Memorandum submitted by the Palestinian
Counseling Center
MENTAL HEALTH
AND THE
ROLE OF
CIVIL SOCIETY
Mental health is the balance between all aspects
of life—social, physical, spiritual and emotional. It impacts
on how we manage our surroundings and make choices in our lives—clearly
it is an integral part of our overall health.
Mental Health is far more than the absence of
mental illness and has to do with many aspects of our lives including:
— How we feel about ourselves.
— How we feel about others.
— How we are able to meet the demands
of life.
Taking into consideration this definition of
mental health, it becomes quite clear how it connects to all other
concerns in the Palestinian life. Therefore in order to measure
the effectiveness of aid it is crucial to understand the psyche
of the people and what motivates or obstructs their productivity
in addition to taking into account the general political and economic
factors.
What is the problem?
The main issue here is to integrate the human
factor in any discussion of effective and sustainable work in
Palestine. To take into consideration that any viable project
has to be worked out mainly with human resources, so understanding
the psyche is critical.
So far we do not have any specific epidemiological
studies of how the situation is affecting the people psychologically
but there are data released by GCMHP in Gaza which states that
75% of the Palestinian children suffer from Post Traumatic Stress
Disorder (PTSD) but with varying degrees. The Palestinian Counseling
Center is conducting a quantitative research of the psychological
effect of the building of the Apartheid Wall on the people in
Qalqilya and environs. Preliminary findings indicate that that
there is a high prevalence of depressive features apparent in
sleeping and eating problems and psycho-somatic symptoms among
the adults and children in the villages of Kufr Attiyeh, Al Dabaa'
and Falamieh in the Qalqilya district. The children in the villages
mentioned above have to cross a gate at the wall twice daily to
go to their school. Needless to say that the gate and the wall
is electrocuted and children can get killed if they touch it by
mistake.
Another assessment (a behavioural checklist)
carried out by PCC in Jenin refugee camp revealed that 47% of
children between the ages of 8-12 have anxiety related behaviours
like bedwetting, lack of concentration, and attention.
THE SOCIOPOLITICAL
AND PSYCHOLOGICAL
CONTEXT
Occupation
The Palestinian people's right to freedom and
self-determination are recognized by the international community
through a number of resolutions passed by the United Nations.
The fourth Geneva Convention of 1949 one of the main pillars of
international humanitarian law call for the protection of civil
persons in time of war, the applicability of the convention to
the OCT has been reaffirmed by UN security council resolution
1322 (2000). The International Covenant on Economic, Social and
Cultural rights, in Article 12.1 states: "the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health". Israel consistently breaches every clause
in the International resolutions, like article 33 , of the fourth
Geneva Convention by imposing collective punishments on the people
by shelling residential areas and indiscriminately terrorising
and killing civilians, imposing prolonged curfews, closing off
villages and towns. Article 55-56 was also breached by undermining
public health and attacking hospitals, ambulances and medical
staff. In addition to attacking schools, mosques, undermining
the right to education and freedom of religion. In our view, it
is the failure of the international community to force Israel
to comply with these resolutions and to uphold customary international
law that is the major cause of the ongoing conflict and the consequential
impoverished environment for mental and physical well being in
Palestine today.
ISRAELI OCCUPATION
AS A
FORM OF
POLITICAL VIOLENCE
Violence is defined (Amir, 1982) as a premeditated
offensive act of one party using power to inflict hurt or damage
on another party. Political violence is a term used to describe
practices committed by a state, political regime, or political
organisations against individuals and groups in order to inflict
hurt and damage and guarantee domination. Political violence
is the illegal and unnecessary abuse of force in order to dominate
others. The violence of Israel as an occupying power is a combination
of physical force with psychological terror and fear (GCMHP, 2002).
The systematic and organised Israeli violence against the Palestinians
takes two forms: a direct one and an indirect one.
Direct Violence
For the past 36 years, and intensively since
September 2000 (Al Quds, 2002), Palestinians have been
living as though in a large prison with a continuous threat and
fear for their lives. Basic human rights are being violated on
a daily basis. The following are statistics (PCBS, 2003) of the
casualties of the recent Intifada, as of the date of writing (September
19, 2003):
— Total number of Palestinians killed
by Israeli security forces and Jewish settlers are: 2,618 deaths.
— Political figures assassinated/extrajudicial
killings by Israeli death squads: 275.
— Bystanders killed during Israeli
assassination operations: 133.
