Traumatised patients who I see in my office often express negativistic mistrust when I ask them about their feelings: "It is humiliating to complain to anyone other than God"; "Don't complain about injuries, don't hurt anyone but yourself"; "Contain your pain in your aching heart to avoid the shame of sharing it". Such reactions are not just limited to individuals. Attitudes like these have become generalised over generations in Palestine, forming a body of maxims and proverbs that communicate a loss of faith in human relationships, a pervasive fear of danger and an avoidance of disclosure. These reactions are barriers to healing.
The most prevalent trauma in Palestine is man-made and deliberate. What's more, the perpetrator is never held accountable, which doubles the effect of the injury. Indeed, the perpetrator enjoys impunity and inflicts guilt on its victims for the trauma itself. Guilt and shame make it difficult for people to complain or demand redress. A woman who was sexually harassed in detention gave me this reply when I proposed that she should file a report about it: "But nothing will happen if I complain! No one will believe me; the perpetrator will be defended by everyone and emerge triumphant. I will be publicly humiliated and become an object of gossip and scorn."
Political trauma in Palestine is both trans-generational and collective, and our current capacity to treat it is very limited. We lack the funding, professional resources and clinical evidence-base to address it comprehensively. Most therapies rely on treating individuals one by one and deal mainly with the here and now.
Because trauma in Palestine is so prevalent, there are overlapping ripples of traumatic grief. A young man is affected by expanding circles of injury: he lives in a refugee camp because his grandfather's home and land were seized; his mother has been preoccupied with chronic depression for twenty years following the arrest and torture of his older brother; his neighbour's home was recently demolished; his classmate was killed in a demonstration. With this background, how do we locate the source of his chest pain when medical causes have been ruled out? The over-abundance of traumatic events in the environment make it difficult to establish aetiology; the repetition of trauma is a challenge to treatment efforts.
READ: Following pressure, mental health academics may reverse decision to cancel conference in Israel
An additional barrier to healing is the lack of social acknowledgement of the trauma, so that isolated survivors are discouraged from seeking help. Freedom fighters who are killed in a violent context are often called terrorists by the Israeli media; to make up for this denial, Palestinian society often glorifies its political prisoners and martyrs. In this context, though, trauma victims who have been damaged by the Palestinian political system as members of an opposition group find it more difficult to recover. I have written previously about a woman who described herself as "dancing like a slaughtered chicken" after her son was killed. She feared that if she disclosed to me that he had been an Israeli informant I would become unable to empathise with her and would perceive her efforts to seek help as illegitimate. Although this was an in-depth treatment, she was profoundly avoidant of revealing the full history. She kept many parts of her trauma story ambiguous and secretive, and thus walled off from recognition and naming.
There is no safe place in Palestine. As a result, paranoia is pervasive. The lack of trust in other people is, in fact, often an appropriate safety measure rather than a psychotic symptom. When detained, prisoners are frequently told that a close friend or a relative has informed about them; others see their comrades testify against them in court. The medical field is especially suspect and my patients suspect that their psychiatric files could be used against them. Patients in Jerusalem often ask me whether my computer is connected to the Israeli national medical system. People fear that their mobile phones and computers are spying on them.
Moreover, everyday life is full of reminders of trauma. I know trauma survivors who circumscribe life into very limited spheres to avoid triggers; moving only within a small neighbourhood, for example, and losing their jobs to avoid crossing checkpoints, or ceasing to use television and social media to avoid images of soldiers' aggression. These reactions are also responses to the surrounding oppressive conditions, in which even the symbolic expression of a traumatic reality has been forbidden. People have been detained for participating in theatre, writing poetry and commenting on Facebook. These oppressive practices help us to understand why some victims of trauma are driven to repetition through re-enactment of the traumatic event.
Survivor guilt is another element complicating the recovery from trauma. I treated a teenage boy who attempted suicide several times after his cousin was killed. I later learned that this boy had encouraged his cousin to participate in political demonstrations before he was shot dead. Feelings of guilt are an important component of trauma reaction in our political context: detained women feel guilty about "leaving" their children and home; fathers of minor prisoners feel guilty about "failing" to protect them; prisoners feel guilty about "making" their parents turn their life savings over to lawyers in the hope of receiving a reduced sentence. Guilt feelings are injected regularly into people under torture when they are told things like, "We will bring your mother, wife and sisters here too" and "We will demolish your house". In many of the interactions with the oppressive Israeli administrative system, people are considered responsible for the punishment that is imposed on them; for example, homes are demolished because people "fail" to obtain the appropriate (and typically unobtainable) licence.
Palestinian dependency on Israel is another barrier to the treatment of trauma through fostering a regressive identification with the aggressor as a superior group. This dynamic adds insult to injury. A Palestinian seeking state-of-the-art therapy for a critical medical condition must travel to an Israeli hospital. A Palestinian seeking redress for torture must rely on an Israeli lawyer. When a story is told by an Israeli journalist, the narrative is perceived as more valid and credible than when it is reported by the Palestinian media. The sequestering of authority and expertise among Israelis creates further confusion in the minds of many Palestinian victims of trauma.
The lack of trust in Palestinian capacities and the ongoing narratives of nepotism, treachery, disorganisation and corruption within Palestinian agencies and institutions are partially legacies of the traumatic effects of the Israeli occupation. Trauma spills over across multiple aspects of life, with an impact on social and cultural traditions, affecting the entire population, impairing critical thinking, destroying self-confidence and relationships, undermining the sense of community integrity and obscuring our hope in the future. Trauma is formative in and distorts the process of child development, the personality, interpersonal relationships, self-concept, social values and overall outlook on life.
READ: NGO study shows rapid deterioration in mental health of Palestinian children in Gaza
It is comforting to have faith in the ultimate forces of fairness. However, such a belief can be dangerous for traumatised societies because it also implies that people get what they deserve. Traumatised people conclude readily that dreadful things have happened to them because they are flawed. They are convinced easily that they are essentially bad and deserve no better; their actions and behaviour will match such a conviction.
The therapist in Palestine is not immune to these pressures, and is sometimes not prepared emotionally for the challenges of trauma processing; the overwhelmed clinician is in danger of joining unwittingly with the patient's avoidance of memory and disclosure. The therapist who is not ready to ask, listen or see must work through his or her own inner barriers; he or she may be practicing a personal avoidance of trauma in unconscious collusion with the patient's resistance.
Our work in treating individual trauma wrought by political violence is part of a longer journey of healing that is faced by the entire Palestinian community. We must recover from trauma by regaining our lost normalcy through social and cultural systems that have been lingering dormant under occupation for generations. This work cannot be achieved fully in clinical office practice alone, but rather requires broad collective renewal of psychological life under conditions of autonomous agency and justice.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.