In one of the venues in which I have practiced in the last 40 years of as a psychiatrist, I was asked to be a member two decades ago in a large city’s psychiatric/mental health trauma team by my partner at the time. He had served on the ‘team’ for some years and wished to give it up. He offered it to me and with my usual gung ho attitude of never turn a chance down to do something new and different, I assented to his offer and was accepted into the inter-agency body upon his recommendation. I underwent all sorts of training but mainly working with victims of mass hostage situations, shootings in public places, and mass industrial or urban accident scenes with the visual presence of much death and human destruction. To date myself, this work occurred over 20 years ago when the post office employees were cutting loose in fits of rage and shooting up large post offices, killing supervisors and fellow employees. Some of the situations involved angry employees who took customers hostage in numbers at their places of employment whether manufacturing plants or large retail stores in large malls. To be sure, all of these situations involved adult perpetrators not children. Our teams of mental health ‘first aid’ workers, or as they are now called, ‘first responders,’ primarily focused on separating victims and shocked witnesses away from the scenes of their spells of captivity,  of being hostages, when permitted by law enforcement and then debriefing them gently to start the painful process of ventilating the toxic and seemingly impossible feelings so that our follow up private office counselling could continue later.

I had a special interest in these issues that jumped up into my conscious realization of what my initially unaware or “unconscious” motives were as I underwent the initial training sessions. I was interested in the victims’ experiences of being traumatized since I had been an early to middle teenager. It was not that I had been abused myself. My motivations were  much more esoteric and farther removed from the growing wave of revenge motivated violence we see now in this country, now having filtered down to middle elementary school students who are often as angry as the begrudging adult mass shooters.

I had lived in Israel for three years in my early teen years since my father was recruited by the Israeli government, the “Histadrut,” and its then Minister, the now 92 year old and finally retiring politician and diplomat, President Shimon Peres. My father was a well renowned underground mining engineer in his super-specialized circles of sinking very deep mines’ shafts through dangerous underground formations such as the “Blairmore” in Canada and many other areas of the world. In the US his mines were always the safest in the country with the highest production, and lowest accident rates. Because of this and his growing reputation after WWII and the 1950’s, his mines were on the required tours for foreign mining dignitaries by the US Bureau of Mines. In our home, wherever we lived at the time as we moved around frequently from job to job, state to state and country to country, it was customary for guests from all over the world to eat at our supper table during their visits at my father’s installations. The talk was always fascinating and from an early age I was spellbound by the stories I heard from my parents’ visitors, as my mother was a geologist herself.

So off we went to Israel, “across the Pond,” as our mountain Appalachian friends called it, to the “Holy Land.” My father had been tasked with the job of taking over the re-opening of the modern site of “King Solomon’s Copper Mine,”located at Timna north of Eilat, for the Israeli government. The Israelis had received many many millions of dollars in reparations from the West Germans for the Holocaust, and had allocated part of those monies for industrial development in many economic sectors including mining the mineral rich Negev desert. I learned Hebrew, went to Israeli public schools including a kibbutz based school on the border then of the West Bank which Israeli did not have possession of at the time we were there.

