Psychological War Trauma and Society

Like a hidden wound

Irit Keynan

• Editorial: Routledge
• Año: 2015
• ISBN:
  9781317540052
• Edición: 1
• Categoría: Psychology
• Categoría: History & Theory in Psychology

This book explores the psychological trauma affecting soldiers and civilians who have encountered the violence of war or terrorism, arguing that the enigmas surrounding war trauma are rooted in culture, collective memory and social norms. Focusing primarily on a large-scale sociological study in Israel, chapters detail the ideological, political, historical and economic factors that shape the multifaceted connection between individual and collective trauma, probing the exterior layers of Israeli society and exposing the complex relationship between society and emotionally scarred individuals everywhere. Divided into three main parts, particular attention is paid to the treatment of soldiers and civilians, and the tension between the medical and societal approaches to PTSD, shedding light on the intricate relationships between war trauma and society worldwide. Part 1 looks at traumatized soldiers and the changing attitudes towards CSR and PTSD; Part 2 explores civilian trauma and shock, including the first published research on the implications of war trauma in Israeli Arab society; and Part 3 analyses the deficiencies and contradictions in current international definitions and discourses of trauma, and the profound consequences of war trauma in society as a whole. Psychological War Trauma and Society will be of key value for academics and postgraduate students in the fields of psychology, sociology, history, Jewish studies, military studies, social work, terrorism studies and political science, as well as professionals who work with traumatised individuals, either directly or indirectly, including psychologists, psychotherapists and social workers. The Hebrew edition of the book was the winner of the 2012 AIS (Association for Israel Studies) Shapiro Award for Best Book in Israel Studies.

Part I
“In the Terrible Silence That Followed”

Soldiers, Society, and Combat Stress Reaction

“Although we had moved on to other places, although we built other worlds for ourselves, in truth we all remained there, in the dissipating black smoke, in the terrible silence that followed, mute, each of us alone.”

Menachem Ansbacher, Fragment of the Silver Platter^*

* Ansbacher (2007). Menachem Ansbacher was commander of the Tel Saki post in the Golan Heights during the Yom Kippur War.

1
Trapped in the Myth

A soldier goes to war. It is as though he has spent his entire life preparing for this moment. He knew that one day his turn would come. He would be called up for military service—regular or reserve—don his uniform, take his weapon in hand, and go off to that unknown about which he has heard so much. He bears a heavy burden: such responsibilities as “the fate of the nation” and those beliefs and myths—though they may be contested—in whose name he fights. He is weighted with expectations: those of his commanders, of the entire nation, and of himself, and with the hopes of his family, his friends, and his fellow soldiers. He carries with him as well concern for the family that he is leaving behind, the pain of separation, and fear of being killed, taken prisoner, or returning injured.

Soldiers are usually shielded from the full brunt of these concerns by an “illusion of safety,” the faith, shared by most human beings, in their ability to overcome danger and difficulty. The army complements this illusion with training and equipment and by instilling in soldiers trust in their commanders, identification with their unit, and the sense of belonging to a group whose size and strength inspire confidence (Solomon 1993).¹ When the soldier finds himself engaged in prolonged battles, when he is exposed to harsh physical conditions and deprived of sleep and food, his faith in the protective mechanisms of the army weakens and the illusion of safety begins to erode. Indeed even in a brief military engagement, if a soldier faces the threat of imminent death, witnesses the deaths of comrades and commanders, finds himself in a situation of powerlessness, or finds his expectations undermined, the illusion of safety crumbles, and he is liable to suffer combat stress reaction (CSR) (Solomon 1993).

Attempts to identify traits that might make soldiers more prone to CSR or post-traumatic stress disorder (PTSD) have not yielded definitive findings. Based on the screening parameters currently in use, it appears to be exceedingly difficult, if not impossible, to make predictions of this kind (Zohar et al. 2009). Current knowledge suggests that every person has a breaking point, and whether one reaches that point depends on the intensity of the battle and the combined effects of an array of factors.

