Local | Mind, Body & Spirit

‘Social net’ key to averting PTSD, IDF expert tells Tucsonans

Eyal Fruchter

What’s the best question to ask a person after a traumatic event? Hint: It’s not, “How do you feel?”

Instead, ask “What do you want to do?” or “How did you react?” says Eyal Fruchter, M.D., former head of psychiatry for the Israel Defense Forces. Recounting feelings may get people stuck in a loop that can lead to post-traumatic stress, whereas action questions engage a more analytic part of the brain. This is important not only for professionals to understand, but also friends, family and other members of the ‘social net,’ Fruchter told the AJP at a community reception on Wednesday, May 13 at the Tucson Jewish Community Center.

Fruchter, a retired IDF colonel and visiting scholar at the University of Southern California, presented “Is Israel a Post-Traumatic Society? The IDF Mental Health Perspective” to an audience of about 25 at the reception, prior to giving the keynote address at a “Cause and Effect of Post-Traumatic Stress” conference on May 14. The conference, which also featured speakers from community agencies, focused on ways to build resilience. It was attended by 135 emergency responders representing more than 40 fire, law enforcement, behavioral health and social services departments from all over Arizona. Both events were co-sponsored by the Weintraub Israel Center and Greater Tucson Fire Foundation.

Speaking at the reception, Fruchter emphasized that in the first few days after a traumatic event, post-traumatic stress disorder doesn’t exist — there is an acute reaction to stress, which is normal and may include tears, anxiety, irritability and trouble eating and sleeping. PTSD occurs 30 days or more after an incident.

Exploring the idea of Israel as a post-traumatic society, Fruchter noted that the country was founded in the wake of an enormous trauma, the Holocaust, in which half of the Jewish population of the world was massacred. It was only a year ago that the world Jewish population again reached the pre-Holocaust number, he added.

Immediately after the Holocaust, Israel was forced into its War of Independence, in which 8,000 people died — a full 1 percent of the Jewish Israeli population then of 800,000.

But at the time, with a nation to build, there was little talk of the Holocaust or other traumas. If there had been, Fruchter suggested, Israel would not have grown as it did.

This does not mean an attitude of “shut up and focus on the future” worked for everyone, he noted. There were Holocaust survivors who couldn’t cope and committed suicide or ended up on psychiatric wards. But having a mission is an important tool in being able to fight against trauma.

It wasn’t until after the 1973 Yom Kippur War and, in America, the Vietnam War, that people began talking about PTSD, he said. The IDF opened its mental health department in 1980 to deal with the effects of the Yom Kippur War. That conflict resulted in high rates of PTSD, in part because of the surprise nature of the attack, which led to a disorganized response in which soldiers were separated from their units. The percentage of PTSD was much lower for soldiers in Israel’s first and second Lebanon Wars, Fruchter noted, only about 2.5 percent, compared with 20 percent for U.S. soldiers in Iraq and Afghanistan.

This doesn’t mean Israeli soldiers are inherently more resilient than American soldiers, he said.

Besides having a sense of mission, Israeli soldiers get to go home for Shabbat every two weeks, while American soldiers are deployed overseas for a year at a time. On those visits home, Israeli soldiers can talk with parents and friends who’ve also been in the IDF, Fruchter said, recalling his own experiences as a young soldier.

American soldiers who adjust well to the constant danger and isolation of being overseas often have a hard time when they come home, he said.

After the first Lebanon War, the IDF began placing mental health officers in units, Fruchter added, so soldiers have immediate access to help. A buddy or commander can ask the mental health officer to speak with a soldier who doesn’t appear to be coping well, whether with the stress of duty or bad news from home.

A sense of mission is also helpful for civilians facing danger, Fruchter noted. Israelis living in Gaza before the pullout in 2005 shared an ideology, which is why they didn’t have higher rates of PTSD than people in Tel Aviv, despite suffering far more terror attacks.

While trauma can lead to PTSD, for those who cope well it can also lead to growth, said Fruchter, who dealt with Israeli POW Gilad Shalit after his release from five years in captivity.

During one of their first conversations, Shalit said that having had a lot of time to think during his imprisonment, “I know there are things that I want to change in myself,” Fruchter recalled. “He did not get stuck on, ‘I’ve been traumatized and I cannot cope.’ He said ‘I am looking forward and I want to change several things so I will be a better Gilad Shalit.’”

Fruchter, who also served as psychiatrist on Israel’s humanitarian mission to the Philippines after the 2013 typhoon, said that after facing a trauma, people have five fields of potential growth, starting with a higher evaluation of the gift of life, or mindfulness. The second is increased empathy, which can promote closer interpersonal relationships. The third is identifying new opportunities, as Gilad Shalit did, he reiterated. Fourth is a growth in personal strength, recognizing that they can rely on themselves. Finally, people may experience a positive spiritual change, believing there is a reason they were saved, as with many Holocaust survivors who found strength in the belief that their purpose “was to represent all their family.”

Fruchter’s visit to Tucson grew out of the October 2013 Firefighters Without Borders trip that sent seven Tucson firefighters to Israel to study how Israelis respond to multi-casualty events, which was a joint project of the Greater Tucson Fire Foundation and the Weintraub Israel Center (itself a joint program of the Jewish Federation of Southern Arizona and the Tucson J.)

Gerald Bates, secretary of the Fire Foundation board of trustees, told the audience at the May 13 reception that since partnering with the Weintraub Israel Center on that trip, the foundation has provided mental health counseling for firefighters. More than 100 firefighters have taken advantage of the counseling so far, said Bates, noting that before the program existed, only a handful of firefighters each year accessed mental health services through employee assistance programs.

At the emergency responders’ conference on May 14, Federation President and CEO Stuart Mellan noted that the Federation made a gift to help establish the Greater Tucson Fire Foundation in 2010. The partnership has grown and will continue to do so, he said, with Tucson Fire Chief Jim Crichley joining him, Tucson Mayor Jonathan Rothschild and 25 others on a mission to Israel this summer, and the foundation bringing a delegation of four Israeli first responders to Tucson this fall.