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Newsletter
Vol. II, No. VI.
Eighteenth Issue,
September 2004
LETTER FROM THE SECRETARY GENERAL
Farouk EL Sendiony
Recently, professor Dr Ahmed Okasha: President of the World Psychiatric Association delivered a keynote address entitled "Strategies for Post War Rehabilitation of Mental Health Services: Focus on Iraq". This was read at the "Presidential Symposium of the American Psychiatric Association Annual Meeting, May 2004.
Professor Okasha - a man who could stand up and be counted - said it all, and made his conscious clear.
His report is stimulating, written with a profound compassion for Victims of Trauma. This is a welcome change from an all-too prevalent cold, clinical approach, which regards patients as experimental subjects rather than people in need of treatment.
I found his work to be a highly scholarly work of major significance to World Trauma Psychology. I recommend this work for colleagues and students and like them to familiarize themselves with this outstanding work.
I asked Professor Okasha for his permission to publish this work in the current issue of the WIAMH newsletter. He was too kind to grant his permission instantly.
I am writing to convey to him my warm appreciation for his courtesy in granting his permission for publication.
Mind matters
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Ahmed Okasha* urges an increased involvement of mental health professionals in Iraq and denounces the psychological and physical damage inflicted on Iraqis by the United States
"Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed."
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These are not the words of an Iraqi or Palestinian politician denouncing war and occupation in their respective countries. They are the words of former United States President Dwight D Eisenhower, spoken on 16 April 1953.
I advise you all to visit www.costofwar.com.A running figure on the top right-hand corner of the webpage indicates the cost of the Iraqi war, not in terms of what the world pays for, but in terms of what the US alone pays. At the time of writing, the figure was a sobering $111,778,777,859, and it is rising by the second.
Instead, the US could have paid for 15,803,624 children to attend a year of Head Start -- a programme designed for lower- income preschoolers to gain early access to education. It could have medically insured 47,912,160 children for one year. It could have hired 2,129,125 additional public school teachers for one year. It could have provided 2,835,234 students with four-year scholarships at public universities. Instead, it could have built 1,596,845 additional housing units for US citizens. I will not even start to think what that amount of money could have provided in deprived Third World countries. Nor have I yet borne in mind the Iraqi casualties: the dead, the injured, the disabled, the destroyed infrastructure and the looted universities and cultural centres.
But this is how the world is run now. Not by health professionals, whose prime concern is saving and improving the physical and mental life of people, but by politicians whose prime concern is power and more power -- be it political, economic or otherwise.
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An Iraqi man weeps on learning that he is not allowed to visit his relative in Abu Ghraib prison (above), while Abdul Hafidh Mekhlef hugs his crying son after being released from the infamous jail |
In April 2003 the World Psychiatric Association (WPA) released a statement warning of the consequences of the war on Iraq; the executive committee's profound concerns were included in that statement. It stressed that the humanitarian and health consequences of such a war must not be underestimated, both in terms of their devastating immediate effect on the people of the region and on international relations, and in terms of jeopardising the possibility of a peaceful future for our planet. As psychiatrists we are entrusted with the mental well-being of all people of the world, with no discrimination on the basis of race, religion, colour or gender. The gravity of war in the region -- which has already reaped far-reaching, tragic consequences on life, health and security for all involved, locally and across the world -- should be highlighted.
On 10 December 2002, the International Day for Human Rights, the World Health Organisation (WHO) issued a report estimating the likely humanitarian scenarios following a war on Iraq to include massive destruction of infrastructure. "Damage to the electricity network will result in collateral reductions in capacity in all sectors, particularly water and sanitation as well as health," the report read.
The report continued: "Direct and indirect health casualties are estimated at 500,000; vulnerable population is estimated at 5.21 million including most pregnant and lactating women and children. Vulnerable groups in need of rehabilitative programs can be foreseen to include 5,000 persons confined to institutions, comprising orphaned children, the severely handicapped and children in detention, 21,000 elderly, 150 million unaccompanied minors and two million internally displaced refugees, most of whom again will be women, children the elderly and the disabled. War traumas and displacements will be but a few of the life events that are awaiting the country's population of 26.5 million citizens." The provision of mental health care through national institutions will probably have to retreat in front of other services deemed to be more vital.
In 2002, the WPA executive committee urgently called on all its member societies to exercise their best efforts and contacts to prevent war and resolve the crisis in a peaceful manner, under the leadership of the United Nations and its competent structures. We emphasised the need to do everything possible to prevent such regional and global major psychological and personal trauma. But nobody listened. The invasion was launched. One of the most tragic traits of modern times is that once war breaks out, it does not end. In most wars, one party is responsible for launching war, and another exercises its right to self-defence. War is no longer the one-on-one clash it once was; it is no longer the war between armies, between leaders; it is now a war of leaders against people who were never consulted, whose opinion was not taken, and yet have to suffer while the decision- makers plot in their secure, protected and heavily guarded offices.
It is those people that are our concern and responsibility.
Indeed, we have tried to fulfill our role. An unprecedented endeavour by the international psychiatric community was launched during an international consultation on mental health and the rehabilitation of psychiatric services in post- conflict and complex emergency situations at the WHO East Mediterranean Regional Office, Cairo from 28 to 30 July 2003. The WPA executive committee collaborated closely in the preparation of this meeting with 15 WPA member societies, including the two largest societies -- the American Psychiatric Association (APA) and the Royal College -- as well as the two zonal representatives from the Middle East and North Africa.
