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Palestinians Under Siege:
A Critical Psychology Perspective
on Mental Health and Justice

Dennis Fox

Conference Presentation

Siege and Mental Health...Bridges vs. Walls

Gaza Community Mental Health Center’s
5th International Conference

Gaza and Ramallah
Palestinian National Authority

October 2008

Portions of this paper have been incorporated into a 2011 paper, Competing Narratives about Competing Narratives: Psychology and Palestinian-Israeli Conflict.





The drastic mental health consequences of living under siege are well-known. Although specific outcomes vary according to local conditions, besieged communities around the globe experience lethal combinations of restricted movement, physical violence, hunger and disease, and disruptions to schools, hospitals, welfare support systems, and other public and community institutions. In whatever combination these and other factors arise, one common result is widespread mental distress. This paper addresses two primary points from a critical psychology perspective. First, the ordinary assistance that psychiatrists, psychologists, social workers, and other therapeutic professionals offer distressed individuals runs into an obvious problem under siege conditions: individual therapy and similar supports are scarcely sufficient to deal with a situation that requires the restoration of justice. This commonsense observation, which critical psychology applies more generally to the work of mental health workers even under more ordinary circumstances, takes on added significance when injustice transforms healing and recovery from an individual concern to a community effort. Second, politically relevant social-psychological factors interfere with both the development of empathy and the recognition of injustice. Two factors are of special importance in dampening global pressure to end the siege of Palestine and hold Israel to international human rights standards: the dominant discourse, especially in Israel and the United States, which dismisses Palestinian suffering as self-induced and politically justified; and the corresponding reliance on conflict resolution methods such as dialogue and negotiation that maintain a stance of academic and political neutrality. Ending the siege and resolving the broader conflict require pressing for approaches that acknowledge the existing imbalances of power and suffering as well as the historical and continuing responsibility for injustice.

Fathali Moghaddam (1990) drew a distinction two decades ago between mainstream psychology in the First World, which he termed modulative or primarily therapeutic and individualistic, and psychology in the Third World, which he hoped would depart from the Western model to become generative, aimed at fostering social change. Emphasizing the importance of despecialization in addressing the multiple causes of significant social problems, Moghaddam suggested that a broader look at political and other macro-level processes would turn psychologists' attention to human rights. Moghaddam's concerns seem to me especially relevant to psychology's potential role today in addressing the severe consequences of living under siege.

Most of you know much more directly than I what those consequences are. My efforts to enter Gaza several years ago failed, and so I have never until now been able to observe conditions for myself. I have read many accounts, which are easy enough to find for those who look for them, just as there are abundant academic, journalistic, and political descriptions of other besieged communities around the globe. Although specific descriptions vary according to local circumstances, it is news to no one here that long-time siege leads to lethal combinations of restricted movement, physical violence, hunger and disease, and disruptions to schools, hospitals, welfare support systems, and other public and community institutions. In whatever combination these and other factors arise, we know that one common result is widespread mental distress. Still, I know that whatever insight one can glean from outside research cannot bring the kind of awareness that comes only from first-hand experience. As explained by the artists from the group Windows From Gaza who organized the Colour Siege exhibit connected to this conference,

Who lives here ... knows exactly what siege means because it became unseparated from our daily life. The blockade became as the clothes we wear everyday in the morning. It is like the air we breathe in order to survive. Who beholds from a distance will not see the hideous face of siege and how we manipulate it by all means to combat it alone. Everything said or heard in this world can't reflect a realistic picture to what is happening here. If you really want to realize the matter, you must listen, see and live here ... and for this reason You ... He ... She...They and even all the world must listen and see this siege in its realistic essence and its ugly face. One scene of the siege shadow is better than thousands of media calls. (Colour Siege Invitation; English translation adjusted)

In my time today I would like to describe the potential relevance to this conference's theme of critical psychology, an approach that incorporates the concerns raised by Fathali Moghaddam and many others. To overgeneralize for a moment, critical psychologists from a broad range of psychology's subdisciplines believe that traditional mainstream psychology pays too little attention to the impact of injustice and oppression on human behavior. Psychology's traditional individualistic focus directs attention instead almost exclusively to individual strengths and weaknesses. This framework, while often serving a useful function in specific cases, oversimplifies multidimensional causes and thus overlooks the possibility of more effective comprehensive solutions. Critical psychologists understand that when thousands of people experience essentially the same problem, diagnosing and treating them one at a time while ignoring the larger societal context is short-sighted at best. (See generally Fox, Prilleltensky, & Austin, 2009.)

