Political Violence and the Palestinian Family

Implications for Mental Health and Well-Being

Vivian Khamis

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781317720164
• Topic: Politics & International Relations
• Subtopic: International Relations
• Index: Politics & International Relations

What has political occupation done to Palestinian family life in the West Bank, Jerusalem, and the Gaza Strip?A psychological study of family members affected by unrest, Political Violence and the Palestinian Family: Implications for Mental Health and Well-Being examines families living in the midst of the conflict in the Middle East to help mental health professionals, social scientists, counselors, and students in these fields create appropriate intervention methods and provide relevant and effective services. Discussing coping, social support, ideology, and the sociopolitical conditions of Palestinian families, this comprehensive guide is the first book that specifically focuses on Palestinians. Political Violence and the Palestinian Family combines quantitative and qualitative research to clarify the sociological and psychological impacts upon Palestinian family life in the wake of the Intifada (the Palestinian uprising against Israeli occupation). This book depicts the human cost of Israeli occupation on this population and the failure of the Palestinian Authority to ameliorate the effects of violence on this society.Political Violence and the Palestinian Family discusses:

• political victimization and how it affects families
• the psychiatric symptomatology of Palestinians
• the psychological and somatic sequelae of political trauma
• techniques for successful sessions with Palestinian clients
• appraisal and coping techniques
• the values and beliefs of Palestinians

Political Violence and the Palestinian Family: Implications for Mental Health and Well-Being will help mental health professionals, social scientists, counselors, and students create appropriate intervention methods and provide relevant and effective services to Palestinian clients.

Chapter 1
An Overview of Political Victimization

Since the Israeli occupation of the West Bank and Gaza Strip in June 1967, life for the Palestinians has been characterized by multiple social problems. The onset of the intifada in December 1987 added prolonged exposure to a staggering array of extreme political stressors, ranging from relentless punitive measures imposed on the occupants of the territories to the pervasive traumatic experiences of loss of life or limb, loss of freedom (e.g., imprisonment), and loss of property (e.g., demolition of houses). The posttrauma environment brought with it a great upsurge of interest, particularly among psychologists and psychiatrists, in studying the impact of political traumas on Palestinians. Particular attention has been paid to those injured during the intifada (Khamis, 1993a,b) and to political prisoners (Sarraj et al., 1996), traumatized women (Khamis, 1998), and families who experienced various forms of political violence (Baker and Kevorkian, 1995; Khamis, 1995a,b). Studies of the injured indicated a high prevalence of post-traumatic stress disorder and low levels of psychosocial adjustment; women and members of affected families suffered from high psychological distress, low subjective well-being, and high levels of anxiety.

The effects of stress associated with major life events and of political stressors on the mental health, psychological well-being, and ongoing life patterns of traumatized Palestinian families have shown that the experience of certain life events, or clusters of these events, can have deleterious effects on subsequent mental health status. However, the nature of the causal connections between such events and subsequent psychiatric disorders has not been established. Previous research (Khamis, 1995a) has limited discussion of life events to how they bear on changes that are primarily personal in nature, and excluded consideration of changes that could be associated with traumatic events or with widespread social processes, such as changes in family roles. Some studies indicated that post-traumatic stress disorder (PTSD) is associated with difficulty in fulfilling family roles (Rosenhech and Thompson, 1986; Solomon, 1988). Specifically, persons with PTSD often experience difficulties with involvement in specific tasks and routines of family life (Maloney, 1988; Solomon, 1988) and marital adjustment (Casella and Motta, 1995). However, most of these studies revolve around interpersonal difficulties in functioning within the family system (Jurich, 1983; Defazio and Pascucci, 1984; Motta, 1990), and they seldom consider factors that mediate the traumatic event-psychological distress relationship.