The objectives of the meeting were to develop a coordinated strategy, methodology and approaches for, first, a rapid assessment and identification of the most immediate needs; second, a comprehensive needs assessment and situation analysis; third, a plan of action for the remainder of the year 2003; fourth, planning for the preparation of a strategic programme and plan of action for 2004-2005; and fifth, the identification of the financial implications of the strategies and fund raising. The meeting concluded with a number of comprehensive recommendations. First, that mental health should be given priority in the National Health Plan and be integrated into primary health care services. Second, the Poverty Reduction Strategy should be tailored to suit the cultural context. Third, a needs assessment should take into consideration the needs of the population, infrastructure, facilities and supplies and available human resources. Fourth, human resource development in mental health at different levels is of critical importance. Fifth, the empowerment of patients and families of the mentally ill should be a priority. Finally, that teachers, religious leaders and voluntary agencies should be involved in health education and in building on people's initiatives.
We were promised a reconstruction phase and we had planned to use it to ensure that our recommendations were appropriately integrated, despite the constraints imposed by security concerns and demoralisation. However, this phase never came.
Non-governmental organisations visiting Iraq have tried to forge a space for intervention. An Egyptian NGO working on the rehabilitation of victims of violence visited Iraq and was torn between addressing traumas left by the regime of deposed Iraqi President Saddam Hussein, the traumas of the 13-year period of sanctions, and the traumas of the US-led occupation. Children are sleepless, enuretic, terrified, lacking all sense of security and left with no answers to basic, legitimate questions of why are those troops still there, why the bombing is continuing, why raids are being carried out and why their homes are being destroyed. Adults live caught between the options of submission and resistance, neither of which spares them from being targetted by missiles. For Iraqi children and the elderly, men and women, it is a no-win situation.
A recent report released on 8 April by the international organisation Occupation Watch states that in Falluja alone, over 300 Iraqis were killed and hundreds more injured since attacks began on Sunday 4 April. In Falluja, hospitals have been surrounded by soldiers forcing doctors to set up field hospitals in private homes. Blood donors are not allowed to enter; consequently, mosques in both Baghdad and Falluja are collecting blood for the injured. Water and electricity were cut off for days.
One needs to be familiar with Arab culture to understand how a state of hopelessness affects the choices of the people, especially when they feel violated. Part of that culture is to avenge defeat, a matter that can cut across generations. Arabs will continue to fight for as long as they feel that their dignity is injured, for as long as they feel violated. They will only stop if the aggressor will publicly acknowledge guilt and assume responsibility for the aggression. Then, and only then are they ready to reconcile.
The US army went into Iraq to overthrow Saddam Hussein and allegedly to search for weapons of mass destruction. The weapons were never found. We should not forget: Hussein was backed by the US and supplied with weapons of mass destruction to fight Iran. Similarly, Osama Bin Laden himself was on the payroll of the Central Intelligence Agency, fighting the invading Soviet troops in Afghanistan.
US presence in Iraq has been and remains an occupation. This is not simply our claim: this is the way the international community describes the situation in Iraq. The Arab people cannot live under occupation -- it is too humiliating. They have come to learn that negotiations do not end occupations. Though it may be true that fighting does not end occupations either, at least it gives them a sense of being, a sense of not giving up.
Certainly, it is in response to such situations that altruistic phenomena such as suicide bombings take place. One could describe the act in Orwellian terms: "You want to live. We want to die." This phrase hints at the bombers' helplessness, hopelessness and despair. Ideology and worldview certainly come into play, but there remains the question of how much the proponents of a particular ideology actually believe it rather than manipulate it in order to use it as a fundamental tool in their fight. For suicide bombing is an act of absolute despair, far more than one inspired by ideological commitment. It creates a sense of achievement: it is seen as the achievement of a "victory" against the "enemy", and it is coupled with the achievement of a state of martyrdom that is rewarded in heaven -- in another life. Both are great rewards for a people whose "here and now" is strongly influenced by religion and a belief that those chosen for martyrdom by God are honoured.
Let us consider what happens in countries that breed suicide operations and so-called terrorism. They have political systems -- usually US- backed -- characterised by despotism, atrocities, oppression and corruption. Their populations are poor. Poverty leads the individual to lose faith in the system, in their leaders, in the world. They turn to faith, religion and ultimately fundamentalism, and because of their helplessness and hopelessness, they chose to be martyrs in their conviction, freedom fighters or terrorists.
This is not meant to be a political presentation about Iraq. It merely seeks to explore the background to the situation in which we have tried to become a party. We might plan as much as we want, and make the most rational and comprehensive recommendations. But we shall not be able to implement any of them so long as the war in Iraq does not stop, if those in charge in Iraq are not made to bear their responsibility of the well-being -- both physical and mental -- of that people.
A generation that sees nothing but death, blood and disability is hardly capable of reconstructing a nation. A generation tormented by post-traumatic stress disorders is a generation drowning in images of the horrible past, rather than one planning for the future. Unfortunately, we psychiatrists have to deal with disasters initiated by policy makers. Our job is to help the sufferers and to try and minimise the consequences on mental health. On previous occasions, we did not do enough. We did not do enough for Rwanda -- where one million died -- nor for Bosnia or Kosovo, nor for occupied Palestine, Somalia or Sudan.
