-Essay-

CAIRO — A nurse and her staff use heavy medications to tame the men in a mental health ward into becoming compliant patients. Lost in a constant drug-induced haze, they have no interest in challenging the petty rules and regulations that govern the ward.

There is, however, one rebel among them: a smug character who longs to be free and who recognizes the nurse for what she is, a tyrant. He begins to challenge her authority by encouraging small acts of insubordination by his fellow patients.

Following the suicide of another patient, it becomes clear to the rebel that his role is larger than his personal desire for freedom and individualism. Defying the nurse's authority, he arranges for a boat trip to give all the men a collective taste of freedom. Humiliated, the nurse punishes the group as a whole. But her response is especially cruel when it comes to the rebel, who is forced to undergo a lobotomy.

When he returns to the ward a few weeks later, it is obvious to all residents and staff that although his body is the same, the man within is gone forever. In the end, one of the rebel's friends, unable to bear seeing his dead soul imprisoned in a defeated living body, smothers him to death and escapes to freedom.

That, in a nutshell, is the story of One Flew Over the Cuckoo’s Nest, a 1962 book by author Ken Kensey that was later made into a film starring Jack Nicholson. On an allegorical level, it is also a story about life in countries under authoritarian regimes and about the psychological death visited upon those who dare resist. And in that regard, it is a story about Egypt.

Recognizing our wounds

Like many, I took to the streets on Jan. 25, 2011 to defy a fascist regime that ruled through fear, mental fogginess and manipulation. I was ready to die for human dignity and a taste of freedom. Following the euphoria of a quasi-victory, however, I was quick to acknowledge that the regime's retaliation would be brutal, and that the ensuing mental hardship would take its toll.

[rebelmouse-image 27088264 alt="""" original_size="220x327" expand=1]

Of all the psychological repercussions we have to endure, trauma and its effects are the worst. Trauma, which means "wound" in Greek, can be a result of an overwhelming event that is beyond a person’s capacity to cope. A traumatic event, whether an isolated incident or an ongoing series of events — such as atrocities committed by the state — can have long-term effects. These not only impede a person’s ability to function normally, but affect society as a whole.

In the years that followed the fall of former President Hosni Mubarak, as a psychiatrist I have observed and documented many psychological changes in a nation that was traumatized by its genuine, but often failed, attempts to escape the cuckoo’s nest. Yes, the world saw us break free and fly out of the nest several times, but it seems that we keep getting entrapped in the plot all over again.

Cyclical attempts to crush our mental health through different atrocities were often met with resistance and creative coping mechanisms, such as creating artwork, valorizing our narrative and continuing to fight. But from a psychological perspective, it is clear that our efforts to resist the traumatic effects by maintaining our mental health eventually gave way.

The ending of One Flew Over the Cuckoo’s Nest delivers an optimistic — albeit melancholic — promise of freedom, and a call to hang on to one’s sanity until then. While it is true that the protagonist was defeated by the system, it is equally important that his friend managed to escape.

In the case of Egypt, it is still unclear which of these endings will be our destiny, and whether we will be able to fly off or will just end up conforming to the system.

Conflict, injustice and crushed dreams breed trauma. What I aim to tackle here and in more articles to follow are the symptoms of the trauma Egyptians are facing. I will focus on the prevalent symptoms, signs and consequences of this societal trauma that is running our lives. I will also address the need for healing, and examine some of the obstacles to this healing — including the lack of access to mental health services, the recurrence and continuity of events that maintain our state of trauma, and the stigmatization of mental health issues in Egypt that prevents many of those who need help from reaching out and coming forward.

Imprisoned by trauma

Societal traumas — such as conflict, systematic torture, rape and injustice, and a struggling uprising such as the one Egypt has been facing since 2011 — can impact the entire population and inflict enduring pain and suffering. Most of the time, the damaging traumas are not recognized by the wounded culture as a whole. Those suffering often feel alone and isolated despite the fact that trauma has become ingrained in their culture.

The French sociologist Émile Durkheim introduced the term “collective consciousness” in his 1893 doctoral dissertation, Division of Labor in Society. He wrote that “the totality of beliefs and sentiments common to the average members of a society forms a determinate system with a life of its own. It can be termed the collective consciousness.”