Despite the enormity of the impact of political violence and the frequency of the problem, few mental health professionals investigated how Palestinian families cope with political traumas. Khamis (1995a,b) examined the Double ABCX model (McCubbin and Patterson, 1983) that regards stressors, family resources, and the family’s perception of the situation as three factors that influence adaptation to stress. The results indicated that each of the predictor variables—stressors, resources, coping, and hardiness—contributed to family members’ reactions; however, each predictor exhibited a different pattern of relations with the outcome domains. Although coping and support are easily distinguished in principle, they typically co-occur. Furthermore, their effects can be difficult to disentangle. The availability of social support is influential in the prediction of coping behavior and also can facilitate coping strategies by removing some of the distress that can hamper certain coping efforts. Because of the presence of a social network that allows for the provision of support, it can be predicted that people with access to such support will be more likely to seek social support as a coping strategy (Terry, 1991). Similarly, Holahan and Moos (1987) found that individuals with nonsupportive family environments use more avoidance strategies than individuals with high levels of family support. Although perceived availability of social support has been shown to protect individuals from the psychological impact of stressful life events (Cohen and Hoberman, 1983; Cohen and Wills, 1985; Kessler and Mcleod, 1985), an individual’s social network also includes conflictive relationships that may be a source of both positive and negative interactions. The negative interactions have been shown to be more consistently and more strongly related to well-being and satisfaction than positive interactions (Fiore, Becker, and Coppel, 1983; Pagel, Erdly, and Becker, 1987; Rook, 1984). Thus, perceived support and quality of relationships appear to be important factors in a complex and interactive stress process including life events, chronic life strains, coping, and social support (Pearlin et al., 1981).

Central to research into coping is an additional factor that might also have a direct effect on the coping process of families of those suffering political traumas: ideology in its political and religious forms (Khamis, 1995a, 1998). Ideology can play an important role in the prediction of behavior. In Lazarus and Folkman’s (1984) stress and coping theory, two processes, cognitive appraisal and coping, are identified as critical mediators of stressful person-environment relationships and their immediate and long-term outcomes. Cognitive appraisal is a process in which the person evaluates whether a particular encounter with the environment is relevant to his or her well-being, and if so, in what way (Folkman et al., 1986). There are two kinds of cognitive appraisal: primary and secondary. In primary appraisal, the person evaluates whether he or she has anything at stake in this encounter. Commit-ment, goals, and beliefs about oneself and the world help to define the stakes that the person identifies as having relevance to well-being in specific stressful transactions. Lazarus and Folkman (1984) report that commitments and beliefs influence appraisal by shaping the person’s understanding of the event, and, in consequence, his or her emotions and coping efforts. Conversely, ideology may dispose the person to cope with political traumas in certain ways that either impair or facilitate the various components of posttrauma recovery. However, although commitment was found to be a vulnerable factor in psychological stress (Bergman and Magnusson, 1979; Fiore, 1979), it could also impel a person toward a course of action that could reduce the threat and help sustain coping efforts in the face of obstacles. In secondary appraisal, the person evaluates ‘what, if anything, can be done to overcome or prevent harm, or to improve the prospects for benefit. Various coping options are evaluated, such as changing the situation, accepting it, seeking more information, or holding back from acting impulsively (Lazarus and Folkman, 1984; Folkman et al., 1986).

Another dimension that might have an impact on the well-being of affected family members is sociopolitical satisfaction, which reflects the quality of life of the people. The ecocultural context of a family is important in determining a person’s subjective experience. In fact, the degree of satisfaction experienced is not determined by the absolute value of an event but rather by its value in relation to other contextual events, such as the political situation, work, and social life. Therefore, the quality of life in Palestinian society depends on more than a relative dearth of identifiable problems. As Zatura (1978, p. 8) states, “Freedom from symptoms, although important, is not the only kind of freedom, and the relative absence of pain is not the only source of happiness.”

Drawing on all these theoretical viewpoints on coping with traumatic stress, this research investigates the psychological sequelae of political traumas in Palestinian families. In the following section, I will review variables used in the analysis that represent psychosocial processes occuring in the immediate ecocultural context of victims who have been subjected to various forms of political oppression during the intifada.

CONCEPTUAL ISSUES IN TRAUMATIC STRESS

Traumatic Events

A traumatic event is conceptualized in the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association as a person’s exposure to an extreme traumatic stressor involving direct personal experience of an event that includes actual or threatened death, serious injury, or other threats to one’s physical integrity; witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (p. 424).

