Institutional betrayal in the face of a collective national trauma in Israel
Authors: Yael Lahav, Menachem Ben-Ezra
Journal: The Lancet Regional Health - Europe (2024)

On October 7, 2023, Hamas and Islamic Jihad militants infiltrated Israel, raping, abducting, and slaughtering individuals at a music festival, and in towns, Kibbutzim, and cities across the border. Over 1400 Israelis and foreign citizens were murdered, 247 were abducted, and over 5500 were wounded. Since then, more than 12,000 rockets and mortars have been fired into Israel, causing death and injury, and leading to the displacement of approximately 200,000 Israelis.1Ministry of Foreign AffairsHamas-Israel conflict 2023: key legal aspects (updated to November 2, 2023). 2023Google Scholar The scope of this trauma has put many thousands at risk for Posttraumatic Stress Disorder (PTSD), and other mental difficulties.2Charlson F. van Ommeren M. Flaxman A. Cornett J. Whiteford H. Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis.Lancet. 2019; 394: 240-248Summary Full Text Full Text PDF PubMed Scopus (666) Google Scholar Nonetheless, this crisis does not appear to be limited to the exposure to harsh national trauma but is also rooted in the rupture of civilians' trust in their government, which for many Israelis resembles that experienced during the 1973 Yom Kippur War. This break in trust refers to various aspects of the government's dysfunction, among them the failure to provide mental health support. In recent years, Israel's mental health infrastructure has been depleted, despite criticism from professionals. Furthermore, although traumatic events like war are relatively frequent in Israel, no contingency plan was made for trauma-focused treatment on a large scale. Thus, the outbreak of war highlighted the Ministry of Health's failure to provide necessary aid, deepening civilians' distrust in the government. The consequences of such a break in the civilians' trust in their own government while facing massive trauma, which has been documented regarding various traumatic events worldwide, are not only political, but also psychological. According to the betrayal trauma theory,3Smith C.P. Freyd J.J. Dangerous safe havens: institutional betrayal exacerbates sexual trauma: institutional betrayal exacerbates sexual trauma.J Trauma Stress. 2013; 26: 119-124Crossref PubMed Scopus (0) Google Scholar individuals exhibit trust upon large institutions just as they do in close relationships. Therefore, when these institutions fail to fulfill their obligations it poses an institutional betrayal that takes another toll on trauma victims' wellbeing, beyond the detriments of the trauma itself.3Smith C.P. Freyd J.J. Dangerous safe havens: institutional betrayal exacerbates sexual trauma: institutional betrayal exacerbates sexual trauma.J Trauma Stress. 2013; 26: 119-124Crossref PubMed Scopus (0) Google Scholar Research, which has been mainly focused on sexual assault victims, has supported this view, and revealed associations between institutional betrayal and various negative health4Smith C.P. Freyd J.J. Insult, then injury: interpersonal and institutional betrayal linked to health and dissociation.J Aggress Maltreat Trauma. 2017; 26: 1117-1131Crossref Scopus (0) Google Scholar and mental health outcomes.3Smith C.P. Freyd J.J. Dangerous safe havens: institutional betrayal exacerbates sexual trauma: institutional betrayal exacerbates sexual trauma.J Trauma Stress. 2013; 26: 119-124Crossref PubMed Scopus (0) Google Scholar,5Monteith L.L. Bahraini N.H. Matarazzo B.B. Soberay K.A. Smith C.P. Perceptions of institutional betrayal predict suicidal self-directed violence among veterans exposed to military sexual trauma: MST and perceptions of institutional betrayal.J Clin Psychol. 2016; 72: 743-755Crossref PubMed Scopus (0) Google Scholar These findings underscore the detriments of governmental dysfunction in providing mental health aid to civilians exposed to trauma, and the need for governments around the world to allocate resources, train specialist trauma therapists, and construct long-term plans for rapid and effective mental aid in the face of national trauma. Forming such a plan will not only enable treatment of trauma survivors soon after exposure, but may also preclude institutional betrayal, which in itself increases the risk of psychopathology. Yael Lahav—conceptualization, writing; Menachem Ben-Ezra–conceptualization, writing. None.