Dr Judith Guedalia

By JUDITH GUEDALIA, YOCHEVED DEBOW AND DAVID DEBOW

In this paper we present an integrative model for helping perpetrators of accidental killing accept
the consequences of their actions and their 'new' selves. We use the model described in the Bible
of the 'city of refuge,' a place defined as a sanctuary to protect the 'accidental killer.' Based on an
understanding of the psychic trauma experienced by accidental killers, we classify their response
to the specific event as a form of Post-Traumatic Stress Disorder (PTSD). We then present a model
for rehabilitation that could be used to facilitate the rehabilitation of accidental killers and facilitate
their re-entry into society.

In our nature, however, there is a provision, alike marvelous and merciful, that
the sufferer should never know the intensity of what he endures by its present
torture, but chiefly by the pang that rankles after it.
Nathaniel Hawthorn, the scarlet letter (1906)

Proposal

For the accidental killer—a person who inadvertently caused the death of another human being—the aftermath of the fatal accident is overwhelmingly painful. Accidental death occurs frequently;  traffic and military accidents often claim fatalities. Such death becomes a double-edged tragedy, for both the bereaved family and the accidental perpetrator, whose experience often sentences him/her to a lifetime of turmoil. The Bible discusses the concept of a “City of Refuge” (Hebrew: Ir Miklat), a sanctuary to protect the accidental killer, who was to move to one of these forty-eight cities and live there for an indeterminate period of time (Exodus 21:12-14; Numbers 35:9-29; Deuteronomy 4:42; 19:1-13) We suggest that an analysis of the guidelines and directives clearly stated in the Bible and Rabbinical commentaries may not only provide insight into the psychological trauma experienced by an accidental killer but also help provide ideas for a contemporary rehabilitation model. We have selected concepts from studies of Post-Traumatic Stress Disorder (PTSD) and have also used the     diagnostic framework of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Moreover, we examine the Ir Miklat (IM) from a psychological perspective. It is our contention that the IM concept can serve as a model for understanding the effects of accidental death on the accidental killer (or, in the words of the Bible, `Rotzeah Beshegaga’, hereafter RB), his/her family and the surrounding society.

Purpose

Accidental death is a frightening prospect, as it may occur to anyone. Most people would like to believe in the orderliness of events in this world, yet accidental deaths occur under many different circumstances. Recently, the secrecy surrounding incidents of accidental killing in the Israeli Defense Forces has been lifted. Live ammunition is used regularly in training exercises, and the dangers of accidental killing in the army are felt more acutely than in everyday life. Nevertheless, newspapers are filled  with reports of fatal traffic accidents, which are the major locus of accidental killing. From 1982 to 1992 in Israel alone there were 4879 people killed in traffic accidents.[i] An extensive search for empirical data,  including a computer search of the psychological literature since 1987, revealed only twenty-four papers mentioning accidental  killing. Of these, not one dealt directly with the impact of accidental killing on the person who caused it. It thus emerges that despite the large number of people facing this tragedy and the ensuing distress, attempts at helping the perpetrators of accidental killing face their own future are insufficient.  In searching for a model, we examined the IM concept presented in the Bible

Ir Miklat

The Ir Miklat (IM), or City of Refuge, is a Biblical concept  described in several Biblical texts (Exodus 21:12-14; Numbers 35:9-29; Deuteronomy 4:42; 19:1-13) as a city to which an accidental killer could flee to escape the vengeance of the victim’s family. The plan as described in the Bible calls for six such cities to be set up, specifically dedicated to being Cities of Refuge (Numbers 35:6). Another forty-two cities, which were set aside for the Levites to live in, were also available to be used as Cities of Refuge[ii] for Israelites who had committed an accidental killing. Immediately after the accident, before a court had decided whether the death indeed conformed with the legal definition of “accidental killing,”  the perpetrator would flee to an IM and would be protected within the clearly marked boundaries of this `sanctuary’. S/he would thus no longer be vulnerable to `blood avengers’, family members of the deceased who would not be tried for murder if they took the life of the accidental killer outside an IM (Numbers 35:27).  Rabbinical sources and biblical commentators, who continually re-evaluate and re-interpret the biblical sources, have endeavored to find a precise legal definition of accidental killing. It is distinguished from criminal negligence on the one hand and total circumstantial involvement on the other. In this paper we are discussing the `inadvertent’ homicide—homicide in which there is a slight degree of negligence.  Once a person was adjudicated an accidental killer, s/he was permitted to live in the IM and continue his/her normal existence there. The exact time of release was arbitrary, as it depended on the death of one of the three High Priests who functioned at any given time. Only then was the accidental killer permitted to leave the IM and return to his/her previous home (Exodus 35:25. It is this concept of Ir Miklat that we wish to explore.

