Under Foreign Skies – Dr. Danny Brom

This entry is part of the series Under Foreign Skies
Dr. Danny Brom. director of the Israel Center for the Treatment of Psychotrauma of Herzog Hospital in Jerusalem
Dr. Danny Brom. director of the Israel Center for the Treatment of Psychotrauma of Herzog Hospital in Jerusalem

Dr. Danny Brom is a Dutch trauma specialist who emigrated to Israel in 1988. He discovered that trauma was virtually unknown in Israel at the time, but research he carried out showed that there were high levels of trauma among large numbers of people. He went on to set up the Israel Centre for the Treatment of Psychotrauma in Jerusalem.

“Under Foreign Skies” is a series of portraits of Dutch people abroad doing remarkable things.

Photos: Eric Beauchemin

Original broadcast: August 1, 2004

Transcript

Radio Netherlands, the Dutch International Service, presents “Under Foreign Skies – Portraits of Dutch people abroad doing extraordinary things”. The programme is presented by Eric Beauchemin.

We started to ask every person that came into that clinic what did you go through in the last two years? And then we saw that 1 out of 3 people had had a severe trauma in the past two years only and we don’t even talk about the Israeli wars and the Holocaust and things like that.

Dr. Danny Brom is one of the founding fathers of trauma research and treatment in The Netherlands. He started working in the field of trauma in 1979, after a series of train hijackings and hostage incidents in Holland. The attacks shook the Dutch nation and not long afterwards, Dr Brom and a colleague established the Dutch Institute for Psychotrauma. It was a time when psychologists around the world were beginning to realise that traumatic events can leave not only physical but also deep mental and emotional scars if left untreated….scars that can prevent a person from functioning normally. Most of the Institute’s patients are victims of traffic accidents or acts of violence. In the early 1980s, Dr. Brom and his team did pioneering research on people suffering from post traumatic stress disorder or PTSD. In 1988, Dr Brom decided to resign as the Institute’s director and emigrate to Israel.

I was born in a Jewish family in Holland as the youngest child and the only one born in Holland. My parents came first from Belgium, before that from Switzerland. And my parents basically gave up their careers after the 2nd World War in order to work with orphans who lost their parents in the war and who had been in hiding and who had survived the 2nd World War as Jewish children. So in some way the whole field of trauma was in my veins. Living as an Orthodox Jewish person in Holland is not such an easy thing with the background of the Holocaust and with being a very small minority that always feels somewhat vulnerable. So it was very clear for me from a very early age that I wouldn’t stay in Holland. It wasn’t totally clear for me where I would go, but Israel was one of the possibilities and I had a lot of family members here. So that is where we actually went with my children. EB: Did the rest of your family also move to Israel? Yes, I was the last one to leave Holland. EB: Do you actually feel Dutch or was it simply a place you were born and you lived and then you left? Well the strange thing is in Holland, certainly if you lead an Orthodox Jewish life, you feel Jewish all the time because you bump into not being able to eat with people in restaurants or just very practical things. And then when you move out to Israel then that is not a problem. But then suddenly you feel more Dutch. I don’t really miss Holland, I must say, except for the free Sunday which we don’t have here. Work six days, but I feel in a way, except for the political situation, I feel really at home here.

EB: So you came in 1988 and you came immediately to this centre or what did you do when you arrived here? No, I started to work as a clinic psychologist in an ambulatory mental health setting. The first thing I heard actually from people is, they said, well, we know you’re a trauma freak, but you know what, we don’t see trauma here. It was an amazing thing that I experienced here, people said, no, we don’t see trauma here. To which I said, oh, interesting. Is it OK to do some research? So we started to ask every person that came into that clinic what did you go through in the last two years? We kept it very safe. And then we saw that 1 out of 3 people had had a severe trauma in the past two years only and we don’t even talk about the Israeli wars and the Holocaust and things like that. And half of them had severe psychological symptoms connected with the trauma. So although it’s true that the people didn’t see it, it’s there and it’s something that is so much there in Israel that people can’t see it. EB: Were people basically in denial then? Yeah, you can call it denial. It’s just shying away from it. You know, when you are in let’s say survival mode, all the time you have to be alert and look around you, you don’t have the possibility to really look at your weaker sides or the pain that is within and the way Israeli society has dealt with it is just go on and don’t look back. It took some years before I actually established this centre, the Israel Centre for the Treatment of Psychosocial Trauma in order to raise the level of trauma services in Israel. That was the idea. You spoke about people living in survival mode.

