This post is also available in: العربية (Arabic)
Were the concepts lost in translation?
Many ‘Arabized’ terms entered the Arabic language as ‘translated’ nouns for things that were not explored by Arabs just yet; in fact, Arabian linguists and researchers were startled by the rise of technology and the repercussions of globalization that reached every corner of the world. At the time, native speakers – who had always believed in the ability of the Arab language to absorb all those new foreign terms because of its diversity of derivatives, vocabulary and styles, like metaphors, for example – were fearful that words which are completely alien to the language would end up sticking to it.
Even though humanities – as the name suggests –deals intrinsically with the human experience cutting across linguistic and cultural barriers numerous terms remain difficult to translate, especially into Arabic. Perhaps because said terms come from a culture and environment which differs completely from where they have originated.
One of those words is ‘trauma’, which was Arabized and translated in many ways; in fact, some Arabian psychiatrists decided to apply the term as is and without Arabization: ‘تروما’ . The Arabic dictionary itself contains several translations for this one term, like ‘yielding’, psychological ‘shock’, ‘becoming subject to harm’ – according to the United Nations – or generally a ‘painful experience’. Whatever the translation, ‘trauma’ seems different from an Arabic perspective, so how will it sound from a Yemeni one?
Brief history of trauma
The term ‘trauma’ appeared in the beginning of the nineteenth century, but under different names. Doctors treating victims of railway accidents, or soldiers on the battlefield, or female patients who were victims of sexual abuse, noticed psychological symptoms in addition to physical symptoms. These symptoms were given different names such as “Soldier’s heart”, “hysteria”, and others. The link between these physical and psychological symptoms remained a subject of debate amongst medical professionals. Many of them did not acknowledge the psychological effects of such phenomena, interpreting the physiological ramifications of the incidents.
Since then, psychiatrists and neurologists studied the impact traumatic events had on the human psyche. The term PTSD (Post-Traumatic Stress Disorder) was introduced and added to the third version of the Diagnostic and Statistical Manual of Mental Disorders in 1980 by the American Psychiatric Association. The term since then became a widespread medical term in the field of psychiatry with its own criteria. For instance, not everyone who goes through a shocking or unexpected event will end up being afflicted with the disorder.
In the early 90s, a group of critics and researchers from the field of literature began to study the cultural effects of trauma. An example of that was Cathy Caruth, Professor of Comparative Literature at Cornell University,who published her book in 1996: Unclaimed Experience: Trauma, Narrative and History, where she introduced trauma as “a response to an unexpected or overwhelming violent event or events that are not fully grasped as they occur, but return later in repeated flashbacks, nightmares, and other repetitive phenomena”.
Despite Caruth’s background being in literature, her book and project were the result of the efforts of experts in various fields, such as psychology and the social sciences. It combined essays and interviews of professionals from all these disciplines. In addition, the academic and literary critic Shoshana Felman worked with Caruth on finding an interconnection between psychoanalytic theory and literature, and together they produced many studies in this area.
After the emergence of various theories and research which studied the effects of past trauma on a person’s present and future lives, more expressions surfaced, examining the subject with more scrutiny. For example, the term ‘collective trauma’ appeared which designates the trauma which befalls a large group of people as a result of painful and violent events, such as wars, massacres, disease, natural disasters and terrorist attacks.
This type of ‘collective trauma’ is complex, whereby it comes in different forms; and a younger generation can inherit it from a previous generation. Researcher Sousan Abadian (whose Harvard University PhD was about ‘Collective Trauma and International Development’) describes, as part of her study, the different types and forms of collective trauma. She explains that it is suitable to describe some collective traumas as ‘cultural’, ‘historical’ or ‘transmitted through generations’.
Perhaps what makes collective trauma more complicated than individual trauma is that in the case of the former is that everyone is sharing the trauma, without a neutral body outside the collective experience.
Mental health in the Yemeni community
Despite psychiatry in Yemen having been through numerous different phases, it has remained unchanged in many ways. Data published in recent years about the situation of mental health in Yemen indicate that it is in a state of deterioration on the collective and the individual levels, as a result of the economic and security situations since the war began six years ago. According to a study by the Family Counseling and Development Foundation, between 2014 and 2017 estimates indicate widespread psychological disorders among populations affected by the Yemen war, with 1 in 5 Yemenis suffering from a mental disorder. It is estimated that this rate is a lot higher now with the spread of COVID-19 and the further worsening of living conditions, which were already in a poor state. A study by the Sana’a Center for Strategic Studies indicates that the suicide rate in Sana’a alone has increased by 40.5 per cent between 2014 and 2015, and that 79 per cent of children in Yemen suffer from post-traumatic stress disorder.
