How Trauma Theory is Oppressive in Occupied Palestine

In Palestine, trauma-informed care misses the mark. Liberation psychology is needed to address neo-colonialism.

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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.”
EREZ CROSSING-DEC 31:Palestinians carried Palestinian flags on Dec 31, 2009. On April 2013, 132 (68.4%) of the 193 member states of the United Nations recognized the State of Palestine.

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:

  1. PTSD is always “post” and cannot identify ongoing traumatization and rights abuses.
  2. 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.

 

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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)

6 COMMENTS

  1. Samantha- have you heard of Social Work? This is exactly what we do, our entire approach separates us from others due to our commitment to social justice and living within oppressive systems. Be careful not to lump mental health workers into one homogenous group who all think and perform alike.

    • I’m sorry but you’ve got to be joking. I have seen so many people put in an asylum forced on treatment that has only made things worse exactly because a social worker put them there. There’s also an extreme difference between social work and a social worker. Social work is what somebody does when they fund a soup kitchen when they get affordable housing when they advocate that the government provides money for people that are underprivileged. That is not what a social worker does whatsoever for the most part. LCSW is not a degree involving social work it’s a degree involving psychiatric diagnosis and talking to people in therapy sessions. You might also not try to insinuate that the person who wrote this article is oblivious as to what the term social worker in practice is and means and entails. And then not start a response with: “Do you know what social work is?” Because what that implies is that you’re not going to look at what usually goes on with social workers and try to make out people that see it and call it for what it is have some lack of understanding or insight. Is this also what you do when you diagnose people? Because that’s exactly what this article is about and the lack in the mental health system and social work-ers. And no just because somebody tagged the end of the word work with “er” this doesn’t mean that there is some holy connection between social work and social workers. That’s more a marketing gimmick and also something the whole mental health system is quite full of.

    • Sadly my experience of social workers have proven otherwise. I am an American Psychiatric survivor married to a man who grew up in Lebanon. I wish the social workers I met were as you claim but they were not. I found that social workers and other mental health care professionals have very little understandimg of the complexities and history and if the Palestinian/Israeli conflict. I have found little cultural awareness and recognition of diversity in the USA mental health care system.

  2. I agree incredibly, only I truly question whether politics is going to fix these situations. When society negates the instincts to feel empathy with others, it still remains for a victim to invest in feeling empathy in understanding what’s going on and that also means not demonizing even the people that are victimizing them. When you do that you actually simply create your own life with those that work for you and put your energy in that not and demonizing those who are victimizing you, and I think that works because then you have the energy to do that and that speaks for itself. That also leaves room for the universe to fix the situation, and I think the universe has much more ability than the human ego and how it judges the situation and others. I think a good therapist this is somebody that strengthens their clients in a way so that they have the right to their feelings so that they feel they are heard and listened to and that way you feel you deserve something better. That is something quite different than hating and demonizing your oppressors, you don’t fight fire with fire and that just goes around in circles according to me. And maybe you have to transcend the limitations you’re indoctrinated with probably by the very people that would victimize you.

    • I agree with you. Hate never solves anything. However, unless one has a cultural understanding where the person is coming from therapy can do more harm than good I actually got terminated by a social worker for going to Beirut Lebanon in 2006 and the 34 day war broke out. She said I had no business being there. Therapy should be about empowering people.

