Published in THE JERUSALEM POST Apr. 5, 2006
To the Rescue… of the Rescuers
by Ruth Ealash
Former police spokesman Gil Kleiman recalls with clarity the day he realized he’d witnessed one too many suicide bombings.
“I just started crying in my office,” he says. “I picked up the phone to call the police psychologist, but I could not speak in a coherent sentence. It was then I realized that I needed help.”
It was exactly one week after the suicide bombing at the Stage nightclub in Tel Aviv in February 2005. It was the 47th suicide bombing Kleiman had witnessed in less than four years as Israel Police liaison for the foreign media – and he couldn’t take it any more.
“I’ve seen hundreds of dead bodies and aside from poisoning, I’ve seen every death possible,” continues Kleiman, 48, referring also to the hundreds of terrorist attacks with which he had to familiarize himself as part of his job. Prior to his role as the “voice” of the police, Kleiman had also spent years working as a bomb disposal technician and investigator.
“Even the strongest piece of metal can break if you put enough pressure on it,” says the New York native poetically. “At some point I could no longer deal with any kind of suffering – even down to a young child crying in the street. I could not deal with my emotions.”
Kleiman immediately sought help from the standard health plan offered by the police force, but the designated psychologist could only fit him in a week later. Reaching the conclusion that the state plan would not give him the kind of help he desperately needed, Kleiman took extended sick leave from the force and opted for another alternative.
“The army and police force give their officers flak jackets, but their souls are ripped apart with no protection whatsoever. The help does not come from the establishment but from private places,” says Kleiman, who moved to Israel in the early 1980s and worked his way up through the ranks.
NOW RETIRED from the force, Kleiman spends some of his spare time volunteering at the Israel Center for the Treatment of Psychotrauma, trying to reach others who are in similar need of Post-Traumatic Stress Syndrome counseling.
“I got emotional help and support from my wife and friends,” says Kleiman. “But the physical help had to come from a doctor – from a mental health professional.”
Dr. Danny Brom, head of the trauma center, estimates that roughly nine percent of adults in Israel suffer from PTSS, triple the amount in the United States. In the police force and other first-responder units – such as paramedics, doctors, forensic experts and bomb disposal technicians – the numbers are undoubtedly even higher.
Based in Jerusalem, the center offers training to mental health professionals, and offers short-term treatment to survivors of all different types of traumas, from rape and traffic accidents to suicide bombings and other terrorist attacks. Those in need of treatment are either referred by the National Insurance Institute or pay privately. Brom says that there is a treatment fund that offers victims of trauma some financial relief.
The center began in the early 1990s as a project of Jerusalem’s Herzog hospital. Today, its programs include outreach to children living in border communities such as Sderot, and a walk-in crisis center.
“If I had known about this trauma center a year ago, I could have avoided dealing with the bureaucracy. I did not have the strength to fill out Internal Security Ministry forms. I should not have been put in that situation. I needed a place that I could just walk into and start talking,” comments Kleiman.
“The Internal Security Ministry only deals with this issue once it has reached the later stages,” he continues. “The police force has an organizational psychologist but not a clinical one. Those who need psychological counseling are offered only three appointments. The system does not take care of these people.”
Brom says the center has been working with paramedics from Magen David Adom and Zaka, the rescue and evacuation service, and that it approached firefighters three years ago.
“At first they said to us that they really didn’t need any help, but when one of our professionals went down there, they wouldn’t let her leave. They hadn’t seen a mental health professional in more than 10 years,” recalls Brom. “We managed to change their whole culture, however, and get them to talk about their feelings.”
“The foreign media would always ask me how we [the police] were dealing with the trauma of these attacks,” says Kleiman. “But in the Israel Police there are no debriefings. There is a real lack of knowledge of the importance of such a thing.”
He continues: “The inner circle of bomb technicians and forensic experts – those who have to take off their shoes after a bombing before they enter their house – are the ones who need the most help.”
It’s all about the adrenalin, he says, talking about how he managed to sustain himself through one terrorist attack after another – often in a single a day.
“I was not crying out for help,” he says. “But if a professional had said to me, ‘Talk it out,’ I would have. I’ve seen it in people’s faces; they would all be willing to talk about it.”
