Mental Health in the Time of Genocide - MHI

ISSUE NO. 6 OCTOBER

THE MARIWALA HEALTH INITIATIVE JOURNAL

Re-Vision

Contesting Global Mental Health

World Mental Health Day, Medicalised Mental Health Awareness, and Psychiatric Subjectivation

Authoritarian Neoliberal Regimes and Global Mental Health

Enough Politeness: Decolonising Mental Health in a Society Oblivious to Its Colonial Wounds

Work with Us, Not against Us

Context

Mental Health in the Time of Genocide

Reshaping Narratives: Reproductive Justice among Women in Kashmir

Mental Health and Marginalisation

Warriors Within: Decoding the Paradox of Strength and Vulnerability among the Naga Tribe

Redefining Queerscapes through Poetry

The Impact of AFSPA on the Mental Health of the Naga People

Engage

Collective Healing and Trauma-Informed Approaches for the Mental Health of Survivors of Trafficking

Assessing the Effectiveness of the Mental Health Equity Global Agenda for Low- and Middle-Income Countries 

Fostering Mental Healthcare in a Postcolonial Continent with Digital Medicine

Tackling Mental Health Inequalities for Roma Communities in the UK

Behind Bars

CONTEXT

06

PERSPECTIVE

Mental Health in the Time of Genocide

Re-defining ‘Recovery’ through Resistance:
Learning from Palestine

Dr. Samah Jabr

AUTHOR

Lina Jadarat

illustrator

author’s bio

Dr. Samah Jabr

Dr. Samah Jabr is an experienced Palestinian psychiatrist, psychotherapist, human rights activist, and writer. She is the head of the Mental Health Unit at the Palestinian Ministry of Health. She is skilled in cognitive behavioural therapy, mindfulness, clinical research, and clinical supervision. She has authored the book Derrière les Fronts-Chroniques D’une Psychiatre Psychothérapeute Palestinienne Sous Occupation.

illustrator’s bio

Amreeta Banerjee

Alice A. Barwa completed her MA in Education from Dr. B.R. Ambedkar Univerity, Delhi (AUD), in 2022, and is from the Oraon Adivasi community, a native of Chhotanagpur Plateau, Chhattisgarh. She has been an advocate for Adivasi rights and voices as a member of an Adivasi youth collective @TheAdivasiPost, and has been an Adivasi youth representative at UN Climate Change Conference in Glasgow, Scotland, in 2021. Her research interests include education, culture, sociology, and linguistics.

Mental health no more occupies a marginalised position within global discourses, in international policy making, and in inquiries around development. Global mental health is a forum whereby new narratives of mental health are forged. Intended to be inclusive and incorporative of the ‘Global South’ voices, experiences, and audiences, it attempts to reimagine mental health by constructing an equalised platform that invites participation of marginalised perspectives on mental health. But the nature of conversations around it and the political assumptions and implications behind them are in need of further critical examination. 

This article is one such analysis of global mental health by narrating the mental health needs of Palestinian people, with the explicit political position the land and its people have been relegated to for decades. In such a narration, what becomes visible is the incongruence between the global mental health movement – specifically its silence on colonial structures – and the actual ground realities of ‘non-Western’ societies. It is these lacunae within global mental health that this article engages with.

The assault on Gaza has left an entire population suffering from trauma and loss. The scale of persons affected makes individual psychological work impractical, especially given the absence of safety and the lack of what is necessary to meet basic needs.

Lessons from Palestine

The psychological wounds and bereavement resulting from violence, annihilation, and forced displacement will continue to be felt. These realities force us to consider other therapeutic approaches – ones that can repair human connections and link individual lives to historical memory. The domain of lost rituals, of lingering grief, and of missing social networks, beliefs, and trust are collective rather than individual issues and cannot be reconstructed within clinics. These can be better addressed in public spaces instead of private ones, in places where people can recognise and share that their suffering has common roots. Since the psychological reckonings ahead of us far exceed the capacities of individual clinical encounters, we must adopt a new collective mental health practice.

Mental health in the Palestinian context is not merely a clinical matter but the sum of intersecting historical, social, and political dimensions. Lessons derived from liberation psychology and community mental health shed light on the multifaceted nature of mental well-being and recognise justice, human rights, and resilience as fundamental components. Understanding this is crucial in redefining mental health practices in Palestine.

Reassessing Our Mental Health Practice

The conventional biomedical approach to mental health often sidelines sociopolitical influences, focusing primarily on individual symptoms. Social dimension is usually understood as the relevant support systems, relationships, socioeconomic status, and cultural norms that impact an individual’s psychological well-being and mental health conditions. 

The Palestinian experience emphasises the significance of the biopsychosocial model and adds an additional dimension: power dynamics as manifest in the lack of justice and the violation of human rights. Critically, global mental health remains silent on the colonial relations that continue to shape the social, economic, and political opportunities of different peoples. Palestinian ‘distress’ does not exist in the vacuum, unattached to structures of Zionism and apartheid. It demands that the global mental health discourse extend to inquiries on such power dynamics. In this context, the process of reframing the concept of mental health must integrate the impact of Zionist political oppression, displacement, and violence on an individual’s psychological well-being and on the well-being of the community itself.

