PTSD STATE OF STATE
A Psychological Assessment of a State in Distress
Prof. Oren Kaplan, Clinical Psychologist, Israel
Prof. Oren Kaplan, Ph.D., an Israeli clinical psychologist, expertizes in positive psychology, resilience, PTSD and coping with stress.
Abstract The present paper presents a psychological analysis of The State of Israel. In light of Israel’s long history of traumatic events and survival attempts, it seems that a mental pattern was created that interprets any current situation as a crisis event. As a result there is a constant desire for transition and transformation – and the fantasy that broad change will turn crisis into growth and calmness. It seems that transition and transformation have come to represent inner needs, instead of objectives or solutions for specific real-world problems. It appears that the obsessive cognitions that concentrate on these themes result in exhaustion of energy that prevents investment in the essentials—the development of authentic and coherent self-experience, one that is independent of episodically events. This paper addresses the background, diagnosis, analysis and prognosis of the State of Israel.
Prologue From Freud’s period to this day, the overwhelming majority of psychological insights refer to individual private worlds. However, in the realm of business, sociology and political science, scant attention is paid to the influence of psychological factors – conscious and unconscious – on micro and macro-processes at the national, social and enterprise levels. This neglect has been somewhat affected by the 2002 awarding of the Nobel Prize to the Israeli-American psychologist Prof. Daniel Kahneman. The acceptance of the wide-ranging effect of psychological factors has extended from individual psychology to economics, and from there, to the world at large. It opens opportunities for a more legitimate evaluation of the individual, the society and the political state – based on the assumption that psychological processes profoundly affect every aspect of our private and communal lives. Ignoring these psychological factors can result in system failure. Attending to them can improve the quality of life of citizens, managers, and workers – and to create a society with higher levels of emotional intelligence. The present paper will address some aspects of the collective psychological experience that influences the culture, lifestyle and quality of life in Israel.
A State on the Analyst’s Couch If Israel were a person, would you recommend psychotherapy? At the very least, you would be concerned. Multiple traumatic events have influenced its existence, and these rest on the even more traumatic Jewish history of the past 2000 years. How does this affect the country’s children, its citizens – the first, second and subsequent generations that suffer abandonment, instability and disasters? The chronicle began long ago, with Abraham, whom God led to a strange (promised) land, continues with the selling of Joseph by his brothers, and finds a certain closure when Moses leads the Israelites back to the promised land, all in the same chronicle. And today? What sounds more credible to you, the biblical reports of Joshua Bin Nun describing a “land of milk and honey” and minimizing its problems, or the claims of the ten remaining and berated spies who claimed this was “a land that eateth up the inhabitants thereof” (Numbers, 13). Whatever your stance on the future, optimistic or pessimistic, it is hard to argue with the history of this country. The country seems a prime example of PTSD (Post-Traumatic Stress Disorder).
Intake Impression The patient, aged 56, looks younger than her age (remark: “Country” in Hebrew is a feminine noun). She is single, married, divorced and widowed, the mother of a large family, including a number of adopted children. Bears difficult childhood traumas, most of which she repressed and denied for many years. Made contact due to feelings of depression and anxiety which have recently increased. Apparently she is indecisive regarding her professional direction, though it seems that this indecision hides a much deeper ambivalence regarding her selfhood and existence. She is an abused woman, and also an abusive and caressing mother; she is simultaneously a model spouse and a treacherous one. She has a fiery temper, with a tendency to unexpected fits of anger. This seems an immature personality, suffering from dissociation with a traumatic background. At the same time, she appears to have immense inner strength, which can aid her, together with appropriate therapy over the course of years, to mature and develop.
