Considering Mental Health Challenges During the Mideast Peace Plan Ceasefire

PSYCHIATRIC VIEWS ON THE DAILY NEWS

The relative lull in whatever the conflict is called in Israel and Gaza allows for some mental health in depth processing. Probably no one in the immediate area of the conflict has escaped significant changes in personal identity and dreams for the future. We in psychiatry should be able to go deeper into the meaning of these challenges and the potential interventions for mental health other than just immediate reflexive reactions.

What’s in a Name?

We know that names often have psychologically beneficial and harmful repercussions. The names used in this conflict have such considerations for how the conflict is viewed and felt. Choices include:

• Israel-Hamas War, which is probably the most common Western perspective
• Israel-Garza War, which then includes the entire population in Gaza beyond Hamas
• Israel-Palestinian War, which refers back to prior settlements in the Gaza area
• Mideast Conflict, which implicitly adds in other influential Mideast countries like Iran, Lebanon, Qatar, and the others now involved in the peace process
• Guerrilla War of Hamas Against Israel, which recognizes that Hamas is fighting like a guerrilla army against the conventional Israeli army

The Harm of Trauma

Right now, there seems to be some widespread—though by no means universal—joy at this pause in the traumatic and deadly fighting. Even so, internal, public, and deadly fighting in Gaza between Hamas and rival militias has erupted. There is also great grief for the losses, as well as for the anxiety of uncertainly for the future. Will it really be possible to establish more long-lasting peace and prosperity for all concerned?

Given the major mutual trauma and its rippling out to so many, posttraumatic stress disorders are likely to rise. Given that there may be some usual delays in emergence, ongoing psychiatric monitoring is desired. If moral injury is associated with the trauma, recovery is even more challenging. Moreover, since resources to care in Israel and Gaza have been reduced and decimated respectively, global help is necessary. In Gaza, basic humanitarian needs also need to be addressed in order to move up from the bottom of Maslow’s hierarchy of psychological needs.

Scapegoating

Psychiatry, though, will be limited in helping if our own rigid stances of blame prevents cooperation, mutual compassion, and a sound historical analysis. Curiosity and respect for opposing viewpoints, the kind of curiosity we are supposed to provide to our patients, is indicated. Politics need to be kept out of the clinical referral process and only be processed in the treatment of patients when relevant to their disorders, and not imposed by boundary-breaking countertransference values of clinicians.

As much as citizens and communities need opportunities to process their reactions to this conflict, so do we within psychiatry. Whenever live forums are not practical, Zoom discussions can be set up. So far, to me, they seem to be more one-sided than unifying interfaith allying.

The Future

Longer term, both anti-Semitism and Islamophobia will need to be reduced. Perhaps those who have more power are using the familiar strategy of dividing and conquering Jews and Muslims in order to maintain their power.

Whenever forgiveness is practically possible and appropriate, that should be processed as it also improves the mental and physical health of those forgiving.

This conflict can be traced all the way back to the Biblical story of the ancient unresolved family conflict of the forced separation of the stepbrothers Ishmael and Isaac. Calling for the insight of family therapists!

Watch carefully for mutually harmful processing like cultish thinking, fight or flight blaming of the other, responding to humiliation with revenge, and hubris.

This may be the best opportunity in a long time for peace and positive psychiatry for all involved. Many political processes have been tried over modern times. Now this may seem fanciful and even delusional, but perhaps we in psychiatry are a missing ingredient, if only we are included and dialectally unified for the conflict resolution.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.