In Gaza, Focus on Symptoms of “Mental Illness” Obscures Structural Violence and Oppression

Mental health providers in Gaza explain the root causes of the Palestinian mental health crisis.

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After interviewing 30 mental health clinicians in Gaza, researchers concluded that focusing narrowly on trauma, symptoms of “mental illness,” and psychiatric diagnosis fails to address and capture the causes and expressions of suffering in Palestine.

The researchers write that “promoting and restoring mental well-being by acting exclusively on psychological symptoms and syndromes prevents the application of social justice and equity in a society characterized by structural violence and oppression.”

Marwan Diab, head of the Gaza Community Mental Health Programme, along with colleagues at that organization and Stellenbosch University, South Africa, led the research. The results were published in Transcultural Psychiatry.

The study was conducted before the current and ongoing Israeli offensive into the occupied territory of Gaza, resulting in over 22,000 Palestinian deaths, mostly civilians, which followed the Hamas attack on October 7 that killed about 1,200 Israelis, mostly civilians. This latest round of violence exacerbates the already challenging and distressing living conditions in Gaza, a territory that has been under prolonged occupation. These conditions are part of a broader and ongoing conflict, deeply rooted in historical and political injustices, contributing to significant human suffering and hardship.

(INT) Gaza feels sad after an explosion killed people near the Israeli border. September 14, 2023, Gaza, Palestine: Gazans are mourning a great loss as thousands gathered to bid farewell to the victims of the explosion that occurred in the Malka area, east of Gaza City. The Ministry of Health issued a statement confirming the tragic incident, and reporting the death of five individuals and the injury of 25 others, some of whom are in critical condition. The explosion was caused by a suspicious device that exploded in Malka camp, east of Gaza. The victims whose names were published by the Ministry are: Baraa Al-Zard, Muhammad Qaddum, and Ali Ayyad. While their names echoed in the streets of Gaza, their sudden passing left a deep scar in the hearts of Gazans, who gathered to offer condolences and support to the bereaved families. Credit: Hashem Zimmo/Thenews2 (Foto: Hashem Zimmo/Thenews2/Deposit Photos)

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22 COMMENTS

  1. Pure unadulterated BS. What about the struggles of Gays thrown off tall buildings in Gaza? What about the mental health struggles of women who have no rights in Gaza? What about the mental health struggles of children outfitted with suicide bombs? Do you understand that more than 80% of Gazans support Hamas and their genocidal plans for Jews worldwide? Will the next article be the mental health struggles of ISIS and the Taliban? The only occupation in Gaza is the occupation of Hamas, but they were voted in. Including the sinister plot of South Africa to gaslight the world into believing that the people under threat of Genocide (the Jews) are the perpetrators. I take it back, this isn’t pure unadulterated BS, it is Antisemitism. Mad In America has caved to the woke mob.

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  2. Your article begins with an assumption that that Gaza is ‘occupied’ and accepts that as a fact. I ask, occupied by whom? Since 2005 not 1 Jew or Israeli has been living in Gaza.
    The Blockade? IN 2006 Hamas was elected to govern Gaza. The Hamas charter, calls for the creation of an Islamic state and the dissolution of Israel. What followed In 2007 was a partial blockage initiated by Israel and Egypt to control the movement of goods and people in and out of the Gaza Strip in order to prevent the smuggling of weapons into Gaza. Only on October 9, 2023 (2 days after the massacre of 1400 civilians in Israel) was a total blockade imposed. It is not difficult to understand the necessity of the blockade for Israel’s protection.
    Gaza may indeed sadly be plagued by poverty. But the elected government, Hamas, has no shortage of cash. Millions upon millions of dollars (much of it intended for humanitarian aid) has been reappropriated by Hamas into creating the tunnel infrastructure for their terror against Israel, weaponry through which to attack Israel, and to also provide extravagant life-styles for their leaders while they let their civilians live in poverty. Really, who is occupying Gaza?
    Re the current war: war is always ugly; it is always traumatic and intensifies existing mental health issues. In the case of Gaza, the mental health crisis is undoubtedly exacerbated by the fact that Hamas tries to prevent the movement of civilians to safer locations (as warned by the iDF), uses children and civilians as spotters and human shields to protect themselves, as well as murdering for and stealing the humanitarian aid intended for civilians. For Hamas, showcasing their suffering Gazans and garnering world sympathy perfectly supports their stated goal to demonize and physically destroy Israel.
    Casting the victim that chooses to fight back and protect themselves into the role of oppressor/ perpetrator is skewed and inaccurate. There are real reasons Gaza has suffered from the extreme poverty and proportionately greater mental health challenges, but accepting propaganda so nonchalantly does not serve to improve their conditions.

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  3. Hamas misrepresented itself during the elections in 2007. Gazans voted for what they thought was a much more moderate party. And that was 16-17 years ago.

