Prematurely, as it turned out. In June and July, new restrictions were enforced by the government, first on towns and communities with a high number of infections – initially, for densely-populated communities of ultra-Orthodox inhabitants, and soon after, applied to the entire population. Once again schools, synagogues, restaurants and entertainment centers were ordered to close. The restrictions, frequently announced directly by Prime Minister Benjamin Netanyahu himself and occasionally altered and then enforced again, gave rise to growing sense of chaos, loss of trust in government officials, and ultimately – a growing wave of mass demonstrations. Rather than post-corona, Israeli society developed post-trauma.
In late March, a coronavirus patient jumped from the third floor of the hospital where he was treated, in an attempt to end his misery. During May and June, the emergency hotline ERAN responded to 70 calls connected with attempted suicides linked to economic despair. This rate was seven time higher than in an entire normal year. And by the end of Jun,e the Health Ministry reported a 58% increase in suicide acts, compared to same month a year earlier.
Indeed, many people are calling the current social and public health state we are in, post-trauma. Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a traumatic event. True, not everyone suffers from it, and the corona PTSD is not exactly the same as post-trauma in normal times. But yes, the symptoms – anxiety, fear of death, depression, difficulty in sleeping and concentrating, panic attacks, outbursts of anger and suicidal tendencies – all these, and others, that characterize post-trauma after wars or natural disasters, are appearing these days among many people, of all ages and in every part of the population. The combination of the threat of infection by the tenacious virus together with the off-again on-again lockdowns, and the desperate economic crisis, with seemingly no light at the end of the tunnel – all these comprise direct causes of the feeling of crisis, leading to severe post-trauma symptoms.
A survey by the Central Bureau of Statistics, conducted in mid-July, showed that 26% of the adult population of Israel, or some 1.5 million people reported that their mental state was “bad” or “very bad .” A similar survey conducted in May, when the lockdown was first eased, showed the proportion then was 22%. In addition, 42% of the population, or 2.4 million people, reported recently feeling high levels of anxiety and stress, compared with 33% in the preceding survey. Some 21% of the entire population said they were depressed, compared with 16.2% two months earlier. And for those aged 65 and older, over 30% said they were depressed. These are far higher rates than during normal times. This is indeed a picture of a post-traumatic society.
True, a precise diagnosis of post-traumatic responses cannot be done through a public survey. That demands careful study by professionals. There is a big difference between responses to an anonymous national questionnaire and a professional, personal and clinical diagnosis. Such a diagnosis takes into account the person’s ability to function normally at work, socially, and in daily tasks and determines whether the post-trauma symptoms persist over time. An important indicator is the length of time the post-trauma symptoms persist. A temporary increase in the symptoms noted above, that disappear in a few days, is not regarded as unusual or of concern. Though not clinically based, but in light of its several month’s persistence, the above profile of the Israeli population at large is alarming.
Psychological research has not yet found an unambiguous answer to the question, who are the “at risk” people for post-traumatic responses. Out of every 100 people who experience the corona crisis under the same conditions – who are the 26% who report that their mental situation has worsened? What characterizes them from the others? We do know that among the factors that increase the risk of post-trauma, are the lack of support systems, or a stable family environment; unsuccessful past-experience in dealing with a crisis also adds to the risk of post-trauma; and similarly – and how relevant! – also an extreme decline in the employment and income situation, especially when there seems to be little light at the end of the tunnel. There are also personality characteristics – such as a tendency to pessimism, the need for control, intolerance of ambiguity and uncertainty, and dependency need – these all raise the likelihood of post-traumatic responses. Note, that despite the relatively high rates of infection among the ultra-Orthodox neighborhoods (owing to crowded living conditions, the large number of children per family, etc.), religious people (whether Orthodox or ultra-Orthodox), are generally more ‘immune’ to post-traumatic responses. Faith in God, it seems, is for them a source of resilience, that distinct secular people lack.
It is important to recall that Israeli society as a whole enjoys a source of resilience that does not exist in other Western democratic societies. The long-time exposure of Israelis to wars and terrorism has induced ways for coping and a level of resilience that has been tested more than once. This is highly relevant today. Nonetheless, the corona epidemic was a relatively novel blow to Israelis, and the resulting anticipated economic distress is not that similar to the threat of war and terror. Thus, much importance must be attached to the result that a quarter of the nation’s population report that their mental health has worsened during the crisis.
We thus arrive at the question of treatment and mitigation of post-trauma. The professional psychological approach differentiates between immediate treatment focused on acute stress, and the long-term treatment focused on other post-trauma symptoms. A successful short-term treatment – one that is afforded at once, close in time and setting to the traumatic event, emphasizing the return to full normal functioning at once – not only restores a large proportion of stress-reaction sufferers to their normal lives, but also reduces the likelihood that the PTSD syndrome will emerge later. Similarly, immediate and efficient actions taken by the government, in returning people to their jobs, compensating them for economic losses, and generating renewed economic growth – these are essential and crucial steps required to strengthen those who are liable to descend into continued PTSD. For them, a combination of efficient welfare system, social services and community-building efforts will be essential, together with cautious professional intervention by trained professions in mental-health and social-work.
Let me conclude with a note of caution. Even if it is inaccurate to diagnose the Israeli society as suffering from PTSD, we should not forget that an increase, even a temporary one, in feelings of trauma and distress as the Central Bureau of Statistics revealed, can lead to an increase in extreme behavior: Violence, inability to function, mental breakdowns and even suicides. This is a situation that requires careful vigilance and sensitivity from all parts of society: Family members, teachers, caregivers, kindergarten teachers, social workers, and employers. Clearly, not everyone who reports being depressed and stressed-out is prone to commit suicide or another extreme act; but examining retrospectively such extreme behaviors usually reveals that there were warning signals that preceded them. These days, we must be alert, vigilant, and act with extreme caution toward any early symptoms.
Israel’s society may not be currently labeled as an entire post-trauma society – but many individuals are. And they need special care and attention. The trauma is not over. Perhaps more than a post-trauma, it is an on-going one.
The writer is a senior research fellow at the Samuel Neaman Institute for National Policy Research, Technion. He served as chief psychologist of the IDF.