While the term “combat stress reaction” was coined in 1973, the condition had been observed and discussed under various names for centuries. During the European wars of the eighteenth century and the American Civil War, the phenomenon was referred to as “nostalgia,” reflecting a belief that it was rooted in a longing for home. The terms “shell shock” and “battle shock” gained currency during World War I, a phrasing based on the notion that soldiers were experiencing a neurological reaction to shock waves from artillery shells. Later, under the influence of Freudian ideas, the syndrome came to be known as “war neurosis,” which implied preexisting pathologies reawakened by war. During World War II the US military adopted the term “battle fatigue” in an attempt to confer upon the phenomenon the characteristics of physical exhaustion, which could be overcome with rest and good nutrition. Far from random, these terminological transformations reflect the evolution of the very understanding of trauma. The term commonly employed today, CSR, embodies a nonjudgmental attitude, founded on the understanding that the syndrome is the direct result of the events of battle, without limiting the condition’s symptomology or scope.²

Through most of the twentieth century, those suffering from CSR were subject to condemnation and regarded as cowards, deserters, or mentally ill, despite developments, over the same period, in psychiatry and the study of emotional trauma. In Israel, authorities instituted sustained attempts to treat CSR only in the wake of the Yom Kippur War (1973). In the US the ongoing effects of CSR gained recognition from the psychiatric establishment only in 1980.³ In retrospect it has become clear that all wars waged in Israel and elsewhere have produced large numbers of CSR sufferers and that the armies, though they denied the existence of the phenomenon and disregarded the plight of its victims, nevertheless collected information on it. This information gathering, however, did not lead to official recognition of CSR as a legitimate psychiatric syndrome, and thus research and therapeutic resources lagged. The information amassed in the course of each individual war was subsequently lost and forgotten, perhaps suppressed, while what therapeutic knowledge existed remained unimplemented, despite the fact that, as early as World War I, basic treatment methods had been developed that are still largely valid today.

Throughout the Western world, a similar process of belated recognition has characterized the historical development of attitudes toward CSR. Although only a handful of clinicians studied war trauma, the evidence was overwhelming. Meanwhile, military authorities, psychiatric professionals, and therapists remained indifferent to this mounting evidence for years. Today psychiatrists and clinicians regard this delay as a “historical professional error” (Levy et al. 1990).

Over the past two decades, Israel has witnessed major progress in the treatment of CSR and PTSD, and now serves as a model for other countries.⁴ After the 1973 Yom Kippur War, military physicians and psychiatrists began compiling information on combat trauma, though this remained the unsystematic work of individuals until 1980, when the Israeli Defense Forces (IDF) established the Combat Stress Reactions Unit, a research unit dedicated exclusively to CSR. Charged with disseminating its findings on the diagnosis and treatment of CSR to field medical teams, the research unit was able to implement its work on a wide scale with the First Lebanon War in 1982 (known in Israel as “Operation Peace for the Galilee”). Despite this progress within the IDF in the treatment of CSR, nearly 20 years passed before the Defense Ministry began, in the late 1990s, to recognize the needs of veterans afflicted with PTSD. This change in policy was prompted by the activism of former prisoners of war, who organized an advocacy group, Erim Balayla (“Awake at Night”), and lobbied the Defense Ministry to identify PTSD victims among the population of former POWs.⁵ Additional self-help groups and public advocacy organizations helped further raise public awareness on the issue.⁶

In response to pressure from these groups, and following protracted deliberation in the Labor, Welfare and Health Committee of the Israeli Parliament (the Knesset), in 2000 the Knesset passed a law acknowledging, for the first time, the unique character of CSR and PTSD among soldiers, differentiating these syndromes from preexisting forms of mental illness (The Disability Law 2000). According to Member of the Knesset (MK) Zahava Galon, who drafted the legislation, “for the first time a distinction is being made between people with mental illness and people who have been injured in battles to which they were sent on our behalf. Those afflicted with battle shock are not mentally ill.” (Knesset Labor, Welfare and Health Committee 2000). Throughout the deliberations over the bill, MK Galon insisted on the importance of the law and the public legitimacy that it would confer on soldiers who “went to […] battle mentally and physically healthy and returned injured.” In doing so, Galon gave expression to the insight that social support for trauma victims, particularly those who experienced their trauma in the service of the nation, has both ethical and therapeutic value. Nevertheless, over a decade later this insight appears not to have been fully internalized by the Ministry of Defense, whose reports still place CSR under the category of mental illness, with just a note mentioning PTSD.⁷ Traumatized soldiers continue to encounter distrust and disesteem by officials and medical committees when they seek diagnosis and pursue recognition as wounded veterans. Difficulty in accepting the phenomenon still prevails in the public view, as do the shame and feelings of guilt associated with it among traumatized soldiers, only a minority of whom seeks treatment. Moreover, recently, claims that trauma is being excessively legitimized have been heard in public discourse and even among psychiatrists, some of whom believe that Israel is moving “from a discourse of fighters to a discourse of victims.”⁸

