Psychoanalysis Under Occupation

Practicing Resistance in Palestine

Lara Sheehi, Stephen Sheehi

• Publisher: Routledge
• Year: 2021
• ISBN:
  9780429947261
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Middle Eastern Politics
• Index: Politics & International Relations

Heavily influenced by Frantz Fanon and critically engaging the theories of decoloniality and liberatory psychoanalysis, Lara Sheehi and Stephen Sheehi platform the lives, perspectives, and insights of psychoanalytically inflected Palestinian psychologists, psychiatrists, and other mental health professionals, centering the stories that non-clinical Palestinians have entrusted to them over four years of community engagement with clinicians throughout historic Palestine.

Sheehi and Sheehi document the stories of Palestinian clinicians in relation to settler colonialism and violence but, even more so, in relation to their patients, communities, families, and one another (as a clinical community). In doing so, they track the appearance of settler colonialism as a psychologically extractive process, one that is often effaced by discourses of "normalization, " "trauma, " "resilience, " and human rights, with the aid of clinicians, as well as psychoanalysis.

Psychoanalysis Under Occupation: Practicing Resistance in Palestine unpacks the intersection of psychoanalysis as a psychological practice in Palestine, while also advancing a set of therapeutic theories in which to critically engage and "read" the politically complex array of conditions that define life for Palestinians living under Israeli occupation.

1 Practicing Disalienation

DOI: 10.4324/9780429487880-2

The first time we met Yoa’d, it was at the Palestine Counseling Center (PCC), sequestered on a small street in Beit Hanina, the residential neighborhood of occupied Jerusalem through which the Apartheid Wall runs. A number of common friends and colleagues strongly suggested that we meet. It was a hectic day and the last of a five-month stay in Palestine in 2018 that was the start of the fieldwork which was the basis of this book. We sat in a room surrounded by play therapy toys where Yoa’d introduced two Palestinian male clinicians, who we will call Karim and Adel.

Yoa’d was matter of fact, though pained: “These are the daily conditions of practicing in Jerusalem. A number of our patients come from the West Bank even though most live in Jerusalem.” When asked about how this might impact therapy, she repeats, “It always enters the room. One way or another, the occupation always enters the room.” This phrase represents a prominent, technical fixture in psychodynamic and psychoanalytic therapy in Palestine. “It” stood for many words: military occupation, the Zionist settler-colonial state project, al-ihtalal, al-dawlah, al-sahyuniyah, al-ist’amar, al-ist’amar al-istitani. Karim, a clinician, political activist and a former political prisoner, reiterates the observation, “the occupation exists even if it is not mentioned. It always enters the room.” While trained analytically, he has come to believe since his release from prison that cognitive behavioral therapy (CBT) is the best tool to combat what he sees as relentlessness effects of settler-colonial Zionism. He observed, “anxiety disorders are the most prevalent among our clients. I think because it is through anxiety disorders that the history of occupation often emerges.” We would come to hear in great detail over our visits to Palestine how somatic complaints were often more accessible, a physical manifestation of the psychic toll of a brutal settler-colonial regime, and, in many instances, the language available to communicate experientially about what may otherwise be overlooked or pathologized by a non-Palestinian clinical gaze.

This somatization was not pathologized by Yoa’d or any of the clinicians with whom we spoke. Rather, in discussing whether patients sometimes use the hardships of the occupation as a means of deflection or avoidance, Yoa’d replied,

That is not unique to the Occupation. Defenses are always in play. Most people who come in for therapy don’t explicitly say ‘Help me Doctor, the Occupation is making me crazy.’ They come to talk about their marriages, their families, their own insecurities and fears, frustrations, and stressors. Just like anyone else. No doubt, when you are always late or miss sessions and blame the occupation when it is not an obvious link [i.e., when there are no checkpoints along your travel], you can see there is deflection maybe. But when you know that they are coming from a camp, their father or husband is in jail, settlers—with the help of the state—are trying to take their house in the Old City, how can you ignore the presence of the occupation? We work through these parallels to identify deflection so that we do not contribute to the “splitting” that the Occupation forces on us.

Adel chimes in, adding, “The challenge in Jerusalem is to separate things like acts of anger and frustration as symptomatic (‘arad, pl.) of conditions that can be both from occupation and reside within the individual.”

