Fostering Resilience After Trauma: A Clinical Conversation

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COMMENTARY

The trauma inflicted during the Hamas attack on October 7, 2023, is being experienced by vulnerable individuals worldwide, as Ofrit Shapira-Berman, PhD, a psychoanalyst supporting victims and their families, explains in our conversation.

In the immediate area of conflict, not only Israelis but also Palestinians are being held hostage by Hamas and the perpetrators of the violent attacks, as they continue to bring death and destruction on the residents of Gaza and the individuals in Israel mourning their losses and waiting for the 136 men, women, and children being held hostage.

Adding insult to injury, many Jewish individuals have felt the impact of rising antisemitism worldwide. The hate and the rhetoric have caused harm to innocent individuals on both sides and impact humanitarian relief and healing.

The trauma is multiplied by history of the Holocaust (many Holocaust survivors live in Israel, some of whom were victims of the October 7 attacks and/or witnessed the violence in a land they had deemed safe), and the shocking willingness of much of the world to look away from the genocide that was perpetrated against the Jews.

The widespread, ideologically fueled denial of sexual violence perpetrated by Hamas as well as the International Court of Justice taking up a charge of genocide against Israel with no probable cause has added to the trauma. An expert on international law who has represented Palestinian interests has noted that sometimes an accusation of genocide becomes an incitement to genocide.¹ This undoubtedly adds to fear and trauma.

Fostering resiliency involves acknowledging the trauma and finding ways to move forward. Fortunately, there are outlets. For those seeking legal recourse against hate speech misrepresented as free speech, there is a movement to seek civil damages for the harms caused by such speech.²

For those treating or consulting to clinicians treating victims and survivors, in addition to the therapeutic approaches outlined by Dr Shapira-Berman, engaging patients in creativity can be one way of helping them grieve.³ Hyman Bloom’s Child in the Garden, painted in the immediate aftermath of the Holocaust, can serve as a model for such therapeutic exploration through art.

Harold J. Bursztajn, MD: What has been the impact on the bereaved, families of hostages, and traumatized victims of kidnapping, rape, and humiliation?

Ofrit Shapira-Berman, PhD: The trauma is so profound and unprecedented—it seems to be very different from “regular” losses normally endured by people. It is partly because each of the victims had endured multiple traumas, simultaneously.

For example, people at the kibbutzes were locked in their shelters for hours. They heard terrorists outside their homes shout in Arabic, they heard the shooting all around them, they were shot at, and their homes were invaded. They witnessed their loved ones being shot, wounded, and killed. At the extreme, their loved ones were abused and slaughtered right before their eyes. Many houses were burned with the victims in them as an attempt to make them run out—then they were murdered.

In the community WhatsApp group, members of the community were texting—crying for help and reporting what was going on—so everyone was exposed to all the various atrocities that took place. People who survived the attack emerged with their world shattered, in terms of their trust and morals. Everything they have ever believed in was completely shattered. Terrorists were able to invade their homes, the army did not appear for hours on end, so their trust is totally shattered.

In terms of morals, the fact that human beings could be so cruel—abuse, slaughter, cutting off people’s limbs, gouging their eyes, and burning children alive, then eating, drinking, and laughing before and after—is something no human mind can contain. The effects of such horrific acts lead the survivors not only to doubt the possibility of living with their neighbors, but to doubt humanity as a whole.

The same can be said for the survivors of the NOVA Festivals. The things they witnessed and experienced are outside of one’s imagination, and 2 of the things they refer to are 1) the extent of the terrorists’ cruelty and 2) the fact that the terrorists were smiling as they were slaughtering people.

It seems that the Hamas’ sadism was one of the main factors that extinguished Israelis’ trust in humanity. I presume that it goes as far as “humanity” because the atrocities were so horrific. It magnifies one’s shattered trust.

Bursztajn: What has been the impact of denial of the Hamas attack (eg, the refusal—including from feminist organizations around the world—to acknowledge the rape of Israeli women and the United Nations’ delay in investigating Hamas)? Is such denial and suppression of conversation foreseeably harmful to survivors?

Shapira-Berman: The Holocaust is a fundamental aspect of the Jewish and Israelis’ ethos. This ethos has 3 basic components: 1) the hatred of Jews merely for being Jewish, 2) the determination and cruelty of the Nazis, and 3) the silence of the world, at least for a long time. Jews were left to be burned, murdered in the gas chambers, and prisoned and tortured in the camps. Eventually, the world stepped in, but for many, it was too little and too late.

The events of October 7, 2023, brought to the surface the Holocaust as a common metaphor. Of course, there are significant differences. Jews have a state and an army, and the Hamas, however vicious they are, are not an existential danger. However, the silence of the world and the apparent antisemitism is a dark reminder of those days.

Surviving such horrific violence, only to be blamed for it, is an additional trauma to what was already suffered by the victims. The world’s avoidance and reluctance to condemn the Hamas and other terrorists, and to acknowledge brutal rape, adds to what the Hamas did on October 7. It is not an exaggeration to suggest that this silence is an additional act of killing of the survivors’ minds and psyches.

Bursztajn: How have victims of the Hamas attack, and Israelis in general, shown resilience? How can such resilience be effectively supported?

Shapira-Berman: The civilians’ resilience and resourcefulness were extraordinary—both from those exposed to the atrocities and from those who lived elsewhere. People in the kibbutzes fought fiercely and with endless courage, often endangering their own lives, in their attempts to save other members of their community. For hours, they fought thousands of terrorists who invaded their homes, all alone, until the Israel Defense Forces (IDF) special forces arrived.

