From the Frying Pan into the Fire: A Haifa Therapist Goes to Nahariya and Ma’alot

Northern Israel was under missile attack in summer 2006. This latest unprecedentedly intense bombardment today of southern Israel triggered memories I had of driving to worse-hit places than Haifa way back then. The roads were scary, empty and threatening, as a black spot could suddenly fly across the clear blue skies with a whoosh and whistle and I might not have time to find shelter. As I reflected on my experience back then and on what friends are going through right now, I decided to upload what I wrote then about working with the people affected by the war. I offer this real-time report and hope you will find it interesting and informative.

Friday and Saturday, August 4 and 5, 2006

I was happy to wake up early and set out in my car.  For the first three weeks of this war, I was inactive at home.  I live in Haifa, and work in Kiryat Motzkin, and the whole arena of my life had become a war zone.  I tried to use this enforced “strike” to make some headway on writing projects and grant proposals.  However, between missile alerts that sent me diving into my “bunker”, calls to friends and my daughter to make sure everyone was okay and watching the hourly news updates, I had neither the concentration nor the energy to focus on writing for more than a few moments at a time. Somehow, in spite of that, I did manage to write one chapter and with that my ability to write and think about my field of expertise, childhood sexual abuse, collapsed.  Feeling useless, I looked for a way to use my professional skills in congruence with the current crisis and I finally got some nibbles to the lines I sent out in various directions.

At 6 am, hoping to make the trip before Hizbollah got into gear, I drove from Haifa to Zefat to meet with the staff at an immigration center. The trip north of Haifa was frightening. The roads were empty and that made it feel quite eery.  With the window open, I hoped that, in the event of a missile launch, I would hear the sirens and that I would have enough time to find cover.  I felt like I had three eyes – one searching the calm blue summer skies for the sudden appearance of foreign flying objects, another scanning the sides of the road for appropriate places to hide (minimal) and another to keep me safe on the road.

I got lost in Zefat and wandered around looking for my way. Every minute lost like this means more time at risk.  Unfortunately, the timing of my visit was not good and I was able to talk for only a short time with a small number of individuals and define the goals of a meeting to be planned for later. Staff members are suffering from the burden of having to cope with their own fears and worry for the safety of their families and at the same time provide support for the new immigrants under their care.  Missiles also landed within the perimeter of the immigration center grounds.

(A siren just interrupted my writing.  Between waiting on the floor in the space I filled with cushions between my sofa and the innermost wall of the apartment, writing text messages to see how everyone is, and making a cup of tea to help my heart-beat get back to normal, the time interval was about 30 minutes. This will undoubtedly occur several more times during the writing of this diary.)

After having talked to the staff about their needs, I asked about the nature of the missiles falling here and the location of the warning sirens on the inter-urban roads. I was told that the missiles falling in this area are not packed with ball-bearings like those falling in Haifa, Acco and the Krayot area. Instant relief: this is easy! In contrast with the larger, more dangerous missiles packed with ball-bearings that can kill at up to 700 meters away from impact, if the katyusha rocket does not land directly on me I have a good chance of not being killed.  About the fact that there are no sirens in the spaces between cities, I didn’t know what to think.

Interestingly, my drive from Zefat to Nahariya was less nerve-wracking. With no sirens, there would be nothing I could do to protect myself from missiles and so my life was in the hands of God (as if it wasn’t if there was a siren). I put my fear aside and did what gives me the most pleasure when driving through the Galilee that I love so much – I soaked in the landscape with my eyes.

However, to my horror, there were many blackened bald spots on the hills – burned out areas where missiles had landed in open forests.  I hear it will take over 60 years to reforest these areas to the predamaged level.

In Nahariya I found a help center bustling with activity.  Two rooms, about 15 telephones manned by representatives of the various branches of city government – those who help assess properties damaged by missiles, health services, psychologists from the education system, social workers from social services, and more.  It was an honour to join these professionals and the volunteers from other parts of the country.  In pairs, volunteers visit the different bomb shelters, talk with the people there, assess their mental state and their needs.  However, this first morning I was there alone and Baruch, a volunteer driver, took me to two shelters from which calls for help had been received.

I had heard stories from my colleagues about the interesting work they had done in shelters with groups, one member of the pair working with the adults and another with the children.  I wondered how I would handle things on my own.  I had no idea what I would find.