Emphasising justice as the core of the social element in the biopsychosocial model ensures a holistic approach, accounting for collective trauma and enabling societal healing. The struggle for justice is not merely a political aspiration but also an essential element in individual and collective mental recovery. Addressing historical injustices, reclaiming rights, and advocating for freedom are inherent components of mental health restoration. Acknowledging the role of justice in mental recovery, then, leads us to encourage activism and social change as vital components of mental healthcare provision in Palestine. At the level of concrete interventions for the present, health professionals must be advocates for ceasefire and boldly challenge institutions that are silent or complicit in genocide. Mental health professionals contribute to the psychological documentation of the victims of torture.

Against Individualism

Palestinian mental health professionals must question the hegemony of a Western mental health practice in Palestine that emphasises positivism, individualism, ahistoricism, hedonism, and a homeostatic approach. These values cannot explain many important features of the Palestinian experience. For example, the Israelis offer financial rewards to tempt Palestinians to inform on prisoners and resistance groups, but in vain. A Western mental health model does not acknowledge that Palestinian resistance to the occupation is a healthy assertion of personal dignity and that international solidarity is itself therapeutic. Similarly, the notion of ‘self-care’ is often judged by Palestinians to be inappropriately self-centred given the context of genocide. 

Foreign therapeutic frameworks fail to recognise both the unique challenges and the special coping mechanisms that characterise our community. Instead, identifying more culturally relevant approaches can offer opportunities for communal healing. Among these are community-centred initiatives; acts of recognition, remembrance, and mass cooperation; and creating support networks. Encouraging storytelling, solidarity, and safe environments can foster unity and resilience among individuals dealing with adversity. Modalities that incorporate collective prayer, street demonstrations, social networking, and public mobilisation represent healing practices and community-based interventions rooted in Palestinian contexts. The retrieval of memory is both therapeutic and an act of resistance, undermining the cynical hope expressed by Israelis that ‘the old will die and the young will forget’.

Faith and National Values as Anchors for Recovery

The Palestinian experience demonstrates the significance of faith and national values in bolstering resilience and recovery. Mental health professionals must be guided by the people who need our support and sensitivity to their cherished concepts.  We need to understand what people mean when they say, ‘We belong to Allah and to Him we shall return.’ Through this, the bereaved overcome the suffering of loss and the pain of separation from the deceased. It establishes the hope that the beloved is in a better place and that they will reunite one day. Just as we emerge from the same origin, we will in the end meet at the same destination. Such a statement, for the believers, can be more effective than techniques like eye movement desensitising and reprocessing (EMDR), or somatic experiencing, or trauma-focused cognitive behavioural therapy (CBT). 
 
Religious concepts like yaqeen (assuredness and certainty) or tarahum (compassion), national notions like sumud (steadfastness), and the politicised religious notion of ribat (protection of religious places) are important elements in understanding the Palestinian mindset as it responds to the horrific political reality.

Incorporating cultural rituals, such as the funerals of martyrs, can be profoundly therapeutic. These methods that recognise the struggle to liberate prisoners and celebrate their freedom as well as integrate traditional healing practices and cultural rituals validate cultural identity and shared heritage, offering avenues for emotional release and communal support.

Addressing Historical and Collective Trauma

While shared traumas must be reprocessed collectively, interventions aimed at healing historical and collective trauma within the Palestinian community require a nuanced approach. First, documentation and witnessing play pivotal roles in acknowledging and validating shared experiences. It is vital to create a safe space for individuals to express and process their trauma collectively. Community-based approaches, such as group therapy or support networks, dialogue, and public talks offer opportunities for shared healing. Emphasising collective resilience and providing platforms for storytelling and solidarity can foster a sense of unity and strength amidst adversity and protect against emotional fatigue among activists. 

Following the Jenin Massacre in 2002, the bereaved youth of Jenin guided by the German artist Thomas Kilpper built a sculpture of a horse from the debris of wrecked ambulances and cars destroyed during the military attack. The Jenin Battle Horse was erected at the roundabout near the survivors’ camp and told the story of the massacre and the heroes lost in that battle. It became a symbol for rebuilding. Unfortunately, in the recent genocide in Gaza, the Israeli Army destroyed and confiscated the Jenin Battle Horse.

Task-sharing among people in the helping professions is another response to the magnitude of injury in Palestine. Mental health should not be left to the few specialised psychiatrists and clinical psychologists alone. We have been training general doctors, nurses, teachers, and school counsellors to respond to the immense needs. Trauma-informed care in health and educational systems and trauma-informed parenting are also key avenues of response. Religious figures, if trained on mental health, can also play a pivotal role in community healing.

In Palestine, the pursuit of truth and justice is not solely a professional or political endeavour but an intrinsic aspect of individual and collective mental recovery.