The negative results of trauma, in other words, are incorporated into the collective consciousness of the culture, thus making ideas and actions that are based on the traumatic event seem natural. One such example is the acceptance of the use of violence. When a nation is exposed to great levels of violence, the use of force is accordingly seen as natural and even justified. The same trauma, if never fully healed, may reoccur in a society undergoing upheaval. It is therefore safe to assume that there will be no real transitional justice without addressing and managing these collective traumas.

Based on the current reality of impunity, torture, injustice, corruption and media manipulation under the auspices of “Big Brother,” Egypt can be psychologically diagnosed as a stagnant nation imprisoned by trauma. Without addressing this traumatic stagnation, there appears to be no prospects for healing. By dismissing the fact that we are traumatized, we are in fact maintaining the trauma.

Societal or cultural traumas, such as those inflicted by the state, are common when populations fight for equality or struggle for freedom and power. Political leaders often promise that such atrocities will never happen again, while at the same time stressing the importance of forgetting or forgiving past atrocities as unfortunate parts of a culture’s history, rather than addressing them in a meaningful manner.

[rebelmouse-image 27088265 alt="""" original_size="1024x577" expand=1]

Martyrs of the revolution in Tahrir Square. Photo: Tungsten

In Egyptian media, we are subjected daily to the narrative of the importance of forgetting atrocities committed by the military, police or even the judiciary so that the nation can unite and focus on fighting terror.

As a consequence of defending or rationalizing the actions of those committing atrocities — whether intentionally or not — the healing process can be delayed or even negated. Social scientist and trauma and healing researcher Duane Elgin suggests that some of the traumas following this pattern include “genocide, slavery, religious persecution, colonialism and gender oppression.” The symptoms and effects of traumatic events will still exist, whether they are acknowledged or not. But neglected traumas will result in an unhealed society with grave and disabling consequences woven into its cultural fabric.

Denial and stigmatization

Some of these negative consequences that we, as psychiatrists and human rights activists, deal with are severe mental health issues that are often dismissed by the state along with the traumatic events themselves. Post-traumatic stress disorder (PTSD), anxiety disorders, violence, depression and suicide attempts are some of the consequences that mental health workers deal with on an every day basis. We also know that the cases we see and document only represent those few people who were able to challenge the stigmatization of mental health illnesses — or cultural taboos regarding sexual assaults and torture, for example — and seek help.

On the individual level, the traumatized person's view of the world around him or her will change dramatically. And when more people are subjected to the same trauma, it develops into a collective problem, which in turn becomes part of the collective consciousness. This collective consciousness determines how all individuals who are part of this collective heal and deal with future conflicts.

Many professionals have observed that traumatic events often engender more traumatizing events. For example, when people are subjected to violence without redress, this often drives them to perpetrate more violence. This occurs because the collective consciousness of the traumatized population internalizes trauma effects, such as violence, as natural behavior and routine.

Many Egyptians are currently experiencing an increase in societal violence, whether physical, sexual, verbal or even psychological.

Medical biophysicist and psychologist Peter Levine, who developed a new method for healing from trauma called “somatic experiencing,” agrees that experiencing traumatic events greatly increases the likelihood of future violence. While violence is only one outcome of unresolved trauma, it is certainly an important effect to examine.

In his book Waking the Tiger, Levine draws a connection between the increase in violent behavior and the absence of healing after trauma, which he describes as “among the most important root causes for the form modern warfare has taken. The perpetuation, escalation, and violence of war can be attributed in part to post-traumatic stress.”

Acknowledging that Egypt is in fact a “traumaland” is a first step toward healing. A good understanding of such collective illness will open an outlet for creative alternatives to transforming future challenges nonviolently, and stop the endless cycle of violence and polarization.

As we have seen from the experiences of countries such as Cyprus, South Africa, Armenia and many more that addressed the issue of collective trauma as key to transitional justice and healing, there are no easy solutions for healing from deep traumas. American author, speaker and activist Elgin Duane supported this notion and argued, “It may seem unwise to bring the dark side of humanity’s past into the light of day, but, unless we do, this unresolved pain will forever pull at the underside of our consciousness and diminish our future potentials.”

The need for us as society to bring our ongoing dark side into the light of day is the path to a possible salvation and our means to flying out of the cuckoo’s nest. It is time to face the truth about our collective consciousness: We are a traumatized nation exerting all signs of mental health issues that follow trauma, including PTSD and violence. Denial or “just getting on with it” will only breed more trauma.

*Sally Toma is an Egyptian psychiatrist