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There is no ‘post’ traumatic stress in Gaza because the trauma is continuous

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The chokehold on Gaza moved into its tenth year in 2016. The suffering born of a decade of human rights violations, poverty and three full-scale military assaults creates a psychological toll on the population which is inestimable. Homelessness, multiple deaths within families, severe injuries, and the ever-present threat of renewed Israeli bombardment create a psychological climate of ongoing continuous, collective trauma. 

Post traumatic stress disorder, as a clinical term, barely touches the enormity of the disabling psychological distress that permeates the reality of daily life here. There is nothing “post” about a continual, unrelenting, multifaceted catastrophe.  There is also no “disorder” in the sense that there is an intrapsychic disease requiring individualized treatment. The abnormality is the unabated war crimes that inflict suffering on the imprisoned, helpless civilian population. The rest of the world, moreover is turning it’s back on this political violence and is thus enabling the trauma-inducing occupation and blockade to continue.

Mental health professionals in Gaza are strained beyond capacity. Of the nearly two million residents of the 360 km2 area Gaza Strip, there isn’t a single person here who has not experienced multiple traumas. Continuous grief, nightmares, disabling anxiety and hopelessness color everyone’s daily life. The therapists charged with healing these injuries are themselves victims of living in this traumatogenic environment. Their burden is thus two-fold: the trauma they share with their clients is compounded by repeat exposure to their clients’ own clinical material. 

As a clinical psychologist from Vancouver, I joined the Washington Physicians for Social Responsibility delegation in Gaza to address the vicarious, secondary trauma that mental health professionals struggle with. In one workshop of ten therapists, four had their homes demolished and three spoke of having family members killed in last summer’s massacre. Overlay on top of this traumatic loss, the painful events their clients unfold all day, and the magnitude of the psychologists’ burden is clarified.

The aim of our training seminar was to introduce burnout prevention skills and the relevant literature on trauma and psychological resilience.  Cognitive behavior therapy, behavioral self-care, self hypnosis, journal-writing and  peer supervision for ongoing social support were among the therapeutic skills reviewed.  In an attempt to keep the material culturally relevant and subjectively meaningful, a relaxation script was created in Arabic language for each participant using personally generated healing imagery. The visualization was then recorded by each therapist onto their mobile phones to be available as their tailor-made “portable” stress management strategy.  Moreover, as the political and the clinical are interwoven, we expanded the idea of “to exist is to resist” to include “resistance is resilience”. Resisting oppression was conceptualized as adaptive coping in that it is a psychologically healthy way to counter hopelessness and promote resilience in face of adversity – both for the psychologist and for the client. The inverse is also true. Practicing self-care promotes resilience, which is an act of resistance. (“I will maintain my psychological health in spite your efforts to annihilate my self and culture”.)

It didn’t take long for a trusting environment to be established and for people to share details of their own experiences of trauma. We worked with this material as a way to model the therapeutic value of peer support, to learn new clinical skills, and to help cognitively integrate and in turn release some of the accumulated emotional pain that comes with living and working here.  We plan to continue working together via Skype.

I learned much from my Palestinian mental health colleagues and am grateful for having met this extraordinary group. May the time come soon when the source of this trauma is ended and we can begin to truly speak of healing post traumatic injuries.

John Soos, PhD

John Soos, PhD is a Vancouver-based Palestine solidarity activist and clinical & peace psychologist. With a longstanding interest in the psycho-spiritual benefits of pilgrimage, he initially travelled to the Holy Land on a pilgrim. Once there, it didn't take long for him to see that the sacred landscape had been transformed by a ruthless military occupation into a scared and scarred landscape. Ending the occupation to help heal the ongoing psychological trauma of living life under military rule is now the focus of his practice.

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10 Responses

  1. on January 29, 2016, 4:10 am

    Dr. Soos, whats your opinion on the relatively mild mental health situation in war ravaged Palestine, compared to the ever growing mental health epidemic in developed countries with strong national defenses and peaceful civil society, like the US and Western Europe? Why are Palestinians far more psychologically resilient and mentally healthy, especially considering their dire situations? I suspect it is because Western societies achieved their present status quo through loot and plunder, racism and genocide and the current predicament of their nation is a form of karmic retribution. Does this make sense?

  2. Liz on January 29, 2016, 9:01 am

    This article makes a really good and important point about the people in Gaza not having the chance to recover from PTSD because it is continuous. So much so that their trauma becomes continuous and far beyond PTSD. Thanks for writing this.

  3. gingershot on January 29, 2016, 1:02 pm

    Dr Soos

    You are precisely right that PTSD is not the appropriate diagnosis for Gazans growing up under the continuous trauma of Israeli Apartheid and Israeli Apartheid Wars on Gaza

    Complex Trauma is the diagnosis which is eluding you … I do not see this mentioned in this article and urge you to read the general article linked below to aquaint yourself with it. Complex Trauma is cutting edge and the professional community as a whole is as yet not well informed about it.

