The Thinking Behind the Mental Health Workers’ Pledge

Samah Jabr MD and Elizabeth Berger MD, M.Phil

THE ISRAELI OCCUPATION OF PALESTINE: In a time of global turmoil surrounding refugee crises in many areas, it is easy to lose sight of the fact that the Palestinians compose one of the largest refugee populations as well as the most longstanding refugee population in the world. Of the 11.6 million Palestinians dispersed worldwide, 4.5 million individuals live today in stateless insecurity within the Israeli-dominated Occupied Palestinian Territory, a geographically discontinuous, increasingly fragmented, and ever-shrinking area including the West Bank, East Jerusalem, and Gaza. The displacement of the Palestinians from their homes by Israeli forces, beginning in 1948 and continuing through the present moment, is fundamentally a consequence of a single factor: the Israeli ambition to clear the land for its exclusive use by Jewish/Israeli people. The catastrophic impact of this ambition has been endured by generations of Palestinians who have suffered the devastating ongoing military, political, economic, social, and ideological assault necessary to secure this land. The historical and current conditions for Palestinians, involving nearly 70 years of systematic ethnic cleansing and apartheid control in the name of political Zionism, thus pose an enormous moral challenge.

The list of human rights abuses perpetrated by the government of Israel in its present occupation of Palestine forms a catalogue of terror: the killing and breaking the bones of defenseless demonstrators, arming Israeli settlers to commit acts of violence against Palestinians, bombing of hospitals and schools, home incursion and demolition, the use of toxic gas, mass arrests, detention, and torture—including the torture of children. It is estimated that since 1967, one third of all Palestinian men have been held in detention by Israeli forces, often without charges being brought against them and not infrequently for decades. Almost all of such detainees are mistreated and torture is so common that the physical and psychological consequences of torture by the Israelis form an important public health problem in Palestine. More insidious forms of community reprisal imposed by the Israelis involve the deliberate, systematic, and massive destruction of the economic, agricultural, educational, and legal systems in Palestine as well as the maintenance of total control over its road-ways, water, air space, human movement, and natural resources. The deliberate effort to decimate the leadership of Palestinian society through specific targeting of Palestinian journalists, attorneys, human rights advocates, community organizers, and legislators—including prominent mental health professionals and their families—has been an especially malignant aspect of Israeli policy.

The violent displacement, containment, and devastation of the people of Palestine could never have been achieved without the astronomical and ever-increasing quantity of military support given to the government of Israel by the United States—more cumulative military aid since the end of World War II than to any other country, estimated to be nearly $100 billion dollars—motivated by its own geopolitical interests in the Middle East. And this war of tanks and fighter jets has been justified through a war of words, a well-financed propaganda campaign which portrays the Israelis as brave victims defending democracy and the Palestinians as dehumanized dangerous fanatics.

The distortions of fact undergirding pro-Israeli propaganda and the details of Israeli crimes against humanity have been documented by tireless reportage by the United Nations, by human rights organizations such as Amnesty International and international organizations against torture, and by international scholars and journalists; an increasingly vocal number of Israeli organizations and courageous individuals in Israel speak out against the oppression of the Palestinian people by their own government and its pernicious effects on Israeli society as well as Palestinian society. Movements to educate and persuade the global public in solidarity with the Palestinian community have emerged in many places, dedicated to exposing the violent aggression, racism, and violation of international standards of human rights perpetrated by the state of Israel.

THE ROLE OF MENTAL HEALTH WORKERS: Mental health professionals, skilled by training and experience to listen to agendas hidden beneath the surface, have the potential to defuse the power of the pro-Israeli propaganda narrative through distinguishing fantasy from fact and through identifying the motivating denial, self-interest, and self-deception behind its assertions. One such propaganda position, fundamental to the worldview of political Zionism, asserts the inherent “specialness” of the Jewish people: special in their history of victimization in Europe, the Jewish people require an ethnocentric militarized state which is beyond criticism and exempt from international law. While playing on the guilt of the West for its passivity and collaboration with the Holocaust of World War II, the questionable assertion of Israeli specialness presents a seemingly-innocent surface while obliterating moral accountability for the covert colonialist greed, entitlement, and ruthless violence of the Israeli government by equating all criticism with anti-Semitism.

Another propaganda position is the oft-heard “liberal” view that Israeli violence—although lamentable—is mirrored and justified by the threat of Palestinian violence; the questionable assertion of symmetry presents a surface of tragic inevitability with an apparently even-handed dispersal of blame and empathy on both sides, while covertly normalizing and supporting the status quo. And overall, the mental health professional will recognize in the Israeli mistreatment of the Palestinian people the contours characteristic of abuse dynamics: the abuse itself and the ensuing relentless campaign to undermine the credibility of the victim, to destroy the victim’s self-respect, and to delegitimize and silence the victim’s narrative. By identifying propaganda manipulations such as these as politically motivated distortions, rather than self-evident truths, mental health professionals can elevate the level of reality-testing within discussion of Israel and occupied Palestine.

