The children of October 7

I will leave the statistics to others; we all know that tens of thousands of Israeli children have been impacted by the horrific events of October 7. A year later, what has become of them?

I am a sole practitioner in Beer Sheba, and can report from direct if small experience. I would welcome other practitioners to add their experience. I very much doubt that there is serious overall data collection.

PTSD was formally recognized in children under the age of 6 in the controversial 5th version of the “Bible” (bibles provoke controversy) of the American Psychiatric Association in 2013, known as DSM-5. Like all “disorders” in that work, the “Chinese Menu” method of listing “groups” of symptoms was employed. This has an obvious disadvantage in dealing with the impact of severe trauma on development. When the (real) Chinese adopted this method to study the prevalence of PTSD among children affected by the 2013 Lushan earthquake after 4 years, they were able to see a low incidence of chronic dysfunction ( 6.6%) and more than 50% with no PTSD symptoms, referenced as “resilient.” Low level symptoms were 32.6 % and “recovery” 7%. Optimists like the 50% resilience, pessimists the 32% “low level symptoms” with their potential to impede health development.

Carl Weems in Iowa has been trying to present an alternative approach can improve our thinking about Israeli children impacted by October 7. He has been demonstrating a “network” approach to the way that various symptoms change over time. For example, he reanalyzed a cohort of 191 children and found that over time some symptoms were more stable according to developmental time.

What I am suggesting here is an attempt to suggest a nationally based clinical approach to the thousands of impacted youngsters.

Some examples:

• A three-year-old was cramped into the “safe room” with many other family members, spent 32 hours hollering at the top of his lungs. The family could no longer tolerate this and chose to make a run for it before the IDF arrived and despite the presence of terrorists on the streets. Nearly a year later he talks incessantly about death, suffers intrusive memories, is withdrawn socially, tense, responds with frequent outburst of rage, cannot concentrate, cannot sleep, stays stuck to his parents, and eats very selectively.
• A ten-year-old girl in Sderot was already tense from frequent alarms. She was cramped in the “safe room” for 24 hours, hearing gunshots and voices of terrorists, her parents stood at the entrance to the room with kitchen knives prepared to defend themselves and their family. A policeman neighbor was killed early on. Nearly a year later she will not step out of her home alone. She is furious that she was not protected and did not want to return to Sderot. She vomits at every alarm today, cannot concentrate, cannot sleep, every noise startles her, and she has intrusive memories of the whole episode.

These children were “treated” with some limited sessions alone or in groups while they were displaced.  By treatment people they will never see again. There is a waiting list of at least a year for more “public sector” treatment which will also be limited. Untreated, what will become of them?

The three year old is at risk for social failure, for impaired ability to achieve the quiet state in which he can learn. He is at risk of developing a negative self-image as a bad or failed boy, one his parents cannot help. In the current Israeli practice he is at risk to be treated with an anti-psychotic which will put him to sleep at the cost of his personality, and the ever-present stimulant to help his attention. (When inattention is due to PTSD, my experience is that stimulants actually exacerbate symptoms).

The ten year old is at risk to give up on becoming an adult, something defined years ago by Laufer and Laufer in London as “developmental breakdown.” Her abilities to “mentalize” (a term meaning  using your noggin) which she needs to be able to think about her development and her identity have been compromised. He social insecurity and fears keep her requiring a childish dependency on her parents, which may diminish her ability to grow into mutuality in her relationship with them.

The families of both children are at risk for settling at a “lower level of differentiation” as they are overwhelmed with the need to just regulate and survive, diminishing the possibilities of the “higher level differentiation” intersubjective communication that allows growth and human fulfillment.

I hope that the reader will recognize that what has been spelled out in professional jargon is just what her common sense would have told her. In short, these children and their families need attention. Serious, concentrated, continuous attention. Even the IDF spokesman has noted the emergence of a major mental health crisis, and  a recent report documented 900% increase in psychological treatments. The report adds that 76% of children aged 2-12 demonstrate psychological distress, 54% anxiety, and 72% of parents reported high levels of anxiety and depression amongst their children. The report adds that 20,000 children have been recognized by Social Security as impacted by terrorism (more on this below).  And one final enigmatic number, parents of children 2-18 have 47% PTSD while non-parents have 12%. And one final note of the lack of mental health providers in the public sector, especially for children.

The children of October 7 will never receive the mental health treatment they require and deserve.

