Socio-Political Aspects of Mental Health Practice with Arabs in the Israeli Context

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Abstract: Since the 1948 establishment of the Israeli state, an event described by Arab peoples as "Al-Nakbah" (catastrophe), the Arab minority in Israel has experienced oppression, trauma and social exclusion; they feel defeated, disempowered and poorer. There are huge gaps in quality of life between Arab and Jewish Israelis. Such social inequities, as well as other issues such as polygamy, have been identified as risk factors for psychological distress. This situation puts the Israeli Arab, like other post-colonial peoples, in an attitude of ambivalence towards modern mental health services. On the one hand, certain forms of intervention, particularly medicinal, may improve peoples' lives. On the other, mental health services, as part of the colonial process, continue to present limited cultural sensitivity towards Arab peoples. A cultural gap leading to mistrust is a given when a non-Arab mental health provider comes into contact with an Arab client. Religious beliefs, the importance of the family and the stigma attached to mental health problems have substantial influence on the Arab's perception and reaction toward mental health problems and their treatment. The expression of conflict and negative feelings are not well accepted within Arab culture. For this reason, mental illness is often denied and kept away from professional help or expressed as a physical illness. There is also a difficulty for a male being treated by a female and for the individual to ask for help outside his family or community. Arab Muslims also generally have a tendency to resign themselves to God's care and thus may neglect or deny symptoms. Another tendency is the preference for using traditional healers and folk medicine. Other problems in mental health work are the passive attitude of the patient and the degree of authority vested in the therapist. To facilitate bridging this cultural gap, the therapist's first task is that of educating him/her self about the religious, cultural and national background of the client. Cultural competence and self-reflection are key components to effective cultural practice.

Over the past half-century, the Palestinian and Israeli peoples have lived in an exceptionally contentious situation (1, 2). Ongoing violence from both sides has wrought traumatic consequences (3). Within this context, economic deprivation, the suppression of political rights, and continuous psychological stress and social dislocation has become normative in both sides.

The Arabs in Israel

Since the 1948 establishment of the Israeli state, people of Arab descent have experienced oppression, trauma, social exclusion and related socioeconomic and political problems. Indeed, Arab peoples describe 1948 as "Al-Nakbah" (catastrophe), and it represents the loss of the homeland, the disintegration of society, the frustration of national aspirations and the beginning of a hasty process of destruction of their culture (4).

The psychosocial and economic consequences have been severe: people lost their homes, livelihood, and political power; families were displaced, separated, and communities were destroyed. Al-Nakbah is the moment when a part of the Palestinian people became homeless, a state that is associated with a deep sense of insecurity. In light of this, the house key has become a symbol of the former home and of the return to it and to normality (4).

Between the establishment of Israel in 1948 and 1967, the Arabs in Israel were under a military regime. The traumatic impact of this social exclusion continues to the present time, as reported by Israeli and other scholars (5).

Arabs in Israel find themselves in a difficult and complicated reality. They perceive themselves primarily as Palestinians. Many have first and second degree relatives in the occupied territories. Most identify nationally and emotionally with the Palestinian people in the occupied territories (6).

Palestinians are now a minority within Israel, constituting 1. …