It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain.

– Judith Lewis Herman, M.D. “Trauma and Recovery”

To understand psychiatric home visits in Palestine necessitates forgoing Western assumptions about patient confidentiality, privacy, and timeliness. Though individual patients often refer themselves to treatment centers after a release from prison, the difficulty of traveling to and from major cities requires therapists to make home visits. Families then participate in the session as a group, thereby coming to better understand their family member’s situation and relieving some of their own symptoms as well. Throughout Palestine, families are regularly made to feel that their own house is unsafe and outside of their control. Violence may overtake a peaceful setting without warning, and to resist an arrest would be to invite danger on the rest of the relatives. A study conducted by the Ramallah Treatment and Rehabilitation Center for Victims of Torture (TRC) examining arrests as trauma-inducing events explains that, “92% of arrests [surveyed] happened at home, and most of [them] happened…in the time periods of deep sleep after midnight. This had caused severe emotional and psychological damages to the families, and doubled the impact of emotional suffering and immediate trauma” (“The Impact of Detention on Palestinian Detainees’ Families in Israeli Prisons,” 2011).

Two weeks ago, I was incredibly fortunate to visit and accompany staff from the TRC on home visits to patients. Founded by Dr. Mahmud Sehwail*, the TRC is a leading organization in the fields of psychology and research on torture survivors in the West Bank. Their work largely focuses on ex-detainees, and how to heal and re-acclimate them to society. Guided by Dr. Rania, an experienced and thoughtful social worker, we were briefed us on the patients’ history and symptoms en route to Jalazone refugee camp.

To my great surprise, the family in the camp was happy to host two Americans along with their regular therapist to talk about the violence they’d gone through, and we were greeted with tea and kisses. Dr. Rania explained the importance of this type of visit: patients have control over their environment and they tell their stories when they feel ready. Serving tea and making small talk is a simple way to prepare oneself for the discussion and reliving of traumatizing events.

The Jalazone refugee camp hangs on the outskirts of Ramallah. Serviced poorly by the UNRWA, Jalazone comprises mainly of families from central Palestinian villages that were ethnically cleansed in 1948. Home to over 11,000 people on 253 dunams, or about 25 square kilometers, space is extremely tight in Jalazone. The entire camp gives the sensation of being squeezed. Houses are built an arm’s length apart; in the building we visited, a two-floor apartment contained nine children and at least five adults.

Twenty-five-year-old Ayman was late to the session, even though he was the official patient. After some gentle prompting and with much chiming in from his parents, he narrated his experience: A few months prior, he had been arrested by IDF soldiers on a nighttime raid, beaten all over his body, and kidnapped to an Israeli prison along with the rest of the men in his family. He had recently been released, and was now unable to sleep, relax, or eat regularly for a pervasive fear of the soldiers showing up to raid his house and re-arrest him. He had taken to staying at home most of the day, dozing whenever sleep overtook him. Now, he haltingly articulated his nightmares, which sounded like exact replayings of what had happened a few months ago: being arrested for an unknown crime, attacked by soldiers, and held in a faraway prison, over and over again.

Ayman chainsmoked throughout our meeting and ran a hand through his hair every few minutes. Waves of stress emanated off his hunched body. He could not seem to stop looking toward the doors and windows, and I began to envision his phantom soldiers crashing into the room.

Judith Herman writes:

Traumatized people relive the event as though it were continually recurring in the present. It is as if time stops at the moment of trauma…[it] becomes encoded in an abnormal form of memory, which breaks spontaneously into consciousness, both as flashbacks during waking states and as nightmares during sleep…trauma arrests the course of normal development by its repetitive intrusion into the survivor’s life (36).

If Ayman were living in another political situation, he might be able to disentangle the rest of his life from the nighttime arrest, and work through the event in a space where he could be certain of his safety. However, being Palestinian in a refugee camp whose population is subject to frequent raids, beatings, and arrests, amidst a larger context of occupation and colonization of his ancestral homeland, healing from the arrest will be difficult. Being re-arrested without charge is not at all unusual, and is the single worst thing that can happen to someone already traumatized by his first arrest. Dr. Rania repeatedly informed us that the only way to heal from trauma is to remove the patient from a traumatic environment, but “in Palestine, we cannot do this.” Here, survivors must process their trauma, fear, and anxiety under the possibility that it could all happen again at any moment.

Though trauma is common in Palestine—Dr. Sehwail estimated about 25% of TRC patients are diagnosed with PTSD—seeking mental healthcare carries a stigma throughout the world, and even here, under such horrific conditions, the fear of being considered “crazy” persists. Ayman’s parents described with some anxiety their son’s ongoing terror, which had temporarily destroyed both his effort to seek employment, and their effort to get him married. Dr. Rania was careful to emphasize that what had happened to Ayman was not normal, and his brain was reacting normally to what should never have occurred. Fear lives on in his body, rendering his ordinary tasks and daily rituals nearly insurmountable challenges. Ayman told his whole story barely above a mumble, eyes fixed on the shattered glass of the front door.

His parents talked for much of the meeting. His father described to us a few years he’d spent working at a Puerto Rican restaurant in New Jersey. His worn-out English contained laughed Spanish, and he tried to chuckle through the impossibility of ever managing to secure a travel visa again, let alone leave the camp. Meanwhile, his mother explained to Dr. Rania her new policy on visitors to their home, designed to deter or at least stall aggressive soldiers: “I answer the door. He [Ayman] stays where he is. I go, no one else.” Their talk was disjointed, alternately cheerful and grave, jumping from topic to topic without transition. I tried to keep up, translate, and process each new subject as best I could. Later, on the bus back to Ramallah, Dr. Rania would tell us: “You can see, the whole family is traumatized. They don’t understand this, but they are.”

Ayman and his parents are lucky—treatment is available for them. Regular meetings with TRC staff will help them develop strategies for managing their pain, fear, and anxiety. Yet even with good counseling, his security and wellbeing will never be guaranteed, particularly in the dilapidated infrastructure of the refugee camp. He is one of thousands of young people having gone through the Israeli prison system, which is designed to weaken Palestinians and suppress their resistance to the Israeli occupation. It is 2015, and there are now several generations of trauma within Palestine, layered and complex and most going without treatment. What will be the next nightmare?

*All other names in this article have been changed.

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