We must find a way to prevent mental ill health, regardless of political conflicts. As psychiatrists we should transcend political, racial, religious conflicts for the welfare of our patients. Yet, how can we draw a line of demarcation between the consequences of decisions of policy makers and looking after the victims of their decisions? To put it simply, how can we gain access considering that one needs a permit to help afflicted patients in regions of conflict?
As professionals, we have to tell the world that in such desperate situations -- where you can lose your child to hunger or missiles, where there is no guarantee that your home will remain intact, where your hours and days are either times of military raids or of waiting for raids -- martyrdom is legitimate, for it is the only way for people to offer a sacrifice, even if it entails death itself.
We have the resources and the volunteers who are ready to help improve mental health in Iraq. What we do not have is a guarantee of their security. In June last year, the president of the APA and I wrote to US Civil Administrator in Iraq Paul Bremer about the mental health hazards implicit in Iraq and the professional need for our intervention. Until this very day we have not received a reply. The international community cannot claim that it did not know of the problems that Iraqis are experiencing, for we -- among many other humanitarian and health organisations -- warned of the consequences of the US-led invasion. Now, we are simply reiterating what we have previously said.
We need to go to Iraq in order to identify the needs of the people. We need to have access to patients and the traumatised. We need to abide by the first provision of the Madrid Declaration, that ours is a medical discipline concerned with the provision of the best treatment for mental disorders, with the rehabilitation of individuals suffering from mental illness and with the promotion of mental health. It is clear that the only solution is to collaborate with NGOs and human rights activists, and to disentangle ourselves from the ideology of selected world leaders. We may even need to address those leaders publicly, and denounce their actions by exposing the damage they have inflicted on the mental ill health of a whole nation. Maybe we should send our own professional messages to the leaders, to the media, to the UN. In short, lobbying may be what is needed before we can hope for intervention.
If we want our efforts to be of use, if we want it to go down in history as those who lobbied leaders to take mental health into their consideration, we should be more outspoken. In that respect the APA and the Royal College of Psychiatrists are in an especially good position to take the lead in addressing their respective governments to give priority to the mental health of the people of Iraq. The British and American public strongly sympathises with the traumatised women and children of Iraq; this is a strong element that can work in the favour of our mission. Needless to say, the WPA will be an essential actor in this endeavour.
For now, we must continue emphasising the hazardous implications of the war on the mental health of the people of Iraq. We have to be innovative in our work, even if that means transcending the boundaries usually imposed on our profession. At best we might make some change. At worst we would spare ourselves the guilt of having stood on the sidelines of a disaster while we could have been agents of prevention.
* The writer is president of the World Psychiatric Association and director of the World Health Organisation's Coordinating Centre for Research and Training in Mental Health.
Source: http://weekly.ahram.org.eg/2004/695/re11.htm
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FIRST PAN MEDITERRANEAN CONFERENCE ON PSYCHIATRY AND CULTURES
9-13 November 2003
World Islamic Association For Mental Health (WIAMH) actively participated in a Conference on "Psychiatric Care Across Cultures" in Malta from 9-13 November entitled "First pan Mediterranean Conference On Psychiatry And Cultures". This meeting was organized by WPA TP Section in collaboration with the University of Malta, Caretranslate International Network and the Italian Institute of Transcultural Mental Health. The Meeting comprised of plenary sessions and the following focus Workshops: (1) Good practice in Adaptation, (2) Good Planning for Adaptation, (3) Researching for better Adaptation and (4) challenges to adapting across the East - West Divide, The organizers also hosted a Gala Dinner that provided all the participants an opportunity to have more social contacts and a Reception courtesy of Ministry of Health.
The theme of that conference week was "Psychiatry Across Cultures." This theme reflected the fundamental purposes of Transcultural Psychiatry, to contribute to the understanding of human diversity, to assert and support the uniqueness of different cultural traditions; and to work toward individual, family, group and societal well being.
It was a well attended meeting with delegates from Egypt , Canada, USA, UK, France, Switzerland and , Denmark, Netherlands, Russia, Greece, Malta, Germany, Austria, Pakistan , Sweden and Palestine .
The first Pan Mediterranean conference on psychiatry and cultures was organized as an integral part of an overall Transcultural Psychiatric Program which preceded it and which will follow it. The multicultural week in Narni (Terni) - Italy, 9-14 June 2003 and the first pan Mediterranean conference on psychiatry and cultures, Malta, November 9-13, 2003 bring us closer to our objective of a Euro - Mediterranean congress intended to gather the reflection of colleagues from the Mediterranean basin.
Any meeting with colleagues of Gofferdos and Ron's stature is an event to cherish, and those days meeting with them in Malta were a memorable event indeed.
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WIAMH'S CONTRIBUTION TO FIRST PAN MEDITERRANEAN CONFERENCE ON PSYCHIATRY AND CULTURES
Thanks to the organizers of the "First pan Mediterranean conference on psychiatry and cultures", WIAMH was allowed to make a significant contribution to this memorable cultural psychiatric event.