At the first shelter, a drug addict, drug-free for about 1 1/2 years, had asked to speak to a psychologist; he was waiting outside on a chair by the entrance. His psychiatric prescription had run out two days earlier and he had been substituting it with something weaker (where did he get that from?). He was beginning to feel the effects of being without his medication and was desperate, claiming not to be able to last the weekend.  He had been too scared to leave the bomb shelter to renew his subscription earlier.  I asked about his symptoms and started to teach him breathing techniques that would help alleviate anxiety.  However, I sensed that he wasn’t really interested – all he wanted was his medication.  I promised to pass the word on at the municipal center and went into the shelter to see if anyone else needed help.

I was immediately directed to a soldier who hadn’t got off his mattress for over a week.  He hadn’t notified his unit – he just didn’t return to service after his home visit. Not yet classified as a deserter, I was hoping he would let us notify his unit that he needed psychological help. A brief conversation with him revealed that he did not relate much to the katyusha rockets landing around his vehicle as he drove in the Kiryat Shmona area but when he returned home to Nahariya for a visit and saw damaged homes in his neighbourhood, his fear for his family caused a severe anxiety attack from which he was not able to recover. Civilian therapists are prohibited from working with soldiers so advising him to report to his unit and get help from their psychological corps was the most that I could do.

The mother of a teenage girl claimed her daughter was having anxiety attacks after a missile landed next to their home while the girl was in the shower. She talked about her fear but did not seem to be overly anxious.  It was her mother who seemed more in need of help.  She kept complaining about how her children were suffering and the father was angry other families were being taken from Nahariya but not them.  The mother was clearly in distress but I didn’t feel she was open to any kind of work and recommended the family be moved to another part of the country to rest and regain their emotional energies after 26 days in the confines of the shelter.

The next shelter Baruch drove me to housed about 70 people.  There were religious and secular Jews and families of Lebanese soldiers who had fought together with Israeli forces in the last Lebanese war.  The woman who had called for help was not there.  Almost everyone was sitting around outside in the small park in which the shelter was located.  I chatted with people and tried to see if there was anyone else who needed to talk.  The only problem that emerged here were interpersonal conflicts among some of the residents.  When a fist-fight broke out between one man and a teenage boy, Baruch intervened and brought a temporary cessation of hostilities.  I later learned that the police had been called in at times to deal with the physical violence that would erupt.  This shelter was famous in the area for its interpersonal problems.

Back at the municipality I passed on my report of the visits to the psychologists at the educational psychology services, the office organizing the volunteer support to the shelters.  Trying to find two pills for the clean drug-addict was not easy, because the health services were already closed for the Sabbath.  While the emergency department at the hospital first agreed, when the driver called to make sure, they rescinded the offer.  I called the man back to tell him he had no choice but to somehow cope until 8 am Sunday when the health clinic would open.  He shouted at me that I am no help and if he falls back into drug use it will be my fault and on my conscience.  Unprepared for the venomous attack, I was shocked by this introduction to anger as a means of coping with fear and helplessness that characterize some people and I felt as if some air had been let out of my emotional balloon;  I felt the enormity of what the shelter residents were dealing with and it depressed me.  Baruch, who has been volunteering since the start of the war and knows all these people, helped me regain some perspective.

By the afternoon, David, a Jerusalem psychologist arrived and we worked together for the afternoon and the next day.  We were asked to follow-up on shelters that had been visited by other teams and were considered to be difficult in terms of interpersonal relations.  In some cases, the problematic individuals had been moved to other shelters or had been moved out of Nahariya to hotels or guest houses in the center of the country.  It seems that many shelters had fewer inhabitants this week than previous weeks and that there were far fewer children than had been reported by other teams.  In addition, we saw fewer cases of anxiety and found people either handling the situation well or distressed or angered by conditions in the shelters.   Our work seemed to be basically taking an interest in the people, asking them how they were doing, playing with their children and asking what they needed.

Working with David was a pleasure.  A child psychologist, he had a lot of energy.  The minute we would enter a new shelter, if there was a child there, David was on the floor with him or her, engaging the child and playing happily, assessing the child’s state of mind through the manner in which the child played, watching how the parents and how other children joined in or watched the games.  That left me to engage the other adults in conversation.