I met a group of people that I had almost no knowledge of, the concentration camp survivors. The first such person I met was the barber in Eilat at the southern tip of Israel next to Jordan’s Aqaba (the scene of Peter O’Toules’ dashing charge leading the Beduin army he had amassed down the long slope of the Negev to the Red Sea in the movie Lawrence of Arabia). The barber was a very silent man who hardly ever spoke and struck me as different if not odd though as a naive American teen I could not fathom why he was so. I was naturally very talkative as I have been all my life, and I had been raised in the American barbershop culture: you go to the barber to get your haircut and to talk and tell tall tales and enjoy conversation. This man did not talk at first with me but realized I wished to practice my Hebrew with him. He opened our talking relationship with the observation in his East European accent, that his Hebrew was poor, but his English was nearly flawless as he was truly an educated man who had lost everything in the Nazi occupation of his country, and being sent to a concentration camp, his professorship, his family, home, everything and all his friends and acquaintances, so he emigrated to Israel. So I spoke mostly Hebrew to him and he spoke mostly English to me and we got along famously. One day, as he was talking painfully about the concentration camp he had been imprisoned in, the unbelievable torture and hardship he had suffered and endured, he pulled back the long sleeve from his forearm and showed me his camp prison ID number crudely inked into the underside of his forearm. I was shocked, petrified and terrified. At the time he had stimulated my interest in WWII and Nazi Germany and I was reading the thick paperback edition of William Shirer’s The Rise and Fall of the Third Reich. In front of my eyes was living witness to what I had been reading about. This man had been so thoroughly traumatized by his experiences that he lived alone, decided never to remarry and to stay distant from people and almost speak to no one. In Israel I came to learn there were many such persons and their extreme reaction and method of coping was well known, understood and accepted. I began to learn of other such ‘survivors’ in Eilat that I had contact with and began to make an effort to hear their “stories.” I have come to see that these experiences were my early unaware fumbling toward people work, talking with people, i.e., mental health work, psychiatry. Two of my 9th grade teachers in Eilat were survivors; two of my closest teachers and mentors who also were Israeli Army (IDF, Israeli Defense Forces) at the kibbutz school up north were survivors. My father’s favorite geologist and best friend at the Timna mine, Zvi was a survivor. I pressed my little curious direct American self upon them all and heard their life stories in awe and respect. But they all had emotional scars that were my second experience with the phenomenon of PTSD. They were over-controlled much of the time, avoided talking for the most part about their trauma and held it inside but let me inside for which I am eternally grateful and ever in their debt for so doing. My first experience with PTSD was with my father and I did not know this until later during our stay in Israel when my father confessed to me that he had not been able to fly in a plane for 10 years after WWII because of the trauma he experienced in the B17s in North Africa, Sicily and Italy, seeing planes carrying his best friends go poof and disappear in a moment after being hit with anti-aircraft fire and flak.

Years later, after my training and clinical teaching faculty years at Duke, it just so happened that I started doing juvenile forensic work at the extremely large juvenile detention center where we lived when I began to participate in the mental health crisis team effort. With the adult and some child victims of hostage or mass shooting situations I quickly learned how to treat these traumatized individuals, gently and empathically, letting them work at their own speeds, doing what they could in the desensitizing work after their public trauma. I realized they were like the camp survivors I had made the effort to get to know personally in Israel. It all came together for me and I started reading everything I could get my hands on in those days on psychic trauma, and the growing knowledge of PTSD. Concurrently I was evaluating and treating traumatized teens at the huge detention center, one of the three largest in the country with 3,700 kids at the time and seeing even the most cold blooded, probably sociopathic of them as battered abused, traumatized youngsters all of whom grew up in cultures of immediate violence, death, gang wars, murdered parents etc. They were all traumatized and some of them I was able to help see in 3-4 years’ work with them, that another way of emotional and behavioral life was possible. I had free rein in the detention center as I was the only child/adolescent psychiatrist there,. No one else wanted anything to do with working there which I understood as a prejudice but realized it was permitting me to tap into a wealth of experience that I would never have been able to do otherwise.

I started to inherit teen and even child murderers and in those days, since almost all forensic child/adolescent psychiatrists were in the major psychiatric medical university centers of learning, New York, Ann Arbor (especially Elissa Benedek who mentored me briefly but richly before I went into psychiatric residency training at Duke), Boston, UNC, and UCLA. I was in one of the five biggest cities in the US and it was just me, so I plunged ahead, took courses, again reading everything I could find on juvenile murderers and began being an “expert witness” in that field trying to help the local courts decide what to do with these anomalous youth who had committed perhaps the ultimate crimes. But in those days, those youth who murdered did not commit public or mass shootings; instead they shot their perpetrators, the sexually abusing fathers or mothers, abusive uncles, grandparents etc. This circumstance in itself stirred up public opinion to steel furnace white hot heat levels as various figures or local vocal citizens would call for draconian punishments. I recall two children who murdered their grandmother by shooting her in the head while she was asleep because she punished them by keeping them locked in a giant heavy iron barred parrot cage for days at a time.

Nowadays the paradigm has obviously shifted from youth murdering their abusers to youth who have apparently not been abused, especially more recently, killing peers who have slighted them in real or imagined ways. The families of these murdering children are subjected to unbelievable media attention that can be traumatizing in itself and I fear that this makes research and responsible inquiry into the developmental lives and experiences of these youthful offenders removed from clinical inquiry and understanding. As well, some of these youth will often suicide by shooting themselves in a fatalistic last act preventing us who care about the origins of these horrific behaviors, from working with them in long term slow efforts to learn what has led them to the decision points of committing mass shootings and murders even of their peers. Some of this research and clinical investigative work is already ongoing with the youth who committed these seemingly unfathomable crimes; but this work must necessarily take place extremely privately behind the protection of confidentiality and our profession faces a dilemma of how to share the knowledge that will be painstakingly gleaned from these long slow efforts.