Psychiatry and the Palestinian Population

Article excerpt

Abstract: Some key issues pertaining to Palestinian psychiatry are described. Bearing in mind the geographical location and history of the Palestinian population, the development of psychiatry needs to be seen in the context of the Arab world, on the one hand, and of Israel, on the other. In the Middle Ages, Arab culture and medicine were more developed than in Europe. Aspects of general and forensic psychiatry on the West Bank and Gaza are outlined. Issues pertaining to the death penalty, suicide and suicide bombers are also discussed. The biblically-described relationship between the Arab and Jewish peoples has its resonance today with regard to cohabitation and conflict.

From remote times, close historical links have existed between Israel and the Arabs (1). A specific Palestinian national identity has now emerged seeking statehood (2-4). The territories of Gaza and the West Bank have since 1967 been subject to Israeli military rule but are now undergoing, albeit turbulently, a process of autonomy. Palestinian sources estimated the population in 1992 in the West Bank to have been approaching 1.5 million and that of the Gaza Strip as just under 800,000 (5), with an increase of about 45% anticipated over the next decade (6). Just under one-fifth or about one million Israeli Arabs also live within the borders of the State of Israel, with a birth rate double that of the Jewish population (7). Significant numbers of Palestinians also live in surrounding Arab countries, especially Jordan, where they may even be in a majority (7). The majority of Palestinian and Israeli Arabs are Muslim, though about 6% are Christian (8).

Aspects of the general and forensic psychiatric care of Palestinians have not been widely reported in the international medical press. The purpose of this article is to seek to describe some key issues in Palestinian psychiatry in a manner intended to avoid political bias (though perhaps in reality such a phenomenon is not entirely possible). The personal perspectives of both authors, one a Palestinian Arab and the other a British Jew, is the hope that the Israeli and Palestinian peoples may coexist in dignity and harmony, even if not in friendship.

Psychiatry in the Middle East

Psychiatry and health care in the Palestinian conurbations needs to be seen in a context comparable to that in Israel, on the one hand, and other Middle Eastern countries, on the other.

The Arab countries may have been among the first in the world to establish mental hospitals at a time when European civilization dealt with the mentally ill by condemnation and punishment (9, 10). Mental hospitals were built in Baghdad in the year 705, then in Cairo in 800, and in Damascus in 1270. In the Arab world, political and religious forces have always been intimately intertwined and Islam is a crucial factor in all aspects of life (11, 12). However, in most Middle Eastern Arab countries until relatively recently, mental illness was thought to be due to possession by demons, failure to follow ritual, or fate - Inshallah (13-15). On the other hand, the secular nature of Western psychiatry means it is subject to the challenge of avoiding any religious or spiritual perspective or any framework for the meaningfulness of life (16). When Sigmund Freud, of Jewish heritage and the founder of psychoanalysis, penetrated the realms of the unconscious mind, he did not relate such psychological processes to God; he saw the human belief as a universal obsessional neurosis (17).

Psychiatry in contemporary Arab societies is well established, though Egypt is the only Arab country with its own postgraduate degree in psychiatry (9). The Arab Federation of Psychiatrists publishes a regular psychiatric journal twice a year from its base in Jordan. British and French influences on Arab psychiatry emanate from the colonial period and are interwoven with Islamic tradition. Traditional and religious healers still play a major role in primary psychiatric care (18-20). …