      • To me that sounds simply superstitious. Although that’s pretty normal for a whole mob of “social workers” and seems to be the majority. It’s none of a “social workers” business to decide where a person travels to. I have heard the same weird phobias from other social workers, fortunately not those I had anything to do with, but acquaintances. Anything anyone does, who is considered to have some diagnosis, can be interpreted to be something a social worker, or psychiatrist or “judge” even decides has some negative effect. It’s like one is supposed to sit and stare at the walls, or watch silly inane television the whole day, and be happy when patronized by well meaning people who think they are doing you a favor treating you as if you’re sick, and they are being kind by treating you like you’re incapable of thinking for yourself, have no history you might want to feel empathy for, but have become some object for them to decide as to how you should be behaving, and anything outside of their fixations is part of a “disease.” Do any normal thing, which anyone else does all the time, anything that expresses personal freedoms and on come the labels. I live in Grand Rapids MI, and a girl I knew who grew up in Chicago, and who was in Grand Rapids, and on “meds” that took away any sexual feelings (typical anti-depressants effect for what percentage of people, I’ve seen it listed as 50%), and then a whole other cocktail which wasn’t helping her; and then if she simply wanted to go to Chicago, like anyone else could do, this was a sign of the “bipolar” disease. If she had a friend visit her, her social worker actually SERIOUSLY said she “thought” she was selling herself for sex. Which she wasn’t doing. And then further stuff I won’t go into. It’s like privilege to make stuff up about people, and the right to officiate paranoia for “social workers.” A lot of them are simply completely unable to understand or relate to behavior they’ve been trained to see as symptoms of a “disease.” And others who DO have perspective, who do have insight, who have helped people understand their normal responses towards life, be it trauma, or challenges with cognition, or knowing what is affecting them in diet or other routine activities, they aren’t even allowed to help; when a person has this perspective, and an approach that correlates with recovery rather than a life on drugs, and more disability, relapsing and loss of life after an interim of symptoms suppression, they are labeled as unprofessional, when they don’t first plug in psychiatric pharmaceuticals. I myself actually never went looking for therapy, because I’d seen SO MANY friends being treated in such a fashion, but then I heard about a different place, with a different approach and have been seeing therapists from there for maybe 6 years or so. Maybe seven. It’s in ways just someone to talk to, and they are interested, and I think learn from me, because I’m going through that, and it’s something different than someone being “taught” what’s going on. One “social worker” who I fortunately had nothing to do with, other than she was teaching a parks and recreation’s class; when she was tremendously paranoid, and clearly does this labeling of anything she feels free to erroneously, I heard actually a voice tell me to not even ask her questions after class, to just go there, and leave. But unfortunately, I was disassociating from such paranoia, because it’s hurtful to know how brainwashed people are, and I also knew there was no concern, I wasn’t doing anything, so I didn’t heed that voice. At one point, along with a whole plethora of bizarre false interpretations, and paranoid hostility, she actually said: “I know, he doesn’t hear voices, he sees things that aren’t there, it’s non reality based.” This after a voice was clearly warning me. I could go into all of the symbolism of stuff I thought was going on for one day, and then the next knew it wasn’t, even how the symbolism was perhaps more objective than physical reality, because it had to do with stuff at a soul level it expressed what was going on conceptually same as fiction describes interactions that have meaning, and even themes of a physical miracle I later experienced (13 years later) from what themes are, and what they have to do with life, and why time exists.. That’s just my experience. Everyone has their own, and their own interests, and their own way of relating to their life, but I couldn’t BELIEVE the plethora of bizarre interpretations going on, and ridiculous paranoia, all because she could look into her computer, and see I had some “diagnosis.” The DANGER then actually becomes trusting people that you wouldn’t think are HIGHLY discriminatory. And if you love human nature, as much as people do who make themselves extremely vulnerable expressing that with all these symptoms listed as being from psychiatric diseases, then you aren’t going to judge others, or you don’t want to. In a way it’s simply embarrassing that such paranoia is going on. It’s not different from people brainwashed in the old South regarding that Black people are dangerous, or the rest of the bizarre indoctrinated discriminatory paranoia towards Jews, or Gypsies, or Homosexuals, or Women, or Children when they are simply human…..

        I notice, looking at your posts from the comment history, that you also were put on a whole host of meds, and then suddenly, you were left without even any help or information regarding the problems with going off of psychiatric medications, when your psychiatrist lost her license. And that’s simply unheard of in medicine, but it’s standard in “psychiatry.” That’s also how they often rig their “scientific” trials, they put people in the non control group that are addicted to a medication or medications, take them off of it or them, and then call the withdrawal symptoms signs of the disease while those in the control group are “medicated”: and thus clear of withdrawal symptoms. What CLEARLY to anyone actually interest in the science of it, is about withdrawal symptoms, is made to be about an organic disease that genetic or environmental (but NOT the holy psychiatric drugs). There’s no attention to withdrawal symptoms, there aren’t any real official resources to help people get off of highly disabling “medications,” unless you’re a millionaire, although there are the unofficial resources like this site. There’s not even acknowledgement that what’s going on IS withdrawal symptoms, that’s mostly listed as signs of a disease, in fact damage that the DRUGS CLEARLY do, the drug companies have tried to make out that’s the disease. Actual scans showing how drugs for “schizophrenia” swell up the inner core of the brain, and shrink the frontal cortex, this was made out to be from the ‘disease,” until this was corrected. And then your story of simply being dismissed, not even told you’re going to have severe withdrawal symptoms, after seeing a doctor who lost her license. Let alone that there would be a place for you to go for help with withdrawal, or that what was going on would even be acknowledged as withdrawal. What I’ve also seen numerous times as well, with another friend is she’d end up in the asylum, and they’d just “change” her meds, without caring to titrate her off of whatever she was on, already. A person doesn’t even know what’s affecting them anymore. You become some experiment to see what effect they can get from the meds, and the disqualify side effects, withdrawal symptoms, long term iatrogenic damage etc. And you’re not even allowed to try methods that don’t correlate with the spike in the occurrences of mental illness that meds are in collusion with.

        And YES MOST social workers, given the way the economy of the drug companies works, are FORCED to take on such. In fact, to simply get ANY money for helping a person with what could be deemed “therapy” and in doing so tell them what the truth is regarding psychiatric drugs, and recommending they get off of them, when there’s problems with withdrawal symptoms, or consequent illicited by it because one told the truth of how the drugs work, you can be sued. But a psychiatrist can force a person on “medications,” when they don’t work and a person commits suicide, which has happened NUMEROUS time with anti-depressants, the psychiatrist isn’t held responsible, they can load a person so full of meds it kills them, force or coerce a person on “medications” that in the end shorten their life span, that after an interim cause more relapsing, and disability, that interfere with their ability to hold a job, and then there’s shock therapy, the loss of memory; and all of the paranoia that the answer has to be someplace that in reality correlates with the current spike in mental illness, and…… THAT is “normal” behavior by a psychiatrist.

        And then there’s what happened to you, that you’re not even told you’ll have withdrawal symptoms, and that could have killed you.