Diagnosis: PTSD According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the main criteria defining PTSD are the existence of trauma in the personal history of the subject. Being present or being witness to a significant life-threatening situation affecting the subject or those close to himcharacterize this trauma. Subsequently, the trauma is experienced time and again, in various psychological iterations. In some instances, the subject avoids stimuli reminiscent of the trauma; and there are symptoms of extreme sensitivity. Countless indications reflect that the State of Israel meets all the criteria required in the diagnostic manual. The Israeli calendar documents a series of witnessed traumatic events: Holocaust Remembrance Day, Ninth of Ab (a day commemorating the traditional date of the destruction of the Jewish Temples), Itzhak Rabin Remembrance Day and so on. Even the cheerful Purim and Hanukah holidays recall ancient traumas of impending extinction and survival. All these harsh memories are supplemented, year-by-year, by the painful memories of terrorist attacks and other bloodshed, which take the lives of civilians and soldiers on a regular basis – and from which no Israeli ever feels entirely immune. The fact that life in Israel is always overshadowed by the threat of a new trauma calls into question the ability to process the traumas of the past so as to stabilize those who survived the terror. During periods of uncertainty in the country’s economy and security, each additional event deepens the feeling of existential anxiety, and adding echoes or “flash-backs” to the present-day uncertainty. There is no need to use the extreme example of those who do not manage to cope with everyday reality. Suffice it to consider the country’s everyday life to see post-traumatic symptoms. Let us consider the Israeli managerial style. The Israeli manager is a survivor. He does not rely on external data – he simply does not trust it, or he does not have the time and attentiveness to hear someone else (the quantity of business and marketing research is several times lower in Israel than in most other western countries). He functions based on gut instinct, mistrusting the potential enemy and reacting with excessive disregard for risks, or with excessive protection from them. Excellence is expressed in entrepreneurialism. Initiatives of new and creative projects are extraordinary and unprecedented. Even so, the Israeli manager lacks the inner resources to maintain his competitive edge over the long term. The capacity to survive is in effect at the most basic levels, and does not enable the growth and development needed to reach the upper levels of Maslow’s famous pyramid. There is survival and earning a living, but the feelings of love, self-worth and self-realization are levels of Maslow’s hierarchy that have so far not been open to the citizens of Israel. The trauma refugee is a champion at surviving. Yet nightmares disturb his rest, and in fact what seems like a normal life to the casual observer may well turn out to be an ongoing nightmare and a chronic state of crisis.
Personal History In a dusty book that few have read until now, I found an interesting testimonial of the spiritual development of Israel, Crisis in Israeli Society by Dov Ben Meir, who was an active participant in Israeli politics. It was published three decades ago, (Jerusalem, 1973, Carta Publishers), when Israel was only 25 years old. Published a few months before the Yom Kippur War and the deep crisis that ensued, the book analyzes various aspects of what Ben Meir calls “crisis.” A reader who is unaware of the book’s publishing date could easily imagine that it was written this year. The importance of this will be discussed, but first I would like to note a short selection of the chapter titles of Ben Meir’s book, since the topics addressed have such a striking resonance to today’s issues: Crisis of Foundations: A need to redefine Zionism – a state of law or a state of religion, ideological hardships resulting from economic pluralism [Socialism versus capitalism]; Crisis of the Western World: Opposed to the economic, scientific and cultural accomplishments, failure to resolve social problems Crisis in Education: Failure in education, from the inner recesses of the home, to the educational institutions Ethnic Melting Pot and Social Equality: Feelings of alienation and inferiority on the part of various ethnic groups, divisions within ethnic groups; dangerous confrontation between various immigrant strains, exacerbating social differences and curtailing integration Poverty, Violence, Crime and Blocking of Managerial Channels: Poverty among the marginalized, the elderly and pensioners, impoverished communities, families with numerous children, increase in social violence, worrisome spurts of crime Economy and Social barriers: A transition from an intimate society, small in number and of a personal nature, to a mass society, impersonal and lacking in intimacy Fissure in National Authority: How to build stable and automatic authoritative institutions, along the model of the traditional democracies in transition? The State of Israel is characterized by a continuous dynamic of crisis. Every hour a news report is broadcast on the radio, and there are updates every half hour. The media have in the past few years developed a tone that is increasingly dramatic, almost hysterical, transforming any event occurring in the national arena into a crisis that is about to destroy the nation. When I read Dov Ben Meir’s 30-year old book, I asked myself whether the growing crisis in Israeli society, as described in the book and in today’s newspaper, is really the objective condition of the country over the course of decades – or whether perhaps the country has succumbed to a culture that seeks crises as fuel for excitement and interest in life. Let us not deny reality: we must admit that Israel is confronted with a chronic crisis that has endured over many years. Yet at the same time, there is an element of autosuggestion, a negative self-image that transforms the atmosphere of crisis and stress into a culture and way of life. However, there is an additional interpretation to this existential experience, which lies between reality and fantasy. The permanent crisis and the permanent striving for change could serve also as transitional space – replaying external reality on its own terms.
