Lessons from Disaster Psychiatry for Israel After October 7

I write with counsel born of responding to too many past disasters.

Earlier this month, an Israeli journalist interviewed me and wrote about the mental health impact of 9/11 and my thoughts about what it foretells for Israel after the "Black Sabbath" of October 7 and the war it spawned. I talked about the importance of planning now for the long-term mental health impact of the horrific events; my concerns that Israel is in a more psychologically vulnerable position than my own New York City was prior to 9/11 due to the pandemic, the recent political upheaval, and their war on terror occurring at their border and not across the world; and how we developed our 9/11 rescue and recovery worker mental health program at Mount Sinai Medical Center in New York City by screening responders with mental health surveys when they showed up for physical health screenings.

Since the publication of that article, I have had the entirely unexpected privilege of hearing from a number of Israeli mental health professionals, government officials, and community members seeking my counsel. Sitting in New York City but with my mind on Israel and Gaza and my heart in Israel and Gaza, this is what I have learned:

• The Israeli government cares about the mental health of its citizens in ways it took my government several years to come around to after 9/11.
• Yet, many Israelis have become disillusioned with Israel's ruling government for what it allowed to happen, although it has responded quicker and more profoundly than I have ever witnessed after any catastrophe.
• While many Israeli mental health professionals have experience with trauma given the threats, attacks, and wars suffered since the birth of the country, few feel equipped to deal with the mass trauma they are enduring now.
• Addressing the mental health of Israel is made more complex by the many different communities affected, among them: survivors of the Nova music festival; families and entire communities and kibbutzim grieving the loss of loved ones on October 7 and in the ongoing war; families of hostages; entire communities displaced into hotels from the south and north of Israel even while entire swaths of their members have been sent to their graves; IDF soldiers; families of the IDF; and, hopefully, soon, the hostages, too.
• It seems every Israeli has been or knows someone directly affected by the attacks of October 7 and the war.
• There is a sense that the entire country is traumatized and grieving, often multiply so. But, some reasonably question how much of this suffering requires a trip to the psychiatrist's office rather than an escape from the darkest of the dark alleys of human experience.
• The country's overwhelmed mental health system is even more depleted now as many mental health professionals have been activated to fight in the war while remaining mental health professionals have to work while coping with their own fears, trauma, and grief.

Putting together what I have learned with what I know, I now share this:

To my fellow mental health professionals in Israel, I know you have the skills to do this even as you question yourselves: Prepare to be in higher demand than ever but embrace the chance to make a difference unlike ever before.

To those government officials and ministries who have concerned themselves with the mental health of the country, I respect you for making this a priority even as missiles and soldiers fall. Remember that most of the 9 million Israelis will not need mental health care because people and communities are resilient, but do not forget that mental health professionals still need you to provide them with more resources now to help the many Israelis who do and will.

To those Israelis launching grass-roots efforts to address the mental health of their fellow citizens, I am inspired by your innovations even when mental health was not your business before. Please follow your passions but also follow science; Charge ahead but don’t charge at one another.

This past week’s Torah portion tells the iconic story of Jacob and Esau and their years-long animosity, and eventual reconciliation, after Jacob steals the birthright of his older brother, Esau, on their father Isaac’s deathbed. They are classic opposites—one loud and physical, the other quiet and cerebral. To those who prioritize the mental health of the Israeli populace following all that has befallen the country, be both Esau and Jacob and apply muscle but use your head. And remember it’s a marathon, not a sprint.

After all, Israel defines resilience.