The organizers were too kind to devote two special symposiums to cover the Islamic cultural context. These two symposiums were entitled: Symposium T1 - Islam and mental health and symposium T2 - 1 - evolving roles of women and their mental health implications in Islamic countries. These two symposiums included papers such as : Islamic aesthetics as a tool for understanding Muslim ethos, Ingrid a all ; sensitizing mental health professionals to Islam, Sushrut Jadhav; The role of Islam in the rehabilitation of survivors of sexual torture during genocide in Bosnia and Herzgovina , A. Kucukalic etal ; Social Institutions and Psychological explanations : The case of Druze reincarnation , Roland Littlewood : Muslim Perspective of Spiritual Healing of PTSD, Osman Sinanovic etal ;
Evolving roles of women and their mental health implications in Islamic countries, Afzal Javed et al. Rape, culture and Islam, Yemi Oloyede. And the first wife syndrome: A culture bound syndrome; EL Sherbiny et al. In addition to these 2 symposiums: Muslims behavior in a new culture was investigated. A typical example is: The incidence of schizophrenia among first and second generation Moroccans in the Netherlands, T. Zandi et al. In the symposium devoted by the organizers to psychiatric Effects of war - related trauma, the Islamic perspective concerning traumatization was never missed. Examples are: Psychiatric Aspects of the Iraqi War, David Kinzie; War-related Posttraumatic Stress Disorder in children, Osman Sinanovic et al; Posttraumatic community impairment, Farouk El Sendiony; the effects of the Iraq war on refugee psychiatric patients in Sweden , Riyadh Al Baldawi, impact of the Iraqi war on traumatized Middle Eastern and Bosnian refugees, Pamela Edwards et al: The effects of the Iraqi War on Psychiatric Patients in Baghdad, Raghad Sarsam, and The Effects of the Iraqi War on Palestinian Patients: What Factors make people resilient or vulnerable in crisis, Iyad Zaqout .
Finally: Symposium w4- entitled - services adapted to context: Some Fly East was fully researched in the Arab World.
The first paper entitled: "Toward A model for culturally - appropriate community mental health care policies and practices in Egypt" was presented by Elizabeth Coker who co-chaired the symposium. This paper reported the results of a large - scale qualitative and quantitative research project aimed at psychiatric services in Egypt through the development of community mental health services that incorporate existing cultural and religious beliefs, attitudes and institutions. The paper concludes with specific policy recommendations to develop and implement culturally acceptable system of community psychiatric care in Egypt.
The second paper in the above mentioned symposium entitled: "A model for the delivery of services to refugee survivors of trauma and torture in the developing World" was researched in Egypt and presented by. Abd-Allah Mansour who chaired the session and who is head of El Nadim center for psychological management and rehabilitation of victims of violence, Cairo, Egypt. Based upon clinical research with refugee victims of trauma and torture who were forced migrants in Cairo, this paper proposed a model for the provision of mental health care for refugees that is sensitive to the very specific needs of this group as opposed to their counterparts who have been settled in the West.
For refugees from Africa and survivors of trauma and torture, they will find in Cairo and other large urban centers in the developing World no post, because stress is continuing and their trauma is far from over. This poses a challenge to the mental health program.
There is plenty in these papers to show that transcultural psychiatry can benefit from the perspective that Mediterranean cultures can offer for the diagnosis, prognosis and treatment of psychiatric disorders.
For readers of this newsletter who may be interested in any of the papers presented in this conference, he/she is advised to check the attached WPA transcultural psychiatry section, symposium, Paper abstracts papers.
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FIRST WIFE SYNDROME: LOTFY EL SHERBINY, M. EL NABULSI & FAROUK EL SENDIONY
We would like to raise two points in relation to this paper:
First: The exposure of the Saudi Women to the mass media. For Everywhere in Saudi Arabia, from the urban centers to the remotest areas in the desert, the Video Revolution is shaking up values including the value of polygamy. Video viewing is all the thing these days, not only for urban dwellers among whom VCRs are an increasingly coveted item, but also among residents of rural and Bedouin areas.
As women watch on the video that many women in the Global village live in strictly monogamous marital relations, they become indoctrinated with relatively high status aspirations.
The problem is compounded by the fact that polygamy as such is a religious right given to the husband by the Holy Quran.
To illustrate, 40 years ago prior to the impact of petrodollar shock, polygamy was not a major or even a minor factor in mental disturbances. In its traditional nomadic tribal setting, it had a biologic (rather than hedonistic function). It preserved the population at a time when tribal warfare killed off many men and disease caused a high infant mortality. In its natural habitat polygamy caused a minimal degree of jealousy.
With urbanization and improvement in health and levels of survival, polygamy was no longer useful and became a source of friction and distress in the family. Today, a lot of evidence seems to indicate that co-wives living in the same flat with one husband, producing half brothers and half sisters is a high tensioned situation developing neurotic anxieties, and in extreme cases rather serious mental diseases .
Second: The second point is related to therapy. "We affirm we believe and assert, indeed" we are convinced that the physician must have a value system, he must support the value of his community and of his day. By this we mean that he should not act as a rebel for the sake of acting as such. Hs should not try to eliminate polygamy.
The physician should show the husband that polygamy as instituted in the Holy Quran does not mean neglect and abuse of the First wife. Perhaps, it is not a mess, at this point, in this connection, to point out that the verse in the Holy Quran pertaining to polygamy amounts to a prohibition because the prerequisite is the capacity of the husband to equalize between the wives (up to four) in every respect.
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TOWARDS A NEW VISION
In recent weeks the international campaign against the destructive military operations by Israeli occupation forces in Rafah and its refugee camp has gained greater momentum. Many are speaking up to demand an end to these operations which are a clear violation of international law and may be considered war crimes and crimes against humanity. With the increased ferocity of military operations and Israel's revelation that it intends to demolish thousand Palestinian homes to enlarge the security corridor along the border between the Gaza strip and Egypt, International rejection of these policies has also widened in scope. Israeli organizations are acting to stop these operations, saying that they constitute war crimes and may subject Israel to international sanctions.