From Crisis to Growth To bring about growth and change, there is a need for calm and distance from the sense of acute crisis. I determined to continue researching other sources, to better understand the roots of the crisis and what may constitute possible sources of growth and change. Today, all the answers are to be found in the Internet, and so I decided to approach the search engines. This may explain the overall atmosphere that creates the sense of crisis. In a random Google search for the word “crisis” (in Hebrew), the following results were obtained: “the water crisis in Israel”, “crisis in religious belief”, “crisis in start-ups and dot.com companies in Israel”, “conditions of crisis and psychological stress”, “social crisis” and “mid-life crisis”. In a moment of optimism, I searched for “growth”, thinking that here I would find allusions to a way out of the crisis, or at least a sense of release. Here are a few of the search results: “Economic growth increases the income of the rich and promotes social inequality”, “Growth is not enough,” “Growth and poverty,” “Downward growth”. I was somewhat disappointed. The results did not provide the optimistic data I had expected. I decided to try once more, and I placed my bets on the words in the phrase “from crisis to growth”. The results were surprising, a series of optimistic terms for positive change: “consolidation of optimistic mind-frame from crisis to growth”, “from crisis to growth: rounding up resources and making significant change”, “we wish to emphasize a number of principles for guiding organizations from crisis to growth”, “from crisis to coping: crisis management as a growth engine”, “tools for growth and crisis resolution” and “appropriate treatment of mid-life crisis will lead to renewed and promising growth”. It seems, therefore, that the most important process is neither the crisis and its causes, nor growth and its objectives, but the transitional space between crisis and growth. It is neither cause nor objective, but a process. So what have we learned so far from the textual sources search? The State of Israel has been in a chronic state of crisis for decades. The characteristics of the crisis have not changed over the decades, even though it always seems that the crisis is new and acute. It seems that the point of view itself defines the crisis. In addition, understanding the causes of the crisis or the objectives to resolve is not sufficient or satisfactory. It seems that as in the characterization of other crises, a dynamic and energetic process is required to feel in motion and not in crisis. A crisis is perhaps an inner experience, and not only a proven fact in the outside world. Since the interpretation of the crisis was moving towards the psychological, going far beyond the external world, at this point I turned to two Israeli psychologists who offer methods of crisis resolution. The psychologists are Amiram Raviv and Edna Katzenelson, and their book is titled “Crisis and Change in the Life of the Child and His Family.” The title is poignantly appropriate to the crisis of Israeli childhood – after all, what are 50+ years of statehood if not a period of childhood? I turned to page 19: “How is the crisis felt? The responses are not similar in their character or force. People and children under stress normally feel tension – lack of quietude – and tend to become angry easily, to feel more fear and worry. There may also be symptoms of fatigue, depression, or apathy. To each his own way of expressing the pressure that is put on him – just as many respond to pressure through excessive fatigue, another response may be excessive activity and running around…” I realized that I had found the right book. A more precise description of the Israeli population is hard to find – inexplicable oscillation between anger, depression and hyperactivity. Now I searched for an explanation of the lack of change in the crisis. I was particularly interested in the following passage: “The child learns that his troubles are a weapon that can ‘triumph’ everyone, and that by expressing suffering it is possible to avoid duties and burdens. The child learns to say ‘bless me, for orphaned I am’ (This expression is taken from Shalom Alechem story), and avoids any effort or responsibility. Instead of helping the child to resolve difficulties and assist him, we avoid having to do this by developing feelings of ‘compassion’, which make us feel that we ‘understand’, ‘empathize’ and ‘are considerate’ – while in fact we are taking the easy way out of having to resolve the problem.”
