Psychologists, researchers, and mental health professionals have been working with civilian populations in Palestine for years, documenting the effects of their experiences with dispossession and violence. The latest violence between Hamas and Israel that began Oct. 7, 2023, has only exacerbated the harm experienced by Palestinian civilians, particularly those in Gaza.
“As a practitioner in Gaza, my first visit was in 2009, after the first major attack on Gaza [Israeli military operations from Dec. 2008 to Jan. 2009, according to Human Rights Watch]. At that time, I was involved mainly as a psychologist and clinical supervisor in a primary school at Jabalia refugee camp, where I used to work with the teachers, and the trauma that the teachers were living with during the attack,” says Guido Veronese, a clinical psychologist and associate professor of clinical and community psychology at the University of Milano-Bicocca in Italy. His research and expertise is on extreme and collective traumas in areas affected by political and military violence and human rights violations. “What is quite evident is the huge and impressive magnitude of the traumatic experience for Gaza people. …So, the continuous and the constant presence of traumatic experiences are totally reshaping the lives of individuals and community there in Gaza.”
Veronese will be part of an online panel discussion with Marwan Diab, head of research and studies at the Gaza Community Mental Health Program in Palestine, from 6 to 8 p.m. Thursday in Warren Auditorium at the University of San Diego as part of the school’s “Spring 2024 Gaza@USD Teach-In” focusing on the Palestinian-Israeli conflict with film screenings, panel discussions, and other events. This week’s discussion will center on “Colonial and Collective Trauma: The Invisible Wounds Among Generations in Gaza,” featuring their years of field research and reporting on the mental health needs of Palestinian civilian adults and children in the region. Veronese took some time to talk about colonial and collective trauma, shifting from Westernized tools for addressing mental health to those incorporating human rights and social justice, and why he says the health system in Gaza is near collapse. (This interview has been edited for length and clarity. )
Q: Can you talk a bit about your work with trauma patients in Gaza? What have you been seeing/hearing as a result of doing this kind of work?
A: From 2009 to now, we have about 15 years of work there and at least three major wars and attacks (I’m excluding this last one where, of course, all of my work has been interrupted.) Take into consideration that kids who are now 14 years old have experienced at least three or four major wars. I totally transformed my work from the beginning to now, even suggesting that the [mental health treatment] instruments that we are exporting from the global north are not effective with people traumatized there. The major difference is that we work in mainly a clinical manner to try and solve the so-called “post-traumatic” reactions to traumatic events. If you look at the Palestinian context, mainly the Gaza context, you cannot ever reason in terms of “post-”—it’s always a continuous, ongoing experience of threat and they are not post-traumatic experiences. So, the fact that there is no “post-“ is totally making our instruments very ineffective and sometimes even dangerous if we export them in very standardized, Western-informed ways.
What I learned is that we need a continuous exchange in cooperation with the local experts, moving from an individual idea of healing to a more collective one. Taking into consideration the traumatic experiences of at least three generations of Palestinians since 1948 [the war that led to the declaration of Israel as an independent state in Palestine], these are transmitted generationally and require thinking of an effective intervention in Gaza that comes from a collective and generational perspective.
Q: You’ll be speaking on “Colonial and Collective Trauma: The Invisible Wounds Among Generations in Gaza” later this week. Can you talk about what colonial and collective trauma each look like?
A: There are three dimensions that are reshaping the construct of trauma, which is not related to our evidence-based and scientifically-informed perspective on trauma. When we talk about collective trauma, it means that the Palestinian suffering cannot be considered just in terms of individual psychological reactions to traumatic experiences. In fact, the Palestinian society is collectively bound by a long-term experience of oppression, dispossession, and a sense of collective insecurity that the Palestinian suffering is a social suffering. Even the individual reactions are connected to a history of suffering, which is not just implying the present, but it’s something that is totally inscribed in the past and it will inform the future of the Palestinian population, of the Palestinian communities, in general. That’s the way to define the collective trauma; the collective trauma is the social suffering of the Palestinian people.
Why call it colonial trauma? Colonial trauma is because of the sense of dispossession, the fact that the majority of the Palestinian population is a displaced population. They are not living, anymore, in their original towns, but they had to move in three major waves (because now there is a third wave of displacement). The first is in 1948, when at least 700,000 Palestinians had to leave their homes and move when the first attack was supported by the British army and was pushing the Palestinians to leave their homes and to move to concentrate in the territories that nowadays are known as the West Bank of Palestine. The second wave of displacement was during the Six Days War in ‘67 when, from the Jerusalem area and surrounding, a huge number of Palestinians were pushed in the territory now known as the Gaza Strip. This was another experience of dispossession. Then, the third one, what happened in the past six months when at least 1 million or more people were moved from the northern Gaza Strip to the southern part of the Gaza Strip. These are examples of how people can develop a sense of insecurity to the pressure of a colonial power. We have many narratives about leaving the home, leaving the small things that remind you of your life and roots in certain areas. The fact that cultural heritage has been totally destroyed in these days, in Gaza, is, in a way, shaping the trauma as a collective experience of dispossession from their land and their territory…so this is a way to create a kind of colonial trauma.
