Dr Judith Guedalia

Collateral Damage

The term Collateral Damage is the military parlance for the damage and destruction of targets or personnel not considered as lawful; when it is used as a euphemism, it is defined as the inadvertent casualties and destruction inflicted on civilians in the course of military operations.   In a ‘terrorist war' the collateral damage may not be obvious to the eye.


Today, Sunday Chol Hamoed Pessach, there was another Piguah (terrorist attack) in Tel Aviv, many killed and more injured.

Erev Pessach, well actually two days before Pessach, I was asked to see a family that was in the ‘vicinity' of a recent Piguah.  I recalled hearing about the ‘event', what I learned since then was that they were ‘just' observers.  The family member who called said that they could not get ‘back on with their lives'.  I wondered why they had not gone to any of the ‘agencies/hospitals' in their locale.

"Well we felt that since we were not injured (physically) there was no need to ‘complain', and the hospital ER was not for us, nor we were told, could we be suffering from PTSD (Post Traumatic Stress Disorder) which is only ‘diagnosed' after thirty days."  Also they could not get insurance coverage as yet for ‘consultation' as they hadn't filled out the paperwork.

I told them to come in and that I was sure that they would work on getting payment after ‘the holidays'.  What I understood is that NO ONE would go to all that effort two days before Pessach unless they were really in NEED of help!!  And so I left the cleaning and cooking behind and went back to my office.

What they, four members of the family, first as a group, and then individually, went on to describe was a horrific ‘viewing' of death and destruction less than five feet from them.  

They walked into the office in a slow belabored fashion; heavy with the weight of what they had experienced.

A 'family' session is usually 90 minutes, I had asked the head of the Social Work Department, at Shaare Zedek Medical Center, Amalia Oren,  if she could join me.    I feel that when dealing with a family, working with a co-therapist helps in ‘modeling' couple behavior.  We can agree, disagree, interrupt, accept input and reinforce each other in ways that the ‘family system' can adopt.  We have worked together (and separately) in the ER for years, I know her ‘style' and she knows mine.  We didn't have any time to prepare ourselves, as we didn't really know, or understand, the full extent of what "we were observers to a Piguah" meant, but I know that she works well ‘on her feet' and I don't do too badly myself. 

So we went ‘to it' using a combined and distilled version of many years of combined study and experience (especially with the work of Milton H. Erickson, MD, and his often unconventional approach to psychotherapy, such as described in the book Uncommon Therapy by Jay Haley). 

Milton H. Erickson's work has always ‘spoken to me' especially his extensive use of therapeutic metaphor and story.  He coined the term Brief Therapy for his approach of addressing therapeutic changes in relatively few sessions and influenced the development of Strategic Therapy and Family Systems Therapy beginning in the 1950s.  For Erickson, the unconscious mind was creative, solution-generating, and often positive.   But more than anything else, his ability to "utilize" anything about a patient to help them change, including their beliefs, favorite words, cultural background, personal history, or even their neurotic habits, ‘fit' with my ideas of the goals of therapy: to help my patients solve problems, achieve goals, and change their behavior.

We met with them for twice the average session-intervention really, both because of the extent of their need, and the fact that they (and I) had wanted to ‘go into' Pessach with as little ‘Hametz' (literally ‘leavened bread' but metaphorically, unacceptable/forbidden material) as was in our control.  When we finished the marathon session we made another appointment for after the holiday.

Maybe I imagined it, but as they thanked us and wished us Chag Sameach, they left with a jauntier walk, a sort of lightness that bespoke of relief.  Amalia and I looked at each other, we felt metaphorically stooped, by what we had heard and absorbed.  I guess we were experiencing Collateral Damage ourselves.


Originally published in the Jewish Press on May 17, 2006.

Tags: Collateral Damage | Jewish Press | Piguah | Post Traumatic Stress Disorder | PTSD | Terrorist War