Feelings of anxiety and depression are normal responses to disasters. But how much is too much? Rana Allam gauges the emotional toll of the war in Iraq
During the United States-led aggression on Iraq, one development became abundantly apparent in almost every Egyptian household: no more did people watch movies, videos or entertainment programmes. Television screens either aired news or were turned off altogether. Everyone listened intently to the anchors with anticipation at first, and trepidation later.
Click to view caption
Many of the new psychiatric patients are young girls suffering from anxiety and depression as a result of the war
In a downtown coffee shop, the sound of backgammon dice was replaced by television news reports. Customers' eyes were glued to the screen. With vacant stares, many patrons looked as if they could not hear what the anchor was saying. "We [were] watching a war between two evils, Saddam and Bush. No matter who [won], the outcome is horrible for all of us," said Mohamed El-Tahhan, a 45-year-old civil engineer. Nodding in agreement, several coffee shop customers expressed similar frustration. "I can't deal with it anymore. I am unable to finish my work. I stopped taking new clients," said Said, a carpenter. Comments flew back and forth in response. "You are not alone," said one. "Who has the energy to do anything?" asked another patron. Suddenly, a loud "Wait!" silenced everyone and they turned their heads again towards the television. Pursuing a conversation with the customers was no longer an option. I sought a passer-by, who stopped to glance at the television screen for a moment before summing it up in one sentence: "It has become unbearable. Unbearable."
"I read non-stop and I watch the news without a break. Then, I get up unable to feel anything other than bottled-up tears," one female friend told me. Anger, detachment, gloom and panic seem to have overwhelmed the Egyptian psyche. "War -- or any extraordinary disaster -- often causes acute stress as well as severe sadness," said Dr Ahmed Refaat, consultant at Behman Psychiatric Hospital.
Depression is one of the symptoms of Post-Traumatic Stress Disorder (PTSD). The very first reaction to war, as psychologists explain, is shock which develops in a short period of time into anger or fear. This can lead to a feeling of numbness or detachment, followed by disorientation. "A general state of frustration is a common reaction to war after the initial shock has subsided," said Dr Khalil Fadel, a psychiatrist. He added that during war times, people suffer from a fear of the future, feelings of being invaded, ambivalence and a general sense of insecurity. "Frustration and insecurity, when combined, can definitely lead to depression," Fadel said. Although the military conflict is now over, "there is a general failure of the psychological system," said Fadel. He explained that Egyptians may be more sensitive to such crises given their own personal experiences of war. If severe, mixed emotions can turn into rage or even hysterical outbursts. "Others get suicidal and blow themselves up -- the manifestation of the idea of 'dying for a good cause'," Fadel added.
Indeed, a young man in his early 20s was a good example. "I don't feel insecure. I feel rage and anger. I want them [coalition forces] to come here so that I can fight back. [I want to] avenge the lives of those innocent people, those dead babies, those widowed and those orphaned," he said, with such animosity expressed on his face that I feared for him.
Others have expressed similar frustrations. One middle-aged woman said, "I am tired. I want to hit something. All the talk about demonstrations, sit-ins and articles. Talk and talk and talk. I feel like a lion trapped in an invisible cage. 'Helplessness' does not even begin to describe what I feel."
But not everyone has reacted in the same way. Fadel described one of his patients, who felt "excited" when the war started. The patient said that it gave "meaning to [his] life, something to look forward to". When the military action in Iraq had stopped, the man retreated to his earlier state of emptiness, feeling neither happy nor sad.
Fadel and Refaat say that the people who have been most psychologically affected by the war are those who were already suffering from depression or psychosis (loss of touch with reality) before the war began. Many suffered relapses of these conditions within the first few hours of the invasion. However, since the war started, plenty of newcomers have visited psychiatric clinics as well. Refaat said that one of his new patients is "an elderly woman suffering from depression [PTSD] caused by the current events". Fadel's clinic was visited by 10 new patients in the first two weeks of the war. Overall, his patient caseload increased by 20 per cent since the war began.
