Jerusalem – inside the Old City and the small amount of settled land beyond the walls – was a bleak place of poverty, poor hygienic conditions, contagious disease, and overcrowding in the 19th century.
The Jewish hospitals founded in the Old City were Bikur Cholim in 1826, followed by Misgav Ladach in 1854, and the Meir Rothschild Hospital in 1870. An English Christian missionary organization also built a small hospital in 1844.
While these primitive institutions were better than none, they neglected one vital field – gynecology and especially childbirth, so the death rate of pregnant and postnatal women residents was high. Finally, in 1894, a women’s association called Ezrat Nashim (Help to Women), dedicated to the improvement of medical problems of women, was founded by Tzipi Pines, wife of Yehiel Pines of the Hibat Zion (Lovers of Zion) movement – founded in 1881 as a response to the anti-Jewish pogroms in the Russian Empire. But Ezrat Nashim soon realized that a completely different field of medicine was even more ignored – the treatment of the mentally ill.
The only hostel for the mentally disabled that operated in the city was a small, neglected building that was able to provide board to only five patients. The association adopted and rehabilitated this facility until it could care for and treat many more patients. Needing more space, Ezrat Nashim moved to a building outside the city walls in 1896.
Soon after the turn of the century, the association bought a 2.8-hectare (6.9-acre) plot of land at the western end of Jaffa Road—near Shaare Zedek Hospital, established in 1902 and across the street from where today’s Jerusalem Post editorial office is located. At that time, the neighborhood was almost empty, except for camels and wagons passing by.
Ezrat Nashim’s two-building complex—the first psychiatric hospital in the Middle East—accommodated a large number of patients and a significant staff.
Rabbanit Sarah Herzog—the wife of Rabbi Yitzhak Halevi Herzog, the first chief rabbi of the State of Israel, mother of diplomat Yaakov Herzog and Chaim Herzog (Israel’s sixth president), and grandmother of the current (and 11th) President Isaac Herzog—entered the scene. She was instrumental in promoting the development of Ezrat Nashim Hospital, which moved to a very large plot of land in Givat Shaul quarter near the western exit from the capital.
Born in 1896 in Riga, Latvia, Rabbanit Herzog grew up in London, the daughter of Rabbi Shmuel Yitzchak Hillman – who invited Belfast-born Rabbi Yitzhak Herzog to his home for a conference on kosher dietary laws during World War I rationing in 1917. According to family stories, she was so attracted to her future husband that she dropped a tea tray and – according to some – spilled the tea all over him.
She died in 1979, and the center was later named in her honor – the Sarah Herzog Hospital, which specialized in diagnosing and treating geriatric and psychiatric patients. Today, it is the comprehensive Herzog Medical Center, which looks like a major university campus. It is the only center in Israel that integrates into one place the treatment of patients of all ages suffering from psychiatric, geriatric, and cognitive disorders, psycho trauma, and those needing physical and emotional rehabilitation. It has done all this as a nonprofit institution, with no help from the governments of Israel.
As a result of the horrendous Hamas terror incursion on Oct. 7 and the Gaza war – with so many emotionally traumatized and physically wounded – all of these types of medicine will be foremost for many years, even decades, for Israelis of this and future generations.
Herzog Medical Center will soon offer hundreds of places for patients needing respiration and kidney dialysis in a huge underground, protected space in the event of a national emergency. And in a few years, it will be even bigger and offer programs to promote good health for the elderly.
The medical center seems to have a habit of appointing physicians who are not specialists in psychiatry or geriatrics to run it, but it has been all to the good. Its current president, after serving as its director-general for over two decades, is London-born Dr. Yehezkel Caine, who graduated in medicine from the Hebrew University Faculty of Medicine and then specialized in general and trauma surgery and aerospace medicine. He served as a colonel in the Israel Air Force, was made a fellow in the American Aerospace Medical Association, and was a member and former president of the Israel Aeromedicine Society and the International Academy of Aviation and Space Medicine. Even today, he has said he would love to land on the moon.
“Our single biggest problem is the lack of staff,” said Caine in an interview with The Magazine. “We have empty beds because of the shortage of doctors, nurses, physiotherapists, occupational therapists, and psychiatrists. We nominally have 550 beds, but 50 are empty. We hope things will improve.”
Geriatric rehabilitation for people who have fallen and broken bones or who had a stroke, for example, “is very important, a lifesaver, and our staff is devoted to them,” Caine said. “But there is a long waiting list; we are in high demand among the four health funds that work with us. However, with October 7, the need for physical and emotional rehabilitation for soldiers and younger civilians will be huge. Because of the war, we immediately opened another 30 beds.”
THE PATTERN of appointing directors-general with no expertise in psychiatry or geriatrics repeated itself with the appointment two years ago of Dr. Jacob (“Kobi”) Haviv, who was born in Bat Yam, studied medicine under the Israel Defense Forces’ academic program (Atuda), where he served as an officer for many years, specialized in public health, occupational medicine, and medical administration, and served as the representative of the IDF and the Defense Ministry in Russia.