EB: What exactly does that mean? Survival mode, we know a lot about now. It’s basically how the body and the mind respond when you are under threat. A lot of things happen. Basically changes in the way the brain functions. When you are really under threat, then there are all kinds of shortcuts. You do things in a very much more efficient way. Everyone knows it from near-miss accidents, that you respond to danger immediately and only when you are safe, you start to tremble, you start to ask what happened, how did I respond, how did I know how to respond? This survival mode is very effective, but it also excludes a lot of processing of what happened. So as long as you remain in survival mode, you also avoid looking at the past. And that is part of the problem I see in this whole region. There is almost an addiction to stress and survival mode, almost in order not to process what has happened to almost everyone in this region. EB: What are the consequences of that? Well, the consequences we see. Getting into cycles of violence, both between societies and within societies. We also see that the level of violence within Israeli society in the past few years has gone up tremendously. And that is one of the motivations of setting up services to really get people out of this survival mode and start looking at themselves and be aware of how it influences us and how it brings us into one-way streets where you don’t see any other possibility than to respond more violent to what is being done to you. EB: But is that actually possible when you are living in these types of circumstances where there are bombs that explode, there are people who are attacked? The most dangerous thing for people in the Western world to do is to drive a car. Many more people die here from car accidents than from bombs. In our consciousness, that’s not how it is. We feel that bombs are much more dangerous and much more frequent even than car accidents because we have a way of denying traffic accidents. It won’t happen to us because we are good drivers. The famous saying and I think it came out of research that 90% of drivers say that they drive better than the average. People have a way of thinking that it will not happen to them.

EB: You said that in 1988 people were in survival mode. I would understand that now with all the attacks that have occurred over the past three years because of the intifadah, but at that time there weren’t attacks, so why were the levels of trauma so high? Well, it’s interesting how memory works. I came half a year into the first intifadah. There was maybe less shooting there, but a lot of people were stabbed in Jerusalem during that period, and we were living there. Although stones are not as deadly as bullets, people were killed when stones were thrown at cars, and people have been in wars. In 1991, there was the first Gulf War which in a way helped me understand more of Israeli society because that was the first time I really felt more of an Israeli because people felt together. When you are really under threat, people come together in a way. There is some sort of attachment, bonding that happens under severe threat. You saw that after 9/11 in the United States and basically throughout the world that people suddenly felt some sort of bonding. And that is what you felt very strongly here. And of course there is the ongoing threat. Every man goes into the army every year. So there is…you are reminded all the time when your children grow up and you have boys, you know, that they are going into the army. They have to prepare for it. The parents have to prepare for it. And it is basically unbearable and that is how you come to not see trauma.

EB: You say that it’s unbearable. Why? Well, thinking that your son is in real danger is for parents basically unbearable. You really have to rearrange your way of functioning in order to be able to just go on. You hear from many, many parents who…the three years that their children are in the army, they say we don’t really sleep. It’s always in the back or the front of your mind, all the time, day and night. It is a post-traumatic or peri-traumatic society. All the time you are busy with what is happening. But how do you get people out of this survival mode and thinking about their lives? There are many ways to do it and I think that the different therapies that are there can help us in that. One of the main changes in the field of psychotherapy for trauma has been that we know now that the first thing you have to do is look at self-regulation, meaning people have to be able to relax and to regulate their arousal. If you get that done, then people can start processing. Israeli society is a very aroused society. If you drive here, if you see how people speak to each other, if you see how members of the Knesset, of the parliament speak to each other, there’s always tension. And to be honest there is something that is attractive to this tension. It’s very alive, but at the same time it has to do with this addiction to tension in order to not deal with other things. So people have to start to be able to regulate themselves. We’re working with all kinds of methods, not only for people who suffer from post traumatic stress disorder but we teach teachers how to teach children how to come themselves down. There is a national school intervention project going from this centre. Many agencies participate now and do the same project and evaluate it and work with it. It means working with teachers on how they feel themselves, making them aware and giving them tools for working with children on what’s happening here, and how they feel, and how they can calm themselves down. It means screening all the children and seeing who are the children who are in most need of services. And it means also creating therapeutic frameworks within the school system. So we’ve been creating methods, group methods for treatment within the school system that we develop and test and then get into the system. So that is one of the examples. Another example is work that is being done with journalists. Journalists are very often – especially photographers and cameramen – very, very traumatised people. They look the most horrific things in the eyes and they film it. And one of the assumptions is that the more traumatised the journalist, the more traumatising his message will also be. And you see that sometimes after bombings when you see the TV camera going, it’s looking for the worst pictures. And I think that that is motivated by what happens within the journalists. So we need to work with many, many different people who are in the system helping people to calm down and not get more aroused. You’ve mentioned different types of programmes that the centre is developing or involved in.

