From 6:29 AM on October 7, 2023, it's as if Israelis have been riding a never-ending high-speed train of trauma, each day punctuated by the sounds of sirens, buzzing drones, artillery fire, and fighter jets. The incessant booms of falling shrapnel, exploding Iron Dome interceptors, the words spoken on TV, on the phone with family, written online between friends – all about the missing, the injured, the murdered, the kidnapped. Civilians become soldiers overnight, others attending funerals and protests en masse, as streets transform into murals of socio-political slogans and portraits of unwitting victims.
Images and videos have seared into the collective memory: mutilated bodies stained with blood; raw terror etched on the faces of fleeing concertgoers across a vast field; Shani Louk's lifeless body lynched on the streets of Gaza; Hersh Goldberg-Polin, whose arm was maimed by an RPG, or the white pick-up truck filled with armed Hamas terrorists driving through the streets of Sderot on what was supposed to be a quiet Saturday morning. The examples are endless, and the horror of the massacres and pogroms at the Nova Music Festival and over 20 towns and villages of Israel's South reverberates far beyond its borders.
In its savage cruelty, in its deliberate targeting of innocent civilians, in its perverse celebration of violence broadcasted for the world to see, the October 7 attack was a declaration of war by Hamas and its sponsors, not just on Israel, but on the very values that underpin civilized society.
The audio-visual trauma is a major part of the weaponry in this war: The taunting hostage videos and discrediting social media posts – these are not mere byproducts of the attack, but central to its aim of sowing fear, helplessness, and long-lasting trauma. Hamas, a ruthless terrorist organization driven by a Nazi-like ideology passed down from Europe to the Middle East at the end of World War II, is built on hatred and savagery. It understands that in today's hyper-connected world, psychological warfare can be as potent as any bomb. Hamas sought to use their atrocities to turn vast sections of the world against Israel through a propaganda campaign. This campaign aimed to justify their actions and has been nurtured for decades.
The debilitating soundtrack and visuals have fueled an algorithm-dictated echo chamber of trauma online and in real life, hour by hour, day after day. In the last 12 months, even the most mundane sights and sounds took on a sinister new meaning, it became clear that no Israeli is immune to this new breed of terror. The color yellow immediately sparks a connection to the 'Bring Them Home' campaign, a haunting reminder of the hostages' plight, and many street noises echo an eerie resemblance to rocket sirens and gunshots, causing people to regularly freeze in panic for a split second before realizing the true origin of the sound.
The trauma inflicted on Israel's psyche is a microcosm of the wounds inflicted on the collective conscience of the Jewish people throughout history. Confronting this threat requires more than military might. It will require moral clarity, psychological resilience, and calling out the double standards that legitimize some victims while ignoring others, the hypocrisy that condemns Israel's self-defense while excusing the provocations that necessitate it.
As Prof. Ofrit Shapira Berman, a historian of Israeli trauma, explains, "October 7th is Israel's biggest trauma yet, not only because of its objective magnitude, but also because it echoes our past traumas – the Holocaust and the Yom Kippur war, in terms of the government's betrayal and failure. The fact that October 7th is experienced by many as a byproduct of the government's actions has broken the trust of many citizens in the government and the state."
A nation forged in trauma
For Israelis, national trauma is a familiar, unwelcome companion. The very inception of the modern State of Israel is inextricably bound with the devastation of the Holocaust, which saw six million Jews systematically murdered. Rising from those ashes, each subsequent war and attack has resulted in Israel's enduring accumulative post-traumatic stress – the War of Independence, Six-Day War, Yom Kippur War, the Lebanon Wars, the Intifadas, Operation Protective Edge, weekly knife attacks and car rammings – seven decades of indelible dents on the collective psyche.
"The events of October 7 result in an estimated 300,000 additional patients who require treatment by a trained professional," notes Prof. Shapira Berman.
This legacy has shaped a society where even schoolchildren practice rocket drills. In the 1990s, they were taught to don gas masks in preparation for biochemical warfare and, today, how to take cover in shelters from incoming missiles. Memorializing the fallen is woven into the very fabric of the Israeli public space. In a sense, it is this shared history of trauma, more than anything else, that binds Israelis together across religious, ethnic, and political divides.
