Samah Jabr: There is no "post-traumatic" safety

On 7 February 2019 the psychiatrist Samah Jabr published an essay in Middle East Eye arguing that the most commonly reported psychiatric diagnosis among Palestinians is the wrong instrument for what she sees in her clinic. Her byline that day read: “Dr Samah Jabr is a psychiatrist and the head of the Mental Health Unit at the Palestinian Ministry of Health.”

She opens not with a diagnosis but with a memory of charity. “Elderly people in Palestine remember, with a sense of irony, the charitable parcels of clothing they received when they became refugees in 1948, as well-intentioned Westerners sent neckties, short trousers and berets to dress a population that had previously worn traditional Palestinian outfits. The new Western garments suddenly appeared on the backs of the local populace, with distinctly amusing results.” Then the turn: “This is how the Palestinian experience of psychological morbidity looks when it is forced into ready-to-wear Western categories, such as post-traumatic stress disorder (PTSD).”

Her objection to the category is historical before it is clinical. “PTSD is a concept developed in the context of warfare to describe the soldier’s experience; it has evolved through terms such as ‘combat neurosis’, ‘shell shock’ and ‘battle fatigue’, having been initially defined to account for the responses of veterans returning from Vietnam.” Broadened since, “it still fails to capture the experiences of communities living with collective historical trauma.”

The heart of the argument is the prefix. “In Palestine, traumatic threats are ongoing and enduring. There is no ‘post-traumatic’ safety.” She makes the difference concrete: “The phenomena of avoidance and hyper-vigilance are considered to be dysfunctional psychological reactions in a soldier who has returned to the safety of his hometown. But for tortured Palestinian prisoners, such symptoms are reasonable reactions, insofar as the threat lives on; they may be re-arrested and tortured again at any time.” Vigilance is not a malfunction when the danger has not left.

What the checklists cannot register, she says, is most of what people actually bring her: “humiliation, objectification, forced helplessness, and daily exposure to toxic stress.” She gives two cases in a line each, and neither would score. “A child who came out of an Israeli prison claiming that the soldier who gave him a cigarette to smoke is better than his father, who denied him cigarettes, might not register PTSD symptoms on a trauma checklist, but one can suspect serious damage nonetheless.” And: “A man who was slapped on the face, laughed at and spat upon might not have experienced ‘trauma’ in psychiatric terms; worse still, his injury might be labelled an ‘adjustment disorder’.”

She also records the vocabulary her patients use, and its untranslatability into a psychometric scale. “Badany Masmoum, Maqhour, Mazloum, Maksour Khatry” — “such are the expressions I hear most often from my patients when I ask about their feelings.” She renders them: “I feel that my body is intoxicated, oppressed, exposed to injustice; my desire is broken.” Her verdict on the instruments: “Western tools and instruments used in PTSD research in Palestine are not clinically or culturally validated.”

From there the argument becomes collective, and it is the sentence most worth carrying out of the essay: “As an individual trauma harms the brain tissue of a person, a collective trauma harms the integrity of the social fabric — its capacity to provide collective connections, trust, norms, world views and moral conventions.” Which produces a question no individual diagnosis can answer: “How can we measure the psychological impact of events not aimed at individuals, such as Israel’s new nation-state law, the Judaisation of Jerusalem or the siege of Gaza?”

She is equally hard on the incentives around the number. Journalists, she writes, sometimes over-generalise “a study with limited scope so that it appears to apply to the entire population”, or “misinterpret epidemiological data or fail to differentiate between a symptom and a full diagnosis.” And: “Non-governmental organisations also like the term PTSD, as it seems to help generate funds. Watching these NGOs pass out inventories of post-traumatic stress symptoms with one hand and offer food with the other, some may be tempted to express their hunger, misery and poverty by checking boxes on the survey.” That warning is a Palestinian clinician’s, made in public, and this archive treats it as binding on its own use of figures.

Her prescription is not therapy alone. Collective injury, she writes, “can be alleviated by promoting cohesive and collective efforts, such as recognition, remembrance, reconciliation, respect for minorities, supporting the afflicted, and mass cooperative action” — and she cites Palestinian examples of exactly that. She is candid about how little is firmly known: “The truth is that we do not have comprehensive epidemiological research on mental health in Palestine. We have a long way to go before we can draw reliable conclusions about mental health in our communities.”

The essay closes on sovereignty over knowledge, not on suffering. “Palestinians need to generate knowledge from their own experience of trauma… We are open to equal partnerships with international researchers who want to help us share understanding from our unique experiences. There is so much to learn about in Palestine.”

Sources

• What Palestinians experience goes beyond the PTSD label — Samah Jabr, Middle East Eye, 7 February 2019
• Radiance in Pain and Resilience: The global reverberation of Palestinian historical trauma — Wakefield Press, 2025 (author biography and current title)