Prison affects the mind as well as the body. Abdel hamid Afana reports from Palestine.

Many people in Palestine have personal experience of arrest and imprisonment. Since 1967 400,000 Palestinians have been imprisoned for political reasons. Many have been badly treated, some have been tortured. What has been the effect of such large-scale imprisonment? In 1992 Gaza Community Mental Health Programme researched the mental health of former political prisoners. Not surprisingly, most experience economic hardship and face problems in finding new employment. Many also said that they found it difficult to adapt to family life and to socialise or had sexual and martial problems. The trauma of imprisonment has had deeper psychological effects. For some people this takes the form of constant intrusive memories and bad dreams, others experience withdrawal and numbness, while some refuse to talk of their prison experience. In many cases, to be a former prisoner is an advantage. They are publicly welcomed back to their communities and celebrated as heroes. They may be offered jobs not open to others.

Shame and stigma

In Palestine if a person is identified as seeking psychological help it stigmatises not only that person but also his or her family. Many people prefer to see a traditional healer or a medical doctor, rather than a mental health specialist. Ironically, former political prisoners face worse stigma than others with mental health problems. There is no room for them to express regret or fear; people who were able to withstand torture and ill- treatment in goal should not be seen to complain. All these factors make it harder for former prisoners to seek help. Former political prisoners may deny their experiences as a mechanism of defense, to try t establish a state of psychological balance. Even where this denial is accepted by the community, it makes the underlying problems harder to deal with. Once former prisoner first told me have no psychological problems'. However, later he revealed how it was difficult for him to take an evening shower since it brought back memories of how his Israeli gaolers used to take him from his cell in night and forced him under a very cold shower. The stigma also affects employment prospects. The new Palestinian Authority has made it a priority to reward people who suffered during the Israeli occupation. Many political prisoners are seeking employment or positions with the Authority. Therefore, they must not be seen to have emotional or psychological problems. Our programme aims to local social services in the community to overcome mental health problems. But the problems of stigma and denial mean that we need to meaningful ways of supporting formers prisoners, whether individually of in a group.

Peer counselling

Unless you a prisoner yourself it is difficult to understand the fears of others. We decided to train former prisoners as peer counsellors. A peer counsellor can communicate more easily with other prisoners, listen to their problems and convince them to seek help when necessary. Working together with the rehabilitation center for political prisoners we designed a three-month training course, focusing on the communication skills, basic counselling, the referral system and the effects of violence and torture. The aim is to be culturally sensitive and to support work in the community. Our peer counsellors are carefully selected and are supervised by mental health professionals. The basic aim is for them to identify mental health problems and work with individuals to understand and resolve them; they refer individuals to specialist services. To facilitate referral, we have compiled a directory of local health services and distributed is free of charge.

Group therapy

We have also trained our staff in the principles of group therapy, where the sharing of experience is part of the recovery process. People participate on a voluntary basis and speak only when they feel ready to do so. Everyone is given time to talk. Group sessions give opportunities to share experiences, to create trust, empathy and fellowship within the group. This provides a basis for individuals to rebuild their personal confidence, to improve their personal relationships and find a positive way forward into the future.