“Naturally people don’t want to talk about a stressful event because they get upset again,” says Brom. “Time does not heal mental wounds; it is important to talk them out. It is not a sign of weakness, but is courageous and healing.”
KLEIMAN SAYS that the high point of his life over the past few months since he left the police force was the day his wife was approached in the supermarket by the wife of another first responder. She told Kleiman’s wife that Gil had inspired her husband – who was so traumatized that he couldn’t even go to the bathroom alone at night – to seek help in dealing with his trauma.
“Once I had found help, word got around and those from the inner circle started coming forward. It became acceptable. People around me said, ‘If Gil can get help, then I can get help, too,'” says Kleiman. “I am walking proof that there is life at the end of the tunnel.”
These days Kleiman is enjoying life as a retiree. He divides his time between studying Tai Chi and Shiatsu (“the police paid for that,” he quips), talking about his experiences to groups visiting Israel from the US and volunteering at the trauma center.
One of his first projects at the center has been to help create a promotional video in which he talks very candidly about his experiences as police spokesman.
As we watch the five-minute clip together, Kleiman rapidly names every suicide bombing that is shown in the video.
“That’s in Ramat Gan,” he says, as images of ambulances and charred bodies flick across the screen. “That’s Caf Hillel; that’s the No. 2 bus in Jerusalem.
“I don’t ever want to go back to that,” he remarks. “It’s not normal standing over a dead body and chit-chatting with a friend I haven’t seen in ages, asking him why he hasn’t been in touch. I don’t want to slip on someone’s jawbone again.
“I’m not a doctor, but I can talk about my experiences and do what I can to help others who are where I used to be,” he says.
Kleiman and the center’s PR director, Aura Wolfe, emphasize the clinic’s need for financial assistance. Although partly funded by the New York Federation and private donations, funding is dwindling and the center is not reaching as many people as it should.
“I was in the US recently and donors were asking why we needed money now when things were quiet in Israel,” says Wolfe.
“As soon as shootings and bombings stop is when PTSS comes out. While it is happening you don’t have time to think about it. It is like a reverse peak,” says Kleiman, reiterating how lucky he feels to have found help when he did, and urging anyone else – first responder or civilian – to seek professional help if they need it.
“I finally mourned for those who had been killed in the suicide attacks. For two straight months I felt like I had 1,100 people outside my front door, and I gave each his and her due,” he says. “It was a period of my life that I wouldn’t change, but now I have learned how to put it in a box and close the lid.”
Although he says he never expected to be retired so young, Kleiman concludes, “Today I am much happier than I was before. I don’t ever want to lose my humanity again.”
Published in THE JERUSALEM POST Nov. 14, 2005
Israelis to help US cope with Katrina trauma
by Judy Siegel-Itzkovich
The Israel Trauma Coalition (ITC) and American Jewish fundraisers will join forces in an effort to teach professionals to help Katrina hurricane victims in the southern US to cope with trauma.
The binational preparedness consortium was announced on Monday in Jerusalem by New York Senator Hillary Rodham Clinton during a stop at the Jerusalem Fire Brigade in the Givat Mordechai neighborhood along with heads of the ITC and the UJA Federation of New York, which helps fund the ITC.
Clinton, who was presented with a red fireman’s helmet, told guests that Israel and the US, both targeted by terror, have a lot to teach and learn from each other. She noted that Israel, which has excelled in organizing skilled infrastructure for coping with terror, has taught the US since September 11 that preparedness – and not only rushing in afterwards to help victims – is vital. After 9/11, a support system was set up by the ITC and American organizations that exchanges information and expertise, and many teachers and parents know how to recognize early signs of trauma.
The first Israeli expert to train Americans on coping with trauma after 9/11, she said, was Dr. Danny Brom, chairman of the ITC and a founder of Herzog Hospital’s Center for the Treatment of Trauma. Brom, co-author of an English-language text on dealing with emotional trauma, sat next to Clinton and said his coalition – comprised of some 40 Israeli organizations that deal with trauma victims – would be happy to provide training and guidance for those who will work with hurricane victims, as it did working in Beslan with terror victims and in Sri Lanka with tsunami survivors.
“You have become experts in this field,” said the Democratic senator, even though Israel certainly never sought to excel in it. “We in New York look to you for help.”
