A 22-year-old escaped unhurt from the Nova music festival but, crushed by survivor’s guilt, months later he still has difficulty leaving his bed. A 13-year-old who fearfully kept his siblings silent in their safe room through 11 long hours while terrorists surrounded his home is in therapy at a post-trauma clinic. At a hotel near Jerusalem, a family forced to evacuate from one of the southern kibbutzim struggles to help their child whose severe ADHD is impacted by the overcrowded living conditions.

These people are among those being helped by the Hadassah Medical Organization and its psychiatry and trauma departments in an agonizing snapshot of the mental health fallout in the months following Hamas’s deadly attack on Israel.

“Even those indirectly impacted by the horrors that began on October 7 feel exposed, unprotected, violated,” said Dr. Esti Galili-Weisstub, senior psychiatrist and immediate past director of the Herman Dana Department of Child and Adolescent Psychiatry at Hadassah Hospital Ein Kerem. “And if they haven’t lost anyone dear, they know people who have.”

The Israeli Pediatric Association reports that 84 percent of Israeli children are experiencing emotional stress, and studies by the Hebrew University of Jerusalem, Columbia University and Israel’s Shalvata Mental Health Center warn that up to a half million Israelis could develop post-traumatic stress disorder—although Dr. Galili-Weisstub cautions that these statistics can be misleading or underestimated.

HMO’s mental health staff are seeing significant increases in symptoms of acute stress disorder, which are stress reactions that continue for about a month. (PTSD is defined by acute symptoms still present after a year.) Self-medication with sleeping pills and antidepressants has leapt, along with increased cannabis use.

“We’re at the beginning of a collective national trauma whose ramifications will be with us for a generation,” said psychiatrist Dr. Amit Lotan, director of Hadassah’s Department of Adult Psychiatry at Hadassah Ein Kerem.

Trauma is a normal reaction to a devastating physical or psychological event, explained Dr. Lotan, “but when fear or agitation persist, when there’s chronic fatigue, sleep disorders, nightmares, anxiety, flashbacks and depression, it can become problematic, damaging formation of stable relationships, study and enjoyment of life.”

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Hadassah On Call

As Hadassah’s End the Silence campaign to speak out against the weaponization of sexual violence by Hamas gains traction, Hadassah On Call: New Frontiers in Medicine tackles the issue. In a recent episode, Dr. Dvora Bauman, director of the Bat Ami Center for Victims of Sexual Abuse at the Hadassah Medical Organization, delves into the implications of sexual violence during and after the October assault on Israel, and the challenges ahead. For this and other episodes, go to hadassah.org/hadassahoncall or wherever you listen to podcasts.

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With the Israel Defense Force’s well-established mental health system responsible for soldiers, HMO has been caring for other groups directly impacted by the attacks, prominent among them Nova music festival attendees and evacuees from Gaza envelope communities.

The young man who escaped the Nova festival remains overwhelmed by guilt, despite the survival of his girlfriend and their friends. He remains at home, unable to care for himself. With the help of a visiting team from HMO, he is making progress. Weeks of cognitive behavioral therapy, support and reassurance from the Hadassah team have allowed him to take a first step: getting out of bed once daily to walk his dog.

HMO psychologists and therapists also visit evacuees who are still living in hotels near Jerusalem for group and individual interventions. One family has been struggling with their 10-year-old son whose severe ADHD was challenging even prior to the carnage. Housed together in a single hotel room, with no organized support system and the boy’s medication no longer effective, they were in great distress. HMO’s team has adjusted the ADHD medication and provided therapy to help the family stabilize in their new reality.

Challenging in a different way is the 13-year-old boy, also from the South, who spent 11 hours in a safe room calming his 5- and 8-year-old siblings, while his mother held the baby and his father guarded the door with a kitchen knife. The boy is attending an HMO post-trauma clinic where “his treatment isn’t yet a success story, but he’s on his therapeutic journey,” said psychiatrist Dr. Amit Shalev, who succeeded Dr. Galili-Weisstub as head of Child and Adolescent Psychiatry one week before the Hamas attack.

“The human mind and spirit are very strong,” Dr. Shalev said, “and the emotional tools and resources that keep us emotionally healthy are inbuilt. But following October 7, many people—because of the intensity of their trauma, the magnitude of their injury or loss or psychological predisposition—need specialized help to move on.”

Development of PTSD remains a major threat. Unresponsive to conventional therapy, those with PTSD strain for productive lives and functional relationships, and are at higher risk of heart disease, stroke and dementia. Psychiatrist Dr. Ronen Segman, who heads HMO’s Ambulatory Psychiatry Services, is hopeful that research underway at Hadassah Hospital Mount Scopus’s Molecular Psychiatry Lab will enable both prediction of the syndrome and effective treatment. The project is testing survivors of the October 7 attacks for irregular hormone and immune biomarkers as possible red flags for developing PTSD.

“In an earlier study, we showed that child survivors of suicide bombings in Jerusalem over a decade ago who later developed chronic PTSD have distinct gene expression abnormalities in their immune inflammatory system,” explained Dr. Segman. “These abnormalities may point to new ways of targeting stress-related inflammation. We’re also embarking on a pioneering proof-of-concept study for treating chronic intractable PTSD with a psychedelic drug—psilocybin.”

The war with Hamas presents extraordinary challenges for HMO’s psychiatrists, psychologists, psychiatric nurses, therapists and social workers.

“Our job is helping patients contain their pain and anger,” Dr. Galili-Weisstub said. “But this is different. We’re part of their same experience. We have to ensure we react as professionals.”

The initial massive military call-up left the department critically short-staffed. In the past few months, significant time and money have been invested in extending training and supervision of mental health professionals, both at HMO and countrywide, to ensure there is additional expertise at hand.    

A different challenge has been that 15 percent of HMO’s mental health staff—psychologists, social workers and psychiatrists—are Israeli Arabs. Initially, some Jewish patients refused to be treated by them, and tensions emerged between longtime Jewish and Arab colleagues.

“The therapeutic bond is a trust relationship, and trust can’t be built if patients are afraid of or hostile toward their therapist,” Dr. Shalev said. “We’ve worked hard to support Arab staff who’ve experienced antagonism from patients, and to reinforce relationships between Jewish and Arab co-workers. Particularly successful are our dialogue groups, where two senior therapists meet with Arab staff to discuss fallout from the Israel-Hamas conflict, validate feelings and consider opposing perspectives.”

Dr. Shalev notes that healing, or at least helping, keeps him emotionally buoyed through the long hours and taxing work. Neither he nor most Israelis, however, is likely to emerge unscathed from the horror of October 7.

“It took Israel a full generation to recover from the trauma of the  Yom Kippur War, and what we’re experiencing now is far worse,” Dr. Galili-Weisstub said. “Exposure to trauma transmits down the generations at a biological level in changes in gene expression. This new barbarism joins millennia of expulsions, pogroms and butchery embedded in the Jewish psyche.

“Along with this, however, there’s collective hope,” she added. “The Jewish experience has shown the possibility of post-traumatic growth, of changing the reality for the better, both for ourselves and for future generations.” 

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Wendy Elliman is a British-born science writer who has lived in Israel for more than four decades.