Cultural Perspectives on the Aftereffects of Combat Trauma: Review of a Community Study of Bedouin IDF Servicemen and Their Families.

Yael Caspi,Ortal Slobodin,Ehud Klein

doi:10.5041/rmmj.10205

Abstract

Combat trauma may affect servicemen from indigenous, traditional communities in ways that warrant special attention. The Bedouins, who enlist in the Israel Defense Forces (IDF) voluntarily, represent a unique, closed, collectivist cultural minority, potentially in a predicament in light of ongoing sociopolitical events. This paper summarizes findings and lessons learned from a community study of Bedouin IDF servicemen and their families residing in Israel’s Western Galilee. This is the only research endeavor to have addressed trauma exposure and posttraumatic reactions in this community. The sampling strategies and interview schedule were designed in consideration of participation barriers typical of hard-to-reach populations. Data collection followed an extended phase of liaising with key informants and building trust. Study limitations are discussed in terms of the challenges presented by this type of research. Interviews conducted with 317 men, 129 wives, and 67 mothers revealed high levels of trauma exposure and posttraumatic stress disorder (PTSD) in the men, and related distress in wives and mothers, but not in the children. The role of aggression in mediating the impact of PTSD and concepts such as shame, the loss of personal resources, and beliefs about retribution are highlighted as key issues for a culturally relevant understanding of traumatized indigenous communities.

Highlights

The trauma of war tends not to wither when the fighting ceases
The direct impact on the soldiers, conveyed through the many faces of the posttraumatic distress, has been studied long enough to warrant the change introduced by DSM5.1 We have come a long way from the transient nature of the Gross Stress Reaction of Diagnostic and Statistical Manual of Mental Disorders (DSM)-I2 and the Reaction to Extreme Stress of DSM-II;[3] the modified definition of posttraumatic stress disorder (PTSD) includes the understanding that exposure to severe trauma may result in persistent, exaggerated, and distorted negative beliefs and cognitions; persistent, negative emotional states, such as guilt, anger, shame, or fear; and persistent detachment and inability to experience positive emotions, such as love.[1]
A few Bedouin veterans were admitted to the Department of Psychiatry at the Rambam Medical Health Center with unusual posttraumatic manifestations that generated a myriad of diagnoses, including PTSD with psychotic features, schizoaffective, adjustment, and personality disorders (Caspi, personal communication)

Summary

Introduction

The direct impact on the soldiers, conveyed through the many faces of the posttraumatic distress, has been studied long enough to warrant the change introduced by DSM5.1 We have come a long way from the transient nature of the Gross Stress Reaction of DSM-I2 and the Reaction to Extreme Stress of DSM-II;[3] the modified definition of posttraumatic stress disorder (PTSD) includes the understanding that exposure to severe trauma may result in persistent, exaggerated, and distorted negative beliefs and cognitions; persistent, negative emotional states, such as guilt, anger, shame, or fear; and persistent detachment and inability to experience positive emotions, such as love.[1] In other words, these tenacious alterations in relationships to self and others represent what patients often describe as being lost to themselves. With its ethnic and religious diversity, provides a unique field of study for cross-cultural differences. The Israel Defense Forces (IDF) (often considered to be the “melting pot” of Israeli society) includes, alongside the Jewish majority, soldiers and servicemen of Arab ethnicity, primarily from the Druze and Bedouin minority communities. Given the unsteady and erratic nature of events in the Middle East, these closed, traditional, and understudied cultural groups find themselves periodically in the midst of public expressions of ethnic/religious tensions[11] and anti-Arab sentiments.[12]

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Conclusion