Open Minds and Warm But Troubled Hearts in Closed Gaza (II), Day 6
December 20, 2009
Day 6
Dear friends,
If Gaza is saturated with tradition, and blessed with generous impulses, it is galvanized by politics. Until several years ago, when we developed a high level of skill and firmness in directing our trainees back to their own present feelings, simple declarative statements often threatened to veer off into impassioned political narratives. The Palestinian faculty we have trained now recognizes the hazards, and has become adept at forestalling rhetoric, foreclosing budding arguments, redirecting attention inward, and calling for immediate feelings as well as the historical conditions that may have provoked them. Inevitably, however, politics and the devastating consequences of political decisions are not far from the minds and speech and feelings of Gaza’s men, women and children.
In the small groups we see and hear that the consequences of history are inscribed in our participants’ pain and fears. Remember the hurt that the young psychologists whom I described in the previous blog carry from childhoods shadowed by loss and deprivation and squeezed by self-righteous brutality. And anxiety about present safety and future survival is absolutely, understandably universal: Gaza is closed off from the rest of the world, vulnerable to unpredictable attack from Israelis who control its borders and airspace and to violent schisms and reprisals within. Inevitably there are symptoms: One stocky young male psychologist from a distinguished family of Gazan warriors admits, embarrassed but eager for help, to “panic attacks” when his toddler daughter develops a cold or returns late from a babysitting relative; several other mental health professionals speak of waking abruptly, hearts racing at innocent sounds that evoke body-memories of Israeli shells landing or Fatah and Hamas fighting under their windows.
Six months ago, Gaza, though deeply wounded, seemed far more hopeful. Crumbled buildings – large public and small private ones – punctuated the streets of Gaza City and Rafah; blasted orchards and fields torn by shells tolled a loss of innocence as well as income; memories of the 1400 who died in the fighting in December and January filled the eyes of families we visited and appeared, often briefly, modestly, but with head-shaking sadness, in conversation. Still, there was a sense that things might, even that they likely would, finally change for the better.
One of Hamas’ top officials, Deputy Foreign Minister Ahmed Yousef, spoke of the renewed faith in American idealism that Barack Obama’s election and his speech in Cairo had inspired in him and others; of his hope for reconciliation between Fatah and Hamas; and of a future in which a regional partnership “of the world’s three great monotheistic religions” would bring peace, tourism and industry to Gaza and the West Bank as well as Israel. “Soon, inshallah, (god willing)” our Gaza faculty estimated, “we will be able to go with you to Israel, the West Bank, maybe even America.”
The current “situation” – the word is an all-purpose one that Israelis as well as Palestinians regularly use – seems by contrast dispiriting, even desperate, to the Gazans I meet outside of as well as in our training. Now Ahmed Yousef reminds me that “we have not fired on Israel for a year,” and asks, sadly, rhetorically, “and what has been our reward?” Young people wonder whether a world that will not open Gaza’s borders to trade that is necessary for rebuilding or to the free passage that will overcome their punishing isolation, understands or cares about or even notices their plight. Several speak, with resignation but chilling firmness, of the inevitability, in the absence of progress, of resuming “resistance”:
I do not feel that the vast majority of Gazans whom I meet – and I have worked closely with several hundred and met many hundreds more over the last seven years – want to return to fighting; it is that they do not know what else to do, how else to lift the crushing weight of the occupation, to signal, amid what appears to them colossal indifference, if not hostility, that they are “human,” and deserve the basic rights that the rest of us assume. “Don’t the Israelis understand we are just like them” one young woman, a well educated “political independent” asks me. “I have parents and children I love. I want to help my people. Yes, I hate what the Israeli government has done to us, but I do not hate Israelis.”
There are to be sure fanatics in Gaza, people chained to an unchanging allegiance to past wounds, committed to a holy war that will wipe Israel from the landscape. They are, however, very few among the very many I have met. Hamas has been a resistance movement and has committed terrorist acts, as, I would add, have other movements in this region. However, many of its leaders and many of the young who have been drawn to it now aspire, in spite of their current distress, frustration, and discouragement, to becoming partners in leading a state, productive members of a tolerant regional and world community. A burly young man, a high ranking government functionary who speaks with resignation about the possibility of resuming resistance, sounds a few moments later exactly like an American graduate student. He is particularly glad to talk with me, he says, because he wants my advice on framing a topic for the PhD thesis he hopes to write.
The day before our training ends, I speak, at Ahmed Yousef’s invitation, at The House of Wisdom, an independent Swiss funded Gaza City “think tank” that he helped found. “Everyone has to speak English here,” he tells me. “We want to be part of the world community.” Thirty earnest young intellectuals – political scientists, environmentalists, government officials – gather on short notice: Some are affiliated with Hamas, others with Fatah; many are unaffiliated with any political party.
I sit at the intersection of long polished seminar tables – it could be Georgetown or Harvard- and talk about the work we are doing in Gaza, the research that demonstrates its efficacy in reducing stress, improving mood, and enhancing hope for the future. I discuss the resilience of the people and the community that supports them; the central role of self-care and mutual help in all health and mental health care; the necessity of knowing and caring for and changing oneself as a prelude to helping others do the same; the dangers of fixed ideological positions that force people to deny or suppress their true and changing needs; and the importance of meaning and purpose in sustaining all of us. There are nods of heads and some smiles. The questions and comments are thoughtful, balancing appreciation for and curiosity about our work – “Yes, I and others in politics could use that,” remarks one man – with reminders of the challenges to safety and survival as well as sanity that continue to confront all Gazans.
