Beyond ‘Trauma’ is a response to the pressing need to rethink prevailing discourses of ‘Mental Health’ in the context of the Middle East. Its broad aim is to engage in an ethical and pedagogical examination of what we assume we know about both mental health and the region. At stake are a number of conceptual frames, both in the social sciences and in psychological disciplines, that no longer seem helpful, yet remain dominant in mental health care practice and policy making. This initiative aims to bring together viewpoints that go beyond the limits of dominant global health paradigms characterized by an individual-centred emphasis and approaches that focus on trauma and PTSD. A critical conversation about the cultural meanings and situated experiences of psychological conditions, as well as the uncritical appropriation of diagnostic categories seems to be long overdue. Beyond Trauma underscores the ethical, clinical, and political implications of a One Size Fits All approach to mental health and psychological wellbeing in the Middle East.

 

In calling the initiative ‘Beyond “Trauma”’, the aim is to challenge the competing disciplinary assumptions that underlie the term and that pathologize and determine the parameters of ‘healthy’ reactions to ‘unhealthy’ conditions. One concern is that ensuing diagnostic labels (such as PTSD) and classifications (such as the DSM), themselves widely contested even in Western biomedicine, individualize and de-socialize experiences and phenomena that are fundamentally social and political. This initiative is also sensitive to the violence inherent in the very process of identifying trauma and the politics of exclusion in applying taxonomies of experience. Such practices risk masking, erasing, and trivializing the experience of some while reinforcing the conditions that created the so-called trauma in the first place. This is by no means to overlook the individual burden and medical conditions that traumatic experiences inflict on individuals. On the contrary, the point is to ask what cultural and historical forces and moral tensions shape the reality of such [clinical] pain and how to best address them.

 

When affliction occurs, it can provide the context in which certain forms of life become either valorised or pathologized. Depending on what gets pathologized and what gets valorised, institutions and politicians may create or instrumentalize certain strategies of living and political projects. From Hezbollah’s identity politics of solidarity in Lebanon, to Iranians’ mobilization of Shiite frameworks during the Iran-Iraq War, to European narratives of heroism in the First World War that inhibited the acknowledgement of psychic pain, institutionalized narratives often fluctuate between the extremes of heroism and victimhood. But the space ‘in between’ is where individuals carve out strategies of living and construct fragments of agency. Beyond Trauma turns to those spaces and invites an interdisciplinary, bottom-up, culturally situated approach to such human condition.  What means are available – culturally, clinically, or historically – for people to work with or through psychological pain? What helps people to sustain a moral life outside rigid clinical and cultural categories, while also acknowledging, respecting, and empathizing with people’s embodied experiences? How can we incorporate, for example, collective acts of remembering and the powerful legacy of oral cultures into therapeutic interventions? What clinical possibilities do cultural analysis and historical accountability offer to practitioners and policy makers?

 

Engaging with the situated forms of knowledge and practice and the cultural resources of each context is a first step for expanding therapeutic possibilities; as is therefore engaging with the social sciences, arts, and humanities as windows into the subjective experiences of inhabiting [ruptured] spaces of everyday life. Another step would be to evaluate the current state of mental health care systems that are in place, the struggles and opportunities of psychiatry’s interactions with various Middle Eastern societies and their medical pedagogies, and the ethical stakes of researching the pain of others. This requires a critical and reflexive assessment of the role of the outsider in such ecologies of uncertainty. In order to overcome several binaries – patient-practitioner, global-local, and cultural-biological – we need to incorporate the situated knowledge of practitioners, whose experiences cannot be divorced from the conditions in which they live and work. There is a need to better understand the region’s various health care infrastructures and diverse ways in which mental health and well-being are understood, practiced, and conceptualized.

 

Beyond Trauma is a call for conversation and action across disciplines and expertizes that share a common concern with the human condition and the construction of a moral life. It seeks a wide network of critical thinkers and on-the-ground practitioners to collectively generate theoretical, practical, and policy-relevant insights that are culturally situated. This is a platform to expand the conversation, connecting research and education to practice and practical experience to scholarship, in order to set a new innovative baseline for how Mental Health and the everyday realities of the Middle East are, and should be, understood represented, and addressed.