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Pathologies of Liberation

The Continued Traumatization of Gaza

By Reem Abu Hweij

I type into a Google Scholar search engine “the effects of genocide on mental health,” cringing in shame for the audacity of such a search phrase, thinking with bitter irony, “What could the effects possibly be?” The answer resounds from every fiber of my being: such an abominable deviation from humanity can only yield unbearable suffering.

Dania Yasser Al-Hasaina (25), a psychologist, killed with her only son, father, mother, a large number of family members and relatives at her home in Sabra neighborhood in Gaza City.

It doesn’t take a degree in clinical psychology to know that the mental health effects of genocide on the psyche of the targeted community are devastatingly negative. This abhorrent reality borne out of the purposeful and total disregard for human life can only profoundly devastate the population, mirroring their incalculable and ever-growing physical losses and wounds. Mental health is intuitive that way; it is linked – directly and undeniably – with the lived environment. Fanoni was among the first to point out that mental illness is conceptualized as a pathology of liberty, and a patient is someone whose liberty, will, and desires are chronically undermined by contradictions and anxieties taken in from the surrounding environment. To feel well within our psyche, we must experience some semblance of freedom in our physical space. In Gaza, much like in the rest of Palestine and the diaspora, but more acutely, a population whose freedom across all basic life needs is curtailed, denied, and obliterated must suffer from pathologies of liberty. We know too well at this point that the mental health of oppressed populations reflects the pathological conditions they are made to live in, and Palestinian mental health is no different from that of other oppressed populations.

Before we delve into the psychological ramifications of the unfolding genocide and the much-needed provision of services, let us be very clear in naming the single most indispensable solution to the mental health crisis in Gaza: an immediate ceasefire and end to the 17-year-long blockade. Since the Gazan psyche does not operate in a vacuum from the environment it inhabits, it is essential that we recognize that as long as Gazans are being held captive in their own land and slaughtered en masse, they will not experience psychological wellness. Like many other Palestinian mental health service providers, I am too well aware that under such severe and ongoing traumatizing conditions, there is very little that mental health services can offer to people who are being slaughtered. There needs to be physical safety and a trace of consistency before the long journey of psychological healing can begin.

Lamia Nasser (28), a psychotherapist, killed while looking for a safe place with her family who live north of Beit Lahia.

Indeed, this point is made even more obvious when we consider that all mental health service providers in Gaza have either been martyred or are grieving their lost loved ones and their decimated communities and cities. In the two pictures here, we see two martyred therapists, Lamia Nasser and Dania Yasser Al-Hasaina (may they rest in peace), from the Aisha Association for Woman and Child Protection in Gaza.

While institutions such as UNRWA, Nafs for Empowerment, Save the Children, and the Palestinian Counseling Center are attempting to provide various mental health support services, holding support groups in shelters or through hotlines, the fact remains that most mental health clinics have been destroyed. Neither Gazan mental health service providers nor their clients in Gaza can find shelter and food to sustain them for the day, making mental health care difficult to prioritize.

In Gaza, the dire mental health conditions have long reflected the pathological context that people have endured under the Zionist colonial regime. Before this genocide, adults and children in Gaza were found to exhibit consistently severe signs of trauma, often misleadingly labeled as PTSD, which indicates – falsely –  that the trauma has passed and can no longer threaten safety in the present or the future. There is now ample literature and theoretical constructs that more accurately capture the severity of Palestinian society’s persistently traumatizing reality. For instance, Continuous Traumatic Stress (CTS), a term coined by psychologists working in apartheid-era South Africa, describes the psychological alterations observed among oppressed and protractedly threatened communities wherein adaptations such as hypervigilance and decreased affective experiencing are contextualized as adaptive shifts in psychological functioning under conditions where violence and danger are ongoing and likely to continue. While these adaptations are considered important, CTS emphasizes the changes that occur in the individual’s core beliefs, where assumptions about the world being a benign and safe place are shattered and replaced by a sense of resignation, exhibited through minimization, avoidance, and nihilism towards a world that is perceived as unjust and colluding with systems of oppression.

