Editor's Notes: How the IDF became a mental health pioneer during this war
The current war in Gaza and on the northern border has caused Israelis to ask many questions regarding how our military has been operating for decades
By ZVIKA KLEINUpdated: JANUARY 26, 2024 10:16 IDF soldiers operate in northern Gaza amid the war with Hamas.(photo credit: IDF SPOKESPERSON'S UNIT)
Almost every conversation I have with a friend who came out of Gaza as a reserve soldier includes questions about how they and their colleagues have been mentally dealing with such a difficult situation. One of my close friends experienced an attack by Hezbollah where his friend, literally meters away from him, was shot dead. Another soldier in that unit was severely injured.My friend complained that they weren’t equipped with bulletproof vests, for instance. Still, there was one element he praised the IDF for. He, like every single other IDF reservist whom I spoke to in the past few months, has said that the mental health issue is being dealt with in the most phenomenal way possible.The current war in Gaza and on the northern border has caused Israelis to ask many questions regarding how our military has been operating for decades, and precisely why it responded so poorly to the October 7 massacre that day, and in the subsequent days after. The intelligence element was lacking, and it took too long in most areas for the IDF to react in time.It just so happens that the IDF is probably the most advanced army in the world concerning the treatment of post-trauma disorders (PTSD), as well as preventing them from incapacitating its soldiers.Earlier this week, I conversed with Elon Glassberg, chief medical officer (surgeon general) of the IDF.“In our military system, we distinguish ourselves in a few unique ways compared to other armies worldwide,” he shared. “The significant difference is our approach within the combat platoon, where the fighters’ roles are crucial regardless of their corps. For instance, in Germany, a corporal in the medical corps holds a higher rank than the air force commander, underscoring the importance we place on medical roles.”
A SOLDIER poses atop a tank near the border with Gaza in October of last year. (credit: Amir Levy/Getty Images)During this war, the officers in charge of mental health, all with backgrounds in psychology, social work, or psychiatry, joined the forces outside of the borders of Israel.“In mental health, we have taken substantial steps,” Glassberg continued. “We have developed a comprehensive approach for dealing with post-traumatic stress disorder (PTSD), including a focus on Active Stress Response (ASR). This approach is crucial, especially in situations where soldiers are exposed to severe stress, such as being under fire or experiencing the loss of a fellow soldier.“Recognizing and normalizing the psychological impacts of such traumatic experiences is central to our mental health strategy. We have established a robust support system ranging from self-aid to body aid and specialized mental health units.”
After every major military operation or incident with terrorists, especially if members of a team were killed or injured, an immediate session of group therapy takes place, whether by the commander who is guided by a mental health officer, or actually by one of the mental health officers themselves. Elon Glassberg, chief medical officer (surgeon general) of the IDF. (credit: IDF SPOKESPERSON'S UNIT)“The demand for mental health professionals increases significantly during wartime. To address this, we have integrated lieutenants from the reserves into each platoon, ensuring that mental health support is readily available. This strategy has been integral in supporting our troops during times of conflict,” he explained.Due to the vast number of reservists, hundreds of thousands, and the trauma of the October 7 attacks, mental health reservists grew substantially in number – four times more than usual.“A remarkable statistic is that over 90% of our personnel return to their units after experiencing trauma. While not everyone may resume their original role, this high rate of return is a testament to the effectiveness of our support programs.“In more extreme cases, we provide up to 4 weeks of mental hospitalization. Our records show that approximately half of these individuals can return to active duty, a significant achievement.“Our total IDF force consists of 350,000 soldiers, and we have only seen 9,220 cases of ASR, a substantial number that highlights the need for our mental health services. In the Tzrifin medical center, out of 290 soldiers who have been treated there for severe post-trauma, about half have been able to return to active duty after receiving support. These figures are crucial in understanding the impact and effectiveness of our mental health initiatives,” he explained.He clarified that if a soldier was inside a burning tank, shot at, or had a friend who died, it’s normal to develop something like trauma. People will say, ‘I hear noises,’ or, ‘I can’t sleep.’