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What made you choose a career in trauma research?
My mother was in Auschwitz. That has shaped my career, my choice of field. I was very close to my mother. She was one of the very few survivors who talked about her experiences.

How do you characterise a traumatic event?
Any event that puts someone in danger of death or serious injury. Most people exposed to traumatic events cope in an effective way, even though they may feel upset by it. A traumatic response, on the other hand, entails a collapse of the coping mechanism, when someone is flooded by anxiety. The most conspicuous outcome of this is post-traumatic stress disorder. People with PTSD experience continuous trauma. Despite the fact that the traumatic event is over 鈥� the war has finished and they have been reunited with their family 鈥� they still feel they are experiencing it. This can take the form of flashbacks: they might hear the screams of their comrades, or smell the blood or the gunpowder.

How do people respond to trauma?
By trying to distance themselves from it, which results in psychic numbing and avoidance 鈥� trying to numb their psyche so they will not be tormented and haunted by the pain. There is an inner struggle between re-experiencing the event and breaking away from it. Avoidance translates into specific behaviours: somebody may choose not to eat watermelon because it鈥檚 red and red reminds them of blood.

Another symptom is hyperarousal: after a traumatic event, they know the world is a very dangerous place, and they feel hypervigilant all the time as a result.

You鈥檝e found that people who have experienced trauma are more likely to contract diseases and die early. Why does that happen?
There are a number of pathways. For instance, if you are always hypervigilant, you expend a lot of energy just for survival. Lack of sleep, especially over long periods of time, is associated with increased mortality. These people age before their time. They also have a sense of a foreshortened future. They are more likely to abuse alcohol or drugs, which in the short-term might alleviate their distress, but in the long-term will be detrimental to their recovery. They are usually quite stressed. They don鈥檛 exercise, they don鈥檛 take care of themselves, they don鈥檛 eat properly.

Do certain battlefield experiences cause particularly traumatic reactions?
Seeing a friend killed is the worst, or seeing your commander killed, because he was like a father to you and you depended on him for your survival. Or seeing other horrendous things. Also, if you changed places on the front line with someone else and they got killed. There is a lot of survivor guilt.

Why are some people more affected by traumatic events than others?
Finding this out is the main challenge in our field. We do know that under extreme stress individual variability almost disappears: eventually everybody鈥檚 ability to withstand traumatic events breaks down. If you put enough pressure on a human being, they will succumb. During the first world war, the number of cases of shell shock was staggering, because the war was such a prolonged and terrible experience.

鈥淓verybody鈥檚 ability to withstand traumatic events eventually breaks down鈥�

There are risk factors. For instance, prisoners of war who are more educated seem to cope better with their captivity.

Does culture influence responses to trauma?
The way people express distress is certainly coloured by their culture. For instance, the Spanish recorded much higher rates of PTSD after the terrorist attacks in Madrid in 2004 than the British did after the suicide bombings in London in 2005. Some of my British colleagues say PTSD never crossed the Atlantic and is an American invention. The British are more reserved and less inclined to disclose or be distressed by traumatic events. At the same time, in the British army there are a lot more cases of alcoholism than in Israel, where it is relatively low. Alcoholism often masks PTSD.

Have you studied Palestinian populations?
It is very difficult to do that in the Palestinian territories as there are practical obstacles such as military checkpoints, and also moral issues. However, as soon as I finished my Israeli army service, one of my first studies was with Palestinian colleagues on children in the West Bank. We found that an extremely high proportion of these youngsters had PTSD, and especially a sense of foreshortened future. In many cases, they don鈥檛 see themselves growing old, getting married, having families or starting a career. That could have dire consequences for the future of the region.

What about Palestinian citizens of Israel?
We studied them during the second Palestinian intifada 鈥� between 2000 and 2005. They seemed to . Clearly they were not exposed to more traumatic stress: there were a lot more Jewish casualties during that period. It had to do with social marginality. For them, the conflict was immense, because it was 鈥渕y people fighting my country鈥�, which was an impossible situation.

You and others have found that parents who have experienced trauma can pass the effects on to their children. How?
This has been documented in many studies of Holocaust survivors and other traumatised populations. Recent studies in epigenetics suggest that trauma triggers some kind of alteration in people鈥檚 epigenetic make-up, to do with the way stress and emotion are regulated, , although this is still controversial. A more obvious cause has to do with parenting 鈥� when the parents are present yet not present at the same time. It is very difficult for a child to grow up with a traumatised father, to have a father who is like the tin man in The Wizard of Oz, who can鈥檛 feel anything.

How does this second-generation trauma express itself in the children?
Often it only becomes apparent when they are exposed to a traumatic situation themselves. In a pioneering study we looked at combat stress reactions during the first Lebanon war in 1982, and looked back at the people鈥檚 family history to see if they were children of Holocaust survivors. We found that children of people who were traumatised during the Holocaust, despite appearing to be socially and psychologically well-functioning before the war, . They were debilitated for longer.

In what way might that be due to the effects of parenting?
These individuals have a lot of qualms about aggression. It鈥檚 very difficult for someone who comes from that kind of background to be an aggressor, there鈥檚 an underlying vulnerability.

How has being the daughter of a Holocaust survivor affected you?
My mother was very open with me about her experiences, but that never traumatised me. For her, my birth was sort of a ray of hope and a victory. She told me stories about how she and her siblings helped each other. I heard a lot of brave things about how they were going to sacrifice their lives for each other. So as far as I can tell, it affected me in a positive way. Although I do have a lot of qualms about aggression. And I鈥檓 also quite anxious.

This article appeared in print under the headline 鈥淭rauma ripples through generations鈥