The events of the last month in the middle east have made it impossible to veer away from the topic of trauma. It is not my intention to take sides or to rehash conversations that you have likely had in recent weeks. I have no expertise in middle eastern politics, and to be completely honest, my sympathies have wavered on a daily, even an hourly basis. Within a few hours on the same day last week, for example, I was disturbed to hear a supervisee describe a patient’s anti-Semitic rant that failed to distinguish between Jews and Israelis, and then horrified to hear that a Palestinian-owned restaurant in Brooklyn had received multiple death threats. Yesterday, I was walking down the street and happened upon a poster of a 12year old kidnapped, Israeli boy who had a striking resemblance to my son and then heartbroken to watch a video of a Palestinian boy of a similar age whose parents had just been killed. In this newsletter, I will air my thoughts and allow them to roam; toward the end, I will make some connections to clinical work. Patients are bringing the middle east crisis into our offices, and many of us, as mental health professionals, are deeply affected ourselves.
It is such a confusing time, and so a good starting place might be to wonder about what it means to be confused. Being confused can be a bad feeling, and often is accompanied by a wish for resolution—to become clear or at least less confused. In my book, Minding Emotions, I introduce the term “aporetic emotions,” where you are aware of feeling an emotion or emotions, but you have trouble knowing what it is/they are.[i] The work of psychotherapy can help to make emotions granular, although this does not always happen. Knowing that you do not know can be a legitimate therapeutic conclusion.
Thus, a second connotation of being confused is as a state that has an upside and can be valued— that is worth sustaining as a hedge against premature closure. In this latter sense, we are imagining that, in a way that is parallel to mentalizing, being confused means that we hold onto multiple perspectives, recognizing that they might conflict, but refraining from endorsing one side without due consideration of other sides. This does not have to be construed as a relativistic kind of neutrality; for example, we can recognize the suffering of Palestinians under occupation both as a backdrop and in the aftermath of 10/7, without ignoring or minimizing the abhorrent hostage-taking and killing of Israeli citizens. To summarize what I am trying to say: being confused can be painful and includes an aim to rid oneself of that state or it can be a challenging and arduous state, but one that is valuable to tolerate.
Of course, from the perspective of people who do not regard themselves as confused, the position of staying confused might seem deficient, and perhaps even cowardly. There is legitimacy to that concern. Defining yourself in terms of prevailing cultural narratives might fully inform your sense of identity, resulting in not much confusion. While holding strong beliefs can help to cultivate and sustain meaning, we might worry that they can also be costly in dismissing information that does not fit. It seems important, for example, for anyone to be open and willing to modify beliefs in the face of new evidence. The opposite of strong beliefs is not weak beliefs, but fallible beliefs.
People with strong beliefs are likely to clash, resisting options of diplomacy and compromise. During a crisis, even people with fallible beliefs will be tempted to adopt strong beliefs. Indeed, the closer to the front, the more it might be beneficial to embrace strong beliefs over fallible ones. Therein lies a double danger: how easy it becomes not to acknowledge, not only the views of others, but their humanity. It must help to prepare you to kill others if you designate them as belonging to a lesser realm.
Ah, killing! Is all killing wrong? If so, wouldn’t I have gravitated unwittingly to defend a strong, rather than a fallible belief? Humans seem to operate with the convention that killing under certain circumstances, like defensive ones. are acceptable. The category of “terrorism” is reserved as a special kind of offense that is akin to cheating: killing people arbitrarily, that is, without regard to their particularity of their identities. Thus, we have heard of terrible ironies like an Israeli woman who has been kidnapped, although she was someone who happened to drive Palestinians in need of medical care to Israeli hospitals. I am sure that innocent Palestinian peace activists have been among the dead, too.
Understanding Hamas in terms of terrorism is justified, but I have concerns about deploying it in a way that curtails further inquiry. There is no disputing that Hamas rejects the existence of the state of Israel and has committed terrorist acts; I am only urging us to pause and ask ourselves questions about what terrorism means. For some, terrorism is a violation of humanitarian standards and thus should not be accorded the status of political action. For others, it might be construed as political action, with two alternatives: that it is not the most effective strategy in winning recognition for the cause or that it is, in fact, a successful strategy. The difference between the two main positions (not political or political) is roughly the difference between two systems of ethics, the first as Kantian and the second as utilitarian. Whether we agree or not, Hamas and its allies might think of themselves as freedom fighters, relying on the means within their possession to win recognition.
Are terrorists and freedom fighters just two sides of the same coin? Maybe, since they both share strong beliefs and are often contrasting ways to assess a group from the inside or outside with praise or condemnation. It would be difficult to imagine that there is a clearcut line that differentiates terrorists from freedom fighters. It becomes more complicated if we introduce related categories, like “guerrilla fighters” or “resistant fighters” into the mix.
