonprofit Center for Mind-Body Medicine. Gordon and his CMBM staff teach doctors, nurses and mental health professionals drug-free methods to help patients suffering from PTSD and depression. They involve mindfulness, deep breathing, art, dance and writing therapy, guided imagery, biofeedback, meditation and exercise, dietary changes and communication. Participants learn these skills with the goal of helping themselves.
In 2002, at the height of the second Intifada’s suicide bombings in Israel and the IDF’s strikes in Gaza, an Israeli psychologist and a Gazan psychologist who had heard about Gordon’s work in Kosovo invited him to visit. Gordon flew in and found PTSD and depression widespread among both populations. PTSD symptoms can include flashbacks, poor memory and concentration, difficulty maintaining relationships, disturbed sleep, crying spells, and self-destructive or aggressive behavior.
Over the years, Gordon raised $2.5 million for an Israel trauma care program, primarily from American donors and foundations and a small Israeli government grant. For the Gaza program, he raised $6 million, most of it from the Atlantic Philanthropies foundation. He flies back twice yearly to lead training and spend time with the locals and his staff.
“My family fled pogroms in Russia and Poland in the early 20th century and I grew up during World War II,” said Gordon. “Later I was so overwhelmed and impressed by stories of how people in the Holocaust managed to survive physically and psychologically it inspired my interest in helping people at the end of their rope find their own inner strength.”
After earned his M.D. in psychiatry from Harvard in 1967, Gordon found evidence for the efficacy of his practices in clinical research studies. He fine-tuned the methods in hospitals and homeless and runaway shelters, and in war-torn Bosnia and Kosovo, post-9/11 New York, Louisiana in the wake of Hurricane Katrina, and Haiti after the 2010 earthquake there. In 2008, the Journal of Clinical Psychiatry published the first randomized controlled study on children in war zones, looking at adolescents in his Kosovo groups who learned his self-care methods. The study reported a nearly 80-percent reduction in PTSD and depression after 10 weeks in the groups. The U.S. Army has since contracted Gordon to study his methods with combat veterans suffering from PTSD.
In Israeli communities along the Gaza border, PTSD and depression rates are high and are much worse after rocket attacks from the Gaza Strip, Gordon said. “In Gaza they are always high,” he said.
Gordon explained that there are tens of thousands of people who previously worked in Israel and are now out of jobs. There is very little electricity, water is both scarce and expensive, and in civilian neighborhoods, the sounds of drones, sonic booms and air strikes are deafening. In addition, many people have lost loved ones, homes or limbs. All of this, he says, "creates a sense of powerlessness that translates into behavior."
Traumatized behavior, he means. “I saw the same thing in Kosovo, Bosnia, Haiti, [and] I was asked to come to Israel and Palestine for the same reasons: violence among children ... [who] were frustrated and the aggression was boiling over.”
In Gaza, the trauma is complicated by having only a handful of psychiatrists with medical degrees, few practicing psychologists with more than a bachelor’s degree, and a public that rarely seeks mental health support.
“Many see depression, anxiety, hopelessness and aggression as ‘evil spirits’ and go to clergy as spiritual healers – they don’t [know about] psychology,” said social worker Jamil Atti, who oversees Gordon’s Gaza programs. To avoid the stigma associated with psychological treatment, CMBM advertises the groups as offering “mind-body skills.”
“Most people come [to our groups] very skeptical but ... it is like magic, they start to open up," Atti said. “One 10-year-old boy who had suffered burns on his face [from an Israeli air strike against a Palestinian fighter] was suicidal and kept drawing himself in the beginning as a black face. By the end [of a 10-week program] he was able to find hope and draw himself as a doctor, helping others with plastic surgery.”
Since 2005, the Gaza program has trained 420 health and mental health professionals, including staff members of hospitals and nonprofit organizations as well as 150 school counselors, through Gaza’s Ministry of Education. About 75,000 adults and children have attended groups run by these clinicians.
Nightmares, bedwetting, aggression
Most mental health services in Gaza focus on medication or recreation, but Gordon’s “mind-body skills” are especially effective in the local culture, where people are not usually encouraged to discuss or express emotions, said Naima Alrawagh, executive director of the al-Zahraa Society for Women and Children, in a phone call earlier this month.
“Teachers don’t give support; parents don’t listen [and] because of the [border] closure, male breadwinners lost their jobs and transfer their anger and frustration onto mothers and children. Since the last war in Gaza, at the end of 2008, the problems have become worse: Children [experience] nightmares, bedwetting, isolation, aggression and poor academic achievement,” Alrawagh said.
After training, children and adults alike become less aggressive and violent, and have more motivation to improve their situation, she added. The focus on healthy communication, listening, kindness and accepting differences with others is spreading “a culture of respect” in Gaza, Alrawagh said, explaining why she spends her weekends volunteering to train health professionals: “There is a huge number of people in need and we cannot reach them.”
In 2011, the International Journal of Stress Management published a study on children after attending Gordon’s 10-week Gaza groups: Ninety percent of those previously diagnosed no longer had PTSD. At the seven-month follow-up, 72 percent still did not have PTSD. Depression was also greatly decreased. Numan Sherif, a Hamas education ministry official, said that the program helps “not only children but also adults. It relieves stress and anxiety.”
The Hamas government in Gaza permits Gordon to work freely and Israel gives him permits to enter that territory from Israel. Neither government interferes with his programs or twice-yearly visits on both sides, but plans to continue training all of Gaza’s school counselors to reach the rest of the children in Gaza’s public schools have stalled.
The Israel funding expired earlier this year and the Gaza funding will end in a few weeks, and now the despair and agitation is worse than before, Gordon noted.
“Without funding we cannot train or supervise and many of the present services [may] cease,” he said.
In Israel, CMBM’s affiliate, The Training Center for Mind-Body Skills, has trained 250 clinicians in HMOs, trauma centers, clinics and hospitals, and 150 school psychologists and counselors employed by the Education Ministry, which partially funded the training. Efforts have been particularly focused on southern areas shelled by Palestinian militants and northern areas shelled over the years by Hezbollah.
“Israel is far better set up and more open to psychological treatment than Gaza,” but there are still many more people who need help, Gordon said. “In Gaza there is no self-care taught and hardly any donors [private or foundation, local or foreign] feel an allegiance with Gaza only when people feel connected do they give.”
As Gordon’s PTSD program funding dries up, he has been able to raise funds for teaching similar self-care protocols to oncology professionals here. In September, he ran a four-day “CancerGuides” training program in Be’er Sheva for 80 Israeli and 16 West Bank Palestinian health professionals, including surgeons, pediatricians, psychologists and a hospital director. The training was funded by the Atlantic Philanthropies, Ben-Gurion University, the Israeli government and private U.S. donors.
Gordon said that in this desperate situation along the Gaza-Israel border, mental health professionals need the training as much as health care professionals. The situation, he says, is urgent. “I will spend the next months with my hat in my hand,” he says.
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