Clinton facilitated funding for the consortium, which will provide school- and community-based intervention for dislocated hurricane victims who lost “everything, their family members, homes, jobs and communities.”
Clinton noted that American agencies also learned from Israel the importance of providing emotional support to first responders – firemen, policemen, construction workers and others – in catastrophes.
Steely-eyed firefighter of 13 years Assaf Abras said that the terror war against Israel has left emotional scars even on him and his colleagues, and that when he was hosted at a New York City fire station, he “immediately felt at home. We are one big family.”
Riding in a US consulate van with a police escort to the Romema neighborhood, Clinton went to the city’s Magen David Adom station and tried her hand at “resuscitating” a mannequin under instruction from an MDA paramedic. She was presented with an MDA vest by MDA blood services director Prof. Eilat Shinar and declared a life member of the organization for her intensive efforts towards getting the International Red Cross Movement to recognize Israel’s 75-year-old first-aid and blood supply organization as a full-fledged member.
Published in the New York Times, September 28, 2004
This Pill Will Make You Feel Better,
but We’re Not Sure Why
By DENISE GRADY
Most people have heard of the placebo effect, in which patients given sugar pills feel better because they think the pills are medicine. But few would like to be on the receiving end of a placebo: a person who asks for a painkiller wants the real thing.
The medical profession, at least officially, frowns upon prescribing placebos, because it usually involves lying, implies disrespect and can destroy trust in doctors. Some hospitals ban placebos, except in experiments, and then participants must be told that they might be given inert pills or shots.
A new survey, though, suggests that the profession may not always practice what it preaches. In the survey, of 89 doctors and nurses in Israel, 60 percent said they had given patients placebos. Many said placebos could sometimes work, and more than a third reported prescribing them as often as once a month.
The patients given fake medicine included women in labor and people suffering from pain, anxiety, agitation, vertigo, sleep problems, asthma and drug withdrawal. Most had no idea that they were getting placebos. Among the prescribers, 68 percent told patients they were receiving real medicine, 17 percent said nothing at all, 11 percent said the medicine was “nonspecific” and 4 percent told patients the truth.
Asked why they prescribed placebos, 43 percent said patients had made “unjustified” demands for medicine; 28 percent did it to test whether a patient’s symptoms were real or imaginary; 15 percent hoped to buy time before the next dose of real medicine; and 11 percent said their reason was “to get patient to stop complaining.”
The doctors who conducted the survey said they had expected that no more than 10 percent of those who responded would have used placebos.
“This is apparently a common practice,” said Dr. Pesach Lichtenberg, a psychiatrist at Herzog Hospital and Hadassah medical school in Jerusalem.
He conducted the survey, with Dr. Uriel Nitzan, at two large hospitals and various community clinics in the Jerusalem area. Their report was published online Sept. 17 by BMJ, a British medical journal (www.bmj.com).
The notion of a placebo effect dates at least as far back as Hippocrates, who observed that certain gravely ill people seemed to recover through sheer “contentment” with their doctors. Thinking the mind could heal the body, later physicians sometimes tried to help it along by giving inert pills or powders to sick people they could not otherwise help.
Today, some researchers are studying the placebo effect, while others doubt that it even exists.
In a telephone interview, Dr. Lichtenberg said he thought the placebo effect was real, could sometimes help patients, and could do so more safely than many drugs.
“I think the placebo has a legitimate place in medical treatment,” he said, but he added that it was wrong to lie to patients.
“There are certain ethical questions,” he said. “Do you tell a patient, ‘I’m giving you an antibiotic or a painkiller,’ when it’s not? Or do you tell them, ‘You are getting an agent which has been proven effective repeatedly in research, which will help you feel better; we’re not exactly sure how it works, but it has been shown to cause changes in brain imaging, to have physiological effects in the body and we are confident you will get relief?’ Do you say something like that?”
Dr. Lichtenberg said he became interested in the placebo effect because he had been helped by it himself. He had suffered for years from repeated throat infections, and consulted a friend who practiced alternative medicine.
“He spoke to me for five hours,” Dr. Lichtenberg said, recalling that he free associated about his throat and described being made to sing as a child for his elderly aunts. The friend told him that he would become slightly ill and then recover. That was exactly what happened, Dr. Lichtenberg said. The experience convinced him that there was something to the placebo effect.
