Society / November 10, 2023

This War Is Causing Mass Trauma. How We Respond Matters.

Too often, trauma has been used to justify more trauma. It is time to break that cycle.

Alex Colston
A boy is seen as the psychological support team of the Palestinian Ministry of Health provides psychological and recreational support to the children who take shelter at the Nassr hospital as the Israeli attack continues in Khan Yunis, Gaza on November 9, 2023.

A boy is seen as the psychological support team of the Palestinian Ministry of Health provides psychological and recreational support to the children at the Nassr hospital in Khan Yunis, Gaza, on November 9, 2023.

(Abed Zagout / Anadolu via Getty Images)

In September 1918, Sigmund Freud and his colleagues Sándor Ferenczi, Karl Abraham, and Ernst Simmel met in Budapest with delegations from the military commands in Germany, Austria, and Hungary. The psychoanalysts were there because they had each come to the same conclusion in their clinical work: that World War I, then in its final months, had taken a devastating toll on the intimate lives of soldiers and civilians alike. The symptoms the men had seen included tremors, hypervigilance, paralysis, recurrent nightmares, hallucinatory repetitions, flashbacks of particularly terrifying events, and embodied acting out of self- and other-destruction—in sessions and in life. Ostensibly caused by external events, these “war neuroses” subsequently became known by more familiar names like “post-traumatic stress disorder“ (PTSD), “shell shock,” and “soldier’s heart.” Freud’s delegation got its point across, and, for a brief moment, psychoanalytic treatments for these symptoms became legitimated by Central European governments in peacetime as a way to repair the ravages of war.

It is rather commonplace to believe that traumas are caused by a singular, objectively traumatizing event, and we owe this conception less to psychoanalysis and Freud—who believed flights into traumatic neurosis had multiple causes, including infantile complexes—than to the the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the diagnostic premium placed on PTSD. This special subset of traumatic neuroses would come to shape Europeans’ and Americans’ conceptions of what trauma is and what it does.

Thus, somewhat paradoxically, whereas the DSM was originally conceived as a way to avoid the causal language of psychoanalysis, PTSD and traumatic stressors are the only “disorders” that retain an external, causal factor for the diagnosis. When we speak of traumas, we are inevitably enveloped in that hegemonic diagnostic determination, and these historical, objective traumas have been codified in clinical literature: war, torture, rape, the Nazi Holocaust, the atomic bombings of Hiroshima and Nagasaki, natural disasters, and human-made disasters. As any history of trauma or PTSD will tell you, this was due to the concerted political-ideological efforts of US liberal activists after the Vietnam War to enshrine certain historical and life events as inarguably traumatic, and for good reason: It meant people got the attention and care they were owed.

In our time, when our eyes and ears are fixed on the cumulatively traumatizing events in Palestine-Israel and especially in Gaza, we are rightfully quick to acknowledge their suffering as traumas. We want for the right language otherwise: As novelist Elias Khoury wrote about Palestinians, well before the recent escalation: “Words lose all meaning because the silence of the victim becomes the only language befitting the horror of genocide.”

It is absolutely not in doubt that Palestinians have experienced unbearable, unimaginable traumas during what scholars have called a “slow-motion genocide” of settler-colonial onslaught and occupation. After recent events, writers and even more scholars have joined together, including Israeli historian of the Holocaust Omer Bartov, to assert that more immediately: “‘The possibility of genocide is staring us in the face.” These traumatic experiences have and will reverberate throughout generations of people, all marked by grief and neurosis. Little would improve upon silent vigils over those lost to the unjustifiable, escalating collective punishment of the Palestinian people for the October 7th attacks, which generated their own unbearable suffering, even as the Israeli government would likely prohibit, police, and limit the full political weight of collective grieving in any case.

I was asked to write this essay in response to the plea for grief and recognition of Palestinian traumas in the pages of this magazine, beautifully written by the Palestinian journalist Mohammed R. Mhawish, who is now being personally targeted by the Israeli government, along with his family. I admittedly tremble at the responsibility involved in that request. This is not because my response is necessarily belated—all responses to felt traumas require reconstruction, mediation, and mourning—but because I fear that any response is irreparably too little, too late.

