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Creating meaning during occupation: Social relationships in the counselling of Palestinian torture
survivors Anwar Saadi Wadi[1] -Published in book of Rehabilitation
and Israeli oppression and abuse of the Palestinian people has lead to a
complexity of traumas and damage in humans and in social relations. A three
dimensional community health approach focusing on family, networks and society
seeks to rehabilitate individuals and to restore social capital. A profound
understanding of the political situation and the motivations behind political
activities is paramount for successful rehabilitation and requires both
professional and human involvement from the therapists. Introduction Dispossession, forced migration, occupation and economic siege.
These are tools used by the Israeli government since 1948 to oppress the
Palestinian people. Fifty seven years of systematic violation of virtually
every internationally recognised human right. Since the beginning of the Israeli
occupation of Torture is used systematically by the
Israeli authorities in the conflict. Humiliation, sexual torture, systematic
beatings and food and sleep deprivation are only some of many torture methods
applied. Torture is used to obtain information from the victims and to weaken
the core of the prisoner’s personality. Furthermore, torture aims at destroying
the victim’s personal network of support, destroying the social structure of
the Palestinian society as a whole as well as discouraging any thought or
speech against the dominant power. Additionally, the Israeli army has systematically shelled and destroyed Palestinian residential areas during the current Intifadah (Al Aqsa Intifadah). As homes have been bombarded and made uninhabitable, many Palestinian families are living in tents. On top of this, the economic crisis
leading to unemployment and poverty and a political development marked by the
failure of the peace process represents severe ongoing stressors for the
Palestinian population. Hence, a significant part of the
population has been directly exposed to torture or other human rights abuses,
and the society is heavily marked by economical constraints as well as
oppression and human rights violations carried out by the Israeli occupying
forces. Families, networks and
communities
In order to improve this situation and to enable victims of violence to cope with their traumatic experiences, individual treatment and social support is being provided by the Gaza Community Mental Health Programme (GCMHP). The programme runs three clinics that serve the population of the Gaza Strip. Therapy is provided to patients through multi-disciplinary teams predominantly consisting of health professionals but also of social workers. The psychotherapist or counsellor as part of the multidisciplinary context involved in helping the survivor is fundamental to our work. Our work is based on a community mental health approach, which considers three levels of Palestinian social life: family, network, and community. We understand these levels as dimensions of systematic interaction in which individuals participate and through which they generate meaning and purpose in their lives. Family In the Palestinian family, gender and age play a big role in determining responsibilities. The father is usually the head of the family and the provider for its needs while the mother plays a key role in raising children and taking care of the home. In the past, most major family decisions were made by the father alone, but this has changed in recent years, and today some decisions are made jointly by both parents. Sons and daughters are taught to follow the inherited traditions and are given responsibilities that correspond to their age and gender. Sons are usually taught to be protectors of their sisters and to help the father with his duties inside and outside the house, while daughters are taught to be the source of love and emotional support in the family and to help their mother with household chores. Palestinians teach their children cultural values and customs from an early age. Expanding in range as the children grow older, there are certain duties, responsibilities and expectations of social behaviour for every age. Thus, an individual who grows up in a family inherits and internalises a range of meanings and habitual patterns or behaviour through which he or she relates to others to give meaning to his or her experiences of the world. All this suggests that it is not only the particular characteristics
of the individual survivors which predict psychological adjustment after
traumatic events; it is also plausible that the family atmosphere shapes the
ways in which the survivors can use their competences. Consequently, a supportive family is the best recovery environment
for a trauma survivor. Indeed,
Garbarino (1992) observed that children cope better with stress and traumatic
events if they retain strong positive attachment to their families and if
parents continue to protect their sense of stability. On this basis, the therapeutic team works with
Palestinian torture victims and their families by making home visits to provide
family counselling, psychosocial education and social support to help not only
the victims themselves, but also to help their families cope with the victim’s
traumatic experiences. Network Individuals who have grown beyond the stage of infancy relate to many other individuals outside their families: friends, neighbours and peers. These relationships have a sort of regularity and continuity over time and can be labelled networks. The individual develops further patterns of interaction and communication through these networks, thereby elaborating his or her comprehension of the world and everyday life (meaning system), whose basis is initially formed in the family system Palestinian networks help and support each individual in the society and enhance the person's sense of well-being by providing social and economic resources through their own collective efforts, social integration and interaction. In this way, networks enable people to deal with ongoing problems and changes. These factors and their positive impact help to strengthen those that have become weak. Both the informal sector (family, friends and neighbours) and the formal or professional sector (doctors, nurses, social workers and the rest of the health care professions) play a significant role in this process. The GCMHP's team also works with networks
through local advocacy and networking. This involves interaction with a large
number of local civil society institutions. The team issues statements and
appeals according to events and works at community level to prevent abuse and
to promote respect of human rights, especially concerning issues relating to
torture and its psychosocial effects and goals. The importance of support networks is generally recognized within the health and mental health sciences and understood as an essential and significant determinant in maintaining health, recovery from illness, preventing the ill effect of torture and recovery from trauma.
