Breaking the binary of trauma and resilience in mental health: Interview with Lamia Moghnieh

Lamia Moghnieh speaking at the Disruption Network Lab , screenshot from their YouTube channel.

Today’s discourse about mental health remains largely dominated by Western-centric concepts and vocabulary. Can survivalism offer new avenues to deal with and talk about mental states?

Global Voices talked to Lamia Moghnieh, a Lebanese psychologist, social worker and anthropologist to analyze and deconstruct the elements of the mainstream narrative around mental health. The interview took place in Berlin in late November 2022 during the Disruption Network Lab conference “Madness. Fighting for Justice in Mental Health.” Both organizations partner regularly for events that shed light on global issues about human rights, freedom of expression and social justice. 

One of the binaries often used by the dominant mental health discourse is the opposition between trauma and resilience, something that Moghnieh finds too reductive, and requiring to be revisited, as she explains:

Trauma has become the global term for understanding suffering, particularly in humanitarianism where it has been fully incorporated, starting from the 1970s in the context of violence and conflicts in Europe and other places. In this narrative, trauma has become this universal and expected way for us to experience suffering. It is understood as what ruptures our everyday life and the world as we know it. Violence is thus understood through trauma. Tellingly, trauma, as well as resilience, are two terms that historically come from military research on building better soldiers.

Such simplistic opposition fails to capture other forms of suffering, as she points out:

When used in humanitarianism to understand the bodies of refugees or asylum seekers, the trauma/resilience binary reduces suffering to these two categories. Yet suffering is much more complicated than that. There is thus no accounting for the experience of everyday’s violence. For example in the case of Lebanon and its many wars, people often live in the expectation that war can restart at any point: That is not traumatic in the sense that it ruptures daily life, but it still creates a lot of suffering. So the question is, how do we imagine what is neither trauma nor resilience?

Lebanon is a country that has experienced civil wars, foreign interventions, massive arrival of refugees since 1975, and faces a major economic crisis in the aftermath of the August 2020 Beirut port explosion that instantly left 300,000 people homeless. Global Voices asked Moghnieh how this experience of war and its consequences is acknowledged in Lebanese society:

I see a lot of transformations in the political discourse on mental health. First of all, Lebanon is a country of mixed cultures, with an Ottoman period, and rich exchanges with European and American experiences, whether by ways of missionaries, or French colonialism that shape our own discourse. Lebanon is the home of the oldest asylum hospital, the Lebanon Hospital for mental and nervous disorders that was founded in early 20th century by Quaker missionaries, where I have conducted a lot of my archival research.

I also observe a generational change: people my age who experienced the [1975–1990] Civil War wouldn't go and see a psychologist. But my students at the American University of Beirut, who were born after the war, talk about their diagnosis, and use psychotherapeutic language. French and American psychiatry and psychology are very much present in their lives, but it is important to note that today, they also become inaccessible for many given how expensive they have become.

I should also mention Mediterranean traditional herbal medicine, which my family and I use and rely on for different illnesses, along with acupuncture. So we have a mixture of different healing practices.

In her research on the Lebanese experience of armed conflict, Moghnieh has identified what she defines as “trauma absence” which illustrates the limitations of the trauma/resilience binary:

The first question I asked myself as a PhD student was: how come there is this distinction going back to 1982 [the year of the Israeli invasion of Lebanon] when, on one hand, there is a proliferation of PTSD cases among Israeli soldiers, civilians and nurses; and on the Lebanese side, an absence of trauma — an expression I use provocatively. PTSD is — once again — a psychiatric term that comes mostly from the US Vietnam War, and brings the question of guilt, which, even in the most recent wars, US military pressing buttons for drone attacks say they experience. In Lebanon, “sumud” (a Palestinian concept that is partly about resilience) has been evoked to explain this trauma absence, yet it ends up essentializing people in Lebanon as the ones who do not feel anything, as they say “We don't suffer from your invasion, we just resist it.”

This absence — or perhaps non-legibility of trauma has consequences on how mental health is framed by international organizations that fail to adapt their models to non-Western contexts and repeat the same mistakes in their responses, as Moghnieh points out:

After the 2006 July War, the World Health Organization (WHO) asked the Lebanese government to open centers for PTSD treatment, yet no one came. Psychiatrists, global and local, faced difficulties in finding traumatized people simply because trauma did not manifest in a discourse they could recognize. I personally experienced that war and remember that, what helped the most was to spend an entire night with friends making jokes about the war, about horrific things than can be horrific and also funny.

The other issue that we face as a society is the erasure of suffering and the desire to rebuild exactly the same way as things were before the 2006 war. This actually hides the violences and reinforces trauma absence.

None of that experience turns into a lesson learnt, unfortunately: Global humanitarianism still comes back with the same textbook approach, and when it incorporates alternative ways to global psychiatry, it makes sure it is never challenged by presenting projects in a community-based way whereas in fact in most cases they are not. We really need to overcome the top-down hierarchy here. 

If international organizations overall fail to embrace change in their understanding of, and responses to mental health issues, can there be truly alternative and powerful narratives? One unexpected source could be science-fiction, particularly the work of pioneer Afrofuturist writer Octavia Butler, according to Moghnieh:

I discovered Butler in 2015 when I was part of a feminist collective in Beirut that asked me to bring some of her books from the US. I didn't know her so read her on my flight to Beirut. Her writing helped me to see a different path towards survivalism. I was so inspired by her way to describe how we live and adapt to violence that I wrote an intimate piece about it.

I wrote: “Butler inspired my thinking on how to be flexible in, mend with, and survive from catastrophe—all of this within the temporality of the everyday—how to change and transform, rather than attend to the aftermath of events. This privileging of doing rather than suffering opens our critique to generative and material ways of reading violence and disaster. It shifts focus on the future rather than the past–present. The past becomes not just a painful and traumatizing event that requires healing, but also a place for deep communal knowledge, learning, and resources that we can use.”

As our collective called her back then, Butler is the Prophetess of our future.

Moghnieh’s intervention at the Disruption Network Lab can also be viewed here.

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