The choking nightmare of extermination in the past few weeks has already shattered the lives of thousands of Palestinians, and even so, to treat the recent past as a singular event unto itself is to suppress the already ongoing and cumulative effect of 75 years of occupation. There is no single traumatic event here but an abominable accumulation of suffering that defies conception. Mhawish’s description of 24 years and five wars as a “living a continuation of the same tragic history” says more about that experience than I ever could from the safety and comfort of clinical reason.

If that suffering could be spoken and heard, one wonders if the word “trauma”—however contextualized or personally felt—would even be enough to convey the situation. Part of the tragedy is that this word and its conceptual, political, and diagnostic ambit are inadequate to colonial violence—consolidating and reducing our thinking more than enabling us to say something different. Thus, we should take care in how we collectively struggle to name this suffering—and identify its multiple causes—with a full understanding of the political-historical weight of these determinations.

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This is acutely the case, because the conception of trauma is mutable, and the political and psychosocial uses and abuses of this diagnosis are fraught. To this end, I was struck by how pertinent it was that Mhawish insisted on naming the traumatizing situation in Gaza but refused to label himself and others as “survivors,” apart from scare quotes. This rhetorical move distills the whole political and historical contest about trauma. Perhaps, if we traverse this complex history, it will be clearer what we owe Palestinians who are right now struggling to survive, whose resistance is inscribed by their will to live. Or rather, if it’s true that in their resistance “Palestinians are freeing us,” not the other way around, this bears upon how we think of, and treat, traumatic suffering too.

As Dagmar Herzog recounted in her monumental Cold War Freud, West German survivors of the Holocaust who wanted some form of reparations from their government were subject to endless litmus tests for how legitimate, how traumatic, their suffering in the Nazi death camps had been. Inevitably, clinical and scientific communities were drawn into this struggle; government-backed psychiatrists routinely rejected survivors’ compensation claims on the grounds that their trauma stemmed from something other than the Nazi genocide. In this way, the theory of psychical overdetermination was abused toward damaging political ends.

The clinical assumption of multiple causes is a dignifying hypothesis that any psychical suffering is shaped by complex, contradictory, overlapping, and sometimes incommensurate associations. But, for traumatized patients, this very ability to free-associate fantastically across the variegated landscape of life and multiple events is vitiated by a repetitive and compulsive fixation on a singular, external cause.

Thus, listening to survivors’ accounts for clinical reasons would require patiently working and associating through the psychical life of events—something reparations would conceivably have helped. Instead, they were simply dismissed. The perceived political legitimacy or illegitimacy of reparation turned on flat reductions of the event. Accordingly, the governmental arguments against reparations only helped to fix the significance of the event in place for survivors, reinscribing the very symptomatic effect of the trauma.

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Some analysts were horrified at this. In 1963, Kurt Eissler, the then-director of the Freud archives, wrote, “I am here arguing that an adequate reaction when one is listening [to the description of camp experiences] is to have the reaction: ‘this is unbearable.’” For Eissler, the government and its psychoanalytic collaborators were so determined to look away from the suffering the German state had caused that they had lost the ability to rationally empathize with the experience of the camps. This situation is reminiscent of those who have been dehumanized and brutalized in Gaza today, but there’s been a horrifying twist: Gazans’ own suffering rises neither to political or clinical recognition—despite massive worldwide protests for their cause—because of the state’s genocidal and colonial designs on their lives.

For Holocaust survivors in West Germany, appeals to empathy did not matter politically on their own. It was not until the 1970s in the United States, when there was a coordinated effort between experts working with both Holocaust survivors and anti-war Vietnam veterans, that the concept of PTSD could enfold both populations. Holocaust survivors attained clinical and political recognition for their traumas only under the broader penumbra of US colonial war-making.