The Accidental Killer -- `Rotzeach Bishgaga’
In any fatal accident, the focus is usually on the deceased and    his/her relatives. However, there is often someone who feels responsible for having caused the death, however unintentionally.[iii]   There are many and varied types of situations in both army and civilian life which can lead to accidental killing. A search of papers published in psychological journals since 1987 reveals almost no literature dealing with the problem of the accidental killer. One book, Fatal Moments[iv], is based on interviews conducted from 1980 to 1990 with nearly 200 people who responded to their call to explore this phenomenon. The study presents the following model of the experience of the accidental killer, claiming that, despite some individual variation, most
accidental killers experience a similar pattern of responses. Generally,
psychological shock comes first. During this brief period of numbness, the
mind hides from the full realization that one has caused the death of
another human being. This is followed by preoccupation with the accident. In the
struggle to make sense of the event, many accidental killers replay it over
and over in their minds. Anger often engulfs the accidental killer, directed
at every aspect and player in the accident, including the victim. Guilt is
nearly universal, causing accidental killers to torture themselves for
unfounded reasons as well as for error and oversight. Depression, also
common, may occur in various forms. Their internal turmoil may cause them to
withdraw from family and friends and keep them from normal social
interaction. They usually experience some form of social tension, often
resulting from the failure of their friends and associates to respond or act
supportively, due to their unfamiliarity with the situation. Family stress
occurs as well.  At some point, virtually all accidental killers begin the process of
healing. Nevertheless, the aftermath of the event extends throughout their
lives[v]. Thus most accidental killers themselves become victims of the event.  All the symptoms experienced by accidental killers are included in the definition of Post-Traumatic Stress Disorder.
DSM-IV[vi]  lists several diagnostic criteria for PTSD:
A. The person has been exposed to a traumatic event in which both of the
following were present:
    (1 The person experienced, witnessed or was confronted with an event
or events that involved actual or threatened death or serious injury, or a
threat to the physical integrity of self or others;
   2) The person’s response involved intense fear, helplessness,  or
horror

B. The traumatic event is persistently re-experienced in one (or more) of
the following ways

 (1Recurrent and intrusive distressing recollections of the event,
including images, thoughts or perceptions.
(2 Recurrent distressing dreams of the event.
(3 Acting or feeling as if the traumatic event were recurring (including a
sense of reliving the experience, illusions, hallucinations, and
dissociative  flashback episodes.
(4 Intense psychological distress at exposure to internal or  external cues
that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma      and
numbing of general responsiveness, as indicated by three or more of the
following:
______  (1 Efforts to avoid thoughts, feelings, or conversations
associated with the trauma;
______  (2 Efforts to avoid activities, places, or people that arouse
recollections of the trauma;
______  (3 Inability to recall an important aspect of the trauma;
              4)  Markedly diminished interest or participation in significant activities;
______  (5 Feeling of detachment or estrangement from others;
______  (6 Restricted range of affect;
              (7  Sense of a foreshortened future (for example, does not  expect to have a
career, marriage, children, or a normal life span).
D. Persistent symptoms of increased arousal.
E. Duration of the disturbance is more than one month.
F. The disturbance causes clinically significant distress or  impairment in
social, occupational, or other important areas of functioning.
There are so many stimuli that can engender an emotional reaction that it is
hard to avoid the cues that evoke the memory of the trauma .[vii]  A study of police officers who had witnessed or taken part in shooting incidents found that many suffered from
a reaction that took the form of severe PTSD symptoms.[viii] It
would indeed seem that these people have experienced a psychologically
distressing event and that their reactions often fit the DSM-IV criteria of
PTSD listed above.
Although recent research indicates that all these symptoms are usually
experienced at the same time, it is still interesting to note the
similarities with the classic model of the stages of mourning described in
Kubler-Ross’s seminal work[ix]. There is a difference only in the final
stage: `aftermath’ in accidental killing and `acceptance of death’ in the
Kubler-Ross model. We propose that what may make it difficult for RBs to
experience `acceptance’ in any way may be that they actually remain in   the
state of mourning. They are mourning not only for the victim who actually
died but also for themselves, who are still alive, but no longer in their
former state of innocence—the person they were before the fatal moment. At
some point RBs apparently realize that they can never be this old self
again; the moment of accidental killing has irrevocably changed them and in
a certain way perhaps “deadened” an innocent and unburdened self. Thus they
may actually be mourning for the person they can no longer be. Shalev[x]
offers a psychodynamic formulation of PTSD as  “incomplete processing of
traumatic experiences similar to pathological mourning”. Although he
considers this definition insufficient to encompass the full nature of
PTSD, it could certainly serve as a partial explanation of the psychic
processes occurring in the PTSD patient, particularly the RB. 
Accidental killers are frequently acquitted in court for the crime of
manslaughter. Legal exoneration, however, cannot reverse the accident and
return the dead person to life, nor can it render the RB a person who has
not killed anyone, albeit accidentally.  Often, an RB’s reaction after being
acquitted is to say that the person is still dead, and “it was still my
finger on the trigger”  [xi]. Although the law has judged them to be not guilty, their own acute awareness of loss prevents them from accepting that judgment. The RB is no longer the same person s/he was before the event and must spend time mourning the loss of his/her former, “untainted” self.   The importance of allowing accidental killers to
experience these feelings of guilt has recently been recognized. Terr,[xii]
  in her book on psychic trauma in childhood, emphasizes the
importance of guilt as an adaptive mechanism. It allows trauma victims to
feel that they had a certain amount of control, even in a situation in which
their control was actually minimal. The event can then be faced and worked
through. Where there is no working through of the guilt, shame frequently
becomes the predominant emotion. It is usually compounded by feelings of
helplessness, which make it more difficult for victims to forgive
themselves and move on to redefinition and acceptance of the self[xiii]


