Reflections on Crisis: Insights from New York During the Pandemic

Navigating Trauma and Maintaining Sanity in Uncertain Times

I was born in New York in the mid-1970s and lived there from 1992 to 2004. I have American citizenship, American memories, and sentiments rooted in the Chelsea Hotel on 23rd Street in Manhattan, between Seventh and Eighth Avenues, where my first home was. I graduated from this city with four degrees, got married twice, and was there on one critical morning, September 11, 2001. Maybe that's why I read with shock every detail about the deadly effect of the coronavirus on New York.

A few weeks ago, I also started talking regularly with Yuval Neria, a dear friend who was also my PhD supervisor, who has been working and living in New York since the September 11 attacks. Maybe I felt that when a metropolis falls in the middle of the Western world and I'm not there to hear it, I should talk to someone who is there, so they can describe to me what kind of noise it makes.

Photo Caption: People run away from the site of the attack on the Twin Towers, archive. The 2001 attacks damaged the psychological fabric that was the perception that New York existed in a safe bubble. Photo: AP.

Neria is the director of the program for mental trauma and post-traumatic stress disorder at the New York Psychiatric Hospital and Columbia University, where he serves as a professor of clinical psychology in the department of psychiatry.

"You can call our conversations 'greetings from the front,'" he notes, and this is not just a statement. Many Israelis, younger and older than him, know that during the Yom Kippur War he fought in several difficult battles and was wounded. He received the decoration of heroism, which is the highest possible in the IDF. I mention these impressive facts to explain that when Neria calls the fight against the coronavirus "the front," he is not doing it casually. I mention all this also to make it clear that it is not easy to worry Yuval Neria. In fact, in the 20 years we've known each other, I've never seen him worried. But now, it's different.

Neria came to New York to study the effects of the attack on the Twin Towers. "This event was like the Yom Kippur War," he says. "A huge traumatic event that can be investigated. It had a very strong element of surprise and it damaged a psychological fabric that resulted from an excessive sense of security.

"In 1973, the psychological texture that was damaged was the arrogance of the State of Israel after the Six Day War, and in the 2001 attacks, this texture was the perception that New York existed in a safe bubble. The feeling before them was that even if the city experienced a huge disturbance, it surely could not happen because of something coming from the outside and penetrating this bubble.

"I came to New York to understand this phenomenon at the individual level, for example, to know who are the people left with post-traumatic injuries, and also to look at the collective and try to understand what happens to society when its psychological infrastructure suddenly collapses due to external damage." According to him, the coronavirus epidemic is completely different from war and terrorist attacks like the downing of the Twin Towers, but it is very similar when you look at it from this perspective: an outside factor unexpectedly harms human society and causes an immediate collapse, revealing that the psychological infrastructure of society was shaky.

This call took place on Saturday evening, April 4th. According to forecasts, within a few days New York City and the entire country should reach the peak of hospitalizations and deaths. Neria describes a city of eight million people trying with superior effort to meet this challenge. "This is not terrorism, war, flood, or fire. The coronavirus disaster is not limited geographically, not limited in time, does not discriminate between populations, and probably does not really distinguish between ages as people think."

"The epidemic is spreading at a truly astronomical rate, and this is a feeling that is almost impossible to digest and is unfamiliar to disaster researchers and psychotherapists to neuroscientists. We constantly receive predictions from experts about what is going to happen in a week or two. This is not a terrorist event or an accident that journalists report on from the scene—we are dealing with an event that happens in the future but we know exactly what awaits us.

"It reminds me of a tsunami, a wave whose movement is normal and lacks energy at first. You see a slight uplift, and it is so easy to handle or ignore that even boats or ships at first only feel a slight movement. But when this thing starts to move with increasing speed, it becomes something that nothing can jump over, run away from, or stand in front of. Today we are dealing with a tsunami of a different kind, as if we are familiar with it but still don't know what to do."