He said: “People in our day and age are surprised that a nonpharmacologic intervention could be useful, and I think that ultimately is the message of the placebo effect. There are other ways of bringing comfort and succor to a suffering patient.”
A survey of Danish doctors published in 2003 also found that many of them prescribed placebos, but Dr. Lichtenberg said it was not known whether doctors and nurses in other countries behaved the same way as those in Israel and Denmark.
Dr. Robert M. Wachter, chief of the medical service at the medical center at the University of California at San Francisco, said in an e-mail message, “The use of placebos in day-to-day clinical care is virtually unheard of in the United States.”
He continued, “They are thought of as a subtle form of deception – both unethical and potentially creating a small risk of a malpractice suit.”
But Dr. Wachter also said that every doctor knew about the placebo effect and that it accounted for much of the benefit people got from antidepressants and all of the benefit from antibiotics taken for viral infections, which are not affected by the drugs.
” ‘Take this – I’m sure you’ll feel much better’ is a placebo maneuver,” Dr. Wachter said. “But in the U.S., it would be accompanied by a real medicine, not a sugar pill.”
Article published in the Washington Post, November 10, 2002
Helping Children Cope With Our Cruel New World
For three weeks, millions of residents in this area lived with the random sniper attacks. Until the arrest of two suspects on Oct. 24, many residents avoided areas and activities that were normally part of their daily routines. Now the community is returning to normal. But for some people “normal” has been changed forever.
The people of Jerusalem can identify with what D.C. area residents experienced. Whether terror comes in the form of anthrax-laced letters, sniper attacks or suicide bombings, the effects are the same. People feel vulnerable, afraid and anxious. For some, these incidents sow the seeds of long-term problems. This is especially true for children and adolescents.
The Israel Center for the Treatment of Psychotrauma in Jerusalem has worldwide experience in treating both children and adults. Our post-Sept. 11 work in the United States began with a New York City social service provider, and now, in partnership with the CDM Group in the District, we are bringing our expertise to groups nationwide. From our experience, we have identified three key points of which parents, teachers and health professionals should be aware:
Children are extra vulnerable to trauma. Don’t believe those who say children cope with crises better than adults do. In the aftermath of the shootings, be especially alert to children who are too quiet. Only by reaching out can you uncover their true state of mind.
At our treatment center, the focus has been on helping children step away from a traumatic event in order to let their natural coping mechanisms take hold. One way to do this is to have the adults in their lives reassure them that they will be taken care of, regardless of what happens. This reassurance takes the form of both family conversations and visible safety procedures.
For example, in Israel, after every terrorist incident, teams of school personnel and adult volunteers implement a standard response that includes taking physical security measures, checking on the whereabouts of students >and preparing classroom activities.
We must be ready to deal with the long-term trauma experienced by terrorism’s survivors, witnesses, first responders and the general population — especially if they are young.
Most people can deal with emergency situations: Survival mode focuses them on the danger and how to deal with it. But some people will continue to be afraid after the danger has passed. They may keep their feelings quiet because they are ashamed that the traumatic event affected them so much. Many will be unable to sleep or eat; some will be afraid to leave home. Those who continue to have trouble functioning four weeks after an incident may be diagnosed as having post-traumatic stress disorder, which is characterized by nightmares or flashbacks, severe sleep disturbances, extreme sensitivity to sudden noises, continual physical alertness, depression and aggressive behavior.
Untreated psychological trauma can manifest itself in violent and aggressive behavior or substance abuse or in other physical and emotional health problems.
From our experience, 80 percent to 90 percent of children and adults adjust to trauma and go on with their lives. Nonetheless, we must find ways to augment their natural coping mechanisms.
We encourage adults to talk to children about what is happening.
Clearly, this is a conversation for parents to have with their children; but it is also a conversation for teachers to have with their students. We have held workshops to teach educators how to discuss violence with their students.
Americans are resilient and optimistic, but on Sept. 11, 2001, they entered a world in which uncertainty and the potential for death and destruction are always present. No one can fully anticipate the next traumatic event, but we can be prepared to deal with its physical and psychological consequences. In so doing, we will be balancing caution and concern with the need to continue living our lives.
is director of the Israel Center for the Treatment of Psychotrauma at Herzog Hospital’s Latner Institute in Jerusalem.