I was amazed at peoples’ resilience.  They spoke of witnessing katyusha landings, seeing the ruins of their apartments or those of their neighbours, learning quickly the distinguishing sounds of enemy missiles landing (referred to as “boomim”) or Israeli missiles leaving for Lebanon (called “yetziot”).  They talked about the difference between the early weeks of war when there were no warning sirens in Nahariya to the last three days since sirens started sounding – the sirens often causing more anxiety than the booms themselves (as long as they or their property did not end up under or too near a missile).  We sat through sirens with them, sometimes arriving at the shelter just as a siren sounded.  People were always happy to see us.  They were happy to tell us how well they were getting along with each other or, alternatively, to complain about the mismanagement of the situation by city officials.  Some complained that those close to city employees were the first to get rooms in hotels outside of Nahariya or seats on day-trips to attractions in the center of the country.  We promised to raise their needs with the officials at city hall who sent us there.

Three cases stand out most strongly in my memory:  On Saturday afternoon, David arranged to have four woman soldiers come with us to two shelters in which we were told were children suffering from anxiety.  In the first shelter, we left two soldiers to play with the children and I left the parents with a hand-out describing children’s reactions to trauma and how parents can help them.  We took the other two soldiers with us to the next shelter.  The soldiers engaged some of the children, while David worked with a mother and her young child who was clinging to her.  I spoke with another mother, who was happy we shared English as a mother tongue.  She had organized the shelter, made sure it was kept clean and that everyone was fed and taken care of.

We returned to the first shelter and found the children and young adults were happy with the attention of the soldiers.  The parents of a young boy who was particularly stressed impressed me deeply.  They said they had read the hand-out and had discussed it.  These were simple uneducated people; yet, the mother said she understood from the hand-out that her child was suffering anxiety because she was anxious.  She also understood that her anxiety would not totally go away until after the war would end because she and her family were still in danger.  The father said he understood that being unemployed one month before the war began was an additional stress that was exacerbated by the war and that he needs to understand his feelings in order not to pass on his distress to his children.  When we left the shelter, the family seemed much calmer and confident in themselves than before. The presence of soldiers in uniform was very significant and we reported this fact to the psychological services, recommending they send teams to play with the children.

Just before leaving for home, we were told about a young boy of 4 who had regressed and was showing signs of intense anxiety.  We found a father who made a show of bravado, a boy who was very unsettled and interpersonal relations in the shelter that were heartlifting.  This family and a neighbouring family of Lebanese refugees had grown quite close during the month’s stay in the shelter.  It seemed that the father expressed his helplessness through his son’s neediness.  We recommended that soldiers be sent to this shelter to engage with the residents.

By this time it was dark outside.  That made the drive back to Haifa seem less dangerous. It seems that the Hizbollah do not send rockets south of Nahariya after nightfall.  And, in fact, I made it home without having to stop for cover.

Sunday and Monday, August 6 and 7, 2006

I met with Yair [my colleague] at his home in Kfar Vradim. Yair is a senior EMDR therapist and I was happy to work together with him. EMDR is a technique that has been found to be effective in dealing with trauma and stress, among other difficulties.

I met up with Yair at about 1100 and by 1300 we were in Ma’alot where he works.  Our original programme to meet with the staff working with the elderly was cancelled because they were in a variety of locations and given the large number of missile landings that day it was considered unwise to have them travel from one place to another.  Instead, we went out to a few shelters.   We met with people who were generally coping fairly well with the situation.  What they wanted most was someone to talk with, someone to take an interest in their welfare.  There seemed to be fewer complaints in Ma’a lot at that time than there were in Nahariya.

Back at city hall for the afternoon and evening, I was given the privilege of meeting with municipal employees.  They were working long hours, with little relief and someone thought of giving them professional attention.  I met with social workers, psychologists, secretaries and other city employees.  Out of consideration for their anonymity, I will report only in general terms about the kind of work that I did with them.

Not all employees live in Ma’alot and the drive to and from work is dangerous and, therefore, frightening.  If they were functioning adequately and driving safely, it would not be reasonable for me to suggest that I could do anything to reduce their fear.  I did suggest to one worker that she sign up for a double shift so that she would drive to work early in the morning and drive home again late at night, thereby avoiding being on the roads during the hours missiles attacks are most likely to occur. This also meant that she was driving to work once instead of twice in the same week.

Some employees found it hard to concentrate at work when family members were at home.  After assessing that these were not cases of disproportionate anxiety but reasonable concerns in a time of war, we talked about concrete ways to reduce the risk to family members who may not be able to descend the stairs to the shelters.  In other cases, employees felt a strong sense of loss when remaining in the city to work while family members were evacuated to other parts of the country.  For someone else, fear was mixed with mourning the death of a family member killed by a missile. Again, concerned listening seemed to be the intervention of choice.

