A Palestinian is detained for trying to catch a 'forbidden' bus. Credit: Demotix/Francesco Mion.
As a sufferer of PTSD, I know how debilitating the long term effects of trauma can be. So too are the effects of a mental health diagnosis. Particularly when trauma comes in the form of abuse, the offer of psychological help can feel like a pitiful excuse in place of intervention. When you have been damaged by the behaviour of others, it hurts to be told you are the sick one.
While my accumulated labels have allowed me to access help, they often leave me feeling trapped in the various categories I have been diagnosed into. They also fail to address the causes and circumstances that made me 'unwell' in the first place.
So it was with trepidation that I attended an event hosted by the recently launched UK-Palestine Mental Health Network - ‘Mental Health and War: A special focus on the Gaza Strip’ to learn about the mental effects of state terror. And it was with great relief that I heard a number of professionals speaking there advocate not just Cognitive Behavioural Therapy, but Boycott, Divestment and Sanctions.
For these professionals who have seen the devastation of the conflict first hand, counselling the victims is insufficient. They are also calling for action, in the form of BDS, against the aggression of the Israeli state.
In warzones, the relatively recent idea of wars as ‘mental health emergencies’ can be used as a form of white-wash. The offer of psychological treatment can become another way of ignoring the fact that war, and the traumas of war, are avoidable, and a distraction from the need to address political issues. As panellist Dr Derek Summerfield stated: “The US funds PTSD programmes for Palestinians, and yet continues to fund the Israeli government”, adding, “Who’s crazy here really?!”
For Gazans, we heard, this summer's invasion was even worse than before, and mental as well as physical exhaustion is endemic. Unlike in previous bombardments, this time there were no safe places to go, leaving people with constant impossible decisions and making the mental strain of this last offensive unbearable.
Everyone has been affected by this war, and the anguish in the voices and on the faces of those who had witnessed the effects first hand further emphasised the sheer scale of trauma in Gaza. In the words of a Gazan speaker from the audience, “occupation itself is trauma”. Living under constant siege, and with the constant denial of their suffering in the media, the craziness imposed on Gaza means counselling alone is not good enough.
A theme emerged as each member of the panel spoke. As Summerfield put it: “Recovery is not just something that needs to happen between people’s ears, it also needs to happen in their lives.”
The misuse of psychiatric expertise and the contentious application of western medical narratives to non western populations were also both discussed in detail. The ‘therapeutic relationship’ is unavoidably one in which the views and beliefs of the professional are imposed on the ‘client’, and in politically complex situations where treatment is being provided and often funded by powerful western organisations or states, this is inherently problematic.
A particular concern in this case is that a lot of the expertise comes from the country inflicting the suffering. In Israel, where war is a constant and teenagers are conscripted into the army after they leave school, PTSD is a common diagnosis. Research and treatment has been developed in response, and a country which inflicts trauma on both the Palestinian and Israeli populations now hosts a wealth of experts in treating it.
Israeli psychologists have contributed a lot to work in war zones, but the problem with offering Palestinians help while supporting the occupation of their land and denial of their culture is obvious.
Speakers emphasised that we should listen to what Gazans say their needs are, how they describe their own suffering, and not only offer post-hoc treatment but do what we can to address the causes of that suffering. As Dr Brian Barber said: “What we might call PTSD, Gazans call "feeling broken and destroyed". And what they want is not therapy, but an end to occupation and siege: “the freedom to breathe.”
While it was difficult to hear these stories, it was extremely encouraging to hear mental health being discussed in such non-pathologising language. Interchanging ‘mental illness’ with words like ‘suffering’, and emphasising social and political action alongside psychological intervention, are not only fundamental to addressing mental health in Palestine, but mental health in general.
The way in which ‘mental health’ is now being related to warfare, placing the focus on the sufferers rather the perpetrator, and medicalising conflict in a way that suggests it is inevitable, is itself indicative of our passive and problematic definition of mental health.
In recent years ‘awareness campaigns’ have improved our understanding of the various symptoms and psychological conditions from which so many people suffer. I often worry, however, that we are losing the ability to talk about suffering and distress in any other way.
Being diagnosed with PTSD has given me an easier way to articulate my distress and make it clear to others that it is something I cannot wish away. However, it has also made it very much ‘my problem’. My normal day to day upsets are often put down to a pre-existing condition, and having learnt to talk about my problems in a medicalised language, it is harder sometimes to connect them to the rest of my day to day experiences.
Mental health is increasingly discussed as if it is a thing that happens in the sufferer's brain, when in fact it is deeply intertwined with our experiences, environments and behaviours. In my case accepting that I was unwell was a particularly difficult pill to swallow, as a lot of the things that caused me to be this way could have been prevented if I had been offered help then rather than now.
You do not have to go to Palestine to see that living under the conditions of occupation and the constant threat of state terror could drive you crazy. Whilst we don’t experience anything like that in the UK, the same can still be said for our own society.
Capitalism, corporatism, misogyny, unemployment, racism, bigotry, lack of affordable housing, traffic, crowds of people who never smile, abuse and bullying, even the mechanisms that keep us isolated from global disasters and conflict create an environment that is rarely conducive to mental 'health'. For many people the causes of psychological illness are less clear cut than my own, but I have rarely met anyone whose distress is completely divorced from the outside world.
Mental illness does not always have a clear cause. But whether or not you agree that this world is causing mental illness, it is a helluva difficult world to recover from it in.
Therapy can be both useful and necessary, but it can also be used to ignore other, often more difficult action that needs to be taken to improve people’s lives. 'Awareness' is inevitably limited when we discuss mental illness as if it is just something that happens in the brain of the sufferer. Framing 'mental illness' provides a prism through which to discuss human suffering without really looking at it - allowing us also to look away when it gets too difficult.
When I saw bombs dropping on Gaza, or heard about the people in Kobane, trapped and waiting as ISIS approached, or read about the 197 Palestinian children currently held in Israeli prisons, I didn’t think about mental health and "the long term effects of trauma". I remembered being helpless and scared in unbearable situations. My father holding my mother’s body. The expression on his face. The stuffy smell of a room where I watched someone die. Opening my eyes, indescribable pain, bright lights and blurred faces. A man standing a few metres away from me, pointing a knife at me and laughing.
I remember the fear and the horror and I think somewhere people are experiencing fear and horror many times greater than what I felt and then I feel helpless. And I remember how I felt to be left in these situations alone, and then later offered counselling.