The Mental Health Toll of Brutal War

Monday, October 30, 2023

By Don Sapatkin

Also: Children who are allowed more independence may be less anxious and depressed. The mental health of health workers has suffered more since the pandemic than that of other employees. Kanye West’s contract with Adidas contained an unusual mental health clause. And 42 states sued Meta, alleging that Facebook and Instagram were purposely designed to addict their children.

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As war and death envelops Israel and Gaza, mental health experts are alarmed

As the war in Israel and Gaza enters a horrific new phase, Israelis and Palestinians continue to reel from the aftermath of the devastating terror attack on southern Israel and the deadly bombardment of Gaza by Israel. The mental health impacts of this trauma are likely to reverberate for years. In Israel, Nathaniel Laor, 73, an emeritus professor of psychiatry and philosophy at the medical schools of Yale and Tel Aviv University, was tapped to coordinate psychological services for traumatized evacuees and survivors of the Hamas attacks in Southern Israel, including family members of people now held as hostages.

In an interview with Israel’s Haaretz newspaper, Laor said that family members of people who were kidnapped by Hamas need solidarity from friends, family and society to help them cope with the complexity of the situation as much they need therapy to heal. Those who survived or witnessed atrocities will need a lot of assistance, he says. “Trauma involving abuse and atrocities bears more long-lasting effects because, among other results, it causes a serious loss of faith in humanity,” he told Haaretz in the paywalled story.

Laor has worked for years to cultivate individual, communal and national resilience even before trauma hits. That needs to be done, Laor says, not just through therapy but also through social interaction. His efforts led to immediate psychological treatment becoming part of Israel’s national response so that every civilian who experiences trauma due to “nationalist” hostilities is entitled to 12 hours of treatment at the state’s expense.

Processing trauma collectively – and promptly – is critical, Laor has shown. “Healing power resides in being with the group that underwent a shared experience,” he told Haaretz in a paywalled interview. He led a field response and study, beginning shortly after the 1999 earthquake in Turkey, that provided evidence for the theory. In classrooms where students participated in teacher-led groups where they talked about the catastrophe, mourned as a group and examined together ways they could reduce fear, the students showed 50% fewer signs of PTSD three months later than those who weren’t part of such a process. The benefits to those students were enduring. Three years later, those students had better family social and learning function.

MindSite News interviews and coverage over the past two weeks have included an interview with an American trauma therapist whose grandfather survived a pogrom in Eastern Europe and a Palestinian psychologist who has researched the sky-high levels of trauma among children living in Gaza – before the latest war.

David Remnick provides a haunting account of the grief and anguish people in both Israel and Palestine are now experiencing in his masterful account in The New Yorker. At the end, he describes going to the funeral of the Kutz family in Israel near the Gaza border:

Livnat and Aviv Kutz had been found dead together on a bed with their children, Rotem, Yonatan, and Yiftach. Throughout Israel, everyone seemed to know the story, that they had been discovered in a kind of final family embrace. Few knew that, over the wall, in Khan Yunis, nine members of the al-Bashiti family were reported to have been killed in an air strike. Killing was the common condition…

The coffins were carried in and the names were read: one by one by one by one by one. At first, there was silence, but now a great communal lamentation convulsed the assembled. I have never heard such weeping as I did that afternoon. There would be many more funerals to come, many more convulsions of grief. But the sounds of lamentation never carry as far as those of rockets, missiles, artillery, bombs. As I was finishing this piece, [Palestinian poet Mosab Abu Toha] messaged me, describing the nightly bombings in his neighborhood [in Gaza]. A ground assault was imminent. “Any moment I may not be in this world,” he said.

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Reduce your kids’ anxiety – let them trick or treat without you

I first rode the New York City subway without a grownup – from my home in Brooklyn to the 1964-65 World’s Fair in Queens – at age 10. My parents weren’t crazy; compared to my friends’ parents, they were even overprotective. But they’d let me trick or treat without them for years. Solo subway rides and confidence-building shouts of Trick or Treat! at scary neighbors’ front doors are far less likely to happen today. Which may help explain why kids are experiencing such high rates of anxiety and depression these days, Jessica Grose wrote in a New York Times column. The headline gives her view: “Stop Micromanaging Halloween — Let Your Kids Be Free.”

To support her argument, Grose cites two psychologists and an anthropologist who write in the Journal of Pediatrics that children’s lack of autonomy have declined over the past 50 years in tandem with growing rates of youth depression and anxiety. Proving a link would be impossible, which may be why their article is written as a commentary, albeit an unusually detailed one that cites dozens of research studies to back up their thesis. The commentary is behind a paywall, but all three authors discussed the evidence in an interview with the Washington Post.