Israel continues to behave as if it is above international law, and the United States will not permit a Security Council resolution to set up an international court to try Israeli officials. Nevertheless, there are increasing fears in Israeli circles that day will come when Israel may find itself before an international tribunal, particularly with the widening scope of house demolitions and the increased aggression against the Palestinian people.
The Israeli committee against House demolitions has demanded that demolitions stop immediately. Committee officer Prof Jeff Halper says that Israel has demolished about 1.200 homes in the Gaza strip over the last three years. Pointing out the disproportion ate, arbitrary Israeli response to the death of its soldiers, Halper describes Israeli military actions as state terrorism, directed against an isolated, occupied civilian population with the use of full - scale attacks on crowded residential areas with plane, missiles, tanks, bulldozers and infantry troops, sometimes entailing the destruction of entire neighborhood.
"In presenting the deaths of the solders as a "terrorist attack", the Israeli government conceals entirely the fact that they died as part of a military force invading Palestinian towns and cities as part of a brutal 37-year occupation by Israel that shows no signs of ending", Prof Halper writes . "The occupation the Israeli peace camp stresses, constitutes the infrastructure of terror." The real issue according to psychiatrist Fannon is the occupation.
New dynamic factors, can only be found in Global civil society and partially in Europe and in the fact that Palestinians are learning on the ground. A new strategy can and should be founded on these factors.
Only when global civil society strongly intervenes in the Palestinian situation in such a way as to give Palestinians serious hope can they re-steer their national struggle towards a renewed peaceful strategy.
The re - invigoration of global civil society on behalf of the Palestinian national struggle places strong pressure on Europe to change its soft tactics in relation to this issue. It might also change the mindset of the World Jewry bringing them to intervene rationally for a peaceful settlement. Only when popular pressures are applied we can expect a new American president, such as Mr. Kerry, to act forcefully and in a semi-balanced manner to reverse the terrible situation in the Middle East generally, and in the Palestinian territories specifically.
Arab and International civil society organizations should act very strongly on this vision, according to El Sayed said "a good start can be the holding of a World conference on Palestine as soon as preparations can be arranged. What he has in mind is an impressive, perhaps unprecedented, global gathering for peace and justice in the Middle East.
Solid planning is needed to hold such a conference. And more vigorous planning for the implementation of its decisions would be required. The United Nations can be instrumental in helping such an alternative to emerge. However, it falls on Arab civil society to discharge the duties of making the initiative , putting together the needed plan of action and making the coming few years an opportunity for restoring justice and peace in Palestine and the whole region . The international community and the Arab World need to end their silence and intervene in coordination with Israeli peace groups such as the Israeli committee against House Demolitions.
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PSYCHOPATHOLOGICAL ROOTS OF GENOCIDE
The Merriam - Webster dictionary defines genocide as "the deliberate and systematic destruction of a racial, political, or cultural group". If we accept that, then what is happening in the west bank, East Jerusalem and the Gaza strip is according to authors Sam Bahour and Dr Michael Dahan - dangerously encroaching on genocide close enough that the pictures of Palestinians in Rafah loading their meager belongings on carts and evacuating their homes are too reminiscent of another time, an other place and on other people.
These very same images should be setting off alarms in the hearts and minds of Israelis. Unfortunately, at stake is not the lexicon of conflict, but rather our children, and we refuse to sit still to watch a deaf, dumb and blind World steal their future from them.
A few weeks ago, Lev Grinberg , an Israeli professor of political sociology at Ben Gurion university , wrote an article that created an uproar in Israel titled , "symbolic genocide".
In that article professor Grinberg wrote, "Unable to recover from the Holocaust Trauma and the insecurity it caused, the Jewish people, the ultimate victim of genocide, is currently inflicting a symbolic genocide upon the Palestinian people …
What is symbolic genocide? Every people has its symbols, national leaders and political institutions; a homeland; past and future generations; and hopes (Together) these symbolically represent a people. Israel is systematically damaging, destroying and eradicating all of these, with unbelievable bureaucratic jargon".
But in the past few weeks, according to authors Bahaour and Dahan, the situation can no longer be accurately defined as "symbolic". In the West Bank and Gaza strip, Palestinian cities and refugee camps are being battered beyond recognition. This is the same fate that the same Israeli leaders of today forced on Palestinians in Lebanon over 20 years ago and on Palestinians inside Israel proper over 56 years ago.
As professor Grinberg said, "This is a dangerous policy. It poses an existential threat to the Palestinian people, but also to the State of Israel and its citizens, thereby endangering the entire Middle East".
Nothing could be closer to the truth. With every Palestinian assassinated by Israeli helicopter gunships, with every Palestinian house demolished, with every Palestinian illegally detained in Israeli prisons, ten times as many child witnesses are radicalized.
Palestinian children now routinely climb on top of Israeli tanks invading their cities. Sadly, young Palestinians who have equated their life - the only life they know under this brutal occupation - with death. They are being recruited to take innocent Israeli lives with them while committing suicide themselves.