Ir Miklat—An Understanding Based on the Biblical Text and Commentaries
The Biblical injunction ordering RB’s to proceed to an IM contains highly specific directives: All homicides, whether inadvertent or not, fled to an IM and were then brought back to their own town for trial. An RB had to
immediately leave the environment in which s/he was living and go to the
nearest City of Refuge. Inherent in the command is the immediacy and
specificity of the directive. It is imperative to gather oneself together
and proceed actively. At every intersection there were signs pointing to the
nearest IM, so that it was always accessible.      The IM was
inhabited by members of the Tribe of Levi and accidental killers.
Traditionally, the Levites had no land of their own, thereby freeing them
from agricultural responsibilities.  Instead, they were the teachers and the
social workers, the caretakers of the nation. Their life was dedicated to
the soul and spirit of the people, and it would seem that part of their
responsibility was to live in the Cities of Refuge, perhaps as the  “support
staff” for those RBs who needed moral support during healing[xiv].   It is explained that the city must be neither too large nor too small  [xv]. This ensured a
sense of community,  while guaranteeing the RB privacy as well. Another
important structural feature was that RBs were never to be a majority of the
population [xvi]. This stricture kept the population healthy and prevented the group

 malaise that might otherwise be self-perpetuating. The number of people suffering

from trauma was never so large that the support mechanism could not function

 efficiently. The city always had a group of empathic people who were not caught up in working the land, but were free to be helpful and supportive as necessary.

Once an RB was sentenced to spend time in an IM, he would not go there
alone; he was encouraged to move there with his family and a “Rabbi” or
mentor. (Here we must use the masculine form, as apparently the rule that
the RB’s family and mentor must accompany him to the IM applied only to
males. The husbands of female RB’s were enjoined to continue supporting
them, but they were not required to accompany them to the IM. Thus women in
this position were given some support, but not as much as men; it is the
model as proposed for males that we suggest for emulation.) The RB was to be
separated from his previous life, but only partially. Perhaps  “relocation”
would be a more appropriate term. Clearly, the resettlement of the teacher
and family would be difficult, yet it was essential for maintaining the RB’s
existence. The importance of taking along parts of one’s former life
to the IM was understood. Perhaps another purpose was to make sure the RB
would not be able to cloak himself in secrecy. On his arrival in an IM he
was announced as an RB.[xvii] This publicity was not a public branding of shame,

but rather meant for the purpose of integration. While the RB was not required to part from his immediate family, the act of relocation clearly separated him from the rest
of society. This might have helped prevent the RB from sensing social
tension in those around him.
 Finally, the “release time” for a RB’s  from the IM was always dependent on an
arbitrary event—the death of the High Priest. The random nature of the
accident is reflected in the release, which is similarly out of the RB’s
control.

How the Ir Miklat Model Addresses the Symptoms of PTSD

Current models for the explanation and treatment of PTSD are generally
found to be unsatisfactory. [xviii] The complexity of PTSD symptoms
seems to call for a multi-dimensional approach.  Although this is generally
agreed on in theory, much of the literature based on clinical work relies on
one-dimensional approaches, and so there is a great deal of  dissatisfaction with treatment results.[xix]  There is still widespread debate
about the various treatment options for PTSD, but what seems clear is that
an effective treatment model must be multi-dimensional.
The literature on PTSD generally states that avoiding situations similar to
the one that caused the trauma or attempting to deny the event gives rise to
the most severe PTSD symptoms .[xx]  However, attempting to
force the trauma victim to place himself in this type of situation may
further exacerbate the symptoms. What is healing is an attempt to treat the
psychological reactions to the trauma with a cognitive approach as soon as
possible and encourage the trauma victim to face the situation. [xxi]
Seligman in his study of “learned helplessness,” described how his
experimental subjects learned to be passive when they came to believe that
they were unable to control their environment.[xxii] Once an event such as an
accidental death has occurred, the initial feelings of shock, numbness and
preoccupation give rise to a need to escape. This need is satisfied by the
injunction to flee to the IM. In a situation of total disorientation and
turmoil, fleeing to the IM gave accidental killers a way of     mobilizing
their energy in defense of the ego, thus helping them avoid the internal
dialogue of self-defeating talk in which such  people may become mired.[xxiii]  It forced