Another, relatively new topic came to the fore during the late 1980s, after the IDF’s CSR unit had already been established. Israel’s defense establishment was then encountering a type of traumatic event that it had never seen before, one that it still has trouble dealing with today. Soldiers were suffering trauma in the wake of events in which they themselves initiated the violence. This form of traumatic experience first garnered public attention as the conflict with the Palestinians escalated during the First Intifada, when the IDF’s use of force against civilians rose to unprecedented levels. The moral and emotional impact on the soldiers of their service in the Occupied Territories, and the question of whether these soldiers are actually traumatized or “merely” afflicted with profound feelings of guilt, continue to elicit emotional and vigorous debate among Israelis. The clamor and controversy are often reminiscent of the profound denial of CSR and PTSD that characterized the early decades of Israel’s statehood.

The state’s attitudes toward soldiers traumatized by war are shaped by a set of tensions. On the one hand, the military establishment needs to preserve its character as a fighting force that cultivates courage and expects soldiers to place themselves unhesitatingly in the line of fire. At the same time, the state has a moral duty to acknowledge the personal suffering of the wounded—including the psychologically wounded—and the military establishment and society as a whole bear the responsibility for the price paid by the individual in service to the state. The position, image, and expectations of the soldier are characterized by contradictory impulses within the societies that send him into battle: adoration, on the one hand, and the expectation of total sacrifice and absence of personal needs, on the other.

In Israel, despite certain gestures of cultural, social, and financial support, such as national ceremonies or special rights afforded to demobilized combat soldiers, the state’s relations with its soldiers is generally marked by ambivalence. While in official rhetoric soldiers are held in high esteem, very often their practical needs are not met.⁹ Soldiers and their families often articulate dissatisfaction and disappointment with this gap between rhetoric and reality (Witztum & Malkinson 1993). In fact, the official admiration for the soldier is something of a double-edged sword: the soldier is placed on a pedestal as an example to the nation and showered with love and esteem. Yet from this lofty position, he cannot display pain, weakness, or doubt. Society traps its soldiers within a myth that, however elevated the language in which it is expressed, hinders the expression of individual pain, fear, or insecurity. In the words of Menachem Ansbacher, commander of the Tel Saki post in the Golan Heights during the Yom Kippur War,

Heroic paratroopers don’t need anything. They are either immune to harm or dead. Anything in between is just a matter of bodywork and a fresh paint-job. Scratches on the interior or hidden structural damage? Those are things that a paratrooper is supposed to deal with himself. Heroes can bleed for ten or twenty years. That’s part of the contract. A lifelong contract.

(Ansbacher 2007, p. 13)

Imprisoned by a myth, soldiers find the walls especially imposing when the war in which they participate is controversial. In such wars, one segment of the public regards soldiers as the nation’s saviors and expects of them heroism, determination, and a constant mobilization of all of their mental and physical resources, without the smallest expression of doubt. Another segment rejects the official, heroic image of the soldier, while often showing hostility toward individual soldiers, seeing them as enforcers of a policy that they repudiate.

When the drums of war stop beating and the soldiers come home, the struggle to reintegrate into everyday life begins. Some feel detached and must undergo a process of emotional reorganization. Others experience a sense of detachment, a disconnect from the collective whose lives seemingly went on as usual, while those who fought on the nation’s behalf often find themselves beset with emotional, physical, and financial difficulties. Reservists, for example, who constitute an essential part of the IDF’s forces, especially during war, must recoup losses or deal with financial hardships from missed work on their own when they return from their service. For soldiers wounded in war, the struggles of returning to daily life are exponentially compounded, as their lives will never be the same. Those who have suffered psychological injury may even endure additional trauma while attempting to reintegrate. The peculiar behavior of the traumatized soldier is often met with misunderstanding by his coworkers, family, and community, and instead of a hero he finds himself the object of suspicion, exacerbating the problem. This additional trauma, compounding the original one, often further hinders the prospects of recovery. The very invisibility of the bloodless wound complicates the wounded veteran’s interactions with those involved in the recovery process, from family and friends to coworkers and representatives of government agencies. Familial and communal relationships of the traumatized soldier are invariably transformed, now marked by stress and tensions. While the soldier often feels that nobody can understand him, his family experiences disappointment brought on by his unfamiliar behavior.

Because in Israel people live with a constant security threat, when a war ends or a terror attack is over, a great effort is made—by the state and by individuals—to put things “back on track” as quickly as possible in an attempt to conduct normal civilian life under the shadow of constant alert. A byproduct of this emphasis on quickly returning to normal life includes the public silencing of any discussion about the price of war in general, and its emotion...