Fadel said that many of his new patients are young girls suffering from panic and anxiety about the consequences of the war. Some have such a strong sense of fear about the future that they have expressed concerns about whether they should get married or have children in light of the current crisis.
In addition, Fadel, who is a marriage counsellor as well as a psychiatrist, has also seen a recent upsurge in cases involving domestic problems. "The husband -- and in some cases, the wife -- may neglect his or her partner in order to watch television. Students have stopped studying and are involved in politics. This causes domestic disputes," Fadel explained.
Children have been affected as well. Dr Wagih Fares, a consultant at Behman Hospital, says that elderly people and children are more likely to exhibit signs of psychiatric problems. "Phobia and neurosis are apparent with these two segments more than others," Fares said.
What has caused the increase in mental health problems? Arabs have lived through many wars, and reports of deaths in Palestine have continued. Why has this war caused such high levels of mental distress? Fadel says that there is a big difference between this war and others. "Iraq is a state with borders. This war has to do with territorial sovereignty. That is why people are out in the streets demonstrating." Refaat agrees, adding that the outcome of the situation in Iraq is unpredictable. The frustrations and anger with the Palestinian issue that have been pent-up for the past 50 years led to an emotional explosion when Iraq was attacked. When Baghdad fell, Fadel suggests, Egyptians were not mourning Iraq as much as they were mourning themselves.
Although Refaat believes that the real psychological impacts of the war may not be immediately apparent, there are several warning signs for those suffering from PTSD as a result of the conflict. Initial reactions to the war, such as sadness, anxiety and sleeping and eating disorders, can lead to serious health problems. Chronic anxiety linked to depression may lead to more severe, long-term syndromes which can be difficult to cure. In other cases, patients may experience somatic symptoms, in which psychological problems are exhibited physically, such as through headaches, dizziness, nausea or skin rashes.
PTSD can be triggered when normal routines are interrupted and people watch too much news. "This is very bad," said Fadel. "People should turn their attention to something else. I am not saying that we should not follow the news, but we have to take a few breaks to calm down and relax."
Many Egyptians -- and perhaps many Arabs -- have put their lives on hold because of the conflict in Iraq. Travel plans and outings have been cancelled, and there is a sharp drcline in the number of people attending the cinema and theatre.
The current economic situation in Egypt and across the globe has made matters worse. Since 11 September, many companies have been forced to shut down and have laid off employees as a result of poor business conditions. In recent months, prices have been increased by an average of 30 per cent in order to compensate for the floating of the Egyptian pound and subsequent decline in its value. As a result, more businesses were forced to close and there were more layoffs. Many of those who still have jobs have had difficulties in making ends meet.
"Along with the economic situation, seasonal changes have caused more depression," said Fares. Seasonal Affective Disorder (SAD) is a form of depression usually experienced during seasonal changes. "It is sometimes difficult to determine the cause of the depression people feel nowadays because of the many factors affecting their psychological conditions," Fares added.
"There is nothing to take our minds off the war. We can't even travel or go out and try to have fun because of current financial problems," said Maher Onsy, 35, an accountant.
Although the military conflict is over, uncertainty and fear continue to loom. "We had a slight hope that Iraq would not fall that easily -- perhaps not at all. But now we are concerned for our own safety. 'You are next' is the line I see on the faces of American and British ministers holding press conferences," said Onsy. A sense of impending danger and insecurity is prevailing among the higher social classes. "They feel threatened all of a sudden," Fares said.
Depression caused by the war (or PTSD, as psychiatrists prefer to call it) and the financial crisis have taken a toll on many people. However, experts advise that we should not give in to a state of depression.
In order to stay healthy despite these troubled times,doctors advise that you should allow yourself to express your feelings. Cry when you feel sad and shout when you feel angry. Join demonstrations if it alleviates frustration and gives you a sense of contributing to a cause. Maintain a daily routine. Eat well, get plenty of sleep and, if possible, exercise. Rather than isolating yourself, connecting with other people and seeking social support may be extremely comforting. Most important of all, if you have watched the news for too long, force yourself to change the channel.