Community Both the family and the networks exist within the context of a larger group of people with a shared language, a shared comprehension of the world and everyday life (their system of meaning), shared pattern of interactions and communication and shared symbols, values and concepts of individuality. The culture of the community
gives meaning to the survivor's experience in the language and symbols of his
or her community. Thus, it is of utmost importance to recognise the rich
sources of meaning and symbolism available to the survivor from his or her own
culture. The destruction of the community, within
which the family and network have existed and from which they have derived
their most fundamental values and systems of meaning, is one of the most
demoralising experiences for torture survivors. At the community level, many
activities have been carried out by the team, such as the production of a
bi-monthly journal, which has a wide local distribution, on issues of human
rights, imprisonment, torture and rehabilitation. Public education and media
activities target the community at large and provide training courses for
police/prison on human rights related issues and mental health. Aspects of counselling and psychotherapy in Palestinian culture In accordance with the three dimensions, family, network and community, CGMHP adopts a community mental health approach that is sensitive to the needs of Palestinian society and its culture. It is necessary to take the social nature of human existence into account and to recognise that a person's sense of self is rooted in his or her relationships with others. Our focus therefore shifts from the ´individual’ person to the ‘individual in relation to others’, which leads us to focus the counselling on these social relations. Following this, we understand torture and organised violence as an assault, not on an individual alone, but on the family and the community to which that individual belongs. The family plays an important role in the therapeutic process. Home visits are made with the aim of involving the family of torture survivors in the treatment plan, thereby ensuring that survivors have a supportive environment to facilitate treatment. The implementation of community educational campaigns which seek to reduce the stigma associated with mental illness and raising awareness of mental health disorders in the community are also used. Much caution is taken in building the relationship between the therapist and the survivor. First of all, it is important to respond to the role that society gives the therapist. In the Palestinian society, the therapist is looked upon as an authority figure in the same way as parents, teachers or leaders in society who are considered powerful and responsible. Moreover, the therapist is seen as a representative of the community and not as a representative of the individual. These characteristics are important to respond to by the therapist to ensure a successful therapy or counselling process. Treatment of Palestinian ex-political prisoners is often difficult due to the problems of constructing a trust based relationship to the therapist. The ex-political prisoners consider themselves heroes who have fought for freedom and nationhood and feel that they should not have psychological problems. Therefore, they are hesitant to accept the need for treatment. They have always told stories of their heroic experience – the only stories that people want to hear - and identify themselves with symbols of power. They posses a strong self-image that can not be compromised by acknowledging weakness or personal problems. Hence, in order for the therapist to build trust between him or herself and the client, the therapist must pursue an equal relationship where the experience and active participation of the survivor is given priority. Recognition, respect and understanding of religion, the
socio-political context and the personal values of survivors is also important
in the therapy. The therapist has to understand the culture and the political
attitude of the torture survivor and the meaning of individual differences on
political and ideological attitudes. He or she should also know how to
recognise these differences and shape the counselling and therapy to fit the
client’s world. To create a safe environment, the therapist has to
listen and to share the experience of the client. It is important for the
therapist to be aware of his or her own behaviour, especially not to remind the
victims of the interrogators’ behaviour. Otherwise the survivor will feel
vulnerable which will prevent him or her in expressing him or herself and to
talk about his or her suffering. At the same time, the therapist should be
aware that the survivors often use denial as a defence mechanism to establish a