— Total disabilities (both partial
and permanent) in the West Bank and Gaza Strip: 3,000.
— Physical injuries: 41,000+.
— Houses demolished during Israeli
incursion: West Bank: 9,750, Gaza Strip: 2,349 (numbers reflect
end of 2002).
— Ambulances damaged and/or destroyed:
222.
This is in addition to the closure of schools,
the damage to school buildings, the people who die from lack of
access to medical care and the infants who die at Israeli military
checkpoints because of inaccessibility to clinics for immunisation.
Indirect Violence:
— People are living under siege, terrorised,
subjected to daily systematic humiliation at army checkpoints
and within their neighbourhoods.
There are limited social relations, as people
are confined to their homes: every town and village is cut off
from the others and completely isolated. There is disintegration
of family and social relationships.
— A large section of the population
is starving and lacking basic needs for their survival. The economic
situation is dire, and people are barely surviving. According
to the World Bank's recent report, the National Domestic Product
declined by 40%, unemployment reached 50% in the Gaza Strip and
63.3% in the West Bank, and thus people living under the poverty
line increased by 65% since September 2000. The poverty line defined
by the World Bank is an income of $2.00 per person per day (in
third world countries). The inability of workers to reach their
place of work because of the closure of all the towns and many
villages in the West Bank and Gaza Strip (Al Quds, April
2002), the difficulties associated with the marketing of products,
and the inability to obtain raw materials have resulted in the
dwindling of the economy.
— Arbitrary measures of closing areas,
shooting at people sporadically as they cross checkpoints, invading
towns and arresting people in the middle of the night leaves the
subjugated people confused and not knowing what to expect and
therefore living in continuous fear.
— The Israeli military practices do
not end with the military, psychological, and economic siege imposed
on the Palestinian people, but include the daily humiliation of
individuals and groups of Palestinians. (http://www.miftah.org/)
THE PSYCHOLOGICAL
EFFECTS OF
POLITICAL VIOLENCE
It is a well-known fact that there exists a
high correlation between life stressors and a prevalence of psychological
problems in a community (Sebastian, 2002). For Palestinians, the
increase in life threatening situations and the fear of losing
one's life have caused grief and trauma and have affected all
sectors of the community. It is usually thought that 25% of any
community directly living in a conflict area or war zone is affected
psychologically on a long-term basis. The PCC believes that the
number in the OPT (Occupied Palestinian Territories) has reached
30-35% who will, be affected on a long-term basis Halileh (2002).
This is primarily due to the sporadic shelling and shooting that
leads to unpredictability— a situation of extreme uncertainty.
Bombing and shelling are more traumatising than other violent
measures because they are more sporadic and constitute a drastic
threat to people's sense of existence and security. For Palestinians,
the lack of control over one's environment is the main cause of
psychological problems. This ghetto-like life not only restricts
psychological development, but also denies individuals the chance
to reclaim the psychological and social advancements they had
once achieved as people. Psychologists who are themselves Jewish,
as well as others (Glabach, D) have written a great deal about
the Ghetto mentality, about how people who are put in a situation
of captivity act, and how they respond physically, cognitively
and emotionally. They also describe the way in which people can
become aggressive, paranoid and ruthless, ie active in trying
to release themselves from captivity, or passive with feelings
of hopelessness and helplessness.
In our work and day-to-day lives, we have increasingly
witnessed signs of psychological and physical fatigue amongst
the Palestinian people. If we take Maslow's hierarchy of needs
(Gilliland, James & Bowman, 1989) as a way to comprehend the
situation, we can conclude that the Palestinians are placed somewhere
near the bottom of the hierarchy in pursuit of basic needs for
food and safety. The natural development of people towards realizing
self-actualization and growth is not possible under these circumstances.
The ability to love and have a sense of belonging
is affected when people are physically separated from families
and loved ones and denied the social support that results from
this interaction. This separation affects the sense of self, as
well as the relationship to others. According to Maslow, people
who are at the lower levels of the pyramid will have low self-esteem.
And consequently are not able to develop and advance socially,
psychologically and professionally, as self-esteem is an important
element in human growth and development (Gilliland et el 1989).
They also tend to resort to primitive process thinking, ie reacting
emotionally and instinctively instead of applying more sophisticated
secondary process thinking, ie being proactive, capable of analyzing,
reasoning and thinking logically (Mitchel, 1995). In relation
to others, it is expected that if a person does not think highly
of him/herself then that person cannot think highly of others.