Victims of a naked aggression, Palestinians are slowly losing control of their society and being blamed for it as well. Israelis, too, are beginning to glorify death rather than life, as Israeli psychologist Yoram Yovel recently noted in an editorial in Ha'aretz . What is happening in Gaza reflects a deep psychological process that Israeli society is undergoing making it more and more similar to Hamas and the Islamic Jihad, Yovel claimed.
History has clearly demonstrated as we can see, that such chronic and unremittingly severe traumatization can lead to national pathological behaviors such as identification with the aggressor, dehumanization of the other and ultimately the desire for total elimination and destruction of the other through state-sponsored and personal acts of terrorism, The Palestinians are now the victims of such historically traumatized peoples.
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DEMEDICALIZATION OF TRAUMA: A CULTURALLY APPROPRIATE PROGRAM.
PAPER PRESENTED BY DR M.F. SENNDIONY:
THE MULTICULTURAL WEEK; NARNI (TERNI) - ITALY;
9-14 JUNE 2003.
The present conference and training course on traumatization mirror increasing awareness of the importance of cultural factors in mental health especially as they affect decisions about diagnosis, prognosis and treatment of the responses to traumatization.
In the present paper I will first outline the concept of "Demedicalization of the responses to trauma". Then I will focus on a culturally appropriate program of evaluation and care for traumatized population. The population which I have chosen is the Palestinian population.
By way of introduction let us outline the history and philosophy behind "demedicalzation of trauma".
Back in the last century, in the early nineties, the UNHCR, in collaboration with the WFMH and the Harvard Program of Refugee Trauma issued for the first time a focused work targeting the needs of victims of trauma and torture.
Entitled "Evaluation and care of Victims of Trauma and Violence", these guidelines designed to "demedicalize" the responses to trauma and to promote population based and culturally appropriate means of evaluation and care for traumatized populations. Those conclusions, including reliance on psycho-education as a basic tool in treatment, focus on realistic, non - stigmatizing, culturally sensitive interventions and encouraging maintenance of the family as a unit. The guiding themes of "demedicalization" are stated as follows :
(1) In the majority of instances, individuals possess the resiliency and adaptiveness to avoid the long term effects of forced displacement and trauma.
(2) Within traumatized populations it is possible to recognize the full spectrum of psychosocial and behavioral responses to trauma, including "normal", short lived, frequently occurring as well as those resulting in significant impairment and long term suffering.
(3) An individual's, response to traumatic experiences is, in general, poorly served by "medicalization", that is labeling the response as abnormal, requiring specialized intervention by the medical community.
By producing Guidelines, UNHCP courageously situates itself squarely in the middle of the current debate on what constitutes trauma, and what is the relationship between an individual's, trauma-related psychosocial impairment on the one hand, and social and economic dysfunction in the community on the other.
Responding to such a discussion, Guidelines promotes a public health model that encourages adoption of psychosocial interventions designed for use on a population rather than an individual's basis. Additionally, Guidelines display an unusually strong commitment to demedicalizing the personal responses to forced displacement and trauma. It repeatedly designates as "normal" the typical and widespread reactions to these experiences and advances the approach as a most effective means of ensuing "normalcy". By doing so, it appears to question the wisdom of using medical diagnostic labels to quantify distress and to justify services in these circumstances. According to Peter Baynes of Charles Sturt University, "PTSD seems to be a psychological rather than a medical condition and responds best to psychological treatment (e.g. hypnotherapy, stress management).
The world of psychiatry and psychology is often dedicated to assessing pathologies that are observed already existing in patients, groups, organizations or entire societies. The reasons behind this "postmortem" approach are many and varied and not necessary to elaborate on here, but it has become our primary lens that we spend much of our professional time patching up the wounded after they fall or quickly providing emergency medications and coping tools after they have lost the battle. We have, for example, proudly identified post traumatic stress disorder complete with multiple approaches and interventions designed to mitigate the outward behaviors and overt symptomatology as well as numerous psychosomatic manifestations born out of the individual's attempt to cope with the trauma after it has taken its toll, But, what if the trauma is continuous as the Palestinian and other countries caught - up in long armed conflict testify?
We have to differentiate between populations where trauma was the result of past atrocities and the Palestinian situation where, in addition to the trauma brought on by decades of a brutal occupation, each and every passing day brings the threat and often the reality of new and even greater traumatic experiences to many members of the population. The Palestinian trainees found clinical distinctions of and statistics about post traumatic stress Disorder, Post Traumatic Stress Reaction and Post Traumatic Stress in other parts of the world irrelevant , or at least certainly not worth the time focus it was given in conferences.
This leads to the following question: How can it be Post, if it is continuing? To place "Dr Masoud Khan's concept of "cumulative trauma" into a social context "the Palestinians are not dealing with Post anything". Their trauma , according to Dr. Mandy Brauer, "is both Cumulative and Continuing".
It may be that the Palestinian situation is - according to Dr. Mandy Brauer highlighting psychological problems that the mental health community simply never had the need to address so directly. Perhaps no other people has been systematically victimized and traumatized for so long a period of time, especially in the modern day World. It is easy to document over eighty years of brutality, loss of land and homes, loss of dignity, humiliation, death and injuries coupled with a dehumanization which has pervaded World - wide opinion.