One worker had a clear case of anxiety – she felt herself “fall apart” at every siren sounding.  A few days earlier, she was pushed up against the wall of a building by the impact of a missile landing not far from her. Her legs were unable to carry her and she crawled around to the other side of the building until she regained her balance and her strength.  We discussed her physical reactions and the triggering of these responses by the sirens.  When I explained the reasons for her shaking, the dryness in her mouth, and other symptoms, this understanding was sufficient and her confidence was restored.  Later that day, she excitedly told me how the numerous sirens following our session did not set off an anxiety reaction as before.

For another employee, the main issue of concern was the uncertainty of when the war would end. Given that her distress seemed reasonable but exaggerated, I took a cue from a comment she had made at the start of our conversation; it turned out that the troubling uncertainty she found so stressful mirrored the uncertainty that characterized an unrelated traumatic incident she had experienced a year earlier.  So her current stress was being magnified by reawakened aspects of the earlier trauma. Understanding this connection was sufficient for helping her cope with the current situation and learning the butterfly hug [a relaxation technique developed by an EMDR practitioner during the aftermath of the Mexico earthquake so many decades ago] gave her a way to ground herself.

The next day, I visited two shelters with Ruti, an art therapist from Tel Aviv.  In the first shelter, the people just wanted to talk about the buildings damaged in their residential area, including two near by the shelter itself.  They did not seem to be overly anxious, except for one couple who were engaged in conversation with Ruti.  In the next shelter, Ruti worked with a mother and her young daughter and I talked with a teenage immigrant from Russia and a Lebanese refugee couple.  At the end of our conversation, both the Lebanese husband and the immigrant teenager wanted to volunteer to help other residents in their city.

For the next few hours, I held sessions with some city employees and casually engaged in conversation with others who said they had no particular need to meet with me in private.  Most of them were tired and stressed by the long hours, the need to find a balance between worrying about their own safety and that of their families and their professional duties.  Finally, well after dark, I set off for home.

I felt satisfied with my work in Ma’alot.  As opposed to sitting with shelter residents who have endless days with nothing much to do (and need not go anywhere at the sound of the sirens), city employees are working very hard and have to be pushed to take a 10-minute break with me to think about their own needs. Ten minutes usually turned into 30 minutes or more, but it was clear that they felt pressured by time. Furthermore, there was no guarantee we could work uninterrupted and several sessions were marked by sirens that sent us out of the privacy of the office in which we met to the municipal shelter down the hall. One woman was “faster than a speeding bullet” and almost before I had “decoded” the opening notes of the siren she was already in the shelter.  That was the end of our session. She was unique, however, and sessions with others would generally continue after the short visit to the shelter.

Driving in the dark on mostly deserted roads is spooky.  It was not late at night, people should have been either returning home after a long day at work in the high-tech industrial park I drove through or they should have been on their way to an evening out.  Even though I felt safe in the thought that Nasralleh would not send missiles out at night, I checked the roadsides for possible hiding places.  I couldn’t help but wonder how civilians survived the uncertainty and constant fear of World War II.  I was afraid of unexpected missiles; those with false papers and a phony life story were afraid of a surprise encounter with Nazi soldiers around the next bend of the road or path.  And they were statistically more in danger and for a much longer time than I.  How did they ever cope!?

Thursday and Friday, August 10 and 11, 2006

I slept a great deal of the past two days.  And at 8 pm Thursday morning I set off for Nahariya once more, this time with the purpose of meeting with city employees as I did in Ma’alot.   Since no appointments had been set up for me until the afternoon, I went with a team of doctors to two shelters in the morning.  This week, the children seemed to be doing much better than the adults, who seemed largely lethargic, depressed and despondent.

In the afternoon I met with several municipal employees.  Again, in order to protect their confidentiality, I will only discuss their situations in general terms.  One was overwhelmed with fear and, in spite of the fact that she functioned well, she felt on the verge of breaking down.  Because we were interrupted more than once by sounds that resembled missiles landing, and at that hour there was constant threat of a siren surprising us, we rescheduled our session for the following morning before the start of the work-day.

Another worker, with a son fighting in Lebanon, was torn between pride at his son’s accomplishments and fear for his safety, between trusting his son to act responsibly and worry that this same responsibility would lead him to risk his life.  I taught him breathing exercises to apply when he would begin to worry about his son because there was nothing he could do except hope for his son’s safe return. As he focussed on his breathing, I did alternate bilateral taps on his knees, a kind of somatic variation of EMDR.  He gradually felt his level of distress ease off and was more confident of his ability to cope with the worry.  He recognized the fact that the very factors that scared him were the same factors that made him proud of his son and that he would not want it any other way.

