Abstract
In 1948, the state of Israel was created as a homeland for the Jewish people after 2,000 years of persecution and deportations in the diaspora. During the past 72 years, its inhabitants have experienced several wars and numerous terrorist attacks. Therefore, the issue of trauma goes beyond academic study, it is part of daily life. These circumstances have, unfortunately, turned Israel into a natural stress laboratory, which has enabled the systematic research of the biopsychosocial effects of traumatic stress on soldiers and civilians. This article reviews the findings of a series of studies that examine (a) the short- and long-term mental health effects of war on combat veterans; (b) the effects of repeated exposure to war on veterans; (c) trajectories of PTSD; and, specifically, (d) reactivation and (e) delayed-onset PTSD. We present the findings of two decades of systematic trauma research, which have followed the ongoing psychopathological effect of war on veterans. In understanding the ripple effects of trauma, it can be seen that veterans do not leave the events of the war behind once they are home; rather, it is with them wherever they go. Consequently, the trauma has a ripple effect that may carry over to veterans' spouses and offspring. The multiple manifestations and trajectories of both acute and chronic trauma will be presented. Clinical ramifications and implications will also be discussed.
Highlights
War is one of the most devastating human constructs
The country is small; all Israeli wars are fought on Israeli land and its borders and, it is significant to note the close link between the Israel Defense Forces (IDF) and the Ministry of Defense
Capitalizing on these characteristics, we have initiated and conducted longitudinal studies spanning two decades of several cohorts of traumatized Israeli veterans [for details see [2, 8]]. These Israeli studies addressed many questions that had been left unanswered by previous research, as outlined by Solomon [1]: What are the frequency and duration of psychiatric breakdown on the battlefield? What are the characteristic manifestations of combat-induced psychopathology? Does recurrent exposure to combat weaken soldiers or lead to greater resilience? How can we explain the many recovered combat stress reaction (CSR) casualties whose traumas are reactivated after a long asymptomatic period? Is delayed posttraumatic stress disorder (PTSD) onset a valid phenomenon? And if so what explains its onset a long time after exposure to trauma? This review article summarizes some of our studies’ findings, casting light on these important questions
Summary
War is one of the most devastating human constructs. There are the visible results of war, such as the loss of life and the destruction of property and culture [1]. Combatants are passive bystanders, they are perpetrators who cause death, injury, and destruction, thereby violating the ethical standards and values commonly held during peacetime [3] They struggle with loneliness, isolation, and forced separation from their loved ones alongside a lack of their physical needs being met in regard to food, drink, and sleep. The country is small; all Israeli wars are fought on Israeli land and its borders and, it is significant to note the close link between the Israel Defense Forces (IDF) and the Ministry of Defense Capitalizing on these characteristics, we have initiated and conducted longitudinal studies spanning two decades of several cohorts of traumatized Israeli veterans [for details see [2, 8]]. These Israeli studies addressed many questions that had been left unanswered by previous research, as outlined by Solomon [1]: What are the frequency and duration of psychiatric breakdown on the battlefield? What are the characteristic manifestations of combat-induced psychopathology? Does recurrent exposure to combat weaken soldiers or lead to greater resilience? How can we explain the many recovered combat stress reaction (CSR) casualties whose traumas are reactivated after a long asymptomatic period? Is delayed posttraumatic stress disorder (PTSD) onset a valid phenomenon? And if so what explains its onset a long time after exposure to trauma? This review article summarizes some of our studies’ findings, casting light on these important questions
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