Is there electricity in the paradise?

Mental Health is defined by World Health Organization (WHO) as "a state that refers to completion of physical, mental and social aspects of a person and not merely the absence of mental disease.” In other words, it is a healthy body with psyche of no external mental pressures, or internal conflicts, in which the person enjoys interactive social activity and good relationships with the surrounding environment.

Recent research suggests that mental health consists of two dimensions: mental health problems (mental illness), for example depression and anxiety, and positive mental health (mental well-being) which includes e.g. life satisfaction, positive relationships with others and purpose in life.

Positive mental health includes such qualities as self-esteem, the ability to manage change, the capacity to influence actively the social environment, assertiveness, enjoyment and a conscious state of well-being.

Mental health lacks most of its aspects under this severe siege imposed on the Gaza Strip, since there is acute shortage of basic food supplies, fuel, medications, and the psyche is deeply influenced by the stressors and conflicts resulted from siege as people feel that they are in a huge prison. Further, the social life is semi-paralyzed as poverty is widely spread among the citizens. They could make social visits; no jobs and deficiency of all daily activities due to stoppage of work in most of economic sectors. Thus, it is impossible for people to enjoy mental health under the current siege.

This is what Dr. Samir Qouta asserted in his study on the impact of siege on the quality of life of Gaza citizens that was published in Al-Quds Newspaper on January 28th, 2008. Dr. Qouta stated that the siege forced 84% of the Palestinian families to change their life routine, while 93% of them expressed their abandon of the daily living requirements. Also, 95% of the families' members especially in Gaza expressed their grieve resent from changing the Gaza Strip into a huge prison in which they spend their days and nights.

Siege and Mental illness

Mental illness is a group of emotional and behavioral signs and symptoms that occur together as a recognizable condition, cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
Not only one factor, but a group of bio-psycho social factors cause the mental illness. In this respect, we observed abundance of these factors under the siege on Gaza and its psychological, physical and social impacts. The siege has a direct effect on the appearance of new mental cases and the relapse of old ones.

We don’t claim that the Palestinian populations become mentally ill patients. There are personal differences on the physical and psychological levels; there are protective factors such as religion, patriotism, norms and values, as well as social support. All such factors and others contributed in the protection of individuals and the development of new mental illnesses.

However, on the level of mental health and appearance of mental symptoms and sufferings, we are certain that all Palestinian populations in Gaza suffer in one way or other from mental symptoms and sufferings, especially after imposing the severe current siege on the Gaza Strip.

Complaints among both adults and elderly

The hereinafter information and data were collected through the GCMHP community centres and their data-base systems. The complaints among adults and elderly concentrated on the following issues:

1. Fear of invasions, lack of basic items of food and lack of medication.
2. Fear of Death particularly among journalists
3. Insecure feelings that led to anger and aggression especially among men, and irritability feelings among women. These feelings of parents reflected on their children who displayed it to other children, thus, recording high levels of violence and domestic violence.
4. The Conversion symptoms have significantly increased, especially among females.
5. Frustration and low self-esteem feelings.
6. Significant rise was noticed in Panic like symptoms.
7. Decrease of attention and concentration was also noticed, thus affecting the memory among individuals, then decreasing the academic performance among students.
8. Alienation, whereas the person is overwhelmed by feelings of alienation from his religion, nation and Arabian identity, as well as feeling of being besieged by his nation-mates and lacks the social support from them.
9. Depersonalisation.
10. Mistrust.
11. Decrease of affiliation, belonging, and providing support to others.
12. Apathy and hopelessness feelings.
13. Multi-somatic Complains.
14. Increase in the tendency of revenge and non-tolerance.

Complaints among children: “Who are Jews? What is Fatah?”

1. Frequent questioning and wondering, according to Parents, children started to ask about: who are Jews, what is Fateh or what is Hamas?
2. Aggression, the therapist in school mediation programme noticed extreme rise in aggression among children especially in role-playing within the school, the same as they leave school, where they form gangs and use sharp tools, and clash by hands, as well as insulting each others.
3. Dullness and lack of risk feelings, as they crowd around shelling places and go to bring projectiles from the shelling bases for instance.
4. Fear of darkness and going to school were shown. In this regard, a therapist encountered a child asking if there is electricity in the paradise, asserting that he's terrified when electricity cut-off.
5. Tendency for sadness, one of the curious stories, that happened during school mediation program and that signify the profound suffering among children: Specialists asked 26 students to imagine the best situation they can ever imagine. At the end of the exercise, none of them could imagine any happy thing, while their fancies were confined on miserable things, as some imagined of being in cemetery and another imagined that his parent is imprisoned and he's crying.
6. Insecure feelings, in one drawing exercise, most of children drew one small home. This indicates the insecure feelings they live.
7. Decrease attention, concentration and school performance
8. Sleep difficulties and nightmares
9. Irritability
10. Nail biting and thumb sucking

Mental illness among both adults and elderly

Comparing between six months before and after the current massive siege started in June 2007, we noticed the following:

• Anxiety disorders statistics recorded rise in:
- Panic Disorder,
- Obsessive-Compulsive Disorder, OCD.
- Post Traumatic Stress Disorder, PTSD
- Delayed onset PTSD, Activation of old trauma.
• In mood disorders, depression cases recorded increase 17.7%.
• Somatoform disorders recorded decreased among clients visiting community centers, while our crisis intervention teams noticed increase in these disorders in the community. This is mostly because of the nature of the complaints and the stigma associated with mental illness. So. They prefer to visit the health primary health care centers and general hospitals rather than mental health centers.

Mental illness among children

According to working teams in the field, diagnoses of children in the post-siege period concentrated on:
1. Functional enuresis.
2. Stuttering.
3. Post traumatic stress disorder (PTSD).
4. Communication disorders.
5. Night-terror disorder.

Regarding the phone counselling experience: GCMHP recorded remarkable increase of clients who asked for phone counselling service to (150%) during the second half of the year 2007 (post siege on Gaza), compared with the first half. It was also noticed that great number of people received phone counseling are holding high academic certificates, which is unusual.

Effects on Professionals of GCMHP

Many of the professionals reported more work load and pressure, accordingly some of them started to avoid receiving new cases. Some began transferring cases to other professionals working in the community center. Others expressed their exhaustion, they tended to take vacations. Others expressed their frustration and difficulty in dealing with their cases under the critical situation of siege. Some of them avoided to provide crisis intervention services for injured people and families of dead ones, as they became unable to tolerate the increased sympathy with them.

Yet, other professional expressed their tendency of offering more services, and feel happy to offer help for others. Other professionals, who were abroad before the siege, couldn’t return back to work and remained stuck outside the country.

Effect of siege on pharmacological work

All sorts of medicines decreased, and GCMHP's pharmacies recorded run-out of many kinds of medicines. Further, 80-90% of the clients was exempted from paying any fees and received free-of-charge medication.

*Tyasir M. Diab, MD, is Psychiatrist and Clinical Supervisor at the Gaza Community Mental Health Programme. (GCMHP). http://www.gcmhp.net/ Contact: taysir@gcmhp.net