Critical psychology's terminology is relatively recent, but the many approaches that might be termed "critical" build on earlier efforts to push mainstream psychology to pay attention to broader political concerns. For many critical psychologists, the ultimate goal is to see individuals flourish within mutually supportive communities in just and egalitarian societies. To help make that possible, we seek to alter norms within mainstream psychology that de-emphasize societal-level influences. As Ingrid Huygens (2009) points out in a recent discussion of interactions between colonizer and indigenous peoples, psychology's norms "emerged and developed in the context of European conquest, exploitation and domination" (p. 267). Failing to take that context into account continues to strengthen an unjust status quo within the Western world and is even more damaging in less powerful societies. Critical psychology, not surprisingly, is generally consistent with critical approaches in fields such as sociology (Levine, 2004), anthropology (Gupta & Ferguson, 1997), law (Kairys, 1998; Unger, 1986), and pedagogy (Aronowitz & Giroux, 1985; Freire, 1970; Illich, 1971). In psychology, unfortunately, endorsement of traditional values, assumptions, and practices remains particularly strong despite activist, feminist, radical, and postmodern critiques (Brown, 1973; Fox & Prilleltensky, 1997; Fox, Prilleltensky, & Austin, 2009; Martín-Baró, 1994; Sarason, 1981; Tolman, 1994; Wilkinson, 1986).

As part of their everyday work, most psychologists try to help individuals cope with mental distress arising from a wide variety of sources. That's difficult enough in routine circumstances even in the developed countries where most psychologists - and most critical psychologists - live and work. But the ordinary assistance that psychiatrists, psychologists, social workers, and other therapeutic professionals offer distressed individuals runs into even greater problems under conditions of siege, war, genocide, and other forms of systemic violence. Individual therapy and similar supports are scarcely sufficient to deal with situations that so clearly require the restoration of justice. Persistent injustice and oppression transform healing and recovery from an individual concern to a community effort.

Critical psychologists, especially critical community psychologists, have for the past few decades focused increasing attention on devastated communities. In 1990, when Brinton Lykes and Ramsay Liem described the early work on human rights and mental health by psychologists in the United States, they pointed to significant efforts in Latin America in particular. They had this to say:

Wars of resistance against political oppression are a major fact of life in most regions of the world. Although frequently local in character, they are often sustained by the material and ideological support of the superpowers.... State-sponsored violence and civil war are generally the concerns of politicians, military officials, foreign policy experts, and the like. Rarely are they considered to fall within the domain of the social or behavioral sciences. In recent years, however, psychologists and other mental health workers have begun to document the human costs of war, especially the psychosocial trauma suffered by civilian victims.... Clinical and community interventions have been developed specifically to aid those directly targeted by state-sponsored violence. (Lykes & Liem, 1990, pp. 151-152).

Lykes and Liem went on to note that "the greatest challenges may be in helping those indirectly affected by war. Whether or not they have lost family members or suffered physical harm, people must still come to terms with a social reality in which terror, destruction, and violent death have become the norm rather than the exception" (Lykes & Liem, 1990, p. 152). In her most recent account of this subject, which broadens the focus to similar work in Africa and Asia, Lykes (2009) emphasizes once again that "psychologists working with survivors in contexts of extreme poverty where there have been or continue to be gross violations of human rights should respond from within a human rights framework" (p. 285), noting that conflict today

often target[s] civilian populations for economic, strategic, and political purposes.... Conflict can displace populations, separate families, and create constant threat of physical violence including sexual violations and death, all of which may undermine the social cohesion and community life that are crucial for individual strength, meaning, and identity. (Lykes & Coquillon, 2009, pp. 286-287)

