Those cycles have caused some to relinquish the clinically accepted PTSD diagnosis in favor of one they've termed continuing traumatic stress disorder or CTSD. "In the United States and the Western countries a person usually gets one traumatic event and later he lives in at least a protected environment," said Mahmud Sehwail, M.D., a consultant psychiatrist and general director of the Palestinian organization Treatment & Rehabilitation Center for Victims of Torture. "We are not living in a protected environment. The situation is unpredictable. You can't even plan for this evening or for tomorrow."
As mental health care workers, Sehwail told PT, their concerns center not only around the impact of current trauma but on the residual consequences that last long into the future and are often invisible. Those long-term results could include social effects that could make it difficult for families to coexist. "It will affect our ability to make peace," he said.
For Israelis, the ongoing terrorist activities affect communities throughout the country in similar ways, regardless of an individual's actual exposure to violence. Arieh Y. Shalev, M.D., a professor of psychiatry and chair of the department of psychiatry at Hadassah-Hebrew University Medical Centers in Jerusalem, told PT that his research revealed that rates of PTSD or its symptoms did not vary significantly between individuals polled in a city close to the violence versus one more removed from the conflict. That result was a surprise, Shalev said, because it seems to contradict literature that focuses on proximity to the traumatic event as a criterion and adds substance to the concept of indirect trauma created by media or word-of-mouth descriptions of violent events.
Despite the effects of terrorism and violence on Israeli and Palestinian societies, Shalev believes there's still a chance for resolution. "There are constraints here that you haven't seen in other national conflicts. Regardless of the trauma involved, there are constraints that keep this conflict more controlled. For some good reason the amount of hate and rage is still counterbalanced by what is done and not done in terms of waging war," he said.
He conceded things could change in a moment. "In a general sense what we're seeing now is that in the [Israeli] population, paradoxically, the more stress there is the more people endorse the likelihood of a Palestinian state," Shalev said. "It is a very fluid thing."