them into action, which can give one a certain sense of control. This commandment

also helped reorient the RB; s/he realized that s/he was not the only accidental killer

 in the world; the signposts put him/her into a new category with others, so that s/he

could redefine him/herself and not feel so alone. The IM thus addresses the
unavoidable change in self-concept following trauma, a notion that is often
a basis for modern-day dynamic psychotherapies for PTSD. Thus, although RBs
were running  ‘away’ from ?the scene of the trauma, they were also
running ’towards’ a place that would redefine them specifically through
this trauma, and force them to face the consequences of their acts, albeit
within a therapeutic and supportive setting.
This combination of running away from the scene of the crime,  while
running towards a place where help could obtained, creates an apparently
paradoxical combination of avoidance and activity.  Activity seems important
for giving one a feeling of control over one’s body, something RBs may feel
they have lost by doing something which seems to have been uncontrolled[xxiv]
. In her book describing her work with the Chowchilla children,
Terr shows that those who were able to actively do something to try and save
themselves from the disaster emerged less traumatized,  apparently because
they had been active in protecting themselves.  She notes in particular that
one child, who was explicitly told not to help because he was “too weak and
too fat”, spent years trying to prepare himself for the next time he could
be a “hero” until he died at the age of fifteen in an accident.[xxv]

Although this is only a single case, it nevertheless supports the contention
that being active provides a certain sense of control that facilitates
recovery. Activity can also help alleviate the psychological numbing defined
as a common symptom of PTSD in DSM-IV (1994). Flooding therapies can
exacerbate symptoms by evoking emotions associated with the trauma. However,
seemingly unrelated activities can work as occupation therapy to provide
inputs that give rise to unassociated feelings. Thus allowing the person to
have safe emotional experiences that do not have to be suppressed through
numbing.

An added function of the signposts placed all over the country, directing
people to the IM, might be to desensitize the population in general to the
idea of accidental killer and thus facilitate their acceptance within the
community.  They became a part of people’s awareness and thus may have
served to minimize the accidental killer’s sense of being a `pariah’. In
describing the City of Refuge, the Midrash, a homiletic commentary on the
Bible, calls it “a healing for you”[xxvi]. This  seems to imply an understanding that

accidental killers indeed need a place to escape to for the purpose of introspection,

1 Road Safety in Israel: Facts and Figures (Ministry of Transportation: Road
Safety Authority, 1993).

2 M. Maimonides, The Codex of Jewish Law. Sabbatical and JubileeLaws 13:1.
3 G. Gilliam & B.R. Chesser, Fatal Moments: The Tragedy of the Accidental Killer
(Lexington, Mass.: Lexigton Books, 1991).
4 Ibid

5 Ibid.
6 American Psychiatric Association, DSM-IV: Diagnostic and Manual of Mental
Disorders, 4th edn. (Washington, DC: American Psychiatric Association, 1994), pp.
427-428.

7 Keane et al. (1985), quoted in Z. Solomon, A. Bleich, S. Shoham, C. Nardi &M.
Kotler, "the ' koach' project for treatment of comb-raetlated PTSD: Rationale. Aims, and
methodology," Journal of Traumatic Stress, 5:175-193 (1992).
8 B.P.R. Gersons, "patterns of PTSD among police officers following shooting incidents:
A two dimensional model and treatment implications," Journal of Traumatic Stres,
2:247-257 (1989)
9 E. Kubler-Ross, On Death and Dying (New York: Macmillan, 1969)

10 A.Y. Shalev, "Post-Traumatic Stress Disorder: A Biopsychological Perspective,"
Israel Journal of Psychiatry and Related Science, 30 (2): 102-109 (1993).
11 "Soldier Acquitted in Death of Officer", The Jerusalem post (October 15, 1993)
12 T. Lerr, Too Scared to Cry (New York: Basic Books, 1999?)
13 R. ???

14 S.R. Hirsch, “A Commentary to the Bible,” Bamidabar 35:34 (1860)
15

Guedalia, J., Debow,D. and Debow, Y.  Accidental Death: A New Look At An Ancient Model.  In Press: B.D.D. - Bekhol Derakhekha Daehu (Journal of Torah and Scholarship) (Ramat Gan: Bar-Ilan University Press). Vol.14 March 2004.

Tags: Accidental Death | Biblical Model Dedication | Mourning | Post-Traumatic Stress Disorder