These catastrophic rates represent a small fragment of the crisis that the Yemeni people are going through as a result of the war and armed conflict; however, if one looks back through time, one learns that the mental health of Yemenis was not in a much better condition in the past. In fact, Yemenis were apprehensive about going to the therapist, fearful of society’s harsh judgment which stigmatizes them as being ‘crazy’ and ‘insane’. Psychiatric specialist Ansam Sabra, currently Assignment Officer at the Sana’a Center for Strategic Studies, explains that Yemeni society has never embraced the concept of psychotherapy and is generally hesitant when it comes to resorting to it: “Someone who would resort to psychotherapy was perceived as a crazy person, but this has changed a little bit, at least in the governorate of Sana’a. Some people have begun opening up to the idea of resorting to the Center’s mental health services; more so, they are no longer embarrassed by their mental disorder. Perhaps this happened thanks to the fact that previous visitors had likely motivated others after realizing that they themselves were doing better mentally”.
This is partially confirmed by therapist and psychological consultant Samah Talal, who currently works at her own clinic after having worked in mental health with several international organizations such as Doctors Without Borders and Save the Children. She explains:
“It is perhaps more acceptable among the more educated in the country to resort to psychotherapy; however, others are still either unaware of the nature of their mental disorder, or pressured by the stigma that is put on those who visit clinics seeking help in their mental health”.
Even though the oppression of war and the severity of living conditions have changed the minds of some Yemenis regarding psychiatry, most of them in many regions still resort to witches and swindlers to cure them of their mental problems. This is due to a lack of information about mental health and how to distinguish between it and physical health, and the fact that society still embraces the terms ‘bewitched’ and ‘envied’ instead of ‘mentally ill’ or ‘crazy’.
It is also painful to see that a lot more women seek mental help than men; in the same study conducted by the Family Counseling and Development Foundation, the percentage of women contacting the mental health helpline was 81 per cent, while only 19 per cent were men, with 46 per cent of those sharing their thoughts for the study. “Men are hesitant when requesting help and it is usually their families who request it on their behalf when the condition is severe”, confirms specialist Ansam Sabra. Depression accompanied with acute schizophrenic symptoms is usually widespread among men, whereas women mostly suffer from anxiety or depression, as confirmed by consultant Samah Talal.
Possibly, this is a result of the nature of the Yemeni society which disapproves of men expressing their feelings or mental state, in contrast with women who sometimes find a safe space – however small it might be – to vent and express their emotions to friends, for example. And despite the existence of this small outlet in the life of the Yemeni woman, she still has fears of society’s judgment on her as a woman, for example, whether she was unable to ‘manage her house’ properly because of her mental state, or her chances to get married lessened because she suffered from mental illness in the past.
Obstacles facing the health sector
The mental health sector in Yemen faces many more problems than in the past; indeed, with the war and military conflicts breaking out, many more issues arose, creating a big challenge for the providers of care and psychological support. Examples are detailed below.
Insufficient numbers of people working in the field: As indicated by the World Health Organization, in 2016 there were less than 46 psychotherapists in Yemen, and most of them were located solely in Sana’a, which means there was approximately one psychotherapist for every 600,000 people. Also, the Family Counseling and Development Foundation reports that in 2017, the number of Yemeni therapists and specialists in the whole of Yemen did not exceed 130; as for nurses, the number was not more than 25.
A strong deficiency in healthcare facilities – other than mental health – public and private: The number of governmental healthcare facilities across Yemen is 13 and no more than 35 private clinics, most of which are located in the capital city of Sana’a. Since healthcare infrastructure is so fragile, we can imagine mental health facilities as being practically absent across the country.
Neglect by officials: Even though there is no indication that practitioners will stop working in this important profession in Yemen, there are obstacles that many psychotherapists face, possibly preventing them from carrying out their duties. Samah Talal notes: “There are many competent and qualified people who are willing to work in this field, however the party concerned in providing such a specialty is not even interested in this service or social development in the first place, especially when there are no laws that can ensure the rights of practicing the profession and systemize its interconnections with the rest of the medical specialties like in other countries.”
Patients’ low income: Most people suffer in silence because of their inability to pay for psychotherapy, as most Yemenis’ wages are barely sufficient for basic living needs during the current dire circumstances. For example, while the Family Counseling and Development Foundation offers all of its services for free, it cannot provide for all of those who require them. Ansam elaborates: “The need for psychological support has increased dramatically, especially with the decline of the situation in the country; at times we even face shortage in medicine and are unable to provide for those in need”.
