Helping Children Deal With Trauma
As if pandemic lockdowns and shuttered schools were not enough, 13-year-old Meirav was hit by a car near her home in Jerusalem in spring 2021. Her injuries were minor, but the emergency care physicians at the Hadassah Medical Organization who first saw the pale and silent teen diagnosed her with post-trauma and referred her for help.
“It was quickly clear that Meirav’s trauma was not related to her accident but to what was happening at home,” said Dr. Esti Galili-Weisstub, head of Hadassah’s Herman Dana Division of Child and Adolescent Psychiatry, which has centers on both the Mount Scopus and Ein Kerem campuses. Meirav, whose name has been changed to protect her privacy, and her four siblings had spent the months of remote schooling largely confined to their small fourth-floor apartment, Dr. Galili-Weisstub explained. Their father had lost his hotel job when the tourists stopped coming. Frustrated and volatile, he had dominated the living room, leaving the television on and blaring all day. Their mother’s attempts to engage the five children—even having the family sit down together for regular meals—proved futile. One of the siblings was previously diagnosed with ADHD, another has behavioral problems and all five were bored and squabbling.
“The pandemic created a new and very difficult reality for this family,” said Dr. Galili-Weisstub, a world-renowned expert in child trauma. “The same is true for many, many others. Covid-related restrictions, fear, stress and isolation brought an avalanche of mental health problems countrywide.”
The psychiatry division, launched 20 years ago and today one of the most comprehensive psychiatric services in Israel, treats children from birth to age 18 and addresses developmental and neuropsychological difficulties as well as social and family problems. Throughout the pandemic to today, the division’s 14 inpatient beds—for those at risk for suicide or self-harm or who require monitoring due to an eating disorder—have been full, with a six-month waiting list for new patients. Its day clinics have been at capacity, too, fielding 17,000 patients in 2021 and a months-long waiting list just to get an appointment.
Eating disorders are among the mental health issues that have risen worldwide among adolescents and young adults during the pandemic. One study conducted by Michal Grinstein-Weiss, director of the Social Policy Institute at Washington University in St. Louis and a faculty member at the Interdisciplinary Center Herzliya, together with Rami Benbenishty, professor emeritus at the Hebrew University of Jerusalem, found that 24 percent of Israeli youngsters experienced disordered eating in 2021, almost double the number pre-pandemic.
Food, explained Dr. Galili-Weisstub, becomes a coping mechanism, something that children feel they can control in a changing world. She recalls treating a 12-year-old girl with no previous history of psychological difficulties who began binge eating during lockdown. Her weight shot up, and she spiraled into depression and began shunning social interaction. Admitted to the division’s eating disorders clinic, the adolescent gained control of her eating and her mood aided by therapy as well as by contact with other young patients. She currently attends the clinic’s afterschool center, where therapists continue to treat her.
Other patients were destabilized by school disruptions. One academically gifted but socially awkward student in junior high school developed suicidal ideation and was hospitalized for eight months. He had been looking forward to beginning a prestigious new school in September 2020, where he had hoped to find friends.
Instead, at home for weeks because of the lockdown, “his social insecurity intensified, and he began urgently desiring to take his own life,” said Dr. Galili-Weisstub. A combination of therapy and anti-anxiety medications helped him learn to manage stress while he kept up with his studies via Zoom. He was also encouraged to create a support network of friends in his new school, which has fully reopened, as well as make time for hobbies. It has been six months since his discharge, and according to his therapist, he has had no thoughts of suicide.
Adding to the challenges of treating children with emotional and behavioral disorders, Covid has disrupted the way Hadassah’s psychiatrists, psychologists, nurses, therapists and dietitians evaluate and treat their patients.
At certain times during the pandemic, many interventions went remote, but “therapy via Zoom is challenging,” said Dr. Galili-Weisstub. “The value of sitting in the same room with a patient can’t be overstated. Besides, an empty room with a closed door isn’t available to every patient, and not everyone, especially those in the haredi community, has access to a computer or smartphone.”
