Gaza Violence Puts Psychiatrists On Alert The conflict in Gaza is one of the worst clashes between Palestinians and Israelis in decades. But for people who live in the region, outbursts of violence have been part of everyday life. Two mental health professional — Dr. Nancy DuBrow, of the Center for International Studies and Danny Brahm, of the Israel Center for the Treatment of Psycho trauma in Jerusalem — discuss the affect of violence on mental health.

Gaza Violence Puts Psychiatrists On Alert

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MICHEL MARTIN, host:

I'm Michel Martin, and this is Tell Me More from NPR News. Coming up in our international briefing, we take a closer look at the new president of Ghana who took office yesterday after a spirited but peaceful election, a hopeful sign on the continent where violent disputes over elections dominated headlines last year.

But first, the Middle East, where the cycle of violence continues. Over 600 Palestinians and about 10 Israelis are dead and thousands injured after days of bombing and ground attacks by Israel. Israel took the action in response to rocket attacks from Hamas fighters in Gaza. Although this is one of the worst clashes between Palestinians and Israelis in decades, for people in the region, sudden bursts of violence had been part of the landscape of everyday life also for decades. So we wanted to ask how this affects people in the short term and the long term. So we've called upon two mental health professionals who have both worked extensively in the region.

Dr. Danny Brahm is a psychologist and the founding director of the Israel Center for the Treatment of Psychotrauma of Herzog Hospital in Jerusalem. Dr. Nancy Dubrow is at the Chicago School of Professional Psychology. She's director of the Center for International Studies, and she's worked on and off with the Palestinian Red Crescent Society since 1998, and she's worked on training programs for treating children in Gaza affected by the conflict - training teachers, doctors and other health-care professionals, and she joins us from Chicago. Doctors, thank you both so much for speaking with us.

Dr. DANNY BRAHM (Founding Director, Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem): Thank you for having us.

Dr. NANCY DUBROW (Director, Center for International Studies, Chicago School of Professional Psychology): Thank you. Hello.

MARTIN: And I should mention that we tried to reach physicians who were working currently in Gaza, and owing to the conditions there, as you might imagine, it's been very difficult. When we have been able to reach physicians, they've been treating patients. So we thank you both for talking with us.

Dr. Brahm, can you first tell me - obviously, without violating any professional confidences - are you currently - are your patients currently dealing with issues related to the conflict right now?

Dr. BRAHM: Well, everyone living in a country like Israel, under fire and in a war, is affected. It doesn't only affect the people who are living at the front or who are soldiers but it affects all of us, and that includes me. And because Israel is a country where there is no professional army but everyone is in the army, so also your kids might be called up or your neighbors or your husband, so everyone is in this tension of what's happening.

MARTIN: I was going to ask you that, actually, a little later, but since you raised it, I will ask you now. How do you manage your own stress, grief, anger at a time like this?

Dr. BRAHM: It's a very good question. It's not easy when your own children are in danger. I think that is the soft spot of every parent, and that is when it becomes really difficult to be both on the side of treating people and helping people, and on the other side caring about your own family members. But at the same time, we know also that helping others helps yourself, and I find that is a great way to also keep my mind off things.

MARTIN: Dr. Dubrow, what about you? First of all, I wanted to ask, when you were working in Gaza, what are some of the effects - psychological effects or issues that you deal with or have dealt with with people there?

Dr. DUBROW: Well, most of my work has been with children and families. You see the images of children on the television. They're crying, they're afraid, they're living under bombardments. Is it safe outside? Is it safe in the house? And I think that generally, it's that issue of safety that concerns children and their parents because under these conditions it's very difficult to make children feel safe, either with words or by physically protecting them because it doesn't seem that there's a safe place, which is really the essence of trauma - is not feeling safe, not having a safe place to retreat.

MARTIN: And having worked in the region on and off for about 10 years now, have you seen long-term effects of this on children? Obviously, this particular situation right now is horrific, and you know, you don't know what affect it's going to have on children. But for people who you've seen over the course of time, have you seen an affect of this long term on them? How does it affect them?

Dr. DUBROW: It does affect some people over the long term, and some children are more affected than others. Children, depending on their experiences and depending on their - the age, their development at the time that the traumatic event happened or the violence occurred. I have known children who were witness in very close proximity to violence, and some of those children were still talking about the event over years, over four years, five years. I've actually had cases like that. Those children really need special attention to recover from that and to understand the experience. But it all depends. It depends on the child, it depends what kind of support they got.