    Situations causing the kind of traumatic stress that can lead to C-PTSD-like symptoms include CAPTIVITY AND ENTRAPMENT (a situation lacking a viable escape route for the victim = this is PRECISELY the situation the trapped population of Gaza finds themself in

    Complex post-traumatic stress disorder (C-PTSD), also known as developmental trauma disorder (DTD)[1] or complex trauma,[2] is a proposed diagnostic term for a set of symptoms resulting from prolonged stress of a social and/or interpersonal nature, especially in the context of interpersonal dependence. Subjects displaying traits associated with C-PTSD include victims of chronic maltreatment by caregivers, as well as hostages, prisoners of war, concentration camp survivors, and survivors of some religious cults.

    Situations causing the kind of traumatic stress that can lead to C-PTSD-like symptoms include captivity or entrapment (a situation lacking a viable escape route for the victim), as well as psychological manipulation (gaslighting and/or false accusations), which can result in a prolonged sense of helplessness and deformation of one’s identity and sense of self.[3] C-PTSD is distinct from, but similar to, post-traumatic stress disorder (PTSD), somatization disorder, dissociative identity disorder, and borderline personality disorder.[4]

    TREATMENT IS THE END OF ISRAELI APARTHEID, first and foremost, then the trillions of shekels it will take to BEGIN the work of treatment for Complex Trauma, which as this article outlines is FIRST AND FOREMOST THE SAFETY OF THE VICTIM, and removal from the continuous abuse being inflicted upon them by generations of Zionists

    Thank you for your service to the people of Gaza

    • gingershot on January 29, 2016, 1:05 pm

      Thus, a differentiation between the diagnostic category of C-PTSD and that of PTSD has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone.[19][26]

      C-PTSD also differs from continuous post traumatic stress disorder (CTSD), which was introduced into the trauma literature by Gill Straker (1987).[27] It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression.

  4. gingershot on January 29, 2016, 1:51 pm

    More Resources for interested professionals and others:

    Getting a grant to study traumatization of Palestinian children will be GAMECHANGING as psychological America turns against ‘Zionism as practiced by Israelis’

    The best resources I can recommend is ‘National Child Traumatic Stress Network’

    The National Child Traumatic Stress Network is funded by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services

    Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) brings a singular and comprehensive focus to childhood trauma. NCTSN’s collaboration of frontline providers, researchers, and families is committed to raising the standard of care while increasing access to services. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and dedication to evidence-based practices, the NCTSN changes the course of children’s lives by changing the course of their care.

    For Professionals
    Can I Become a Member of the NCTSN? – yes – see link above and follow internal links

    Apartheid is a ‘crime against Humanity’ as clearly identified by the UN and Geneva Conventions –

    ‘Israeli-style Zionism’ is a crime against humanity and a crime against the human mind – and the crime is called COMPLEX TRAUMA

    ‘Israeli-style Zionism’ IS Apartheid and a crime against humanity and the human mind.

    Time for a little real Tikkun Olam … stopping the DELIBERATE Israeli Complex Trauma of generations of Palestinian children/adults


  5. John Max Soos on January 29, 2016, 3:21 pm

    Good to see the thoughtful comments. I’ll try to respond to them in order they were posted.

    Not sure about the role of karma – although I suppose it’s possible. I tend to see the Palestinian people’s resilience in face of the adversity as being more related to comfort derived from faith; close family ties; maintaing purpose in life amidst injustice.

    As the term ‘complex trauma’ has evolved to highlight childhood abuse, for the ongoing trauma characterizing conflict situations like in Palestine, I am using ‘continuous traumatic stress’ – the term originally developed (as pointed out) in apartheid-era South Africa. Unlike C-PTSD, the point is to move away from localizing the trauma to the past, and to underline that it is ongoing – clearly the case with the occupation.

    Agree that apartheid is a crime – wherever and whenever it takes place.

    My main point was threefold.

    1. To highlight that common language usage (i.e. PTSD) — while perhaps good-intentioned, can actually distort the narrative to suggest that ongoing political violence characterized by numerous human rights abuses is somehow a single episode traumatic event that’s intruded onto a previously stable situation.

    2. To bring to awareness the central role that mental health professionals play in helping maintain hope and resilience amidst ongoing war crimes.

    3. Shift the emphasis from a disease model – to a political solution. End the Occupation – Lift the Trauma.

    ~ john

    • gingershot on January 29, 2016, 4:23 pm

      Dr Soos

      I would love to go into this in depth with you — here is not the place — but I think it is a very important distinction with a very critical and deep psychiatric difference – development of ‘Complex Trauma’ has narcissistic (meaning sadistic and masochistic) characteristics which differentiate it from Continuous Traumatic Stress. This relates to the development of the Narcissistic defenses (masochism) which victims are forced to develop in the face of these Sadistic-Narcissistic onslaughts of the Zionist/Apartheid/Triumphalist (Narcissistic) Judaism. These sadistic/masochistic qualities of the Narcissism of the abuser and victim are critical – and it THAT in addition to the ‘trapped victim’ (open air prison/ghetto/conc camp) component of it that makes it ‘Complex Trauma’ and not just Chronic/Continuous Trauma

      Forgive me for the quick and dirty here. There are two sides to the ‘Narcissistic coin’ – sadism on one side and masochism on the other. The brutalized Palestinian victim of the Zionist sadist becomes psychologically masochistic (it’s the forced ‘narcissistic defense’ and a key to what makes it Complex Trauma). Unfortunately, all a sadist is is a masochist with power – think post-Holocaust traumatized/Borderline/etc Israelis. (See Richard Silversteins Tikkun Olam website cartoon of the ghetto boy looking into the mirror and seeing the Zionist Hulk) Once forced into masochism, if only given a little power the masochist transforms into the sadist. That’s the problem and that’s also what the Israelis WANT – it’s just that sick.