The third one is transgenerational trauma; the fact that this sense of dispossession, this sense of insecurity, this sense of unsettlement is transferred from generation to generation. Nowadays, the people that have to flee their homes from the north of Gaza are re-experiencing something that, generationally, has been transmitted by the grandparents to the parents, and from the parents to the new generation of kids. That’s a way that is expanding the sense of uncertainty and unsettlement in the native Palestinian population.
Q: In a 2023 article you and Marwan Diab co-wrote with colleagues in Transcultural Psychiatry, you interviewed dozens of psychologists, social workers, psychiatric nurses, and psychiatrists working in Gaza about their clients mental health. What were some findings that stood out to you that illustrate these collective wounds for people living in Gaza?
A: This was a collaboration with the Gaza Community Mental Health Program. At that time, Marwan was the head of research and training for the program, and this idea of research was a collective and participatory production of discussion, conversation, and ideas with the practitioners in the Gaza program. At that time, it was quite urgent to try and understand the local and international NGOs who were taking the right direction to think of psychological intervention in Gaza. With the help of the Gaza program’s practitioners and the system researchers, we were interviewing the most important figures working in the community mental health system in the Gaza Strip. What emerged as a really important appendix from that research was that the mental health system, and in general, the health system in Gaza, is close to collapsing. There are no resources, there are no insurance specialized professionals that can answer to the huge psychological needs of the population. So, what was very clear is that one of the main consequences of colonial occupation is that all of the functioning factors, individual and collective functioning factors, are under attack. Gaza, like most Islamic societies, is mainly a collectivistic society where the mutual help and interconnection is the main structure that helps people protect themselves from the trauma from psychological burdens. These disruptions of the social fabric, and these disruptions of the absence of the social structure in the Palestinian society, are creating huge psychological problems, both in terms of trauma reactions, but even other kinds of psychological burdens that can range from child psychopathologies to internal and domestic violence. What is really happening is that the blockade and closure that Gaza is enduring since 2007 [enforced by Israeli authorities after the Hamas takeover of the Gaza Strip in 2007, according to the United Nations] is totally disrupting those competencies of individuals and communities to cope with potentially traumatic experiences. The fact that a few professionals using very ineffective instruments belonging to the global north are trying to contain these problems is increasing psychological suffering. What we see is, day after day, that this psychological social suffering is becoming totally overwhelming and huge. I think the very main issue is that we cannot act psychologically in the Gaza Strip situation if we don’t take into consideration the political antecedents and the determinants of the psychological suffering of people. If you don’t solve the political issues that are affecting this population, there are no instruments that can help them to cope with their suffering. So, now the point is if the situation will not change politically, we don’t have many instruments to help people to endure this increasing, continuous suffering.
Q: In that article, you all write that, “Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice.” Then, you have another article from 2023, this time in the International Journal of Social Psychiatry, which also recommends a human rights approach to Palestinian trauma and suffering. What would it look like to include human rights and social justice within this mental health approach? How would this make a difference, in practice?
A: I think, in general, is that it’s not just related to the Gaza situation. Of course, the Gaza situation is creating a very strong and unavoidable tie between human rights and mental health, but if you do not involve, from the very beginning, the communities’ ability to self-organize and to move in a way that can create competencies, capabilities to cope with their sufferings — in terms of advocacy, in terms of very practical and feasible resources that they can use to try and confront external oppression — if you don’t organize these communities, if you don’t make it so they can participate to produce a sense of possibility to change their lives, you will not be effective in your intervention. This is something that, in general, as a practitioner in mental health, we have to take into consideration when we act to psychologically help people: Do we want to help them to readapt and to adapt to conditions that, at the very beginning, are very inequitable and very wrong conditions? Or, do we want to help them organize and change these conditions? I think that if we act more as an agent for social change, rather than an agent for resocialization or readaptation to an inequitable condition, we are doing a great job and we are really promoting community mental health. I think that the people of Gaza, as well as all of the oppressed communities all over the world, need instruments, competencies, practices that can help in healing themselves from their condition of oppression and make them able to get away from these conditions. If we work to adapt people to inequitable conditions, I think, even ethically, this is very wrong.
Q: What is your response to those who might argue that since the latest violence that began on Oct. 7 — resulting in deaths, hostages, and a rise in antisemitism — there is a need to address the trauma experienced by Israelis?
A: If we just focus on one star and we don’t look at the galaxy, it means that we are totally losing the context. Of course, I think that Oct. 7 was a really horrible experience for the Israeli people, and this war is creating a huge sense of insecurity and trauma among the population. I think this was a really horrible act against innocent civilians; but this real and continuous suffering and injustice the Palestinians are enduring, there is no excuse to what is happening now in Gaza. Even such horrible events, such as Oct. 7, if you just look at this and you think, ‘There is only Oct. 7 and this is only a consequence of these tragic events,’ you completely lose the possibility to speak the truth to see what is really happening. There are no excuses to these human reactions where schools, hospitals, journalists, universities, everything was completely destroyed…That’s not diminishing the horror of the Oct. 7 for the Israelis, but the consequences of these days are not related to just this. This is a realization of a colonial project that started in ’48.
