Thread by @PeterHarling

Given our recent work on the mental health crisis in Syria, combined with the distress we can all feel in and around Gaza, I wanted to share some very practical observations on the psychological effects of conflict, through the lens of "trauma". 🧵

It’s important, in this context, to understand the difference between two types of trauma. A single traumatic event can break the continuum of one’s life journey: Because we can’t process it, we stay stuck in a loop.

That’s what is treated, effectively, as PTSD.

But war can create conditions that are almost the opposite: a continuum of traumatic events that envelop one’s life journey.

The difference is similar to surviving a rape, on one hand, or building oneself despite repeated abuse, on the other.

War can be akin to the latter: an extended experience of extreme powerlessness in the face of threats. These threats may be real or perceived, direct or ambient, material or emotional.

The point is that powerlessness is key, in addition to threat.

That’s the origin of a major misunderstanding concerning trauma. We naturally tend to play up the magnitude of the threat: The bigger the hurt, the greater the trauma, surely. That implies a hierarchy of suffering, which silences people who haven’t been through “the worst”.

But in a place like Syria or Gaza, pretty much everyone has been exposed to the second kind of trauma: when people must adjust to unremitting threats over which they have very little control.

This is called complex PTSD, which is trickier than PTSD.

It’s a nastier condition to tackle because it’s harder to pinpoint events amid a deeply disturbed chronology. People also develop all sorts of coping mechanisms that become part of themselves, part of a system: Tellingly, breakdown may even occur as threats decrease.

This distinction has implications for mental health support programs. In the West, we now have sophisticated response mechanisms designed around single events, in support of soldiers, expats evacuated from a conflict zone, or victims of an earthquake.

In our societies, however, complex trauma tends to be associated with things like childhood abuse or gender-based violence, simply because in recent decades we haven’t experienced war or occupation, not as a persistent mix of intimate violence and extreme powerlessness.

In other words, well-meaning professional interventions can miss the point, when applying run-of-the-mill PTSD techniques to people whose trauma is deeply layered.

Moreover, the problem of ambient threats is another regional trait that is insufficiently understood.

Although many people, in Syria or Gaza and beyond, have lost a home, a loved-one, or a limb, the trauma doesn’t stop at that. It encompasses everyone's exposure to everyone else’s suffering, notably through an endless stream of raw, terrifying content relayed by all media.

That’s also what connects Syria with Gaza, but also with Iraq and Yemen, with repression in Egypt, with a catastrophic flood in Libya, and so on. The region faces an overload of fear and pain, whereby nothing can truly be processed anymore.

Grief chases grief.

The booming drugs business that we describe is just one aspect of a much deeper crisis, of which we see many signs region-wide. By the same token, mental health is becoming less of a taboo. We’d like our own research to be part of this rising awareness. synaps.network/post/syrian-dr…