Leaving the Victims Behind

Irit Keynan’s depiction of the development of trauma treatment, starting with World War I, is intriguing. But she doesn’t tell us nearly enough about the torment that PTSD can inflict.

Ke’ilu Hi Petza Nistar

(Like a Hidden Wound: War Trauma in Israeli Society), by Irit Keynan. Am Oved and Natal: Israel Trauma Center for Victims of Terror and War (Hebrew), 288 pages, NIS 94

Southern Israel experienced another round of violence last month: Mortar fire, Grad and Qassam rockets and anti-missile missiles from the Iron Dome defense system danced overhead in a threatening manner. Yes, Iron Dome can also be dangerous, if pieces of exploded rockets fall to earth and land at a spot where you happen to be standing.

From my office in the Ashkelon Beach Regional Council headquarters, where I head the social services department, I can hear the startled cries of colleagues when the sirens begin to wail. Of course it’s frightening; after all, our lives are in danger too. Nonetheless, we continue to provide services as best we can, referring at least 30 people to a trauma treatment center during an earlier round, in March − a center that was visited by many more in the following weeks.

After things calmed down a bit, I was able to turn my attention to Irit Keynan’s “Like a Hidden Wound: The Trauma of War in Israeli Society.” If you are expecting to receive a true glimpse into the hidden wounds of post-traumatic stress, as I was, you might be disappointed. But as a book about the history of the treatment of trauma and post-traumatic stress, from World War I to the present day, “Like a Hidden Wound” serves as a useful primer for those unfamiliar with the treatment of PTSD as it has developed over the years. The book is engagingly written, accurate and reader-friendly.

Keynan, a historian and social researcher, divides the book into three sections. The first opens with a quotation from Menahem Ansbacher’s 2003 book “Fragment of the Silver Platter” (in Hebrew). Ansbacher, a young officer in Paratroop Battalion 50, the commander of the Tel Saki post in the Golan Heights during the Yom Kippur War, describes the inner world of fighters in that war concisely, delicately and touchingly. “Even though we had moved on to other places, even though we had built other worlds for ourselves, we all, in effect, remained there, in the receding black smoke, in the terrible silence that followed, mute, each of us alone.”

This sentiment might have swept readers along directly into the inner world of those suffering from post-traumatic stress, but that’s not where the author wants to take us. Instead, the first section of the book offers up the history of shell-shocked soldiers in World War I who were considered “frightened, service-evading psychopaths who preferred their own selfish interests and betrayed their countries’ values,” as Keynan writes.

Keynan then moves on to World War II, when the American establishment feared that what we now refer to as post-traumatic stress disorder but was then more commonly thought of as combat fatigue or shell shock “was a sort of epidemic, a passing problem stemming from exhaustion that could be cured by a week’s rest and a few square meals, when the soldiers could be returned to the front with renewed energy.” And then she moves on to the history of post-trauma treatment in Israel.

According to the author, Israel’s War of Independence can be characterized as “a struggle for existence, a war in the name of those who had suffered and dreamed in the past and died amidst hardship, a war to achieve the dream of Jewish souls free in their own land.” During the conflict itself, those suffering from post-trauma symptoms were treated in psychiatric wards in Jaffa, Tzrifin and Haifa. They were released from the army, but not officially recognized as having been disabled in the course of their service. Keynan explains that here, too, shell-shocked soldiers were considered to be malingerers or ideologically weak.

Only after the Yom Kippur War did the state recognize shell shock as a war injury for all intents and purposes. One of the reasons that Keynan gives for this recognition is that, unlike the wars that preceded it, the 1973 war gave rise to, for the first time, “a sort of collective response,” a national trauma that affected civilians as well as combatants. Keynan describes a “change in values reflected in the way the army and the state grasped their duties to the individual fate of each soldier.” She suggests that “a crisis over obligation to soldiers is related first of all to the firmly established Israeli ethos that one must rescue [captured] soldiers under all conditions, an ethos whose deterioration became clear in the first decade of the 21st century.”

Keynan offers three examples to support her latter claim: the death of Border Police Corporal Mahdat Yusef, wounded near Nablus and abandoned during the second intifada; the Second Lebanon War, which reduced faith in military and government leadership; and the public campaign for the release of captive soldier Gilad Shalit.

I agree with the author about the deterioration of the Israeli ethos, and the public response it has elicited, but I see it as having begun in the last century. It suffices to remember the struggles of Capt. (res.) Motti Ashkenazi, the commander of Fort Budapest on the Bar-Lev Line along the Suez Canal during the Yom Kippur War, and many others who demonstrated after that war against Prime Minister Golda Meir and Defense Minister Moshe Dayan, pressure that played a prominent role in the subsequent resignation of the government.

In the book’s second section, Keynan discusses the heroism on the Israeli home front, describing with great emotion the way Israelis in recent decades have coped with terror attacks, exploding buses, the Gulf War, Grad and Qassam rockets from Gaza, and the hundreds of missiles that fell here during the Second Lebanon War. Keynan notes important historical and political aspects of the subject, discusses the stigma attributed to psychological trauma victims by public institutions, and goes on at length about “the comparison of material rights accorded to civilians who are victims of terror acts and to soldiers” suffering from PTSD. In my opinion, there is no place for a discussion of comparing the rights of civilians with those of soldiers in a book about trauma victims, since it is beyond the scope of this topic.