In another but equally important dimension, Martin-Baróii coined the term psychosocial trauma to describe the proliferation of heightened vulnerability and alertness, a sense of subdued rage and loss of control over one’s life, and the shift in one’s sense of reality observed among people living under conditions of prolonged collective suffering inflicted by state and colonial violence. He noted that the undermining of four important processes facilitates these changes: 1) the capacity to employ lucid thinking freely, 2) the willingness for honest communication, 3) empathy in response to the suffering of others, and 4) the capacity for hope. We thus see that collective trauma inflicted by oppressive systems alters the functioning of the individual in ways that require deliberate and slow care and recovery; this healing, however, cannot take place as new wounds are being created by a force that insists on eliminating the individual and their community. To repair a traumatized community’s altered beliefs about a colluding world, the world must stop colluding.

Given the level of destruction and death inflicted by the armed Zionist colonizers, it is difficult to give an exact number of the martyred mental health service providers. Nevertheless, in their most recent online update in March, the Gaza Community Mental Health Program team described their main challenges being the deaths and injuries of their employees, the demolition and destruction of their therapeutic clinics, the loss of access to communication given the internet and power outage, and the displacement of more than 95 percent of their employees struggling to provide their families with basic needs for food, drink, and shelter. It should come as no surprise to anyone that when physical safety is so severely undermined, psychological wellness comes to be perceived as a luxury.

Nevertheless, as we Palestinians outside of Gaza prepare for our role in caring and rebuilding alongside our brothers and sisters in Gaza in what comes after the genocide, it is important to look towards groups that have suffered similar tragedies. From the current research we have on post-genocide care from Rwanda and Native American nations, we know that it is essential that the experience of fear be soothed and regulated before traumatic experiences can be processed and grieved. Fear comes to weave itself into the fabric of the psyche when activated for prolonged periods. While fear continues to be actively constructed in response to very real fear-inducing stimuli such as bombings and mass killings, it is difficult to begin working on memory integration and emotional regulation, capacities that are destabilized during traumatic experiences.

Once relative safety is established, we must center community healing with additional individual support for bereaved individuals. This means that capacity rebuilding will have to occur in conjunction with services actively provided by psychologists and other mental health service providers. One tried and tested model for post-genocide interventions has been the RICH treatment model,iii which has been implemented with Rwandan survivors. Although the RICH model was constructed in the US by Western psychologists, thereby reducing its ecological validity for the Palestinian context, we can critically utilize the philosophical tenets of this model to inform our preexisting and effective coping methods within our Palestinian community. The RICH acronym stands for Respect, Information, Connection, and Hope. Respect, broadly defined, encompasses restitution, recognition of hurt done, witnessing and reaffirming agency to address justice and esteem needs. Information includes the collective building of the narrative and details of the mass trauma that unfolded, alongside increasing the affected community’s awareness of the psychological effects of the experienced traumas to confirm the truth of one’s pain and rebuild psychological safety. Connection centers on the relationship with oneself and with one’s community; this can entail rebuilding social networks, processing grief and loss with others, and experiencing emotions and coping strategies alongside other survivors. Hope results from implementing the former three components and the purposeful rebuilding of a desired life and outlook. This model is one of the many supports that can serve us as we move forward toward healing, which will need to integrate the existing frameworks of healing and survivance already ingrained within Palestinian culture. When this genocide ends, which it eventually will, the path for healing from pathologies of liberty will continue to be paved by the pursuit of liberation and decolonization of Palestinian land, where our genuine wellness lies. How else does any psyche thrive if not in freedom?

i Frantz Fanon, The Wretched of the Earth, New York, Grove, 1963.

ii Ignacio Martin-Baró, “Political Violence and War as Causes of Psychosocial Trauma in El Salvador,” International Journal of Mental Health, 18 (1), 1989, 3–20.

iii Anne Pearlman, “Restoring Self in Community: Collective Approaches to Psychological Trauma after Genocide,” Journal of Social Issues, 69 (1), 2013, 111–124.

  • Dr. Reem Abu Hweij is a clinical psychologist. She is based in Palestine and works with Palestinian clients from across the world through her virtual private practice. Reem’s research and writing center on psychoanalytic conceptualization of the psychological dimensions of colonial oppression and their effects on the colonized individual. Through her work in psychotherapy, academia, and research, Reem is focused on increasing psychological literacy and capacity building of mental health services within the challenging context of Palestine.

1 Comment

  1. Ace Thelin

    Thank you for writing this important article. May the genocide, colonisation and apartheid end and the healing begin. Free Palestine!


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