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.
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?
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.
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]
https://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder
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
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’
http://nctsnet.org/
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
ALL ABOARD!
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