Re: The Prevalence of Psychological Morbidity in West Bank Palestinian Children/Reply: The Prevalence of Psychological Morbidity in West Bank Palestinian Children
Albert, Steven M., Chesler, Phyllis, Jacobson, Judith S., Kaplan, Mitchell, et al., Canadian Journal of Psychiatry
Dear Editor: We are writing to bring to your attention our concerns about the abovereferenced article (1). We believe that it is an example of the misuse of science to further a political agenda. Below we list a few of the significant scientific flaws we found in our review of the article. Together, they raise questions about the integrity and credibility of the research.
The authors hypothesize that "settlement encroachment" caused what they characterized as psychological morbidity, but they did not define that term, measure it validly, or empirically test their hypothesis. Along with unsubstantiated "anecdotal evidence" and "personal observation," the authors cite only a political source (Noam Chomsky), not a scientific reference, to support their hypothesis. Although they assert that Palestinian children feared the Jewish settlement communities near the Bethlehem-area villages studied, they fail to cite a single documented case wherein Jewish residents were involved in violence against children, and they ignore the documented evidence that children from a Palestinian school stoned hundreds of Israelis on a frequently travelled road in the same area. The authors also fail to note the well-documented campaign of incitement to violence to which Palestinian children were exposed. That exposure bears directly on interpretation of the results and is a credible alternative explanation for the possible morbidity found.
Although the authors report using the "standardized " Arabic Rutter A2 scale for assessment of chidren's behaviour, the reference cited did not indicate that this instrument (2) had been standardized on a Palestinian Arab population. The scale is no longer used by Palestinian researchers (P Vostanis, personal communication, 2004 October 4). Other references cited did not address or support contentions in the study.
The authors cite a reference to support the claim that "displacement and military occupation" since 1948 have caused "violent and psychological pressures." A check of the reference (3) finds that it did not study or support those contentions. The authors also cite a study (4) to support the contention that "in the absence of direct traumatic events, poor psychological status may arise from anticipating such events" (1, p 62), although the subjects of their study were clearly not, as our authors imply, living in a "period of relative calm."
To summarize, the article contains numerous assertions not supported by the authors' own references, ignores available data that can explain the results, fails to define terms properly, and presents as conclusions unsubstantiated conjecture. None of the authors has a mental health background, and their use of references that do not support their statements calls their credibility into question.
We are surprised that your editorial peer review process failed to find these errors. Mixing politics with science is a risky proposition, especially without solid evidence to support the conclusions reached.
The complete analysis of the article is available at www.spme.net/Mansdorf 10_20_04.pdf
We urge all to read it.
1. Zakrison TL. Shahen A. Mortaja M, Hamel PA. The prevalence of psychological morbidity in west bank Palestinian children. Can J Psychiatry 2004;49:60-3.
2. Rutter M. A children's behaviour questionnaire for completion by teachers: preliminary findings. J Child Psychol Psychiatry 1967;8(I):1-11.
3. Baker AM. The psychological impact of the lntifada on Palestinian children in the Occupied West Bank and Gaza: an exploratory study. Am J Orthopsychiatry 1990;60:494-505.
4. Thabet AA. Abed Y.Vostanis P. Emotional problems in Palestinian children living in a war zone: a cross-sectional study. Lancet 2002;359:1801-4.
Scholars for Peace in the Middle East (partial list of endorsers)
Steven M Albert, PhD, MSc
Phyllis Chesler, PhD
Judith S Jacobson, DrPH
Mitchell Kaplan, MD
New York, New York
Gustav J Beck, MD FACP, FCCP, FACAAI
Edward S Beck, EdD, LPC
John R Cohn, MD
Paul Root Wolpe, PhD
Mag rer nat Dr Phil Ruth Contreras
Stan Dubinsky, PhD
Columbia, South Carolina
Georges Gachnochi, MD
Charles David Isbell, PhD
Baton Rouge, Louisiana
Mark S Kisclica, PhD
Ewing, New Jersey
Irwin J Mansdorf, PhD