It is difficult to concentrate our efforts as psychologists, psychiatrists and social workers while facing an epidemic. We can't pretend we can face the problem of violence and talk about peace in either Israeli or Palestinian societies if we don't address the sources of this epidemic. We should pay attention especially to the ways our trauma-producing environment rules our lives. People here are at increased risk of experiencing traumatic events. Our role as professionals is not only to treat victims, but also to oppose dehumanizing conditions and to encourage cooperation and network building between professions and professionals, especially in Jerusalem which should be a model of tolerance, peace and human integration. We are looking for an integral psychosocial model for health professionals to deal with the problem on different levels, and to be more creative and more involved in forming public opinion.

Checkpoints and Humiliation

Since the beginning of the Aqsa Intifada, Israel has placed a series of sweeping restrictions on the movement of the Palestinian population in the West Bank and Gaza Strip. These restrictions severely impair the right to work and earn a living, the right to education and the right to maintain family life. Israeli restrictions on the freedom of movement disrupt all aspects of daily life for some three million people. Checkpoints affect people from all walks of life, at least indirectly. The restrictions they impose directly harm those hundreds of thousands of Palestinians whose livelihoods are affected: farmers unable to reach their land, students unable to reach their places of study, businessmen unable to trade with other parts of the West Bank and Gaza Strip and so on.
Physically, of course, there is the direct threat to peoples' health when they are denied health services or are delayed in ambulances at checkpoints. Palestinian emergency services have been debilitated by the closures, and there is no effective police force operating. Cumulatively, these, and the less visible effects of simple delays, long hours in queues and the daily humiliation of being treated always with suspicion, will have long-term and pernicious psychological effects.
One must also take into account the psychological affect here of the victimizers, the soldiers who are the physical instruments of policy. Much has been written about the effect on those who engage in ritual aggressive behavior, those who by choice or by job description have to treat the other as a justified target for aggression. There are long-term effects on those who find themselves forced into a conditioned mode of thinking in which it is justified to treat other human beings in such a way because they are somehow seen as less than human. The dehumanization inherent in collective punishment cannot help but have such a negative effect.

"Trauma Organized" Societies

I use checkpoints as an example to illustrate how pervasive the harm caused by our current situation is, and how everybody is affected. However we describe the checkpoints - as collective punishment or security precautions - what they invariably serve to do is to increase the space, physically and conceptually, between neighbors. In effect, both the Palestinian and Israeli societies behave as "trauma organized" societies, where violence is tolerated as a normal way of life. By saying that we are living in "trauma organized" societies, I mean to show that the effects of multigenerational trauma are like an iceberg in our social awareness. Legal and mental health professionals and systems work from inside a paradigm of individual pathology and/or culpability based on deviance, and separating justice and repair. The victim-perpetrator dichotomy is part of this paradigm. It is becoming increasingly obvious that all of us participate routinely in this cycle of victim-perpetrator behavior to such an extent that it has become acceptable normative human behavior. As such, it serves only to reinforce trauma-producing contexts that contribute to the intergenerational transmission of sexism, racism, exploitation and poverty and a tolerance of different levels of violence as a way of life among individuals and between nations. In our situation, this is evident as we watch the wealthy among us vote to decrease social programs for the poor, the powerful abuse the privilege of their positions repeatedly to hurt the people who depend on them, and the poor and disenfranchised self-destruct rather than organize for constructive social change.
In our situation, under great risk of being exposed to traumatic experiences, we must understand how trauma-producing environments rule our lives. The male conditioning - to use violence as a means of control - added to our acutely violent and militaristic political climate, embedded within religious and philosophical belief systems that permit and even encourage the use of violence, has left us in a crisis that we will still be paying for a long time from now, regardless of what happens. It is thus vital for us to develop a framework of understanding for our collective psychological situation and to inform professionals, policy makers, public opinion leaders and sponsors, without whom we will not be able to address correctly the needs for healing that both societies face.
Entrapped in the national and political violence, we have failed to see that all violence is interconnected and that there are identifiable cycles of violence that can be avoided, prevented or circumvented. Israeli and Palestinian societies are a strong case of societies that have become organized around unresolved, multigenerational traumatic experience. Much like an individual victim of repetitive abuse, violence has become a way of life - the rule not the exception.