    And I agree with you, Hamas is terrible. But gazans aren’t Hamas.

    And btw – I’m gay. I don’t understand when people say “but they hate gay people.” Yes, that’s true, but that doesn’t mean that I think they deserve to be destroyed.

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  4. Therapist Wendy Dolin requested that I post this comment for her; “After you all educate yourself about what happened on October 7th I might have an interest in being part of this group.
    I was in Israel when it was attacked. This was genocide. Hamas was offering $10,000 for every hostage brought alive
    There are videos of women who were raped. Shot and raped after they were dead. Breasts cut off and used as balls for sport Women mutilated so badly their pelvises were broken. Bullets in vaginas. Men were sodomized Sounds like mentally sound practices from Hamas!
    Any thoughts on babies and toddlers burnt alive? Perhaps you might start quoting Hitler now too!
    Now talk about mental health issues and trauma Do you think any tortured hostage will ever be mentally sane Parents threw their bodies over their children and died to save their kids
    Any thoughts of Hamas building tunnels with weapons under schools. What a woke idea Using innocent civilians as human shields Talk about oppression. Taking billions of dollars building tunnels with weapons Money could have been used for Gazans
    I joined Mad In America because I respected what you do.
    Promoting antisemitism I hope is not part of your new mission statement Just another excuse to hate Jews.”

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    • POSTING AS MODERATOR: We are drifting over into areas of politics that transcend “mental illness,” largely because of the nature of this article. But we need to keep focused on the “mental health” themes and whether “mental illness” focus obscures structural violence. There are many other contexts besides Gaza to draw on.

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      • Steve McCrea, As a person who loves truth, I find it impossible to evaluate the purpose of this article in isolation of the distorted assumptions that it is built upon. Perhaps you see that as political; I see it as ethical. I think it was a sad mistake for MIA to post this article as “RESEARCH”?! Isn’t research supposed to unbiased and scientific??

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      • Thank you, Steve. My husband grew up in Lebanon all through the civil war and invasions of Lebanon by both Syria and Lebanon. I was in Lebanon in 2006 during the 34 day war. There will be survivors on both sides who will suffer from the distress of this conflict and the medical model of mental illness has no place when testing trauma from living in war zones.. thank you, Steve, for striving to make everyone feel safe. This article is about mental health treatment of trauma. I don’t see it as promoting one side over the other. Thank you.

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  5. Such a well written article that really highlights why healthcare professionals, and especially mental health care providers, need to be informed on social justice issues. Thank you for shedding light on this important issue.

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  6. An excellent summary about a very important topic, which has implications well beyond the current tragic situation in the Middle East. My only reservation is that use of the term ‘mental health’ can have just as strong a depoliticising effect as ‘mental illness’ (for which it has become a synonym.) How does the concept of ‘mental health’ translate into Arabic? (if it does.)
    I think this quote illustrates that even the authors have fallen into the conceptual trap to an extent:

    “The overwhelming need now [in Gaza] is not mental health but a ceasefire. In comparison to ending the immediate assault, the meeting of mental health needs—important as they are—cannot claim the highest priority.”

    The point is that there are no ‘mental health needs’ separate from the appalling situation in Gaza. It’s not a question of ignoring ‘mental health’ while we work towards a ceasefire. To do the latter IS addressing what they call ‘mental health needs’, which are perhaps better framed as ‘the need for all human beings to live in peace and justice.’

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  7. The criticism here does raise an important question about Mad in America.

    We like to stay out of politics, whether domestic or in this case Middle East “politics.” However, we are interested in writing about research regarding the “social determinants” of mental health, and the reason is this: the prevailing narrative places the psychiatric suffering inside the head of the individual, and ignores the environment.

    And so we have written about articles in Transcultural Psychiatry before. When one of our science writers decided to write about this publication, we asked ourselves, how does it fit into the “social determinants of health” framework?

    I personally am given to being open about writing about journal articles, and so my thinking–perhaps naively–was this: if there was an article that spoke about “psychiatric difficulties” among the Israeli people, and then placed it within a framework of the social determinants of health, would we run it? And I thought, yes we would, because it fits into this theme of interest to us.

    That said, I should have made sure that theme was understood to be the point of this article, and I should also have made sure that it was correct in its facts regarding whether Gaza was “occupied” since Hamas took over. But that is the reasoning behind our publishing this article: we do regularly write about the “social determinants of health,” in opposition to a narrative that puts the suffering into a story about an individual’s “mental illness.” And we do so not because of politics, but rather we think that is a conception that, if embraced, leads to a different paradigm of care, starting with the understanding that you need to create environments that better nurture the “mental health” of populations around the world, and stop seeing suffering and psychiatric difficulties as arising within the individual, and that is the individual that needs to be fixed.

