Study of Zaka volunteers shows surprisingly low levels of PTSD

Jerusalem Post | Breaking News from Israel, the Middle East and the Jewish World: "A recent psychological investigation on the resilience of Zaka volunteers to Post-Traumatic Stress Disorder (PTSD) and other psychological disorders has found relatively low levels of psychological malady, despite repeated exposure to scenes of terror attacks and other types of violence. ".....click more
The study, carried out by clinical psychologist Dr. Howard Fine of England's University of Surrey, chose Zaka – Israel's Disaster Victims Identification organization – due to its unique population.

Zaka is a voluntary, humanitarian organisation whose members can normally be found at the site of a terror attack after the police have finished sealing off the area and the ambulance sirens have dissolved into the background. Usually recognised by their bright-yellow vests, the volunteers have two jobs. The first is to search the area for any detached body parts of the injured in order to rush them to hospital for reattachment. The second task is to collect all remaining limbs and pieces of flesh and blood from the scene in order to bury the dead in complete accordance with Jewish law.

PTSD is a psychiatric disorder that can occur months after experiencing or witnessing life-threatening events such as military combat, natural disasters and terror attacks. It can often cause nightmares and flashbacks while the patient relives the experience. PTSD is also known to occur in conjunction with other physical and mental problems, including depression, memory and cognition disorders, and social problems, such as marital, family and parenting difficulties.

One would assume, looking at the occurrence rate of PTSD in the Israeli population and internationally, that Zaka's volunteers are probably higher up on the PTSD frequency scale than most. However, studies have proven this assumption wrong. In fact, investigations into the effects of repeated trauma, dating back from the beginning of the second intifada four years ago, have demonstrated quite the opposite.

Fine's investigation aimed to study the impact of mass-casualty incidents such as terror attacks on a specialised emergency response group. Zaka was chosen for its unique character, as the majority of volunteers are part of the Orthodox community. The study aimed to examine the effects of the volunteers' work on their mental and physical health, particularly concerning the development of PTSD.

One of Fine's intentions was to understand the volunteers' culture, societal and religious perceptions, and to provide recognition of the unique pressures that this particular group of people endures throughout the course of their work. He wanted to use his findings to assist in shaping training programs for emergency first-responder and body-handler volunteers, in order to develop psychological resilience.

With the help of Fine's research assistant, Lilach Benisti from Netanya, questionnaires were sent to 829 volunteers in six locations throughout Israel, investigating measures of ''personality, trait resilience, severity of PTSD symptomatology and general psychiatric symptomatology.'' The questionnaires included queries about religiosity, how much time - if any - spent serving in the IDF, and general questions about the volunteer, such as age, marital status, education and employment.

The investigation noted that in the past, Israelis were well known for their ability to recover rapidly after war. Although recent studies have focussed on Israel's PTSD rate after terror attacks, Fine directed his research toward factors that lead to the development of PTSD.

Zaka volunteers are a very appropriate choice of population for evaluating the factor of religiousness on the development of PTSD. The volunteers are mainly religious Orthodox men, who spend their time volunteering because they believe they need to try their utmost to ensure that the dead are buried with maximum dignity and according to Jewish rituals.

Jewish law regards the human body as holy, placing great importance on treating the deceased with the utmost dignity. Of all benevolent acts that a person can perform, caring for the dead is considered almost pure altruism, for the beneficiary cannot repay the deed.

Preparing the deceased for burial is a difficult duty, even in normal conditions, and is further exacerbated under the extreme environment of a terrorist attack or a violent accident, Fine told The Jerusalem Post.

In his report, Fine highlights the importance of a ''sense of belonging, strong group cohesion and social support network'' that a religious lifestyle encompasses. He stresses that these are likely to be contributing elements to the unusually high levels of psychological wellbeing among Zaka volunteers in comparison to the rest of the Israeli population and other workers who come in contact with mass-casualty scenes.

Religiosity in this particular context does not necessarily refer to being a religious observant Jew, Fine explained. Being raised with a strong sense of ideology can aid in fostering resilience and lead to an improved state of mental health. In addition, it has been argued that these religiously motivated elements are also associated with a decrease in the incidence of physiological diseases and an improved quality of life.

In addition to the unique factor of religiosity, studies have shown other protective factors relevant to Zaka volunteers that may help foster resilience to trauma. These elements include being male, well educated, employed and married.

The results indicated that the more religious and agreeable the volunteer, the less effected he was by PTSD. Mental wellbeing deteriorated in accordance with the degree of neuroticism and openness of the volunteer.

Fine attributes these results primarily to the fact that because the volunteers are mainly very religious, they have developed "religious resilience'' in order to create a direction for their efforts.

"Surviving adverse life events may be achieved through a sense of religious belief that the individual is here for a purpose. This purpose in life, or existential meaning, helps these resilient individuals endure hardships in order to continue with duties," according to Fine's report.

These results are particularly interesting, as Zaka volunteers are also fully aware that they are at risk of being involved in secondary disaster incidents, such as hostage situations or second explosions on the scene. Fine's study found that although these dangers add to the stress of the situation, the volunteers seem to cope remarkably well.