As the seminar draws to a close, the House of Wisdom executive director Mahmoud El Madhour, a wavy haired, urbane PhD engineer and MBA who has studied Greek philosophy in Greece, and is a proud independent, thanks me. He ends the afternoon with a few words of reflection: “Without communication,” he begins in easy but urgent English, “we have nothing.” He pauses for a moment. “We stand here in Gaza, with no other place to go. This is my resistance. Gaza is a lovely place. And I want you to know I do not mind sharing it.”
Obama: Addressing the Healing Crisis
Dear President Obama,
Before you even took office you asked us Americans to share our ideas about healthcare reform with your new Administration. Thousands of us, thrilled to be invited to participate, gathered in small groups and offered our vision to you. Now, tonight, as you address us, it’s time for you to give us back our vision, enhanced by your broader perspective, enriched by detail, unencumbered by fear.
Americans for Healthcare Reform © Dreamstime.com
I’m sure you and your advisors have seen the polls that have repeatedly shown that the vast majority of Americans (up to 85%) believe that our healthcare system needs to be “fundamentally changed and completely rebuilt,” and that almost equal numbers are concerned that “access to medical tests and treatment would be more limited” as a consequence of healthcare reform. The polls tell us that Americans know that our far more expensive healthcare system is significantly less effective and efficient than that of other developed countries, and that, in general, we like the doctors who care for us.
These apparent contradictions are best understood as Zen koans, paradoxes that work to boggle our minds prior to opening them to new ways of seeing and thinking. I hope tonight you will invite us to look at healthcare reform in such a new way; help us to find, beyond the fears that have been evoked, and the mind-numbing horse-trading and compromise of the legislative process, the vision that continues to animate your commitment to the health and wellbeing of all Americans.
The vast majority of Americans-not just “Democrats” or “progressives,” but all of us – are decent, compassionate people who really want all our fellow citizens to have the healthcare they need. We know that change is necessary, but we don’t know yet what’s actually being proposed, and we fear that the change that comes may take away the surety of care and the security of our relationship with our doctors.
Fear is an enormously powerful emotion-deeply embedded in our evolutionary heritage and in our central nervous system. It signals danger, mobilizes the fight or flight response and all the psychobiological mechanisms of survival. Fear, as this summer’s town halls illustrate, overwhelms our capacity for nuanced observation or even rational thought. The very thought of going to the doctor makes many people tremble. The possibility of failing health, or of a vulnerable old age, or a change in access to those who are supposed to care for us makes us deeply uneasy. When opponents of healthcare reform have used evocative and provocative words to summon up these specters, the fear factor has obviously jumped off the chart.
To our agitated minds, “rationing” means that we will likely lose the diagnostic tests which we hope will clear away threatening uncertainties, the treatments that may restore us to health, and the doctors whom we have literally trusted with our lives. “Death panels” signify that anonymous others will, in the name of some impersonal, financially motivated calculus, shorten our lives.
Outrage, reassurance, and careful reference to the actual texts of proposed legislation-the principal defensive strategies of healthcare reform proponents to date-only take the edge off our collective apprehension. Relaxed, even meditative, clear-eyed assessment of healthcare realities, active engagement of each person in responding to them, and a call to transcendent and common purpose are what will ultimately make it possible for us-individually and collectively- to move through and beyond the fears that have been dominating the discussion. We are an energetic, inventive people and once we know it is possible and even necessary, we will want to be actively, effectively engaged in our care, and in determining our destiny.
Think of the “terminally ill” mother, who “somehow” lives to see her daughter’s wedding, the firefighter who enters a burning building to save an endangered child, the soldiers who brave bullets to protect one another. Think too, of people with life-threatening or life burdening illnesses (coronary heart disease, diabetes and cancer, clinical depression and post traumatic stress disorder), who, in the therapeutic programs many of us have created around the country, are healing themselves: sharing their fears and developing strategies for dealing with the threats to their lives; regarding illness more as a challenge than a disaster; eating and exercising in more healthy ways; learning from and supporting one another. William James coined the phrase, “The moral equivalent of war.” Caring for ourselves individually and collectively is such an equivalent.
I’m asking you, really, all of us are asking you, to mobilize and inspire us to participate actively in our own healthcare; to insist that those professionals who are supposed to help us treat us respectfully, even lovingly, as active partners, not passive patients.
We don’t, for the most part, need more drugs or procedures, but rather doctors and other healthcare professionals who will spend adequate time with each of us, listening and creating partnerships, as well as writing orders and prescriptions. The powerful therapeutic effects – and cost effectiveness – of such instruction in self-care, of what some are calling “lifestyle medicine,” on outcomes of chronic illness have been repeatedly documented.
If every older person were guaranteed a physician with time to talk about life and ways to live it more fully, as well as to discuss the best ways to deal with the inevitability of death, debates about “death panels” would wither from lack of fearful fuel. If doctors spent more time looking at the excess of often clashing and contraindicated medications that older people take, much of the unnecessary suffering and fear that accompanies care in old age would disappear. As we actually learn what combinations of self-care and physician-administered therapies are most effective, for which condition, most concerns about rationing-raised now almost entirely by drug companies, which fear that their products’ flaws will be revealed- will dissolve. We need to hear clearly from you that all those individuals and institutions that profit from our pain – hospitals, insurance and pharmaceutical companies, and those of us who are doctors too – can be justified and supported only as long as they serve all of us.
Finally, you must assure all of us, left, right and center, that you and your Administration will continue to give us and our health care the careful consideration we deserve, that this present effort is only the first stage of healthcare reform; the beginning of a process of national education; and a framework for the more profound and pervasive changes that we want but are not yet sure how to achieve. Tonight, we need you again to inspire us, to give us a vision not only of how we can all be safely and effectively treated, but how we can thoughtfully, lovingly, energetically, even joyously, learn to better care for ourselves and one another.