MARTIN: But when you say understand the experience, there are so many ways that you could understand an experience like that. When you're training professionals in the area to try to help them help these children, what do you tell them to tell them to help them understand the experience?

Dr. DUBROW: If children hear, for example, shooting, I've had mothers ask me or professionals, should we tell the children that that's a firecracker or that that's fireworks to protect the children? In most cases, the children know what they're hearing and what they're seeing, and they also understand quite well the reason for the conflict, and they are much more politically aware than perhaps children in other parts of the world. They're very aware of that ongoing conflict and the history involved in it.

MARTIN: Well, Dr. Brahm, what about that on the Israeli side? First of all, what is the challenge for caregivers, parents because you can't lie to children. You can't say you're safe because they're not. So how do you counsel people to address this?

Dr. BRAHM: Well, yes. What we have found, actually, is that the extent to which the parents can function and feel OK, even in these circumstances, is what determines whether the child will feel OK. And of course, it's different according to the developmental stage of the child, but the smaller the child is, the more important it is that the parent will stay in his or her role as parent. And sometimes what you see is that the parent is so afraid that he will use his child as a sort of parent. You hear parents will say, I only dare to go out of my house with my child, and that's, of course, a difficulty.

So what most of our programs try to do is to really impress upon the parents and help the parents to regulate themselves and stay in their role as a parent.

MARTIN: One of the things, Dr. Brahm, I was wondering about was - as you pointed out, that just about everybody in Israel is a soldier. Is there an affect of civilians in seeing children - civilians in the Palestinian side in Gaza being killed? And is that traumatizing to think that your army has inflicted this kind of hurt?

Dr. BRAHM: Well, of course, the whole situation is a lose-lose situation because Israelis have in the past 10 years increasingly felt threatened in their homes and in their towns and wherever they are - in the buses, in the restaurants. And then, when in the past eight years the attacks were really daily on the southern border, people really felt that this is what could happen to the whole country. We could be terrorized just by people sending missiles from wherever. And if - and that is being increased by what some of the organizations on the other sides say, and that is that they would like to kill all Israelis or do away with the state of Israel.

So there's an existential fear that is there, and that doesn't make the impact of the killings any better. Everyone is really very afraid of what's happening in Gaza and concerned about it, and at the same time, there's a very general feeling of people saying, we have no choice, we have to protect ourselves...

MARTIN: Can I...

Dr. BRAHM: And I combine that to really lose-lose.

MARTIN: Finally, can I ask each of you - and I mean this not as a political question but in the spirit of the conversation that we have been having - in a time like this, there are many people who on the outside who wish to engage with people who are at the center of the conflict there - politicians who are pouring into the region, family members are sometimes coming to be in support of family members who live there all the time. Is there something that outsiders can do to be particularly helpful at a time like this? Dr. Dubrow, if you could start.

Dr. DUBROW: You know, you asked Dr. Brahm if he was affected by this, and I have been a person who has been concerned about children who live in armed conflict all over the world, so I'm definitely affected by this. And I'm very concerned about the civilian population, children who have been killed in this, and I tend to look at it as if I can't go there physically and lend my support, then I am willing to talk to my representatives in Congress to urge them to bring an end to this violence, to go to the table and negotiate and talk, and I'm very much of that mind.

MARTIN: Dr. Brahm, what about you? Is there something that...

Dr. BRAHM: Well, I...

MARTIN: People on this side can be doing?

Dr. BRAHM: You know, what we've experienced in the many years of wars here in Israel that it's extremely important for people to feel that people care from the outside. And so people coming to the region, I think it's very important because sometimes you use their eyes to look a bit at yourself from the outside, which I think is very helpful. And it also reminds you that this is a temporary thing because when you're in the middle, the feeling is this will never change and it will never stop. And whatever bridges can be built and whatever relationship you can have with people who are not in the same situation, I think it's helpful to help you cope with not getting stuck in seeing the enemy only as an enemy but seeing how much suffering there is on all sides.

MARTIN: Danny Brahm is a psychologist. He's the founding director of the Israel Center for the Treatment of Pyschotrauma at Herzog Hospital in Jerusalem. He was kind enough to join us by phone from his office there. Dr. Nancy Dubrow is at the Chicago School of Professional Psychology. She's director of the Center for International Studies. She's worked on and off with the Palestinian Red Crescent Society since 1998 and has worked extensively on training programs for health professionals who work with children in Gaza, and she joined us from Chicago. I thank you both so much for taking the time to speak with us today.

Dr. BRAHM: Thank you.

Dr. DUBROW: Thank you.

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