Savaged by Trauma and a Proposed Way Out

Palestinian and Israeli societies exemplify the nine "A"s of trauma:
1. Attachment (disrupted): We are immigrant and refugee societies. When disrupted, attachment becomes an instrument to shape individual histories and environments. This is also characteristic of accelerated mega urbanization, another phenomenon we are witnessing.
2. Affect (unmodulated): This refers to emotional numbing due to continuous political/military/terrorist violence. Abuse becomes fundamental to the functioning of society, almost an entire cultural system.
3. Anger (unmanageable): Instead of facing the need for reconciliation and making amends to those who have been hurt, people focus on retribution, blaming only the "other" for their situation and retreating into anger and passivity, while developing "martyrology" and "victimology."
4. Authority (abusive): Power becomes divorced from responsibility. The brutal exercise of law enforcement, the consequent devaluation of human rights, a longing for a strong leadership leads to an abdication of initiative and autonomy and conformism and obedience to social and political pressures.
5. Awareness (diminished): As a consequence of dissociation there is tolerance of incongruity, leading to a culture of denial for obvious consequences of actions by individuals and institutions (government and other), with a lack of attention and care for one's life and the lives of others.
6. Addictions (multiple): The addiction to violence (media, games, culture, faith in punishment, correction and incarceration, segregation), a desire for escapism and substance abuse increase and passive acceptance becomes a way to deal with "the situation."
7. Automatic (repetition): Self-destructive behaviors, cycles of violence and their repetition and pressure for more punishment as prevention of repetition, feed themselves into an almost unbreakable circle.
8. Avoidance (of feeling and accountability): The high level of violence leads to indifference to non-national-conflict-related suffering and their possible resolution, to less attention paid to rehabilitation processes. Everything becomes identified as "situation" related, and both victims and perpetrators are "de-subjectivized."
9. Alienation (from self and others): Our situation also increases the tendency for individualism and greater importance is attached to "me, myself and I." The consequences are less social cohesion and solidarity, a greater deepening of income gaps with more intrusive economic deregulation.
Treating these symptoms as premises, we need to develop approaches and services that will serve both populations based on the following principles:
* Effective theories and practices for ending violence could be considered adequate only to the extent that they are capable of integrating all three levels of abstraction: the biological, the psychological and the social/historical. Trauma-producing environments increase the mind/body split paradigm. Most of the funded policies, research and practices are language-centered and ignore the emotional, bodily and biological dimensions and effects of violence for both victim and perpetrator.
* Multidisciplinarity, both of method and concept, must be the order. For therapy, we need intensive integrative settings to help patients and communities integrate fragmented and traumatized parts. Non-verbal/body-oriented approaches can bring back emotional life, and the emotional life should be one of our main concerns.
* We must try to create a trauma-informed and coordinated community response based on a public health perspective with a primary, secondary and tertiary prevention and intervention policy as an alternative to our current trauma-organized society.
* Finally, we need to develop an organizational model for an integrative approach, substituting "wholeness" for "fragmentation," acknowledging the self as overwhelmed, working to replace a feeling of powerlessness with a sense of control, and a model that seeks to downplay divisive factors, such as class, gender and race, with an overall sense of humanity.

The Needs and Strategy for Cooperation

Based on what was explained above, I believe a need for cooperation is urgent since the return to a less violent environment alone will not address the consequences of the traumatization endured by both populations. To be able to effectively address peoples' traumatization and engender a true healing process, we must go beyond the dichotomy of victim and perpetrator. Ignoring the national and political environment and the demand for retribution and restitution will impair healing and public health services. There is a therapeutic need for cooperation that will help professionals and advocates on both sides handle the inclination of their clients to identify the perpetration with the "other side," thus freeing themselves from having to adopt a victim-only point of view. The ability to address perpetration, victimization and healing within a paradigm of reconciliation necessitates this cooperation. Furthermore, ignoring the difficulties and the resentments that are parts of the communities of professionals and advocates from both sides toward the "other side" is therapeutically erroneous and dangerous.

Affeck G. and Tennen. H. 1996. Construing Benefit from Adversity. Journal of Personality 64: 899-922.
Aldwin W. 1994. Stress, coping and development. Guildford.
Barlow H. 1988. Anxiety and its disorders. Guilford.
Beck A. and Emery G. 1985. Anxiety disorders and phobias. Basic Books.
Jareg E. 1992. Basic therapeutic action: Helping children, young people and communities to cope through improvement and participation. McCallin.
Kardiner M. 1941. The traumatic neurosis of war. Hoeber.
Helezer J. et al. 1987. Post-Traumatic Stress Disorder in the General Population. New England Journal of Medicine 317: 1630-34.
Van Der Kolk. B. 1984. PTSD: Psychological and biological sequalae. American Psychiatric Press.