Among events that meet the stressor criteria of the DSM-IV are those associated with political violence. The Palestinian Human Rights Information Centre estimates that during the period of the intifada from December 9, 1987, to December 31, 1993, Palestinians suffered 130,472 injuries and 1,282 deaths, of which 332 were deaths of children. Among these victims are those who were shot, beaten, teargassed, or burned to the extent that they are suffering from permanent disability. Records also show that over 22,088 people were imprisoned, 481 were deported, and 2,532 had their houses demolished during the intifada. The psychosocial and financial costs for the affected families in terms of medical and psychosocial care, loss of productive time, chronic disability, loss of function, and loss of life and property are enormous (Khamis, 1995a).

While early disaster and traumatic stress research tended to present a unitary view of trauma, there is increasing recognition of multiple stressor dimensions and that each may be identified by multiple quantitative parameters, such as severity, duration, and potential for recurrence (Raphael and Wilson, 1993). Dohrenwend and Dohrenwend (1974) point out that the multiplicity and periodic recurrence of traumatic events are far more stressful than a single one-time traumatic event (p. 812).

Many Palestinian families have suffered the occurrence of a number of traumatic events simultaneously or within a short time. Also, a number of adverse stressor parameters characterize the political traumas experienced by Palestinian families. For example, a threat to life and limb has been more stressful than threat of loss of freedom (e.g., imprisonment) or even loss of property (e.g., demolition of houses) (Khamis, 1995b).

These traumatic events, by definition, have the potential to raise the family’s level of stress. Anything that changes some aspect of the system, such as boundaries, structures, goals, processes, roles, or values, can produce stress (McKenry and Price, 1994).

When a family is in a state of crisis, it does not function adequately. Family boundaries are no longer maintained, customary roles and tasks are no longer performed, and family members are no longer functioning at optimal physical or psychological levels (Boss, 1988). A clearer understanding of the relation of political traumatic events to psychological distress and family functioning requires examining specific stressors, such as role strains.

Role Strains

Role strains are the hardships, challenges, conflicts, or other problems that people come to experience as they engage over time in normal social roles (Pearlin, 1983). These strains, in turn, stand as potentially powerful antecedents of stress and its emotional and physical manifestations. A variety of strains may be experienced by people in the context of their ordinary social roles (Hirsch and Rapkin, 1986; Goode, 1960), such as those generated by multiple roles, inter- and intrarole conflicts, role captivity, loss and gain of roles, and role restructuring (Pearlin, 1983).

Evidence from research (Pearlin and Lieberman, 1979; Pearlin et al., 1981; Brown and Harris, 1978) shows that events can create stress by adversely altering or intensifying the more enduring aspects of key social roles. However, role strain as a response of the family to the demands experienced as a result of a traumatic event has been given little attention in the literature. This response denotes something different from the routine changes within a system that are expected as part of its normal, everyday operation.

Two major hypotheses have been proposed concerning the relation of role involvement to psychological well-being. The “scarcity” hypothesis (Marks, 1977; Goode, 1960) assumes that the social structure normally creates overly demanding role obligations and more cumulative intrarole conflict. Responsibility for multiple roles also opens the door to interrole conflict, involving potentially incompatible demands of individuals across life domains (e.g., spouse versus employer). Moreover, there may simply be too many tasks to perform, leading to role overload (Hirsch and Rapkin, 1986). Because human energy is limited, psychological well-being is impaired by the overload and conflict inherent in numerous, often incompatible roles.

In contrast to this view, the “enhancement” hypothesis (Marks, 1977; Sieber, 1974) emphasizes the benefits rather than the costs of multiple-role involvement: status, privileges, increased self-esteem. However, Pearlin (1983) indicates that whether or not the objective features of roles are transformed into role strains often depends on the dispositions people bring with them to their roles.

Although major social life transitions that are part of life under trauma (e.g., role reversals or dual responsibilities) may tax family members’ psychological well-being (Khamis, 1995b), without a doubt there are people for whom the consequences of these role strains are more benign. From this perspective, it is not a question of whether the positive or negative model is correct, but a question of the conditions under which different outcomes occur (Long and Porter, 1984; Stryker, 1980). Therefore, considerable attention should be devoted to the investigation of strategies that might reduce multiple-role stressors as well as various factors that may affect the mental health and psychological well-being of those who experience role strains in Palestinian families.