The sheer scale and brutality of the October 7 attack and its aftermath reactions have ushered in a new level of national trauma into Israel's battered consciousness, be it the slaughter of innocent families, the shattering of the idea that the home is a safe haven, the agony over the fate of the hostages, and the global campaigns to delegitimize and gaslight the Israeli narrative by major organizations like the United Nations, and individuals alike. Beyond the initial attack itself, the hate and antisemitism running rampant anywhere from major news networks to the campuses of the biggest universities have shocked Israelis to their core, struggling to understand how their suffering is being ignored or, worse, manipulated and vilified.
Audio-visual trauma: No escape from the horrors
Experts say the constant multimedia conversation can cause a state of hypervigilance, anxiety, flashbacks, and difficulty functioning for many, causing some to slip into dissociative states.
"We are seeing a shared reality where all Israelis are victims," explains Dr. Rony Berger, a clinical psychologist specializing in community resilience. "This leads most Israelis to experience symptoms of acute stress, even if they were not directly impacted." Dr. Berger notes that "Even those not directly exposed to the attacks were deeply traumatized by the constant barrage of disturbing images and stories on TV."
Dr. Berger highlights the unique challenges posed by the unfiltered videos of the attacks circulating online: "From an evolutionary point of view, we know that the worst flashbacks or sensations are either smell or voice because, in prehistoric eras, these were the cues for danger. Audio-visual pictures that we see on TV could be really traumatizing. I've known a lot of people who were not directly exposed but were extremely affected just by the sights they've seen on TV."
For those near the southern and northern borders, and indeed across most of Israel with the proliferation of threats on multiple fronts, the whole country is impacted by the terrorizing fear of attacks from land, sea, and air as well as online. Mental health professionals are treating a nation reeling from audio-visual trauma on an unprecedented scale. With one in three Israelis exhibiting PTSD symptoms, new treatment approaches are being pioneered, like virtual reality therapy, to help patients process traumatic memories more safely.
The psychological toll spares no one
The war's psychological impact has cut across all sectors of Israeli society. Soldiers and reservists grapple with the horrors witnessed on the battlefield. Families of the murdered and injured face a lifetime of grief and challenges. Survivors of the attacks relive the terror in flashbacks and nightmares. Even young children are not spared, with a generation growing up to explosions and horrifying footage, their innocence forever marred.
Psychotherapist Dr. Shlomit Bresler, who has treated dozens of bereaved families and injured victims, describes the long road ahead. "For many, the grief and trauma is still very raw. First, we focus on stabilization and establishing a sense of safety. The real processing often can only begin once they feel secure that the threat has subsided. With the war still raging, that is a long way off for most."
Dr. Bresler emphasizes the collective nature of the trauma: "We are living in a mass-trauma situation. The entire population is under trauma and various types, but this started before October 7th. October 7th simply reopened a wound and infected it worse. The healing process can only come from deeper sociological and political changes."
"The families of hostages are suffering the most, their lives completely upended, consumed by anguish and despair with each passing day," Dr. Berger reflects. Each day without news chips away at their resilience, the unknown becoming a unique form of torture.
Yehezkel Caine, President of the Herzog Medical Center, Israel's leading mental health institution, describes the situation as a "psychological and emotional catastrophe." He warns of a "coming tsunami of mental health problems" as people return to the remains of their communities, confront the death and destruction, and soldiers return with physical and emotional scars.
"Already our main clinics are overflowing," Caine reports. He emphasizes the shortage of trained therapists proficient in trauma as a major challenge, necessitating extensive training programs and support for the mental health professionals themselves to prevent secondary trauma and burnout.
Caine notes significant differences in the psychological impact and treatment needs between civilian victims, soldiers, and first responders. "The civilian sector is way behind, both due to a lack of trained therapists, little government support and a lack of infrastructure, due to years of neglect of the mental health sector," he explains. The military sector is comparatively better organized, while first responders typically receive services through their units.