Keynan justifiably devotes space to organizations that treat PTSD, such as Natal: Israel Trauma Center for Victims of Terror and War, whose important work I am, by virtue of my position in Hof Ashkelon, very familiar with, and the trauma treatment centers established seven years ago in Israeli communities near Gaza. Unfortunately, she does not mention that such centers were erected only due to unceasing struggle by the heads of social welfare departments in those areas. It should be noted as well that despite the rockets that continue to fall in the south of the country, the government of Israel, with a great lack of understanding and compassion, now seeks to close these same centers, which have treated thousands of trauma victims.

In section three of the book, Keynan looks at the way formative events affect the development of anxiety among citizens of Israel and around the world: “Two factors whose force was unknown until recently must be taken into account: the frightening extent of acts of terror and the inability to prepare for them in advance, and the dizzying changes in the way news travels.” She discusses the World Trade Center attack: its large proportions, the element of total surprise and the ease with which thousands of citizens were killed in the very heart of the world’s principal financial district. And she cites the second intifada, which killed or wounded many Israelis and reached into our living rooms on the nightly news, causing a nationwide feeling of trauma.

Keynan compares the different ways the Israeli and U.S. governments have addressed financial compensation for those suffering from post-traumatic stress caused by war or acts of terror. “Financial considerations too, with the intent to reduce the number of people entitled to compensation, are at the root of attempts to limit the definition of a trauma victim,” writes Keynan. “After the attack on the World Trade Center, these considerations were obvious in the congressional decision not to include post-trauma victims among those awarded compensation, unless they had also suffered proven physical injury.”

Keynan sees this as comparable to the idiotic attempt by Israel to limit payments to wounded veterans or the families of soldiers killed in action. The Goren Committee on the Rehabilitation of Wounded Veterans, established in 2009, was asked to develop criteria for when the government would provide support and aid. The transcripts of the committee’s deliberations show that the discussion was diverted from the actual injuries to questions of responsibility and the range of compensation. The disagreements had at least as much to do with budgetary considerations as with ethical ones. The Goren committee’s findings impinge on the rights of veterans suffering from PTSD as well as those with other injuries.

The walking wounded

“Like a Hidden Wound” contains some interesting tidbits about the post-traumatic stress caused by war, but it sorely lacks a closer look at what those who suffer from PTSD actually experience. Perhaps this would have been less of a problem if the book’s title and introduction did not give the impression that those experiences would be more fully addressed.

In the introduction, for example, Keynan tells us that that her goal is “to present a broad picture, one that − even when painful − is drawn with empathy and tries to bring the subject to light and suggest a different approach.” This line, along with her comment that “I immersed myself deeply in the world of traumatized people, on the one hand, and the issues, fears and distress of Israeli society, on the other,” led me to expect the book to focus on the victims of trauma and shed light on their pain.

I saw in my mind the images of fellow soldiers in my own unit during the Yom Kippur War, shell-shocked paratroopers who fought the Battle of the Chinese Farm in Sinai. There’s Dedy, who never fully got over seeing the severed head of one of his soldiers flying in his direction. There’s Benny, who dragged the body of an injured soldier to relative safety and was injured himself in the process, though the wound that still remains is not a physical one.There’s Henry, who to this day cries every time he sees a paratrooper. And there were and are many other good people who give credence to the conception that members of the Yom Kippur War generation comprise the “walking wounded.”

The fact that the Natal trauma center was one of the book’s publishers also led me to expect this to be a book about those who suffer from trauma. I though this would be the book that would describe what prisoners of war go through if they are lucky enough to make it back home: Sleepless, they spend their nights reliving the shouts of their fellow prisoners and other unbearable experiences that remain with them all their lives.

But I turned out to have been mistaken. Only toward the end of the book does Keynan give expression to what really goes on in the minds of trauma victims, and even then, she only touches on the subject: “Traumatized people see points of danger when they look at the world around them. They respond with exaggerated fear to daily scenes, sounds and events, have hostile tendencies and are given to angry outbursts.”

To my mind, this is insufficient. Irit Keynan has undertaken serious research that helps the reader understand the history of post-traumatic stress; the segments of the Israeli population that are most affected by it; the approach of both society and state to the problem; and the stigma attached to those who suffer from PTSD. Keynan is to be applauded for this important work, but she has written almost nothing about the wounded, and sometimes tormented, souls of the victims. The book may be dedicated to the victims of war, but this is not their book. They are secondary characters for the author. It seems to me that Keynan did not dare to dip her hands into the bubbling pot of trauma and post-traumatic stress. She does not reach into the dark and difficult places in the souls of the veterans she purports to write about. Even after reading the book, the wound remains hidden.

Maozia Segal, a social worker, is the director of the social services department of the Ashkelon Beach Regional Council. He previously served as head of the Defense Ministry’s rehabilitation unit.

Maozia Segal, a social worker, is the director of the social services department of the Ashkelon Beach Regional Council. He previously served as head of the Defense Ministry’s rehabilitation unit.