The role of psychologists in a state of ongoing siege, the authors suggest, is to devise interventions based on critical and liberation psychology that are (citing Prilleltensky and Nelson, 2009) "contextual (ecological), political (focusing on social injustice and power), and value-driven (emphasizing social justice)" (Lykes & Coquillon, 2009, p. 289) This approach to trauma stands in stark contrast to that of mainstream psychology, which sees trauma as "embedded in medical conceptions of illness wherein selected symptoms and behavioral indices provide evidence of post-traumatic stress or other diseases" (Lykes & Coquillon, 2009, p. 289).

Although this is not necessarily a "bad" or problematic approach, attributing the effects of war, state-sponsored violence, and structural oppression primarily or exclusively to biomedical factors constrains medical and social scientific understandings of survivors' deeper distress. Survivors' pain or "social suffering"... embodies political, economic, cultural as well as psychological phenomena. (Lykes & Coquillon, 2009, pp. 289-290)

Many critical psychologists such as Brinton Lykes who work with victims of war, siege, repression, and oppression cite as a model the work of Ignacio Martín-Baró, the Salvadoran Jesuit priest and social psychologist who sought to define and develop a psychology of liberation. For his efforts on behalf of his beleaguered people, Martín-Baró was assassinated by a right-wing death squad in 1989. Perhaps because of his background in social psychology, his focus was not just on therapy for isolated victims but on behavior outside the therapeutic setting. Indeed, he saw no sharp distinction. Critiquing narrow traditional views of "mental health," Martín-Baró had this to say:

The problem is rooted in a limited conception of human beings that reduces them to individual organisms whose functioning can be understood in terms of their individual characteristics and features. Such a conception denies their existence as historical beings whose life is developed and fulfilled in a complex web of social relations. If the uniqueness of human beings consists less in their being endowed with life ... and more in the kind of life they construct historically, then mental health ceases to be a secondary problem and becomes a fundamental one.... To put it more plainly, mental health is a dimension of the relations between persons and groups more than an individual state. (Martín-Baró, 1994, p. 109)

Martín-Baró's perspective foreshadows recent work by critical social psychologists who reject their field's traditional assumptions. Even mainstream social psychologists have paid attention to factors that interfere with the empathy that's needed to recognize injustice. Social psychologists have also sought to improve methods of conflict resolution. From a critical perspective, however, both traditional empirical research on relevant social psychological constructs and the reliance on conflict resolution methods such as dialogue and negotiation too often leave injustice in place. In my view, a stance of academic and political neutrality often does little more than help sustain an unsatisfactory status quo.

In my remaining time I would like to focus on this last point in particular, especially as it relates to the situation of Palestine and Israel. The dominant discourse, for example, especially in the United States, dismisses Palestinian suffering as minimal, self-induced, and justified. This stance dampens global pressure to end the siege of Gaza and hold Israel accountable to international human rights standards.

Mainstream academics often internalize the assumption that their research must be, and indeed actually is, objective and value free. Critical theorists, in contrast, point out that even in the hard sciences our personal, professional, and political biases inevitably come into play, from the choice of theoretical model and framing of research questions to the scramble for funding and selection of methodology to the analysis and presentation of findings and policy recommendations (Rein, 1976). Most significantly for our purposes here, the pose of objectivity and ethical neutrality often masks personal preferences and institutional inertia that favor the powerful at the expense of others. Focusing on the centrality of data rather than on value disparity and power imbalance leads in conventional rather than system-challenging directions.