Truth is another victim of political violence and to be able to seek and share our truth is affirming and empowering. It is important, too, to recognise that collective trauma is amplified by spreading misinformation and propaganda that denigrates Palestinians and injures their reputation. Documenting and bearing witness to shared experiences create spaces for truth seeking, acknowledgment, and validation. Truth-tellers should be supported and celebrated. More than one hundred journalists were killed during the attack on Gaza. Despite the danger, Al Jazeera correspondent Wael al-Dahdouh, who lost immediate family members and was then injured, continued to broadcast the truth about Gaza, and Palestinians admire his courage. Palestinian journalists and medical staff need to be provided with psychological support to help them deal with stress and trauma consequences, burnout, and emotional fatigue. The preservation of the Palestinian narrative and cultural identity, its resistance against oppression, erasure and denial, and the collective struggle for freedom foster a sense of agency and empowerment within the community. By encouraging active participation in collective movements and advocating for justice, individuals can reaffirm their role in the restoration of mental health and community well-being.

Conclusion

The margins, from where the Palestinian experience speaks, question the dominant modalities of mental health work that are biomedical and individualist, thus putting their utility in crisis.  As global mental health continues to uphold Eurocentric models, it fails to imagine the relationships between mental health work and the necessary fight against colonial power. 

The lessons learned from Palestine’s poignant context offer profound insights and a transformative approach for mental health professionals worldwide.

These dark times in Palestine require tireless dedication, innovation, and commitment to culturally sensitive and trauma-informed care. Our mental health professionals must navigate an intricate web of trauma, resilience, and healing. Their practice is a testament to the remarkable strength and fortitude exhibited by individuals and communities enduring protracted violence.

Cite this Article View all References

references

  • United Nations. Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. United Nations, 2010; Mnookin, Seth. Out of the Shadows: Making Mental Health a Global Development Priority. World Bank Group and World Health Organization, 2016. www.mhinnovation.net/resources/out-shadows-making-mental-health-global-development-priority.
  • Patel, Vikram, et al. ‘The Lancet Commission on Global Mental Health and Sustainable Development.’ Lancet Psychiatry, vol. 5, no. 10, 2018, pp. 833–881.
  • ‘Gaza Death Toll Surpasses 30,000 with No Let-Up in Israeli Bombardment.’ Al Jazeera, 29 February 2024, www.aljazeera.com/news/2024/2/29/gaza-death-toll-surpasses-30000-with-no-let-up-in-israeli-bombardment.
  • ‘UN Expert Warns of Mental Health Risks for Gaza Citizens from War.’ Reuters, www.reuters.com/world/middle-east/un-expert-warns-mental-health-risks-gaza-citizens-war-2024-04-22/.
  • Ingle, Micah. ‘Without Liberation Psychology, Therapy Reinforces the Status Quo.’ Mad In America, 1 December 2022, www.madinamerica.com/2022/10/without-liberation-psychology-therapy-risks-reinforcing-status-quo/.
  • ‘Mental Health Crisis Support Rooted in Community and Human Rights.’ Human Rights Watch, 19 January 2024, www.hrw.org/report/2023/11/15/mental-health-crisis-support-rooted-community-and-human-rights/case-study.
  • Deacon, Brett J. ‘The Biomedical Model of Mental Disorder: A Critical Analysis of Its Validity, Utility, and Effects on Psychotherapy Research.’ Clinical Psychology Review, vol. 33, no. 7, 2013, pp. 846–861.
  • Mills, China. Decolonizing Global Mental Health: The Psychiatrization of the Majority World. Routledge, 2014.
  • Narvaez, Darcia F. ‘Indigenous Psychologies Contrast with Western Psychology.’ Psychology Today, 19 October 2019, www.psychologytoday.com/intl/blog/moral-landscapes/201910/indigenous-psychologies-contrast-western-psychology.
  • ‘Israel offers Gazans Financial Rewards for Intel on Hostages.’ Middle East Monitor, 24 October 2023, www.middleeastmonitor.com/20231024-israel-offers-gazans-financial-rewards-for-intel-of-hostages/. Accessed 4 June 2024.
  • Kasrils, Ronnie. ‘Like the Phoenix, Gaza Will Rise from the Fire.’ Palestine Chronicle, 2 November 2023, www.palestinechronicle.com/like-the-phoenix-gaza-will-rise-from-the-fire/.
  • ‘Removing Symbols of Resilience: Israel Demolishes Palestinian Monuments in Jenin.’ YouTube, uploaded by Al Jazeera English, 13 December 2013, www.youtube.com/watch?v=dXetgJbOS0s.
  • Jones, Marc O. ‘Analysis: Why Is So Much Anti-Palestinian Disinformation Coming from India?’ Al Jazeera, 16 October 2023, www.aljazeera.com/news/2023/10/16/analysis-why-is-so-much-anti-palestinian-disinformation-coming-from-india.
  • Juhjouh, Mahmoud. ‘Journalist Casualties in the Israel-Gaza War.’ Committee to Protect Journalists, CPJ, 3 June 2024, cpj.org/2024/06/journalist-casualties-in-the-israel-gaza-conflict/.
  • Al Jazeera Staff. ‘To Kill a Family: The Loss of Wael Dahdouh’s Family to an Israeli Bomb.’ Al Jazeera, 1 November 2023.
    www.aljazeera.com/news/2023/11/1/to-kill-a-family-the-loss-of-wael-dahdouhs-family-to-israeli-bombs.

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