The background story goes back two decades. The State of Israel purposely diminished all mental health services in a bluff called “reform” a good dozen years ago. The Governmental Department of Health services were closed down with the “agreement” of the Sick Funds to replace them. Oops, we forgot, sorry. That was never implemented. Anyone cognizant of the economic ambivalence of health care providers towards mental health services shouldn’t have trouble seeing the $ behind this.

In the meantime, a few experiences of children of October 7 with the State of Israel:

• A child was recognized by Social Security for a year. And then? Well, you have to apply separately for each child. Each child requires a psychiatric evaluation. Now Social Security is a public entitlement, but there are virtually NO child psychiatrists in the public sector to perform this evaluation. SO you have to find a private child psychiatrist to do this. And pay a private fee. For a public entitlement? Well, at least the Sick Fund will reimburse for the consultation? Not so fast – only if the “specialist” is recognized by the Sick Fund as of exceptional experience and reputation. Who decided that? The Sick Fund. Doesn’t that create an internal “Mafia” (the white washed term is “LIST”) for the providers at the expense of the customers? And didn’t the Supreme Court rule that the “LIST” rule cannot be applied in the periphery (100% of the Children of October 7) or when the Sick Fund itself cannot provide the service (same 100%)? Welcome to Israel, where “LIST” trumps all. For years I was unwilling to subsidize this corruption out of my own pocket, but since October 7, people pay whatever they can. We are all in this together (except the mafia). This unconscionable situation could be corrected in a moment by a directive of the Minister of Health that Mental Health consultations for the Children of October 7 are exempt from the “LIST.” Go find the Minister.

The Children of October 7 can hardly afford to apply for a Social Security entitlement a mere 12 months after they were terrorized.

• While waiting a generation for treatment, are there some herbal treatments that could help relieve anxiety and sleeplessness? Yup, but not for the Children of October 7. The leading remedy worth trying is CBD oil, which has no side effects and is often quite helpful. More than two and a half years ago, the only non-Bibi government made CBD completely legal by removing it from Schedule 1 where it never belonged. But leave it to the Health Ministry to just not get around to regulating sales of some plant that cuts drug profits. CBD is in Chelm, you can buy it but not sell it. Nu, Chelm, so what? For a year CBD providers were cropping up and no one bothered them, But the day of Bibi’s return, his Health Ministry or Customs or VAT or whatever got busy confiscating CBD orders from abroad. And after October 7, it just became worse. In order to help with CBD, I have to try to stay in touch week by week with providers who get shut down for months at a time, to find out where the 3-year-old or the ten-year-old or countless other Children of October 7 can find some relief that they could pick up in a store on their own in any normal country.
• The second herb that could potentially help and is worth trying is St. John’s Wort. Back in 2000 when it started to get popular (read “negative impact on drug sales”) the Health Ministry removed it from OTC status because of some “research” that the FDA found irrelevant. So during the entire second Intifada buses were blowing up and SJW could not be found in Israel. Until 2007, when a single product was admitted as a prescription drug. Since this product contains hypericin but not hyperforin, the latter being recognized now as necessary for clinical effectiveness, that doesn’t help much. Only around a decade ago Customs finally stopped interfering with shipments from abroad, so internet savvy Israelis became a virtual part of the normal world. Oh, and hypericum was approved only from age 11 and up. So only in the past decade Israelis can order from abroad SJW drops that they could just buy in a normal country.

The Children of October 7 have to scramble even to acquire herbs that could help.

I will spare the reader the obvious and useless recommendations to increase child mental health providers and subsidize treatments; maybe in 2123. I will settle for a simple formulation:

WHEN SECURITY FAILURES IMPACT ON THE MENTAL HEALTH AND EMOTIONAL DEVELOPMENT OF CHILDREN, THE GOVERNMENT THAT WAS RESPONSIBLE FOR THE SECURITY FAILURES MUST ASSUME RESPONSIBILITY FOR MINIMIZING THAT IMPACT BY ESTABLISHING A NATIONAL PROGRAM OF INDIVIDUAL AND FAMILY TREATMENTS ADEQUATE TO THE IMPACT.

There, I wrote it, on water. Would anyone care to play hide and seek and identify anyone in Israel who has been assigned responsibility for creating such a program? Or what funds are being allocated? Or shall we wait until 2033 when by some surprise young people are refusing draft or unable to serve and are streaming to Berlin, Portugal or wherever?