It may be, therefore, that Algeria or South Africa would be a more appropriate model to investigate than Bosnia which was used extensively by teams from University of Missouri which volunteered to train them 4 times, inside and outside Palestine. However, because of the specific conditions resulting from the Palestinian people having been occupied and brutalized for so long, the mental heath community, along with Palestinian mental health professionals, also need to think about new and innovative mental health interventions which will be effective. This in itself needs to be the focus of a conference. There is also a great need for re - examination of the diagnostic category entitled:
"Post Traumatic Stress Disorder" described in great detail in DSMIV
This leads to the following questions: What do we do with this massive traumatization? How do we begin to heal? How do we heal?
Recently Dr. Ahmed Okasha, the President of World Psychiatric Association describes the situation of the Arab people as a people whose "here and now" is strongly influenced by religion, It would have been helpful if the mental health worker looks deeper into his Islamic heritage for religiously and culturally appropriate ways to handle many of the issues related to traumatization.
Islamic social influences upon traumatization will be discussed along two main themes the preventative aspects were illustrated by the Islamic religious code with its encouragement of patience in the face of Natural and Man Made disasters.
The Quran, the Book of God says: that acceptance of disaster and misfortune is rewarded in Heaven. This is exemplified by the following Surah from The Glorious Quran:
"And surely we shall try you with something of fear and hunger and loss of wealth and lives and crops, but give glad tidings to the steadfast.
Who say, when a misfortune striketh them: to We are Allah's and do unto him we are returning. Such are they on whom are blessings from their Lord, and mercy. Such are the rightly guided"
Thus you see that ideology and world view certainly come into play in the phenomena of trauma. The reader can see from the above mentioned Surah that trauma is a test from Allah. There is some aspect of desensitization with this respect. There is also great reward for those who accept it. Islam as a religion and a way of life is rooted in the belief that whatever happens to man in this world is the will of Allah. The test of the true believer's is piety, patience and surrender to the divine will. The author must make a distinction between surrender to the will of Allah and Fatalism. It is a qualitative distinction marked by intentionality, positive acceptance and even contentment.
A mental health worker may use these Islamic principles to face the inevitably painful experience of Man-Made Disaster.
In this connection he may invoke the holy Quran: "You might hate something that is good for you".
From the psychotherapeutic point of view, religious practices, especially prayers (which provide hope) improve morale, and enable temporary states of released detachment from mundane problems, relieve the despair of demoralized traumatized Muslims.
Thus, the mental health worker should also have a fairly good knowledge of the content of the religious thinking of the Muslim victim of trauma in order to assess his faith as a resource in the management of trauma. A Muslim under whatever physical, mental, social and emotional circumstances is a believer in Allah. This unshakable faith in Allah and acceptance of his divine will may be mobilized by mental health workers successfully in the support of their clients who have been exposed to major traumas as several verses from the holy Quran testify.
It is interesting to note that there are usually traditional means for the alleviation of the effects of trauma. The individual is not altogether left at loose ends; he may obtain some relief and reassurance through the utilization of institutionalized defenses.
8
URGENT COMMUNIQUE
FROM
THE WORLD ISLAMIC ASSOCIATION FOR MENTAL HEALTH
OPERATION RAINBOW: MAY 18-MAY21, 2004 BY ISRAELI ARMY. A MASSACRE OF PALESTINIANS IN RAFAH
The World Islamic Association for Mental Health, which has a World wide membership encompassing mental health practitioners in all health specializations, reaches out in solidarity and empathy to all who are suffering in the tragic struggle of the Palestinians to obtain the liberation of their homeland and to obtain basic human rights, safety and freedom.
Realizing the terrible and long-lasting effects of trauma, especially that of the cumulative and overwhelming trauma which the Palestinians are experiencing on a daily basis, the World Islamic Association for Mental Health, calls upon our Palestinian colleagues to share with us specific ideas concerning how we can be of direct and indirect assistance.
The World Islamic Association for Mental Health, further, calls upon the Worldwide mental health community, including our Jewish colleagues who have been the historic victims of trauma, to educate all citizens about the devastating effects of cumulative trauma, which include such issues as loss and grief, depression hopelessness, rage and despair , History has clearly demonstrated , as we can now see, that such, chronic and unremittingly severe traumatization can lead to national, pathological behaviors such as identification with the aggressor, dehumanization of the "other" and ultimately the desire for total elimination and destruction of the "other" through state-sponsored and personal acts of terrorism . The Palestinians are now the victims of such historically traumatized people.
The World Islamic Association for Mental Health looks forward to joining with our Palestinian colleagues to help deal with the massive devastation and trauma to which their people are being subjected on a massive and unprecedented scale. In the past few weeks the situation in Gaza and Rafah can be accurately defined as Genocide, Israel's targets have been many including as we write Rafah city and the Rafah refugee camp in the Southern tip of Gaza Strip, this Isolated, poverty - stricken community is facing the same brute force of the Israeli military occupation that the Jenin refugee camp, in the North of the west Bank, faced less than two years ago.
Israelis deliberate and systematic destruction," does not necessarily mean the physical killing of people. The destruction, Israeli occupation style, is equally focused on demolishing Palestinian homes under the false pretext of security.
Minister of Justice Tommy Lapid made no bones about the Israeli plan to widen the security corridor, which will require the demolition of hundreds, perhaps thousands of homes in Rafah when he warned of the danger this poses to Israel.
This policy outraged, the Jewish American president of the World Bank, James Wolfensohn who attacked the demolitions," Israel's military operations pertaining to the demolitions of thousands of homes in Rafah are reckless, and leave tens of thousands of people without a roof over their heads, "Wolfensohn told Ma'ariv newspaper. He added " as a Jew, I am ashamed of this kind of treatment."