Currently, Zoom sessions are no longer used, but staff and patients continue to be fully masked. This remains a challenge, added Dr. Galili-Weisstub, since masks conceal facial expressions crucial to communication during treatment.
Zoom therapy was not suitable for Meirav, who suffered from post-trauma, so Dr. Fortunato Benarroch, director of the division’s Center for Pediatric Traumatic Stress, treated Meirav and her family in person. “I worked intensively with Meirav’s parents, helping them structure the day,” he said. “We had the older children teach the younger Covid rules—masks, handwashing.” He also guided the mother in involving her children in meal preparations, emphasizing the importance of a family meal at least once a day, and helped the father recognize his impact on his children. The family instituted “a daily movie time when they watched TV together, the children taking turns to choose the movie and make popcorn. This gave their mother a precious 90 minutes to herself each day.” The changes in the family dynamics, plus a return in September to in-person schooling, created marked improvement in Meirav’s mood.
Whether the trauma they suffer is through plague, family tensions, terrorism or natural disaster, “children try to give meaning to their experience and seek strength to come back to themselves,” said Dr. Galili-Weisstub. With its multiple approaches to overcoming trauma, Hadassah’s child and adolescent psychiatry division helps children find their way back to mental health.
The pandemic reinforced global connectedness around health care—something long internalized by Hadassah Medical Organization’s child and adolescent mental health specialists. Dr. Esti Galili-Weisstub’s team has shared their experience in disaster-hit regions worldwide for decades, including training local mental health professionals following a tsunami in Sri Lanka and an earthquake in Mexico.
“Israel is a global leader in teaching coping strategies to trauma victims,” she said.
After the 2018 shooting at the Tree of Life Synagogue in Pittsburgh, HMO therapists advised local Jewish schools on how to help their students cope. Several years ago, HMO also launched an initiative to train therapists closer to home. At a conference in Berlin some 20 years ago, Dr. Galili-Weisstub joined mental health professionals from Gaza, the West Bank, Lebanon and Jordan at a session on the impact of the Middle East conflict on children in the region.
“We considered its effect on the developing brain, emotional capability, creativity and flexibility. In doing so, we perceived a mutual reality,” she said. That meeting was the beginning of ongoing relationships between Israelis and Palestinians in the field. Fifteen years later, these relationships evolved into the Binational School of Psychotherapy in Jerusalem. Under the aegis of HMO and jointly headed by Dr. Galili-Weisstub and Shafiq Masalha, an Arab Israeli clinical psychotherapist, the school’s purpose is to upgrade the skills of postgraduate Israeli and Palestinian mental health professionals in treating youngsters affected by war and terror.
“We started as students in this school that treats Palestinians and Israelis equally,” said a Palestinian graduate of the school’s 2016 pilot cohort who asked to remain anonymous. That inaugural class included 14 child psychologists—Palestinians from the West Bank and Gaza as well as Israelis Jews and Arabs from Jerusalem and Tel Aviv.
By the end of the program, we “acquired a wide variety of interventions and specializations in different, complex therapies and an understanding that both Palestinian and Israeli children are the eternal victims of wars and conflicts. “We and the Israelis are mirror images,” he added. “When they talk of their children’s suffering, they could be talking of our children.”
Clinical psychologist Hadas Schroder Rahamim of Jerusalem is one of 29 professionals enrolled in the school’s second course, which began in fall 2020. “My encounter with Arab Israeli and Palestinian colleagues at the school has been important life exposure,” she said of the two-year program. “It is making me more aware of cultural aspects of identity and refocusing emphasis on understanding culture and heritage in therapy.”
During the program, therapists form close connections around a joint commitment to children’s well-being. Nevertheless, “we walk a kind of tightrope,” said Schroder Rahamim. “There is tension concerning our conflicting experiences of life in Israel.”
Despite the obstacles and tensions, Dr. Galili-Weisstub believes that the school’s Israeli and Palestinian graduates can impact substantively on mental health in the region and, in her words, strengthen “a new generation to create a more peaceful Middle East.”
Wendy Elliman is a British-born science writer who has lived in Israel for more than four decades.