Israeli Center for the Treatment of Psychotrauma
Israeli Center for the Treatment of Psychotrauma

EB: Is that the only thing that the centre is doing? No, the centre has about six strands of activity. There is the clinic side. People come – adults, children – for treatment, which is one thing. We have a side of training mental health professionals and lay people in knowing what trauma is. We have this school intervention programme which is a natural programme…a national programme. We have the first crisis walk-in centre in Israel we established here a year ago. When in most parts of the world, certainly in Holland, you have crisis centres, that concept didn’t exist here in Israel, as if we don’t have crises which is very interesting. So we opened the first crisis walk-in centre… EB: And what is that, I mean, do people? It means a place where professionals are available to talk to you from eight in the morning till ten in the evening. You don’t have to call. You just walk in because we saw that after bombings, for example, for each person that is wounded, 10 to 15 people come to the emergency room with psychological symptoms, which is not exactly the place to be in these times. So we’ve seen now in one year over 600 people who are in crisis. Some need therapy. Others need some 2 or 3 sessions to mitigate the symptoms of this crisis and then can go on. Another thing that we do is create a coalition of organisations that deal with trauma in Israel and with that group of now over 40 organisations, for example all the general hospitals here in Israel, we’re working on the concept of a continuum of services because what you saw is that after a bombing, for example, people are in the emergency room. After four hours they go out of there and no one knows about them. So how do you take care that information goes from one institution to the other or people will know where they can find support if they need it. How can you assess the gaps in the services and then fill them? And that is what we do with this coalition of organisations.

EB: You’re talking about what is happening at the moment but Israeli society is already traumatised in a sense because of the Holocaust and because of events in the past. Yeah, of course, there is the background that pushes this whole process to crazy dimensions because there is the Holocaust which is a trauma that everyone is aware of. But there are Israeli wars and the army which is a constant push also. What has to happen here is clear to me is not only on the individual level, but is also on the political level where I think leaders have to realise that they or we as a system – Palestinians and Israelis – are in a system of violence and being over-stimulated and seeing only one way. There are some people who are also working on that, on helping politicians see what is an over-aroused nervous system, and what does it mean and how can you let that go. What does it mean when you let that go? Of course the most important healing method for people is being together and that is one of the strongest dangers in this society that you see that terrorism is basically aimed at the community and aimed at taking the community apart, making people so afraid that they won’t leave their houses, which we’ve had weeks of that in Israel where people didn’t leave their houses. And that is one of the strongest dangers because then you create a situation where there’s no healing because healing means you have to be together.

EB: You say you have to be together and yet at the same time what is happening at the moment is that in Israel with the construction of the wall for instance is that there’s absolutely no communication between the two sides, and speaking to Israelis there’s a great…among many Israelis, there’s a great fear of Palestinians. Speaking to Palestinians there’s perhaps not fear but perhaps anger and hatred against Israelis. And so living together is impossible in these circumstances and it’s becoming more and more difficult because the wall is going to be finished at the end of the year. Yeah, that’s personally a very disturbing thing, the wall. But you know walls are being built in order to be torn down at some point. Yeah, I think it’s a very destructive thing that’s happening, but people feel so afraid that that is what they see as the only possibility. There are and I think that they are not enough in the spotlight, there are all kinds of collaborations between Palestinians and Israelis still going on. One of the most impressive examples is the Family Circle which is a group of 500 parents who lost a child in the violence: 250 Palestinians, 250 Israelis who work together, meet together, lecture and say if we can sit together, anyone can. I think that is a seed of hope that is there. EB: Would you say that all of Israeli society is traumatised? I think that Israelis as a group, as a nation, are traumatised. What I mean by that is one of the effects of trauma is that you relive it over and over. In individuals you see that in dreams, in associations, in things that come up in your mind. But you can see it also in behaviour, that people start to repeat almost what happened to them. We know for example that people who went through one traffic accident are more vulnerable to go through another traffic accident. We know that they are even more vulnerable to even go to a traffic accident from the same side they had the accident. So you have a blind spot, to say it mildly, for things that happened in the same way, if not recreating trauma. And I think that as a society one of the dangers is that we are recreating traumas from the past, and that you start to see everything that happens in the world through the glasses of what happened to you, like Palestinians are like Nazis or Arabs only want to push us out into the sea, which is clearly coloured by the past and there were such expressions. It doesn’t come from nowhere. But if you stay with it, it’s almost a prophecy that fulfills itself.