My concerns about academia also apply to other institutions claiming objectivity and neutrality such as journalism and education. They apply as well to mediation, dialogue groups, and other forms of dispute resolution that outsiders frequently proclaim to be the preferred way to resolve differences between Israelis and Palestinians. However, although approaching issues as a neutral can help a newcomer, a mediator, or a helping professional discover how each side frames important issues, in deep political conflicts reconciliation requires acknowledging and resolving long-standing grievances and being open to transforming institutions. Although dialogue and self-disclosure can generate powerful emotions and personal change, thus increasing interaction and sometimes even empathy and friendship, they do not reliably enough motivate a commitment to end institutional injustices linked to favored values and group interests.

Key conflict-resolution assumptions are not appropriate when the opposing parties have unequal access to power or when reasonable external standards such as universal principles of justice overwhelmingly support the weaker side. Pretending that all perceptions are not only equally relevant but equally valid, thus making compromise down the middle the obvious solution, renders victim and victimizer equally responsible. In this way, neutral mediation de-legitimizes crucial concerns, rewards the more powerful side's stubbornness, and institutionalizes existing power imbalances. Two years ago I spent a day in Bet Jallah observing a group of Palestinian and Israeli high school teachers working on a dual-narrative history project. Directed by Sami Adwan and Dan Bar-On of the Peace Research Institute in the Middle East (PRIME), the teachers had already produced a series of short texts on key historical events; the Israeli narrative runs down the left side of each page, the Palestinians' down the right (PRIME, 2003).

One thing about this difficult project struck me as curious: PRIME did not envision working toward a single historical narrative that both sides might come to accept. Integrating the conflicting perspectives, I was told, if such a task could even be accomplished, would likely make it impossible to use the material in either Palestinian or Israeli schools.

Most Palestinians I met on my previous visits were less interested than PRIME's researchers in prioritizing mutual understanding. They were equally skeptical of political negotiations that bypassed core historical and legal disputes or that seemed designed to resolve those disputes in Israel's favor. They too wanted peace and many even sought reconciliation, but they asked this: Where is justice? The academics and activists among them had little confidence in Israelis who were eager to talk and understand but unwilling to reassess their bottom line.

Last winter, I attended a conference in the United States based partly on the assumption that traditional academic research and conflict-resolution techniques would lead to a stable two-state solution. My own presentation objected to this assumption (Fox, 2008). In making some of the points I have already noted here, I pointed out that the conference's list of relevant topics omitted any mention of justice and law. From a traditional conflict-resolution perspective, of course, these omissions make sense. Addressing justice and law would push the conversation closer to the Palestinian narrative and make an even-handed framework more jarring. The conference, as a result, was not designed to explore as a central question which side's perceptions more accurately reflect historical events and global standards of human rights, or even whether those events and standards are relevant.

The same criticism can be made of other work in psychology based on the assumption that the underlying conflict is social psychological rather than political and that "perception is more important than reality" (e.g., Salinas, 2007; see critiques by Fox, 2007, 2008, and Elbedour, 2007). Shunting aside history and ignoring relevant standards make sense only if one considers all perceptions equally legitimate.

In concluding, I would like to refer one more time to Brinton Lykes' important work. She and Coquillon note

a concern about an unexamined assumption underlying much psychosocial work: that the expected outcomes are "recovery and healing." As critical psychologists and human rights activists, we should consider the multiple meanings of words like recovery, healing, reparation, and reconciliation. Critical psychological work with survivors of human rights violations stemming from war and other forms of violence implicates questions of justice and truth. Thus psychological language of "recovery," as commonly used, is insufficient to encompass the search for justice with truth. Moreover, if justice is "pending" in most if not all communities emerging from war, what are the possible consequences of psychosocial interventions in its absence? (Lykes & Coquillon, 2009, pp. 296-297)

I think it fair to say that Lykes and Coquillon's caution about working with direct victims applies as well to the broader conflict between Palestinians and Israelis. Ending the siege and ending the broader conflict require pressing for approaches that acknowledge the existing imbalance of power and suffering as well as the historical and continuing responsibility for injustice. Mainstream psychology is ill equipped to advance such a task, because its professional horizons and ideological defenses dismiss such concerns as irrelevant. Critical psychologists, in contrast, understand that power cannot be ignored and justice cannot be abandoned.


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