“That’s a normal response to an abnormal situation,” Glassberg explained. He shared that the IDF does a lot of secondary prevention of PTSD by “mainly explaining to people that it’s normal to react in such a way. We implement grounding techniques.”The IDF built a mental health unit for those who still cannot cope with their mental situation.“If the organic company commander doesn’t fit with the functioning of a soldier, he moves them to the mental equivalent of a hospital. There is a hierarchy.”Glassberg explained that for the past few years, the IDF has been dealing with the question of the essence of resilience.“One of the solutions to preventing trauma is resilience, whereby the commander will be at the front of this process, not a mental health officer. In building resilience, combining unit pride and our nation’s love, the soldiers know exactly what they are doing during war.“To our surprise, most soldiers were more resilient in the war. We thought Gen Z and the TikTok generation were unsound. We didn’t know they could take their service seriously, but we were wrong. I told the chief of staff that we need to apologize to Gen Z.“Another program in the IDF is the Magen Program, which was even adopted by the German army a few years ago. The idea is to identify if something is wrong with one of your fellow soldiers.“There are certain acts the friend is guided to do if he thinks a different soldier is distressed. You tell him, for instance, ‘look outside the window,’ or ‘in two hours, they will replace us on duty,’” Glassberg detailed.Further, if a soldier needs more professional help, there is a specific army base with mental health treatments.“They meet with experienced psychologists or psychiatrists at other dedicated bases. They do the grounding. We tell them, ‘Take a shower. Change your clothes, go to sleep, we’ll talk in the morning.’ We make them understand that not everything is lost.”Many reservists have been sent back home in the past week or two; others will join in the next few weeks. Glassberg spoke of the processing element at the end of combat activity, about the emotional issues. The closer the mental transition between what happened in Gaza and what happens in the outside world is, the easier it is to negate the two worlds. The treatment is aimed at allowing discussions about the things that the soldiers went through. “Who else will understand them but themselves?” Glassberg asked.When a recent brigade finished its reserves duty, Glassberg said there was a unit where 50 mental health officers were sitting in a group to help the commanders manage the discussion. “The commanders themselves lead the discussion. It’s not correct to depend on a therapist present there.”
This whole approach is new: “After Operation Protective Edge, there was a great military effort to try and assist those who needed mental assistance. But we were too late and approached reservists individually after they went back home. It didn’t work out well. They moved on. Some asked, ‘Where have you been until now?’ We thought the closure with their comrades was much more professionally correct and would assist their return home.”Glassberg said that in many cases, the mental health officers needed to assist the wives of the reservists who were in distress. “There is a very extreme transition ahead of reservists returning home to their families after three months. Sometimes, we try to have a Zoom call with the families and tell them how they should allow their son, husband, or father to return gradually.”Though across Israel, psychiatric medications have been on the rise since October 7, in the IDF, that isn’t the case. “The solidarity and the fact that there is unity and cohesion affect and help the feeling of confidence among the reservists. It seems to work.”Asked about the ‘day after,’ Glassberg said he was also worried, hoping for the best. “Mental health services must offer a more significant service to these reservists. We will copy the model of treatment levels for the day after.”In addition, the IDF’s medical advancements are impressive: The average time from being wounded in Gaza to getting to the operating table in a hospital has been shortened to a mere hour and five minutes. While the global average death rate from injuries stands at 15%, the IDF has managed to reduce this figure to 7-8%.“We have transitioned from traditional methods to more modern approaches, like replacing paper-based medical records with tablets. We have also introduced NFC technology in our operations, particularly useful in hospital settings.”Finally, Glassberg surprisingly shared that all soldiers and reservists received a link to download a particular meditation application on their cellphones to calm down and stay focused. This is what the battlefield will look like in 2024.