Haviv admitted that he had hardly heard of Herzog Medical Center when Caine – who heard good things about him from a friend in the IDF – suggested that he succeed him as director-general. “I refused him outright. I thought, ‘What will I do with old people and those with mental problems? They weren’t sexy fields. Israel offers excellent physical medicine treatment, but not in geriatrics and psychiatry.’ Yehezkel insisted, so I visited the campus several times, but I again refused. But when I told my wife, Yael, who runs emotional support sessions for the elderly around the country, she rebuked me and insisted I take the job. ‘What kind of doctor are you? If you don’t do it, who will?’ she asked. I came again, tried, and fell in love with it.”
Haviv toured the whole hospital, seeing children who were unable to breathe on their own, some deformed, drooling, unable to speak or even open their eyes. He continued, “They don’t look good like children hospitalized in regular pediatric wards. But our occupational therapists and nurses have so much compassion for them. They hold their hands and speak to them softly, even bringing service dogs to touch them.”
Haviv’s views turned completely around. He strongly opposed ageism and suspicion by the population of psychiatric patients. “I suddenly got angry. I want Herzog to be great and an example to medical institutions around the country that will raise their standards. Heads of other hospitals treating such patients come here and say ‘Wow!’ and become determined to upgrade their facilities.”
As a public health expert, the hospital director proposed a new idea – “like Tipat Halav (“drop of milk” well-baby clinics) but Tipat Zahav (“a drop of gold”) to promote good health among the elderly and keep them healthy longer. “Israel has among the longest longevity rates in the world, but for many of these final years, they are not healthy and are disabled or in pain. After showing them research, we finally persuaded the Treasury that this would save money instead of hospitalizing them in complex nursing departments. They will help cover costs. As a pilot project that could spread nationwide, we will have a swimming pool, spa, massage, restaurant, dental care, hearing checks, early diagnosis of diseases, and more at low cost. We want to add health to their years.” He is also negotiating with the four health funds to begin covering the cost for those 75 and over and then include younger retirees as well.
The Health Ministry has now, for the first time, asked Herzog to build geriatric and psychiatric beds and to help finance them. It has also initiated the construction of several hundred beds for dialysis and respiration in an underground space protected from rockets in the event of a national disaster in the Jerusalem area. Haviv is annoyed that the Treasury charges a 17% VAT tax on everything it purchases, including construction materials and workers. “We paid over NIS 100 million VAT to build two new buildings; I could have produced a whole new hospital just with that tax.”
The Gaza war has had a massive effect on the medical center, as the general hospitals filled up with wounded soldiers and civilians. Herzog admitted many patients who needed to be ventilated to free up beds. It now has 250 such patients, ages two months to over 100 years old. “Most are conscious. So they don’t get bored, we offer things to occupy them, from toys to computers,” said Haviv.
He said he also opened beds for the rehabilitation of young people. He sent teams to Jerusalem and Dead Sea hotels to help 1,500 traumatized evacuees from the South, paying overtime to the staff and even full salaries to women employees whose husbands were away on reserve duty but couldn’t work full time.
PROF. DANNY BROM, director of Herzog’s Metiv-Israel Psychotrauma Center, and his staff have had their hands full with patients from previous military actions or from peacetime traumas like car accidents and sexual abuse; since Oct. 7, the demand for their services has quadrupled. The center is located in a beautiful new building financed largely by Canada’s Jewish National Fund.
“Psychotrauma victims have to land, lean back a bit, realize that their previous worlds still exist but that the transition from hyper-alertness is not easy,” said Brom, who established Metiv in 1986 after his aliyah from Holland and was warned by Dutch friends that “there is no emotional trauma in Israel.”
“The more the brain adapts to the situation, some parts of the brain like the amygdala serve as an active ‘smoke detector’ for danger, making the person very reactive to smells and sounds, while the prefrontal cortex becomes less active,” Brom explained, “but most suffering from trauma can improve on their own and not develop fully fledged PTSD.
“Not all soldiers have problems sleeping because they learned to sleep during battle in impossible situations. One soldier told me that he ‘can’t stand the silence.’ In Gaza, when there’s quiet, you worry if terrorists are nearby waiting to shoot you. In survival mode, you learn differently than in normal life because your life depends on it. Then they return home.”
There are several therapies for PTSD, such as “somatic experiencing,” based on the fact that trauma lodges in the body, not only in the mind. “It’s in the nervous system, so when you’re in a traumatic state, you go into survival mode. When it’s over, you are stuck with all the energy in your system,” said Brom. “Your body knows how to take care of it if you let it. You might shake, just as when dogs are anxious; they twist their entire bodies as if they’re wet. We offer up to 20 sessions to teach veterans with full-blown PTSD how to do this.”