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    • Thank you, Bob, for meeting the moment. Having said that, the facts don’t stop with the reality that Gaza has not been “occupied” by Israel since 2005-6, when thousands of Jewish families were uprooted from their homes in Gaza. An honest treatment of mental health in Gaza would include that UNWR teachers celebrated Oct 7 en masse. How does this affect the mental health of children? Or the fact that Hamas instills the notion that they love death more than we love peace. How does this death wish affect the mental health of people who believe this? Why is there no mention of the mental health of LGBTQ persons in Gaza, or the people who love them? These are all very hard conversations, but the Mad In America I have known and loved has not, in the past, shied away from those. The obstacle that I see as being in the way of that, is the intolerance I have seen in “social justice warrior” camps who have seized on Hamas as being “the oppressed”. Jews have been cast as “white”, and Palestinians as “People of color” (which is just nonsense). So now there is this broad overlap of DEI and CRT focusing on the “white privilege” of Israel, and since Mad In America has heavily bought into both of those, it is not surprising that this article, with all it’s falsehoods, was published in the first place. A good place to start to rectify this moment where Jews may very well not feel safe here, after this piece, would either be to publish a retraction, or allow those of us with family in Israel to publish a piece on mental health challenges in Israel.

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  8. This article does a fantastic job of challenging how Americans, and other western nations, think about mental health as a in individual problem when it is so often a symptom of structural issues. It opened my eyes to how we need to expand our considerations of social determinants of health when considering those living in oppressive conditions. We have seen over and over how publications humanizing Palestinians are considered controversial, but I think that overlooks the purpose of this article. Whether or not you agree with the term “occupied” does not change the fact that access to basic resources, including natural resources, is severely restricted for people living in Gaza – both before and after October 7. These restrictions on day to day life, and the constant threat of violence, present major challenges to mental health that need to be understood by healthcare providers as a part of social determinants of health. Oppression all over the world and if we want to be caring and effective providers, we need to understand how it affects the mental health of those being oppressed. As this article so thoughtfully explains, remaining neutral harms those who are victims of state violence whether it be in Palestine or systematic failures within the US.

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  9. This article presents an opportunity to initiate a meaningful discussion on the cultural context of mental health, specifically addressing PTSD, while carefully avoiding entanglement in political and controversial aspects.

    The cultural dependency of PTSD is evident, particularly when contrasting individualistic societies, where responsibility is predominantly self-oriented and environmental impacts are often unconsciously disregarded or actively avoided, with collectivist societies, where experiences are commonly shared. This contrast is particularly noticeable in the approach to PTSD treatment. In individualistic societies, such as ours, the experience of PTSD is often internalized, with the focus on the individual’s journey to process and derive personal meaning. Conversely, in collectivist societies, the emphasis is not solely on meaning-making (Reality is often considered as is) but rather on communal healing and collective progression towards physical health. Thus, this topic emerges as both fascinating and significant in understanding the varied approaches to mental health across different cultural landscapes.

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  10. What an important and timely reminder of the stakes and determinants of mental health that lie beyond biomedicalized processes bounded within an individualized body. Without addressing the root of harms and alleviating the conditions which propagate collective suffering, it is impossible to move toward any kind of solutions, biomedical or otherwise. A turn away from the notion of treating a biomedically defined, universalized, individualized patient completely extracted from all context and toward the recognition of the structural forces at work on communities has long been championed by critical scholars of science and medicine. And, as it is especially apparent in the case of Gaza and the Palestinian people, ignoring or denying the historical and political causes of mental suffering and trauma only works to reinforce and obscure the power structures which maintain these conditions in the first place. It is heartening to imagine a paradigm shift happening in medicine which leaves beyond the tendency to deem an individual’s response to structural violence as pathological or indicative of being mentally ill. More than ever, a structural lens which seriously incorporates the political, historical, and social determinants of health into our understandings of these conditions is needed, and more research like this should be done to teach us how to achieve any of our ambitions to partake in medical practice which does not merely reproduce its own well-known harms.

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  11. Beautifully written article that sheds light on an important need. What is happening in Palestine is genocide. And it has been happening for over 70 years. The collective trauma and effects of Israel’s occupation of Palestine on the mental and physical health of Palestinians is important to acknowledge as healthcare providers and is important for further study. Thank you for writing!

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  12. This article highlights the limitations of individualistic western paradigms of understanding trauma when discussing Gaza… and the need to understand mental health in the context of structural oppression and collective punishment…you cannot scream “political” when Western scholarship, which includes western psychiatry, about the middle east is inextricably tied to the imperialist societies who produced the scholarship. It’s as inherently political as it is in service to maintaining western hegemony.

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  13. At this point, we are closing the comments. We have posted comments that criticized us for reporting on this article, and posted comments from readers who appreciated the article for looking at “mental illness” through this lens of responding to an environment. Thus, we think both perspectives have been heard.

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