Psychiatry and Peace Promotion

Jiri/AdobeStock

Introduction by H. Steven Moffic, MD

As you may have been noticed, I have been trying to have intermittent guest columnists, especially from various sociocultural and religious backgrounds for my weekday column, “Psychiatric Views on the Daily News.” That has been a recent goal in regard to the war in the Middle East, with the psychological repercussions rippling out to protests that also threaten general peace, especially on our college campuses and elsewhere. There have been precious little interfaith writings of the war, whether within psychiatry or from our broader society, especially any cowritten by those directly related to the warring parties.

This column, led by Mansoor Malik, MD, is an exception. We know that it thereby can be controversial. Nevertheless, on this 1-year anniversary of the 10/7/23 invasion of Israel by Hamas and the ensuring Israeli declaration of war, which has now expanded to Hezbollah in Lebanon, and the overall role of Iran with their proxies, we hope it models the possibility and need of psychiatrist interfaith endeavors in such wars and other related conflicts, ranging from homes to homelands.

-H. Steven Moffic, MD

Psychiatry and Peace Promotion

Although 'madness and insanity' is often used as a metaphor to war, politicians rarely turn to psychiatrists either to prevent wars or to stop them. On the other hand, most psychiatrists do not feel that their knowledge, which derives from research and individually-based clinical work, could be of much help in discussions of international relations and the peace/war issue. This week marks the 1-year anniversary of the 10/7/23 Hamas attack of Israel and the ensuing war in Gaza. It is also 2 years and 8 months since the invasion of Ukraine by Russia.

These events have resulted in countless deaths of innocent civilians on all sides and a tsunami of unmet mental health needs. We have helplessly seen the escalation of war and dehumanizing rhetoric, resulting in the continuing capture and murder of hostages from many countries, the killing of tens of thousands of innocent children, and the destruction on health care infrastructure. The need for peace advocacy is clear and urgent.

But what do psychiatrists have to do with peace promotion? Indeed, supporting peace may arouse suspicions of a political agenda. Yet, the World Health Organization (WHO) has included the preservation of peace within the targets of mental health promotion. WHO Global Health and Peace Initiative (GHPI), launched in 2019, aims to address the connections between healthy human development, social ties and cohesion of communities needed to sustain peace. As the COVID-19 pandemic demonstrated, addressing issues of conflict and marginalization is critical for promoting positive health outcomes, not only in conflict zones, but in all societies. This must include attention to, and expertise, about human emotional and mental development, as well as the collective trauma.

Over 2 billion individuals worldwide live in a war zone. Wars resulted in nearly 191 million deaths in the last century.¹ Exposure to violence ranging from domestic abuse to being trapped in an armed conflict has similar impacts. Conflict takes a toll on mental health and social relationships that are directly relevant to the capacity to build peace. Individuals who have been victims of violence are at a greater risk of engaging in violence themselves. Violence against children can push youth to join armed groups, perpetuating the cycle of violence. Reportedly at least 16,000 children have died in Gaza and tens of thousands have lost one or both parents.² With the expansion of war in Lebanon, similar fate awaits the children there and with the indiscriminate attacks of Iran and Hezbollah on Israel, the well-being and mental health of children in Israel are also being severely impacted.

The Mideast war is rekindling intergenerational transmission of trauma related to the Holocaust to the ensuing generation Israelis and to the Nakba among ensuing generations of Palestinians. In the West, in a terrible irony, both anti-Semitism and Islamophobia are together on the rise. Understandably, many Jews recall or reexperience the threat of persecution and annihilation during the current rise of anti-Semitic hate. Palestinians also feel devalued and dehumanized by the disproportionate devastation and by the lack of effective outside intervention to bring about either the short-term ceasefire or the long-term just and lasting peace.

Beyond the direct effect on civilians, war also has devastating effects on the economy of the region and on the mental health of combatants. Reportedly at least 30,000 IDF soldiers have been treated for mental health issues to date since the start of the war. A recent study in Israel found that posttraumatic stress disorder in Israeli soldiers alone can cost Israeli economy more than 50 billion dollars over the next 5 years.³ The war in Ukraine has resulted in displacement of almost 10 million individuals with significant impact on the mental health systems across Europe, with the influx of a large number of refugees changing the regional economies.

Psychiatrists are uniquely trained in an interdisciplinary model with skills and knowledge for contributing to both the science and practice of nonviolent conflict resolution. From Freud’s famous proclamation that “war is against civilization” to Volkan’s development of track II diplomacy, psychiatry has shown its potential to promote peace. Indeed, the American Psychiatric Association (APA) facilitated Track II negotiations for Arab-Israel peace from 1979 to 1964, by convening Egyptian, Israeli, and Palestinian psychiatrists, psychologists, and diplomats in the buildup of peace between Egypt and Israel.⁴ But unfortunately, in recent years, the psychiatric community has done little to purposefully cultivate and apply peace promotion to the growing societal challenges of peace building internationally, and also domestically.

In contrast, the American Psychological Association established a division of peace promotion in 1990 to address “the causes, consequences, and prevention of war and other forms of destructive conflict” and established a Journal for Peace Studies. Perhaps our 2 APAs can work together. Prevention of a new world war is existentially essential, especially in our age of widespread nuclear capability.

In an effort to address the mental health impact of the war in Gaza, the APA’s Caucus on Global Health is launching an effort to compile mental health resources, make connections with the local humanitarian organizations and mental health leaders, and undertake the planning needed to develop capacity to put those tools to work in Gaza as soon as the war ends. That especially means getting to know and be in dialogue with the Palestinian diaspora, which is well educated and has significant number of motivated health care workers and is uniquely positioned to accelerate medical relief efforts in Gaza, and now in Lebanon. This also means building bridges with the Israeli mental health community and getting them involved in post-war relief efforts. Similar efforts are needed to rebuild the mental health infra-structure in Ukraine. In the midst of these great tragedies, the need for active and engaged compassion and human dignity has never been higher. Indeed, any efforts to build lasting peace cannot ignore the massive mental health needs in these war-torn regions.

Dr Malik is a professor of Clinical Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Moreno-Chaparro J, Piñeros-Ortiz S, Rodríguez-Ramírez L, et al. Mental health consequences of armed conflicts in adults: an overview. Actas Esp Psiquiatr. 2022;50(2):68-91.

2. Khatib R, McKee M, Yusuf S. Counting the dead in Gaza: difficult but essential. Lancet. 2024;404(10449):237-238.

3. PTSD could cost Israeli economy 50 billion dollars over the next five years - study. Updated 2024. Accessed October 7, 2024. https://www.jpost.com/health-and-wellness/mind-and-spirit/article-812999

4. Aggarwal NK. Roles that psychiatrists can play in international negotiations to reduce conflict. JAMA Psychiatry. 2024;81(8):745-746.