EB: How do you deal with that? Does all of Israeli society need to go see a shrink? It would be good for business, but that’s not what we are looking for. What we actually need is for people to dare to relax and that’s not an easy thing. That means leadership. I think that’s one of the things in the ‘90s you saw that Rabin dared to do and change his whole vision of things and say listen this doesn’t work. Let’s not keep on doing what doesn’t work. And he really dared to say, OK, let’s sit back, think again and see where do we go, and speak and see it as a human problem. At this moment, I hardly see anyone who dares to do that except for some people here and there who collaborate with each other and have these good memories of that is the way to go. EB: Rabin was killed a decade ago. As you say, it’s changed completely since then. It’s gone 180 degrees in the opposite direction. Do you think within a few years that it could go back to that situation? Well, we had this situation in 1978. There was a survey. People were asked: do you believe in peace with Egypt? And I think 80% said no way, it will never be. They want to kill us and we want to kill them, and I don’t know what. And in ’79, Sadat came to Jerusalem and something changed very quickly. So I do believe and that is what Israelis very often say that the only way to be a realist in Israel is to believe in miracles. I do believe in changes. The way that I believe in trauma as a sudden disruptive factor, I do believe in let’s say positive traumas in the sense of good changes can also happen very quickly. How exactly is hard to foresee.

EB: Do you also work with Palestinians or do you work exclusively with Israelis? Well, at this moment, it’s not realistic to think that a Palestinian would come to an Israeli psychologist to be treated for trauma. What we do is work together with Palestinians in order to empower that society and the psychologists there to do the right work on the Palestinian side. EB: You’ve been living in Israel for 16 years now. Do you feel like you yourself are traumatised because you have been living here? Well traumatised is of course a very broad word. In general I am even hearing a lot of horrible stories. I can sleep and I function and I’m more or less happy with my life. The times that it really comes close and is difficult is when it reaches your children. One of my daughters was with a friend of hers, stood in front of one of the cafés here in Jerusalem when it blew up. She had just finished a course of first aid, so immediately she went out of the car and into the café and tried to save lives. Well, hearing how she was exposed to the most horrible sights, although she was able to save lives and to help people really, then it comes too close and then you feel it gets into your system. And I feel the same about my children going into the army. That is something I feel that, looking at it…I don’t know how I will cope with it. It is going to happen next year and I feel that it’s almost impossible. Well, I also know that in some natural way, I’ll…you know, you’ll live with it, but it comes too close and too much in, and then I suppose you become blind for some of the things that you won’t hear everything that is happening as a natural response to it. And what keeps me busy most is not only how bad it will be to be in the army, but how it will change them. And I think that is one of the worst things of ongoing violence, that you see how it corrupts society, how it changes people who are reasonable people into people who can see only one thing and that is that we have to hit back. That’s one of the frightening things about living here. EB: Can you elaborate on that? I grew up in Holland. My children were born in Holland. And we didn’t have guns in the house or play toy guns. We didn’t want that. And then we came here. And then the question was, well, do we allow it? Well, they see soldiers. They see our friends. Every man is every year a month in the army, so how can you not let them play with it in order to cope with that. And at the same time, what does that do? What does that do to your mind, to the way you view the world? I find it very hard and that is maybe the part that I am traumatised. I find it very hard to really follow what it does to you because it does the same to me. But it’s one of the things that worries me. When you accept the level of violence and when you accept to hear every day that one or two or three people are killed on that side or this side, what does it do to you? I don’t know exactly.

EB: Do you yourself have to serve in the army as a reservist? No, I came here when there was this whole influx of Russians. In 10 years, a million Russians came, and I was 33 when I came here, so they didn’t recruit me. So I’m not in that system. Maybe that’s why I still worry about it and not just live it and with it. But there is a certain hardening of people. You see that happening in the army, that the children, 18 years old, which is young, and is the time that you want people to have fun and go study with peers and try out partnerships and things like that and then they are in that very harsh environment and you see them hardening. They become adults. They think about life and death and you don’t want that. That’s where I become emotional because I don’t want them to grow up and have to think about that. I want them to be free. EB: In that sense do you regret having come to Israel? It’s one of the hard sides of being in Israel. I don’t really regret living in Israel. I feel it’s the place for us…yeah, how should I say? EB: How do your children and wife feel about it? Do they have the same sentiments as you? Well, the children just live it and you see in the past few years that nationalism has grown. I have twin boys and one went clearly in an extreme right position for some time when he was in adolescence and the other one in extreme left side. And now they’re coming back again and can think. But they live it. So they see it as their natural place. My wife, I think, is more like me and sees it as horrible things are happening here. Of course we sometimes ask ourselves did we do the right thing? But then also you look into the world and you also look at what we hear, also from friends, about growing anti-Semitism in Europe, also in Holland. We hear about Jewish people in Holland being afraid, and making comparisons with the 1930s. That is frightening. Then I ask myself, well what is better? I don’t know.

Eric Beauchemin was in conversation with Dr. Danny Brom, the director of the Israel Centre for the Treatment of Psychotrauma in Jerusalem. “Under Foreign Skies” is a Radio Netherlands’ presentation.

Series NavigationTheatre in the rubble >>