It was as if a perverse exchange had been made with the Vietnam veterans, a symptom of the traffic in trauma for political legitimacy: We will recognize you as a trauma survivor if you count yourself among those who had waged an imperial-colonial war. Reprising psychoanalyst David Becker’s critique of PTSD’s diagnostic “amoralization of trauma,” Herzog puts this accordingly:

[T]he ascent of PTSD could be understood as a side-effect of both the Cold War and of struggles over decolonization. From this perspective, Becker came to see Vietnam as “one of the last great imperial wars” and to rethink PTSD’s emergence as a striking compromise, a compromise which, at one and the same time, managed both to acknowledge and to disavow its late colonial context: “The war was lost. The horrors of this war should somehow be recognized, but its political significance, its colonial destructive force should simultaneously be disavowed.” This doubleness in the response to Vietnam in turn provided the key to the PTSD concept as it had been formulated in the DSM: “Suffering is acknowledged, but it is stripped of its (colonialist) contents. It is understood that social processes cause pathology, but the processes themselves are off limits for discussion.”

Thus, symptomatically, the recognition of the traumas of the Holocaust as PTSD came at the expense of being laundered into a diagnostic formulation where two things are salient: Suffering is acknowledged on the condition that the colonial context be suppressed, and social and external causes of suffering are said to exist, but they cannot be addressed materially apart from their pathological effects.

In just this way, when Israeli political actors gesture to their national-constitutional founding trauma as justification for their right to military defense and to annihilate, they are, knowingly or not, making this very same perverse exchange: recognition of their traumas in exchange for political recognition as an imperial nation-state in a late colonial war that no one will win.

In its terminal identification with historical US war events, Israeli political actors repeat this exchange at the symbolic level. In the original political calculus, such recognition did relatively less for everyday Holocaust survivors or anti-war Vietnam vets, but it did engender a social-political paradigm of the use and abuse of PTSD as a disavowed martial and moral justification for late colonial war.

To stick with the symptoms, as any clinician should, one could speak of PTSD as a kind of de facto martial mentality, one shared by both the US and Israel in its forever wars. It’s hard not to be struck by the psychical logic of preemptive self-defense, insofar as it resembles the mentalization of PTSD.

Consider the presenting symptoms of the disorder: External stressors cause suffering to an otherwise healthy constitution; after a breach, there are random, stochastic terrors like traumatic flashbacks and vivid reenactments; a hypervigilance to avoid, ward off, and even exterminate any possible reencounters with the traumatogenic event; affectively negative and extreme, often panicked and paranoid, beliefs and moods. Then, holding this in mind, remember the post-9/11 Bush Doctrine, articulated as the commitment by the mightiest militaries in the world “to bring force to bear to thwart possible aggression.”

In so many ways, the symptomatic figure of the traumatized soldier-civilian—against the ground of stochastic, formless terror—has become the framework of care for trauma. In other words, the promulgation of imperial strength against external shock has become the standard of geopolitical reasoning, but it’s been insinuated, through a therapeutic vocabulary, into the very fabric of daily ethical reasoning.

This, in part, is the argument of Nadia Abu El Haj’s Combat Trauma, a comprehensive anthropological account of how PTSD has shaped our notions of moral injury. She tracks a pivotal “transformation of left politics toward a focus on relieving human ‘suffering,’ rather than the fight for equality, justice, or material redistribution.”

This shift, moreover, deployed the remembrance of the Holocaust to characterize the 20th century as “a century of genocide,” and this new politics of human rights, as political scientist Robert Meister has put it, “presents itself as an ethical transcendence of the politics of revolution.” To the extent that this transformation has only reinforced the ethical-political reasoning behind the Global War on Terror, as El-Haj recounts, it has staged an unholy union between therapeutic humanitarianism, imperial war-making, and Holocaust remembrance that has justified in advance the US-Israel military alliance against Palestinian self-determination.

This entrenched conception of trauma shares a family resemblance with the logic of a helpless fait accompli that runs together far too many presupposed inevitabilities: the compulsively repetitive violence of self-defense in the name of foundational traumas, the self-justifying violence of imperial might against perceived terror, and the hallucinatory violence of vivid reenactment with no other material-symbolic means for expression other than more war and conflict. In the end, this is a berserker fantasy of the meaning of past trauma that stretches its retroactive justification past the limits of comprehension.

If we consider the presenting symptoms of PTSD from a more psychoanalytic perspective, we are guided by the possibility that repression must be at work here. After all, somehow an insidious reversal has taken place: If the paradigmatic example of PTSD symptoms were ones caused by genocide and war-making in the 20th century, how is it possible that the symptoms themselves could furnish the cause and justification of making war and genocide in the 21st?