The objective is transformation, which is actually a transformational object Transformational objects, as defined by Christopher Bollas, can explain processes in the mature person’s life by emphasizing some infancy processes inspired by the Object Relations approach. The mother of the child incessantly changes his world. She protects him, cleans him, seats him,plays with him. All these activities represent a change in the baby’s external environment, while also affecting his inner world. From a state of irritability, crying and confusion, inner calm and harmony are created. Inner content is created in the infant’s ego. The mother therefore represents a complementary ego and a supportive environment: she safeguard’s the infant’s well being and satisfies his physical needs. By so doing, and through her relationship with the infant, she transmits to him the abilities that later become his self. The transformation, the change, is going from a state of tension and unsatisfied need – hunger, thirst, dampness and discomfort – to a state of calm and harmony created seemingly by magic through the presence of the transformational object, the mother. The transformation from suffering to harmony is unconsciously encoded into the infant’s memory, and it becomes a desire that accompanies the individual throughout his life. The object (mother) represents change. Therefore, in the life of the individual, there is no concrete objective of changing the external environment. Rather, there is an addiction or wish for the positive transformation and change. It is possible to see how hope serves as a transformational object in many stages of the individual’s life: a new job, immigration, holiday, a new relationship, a new home – all these can represent the wish for a transformational experience. Granted, only a technical aspect in the person’s external life has changed – yet there is the expectation that the technical change will bring with it a feeling of inner harmony and completeness. The search for the perfect occupation, the perfect partner, the perfect crime – these are not just quests for the perfect object. They also attest to internal ego deficiencies. The quest helps to differentiate between the negative inner experience, and external reality; it creates hope that simple logistical changes will bring inner reconciliation, and perfect harmony. Israel has strived for many years to change the external reality in a concrete and technical manner. Its inner experience remains isolated and alienated. We are told that economic success, international recognition, support from world Jewry, support from the President of the United States, the love of the Arab world and the world at large – all these will make the necessary difference. It is doubtless true that changes in external reality can bring about positive and more harmonious feelings. Yet the source of these feelings is the translation of the change into an internal-harmonious experience. To achieve harmony as a way of life one needs to be highly conscious of inner processes. Otherwise, one risks running amok after external achievements that ultimately leave no trace on the soul, meeting none of the needs they seemed capable of fulfilling. It seems that the experience of crisis and the struggle for change became transformational objects that represent the opportunity of harmony and calm. However, they result in stagnation and obsessive cognitions that block real opportunities for transformation and growth. A psychodynamic therapy assumes the development, over the long run, of a better understanding of internal processes, both conscious and unconscious. As Freud famously said, “Where id was, there ego shall be.” The desire for the transformational object continues forever, and is a source of motivation for external achievements. At the same time, however, one must recognize that the real change is a spiritual function, which is not solely dependent on changes in external reality. The crisis that has accompanied Israel for so many years expresses the despair and disappointment of the country and its citizens from the object of external change. Changes in the economy andsecurity, support from the U.S. and the rest of the world – all these will doubtless bring success and a better overall feeling. In such situations, there is often euphoria, which is purportedly linked to the external achievement. It is important to remember that the rate of depression in wealthy countries is equal (or even higher) to that of poorer countries. Likewise, winners of the lottery do not automatically become happier; on the contrary, they sometimes experience difficult personal crises. Harmony is found within, in the soul, and not in the external reality – which is but the transformational object that represents inner peace.