Collaboration and long-term needs
Looking ahead, Caine emphasizes the critical need for investment in mental health infrastructure and resources to address the long-term impacts of this unprecedented national trauma. "Manpower, manpower, and manpower!" he stresses, highlighting the years of training required to produce qualified psychiatrists, psychologists, and clinical social workers. "If one can see a positive aspect to the events, it is the sudden recognition by everyone of the problem and, to a certain extent, the destigmatization of mental health," Caine notes. "This is, of course, a good thing. Unfortunately, there is no magic wand that we can wave to produce good quality therapists. It takes at least 5 years to produce a psychiatrist from a qualified doctor. A clinical psychologist can take a similar period. Clinical social workers also require extensive training."
Caine also underscores the lack of physical facilities, with Herzog Medical Center's new clinic building already overflowing just two years after opening. The hospital is embarking on an ambitious $90M project to build a new Mental Health Center, but completion is not expected until 2028.
The road ahead
For a society so deeply shaped by its history of existential threats, regaining a sense of safety and security on both the individual and collective level will be a long and difficult process.
"We need a 'mental Iron Dome' to protect Israelis from this bombardment on our psyche," asserts Prof. Mooli Lahad, Israel's leading expert on coping and resilience. "That means embedding mental health professionals in schools, workplaces, community centers, building a societal infrastructure of psychological support and resilience."
Lahad's BASIC Ph model outlines six coping and resilience styles: Belief, Affect, Social, Imagination, Cognitive, and Physical. "The more of these we are able to utilize, the more resilience we are able to harness to regain a sense of control in an otherwise terrifying situation," he explains.
Prof. Lahad provides some concrete examples of what a "mental Iron Dome" could entail: "It is possible through the resilience centers and through the government services such as community welfare and education. This model is based on the 'cascade' model: we train master trainers who commit themselves to training others. If we manage to train 40 trainers who each commit to training 25 trainees twice, we get around 1000 trained therapists."
He also suggests leveraging technology: "One other method that we developed is an app where the therapist meets the client online but uses the same method of treatment called SEE FAR CBT, making it accessible to those who can't leave home for various reasons."
"The recent pre-war civic conflict surfaced what sociologists warned us about – the growing rift in Israeli society," Prof. Lahad reflects. "This, combined with the feeling that the state is changing course, the global loss of trust in authorities, the social media 'poison' of fake news, the colossal failure of the IDF, the ongoing inability of the government to resolve the conflict and bring an end to the attacks, and the burning issue of the hostages, is causing attrition in the morale and mental health of Israelis."
As Israel marks one year since the October 7 attack, the nation remains haunted by the sounds and images of that horrific day and the war that followed. The collective and personal scars run deep, with mental health professionals warning of a looming crisis as hundreds of thousands grapple with trauma.
"The cruelty of the savage infiltrators has ignited a dormant Jewish post-Holocaust fear of annihilation and disappointment that the state did not manage to fulfill the basic belief of 'never again,'" Prof. Lahad concludes. "It is, therefore, a long road to recovery. Because of the mistrust in authorities, we believe the recovery will have to be bottom-up – back to the local communities, back to human relationships."
Prof. Ofrit Shapira Berman offers a powerful call to action: "I cannot be hopeless about our future as a nation and a society. The Holocaust gave us a nation of our own. October 7th has to have a similar impact on our lives. It is clear that no other nation or people has such a powerful ability to transform suffering and trauma into strength and success, but with that said, ultimately, healing will require placing the spiritual dimension of life at the center because emerging from this crisis will take a sustained, society-wide effort, working together, from the grassroots community level up to the highest echelons of leadership."
NATAL's frontline response
NATAL (Israel Trauma and Resiliency Center) has been at the forefront of addressing the psychological fallout of the October 7 attacks. The organization operates dedicated helplines for civilians and veterans, funded by the Ministry of Defense. Immediately following October 7, these helplines saw an unprecedented call surge, with over 23,000 in the first month alone. To date, NATAL's helplines have received over 53,000 calls, with dramatic spikes during escalations like the Iran missile threats.
To meet the increased demand and complexity of needs, NATAL has significantly expanded its workforce, developing innovative therapeutic approaches like neurofeedback therapy and tailored interventions for specific populations like reservists and soldiers' families. NATAL's Career Development Unit is providing specialized support for young adults transitioning from military reserves back to work.
NATAL's 24/7 Helpline provides psychological support to those affected by war and terror-related trauma. Call *3362 for assistance.