El-Haj’s answer is immediately compelling: The political push to recognize the symptoms of Vietnam soldiers was originally meant as an indictment of colonial and genocidal war. “The concept of ‘post-Vietnam syndrome’ was a radical critique of the US military and its actions on the killing fields in Vietnam,” she writes. “It showcased the ways in which atrocities were a structural outcome of the imperial hubris and indelible racism of the American war.” Its particular treatment, moreover, turned on the claim that “moral transgression—that is, the perpetration of violence—was often the primary cause of psychological pain.”

Through the concerted revisions of the Reagan counterrevolution in the ensuing decade, however, the Vietnam veteran would eventually be redeemed as a victim in need of care and compassion precisely because of their participation, and in this way, the critique implied by recognizing the symptoms was repressed.

What are we to make of this partial genealogical history of the creation of the paradigm of trauma, so far as it is inextricable from this messy ambiguation of imperial justification, where victor and victim transform into one another?

Just last week, in a press conference, Israel’s ambassador to Australia made an alarming yet textbook Freudian slip: With reference to the October 7 Hamas attacks, he said: “There is no moral equivalence. We are not the victims. Ahh, sorry, we are the victims, we are not the aggressor, sorry…”

Apart from the slip, which a child could understand, I mostly hear the empty apologies in this confusion of tongues. So far as a political task is made available to us through this history of the present, we can see that historical traumas have been routinely conscripted into the perpetuation of the very social and material structures that set the traumas in motion in the first place. It’s a terrible truth, but we must face it.

Accordingly, there is a clinical political struggle outlined here against this humanitarian-therapeutic regime that deploys psychodiagnostic schemas of trauma for the sake of imperial war-making and genocide. This is as much true of the US as it is true of Israel. There’s a corresponding demand, I believe, placed upon our publics, too: Do not let your traumas—the very signs and symptoms and pathologies of the social and material structure in which you live—be used as cannon fodder for the creation of yet more traumas.

It is easier said than done, I fully admit, but this is the deep well of resistance Palestinians draw upon against the forces of death that are now bearing down upon Gaza as we speak and write. In this precise way, there can be no doubt that this is what it means to hear them speak their traumas. If we short-circuit listening by hearing in their pleas only a premeditation for worse genocidal designs on their part, I believe we have unconsciously, but no less deliberately, heard nothing they say. We have not heard the plea for peace—for the revolutionary overthrow of the structures of our world that would allow for a time of shared grief.

In the afterward of The Holocaust and the Nakba, Jacqueline Rose references Charlotte Delbo, a Holocaust survivor, who, as Rose puts it, “makes a distinction between common memory, which passes into public life and onto the street (always a type of bravado and a bit full of itself), and deep memory, which flows beneath the surface and persists for all time. Only the first enters the register of speech, while the second remains viscerally, and often silently, bound to the unconscious, to the senses and body parts.” That latter, visceral memory—that is the stuff of trauma. And so much depends then—in both psychoanalytic clinical work and in the public world—on how one effects a translation between these two types of memory.

As Rose acknowledges, “Israel has progressively enshrined the former type of memory of the Holocaust at the expense of the latter,” arguing that the nation has not yet even begun to grieve. “This is another reason,” she concludes, “why Israel will not allow the Palestinians to grieve.” This is remarkably understated now, but it repeats the flip side of Edward Said’s call for Israelis and Palestinians to become something other “than antagonists of each other’s history and underlying reality.”

It’s, therefore, only here that I feel capable of responding to Mhawish on his terms: We owe it to him and the Palestinians to politically force the United States and Israel to recognize the traumas of their wars—not for the sake of more war, more symptomatically ludicrous public speech and recrimination, more blind witness and futile compassion, more maudlin and useless humanitarian apologia. But so that finally we all might be given the freedom from this clinical and historical-material vise grip and be given, instead, the chance to speak the mutual recognition of grief.

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Alex Colston

Alex Colston is a writer, the deputy editor of Parapraxis, codirector of the Psychosocial Foundation, and a clinical psychology trainee at Duquesne University.

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