Another male employee was traumatized by witnessing a missile kill a citizen. I taught him how to breathe for relaxation and, as he talked about the experience, I did bilateral tapping on his knees, instructing him to stop at intervals and apply the breathing exercises.  His physical sensations changed and he felt lighter and less troubled.  He had a need to talk and we had a long discussion on various issues concerning the war and peoples’ reactions to it.

For the last session of the day, I worked with a woman who felt torn between her need to take care of others and her need to take care of herself.  I helped her identify the conflicting forces at play within her. She talked about boundaries and her need to learn to define them in a way that balanced between the needs of others and her own needs.  Recognizing that she is growing more assertive with time was reassuring for her and she felt she was learning better how to cope with her own conflicting needs.

The next morning, the employee who was overwhelmed with fear the previous day, talked about having been able to sleep better that night and hearing the birds chirping in the morning for the first time since the start of the war.  She recognized that the intensity of her fear was related to a childhood trauma.  It made her feel both angry and afraid.  We did an EMDR intervention on this issue.  This led her to talk about her anger for the first time ever.  It was enough to relieve her tension and she felt much lighter and able to cope with the tasks ahead of her that day.

For another employee the deaths of our soldiers brought up memories of his own war experiences and he felt he needed to stay alert, could not allow himself to rest, worried that he would not know where to turn in time of imminent danger in contrast to what he felt was his less than satisfactory performance as a soldier.  Finding a metaphor for the fear in his chest, using EMDR, we were able to soften the image, thereby connecting him to a source of inner strength upon which he felt he could rely.

A sharp fissure between life before the war and life after the war troubled another employee.  He had never felt such fear before and was more worried about his children than about himself.  Breathing exercises and teaching him Tom Cloyd’s safe place meditation, together with EMDR, provided him with a way to cope.  He knows he will need time after the war to learn to trust again that he can leave his children at home alone.

Another employee finds herself constantly tired because she can’t sleep properly.  We discussed setting up a safe spot in her house where she would feel more protected in the event of a surprise missile attack in the middle of the night.

Interestingly, some of the workers I was recommended to see seemed to be coping quite well.  They were happy to talk with me and appreciated the concern, but did not seem to be in great distress.  It seems what was most difficult was the emotional exhaustion and nobody had enough rest. Many were bothered by phone calls even late at night at home, but took their responsible too seriously to turn off their phones.  Also interesting is where this war is touching everyone so differently – some are learning lessons about themselves and others are learning lessons about their co-workers and fellow citizens.  Not all these lessons about life are happy ones.

Sunday August 13

I arrived home at 21:30 Friday night and it seems I have been sleeping off and on ever since.  Yesterday we were lucky to have only two sirens in Haifa but in the past hour this morning, there have already been five.  Missiles landed in Haifa and other places farther north.  My heart sunk to learn that one person was killed in Shlomi.  The skies are silent.  I can’t hear any planes on the way north to blast the launching sites.  What does this silence mean?

Thinking that the missile threat might end tomorrow lifted my spirits and I could hear it in the voices of those I asked in Ma’alot if they feel they need my help this week.  We’ll talk tomorrow, they said, and see what is happening.  And then came five sirens soundings.  My body feels hot now, I am alert and my previous exhaustion has lifted, at least apparently; I can feel it just under the surface, just out of reach.

This makes me wonder about the difference between volunteers who come from other parts of the country and those, like me, who come from areas under threat. Some shelter residents were amused when I said I’m from Haifa, asking why someone from one place under threat would come to another and at the same time, there was a sense of common destiny. We would compare frequency of missile attacks and the differences in the types of rockets launched.

I am tired and resting at home does not give me the refreshment I really need. This is semi-rest, on-alert rest.  I could see the difference in how it was for me to volunteer in the shelters and how it was for those who came in from farther away.  I was impressed with their energy, an energy I couldn’t summon up. Working individually in private quarters with municipal employees, a more focussed kind of work is quite suited to my current energy level.

There!  I just got a call.  I am needed by a family from Ma’alot who are staying in Haifa to be near a loved one, an injured soldier from the frontlines.  So I get to use the siren-generated adrenalin before it wears off.

Feature Image Credit: paffairs_sanfrancisco [CC BY-SA 2.0 ], via Wikimedia Commons