PTSD Treatment in Israel: Signs of Progress

The condition is common in countries where many civilians are exposed to traumatic experiences

The month of June is PTSD (post-traumatic stress disorder) Awareness Month, and in Israel, 2022’s edition will see better government support for people suffering from the disorder and the development of cutting-edge treatment methods.

After Itzik Saidyan, a 26-year-old veteran of the Golani Infantry Brigade who fought in Gaza during the 2014 war, self-immolated outside the Defense Ministry’s Petah Tikva office responsible for rehabilitating injured soldiers, PTSD received greater attention.

He was protesting the ministry’s allegedly unfair treatment of him, after he requested to be recognized as 50% disabled by PTSD, up from 25%.

Superintendent (ret.) Gil Kleiman, former Israel Police spokesman during the Second Intifada, spent 23 years as a police bomb squad technician.

He described to The Media Line how PTSD can develop suddenly and hinder an individual’s ability to function normally in society.

Having attended 48 suicide bombings in his capacity as police spokesman, Kleiman experienced what is known as cumulative trauma.

“I’d been a bomb technician since 1983 − and this was already 2005 − and one day at a suicide bombing in Tel Aviv, after all of this, I went blank, I crashed, and I had my breakdown in February 2005,” he said.

A year later, Kleiman retired from the police and was recognized as a disabled veteran by the Defense Ministry.

There is a common tendency to identify PTSD exclusively with combat veterans, he said. Yet in a country like Israel, where a large proportion of the civilian population has faced traumatic experiences, PTSD can be widespread.

“This country has PTSD all over the place because civilians have PTSD from [terrorist] attacks and suicide bombings,” Kleiman said. “Children have PTSD from bombs and missiles landing around them from Gaza; parents have PTSD from their child being wounded or hurt. So, to put the focus only on combat is wrong.”

Professor Danny Brom, a clinical psychologist and founding director of Metiv: The Israel Psychotrauma Center at Herzog Hospital in Jerusalem, reinforced this conclusion.

Metiv conducted a study on 1,000 Israeli soldiers, 500 of whom were in combat roles and 500 of whom were not, and found that exposure to violence was more indicative of a PTSD diagnosis than direct engagement in combat.

“Apparently quite a lot of people who were not in combat roles have been exposed to a combat situation, and the exposure is what is important, and not the official role,” Brom said.

“A lot of Israelis have been exposed to all kinds of things, and that is a major issue,” he added.

Indeed, figures published by the World Health Organization suggest that almost 4% of the global population and 30% of combat soldiers develop PTSD.

For Israelis who undertake compulsory military service, many of whom encounter combat in some form, these figures are likely significantly higher.

Brom told The Media Line that whereas in previous years, the Defense Ministry set narrow parameters for PTSD treatment eligibility, that is beginning to change, partly due to protests and greater publicity in 2021.

Metiv has been conducting a program called Peace of Mind for the last 15 years, in which entire combat teams are taken in and helped to process their experiences.

As Brom explained, even those who do not meet the criteria for full-blown PTSD often require support.

“In reality, most people are somewhere on the spectrum but don’t fulfill the full criteria for PTSD, so they fall between the cracks, and no one looks at them.”

Peace of Mind provides support for every member of a combat unit who wants it, and after 15 years of operation, the Defense Ministry has started to fund the program.

Such measures may serve to strengthen the state, with commentators claiming that a society’s resilience in the face of terrorism is directly related to the support networks in place for affected civilians and soldiers.

Kleiman founded IResilience.org as a platform for educating law enforcement audiences on how to deal with terrorist attacks and their aftermath.

He told The Media Line, “We’ve found that … the resilience of your society is what’s going to have you succeed in the war against terror.”

Therefore, Kleiman argues that having a strong home front is of paramount importance in withstanding terrorism.

“Terror is directed against civilians, against your society, so if your society is resilient, you can withstand and have the fortitude to deal with major terror attacks. If your society does not have the resilience and does not feel that it’s being taken care of, then it won’t succeed in dealing with terror,” he said.

On Israel’s home front, researchers are continuing to investigate new treatment methods for relieving the symptoms of PTSD.

Researchers at Tel Aviv University’s Shamir Medical Center (formerly Assaf Harofeh Medical Center) released a study in February showing that symptoms of PTSD could be relieved in combat veterans using hyperbaric oxygen therapy (HBOT).

The research, led by Professor Shai Efrati, Dr. Keren Doenyas-Barak, and Dr. Amir Hadanny, subjected patients to a pressurized chamber in which the atmospheric pressure is higher than at sea level and the air is rich with oxygen.

Doenyas-Barak spoke with The Media Line about the results of the initial study and other clinical trials, which reveal an astounding success rate for the treatment.

“We have data based on the first study that we’ve just published, and some clinical experience, that about 70% of the veterans who are treated with hyperbaric oxygen therapy get better, and that includes reduced symptoms and at the same time, increasing brain activity and connectivity,” she said.

According to Doenyas-Barak, the results indicate that HBOT can reverse some of the negative sequela, or aftereffects, of PTSD, and is especially effective for those who do not respond to initial treatments.

Since the treatment requires patients to sit in the pressurized chamber for sessions over 60 consecutive days, Doenyas-Barak does not envision HBOT as an initial treatment option, but rather as an important backup solution.

“I don’t think this treatment should be the first line of treatment, but it should be the second or third line for those who did not respond to psychotherapy, or for those who did not respond to various drugs that are prescribed for PTSD,” she explained. “It should not be the first line of treatment because they need to come every day to the center for 60 sessions.”

This PTSD Awareness Month, commentators are hopeful that the Israeli government is making greater efforts to alleviate the suffering of those with PTSD and is directing more resources to its investigation.

“Everybody feels that there is change, great change!” Doenyas-Barak said.

This sentiment was echoed by Brom, who described the Defense Ministry’s attitude as “slowly changing in the past year as they are trying to do their best to change it.”

Aron Rosenthal is a student at the University of Edinburgh and an intern in The Media Line’s Press and Policy Student Program.