A sticking plaster for a shattered world

The last paragraph of this article from the American Journal of Psychiatry on people displaced by the Syrian conflict essentially sums up the entire practice of conflict-related mental health.

Looking at this endless list of horrible stories from a psychiatrist’s perspective, I see only patients suffering from what my profession calls posttraumatic stress disorder. It is a disorder with well-described symptoms and therapeutic options. Looking at this same list from a human being’s perspective, I only see in the looks and attitudes of those patients—as I empathically explain to them their disorder, prescribe a few pills, and orient them to psychotherapy—something that is beyond what contemporary evidence-based medicine can describe scientifically.

In every one of these patients, I see intense, irreversible mistrust and a lack of belief in every principle or rule that is supposed to control our relationships with each other. I see question marks regarding the meaning of their whole existence as well as the meanings behind the most important concepts that seemed unquestionable to them in the past, such as religion, politics, work, family, and finally, last but not least, health. These patients manifest symptoms that justify the wide array of treatment modalities I offer to them, but I am left with a terrible feeling that this management is somehow wanting. All that has been shattered in these patients’ lives cannot be mended by the small treatment that we can offer.

It’s written by Lebanese psychiatrist Rami Bou Khalil, who mentions this little told but often learnt lesson about the effects of war.

Link to ‘Where All and Nothing Is About Mental Health’

One thought on “A sticking plaster for a shattered world”

  1. I appreciate your post on this topic however I want to remind everyone that this very same problem exists with inner city folks who live in some of our most wealthiest American cities. After multiple generations of severe drug addiction, community dysfunction, and economic displacement, the youngsters who I used to work with in foster care and diversion programs as well as their adult uncles and aunts in ex-offender or domestic violence programs have the same vacant looks as I see on the faces of Syrian refugees whenever I watch the BBC. And I believe we care about them even less than we care about the Syrians and these are our own citizens. I have wondered for years if there is a “point of no return”, where a psychological “disease” is so bad, has gone so far for so long that we can do nothing (something we acknowledge and appreciate in medical conditions). If true, the question where is the comparable “hospice care” in behavioral health? Maybe we need to start talking about that instead of waiting for a miracle or for someone to pull themselves up by their boot straps.

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