In her work with Israeli military veterans and victims of trauma, Sigal Haimov asks a lot of sensitive questions.
But over a lengthy career as a mental health professional, she’s found that it’s one of the easiest questions to ask that’s trickiest for Americans to answer genuinely: “How are you doing?”
“You” — that is, Americans — “ask each other ‘How are you doing?’ whenever you see someone you don’t even know,” said Haimov, director of the telephone-based help line at NATAL, an Israeli trauma center.
On the other hand, “When [Israelis] ask you how you’re doing, we expect you to answer — and not just say, ‘Fine, thank you.’”
There’s a lot to be learned from the Israeli response — one of many reasons the Wounded Warrior Project reached out to Haimov and her organization a year and a half ago, to establish a telephone help line for American veterans dealing with post-traumatic stress disorder and suicidal thoughts. The Wounded Warrior Project’s mission is to “honor and empower” veterans, and it does so through its 19 different programs, including physical therapy, peer mentoring and job skills and placement assistance — and now, over the phone with a help line.
Haimov is a major force in setting up the service — named WWP Talk — based on her experience setting up and running NATAL’s own help line for the past 16 years. Instead of serving solely as a crisis intervention line, where caller-to-counselor relationships usually end when the phone is hung up, the NATAL method focuses instead on strengthening that initial relationship, and providing assistance beyond suicide prevention. Over the past year, she has traveled back and forth from Israel to Jacksonville, Fla., helping to train the WWP Talk’s first few cohorts of volunteers.
“We don’t do anything at the Wounded Warrior Project that we can’t be the best at,” says Dave Ward, who oversees WWP Talk as well as other mental health services at the organization. “NATAL are the experts, specifically with this help line model.”
And experts such as Haimov and the staff at NATAL are helping to address a very real problem in the United States. A Department of Veterans Affairs study released last year estimated that approximately 22% of all suicides in the United States from 1999-2010 were committed by veterans. Veterans make up just 10% of the United States population, and their rate of suicide is increasing at double the pace of civilian suicides. The majority of the suicides were committed by male veterans older than 50, but an update from the VA released last month noted an increase in suicides among men between 18 and 24, and female veterans of all ages.
What’s more, those statistics don’t account for all cases of suicide, since not all states report data to the VA. It’s not always possible to reach out to a victim’s family for confirmation of veteran status (for example, if the victim was homeless). And some cases are difficult to rule definitively as suicides (for example, if the veteran was found behind the wheel at the time of death).
The NATAL model is unusual because of what it provides to veterans after the initial call — namely, repeated counseling sessions with the same volunteer. Speaking with one counselor continuously helps veterans avoid retelling traumatic memories to a succession of different voices on the other end of the line. Counselors also direct callers to other organizations which help them set up appointments with psychotherapists, or secure government services they had been previously unable (or unwilling) to use. By using the NATAL model, WWP Talk is differentiating itself from other United States veteran hotlines, namely the VA’s Veterans Crisis Line, which focuses mainly on suicide prevention.
“I found it to be very necessary in Israel,” Haimov said. “Warriors, when they come back home, they struggle with so much — they have neither the energy nor the patience nor the capability to get what they deserve from governmental institutions.”
Haimov said she hears similar battlefield experiences from Israelis and Americans — “trauma is trauma,” she said — but that it is in actually dealing with the trauma that the two groups begin to diverge.
There are two key factors that affect the different ways in which Americans and Israelis deal with trauma — the nature of military service and the national culture. With some exceptions, military service is mandatory for all Israelis over 18, and almost every family is familiar with the demands of war. In America, on the other hand, military service is voluntary and most families have no experience with it. Importantly, the traumatic effects of multiple deployments for American soldiers are minimized for Israeli veterans. Haimov explained that in Israel, deployments are shorter and soldiers are able to return home to their families each month — after all, they are stationed within the borders of their home country, where a cross-country trip means traversing a territory the size of New Jersey.
But a more subtle challenge has to do with the cultural differences between Americans and Israelis themselves — like the way they answer the “how are you doing?” question.
Americans are overall more polite and reserved, Haimov said, and therefore not used to talking about their feelings with others — particularly strangers on the other end of the phone line. That may mean it takes longer for a veteran to open up about his or her problems, but it also means that the training for American volunteers is even more emotionally involved than that for Haimov’s Israeli staff. The American volunteers must resist the impulse to offer easy platitudes, and instead address their own mixed emotions that arise when speaking to veterans each week.
“We want them to stay with the pain, hear the sadness, hear the helplessness — deal with those difficult emotions,” Haimov said.
A.W., a volunteer at WWP Talk in Jacksonville who requested to be identified by her initials only because of the confidential and personal nature of her work, found herself in just such a situation.
“There was a warrior whose story touched me so much that after the call, I really had to take some time,” A.W. recalled. “I was very sad and cried and couldn’t figure out why.” She made a long-distance call to Haimov, in Israel at the time, to discuss her feelings about the interaction.
“My friends had always told me I was a good listener and had a lot of empathy,” A.W. said. She is also the mother of a soldier who has served in Iraq and Afghanistan and the wife of a veteran, and has a father who was a prisoner of war in World War II, and a grandfather who served in World War I.
“As a mother, I couldn’t help my son with his transition back to the civilian world other than being a mother, but I just feel like I’m sort of the help I couldn’t give my son,” A.W. said. “I just feel like I’m giving back something.”
“It’s almost like being in a confessional,” A.W. explained, comparing the phone call experience to the Catholic ritual. “You’re just letting the thoughts flow without wondering if I’m saying this right, or if this is what the other person wants to hear.”
Along with the tough situations, there are successes. Haimov spoke of soldiers who had already quit drinking in the short time that WWP Talk has been accepting calls (about 10 months), and of one veteran in particular who felt confident enough to leave his house for the first time in six years thanks to WWP Talk’s counseling. And A.W. spoke of a veteran she’d been working with for five months, who had resisted talking to her about his combat experience, or taking her suggestions for outside help, and who is now enrolled in one-on-one therapy sessions with a mental health professional.
“That’s huge for these guys — to be able to come from that place of sort of wallowing in it, and realizing, wait a minute, there’s nothing I can really do about what happened, but there is a lot I can do about what happens in the future.”
Haimov and others from NATAL will begin training another cohort of volunteers for WWP Talk in February, and given the results so far, both parties are optimistic about the future. WWP’s Dave Ward said another year will give the program time to mature in Jacksonville, but there is talk of possible future programs to address western time zones, probably based out of Colorado, once the program strengthens its base of volunteers and serves increasing numbers of veterans. He estimated that “well over 100,000” wounded veterans will seek WWP’s help in the next two or three years.
“We’re looking to impact as many warriors’ lives as possible,” Ward said. “We couldn’t have had anybody better to help us put this program in place than [NATAL].”
“For me, it is so important that the American society recognizes the needs of those soldiers, and the price they are paying for being deployed for such a long time,” Haimov said. “I’m hoping we can help them as much as we can help our own warriors.”
Jared T. Miller is a freelance journalist based in New York City. He has written for Time, the New York Daily News and GlobalPost, among other publications.