When I ask about mutual acquaintances and the many people Neria works with, he says he does not feel that people are running away: "Maybe because there is nowhere to run, and maybe because it happens to everyone. I mean, you can go up on a mountain and sit there for two days, but in the end, you will return to your previous life. Even now, those who could leave the city did so, but the rest simply stayed where they were from the beginning."

The main action New Yorkers are taking in the face of the coronavirus is seclusion at home while maintaining functional routines. Neria's entire team is currently working online, and the university has ongoing research. "I don't know people who took time off," he says, "and not one of the people I work with canceled a meeting."

Maintaining a routine, whether by taking care of the family, continuing to work from home, or even sticking to sports, is currently the key to maintaining sanity. "When the threat is so vague as in the current situation, it is difficult for us to function. The brain knows how to recognize a violent face, a writhing snake, or a dog baring its teeth. But it is not built to withstand high levels of vague threat for a long time. There is something very tiring and draining in terms of system resources, and the result is great fatigue, an inability to cope in the long term, and an attempt to shorten the processes."

The ambiguity of the threat we face causes anxiety, confusion, dissociation, and emotional attacks that are unfamiliar to us, such as rapid transitions between crying and laughing and between anxiety and disconnection. Similarly, if we constantly expose our brains to this vague threat, we also make strategic mistakes and stop paying attention to safety. "The functional sequence allows a respite from the extreme sense of threat and thus helps us to preserve our resources," he concludes. And there is also the obsessive consumption of news, which I think is an attempt to make the vague tangible. Neria agrees: "This is indeed the function of this immersion, but tragically this consumption leads to more anxiety."

This list was written on Sunday morning, April 5th. The previous evening Neria said: "We are waiting to know if we will get out of this alive or not. We are afraid that we will not get out of this, and the answer is not coming." I wonder if the strategy of slow containment, which most countries employ and which currently seems to be the most correct from a medical point of view, is the worst thing from a mental point of view because it leaves us for a long time in exactly this situation: we fear that we will not get out of this and we do not know if there is an end to it at all. "You're right," he answers me.

Photo Caption: Dr. Yuval Neria. Photo: Yneria.

At the beginning of this column, I wrote that it is difficult to worry Neria, but that is not accurate. In November 2017, he and his wife were staying with us for dinner when suddenly a huge explosion was heard from the direction of Jaffa. Yuval Neria and Yuval Baali, who is a decade younger than him, got up from the dinner table and stood alert, ready for action. Mariana, Yuval's wife, and I remained seated, watching the display of the post-traumatic purpose of the Yom Kippur War and the Lebanon War.

When I look at Neria, I remember that there is a connection between a person's and a friend's chance of developing post-traumatic syndrome and the type of conclusions they draw about the world. For him, the conclusion was that he should try to lead a change in Israeli society, and therefore he was one of the founders of "Shalom Now" and was one of the signatories of the officers' letter in 1978 that was sent to Prime Minister Menachem Begin with a request to push for the signing of a peace agreement with Egypt.

A traumatic event changes our worldview. This change is expressed in the answers we give to two questions: Is the world dangerous? And if so, how do we make it safer, through aggression and suspicion towards every other person or through mutual guarantee and reconciliation?

Neria's life and the choices he made show well the answers he gave to these questions: it is certain that he perceives the world as dangerous, and you could see it in the way he jumped out of his chair when he heard the explosion. Besides, being one of the founders of "Shalom Now" and a psychologist, and perhaps even the fact that he lives in New York and not in Israel, it is also clear that he believes that the right way to make the world safer is to show empathy and mutual guarantee.

Neria asks these questions even now. All of humanity is going through a traumatic experience, after which it is expected to perceive the world as more dangerous. What strategy will humans adopt in an attempt to make the world safer: aggression, suspicion

, and seeing every person as a potential threat, or mutual guarantee? It is clear what Neria hopes will happen, but the answer will only come in time.