Society’s lack of information on mental disorders and illnesses: This results in patients’ suffering and distress as they undergo their therapy journey while unable to find the appropriate solution to their agony.
Does the Western term coincide with the Yemeni society?
Among the criticisms that the ‘Trauma Theory’ which was established by Cathy Caruth has received is (euro-centric) without taking other cultures into consideration, and that it repeatedly examines the Holocaust during the Second World War while ignoring other shocking events which would be similar or comparable, or continuous in their nature. Among studies looking at ‘decolonization’, the most famous was ‘”Decolonizing Trauma Studies: A Response”’ by Holocaust historian and memory studies scholar Michael Rothberg. Rothberg criticizes the employment of the ‘shock doctrine’ for events in a specific time period without taking into account traumas that are continuous in their nature, such as the Palestinian Nakbah. Rothberg also denounced the anchoring of the concept of the ‘victim’, especially in the minds of those who have suffered from occupation and colonization, all while disregarding the notion of the ‘survivor’ or the ‘resistant’, those who tried to get rid of their persecutor by any means. Caruth was also criticized for stating that describing an event from the victim’s point of view would be an unreliable approach since that person’s memory would be clouded and their ability to express themselves properly while still under shock would be inhibited.
Many of those criticisms seem important in their essence; undoubtedly, a crisis in a country like Yemen is more complicated than one passing event, considering that individuals went through several consecutive shocks which cannot be reduced to ‘one single event’, especially considering that the war and armed conflict have not yet come to an end. Even if the armed conflict ceased completely in some regions, the state of instability itself would leave continuing shock.
Thus the usage of the term ‘shock doctrine’ for Yemeni society is justified; a society whose very fabric was destroyed by conflicting loyalties, and whose majority now live in catastrophic conditions. This being the case, how can it recover from the collective shock which has not yet ended?
Nevertheless, the journey to recovery begins possibly by talking about the shock and the event; indeed, the ability to tell the story – even if in fragments – is a sort of empowerment. Moreover, in a situation like that of a collective shock that societies experience during wars and other such events, documenting the memories of those who have endured the events is somehow a way to confirm their ‘story’ and relay it to those who have not lived it. One feels their wounds and pain are real, because denying them is sometimes more painful than surviving them. Perhaps a problem lies in the conflicting stories transmitted among members of society, thereby increasing the gap between people and causing greater discord. However, the solution to this dilemma seems simple, when the core of the stories becomes the human being, relieved of all their political opinions and affiliations; and thereafter, no one other than the innocent human who has suffered gets to tell their story.
Beside the fact that Caruth’s critics were supportive of the idea of a recitation which anchors the idea of ‘resistance’ rather than ‘victimization’, whereby a person going through shock adapts to their environment until they can fight against what is happening to them, there is another movement which defines the concept of resistance through ever-changing facts. That movement sees that navigating shocks and adapting to them does not justify blaming the victim, in case those were not able to rescue themselves from the grip of the shock. Certainly, the victim is a victim, and they should receive help if they ever need it.
Stitching the social fabric
While international organizations have many initiatives to support Yemen, the solution should come from the inside rather than the outside. In fact, the way Western organizations tend to treat the problems from which Yemenis suffer, and the fact that they pick certain issues to address instead of others makes us unable to foresee substantial development on the issue of mental health. Even more so, little effort was put into reinforcing mental health in the past – at the time it was not as needed as it is now – which reduced awareness; in fact, raising awareness was never awarded adequate attention.
Therefore, the solution might lie within the local civil society organizations, and in the efforts which might enhance trust between individuals, in order to reconstruct the fabric of society. It is undoubtedly important to find a collective healing process, instead of scattered individual efforts, chiefly because it is a collective crisis, which has been going on for year and does not appear to be close to reaching an end in the near future.
In short, the ordinary Yemeni should tell their story, the story of the person who is far away from all these intricate conflicts, so that the ordinary Yemeni on the opposite side of the conversation hears it and notices that they are both suffering and agonizing in the same way, so that they can go hand in hand on their healing journey, away from all other complications.
*Special thanks to my friend Dr. Zeinab al-Mansi for introducing me to the world of the ‘Trauma Theory’. I would also like to thank the Family Counseling and Development Foundation under the leadership of Dr. Balkis Al-Jabari for their welcome and cooperation, and psychological counsellor and therapist Samah Talal who never got bored of my many questions.