Another therapy technique is “prolonged exposure to what the patient is avoiding.” It’s based on cognitive behavioral therapy. If a patient is afraid of boarding a bus, they get on one, and if they stay with the feelings that come, it can help. This technique is a gold standard.
Brom and his team plan to run psychological seminars for traumatized Oketz Unit soldiers [independent canine special forces] who have fought Gaza terrorists with their trained dogs, many of whom have been killed or wounded in underground tunnels. It is an adaptation of the Peace of Mind program, which has reduced post-traumatic symptoms in tens of thousands of IDF veterans by helping them process their experiences and giving them time and space to heal.
TURKISH-BORN PROF. PINHAS DANNON has been Herzog Medical Center’s chief of psychiatry for the past two years after working in the Be’er Ya’akov Mental Health Center. It continues to teach at Tel Aviv University’s Medical Faculty. He is internationally recognized for his research in the psychiatric treatment of depression, panic disorder, and behavioral addictions such as kleptomania, Internet, food, sex addiction, and pathological gambling.
He is in charge of two large psychiatric wards – one for men and one for women. After the Health Ministry psychiatric reform several years ago, many chronic patients were sent to live at home or in community hostels, receiving outpatient treatment. There are no empty beds in Herzog’s wards, as there are many men with psychiatric conditions due to substance abuse from painkillers such as fentanyl and addictive cannabis. Female patients suffer more from bipolar, schizophrenia, and other psychiatric disorders.
Dannon said that women are not addicted less but are directed less by impulse and have less need to be in closed wards.
All the Herzog officials and professionals said that despite their great efforts, they are ashamed of the condition of the psychiatric wards – as are those in all the country’s psychiatric hospitals because of historic negligence by the government for many decades. “Psychiatry has been the lowest on the totem pole throughout Israel, but we are determined to change the situation, demolish old facilities, and replace them with the most modern and comfortable ones.”
Dannon is very proud of his transcranial magnetic stimulation (TMS) clinic with a technology from the BrainsWay that has almost completely replaced the painful and not very effective electroconvulsive therapy (ECT) used in the 1960s to 1980s to treat severe psychiatric diseases. It involved sending an electric current through the brain of anesthetized patients, creating a short seizure to change its neural functioning.
Noninvasive, traditional, and deep-TMS typically involves a series of 10- to 20-minute sessions over several weeks while the patient is seated in a comfortable armchair facing a pleasant view. TMS does not require the use of anesthesia, nor does the patient require a lengthy recovery period.
The Herzog clinic has three “treatment cap” devices, one of which – depending on the problem to be treated – is worn like a hair dryer in a hair salon. It emits not hot air but an electromagnetic field that can safely reach brain structures found to take part in the appearance of the targeted condition. By influencing these structures, TMS can safely regulate their neural activity, creating a more stable rhythm to their activation, alleviating symptoms, and contributing to the patient’s well-being without causing any significant, long-lasting, or adverse side effects. A mild headache may follow, but it usually passes independently after the first few sessions.
While traditional TMS has a narrower range of activation, deep-TMS can safely reach deeper brain structures directly, contributing to its higher efficacy level. It has been approved by the US Food and Drug Administration (FDA). Using patented coils in the helmet, the electromagnetic fields effectively regulate the neural activity of brain structures, and as the treatment progresses, the relevant symptom’s conditions become less frequent and less severe, allowing the patient to enjoy a better quality of life.
The FDA has approved deep-TMS even for Alzheimer’s disease, chronic pain, Parkinson’s disease, autism, multiple sclerosis, post-stroke rehabilitation, and other conditions. But these are not yet available at Herzog.
Dannon has also researched combination-PTSD treatment using psychotherapy with pharmacotherapy with MDMA (methylenedioxymethamphetamine), which he researched at Be’er Ya’akov and continues to do at Herzog with Brom.
The psychiatry department head complains that when the National Health Insurance Law was enacted almost three decades ago, the four public health funds did not require psychiatric care. Instead, the government and private institutions remained in charge. “The health funds must get designated budgets for treating psychiatric patients,” he concluded.
SHAMAI KEINAN, Herzog’s board chairman for 24 years, recalls that the hospital had only 180 beds and wasn’t well known when he was asked to serve in the voluntary position. For two decades, he had been the spokesman and a close adviser to the then-state comptroller of Israel, Dr. Yitzhak Nebenzahl, a distinguished banker who served on the Agranat Commission that investigated the failings of the Yom Kippur War. “He was a genius,” Keinan said.
Expanding Herzog Medical Center became Keinan’s life project. He travels abroad at his own expense to meet potential donors and supervise projects, even bringing in Chinese workers to build the eight-story Samson Pavilion that added 270 beds to the center. He also encouraged Max Glassman to give $10 million for his building and is working intensively – following the Jerusalem Municipality’s permission to build on the land – to construct a new psychiatric hospital and tear down the old one. Keinan added, “There will be no other place in Israel that combines all fields. We have a mission to carry it out.”