state of psychological balance. Building trust between therapist and survivor is
therefore key to the successful treatment. Providing new relationships in which
trust and empathy can be re-established provides a basis for the generation of
new meanings with which the torture survivors can make sense of their
experience. In paying attention to the survivor's socio-political
status and subjective experience, it is necessary to take account of the social
nature of human existence and to recognise that a person's sense of self is
rooted in his or her relationships with others. This means that therapists should understand
the sub-cultures of the society and have sufficient knowledge of the different
Palestinian political organizations to establish a good therapeutic
relationship with the victims and their families in order to facilitate the therapy
process. It is fundamental for a successful process that both the survivor and the therapist
understand the political-social-historical context, and know that the survivor
was subjected to torture scientifically designed to destroy the core of prisoners'
personality and the social structure of Palestinian society. All the above mentioned elements enhance and facilitate the therapeutic relationship with the torture survivors. Conclusion In this article, guidelines to understanding the individual within the contexts of family, social network and community have been presented. It is through contextual relationships that individuals establish and maintain a sense of identity and a sense of meaning and purpose in their lives. Torture and organised violence radically transform and sometimes destroy these contexts of family, network and community including the patterns of relationships within them. The transformation or loss of these patterns of relationships drastically undermine the individual's sense of purpose and meaning in life. It is, therefore, extremely difficult to retain a sense of continuity and to reassert a sense of identity, purpose and meaning. The individual does not only suffer mentally and physically but is also faced with new economic and socio-cultural problems. In our work with torture survivors we focus not only on the torture
and its impact on these individuals, but also consider how their relationships
have been changed and how they understand themselves now as a member of the community. Our therapeutic task is to provide a context
in which previous systems of meaning can be recovered and new ones developed. Palestinian
patients seeking treatment for their psychological problems have unique
characteristics related to socio-political, cultural, and other factors that
affect the therapeutic process. These patients present challenges to their
therapists due to the contrasting cultural understanding and conceptualisation
of mental illness and therapeutic process. Therapists need to fully appreciate
the relationship between culture and psychotherapy, especially when providing
counselling to ex-political prisoners. We are further aware, not only of the value of scientific theories, generalised categories, and conceptual frameworks, but also of their limitations. We see our role not so much as directors and organisers of a process, but as participants. This calls for us to engage in the process not only at a professional level, but also at a human level; to be prepared to subordinate our scientific theories and professionalism in a struggle for human rights and human values. The process of arrest, torture and release involves
trauma at many levels. This trauma can be understood, not only as an assault on
the individual person, but also as an assault on the links and connections
between people and patterns of relationships through which people define
themselves and give meaning to their lives. As Palestinians, we share a trauma
which has affected us all. We all need help and can, in return, give help to
others. However, without stable political and geographical boundaries and
without recognizing the right of others to re-build their countries, the
suffering will increase. That is why those who inhabit communities that are
currently stable and democratic must support those of us who have chosen to
practice our therapeutic task, at great personal risk, in countries under
occupation. As Palestinians we share a trauma which has affected us all. References Basoglu M, Parker M, Ozmen E, Tasdemir O, Sahin D: Psychological responses to war and atrocity: The limitations of current concepts. Social Science & Medicine 1994;40:1073-1082. B'Tselelem: Policy of destruction: house demolition and destruction of agricultural land in Gaza Strip. Corey G: Theory and
Practice of Counselling. Lazarus RS, Folkman S: The concept of coping.
In: Monat A, Lazarus RS (Eds.): Stress
and coping: An anthology. |