Kathleen M. Pike, PhD

It’s Complicated

A delegation of Advisory Board Members from our Columbia WHO Center for Global Mental Health joined me in Israel for a 10-day trip that concluded earlier this week. Interspersed with the more typical sightseeing, we focused on learning about mental health priorities in Israel –  specifically, conflict, trauma, resilience, and recovery.

The reality is that this postage stamp of a country has outsized significance as both a spiritual holy land and as a hotbed of conflict. Our meetings with mental health experts around the country ranged from discussions of brain science to community efforts serving youth. Trauma is a collective experience in Israel, and expertise abounds.

1. The Healing Power of Being Present. We began our learning trip with a visit to the Israel Trauma Coalition (ITC), a non-profit partnership of non-governmental organizations that specialize in emergency preparedness, building resilient communities, post-trauma care, and rehabilitation. ITC has systematic training programs and uses practical, evidence-based strategies to support individuals and communities dealing with conflict and trauma. ITC Director Talia Levanon also emphasized the particular power of simply being present for someone in crisis. Sometimes this may mean sitting quietly beside someone or resting a hand on a shoulder. Sometimes words fall short. Sometimes they are not needed. Presence is its own form of healing that can transmit hope, empathy, attention, intention, connection, safety, and hope – all factors that help people regain health and wholeness in the wake of trauma.

2. The Healing Power of Staying Power. Located atop Mount Carmel, Yemin Orde Youth Village is a “home, school, and safe haven” for 450 at-risk immigrant youth. Founded in the wake of the Holocaust to support orphaned children, Yemin Orde has been home to children from around the world. Today, Yemin Orde’s youth are from Ethiopia, France, the former Soviet Union, Brazil, and Israel. Most of the young people arrive at Yemin Orde having suffered trauma due to experiences such as war, loss, neglect, abandonment, and extreme poverty. Interpersonal trust is low, and mental health issues are widespread. In addition to appropriate, formal therapeutic strategies, a key component of Yemin Orde’s success in helping kids build resilience and recover their lives is the organization’s long-term commitment. Over time, Yemin Orde youth build interpersonal trust and self-confidence. Whereas some health needs – like setting a broken bone or prescribing an antibiotic for an infection – are treatable in a one-and-done manner, recovery from trauma for kids takes time. Yemin Orde Youth Village is an inspiring demonstration of the healing power of staying power.

3. The Impact of Trauma on the Brain. Weizmann Institute of Science President, Professor Alon Chen, spoke to our delegation about how brain function is disrupted in stress-related psychiatric and physiological disorders. Linking the basic science of how the brain copes with stress, Chen and colleagues are working to create more precise therapeutic interventions for stress-related mental disorders. During our visit to Soroka Medical Center, Dr. Hadar Shalev shared brain imaging data that illustrated dramatic alterations in brain functioning for individuals experiencing post-traumatic stress compared to those who were not suffering from trauma. The adage, “it’s all in your head” takes on a whole new meaning when you really can see the changes that occur in our heads in regard to trauma.

4. The Ethics of Mapping Genetic Risk. Medical imaging technologies are making visible the changes in our brains that result from trauma. Genetic and epigenetic research is moving the field closer to being able to identify who is at risk for developing psychiatric symptoms due to traumatic exposures. We know that most people will not develop post-traumatic stress disorder following a traumatic event. But a significant minority will. Genetics research is getting closer to being able to identify who will be resilient and who will become symptomatic. With these data in hand, ethical questions arise. Is it a protective duty of care in the military, for example, to tell individuals with certain genetic risk that they are not permitted to serve in a combat unit? Or would such policies be deemed unethical, interfering with free choice and opportunity?

5. The Potential to Build Capacity and Bridges. In the outskirts of Jerusalem, we met with the co-directors of Project Rozana, an audacious initiative at Hadassah Hospital that aims to build meaningful personal and professional connections between Israelis and Palestinians through healthcare initiatives to create a more peaceful and cooperative world. The program focuses on training mental health professionals – 1/3 Palestinian, 1/3 Arab Israelis, 1/3 Jewish Israelis – in evidence-based psychotherapies. There is a dire need to build capacity in mental health expertise in the Palestinian community; there is an equally dire need to build bridges among these communities where conflict has reigned, and trust has waned. The co-directors, faculty, and trainees aspire to advance mental health care, and in doing so, build a more inclusive and equitable society for all.

Without exception, the presenters quipped at some point in every meeting, “it’s complicated.” Understanding and treating trauma is complicated. The unrelenting conflict in the region is complicated. Persevering in the face of many naysayers is complicated. The different groups of people who each have the solution for the future of Israel, just not the same solution, is complicated. If it weren’t all so complicated, we would already have figured out how to have more peace and less trauma in Israel – and the world. Missile fire, iron dome interception, sirens, and taking refuge in shelters were all part of my last few days in Israel. As I pack my bags to head back to the USA, I am deeply grateful and humbled by those who are undaunted by how complicated it is. You are the torch carriers of hope and possibility.

Picture of Kathleen M. Pike, PhD

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University.

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