The resilience could be seen in some of the most famous footage that was published of an 84-year-old woman who was kidnapped and taken to Gaza and was seen sitting among her kidnappers with a thin, serene, almost smile on her face. It was such an extraordinary sight that people wondered whether she was suffering from dementia. Her children said she was as lucid as possible and that this was an expression of her strengths and resilience.

The civilian population showed its resilience by organizing, immediately, and setting up a war room, replacing almost all of the formal authorities, within hours of Saturday morning. Thousands of civilians not only joined the army, but started gathering food, clothing, and all other necessities for the victims of the attack who had been evacuated from their homes. Some of them went to the south to save the injured.

Civilians, who were on the verge of a civil war for 10 months prior to October 7 after the political coup of Netanyahu’s government, united immediately in their support of the victims, the survivors, the bereaved families, and the combat soldiers fighting in the south. The victims themselves were able to hold in their rage and express their unity with the rest of the Israeli society and the IDF, although they did feel betrayed by the “state” and the army.

With much dignity, they have been able to postpone whatever needs to be examined until after the war. Israelis’ reliance can, and should, be supported by a global recognition of the atrocities and the horrible suffering they endured. Such recognition and acknowledgment act as empathic witnessing—the opposite of the ignorant and indifferent bystander.

Bursztajn: What are effective treatments for trauma like this? Can individuals who have suffered in different ways benefit from different forms of treatment?

Shapira-Berman: Therapists have mainly been using the following interventions:

• Support: recognition and acknowledgement of the atrocities, their effects, and the individuals’ attempts to survive them
• -Short-term therapy: both dynamic and cognitive behavioral therapy (CBT)/eye movement desensitization and reprocessing (EMDR)
• Long-term therapy: both analytic and trauma informed; survivors, bereaved family members, and the hostages who are back are just beginning these therapies now

For NOVA Festival survivors, specific locations were opened in which various kinds of alternative methods were combined with the more classical ones. In addition to these methods, these places employed therapies that focus on psychedelic drug usage, as many of the NOVA survivors had been using them at the party.

Bursztajn: How has the denial of Hamas horrors, including the systematic rapes of Israeli women, impacted victims of sexual violence worldwide and of other recent genocides (ranging from the Shoah to Biafra and beyond), as well as emboldened antisemitism and racism? What can be done to detoxify this worldwide impact?

Shapira-Berman: I think this is one of the most painful aspects of the October 7 events. I find this issue of sexual abuse to be the most difficult of all for the Israeli citizens to contain. Most say, “I cannot handle this. This is too much for me.” I think its effect on women in general, but especially Jewish women, is horrible. What can we think now, other than that our lives do not matter, women’s lives do not matter, and Jewish women’s lives do not matter at all?

I cannot believe that if American women were raped, as a war crime, the world would react in the same way. This is being understood in Israel as another manifestation of antisemitism, and it should be addressed as such.

I think it is not only women’s organizations that should be approached. I refuse to see sexual violence as a “women’s issue.” It is a human issue and should be addressed as one. Men who rape women (and other men as well, as was the case on October 7) should be perceived and judged as war criminals, and those who perceive themselves as the gatekeepers of the moral civilization should all stand up and shout, no more.

The violence that took place on October 7 should not be regarded as a problem of the Israelis, but as a problem of the whole world. World leaders who permit such violence are bringing the world nearer to its end.

How to detoxify the effects of double standards relative to Israeli self-defense efforts? For instance, what does it mean to the survivors you are treating that some American politicians insist that conditions be placed on military assistance to Israel that were not placed in instances such as aid to the Iraqi army in liberating Mosul from ISIS?

Bursztajn: How can restorative justice be helpful in the face of such trauma? How might restorative justice be achieved?

Shapira-Berman: I cannot see it happening in the near future. No survivor will be able to forgive the Hamas and those who support them for any of the horrific things that took place on October 7.

Bursztajn: Is there anything else you would like to share with your colleagues in the United States?

Shapira-Berman: No therapist can allow herself, or himself, to stay silent or to remain an innocent/ignorant bystander when children are being burned alive; people are having their limbs cut off while they are still alive; women are being raped, abused, and then murdered; men’s genitals are being cut off; and innocent people are being kidnapped and taken to Gaza. This amounts to keeping silent while another Holocaust takes place. No nation should ever suffer such atrocities.

Therapists who dedicate their lives to the suffering and healing of others but do not stand with the people of Israel at the moment are hypocrites, to say the least. They should all remember: Not reaching out for the victims is strengthening the abusers. On October 7, the abusers were the Hamas and other terrorists, and the victims were the people of Israel. There is no justification, and there should never be any justification, for such atrocities.

Note: The opinions expressed in commentaries are those of the participants and do not necessarily reflect the opinions of Psychiatric Times®.

Dr Bursztajn is in clinical and forensic neuropsychiatric practice in Cambridge, Massachusetts. He contributes as a senior faculty member of the Harvard Medical School (HMS) Department of Psychiatry and as founding director of the HMS Program in Psychiatry and the Law and of the American Bioethics & Culture Institute.

Dr Shapira-Berman is a psychoanalyst, social worker, and lecturer at the Hebrew University of Jerusalem School of Social Work and Social Welfare in Israel and an expert in trauma therapy. She leads a 450-plus team of psychoanalysts who have volunteered to treat families of the hostages.

References

1. Sands P. East West Street: On the Origins of “Genocide” and “Crimes Against Humanity.” Vintage Books: A Division of Penguin Random House LLC; 2017.

2. Bursztajn HJ, Stein MA. Restorative justice vs hate speech. Psychiatric Times. November 8, 2023. Accessed February 7, 2024. https://www.psychiatrictimes.com/view/restorative-justice-vs-hate-speech

3. Richman S. Witness to war: enlisting the creative process in working through trauma. Psychoanalytic Perspectives. 2023;20(2):189-208.