Recommendations for Future Treatment This may be the right moment to emphasize the second axis of the DSM, which focuses attention on personality aspects. In many cases, life events are woven into pre-existing conditions; it is difficult sometimes to distinguish between traumatic events and the factors that preceded them. It may be necessary during therapy to focus on the immature personality and coping difficulties, since a change in these aspects of the country may naturally facilitate processing of the trauma and resolution of the crisis. Self-Psychology therapists often postulate that psychological problems result from inappropriate leave-taking from the state of infancy, and from lack of appropriate parental attentiveness to the developmental needs of their children. Ideally, psychotherapy provides an opportunity to reconstruct the self, regaining the sense of coherence, authenticity and liveliness. This is a process of internalizing spiritual processes, which, in the normal course of development, the parents carry out on behalf of the child who cannot do it for himself. The parent helps the child to contain the failure and thereby to strengthen his self. It is natural that the parent will fail occasionally. The problem normally arises when the parent fails again and again in those functions that are necessary to build a solid base – leading to gaps in the experience of the self. In knitting, one can occasionally miss a stitch, and still complete a fine product. Yet, if one repeatedly misses a stitch in the same place, line after line, one will ultimately have a hole in the fabric. In this sense, therapy is meant to patch the hole, and to permit a new beginning in the processes that did not occur, leaving the individual with a self experience of being cracked, empty, fake, insecure, lifeless, unmotivated and aimless. Therapy aims to give the patient a sense of fulfillment and significance to himself and others. The State of Israel suffers from a number of prominent gaps. This causes Israel to express a lack of empathy towards its citizens and its environment in several factors that are significant for quality of life. The recommendation is for a therapeutic process that will rebuild a sense of self that is whole, authentic, alive, and well – a sense of self that Israel has apparently lost. I will quote from the Israeli psychologist Zehava Osterville’s book, “Open Solutions”: A weak self, constantly under threat, tends to react to everyday frustrations in a way that is out of proportion to the real event – with despair and depression or in narcissistic anger… the therapeutic objectives of psychoanalytic self psychology can be defined as: [try to see the patient as the State of Israel as you read] 1. To help the patient to reengage with the parts of himself that he has cut off and banished from himself and his world. 2. To help the patient to stop hiding or defending himself out of a sense of shame or guilt. 3. To help the patient to maximally realize his ambitions, according to his talents and abilities, and according to his ideals. The objective of the treatment is rehabilitation of the self through rehabilitation of the functions whose development was delayed or impaired.
In conclusion, external solutions such as economic revitalization, improvement in security, justified wars, and any other technical and external solution, are not enough to create an authentic, full and satisfying self experience. One must not underestimate the importance of economic and external stability, for the individual, the country, and all its citizens. Nevertheless, together with attainment of the necessary external objectives, it is necessary to undergo a spiritual process, sometimes a painful one, which is linked to the essential inner values that have nourished the country from its establishment to the present day. The analogy comparing this process to a dynamic psychotherapeutic process can serve as a strong basis for understanding and carrying out this process.
Prognosis The prognosis depends on Israel’s capacity to dedicate itself to the treatment and to undergo the complex process of discovering an authentic self. A poem by one of the most famous Israeli modern poets, Yehuda Amichai can demonstrate two types of prognoses. The first part of the poem concerns our ability to process the trauma, to accept our authentic selves and to go on despite the death reverberating in our nightmares. The second part of the poem concerns the stereotype of the typical modern Israeli, the opportunity seeker who grasps at any straw so as to feel the “moment” and to know that he is really alive – and yet does not leave much chance for a cure, for growth or for a new generation, a little more naïve and a little less wounded.
Advice for Good Love / Yehuda Amichai
Advice for good love: Don’t lov those from far away. Take yourself one from nearby. The way a sensible house will take local stones for its building, stones which have suffered in the same cold and were scorched by the same sun. Take the one with the golden wreath around her dark eye’s pupil, she who has a certain knowledge about your death. Love also inside a ruin, like taking honey out of the lion’s carcass that Samson killed.
And advice for bad love: with the love left over from the previous one make a new woman for yourself, then with what is left of that woman make again a new love, and go on like that until nothing remains.