On International Suicide Prevention day, Dr. Leah Shelef, an expert in trauma and mental health, board member of MOSHE and faculty at Sapir Academic College, delivered a profound and timely presentation on the connection between post-traumatic stress disorder (PTSD) and suicidality.
Drawing from her extensive research and personal experiences, she illuminated how these two mental health challenges are interwoven, especially for those exposed to traumatic events, such as soldiers in combat.
PTSD: An External Trigger with Devastating Internal Effects
Dr. Shelef began by underscoring a key distinction in PTSD that sets it apart from other mental health diagnoses: its external origins. "PTSD is the only diagnosis where the cause is external," she explained. "It’s not about a person’s inner world; it’s a reaction to something that happened outside of them." Whether in soldiers returning from war or civilians who experience violence, PTSD is often triggered by events so traumatic that they shatter one's sense of self and safety.
For those affected, PTSD manifests in ways that go far beyond anxiety or flashbacks. Dr. Shelef detailed four main clusters of symptoms: intrusive thoughts, avoidance, heightened arousal, and cognitive shifts. Each of these contributes to a person’s overall mental health and can create a dangerous environment in which suicidal thoughts may begin to develop.
"Intrusive thoughts are like uninvited guests," she said. "They come in without warning and refuse to leave."
This endless loop of reliving trauma makes it difficult for individuals to move forward, leading to feelings of despair.
Avoidance and Isolation: The Silent Dangers
One of the most insidious aspects of PTSD is avoidance. While it might seem like a way to cope, Dr. Shelef warned that avoiding reminders of the trauma often leads to isolation. "People avoid anything that reminds them of the trauma, whether it's a specific place, person, or even a smell," she explained. This avoidance isolates individuals from their support systems and can cause feelings of loneliness, intensifying the risk of suicidality. In a culture like Israel’s, where community is often a pillar of support, this isolation can be especially damaging.
Guilt and Shame: The Cognitive Shifts that Fuel Suicidality
Another major theme in Dr. Shelef’s research is the role of guilt and shame in PTSD, particularly among soldiers.
"As a collective, we are a nation that experiences shame and guilt deeply, and this is especially true for soldiers,"
-she noted. Many soldiers carry feelings of guilt—whether it’s for surviving when others did not, or for actions they may or may not have taken in the heat of battle. These cognitive shifts, combined with the trauma, create a perfect storm that can lead to suicidal thoughts. Dr. Shelef highlighted that women, in particular, often experience guilt more acutely, which correlates with higher rates of suicidality in some of her studies.
The Role of Dissociation: A Double-Edged Sword
Perhaps one of the most chilling aspects of PTSD that Dr. Shelef touched on was dissociation, a phenomenon where individuals mentally "check out" as a response to overwhelming trauma.
"Dissociation is like looking at your life from above, like you’re floating outside your body," she explained. While this mechanism may help people survive in the immediate aftermath of trauma, it can also prevent them from processing their emotions, leading to long-term issues like severe depression or suicidal ideation.
Dr. Shelef’s studies revealed that those experiencing dissociative symptoms often report higher rates of suicidality, with their disconnection from reality making it harder to feel a sense of hope or belonging. "You can’t connect to your emotions, you can’t feel joy, and sometimes you can’t even recognize reality," she said.
Habituation to Violence: The Slippery Slope
Another critical point raised by Dr. Shelef was the concept of habituation to violence. As individuals are repeatedly exposed to traumatic events, whether in combat or in civilian life, they can become desensitized. "We are afraid of habituation," she said. "When people are exposed to violence repeatedly, they start to become desensitized, and that desensitization can, in some cases, lower the barriers to self-harm." This desensitization is particularly dangerous for soldiers, as their frequent exposure to violence can erode their moral and emotional boundaries, making suicidal thoughts more accessible.
Collective Resilience and Post-Traumatic Growth
Despite the gravity of her topic, Dr. Shelef ended her presentation on a hopeful note. While PTSD and suicidality are pressing issues, they do not represent the entirety of a person’s experience with trauma. She reminded us that trauma can also be a catalyst for growth. "We are a people who have survived 2,000 years of hardship," she said, referencing Israel’s long history of resilience.
"And yet, despite all the challenges, there is post-traumatic growth. Many people find meaning in their suffering; they find strength in their families, their communities, and themselves."
This resilience, she explained, is a crucial factor in the healing process. It allows individuals to begin rebuilding their lives, even in the wake of immense loss. She cited studies that show how people emerge from trauma with a renewed sense of purpose, drawing strength from their connections to others.
What Can We Do?
In closing, Dr. Shelef offered a practical approach to helping those who suffer from PTSD and suicidal thoughts.
"We must find the key to unlock each person’s experience," she said. "Don’t tell them you understand. Because you don’t. What you can do is help them bring the past into the present, so they can start to reinterpret it and see a future again."
This empathy, combined with a focus on the present moment, can be the key to breaking the cycle of trauma and helping individuals move forward.
Her final message was one of collective responsibility. "We must hold the burden together," she urged. "No one can bear this weight alone. Only by standing together can we hope to ease the suffering of those affected by PTSD and suicidality."
Dr. Leah Shelef’s talk at the MOSHE conference was a powerful reminder that while trauma and its effects can be devastating, there is always room for hope. By understanding the complex relationship between PTSD and suicidality, and by offering support in meaningful ways, we can help individuals find their way back to themselves, their families, and their communities.
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