In addition to bringing insight to discourse on the occupation, the mental health community is in a unique position to properly assess the gravity of the immense psychological and social damage being inflicted by the occupation through a professional understanding of the emotional consequences of war, occupation, and pervasive insecurity and especially through the viewpoint of child development. Through these lenses, the overt atrocities which now achieve public prominence in viral internet video clips (such as Israeli soldiers beating a Palestinian child) can be placed in a larger context of overall violence, racism, social fragmentation, detention without due process, unemployment, impoverishment, malnutrition, family dysfunction, humiliation, and human misery and the devastating everyday impact of all of these factors on the psychological well-being. The psychological assault of 1948 was simple—designed to instill fear with the goal of inducing Palestinians to abandon their homes; but the psychological assault of today is sophisticated—designed to destroy Palestinian morale, to induce a state of passive hopelessness, and to undermine the sources of individual, family, and social cohesion. The goal today is to achieve the pervasive psychological isolation and surrender in an entire captive population which has nowhere to go and to crush Palestinian resistance at its roots in the human spirit.

The effects of the occupation on all sectors of Palestinian society is thus the driving force for a major burden of mental health distress afflicting millions of individuals, a distress in which very high rates of common psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder have been documented. But unlike the damage to a community in the wake of an earthquake or a flood, the harm to the Palestinian people includes and exceeds the domain of acute injury; the Palestinian people have suffered from chronic injury inflicted by chronic injustice. Under occupation, the people of Palestine face a purposefully inflicted degradation of the entire system of meaning which has given them identity as a people. Not only individual selves but the collective self has been damaged. We are challenged as healers to think in new ways to develop comprehensive theories and practices appropriate to this context.

In our view, the mental health community is especially equipped to be active and proactive in addressing these clinical and—at the same time—moral challenges both in our daily practice whenever these issues arise and beyond, through our professional organizations and activities. Our professional skills as active listeners, as clarifiers of contradictions, as confronters of confused thought, as persuaders in the community and care-givers to the suffering, and as defenders of justice for the vulnerable and the victimized—these skills prepare mental health workers to be useful in multiple ways in the struggle against the occupation.

We encourage mental health workers first to do no harm: for example, to speak out against the participation of fellow professionals in roles which advance the practices of the occupation, such as assisting in the development of “interrogation” techniques. In addition, we encourage mental health workers to join projects to open the scope of debate, to witness, to document, and to engage in research addressing the occupation and to seek out partnerships with Palestinians to expose the full extent of its consequences. There is great need to support Palestinian initiatives that provide direct mental health services for patients and foster forms of community life which are genuinely therapeutic for the Palestinian public. As mental health workers, we have skills as clinicians and trainers which may be of practical use on the ground.

But just as no mental health professional would treat a victim of ongoing incest or torture without “calling the authorities,” no mental health professional can treat a victim of occupation in a vacuum. Our duty to report abuse is part of our professionalism and in many instances is codified in statute as our legal obligation. The abuse must stop or all of our therapeutic efforts will be meaningless or perhaps even harmful, because victims of abuse need justice in the world as well as therapy. The treatment of victims of violence is thus multi-disciplinary in its essence, because outside forces such as the police and the court systems are required to restore fundamental rights to the injured parties, acting in coordination with mental health as a discipline. It is consistent with our mandate as healers that we integrate public health agendas which examine and take action to address the root causes of human suffering. Therefore human rights must matter to mental health workers, requiring activism in response to their violation and disregard.

The psychological and psychiatric consequences of the Israeli occupation are not only mental health events but legal and geopolitical events; restoring mental well-being requires us to call for the intervention of moral and legal authorities with international stature. Just as professional organizations in mental health have cooperated with legislators and judges to create and to enforce laws protecting the victims of incest, rape, and family violence, thus too the mental health community must work in mutually supportive ways with legal, political, and human rights organizations to seek justice for the Palestinian people and restoration of its human dignity.

Thus, as concerned professionals, we may need to move beyond the confines of our accustomed professional roles and to act as a group in support of movements to achieve a genuine transformation in Israel and in occupied Palestine that respects the human needs and human rights of all who live there. We must commit ourselves not only to work as clinicians for the liberation of the individual but for the liberation of the community. We call upon mental health professionals to engage in sociopolitical solidarity with the people of Palestine as a therapeutic position. Dedicating ourselves to this work while the occupation continues will give us the insights we will need in the future, as facilitators involved in the process of reconciliation. Laying down a foundation of involvement during a time of crisis prepares us for participating in a resolution to the crisis that will bring genuine redress, justice, and full civil rights to the people of Palestine.

Samah Jabr MD is a Psychiatrist and writer living in East Jerusalem

Elizabeth Berger MD, M.Phil is a Child Psychiatrist and writer living in New York.