For those in Gaza and the West Bank, the tensions and tangibility of how the “outside” can only but structure the “inside” of the room are palpable. The occupation “enters the room,” if not through the door, then through the window. Caesar Hakim in Bethlehem related an illustrative story of being in session while the Israeli military suddenly raided Bethlehem. He states,

you and the patient are always aware of the outside—one time, I was with a patient and the Israeli military were chasing Palestinians in Bethlehem. You know Checkpoint 300 is, what less than 1200–1300 meters from here? We could hear [the Israeli military] shooting. There was smoke and [tear] gas. You could smell it. You could smell the gas and smoke in the room. We just carried on with the session. We closed the window, but the smell in the room was already heavy.

Caesar then wondered, “It is like a form of [Kleinian] splitting. Right? Separating that part of you that wants to pay attention to the outside from the patient and clinician. Or dissociation?” and then smiles, his usual playful smile, “Or maybe no. Maybe that is just what it means to practice in Palestine. It’s always present. It becomes part of the practice.”

What struck us here, apart from the mindful self-reflection of clinicians such as Caesar, is that he was speaking not only about the sheer violence Palestinians under occupation in the West Bank are exposed to, but also of a shared condition of daily violence and the political condition that structures everyone’s life economically and socially, coming to be constitutive of the Palestinian experience. Fathy Flefel, the director of the Palestine Red Crescent Society Resource Center, responsible for providing mental health care to Palestinians in the Occupied Territories, likewise directly associates alienation as a feature of practicing under occupation, a feature that the clinician is faced with either confronting or reproducing. He states,

The occupation is in everything. It is in rules. It is infrastructure. It is how we pass from one town to another. And even how we deal with our own [Palestinian] Authority. The group dynamics result in competition, ideologically and theoretically, between us. It feels as though people have a split identity under occupation, especially with regard to the identity of the clinician.

On another occasion, Fathy returns to this point,

we feel as though people have a split identity under occupation, especially with regard to the identity of the clinician. Can we leave our condition at the door? If we commute between Jerusalem and Ramallah, Haifa and Jenin, can we pretend that we don’t experience occupation and we are not differentiated in ways that the occupation intends? Checkpoints, for example. They are experienced by both the patient and the therapist. We need to recognize this. We share a language that emerges not only out of history, a history of struggle, but a daily condition that is defined by the ever-present colonial violence.

Fathy reiterates the condition of Yoa’d and Caesar, the demands of splitting as an intended, rather than just a by-product, psychological effect of the Israeli settler-colonial project and, by extension, a prerequisite for apolitical clinical practice.

The conversation at the PCC in Beit Hanina went beyond the question of whether and to what extent the “outside,” “the social,” and the “politics” are “always there in the room,” a phrase that emerges and reemerges not only in Palestine but anywhere psychologists are debating the limits and power of sociogeny. Rather, we found ourselves tracking the emergence of a collective clinical practice already “in the room,” already saturated by the violence of Zionist settler colonialism and its history. That is, what emerged clearly in our conversations is how Palestinian clinicians operate within and seek to define a collective practice through a shared “language.” No doubt, Arabic as a medium of therapy (and, as we will see, education and training) remains a central priority to all the clinicians whom we interviewed and with whom we collaborated. More so, however, there emerged an explicitly conscious attempt to locate a common nomenclature of both personal and communal suffering, a practice that itself was dynamic and attuned.

Caesar tells of the series of different words for “anxiety” and “anxious” he encounters, each being determined by gender, social context, and even geography. “Language and vocabulary for anxiety, stress, and depression,” he states, are not consistent. “There are delicate differences. This is why it is so important to listen to the use of language. Not to replace it with ‘clinical language’ but to connect with the patient in the language they choose to use.” Caesar reminds us that the terrain in which the clinician meets the patient is often what determines if the Palestinian clinician is prepared to break the “splitting,” to take on the demand of disassociation of oneself from the shared conditions of settler colonialism and military occupation that has compelled their patients to seek out the clinician. This is especially important when, as Fathy reminded us, “the patient talks about my own pain” and therefore can both at once understand implicitly and perhaps be wounded and/or wounding in response.

This understanding seemed ubiquitous across clinicians, whether they lived in Gaza, West Bank, occupied Jerusalem, or within 1948 borders—a shared understanding of clinically relevant historic impact that dictated the parameters of clinical practice and, most importantly, affective attunement. In the words of Samah Jabr, director of the Mental Health Unit at the Palestinian Ministry of Health,

We understand how psychological intervention can and is used to punish political behavior. We understand how it is used to dismiss political claims of the Palestinian people. Preserving the social fabric and coherence of Palestinian society is essential to mental health but also we are aware how we treat our patients so therapy is not continual process of re-traumatization.