      Key to the differential is the Sadistic qualities of the abusive source/parent or Zionist policy – and the creation of a masochistic Palestinian dynamic in the victim.

      Along with this sadomasochistic dynamic, add to it a hallmark of ‘Complex Trauma’ absolutely relevant to Gaza — the phenonmen of CAPTIVITY AND ENTRAPMENT of the individual – though this can arise from (sadomasochistic) Israeli Apartheid

      Said another way — it’s not just the sadist forcing their victims into masochism — it is the sadist has the victim TRAPPED and can continue to do it at his convenience for years, which has big payoffs and benefits (politically and psychologically) for the abusers

      To miss the sadomasochistic/narcissistic/paternalistic elements of Israeli subjugation of Palestinian society/children/adolescents/adults is to miss critical elements of the damage/trauma being inflicted, and it’s (sadomasochistic/intentional) nature.

      Israeli domination and traumatization of the trapped victim IS CRITICAL to the whole Zionist dynamic

      I could go on at length here but it is probably not the place to do it — I urge you to consider the constellation from the ‘intentionally trapped victim’ aspect of it and having internalized that, add the other features up and see if Complex Trauma does not better describe the dynamic. It is the Sadomasochistic element of Zionism (The Chosen/The Entitled Narcissism of the Jewish Mind/Gods etc) forced upon the prostrated ‘Created Masochistic Victim’ that is key to the dyanmic and diagnosis.

      Complex Trauma, as understanding of it broadens and evolves, certainly does focus on childhood origins and that is the whole point. That the adolescent adult is continuously revictimized by continuing Sadistic Zionist attacks after these experiences – as they are – is also precisely the point. That’s what happens with the adult children of Borderline Parents etc as well

      Think a very sick sadistic parent (the Zionist like Bennett or Lieberman) that is going to make the Palestinian victim pay over and over and over again.

      childhood abuse

      Situations causing the kind of traumatic stress that can lead to C-PTSD-like symptoms include CAPTIVITY AND ENTRAPMENT (a situation lacking a viable escape route for the victim = this is PRECISELY the situation the trapped population of Gaza finds themself in –

      BTW – I am in full support of the “to exist is to resist” to include “resistance is resilience”. Resisting oppression was conceptualized as adaptive coping in that it is a psychologically healthy way to counter hopelessness and promote resilience in face of adversity – both for the psychologist and for the client. The inverse is also true. Practicing self-care promotes resilience, which is an act of resistance. (“I will maintain my psychological health in spite your efforts to annihilate my self and culture”.)

      * think Ariel Sharon Dore Gold, Weiss’ formaldehyde, etc)

      Thank you again for your skin in the game, Dr Soos.

      Giving Palestinians the psychological ammunition to take it to their sadists is all part of the FAIR FIGHT that Palestinians will win, psychologically and politically. It’s the way out of masochistic hermetically sealed entrapment in the Narcissistic Defenses they were forced to adopt to survive their (sadistic) Israeli abusers

      A triumphalist sadistic Narcissism, if that is what one’s ‘Zionism’ is, is a philosophy of abuse. That is what Palestine is suffering in addition to the F16s and smart bombs

      • on January 30, 2016, 3:24 am

        Thanks John for your reply. I am fascinated with the sociological aspect of mental illness and health because it allows us to judge a nation’s socioeconomic system in a more meaningful way, compared to measures such as GDP and HDI. For example, the mental health among the Gazans do not correlate at all with their probably bottom-ranked GDP and HDI placements because most are well-adjusted, with little societal-scale psychological issues or complexes and show great appreciation of the lives. I agree with your assessment that having faith, close family ties and maintaining a purpose in life plays a strong role in this rather unusual scenario. Could the lack of any of these lifestyle components be the cause for the current mental health crisis among the extremely privileged white men in the West? Why are many of them angry, resentful, bitter, narcissistic, hateful and depressed even when they make the global 1% in wealth and assets? Could any other readers offer their opinion on the matter?

  6. gbclinic on February 2, 2016, 4:36 pm

    Dear Dr John Soos,

    It is excellent article and thank you for sharing your experience.
    People in Gaza are very thankful for your visits, which means a lot for them… it is kind of breaking in some how the 10 years blockade.
    All the best for future visits.

  7. tidings on March 8, 2016, 11:11 pm

    I had the pleasure of interviewing Dr. John Soos for my radio program Tidings, to be broadcast on March 9 on WPKN. Very recently returned from Gaza, he talks about the continuing and deep trauma endured by the people of Gaza and he describes the psychological work in which he and his colleagues are engaged. You can hear the podcast at Your comments are welcomed.


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