Rights-based approaches to mental healthcare are needed in occupied Palestine territory (oPt) to combat the deleterious mental health impacts of human rights violations and neo-colonialism.
Palestinian-based mental healthcare professionals Maria Heilbach (psychotherapist) and Samah Jabr (psychiatrist) argue that purely biomedical understandings of Post-Traumatic Stress Disorder and well-intentioned trauma theory cannot capture the extent of suffering that occurs in and around the West Bank and the Gaza Strip.
They then argue that to alleviate both the suffering of Palestinians and their victimization, mental healthcare professionals must promote rights-based, liberatory understandings of mental illness and trauma.
The authors explain:
“Solidarity starts by acknowledging human rights violations and by blaming the victimizer, not the victims who react to these experiences. Who better than mental health professionals are able to understand how constant fear, pain, and terror influence individuals? As psychotherapists or mental health workers, we are confronted with the question of how we regard our ethical role and how we intend to act on it:
Do we see ourselves as an active part of society, or do we consider the therapeutic space a ‘nonpart’ of society? Work with trauma victims confronts us with questions of social involvement that are inescapable, even if we are not always aware of them.
However, trauma theory has reached an impasse worldwide: it has developed into a medical, symptom-oriented approach that produces methods of therapy that stubbornly disregard sociopolitical discourses and that disguise social and political problems as pathological disorders. In general, there is little effort to address the effects of trauma on an international policy level. Yet in order to respond to trauma in the oPt, a political solution is required not only to reduce physical and psychological threats but also to establish historical, political, and moral justice.”
PTSD, the authors argue, is a hegemonic, quantifiable, and measurable diagnosis that puts the human rights abuses Palestinians suffer daily into a box that is understandable by psychologists and psychiatrists. However, a PTSD diagnosis, without specific intent to contextualize apartheid and rights abuses, necessarily decontextualizes and depoliticizes Palestinians from their reality.
The emergence and rising popularity of the PTSD diagnosis in the United States and Western Europe in the late 90s and early 2000s initially paved the way for Palestinian victimization.
Heilbach and Jabr note two key ways depoliticization occurs:
- PTSD is always “post” and cannot identify ongoing traumatization and rights abuses.
- By pathologizing and individualizing the response to ongoing human rights abuses via a PTSD diagnosis, well-intentioned mental healthcare professionals stigmatize suffering.
“The uncritical adoption of the trauma context moves the narrative away from the social and political context and underlying reasons for trauma and reduces it to individual psychological suffering, thus stigmatizing people.”
Individualization is a harm in and of itself, too.
“The sociocultural conditioning of pain and traumatization requires an approach that is dedicated to the collective meaning of suffering, and that strengthens the meaning of social cohesion and solidarity. Otherwise, social suffering will be mistakenly diagnosed as a clinical pathology. Consequently, an individualistic approach does not suffice when trauma is caused by colonial practices on the collective level.”
This harm of individualization does not only come from biomedical-based PTSD diagnoses but also from non-liberation-oriented psychotherapy modalities that do not look to consider the systems of oppression and forms of neo-colonialism at play in the collective Palestinian psyche. “Trauma-informed” approaches are not enough, as the concept of trauma has also been colonized. The authors note that commonly:
“Proposed interventions do not focus on personal empowerment or political advocacy to change the system of political violence, instead individualizing and depoliticizing human rights violations. Many proposals strategically adopt and reproduce a Western neoliberal framework of trauma in order to be eligible for funding…On account of international funding, psychological aid pro- grams are offered, but political fears and concerns lead to their political decontextualizing. As a result, the majority of programs take place in a political vacuum.”
To combat these harms, whether intended or not, mental healthcare practitioners and rights advocates must begin looking at the overall mental health of Palestine through a rights-based liberation psychology lens.
Liberation psychology, founded on the core principles of liberatory thinkers Franz Fanon and Paulo Freire, allows the stereotypically individualistic process of psychotherapy to become an intentional act of resistance. Rather than asking, “what’s wrong with you?” This movement toward liberation psychology will encourage mental health care professionals ought to begin asking: “what’s happened to you?”
Both authors call on psychologists, psychiatrists, and mental healthcare practitioners across the globe to stand in solidarity with Palestine and begin the movement toward rights-based approaches to mental healthcare.
Heilbach, M., Jabr, S. (2022). A Call for Social Justice and for a Human Rights Approach with Regard to Mental Health in the Occupied Palestinian Territories. Health and Human Rights Journal. (Link)