We will see in this chapter (and in Chapter 4) why connecting to language is so pivotal, especially when the political forces, whether that of the Israeli settler-colonial state, the international aid community, or the PA, work to vacate and reengineer the language that describes political and social conditions. In other words, what will emerge in this chapter are the ways in which Palestinian clinicians allow the occupation to become legible in their patients, while also tending to their internal worlds and suffering.

Negotiating Settler-Colonial Reality

“You know we do not accept [Israeli] state funding,” Yoa’d told us. “There’s a constant struggle (sira’), a tension between needs and responsibilities. Between cooperation and coercion. Between serving our people as much as we can and remaining independent [as a people].” The PCC was started in Jerusalem in 1983 by a group of Palestinian psychologists led by the well-known pacifist psychologist Mubarak Awad, in order to attend to the mental health needs of Palestinians underserved in Jerusalem, Gaza, and the West Bank. Since that time, the PCC has expanded its mission and operation to include centers in Jerusalem, Ramallah, Jenin, Nablus, and Qalqiliya. Rana Nashashibi, a pillar of community organizing and mental health, has served as the Director since 1991 and worked assiduously not only to provide clinic-based services, but also to promote community-based approaches and practices around mental health in Palestine. The PCC (with its many branches) is an example of a handful of other psychological enterprises (visited further in Chapter 4) spread throughout occupied Jerusalem and the West Bank, which work with a series of other Palestinian-run organizations to serve the Palestinian population under Israeli military and direct and indirect administrative occupation. What we will see in this chapter, and throughout this book, is that these enterprises do not merely seek to ameliorate or relieve suffering, but rather, their practice, individually and as a part of autonomous institutions, creates and maintains independence from the settler-colonial state, if not also from the international NGO industrial complex, as we will see in the following chapter.¹

We locate the “tension between needs and responsibilities” not only in a dynamic of forces between individuals of a collective living under occupation. To the contrary, repeatedly, clinicians, and so many others, have identified that the goal of the colonial state is to atomize and isolate Palestinian individuals, removing them from their communal networks.² The “tension between needs and responsibilities,” then, is a national, communal, and popular condition, which is manifested in the sort of communal projects of mental health services that these clinicians understand themselves as building. Yoa’d and the other clinicians in Beit Hanina, for example, referred to how providing psychological services for underserved Palestinian communities is inextricable from a myriad of political and economic challenges. Many of these challenges would be familiar to any clinician who attends to historically excluded, neglected, and/or marginalized communities. Yet, in Palestine, like so many clinicians told us, normative challenges are amplified and intensified by the settler-colonial project and military occupation of Palestine.

Caesar would say that

for the Palestinian things are the same as everywhere else but worse. It’s like the hassle of traveling or horrible traffic. You know, just the normal pains found in any developing country; going nowadays from A to B is complicated by normal situations. But here, in Palestine, the normal headache becomes three times worse (aqsa). Access. Funding. Training. Awareness. Treatment. Therapy. You name it. Everything is complicated by occupation.

“Normal” stressors and difficulties—whether personal, relational, or social—become exacerbated by Israeli military occupation. Fathy, working within an institutional capacity that interacts with Palestinians not only under occupation but also in exile in camps in Lebanon, for example, sees these tensions not as coincidental or a by-product of the settler-colonial regime. Rather, “occupation,” he states,

creates a crisis, creates an abnormal condition. Where people could ask for and access services that have always been needed in normal situations, the demand here [in Palestine] is not only elevated much higher now than the services that are available, but regularized as a part of everyday life, for the people—and the clinicians and clinics are part of them [the people]!

Practicing psychoanalytically in Palestine is a collective endeavor, an endeavor of ego- and identity-building as much as institution building for a society that fights tirelessly for national liberation. Without a doubt, Palestinian psychologists, inside the State of Israel, as well as those under occupation and siege in Jerusalem, the West Bank, and Gaza, clearly understand, in the words of the Palestine Global Mental Health Network, “Palestinian intellectual and mental energies in the field of mental health and psychotherapy in historic Palestine and the world [dedicated to] the sake of a free people, free nation (watan), and free world.”³ In other words, as we will see in Chapter 4, their practice seeks to foster and support a community-generated concept of healthy Palestinian ego development as a part of a larger set of social practices by Palestinians to nurture, forge, and attend to Palestinian cultural and national identity.

In this regard, we should not limit our understanding of the “nationalistic” and “patriotic” intonations of this project in that, for people engaged with colonialism, such terms can only be understood within their context of national liberation. The thrust of...