When a psychiatrist is asked to write an article about the
consequences of violence, it is inevitable and imperative that the
issue of aggressive instincts be addressed, even though theoretical
talk can seem ridiculous when the lives of human beings are being
squandered under the pretext of fighting for one cause or another.
It is hard to imagine that any reason could exist that would
justify the elimination of any human being from this earth. The
following article is presented to tackle the societal costs of
continuing inter-group violence. The brainwashing that is rampant
in this context perplexes even the greatest scientists. How can any
civilization allow a child to starve to death or die from a simple
anemia in this day and age? How can anyone justify a war?
Children Pay the Price
In this part of the world, children have paid the price of
sacrificing human life for national ideals. These children dismiss
any other type of pleasure, even the right to be children or
receive an education, for the opportunity to express anger at the
occupying forces. Many children in the West Bank cannot express
wishes and dreams or even sleep because they feel threatened and
traumatized. Political unrest in the area touches everybody.
Children who were ambitious are now mute; after a great deal of
prompting some might express one wish and one wish only, "to be a
martyr." This seems like such a heavy load to most clinicians
because we feel most of the time that these children are depressed
and often, after a good psychotherapeutic intervention, they will
get in touch with the desire to study and be children again. The
only ray of hope in this morbid situation is the unsolicited
expression uttered by some children who said that if someday they
could talk to the leaders of the occupying force they would want to
thank them because with all these curfews and closures, they got to
know their fathers, who previously were more occupied with work and
rarely had any time to spend with them. This capacity to see
something positive and to be able to be thankful for such a
blessing in disguise leaves the author, and hopefully the readers,
optimistic and encouraged.
Intervening in the Cycles of Violence - A Clinical
Perspective
This article provides a clinical perspective on children affected
by war and violence. With Anna Freud's In the best interest of the
child as our guide, this paper aims to create awareness of the pain
suffered by Palestinian children and address effective
interventions to break the cycles of violence. Reflections on years
of observations in clinical materials collected in the US and the
Middle East are given with the hope that these interventions and
outcomes will offer treatment tools to the psychotherapeutic
community in its attempt to intervene by understanding, containing,
and trying to heal the wounds of abused and abusive children and
the adults they will ultimately become.
The rights of a child are reflected in the ability to face and
overcome the different stages of development in a proper and
healthy way. A child deprived of this right suffers severe
consequences, usually expressed through extreme psychosocial
deprivation, violent episodes, and sometimes, irreversible damage.
The exception to this rule is that occasionally such psychological
disasters may perpetuate creativity, genius and result in excellent
human beings.
In the late 1980s and early 1990s the first Intifada exacted a high
casualty toll, with many Palestinian children sacrificed to fate,
politics and nationhood. The children of that Intifada are both
Palestinian heroes and victims. Heroes, because their sacrifices
attracted world attention and consequently influenced the
Arab-Israeli peace talks, breaking the cycle of violence. Victims,
because their rights as children - to be nurtured, loved, and
educated - were forgotten and replaced by the glorification of
their aggressive drive. The statistics of children killed, wounded,
imprisoned, tortured, or psychologically damaged are frightening.
The number of children who then kill, wound, imprison, torture or
psychologically harm others is smaller but still exists and
reflects an even greater loss of control over one's drives,
instincts, human ethics and morality. To provide vivid
demonstrations of the heavy price that children and adolescents pay
within the context of the ongoing violence, I have included some
cases.
Methodology and Theories in Psychoanalytic - Psychotherapeutic
Interventions
Treatment involves helping the patient become more conscious of
unconscious processes, in the hope that this development will offer
him more of a choice in his destiny, decisions and lifestyle. To
allow this to happen, experts use play therapy and free association
games for children or dream interpretation and analysis of Freudian
slips for adults.
There are many issues that need to be dealt with in therapy to help
people become more aware of the unconscious conflicts causing their
emotional problems, such as helping patients to contain their pain
and to understand and accept that there are certain irreversible
tragedies and experiences whose consequences we cannot cure but
only contain. But how can this help a traumatized patient whose
experience of the outside world has been monstrous? The therapist
must help the patient interpret his contribution to his pain - the
vicious cycles of violence that he has developed for himself - and
help him become aware that he doesn't have to be trapped by them.
Because the patient feels his projection into the abuser is his own
doing, he identifies with it, not only as a punishment but also as
a way of being. Recognizing and becoming aware of this makes it
possible to visualize and develop other options.
Case Presentations
At the guidance center in the West Bank town of Bethlehem, the
following cases were dealt with:
* M., a 17-year-old male seen in treatment twice weekly for the
past two months. He had spent six years in jail for his political
involvement, from the age of 11. He was brought for treatment
because of depression and suicidal urges, alienation from his
family and disruptive behavior around them. His mother left home
when he was seven, and M.'s life seems to be one of loss, isolation
and deprivation. His father, a physician, and his strong extended
family unit have been his pillars throughout these very difficult
experiences. M. turned his time in jail into a learning experience
by studying philosophy. Now out of prison, M. is concerned about
studying other subjects that seem unnecessary to his daily life.