There is so much that we do not know. Did Hamas strike out indiscriminately, using all the power within its means, primarily as an intimidation tactic? Or did it include anticipation of the Israeli response, which has redirected sympathy back to the plight of Palestinians? If so, it is awful that Hamas would be willing to sanction the devastation of its own people. But it is also depressing to reckon with the inevitability of the Israeli response, which at this moment, continues to unfold in a brutal and unacceptable way. What if Simone Weil was right about her contrarian interpretation of the Iliad: that the exercise of force is destructive to those who wield it, not just to its victims?[ii]
We are facing an orgy of destructiveness that threatens to expand to have global proportions. The little dog that bit the bigger dog might be bit by an even bigger dog, until all the dogs go at each other. The consequences are enormous—now, and also in anticipating future generations plagued by the intergenerational transmission of trauma. The victims become the perpetrators and the cycle continues, and as Michael Rothberg has argued, we are all implicated, not just bystanders.[iii] Indeed, we need to consider that the intergenerational transmission of trauma as an explanation, not just for what lies ahead in the future, but for making sense of the background and immediate context.
Although much has been made of the 10/7 attacks as equivalent to 9/11 in significance for Israelis, that analogy needs unpacking. There is a shared symbolization of an intrusion upon the physical boundaries that serve as protection against the external world. Not to mention the narcissistic injury of realizing that the boundaries are more permeable than was imagined. We should keep in mind, though, that Hamas targeted several military bases as well as ordinary citizens, the latter of which has understandably claimed more attention. There is further function, too, that this analogy serves: urging the world to be shocked and sympathetic to the horror of such brutality. And this is what at first transpired throughout much of the Western world.
Until? Until Israel made it apparent that it would raise the level of violence, apparently unconcerned about the lesson of the US response to 9/11, with the invasion of Iraq, as many people have observed. There is no ethical argument that could justify the exercise of force against a defenseless population—it is problematic from a Kantian view because innocent Palestinians are being treated as means to the end of obliterating Hamas, and it would not fly from a utilitarian view because the proportion of innocent to guilty deaths is unacceptable. According to Adam Schatz, there have been a very small number of confirmed deaths of Hamas fighters out of the approximately 8000 Palestinian deaths, a figure that will be out of date by the time you read this (https://www.thenation.com/podcast/world/sms-shatz-israel-hamas/). As of now, the Israeli military is moving ahead with the ground war, a humanitarian disaster, and not in their own self-interest. The Israeli government seems either indifferent to or ignorant about
the growing support for the plight of Palestinians throughout the world.
When we contemplate the intergenerational transmission of trauma, we usually are thinking of one person or one group. What is striking in the case of the middle east is that trauma and its history are playing out at the same time for both parties. This is why it is easy to find oneself shifting from sympathy from one side to the other. As a Jew who has family in Israel, I find myself agitated and worried about the people I know and care about. My wish is for the democracy movement in (and out of) Israel to thrive and expand its focus, bringing elected people to power who confront the serious failure of the current administration and adopt a new stance of recognition to Palestinians, even if that entails incurring vulnerability. Yes, the middle east is a dangerous neighborhood, but remind yourself that out of the ashes of the Holocaust, Jewish people who survived gained determination and purpose to build a home for themselves. Even if Hamas is destroyed, the Palestinian people will not disappear, and they will not cease to fight for their sovereignty.
I vowed not to stake out positions and I am aware of treading dangerously close to the precipice. Let me shift gears and articulate what is specifically relevant to our clinical work. We can imagine our empathy impinged upon, where differences emerge between the beliefs of therapists and patients. Such differences can be negotiated as long as both parties do not slip into the mode of strong beliefs. The burden is on the therapist, especially, to make the effort to distinguish the strong beliefs they might hold personally from the professional beliefs that are required in order to continue treating the patient. If this seems impossible, the therapist must be willing to acknowledge this and face the consequences—like referring the patient to another therapist.
We should not ignore the possibility of using political differences to be a productive way to explore transference, countertransference, and the therapeutic alliance. For example, it might provide an opportunity for a patient to voice negative feelings toward the therapist that had been submerged. We can also imagine that political differences might be an occasion for therapists to self-disclose (like having family in Gaza or knowing someone who lived in one of the kibbutzim that were attacked), helping the patient make better sense of their views. The differences themselves are not necessarily the problem. The problem can be located, as Jeremy Safran stressed, in whether (or not) the disruption can be repaired.[iv]
We should not overlook that even where therapist and patient are not on opposite sides, they may disagree in ways that can be disruptive. Small differences can matter hugely in the middle of a crisis. People can be dubious about or opposed to a ceasefire. People can wish for a ceasefire and either countenance or reject the imposition of a new Palestinian government.
Therapists would be wise to anticipate that the polarization in our country, and in the world at large, means that this is likely to trickle down and be reenacted in our offices. Even where profound differences emerge, we can hope to find consolation that the polarization was once less extreme in the past and might recede in the future. Of course, there is no guarantee that this will happen. At this moment, things remain tense and worse every day. Strong beliefs are rampant. Modulating our beliefs to be fallible seems like the path that is most likely, I tentatively suggest, to ensure our survival.
[i] E. Jurist (2018). Minding Emotions: Cultivating Mentalization in Psychotherapy (New York: Guilford).
[ii] S. Weil (1939/1956). The Iliad or The Poem of Force (Wallingford, PA: Pendle Hill). I alluded to Weil in a previous newsletter: https://elliot4cc.substack.com/p/mentalizing-health-727.
[iii] M. Rothberg (2019). The Implicated Subject: Beyond Victims and Perpetrators. Stanford, CA: Stanford.
[iv] J.D. Safran, C. Muran, & C. Eubanks-Carter (2011). Repairing Alliance Ruptures. Psychotherapy, 48, 80-87.