Amnesty international released a report last month stating that the destruction of homes (over 3.000 and causing damage to 16.000 more) and displacement of thousands of Palestinians is a war crime". The Israeli Committee against house demolitions says that Israel has demolished about 1.200 homes in the Gaza Strip over the last three years.
WIAMH joins the UN Secretary - General Kofi Annan, the Israeli Committee Against House Demolitions, and its officer professor Jeff Halper, and the Jewish American President of the World Bank,
James Wolfensohn in strongly condemning the demolitions of homes in Rafah and Palestinian territories stressing that it is a violation of international law.
WIAMH also expresses its support to the Norwegian Oil and Petrochemical Workers Union (NOPEF) who called on all parties and political forces in Norway to adopt a complete boycott of Israel as a response to the incomprehensible killing of civilians and clear violations of Palestinian human rights.
WIAMH hoped Norway would adopt the previous proposal and present it to the EU and the UN to produce a resolution that would oblige other nations to deal firmly with Israel.
We await your specific responses about how we can help and urge other Mental Health associations & practitioners to do the same.
URGENT - RESPONSE SOUGHT-URGENT-RESPONSE SOUGHT
Please send responses to:
WORLD ISLAMIC ASSOCIACION FOR MENTAL HEALTH:
[email protected]
9
UNIVERSITY OF MISSOURI - COLUMBIA INTERNATIONAL CENTER FOR PSYCHOSOCIAL TRAUMA
Training Iraqi and Jordanian Psychiatrists July 6th-20th 2004.
Professor Dr Arshad Husain, the ex-President of WIAMH returned on the 21st of July 2004 from Amman, Jordan where he and the Trauma Team at the University of Missouri has spent two weeks in training 20 Iraqi psychiatrists from various cities in Iraq and as many Jordanian Psychiatrists were trained in Child Psychiatry and Trauma Psychology.
Since 1995 the International Centre for Psychosocial Trauma of the University of Missouri Columbia, has held an annual summer training course. Each summer selected teachers and mental health professionals from predominantly Bosnia, but also from other war-torn countries such as Chechnya, Rwanda, and Iraq are brought to Columbia for intensive training in Trauma Psychology. These trainees return to their country of origin and provide training to others.
10
XIII World Congress of Psychiatry Updates
| DATES TO
REMEMBER |
DEADLINES |
| Submission of proposals for Symposia, Workshops and Courses |
October 31st, 2004 |
| Submission of proposals for Lectures, Papers and Posters |
October 31st, 2004 |
| Fellowship Program and Award Application |
December 31st, 2004 |
| Reduced Registration Fee |
March 31st, 2005 |
| Notification of acceptance of Abstracts and Posters |
March 31st, 2005 |
| Submission of proposals for New Research Findings |
March 31st, 2005 |
11
WORLD FEDERATION FOR MENTAL HEALTH: EASTERN MEDITERRANEAN REGIONAL COUNCIL
SUBSTANCE ABUSE WORKSHOP 16-17 JUNE 2004 PORT SAID EGYPT
In the 1980's during use-Worldwide gradually declined a trend that continued until 1992. the education of young people about the hazards of using drugs contributed to this decline. The turn around that occurred in 1992 is a cause of concern, because students attitudes about the dangers of drug use appear to be softening.
Dr Ahmed Abou El Azayem Chairman of EMRC organized a workshop on "substance Abuse" for General Practitioners and NGO's. this was based on the premise that "substance abuse" should not only be "legislated away" but it should be "educated away".
The audience consists of general practitioners, parents, teenagers, NGO's, Egypt's Governorates, and the Whole Arab World. The message to teenagers was; "Pushers out; use your brain, not your vein." Teenagers participated in role-playing exercises that helped them to develop the behavioral skills they need to "say no" to drugs. All through the workshop the emphasis was "from young people to young people;" young people who were sociometric stars an who were not drug abusers were chosen to teach their peer about the hazards of drug abuse.
New dynamic forces in combating substance abuse can only be found in global civil society and partially in the Arab World. This is why Dr Ahmed Abou El Azayem and his team met with Dr Mustafa Kamel, the Governor of Port Said who was keen on the re-invigoration of local and civil society in Port Said in the area of Substance Abuse. He gave the initiative for NGO's to work in this area without bureaucratic jargon.
The Eastern Mediterranean region represented by Ahmed Abou El Azayem believes that when global rural society strongly intervenes in the situation against "drug abuse" in such away as to give drug abusers and drug prone youngsters serious hope. Can NGO's re-steer their national struggle towards a new vision. Therefore the meeting ended with the establishment of an "Arab Federation Against Substance Abuse". The role of this new regional NGO is preplanning, planning in process and evaluation of outcome as an integral part of policy making. All these apply to the field of "substance abuse".
Notable who contributed to the significant meeting were Professor Fatma Mousa, Dr. Fikry Abd El Aziz, Dr Ahmad AbdAllah, and Professor Mohamed Abd El Mageed, Flefal Professor Husain Zohdy.
Members of the Arab Federation Against Substance Abuse who met as part of this very important regional occasion are Saud El Dahian from Saudi Arabia, Dr Khaled El Saleh from Kuwait, Dr Hesa Shahine from Kuwait, and Dr Zohra from Yemen.
Dr. Ahmed Abou El Azayem has planned to hold a similar workshop in the City of Damietta on 16-17 August 2004.
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