If he/she does not respect his/her own life, he/she will not respect
the life of others.
Some people who survive and are surviving organised
violence such as war, occupation, torture or imprisonment, may
have already moved out of their bodies (Crosbie-Wheatley) as a
survival mechanism. The goal of torture and organised and systematic
violence is to take away a person's power of being a subject and
turn him or her into an object. We as a people have noticed recently
that death, which is a spiritual concern, preoccupies us less
and less. The news of yet another death or another injury has
become part of our "normal" daily lives. To ignore death,
treat it indifferently, and not allow ourselves to be affected
by it, these are not only linked to an overwhelming sense of grief
and frustration, but are also the result of our perception of
the self as an object, the acceptance of the notion that an object's
life is not valuable. If life, in our eyes, is considered so diminished
then preserving it is no longer a holy task.
CONCLUSION
In conclusion it is important to note here that
any consideration of the viability of projects and effectiveness
has to take into consideration the mental health of the Palestinian
people. The Israeli systematic policies of humiliation and psychological
torture have a debilitating effect that is affecting productivity
and organisation.
It is known worldwide that unemployment and
restricted mobility constitute a main stressor that harm the mental
well being of the individuals and community.
Background on the Palestinian Counseling Center
The PCC was established in 1983 by a group of
professionals from the social sciences field in Jerusalem. The
aim of the Center since its establishment has been to promote
the mental health and well-being of the Palestinian people.
The PCC is an important capacity building center
for students from the Universities and professionals from the
mental health field who are trained in clinical work at the Center,
and who also receive support to further their education in other
institutions locally and abroad in the same field. The Center
has also been able to make an impact on progress in the mental
health field by starting projects, which have been adopted nationally.
One of these projects is the training and placement of counselors
in the public schools. In addition, the Center has worked to integrate
mental health care into primary health care settings. The Palestinian
Ministry of Health and the Palestinian Red Crescent Societies
have adopted this work.
Most importantly, the PCC has been a strong
advocate in emphasising the importance of responding to individual
needs in the community, ensuring that the individual and his/her
needs are not forgotten in the midst of collective needs. This
is very important in light of the fact that individual counseling
and personal growth might be considered a luxury for a developing
community like ours. In spite of this, the insistence on providing
quality mental health services to the community and providing
further training for the professional staff in the field are a
priority of the PCC. As a Counselling Center we deal with people
with a wide range of presenting difficulties, some of which are
directly or indirectly related to exposure to political violence
(occupation and military force). Others are victims of domestic
abuse, while yet others have physical conditions, possibly aggravated
by the political situation.
September 2003
NOTES:
1. Intifada statistics are taken from the
database compiled by the Gaza Community Mental Health Program
(www.gcmhp.org). Updated regularly.
2. Intifada statistics are taken from the
database compiled by Miftah—the Palestinian Initiative for
the Promotion of Global Dialogue and Democracy (http://www.miftah.org/).
And the Palestinian Bureau of Statistics (PCBS) www.pcbs.org.
Updated regularly.
3. Dates and news are quoted from the website
of Al-Quds daily newspaper www.alquds.com
BIBLIOGRAPHY
1. Amir, M (1982). "Basic Concept and
Terminologies Related to Violence", Improving The School
Environment, The Ministry of Education, Jerusalem. pp 15-18.
2. Crosbie-Wheatley, J Attachment Trauma
and Somatization in Adults: When Time Does not Heal.
www.n2nconf.org/handouts/C9-Wheatley-Crosby.doc view
as html
3. Giacaman, R & Johnson P (2002). Who
lives in Jenin Refuge Camp? electronicintifada.net/forreference/briefings/jenincamp.html
4. Gilliland, B James, R & Bowman, J
(1989) Theories and Strategies in Counseling and Psychotherapy.
Needham Heights, MA: Allyn and Bacon Press.
6. Glabach, D An Evolutionary Psychological
Perspective on Natural Rights as an Inherent Aspect of Human nature.
http://www.geocities.com/xavy04/english/nat—rights.htm
7. Halileh, S (2002) The effect of Israel's
operation Defensive Shield on Palestinian children living in the
West Bank. http://home.birzeit.edu/icph/PDF%20Emergencey%20Publications/Child%20Report%20final
%202002.doc
8. Mitchell, Stephen A, Black, Margaret
J, Freud and Beyond: A History of Modern Psychoanalytic Thought.
New York, N.Y. Basic Books (1995).
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