Coping

Coping strategies are the constantly changing cognitive and behavioral efforts to manage external and/or internal demands that are appraised as taxing or exceeding the resources of the person (Lazarus and Folkman, 1984). This construct has received considerable attention in the psychological literature (e.g., Billings and Moos, 1981; Folkman and Lazarus, 1980; Lazarus, 1981; Pearlin and Schooler, 1978), most frequently as a factor that mediates the relation between stress and physical or mental disorders.

Coping responses are classified in many ways. Pearlin and Schooler (1978) differentiate between efforts to change the situation and attempts to control distress, as well as responses that alter the cognitive appraisal of stress. Billings and Moos (1981) suggest a related typology consisting of active-behavioral strategies, active-cognitive strategies, and avoidance strategies. Lazarus and Folkman (1984) describe two forms of coping: problem-focused strategies that are directed toward the management of a problem and emotion-focused strategies that are directed toward amelioration of the associated level of emotional distress.

In several different studies, problem-focused strategies have been reported to have positive association with well-being (Folkman et al., 1986). A reliance on emotion-focused strategies, on the other hand, tends to be associated with poor mental health (Aldwin and Revenson, 1987; Terry, 1991). However, previous research (e.g., Folkman and Lazarus, 1980, 1985) has shown that people use both forms of coping in virtually every type of stressful encounter. The efficacy of problem- and avoidance-focused coping strategies is also thought to be situationally contingent (Folkman et al., 1986). Emotion-focused coping is believed to be particularly useful in situations in which the source of threat cannot be influenced, whereas problem-focused coping is thought to be most effective in situations in which threat can be altered. For example, in the families of the killed, reliance mainly on emotion-focused coping may be considered effective and appropriate, since not much can be done. In contrast, in the case of families of the injured, resorting to emotional discharge would not be appropriate as a substitute for the direct action of seeking professional help. Thus, the presence and type of specific political traumas may create or promote specific coping strategies.

Recent research has focused on the identification of variables that may influence the type of coping strategies that an individual chooses to adopt in a particular stressful situation (Holahan and Moos, 1987; Terry, 1991, 1994). The results of the studies indicate that stable and situational variables are important. Lazarus and Folkman (1984) view the way in which persons cope as determined in part by their resources, which include existential beliefs, commitments, social support, and personal resources, as well as constraints that mitigate the uses of resources. Personal constraints include internalized cultural values and beliefs that proscribe certain ways of behaving and psychological deficits.

The study of the mechanisms through which coping may be related to outcomes has been approached from several directions. Characteristics of the personality such as fatalism and inflexibility were identified by Wheaton (1983), whereas hardiness was identified by Kobasa (1979). Others focused on the characteristics of the stressful situations (Shanan, De-Nour, and Garty, 1976). Pearlin and Schooler (1978) considered the relative contributions of mastery, self-esteem, and self-denigration and the ways in which people cope with chronic role strains in relation to the amelioration of stress in four role areas: marriage, parenting, household economics, and role occupation. A number of studies ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Forword
• Preface
• Acknowledgements
• About the Author
• Chapter 1. An Overview of Political Victimization
• Chapter 2. Methodology
• Chapter 3. Trauma, Mental Health, and Mediators
• Chapter 4. The Psychosocial Contexts of Political Traumas
• Chapter 5. Conclusions and an Agenda for Action
• Appendix A: Factor Structure with Loadings for the Psychiatric Symptoms Index Obtained by Ilfeld and Pilot Study (N = 150)
• Appendix B: Factor Structure with Loadings for the Well-Being Scale (N = 150)
• Appendix C: Factor Structure with Loadings for the Trauma-Induced Stress Scale (N = 150)
• Appendix D: Factor Structure with Loadings for the Role Strains Scale (N = 150)
• Appendix E: Factor Structure with Loadings for the Ideology Scale (N = 150)
• Appendix F: Factor Structure with Loadings for the Coping Scale (N = 150)
• Appendix G: Factor Structure with Loadings for the Coping Scale (N = 150)
• Appendix H: Factor Structure with Loadings for the Sociopolitical Satisfaction Scale (N = 150)
• Appendix I: Guide for Focus Group Discussions
• References
• Index