They basically argue that independence, including playing with no adults around, builds what is known as an internal locus of control (believing that you have control over your life) in contrast to an external locus of control (believing that your experiences are ruled by circumstances beyond your control). Even risky play, like climbing high up a tree, “helps protect against the development of phobias and reduce future anxiety by increasing the person’s confidence that they can deal effectively with emergencies,” they write in the commentary. They also suggest a resource for parents who want to buck the trend (and weather the inevitable criticism): the Let Grow project.

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Health workers are facing a mental health crisis

Health workers nationwide are facing a mental health crisis, CNN reported, with burnout up 44% from before the pandemic and harassment from patients and coworkers more than doubling in a federal survey. Indeed, nearly half of health workers – 46% – said they were experiencing burnout in 2022 and 13% were experiencing harassment, rates that were significantly higher than for other workers. About 44% of health workers said they intended to look for a new job in 2022, up from 33% in 2018. It also found that health workers had declining levels of trust in management.

The CDC Vital Signs report was based on a detailed survey of nearly 4,000 workers published in the agency’s Morbidity and Mortality Weekly Report. Staffing levels also impacted health workers’ sentiments: Among the 38% who reported inadequate staffing levels at their workplace in 2022, symptoms of anxiety were nearly twice as high and rates of burnout nearly three times as high compared with who reported adequate staffing levels.

The CDC listed several ways to improve worker mental health in a call to action for employers. These included allowing workers to participate in decision-making, preventing and paying attention to harassment reports and providing “enough time to complete work.” The president of the American Medical Association, meanwhile, sounded the alarm on a national physician shortage in a speech that focused on burnout and listed specific legislative solutions. A Harvard Business Review article about workplace mental health offered suggestions for both workers – “speak to leaders in the language that they’re familiar with, such as data”–  and bosses – build structures that encourage contributions. And Boss Magazine suggested “Seven Ways Office Design Can Support Mental Health,” from natural lighting to open spaces and greenery.

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Bad precedent: Ye’s employment contract prohibited intensive mental health treatment

Last year’s decision by Adidas to end its fraught relationship with Kanye West – now known as Ye – whose Yeezy shoe line was bringing over $1 billion a year in sales, has gotten lots of press. A New York Times investigation into how the athletic footwear company tolerated and appeased him from the very first swastika he drew on a sneaker prototype digs deeper.

Mark Wilson, the global design editor for Fast Company magazine, took one sentence from that piece and built a story around it: Ye’s 2016 contract extension included a morals clause – typical for protecting a brand’s reputation – and also an additional, very atypical clause: “30 consecutive days of mental health or substance abuse treatment” was grounds for termination. Ye spoke publicly about his bipolar disorder later that year,  and about his alcoholism several years later.

Wilson wrote that he had “no idea if the morals clause ever impacted Ye’s decision to pursue treatment.” A mental health clause in a celebrity endorser’s contract seems odd – and an awfully bad precedent. “I don’t think I’ve seen it before,” Alexandra Roberts, a professor of law and media at Northeastern University School of Law, told Wilson. “It feels like Adidas was defining its morals clause in part based upon what they already knew about Ye.”

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In other news…

Teens who say they have strong, loving relationships with their parents or caretakers report better mental health – and, notably, no negative impact from social media – compared with those who don’t, according to Gallup. The survey found that, without strong parental support, teenagers who spent more time on social media reported more symptoms of anxiety and depression.

The off-duty pilot who tried to shut off a plane’s engines last week was afraid to tell superiors that he was depressed, friends and colleagues told Oregon Public Radio. The Federal Aviation Administration has long been criticized for overly strict rules that prohibit pilots from flying if, for example, they are taking common antidepressants. Advocates say such rules have the effect of discouraging reporting of mental health issues. The FAA has said it will make changes.

More than 40 states filed lawsuits against Meta in federal and state courts, all alleging that the company intentionally designed Facebook and Instagram to be addictive and “exploit and manipulate children,” NPR reported. Wired described five Instagram features that the lawsuits claim deceptively hooked teens and harmed their mental health. Meta said in a statement that it has introduced a number of features to support young users and their families.

Hero Journey Club, a digital startup that offers mental health support for people while they play video games, won $14.6 million in new funding, Behavioral Health Business reported. The San Francisco-based company uses responses to a questionnaire to match people in small groups playing games like Minecraft, Animal Crossing and Stardew Valley. Although licensed therapists facilitate the four-member groups, the startup describes the arrangement as mental health support rather than therapy. Meanwhile, New York-based Headway, a more traditional mental health startup that connects patients with therapists and psychiatrists in their insurance plan’s network, raised $125 million to reach a $1 billion valuation, Reuters reported.

People with severe mental illness who were infected with COVID-19 were 50% more likely to die of any cause than those without severe mental illness during the first two pandemic waves, according to a British Journal of Psychiatry study, described in a King’s College London press release about faculty research. The research examined 660,000 records of patients 5 and older in a family practice database covering England and Northern Ireland. I reported last year that severely mentally ill Medicare recipients died at much higher rates during the pandemic than those with nearly every non-psychiatric diagnosis included in the data.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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