According to his father, M. seems totally inadequate with
machinery, instruments and regular daily chores. At home, M. feels
out of place with his father and siblings. He loves his family but
feels he does not belong with them.If the "enemy" is a real
external object, or a family member or unit, these projections are
easily identified and analyzed. The internal "enemy" is harder to
deal with and control. Though difficult, M. has to face this and he
listens to these interpretations in every session. M. finds this
painful and at one point stayed away from treatment following such
analysis. At his father's prompting, he came back to treatment.
Again, this was interpreted in the transference.
* A 7-year-old boy was brought for treatment because of his
sleepwalking and a phobia of school. The child and his family
reported he was taken for interrogation by the army, following a
stone-throwing episode. His grandmother tried to stop the army from
taking the patient but, in the altercation, she was pushed and fell
to the floor in a pool of blood. The patient saw this and thought
his grandmother had died. After a few hours of investigation, he
returned home to learn that his grandmother was alive and in
hospital. He later developed the symptoms of sleepwalking and
school phobia. His therapy was quick and successful; it consisted
of play therapy with some dream interpretation. One dream in
particular should be mentioned to clarify the use of dreams in
therapy. The child reported that he had recurrent dreams of someone
kidnapping him in his sleep and putting him in danger. The author
looked at the child and said; "I think I know who the kidnapper
is." The child answered, "Oh yes! Tell me! Who is it?" The author
said: "It's you, you are the author of the dream and you are the
one who sleepwalks and endangers yourself at night." After this,
the child stopped coming to treatment. The author wondered what had
happened to him and was relieved when his grandmother appeared at
the clinic one day and expressed gratitude for the treatment,
reporting that the child was better - not sleepwalking anymore and
attending school regularly.
* E. is a 14-year-old boy in therapy following a suicide attempt,
bouts of depression and aggressive behavior toward other children
in his family and in the neighborhood. E. thinks that ever since he
was beaten by the Israeli army in front of the Church of the
Nativity he has changed and become aggressive - first toward other
children, then toward himself. His therapy is just starting.
Making the Unconcious, Concious
Whether in play or talk, with family, in groups or individually,
therapeutic work consists of helping the patient become more
conscious of unconscious processes that have been controlling his
life, with the hope that he can have more of a choice as to how to
live his life and, hopefully, opt for a more harmonious
existence.
Victims of war and violence are often stuck in a vicious cycle of
reliving the trauma in an attempt to "feel in control." Victims
often resort to reliving the traumatic experience in a safe
environment from which they do not expect retaliation, such as
acting out on their loved ones or themselves. These attacks,
frequently expressed in suicidal gestures, need to be interpreted
by making the unconscious conscious. There are so many such cases
that it is impossible to fully report on the phenomena in this
context, but the underlying theme is that an aggressive instinct
that is experienced as frightening is projected onto an external
object. If this external object also joins in the aggressive
projection, then, of course, the projection becomes even more
frightening. It does not matter if this external object is a war,
enemy, parent, teacher, friend, lover, spouse, child or boss, as
the experience is usually traumatizing and the patient often falls
into the trap of projective identification.
The aggressive drive is present from birth and needs sublimation
and taming to allow humans to develop into the responsible, social
beings that we need to be. These urges can get out of control if
glorified and allowed to be expressed indefinitely and without
boundaries. The ultimate example of this is Melanie Klein's remarks
that if left alone because of the savage unconscious and the
projective identification defense, a child will self-destruct. As
the destructive instinct is strong, it takes a great deal of
mothering to tone it down. Literally and symbolically, intervening
in cycles of violence needs to address and provide this kind of
care where it has been lacking or arrested.
Summary and Reflections
Is human nature naturally aggressive because of its prehistoric
inheritance of violent, savage traits, or is it a learned behavior
of violence and survival of the fittest that perpetuates and
develops this dangerous attitude? Is the passive-aggressive,
sado-masochistic, male-female, foe-friend, one and the other
situation necessary for procreation and the continuation of the
human race? Or is it possible to exist, live, love and tame the
aggressive and sexual instincts, sublimating them into a
harmonious, fulfilling and active life?
Solutions to break these cycles of violence were exhibited in the
cases discussed. This consisted of providing proper, efficient,
accurate psychotherapeutic interventions at the right time in
treatment to assist the patient in containing and later analyzing
the maze of his or her complicated unconscious. Understanding
violence, sublimating what is possible, finding inner peace and
avenues to express oneself and achieve one's goals to lead a
harmonious and healthy existence, is the hope of the present and
future generation despite problems and complications.
Bibliography
Joseph Goldstein (ed.). Freud, A. 1986. In the best interest of the
child: The least detrimental alternative. New York: The Free
Press
Freud, S. 1993. The interpretation of dreams. US: Basic Books
Klein, M. 1984. Love, guilt and reparation. New York: The Free
Press
Lewis, M. 1982. Clinical aspects of childhood development.
Philadelphia: Lea & Febiger.
Mason, A. 1983. The suffocating super ego. US: Caesura Press.
Segal, H. 1978. Introduction to the work of Melanie Klein. US:
Hogarth Press.