Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed

Abstract

PurposeThis mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed.MethodsGroup interviews were conducted in 2011 with 68 Palestinians, most aged 30–40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one’s spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items—along with standard survey measures of mental health—to a representative sample of 1,778 32–43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct.ResultsAcross samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress.ConclusionsFeeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip

“…These findings provide support for studies (Barber et al, 2014; Barber, McNeely, Allen et al, 2016; Barber, McNeely, El Sarraj et al, 2016) that have similarly identified a unique type of existential form of mental suffering among Palestinians in the oPt linked to oppressive political and economic conditions. In addition, there was a marked absence of stability and safety due to the occupation, which adversely led to psychological and social suffering for participants (Barber et al, 2014).…”

“…Consistent with Barber and colleagues' (Barber et al, 2014; Barber, McNeely, Allen et al, 2016; Barber, McNeely, El Sarraj et al, 2016) findings, aspects of existential mental suffering linked to oppressive political and economic conditions in the oPt were described in reference to one's spirit, morale, life and/or future as broken or destroyed; emotional and psychological exhaustion; and feeling tired. Suffering was described in reference to the self or spirit, morale and hopes and ambitions for the future, which was also found in this study.…”

“…Evidence from recent research (Barber et al, 2014; Barber, McNeely, Allen et al, 2016; Barber, McNeely, El Sarraj et al, 2016) has identified a unique existential form of mental suffering among Palestinians in the oPt, linked to oppressive political and economic conditions, which included feeling that one's spirit, morale, life and/or future was broken or destroyed; emotional and psychological exhaustion; and feeling crushed, shaken up and tired. These aspects of suffering were described in reference to the self or spirit, morale and hopes and ambitions for the future.…”

Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside”

“…Given that muhattam could be reliably measured, the investigation emphasized the importance of using grounded and contextualized measures to assess the impact of political conflict on functioning (and health). 55 Muhattam was an important addition to the lexicon of idioms used by people to describe their health-where being well, afyeh in Arabic, is understood as a combination of physical, psychological, social, and emotional components that cannot be separated from each other. Such idioms not only form part of a health-disease continuum, but they are also used differently in different contexts so that sometimes they cannot be meaningfully (as opposed to semantically) translated into English using a single word.…”

Ambivalent Attachment — Melancholia and Political Activism in Contemporary Palestine

“…A recent study of Palestinian wordings of distress concludes that in tandem with the conventional measurements of PTSD and depression, a representative, local expression of the consequences of living with the exhaustion of being occupied for years on end is “feeling broken” (Barber et al. ). This finding resonates with my attempt to think about how the pressure of the occupation and the obligation to keep fighting against it registers among the relatives who have to endure while their husbands and fathers fulfill this ideal…”