War Exposure Martyrs Crossing - Book Report/Review Example

Book Review: War Exposure Martyrs’ Crossing War exposure refers to the effects active participation in a violent conflict between parties where a person’s life is constantly exposed to mortal danger. War exposure is synonymous with referring to violence exposure and how this phenomenon affects an individual on a personal level and their relations with the external environment. War exposure has been declared as a possible risk factor to mental health and the development of mental disorders. Mental health and disorders related to war exposure include post-traumatic stress disorder (PTSD), distress due to fear, sleep disturbance, changes in economic behaviors, and health risk behaviors like evacuation behavior, excessive alcohol consumption and smoking. The effects of war exposure not only affects those who are directly involved in the fighting out on the war front, but also their families, friends and the society (Benedek & Ursano, 2008). The degree of influence and impact with regard to war exposure depends on a myriad of aspects that act individually or in concert to bring about the observable changes that help classify them as significant psychological effects of war exposure. The potential for war exposure to impact negatively on an individual’s mental wellbeing increases with the frequency and duration of exposure to the elements of war. War exposure affects the lives of all those involved at all levels of the existence by dictating the way that people relate and perceive one another and their environment, which can either be in a positive or negative light. According to David M. Benedek and Robert J. Ursano (2008), psychiatric and psychological epidemiological studies on the effects of war exposure have been predominantly focused on Western industrialized countries (Benedek & Ursano, 2008). The one sided nature of these studies makes it apparent that there exists a huge empty gap with respect to literature and information regarding the effects of war exposure on populations that define other regions of the world like Africa and the Middle East. The effects of war exposure and its influence in the development of mental disorders on civilian and military populations at a national level have been left largely unexplored. In this regard, Karam and his Co-authors (2008) established that there was no published data on a national level of national lifetime prevalence and treatment of mental disorders in the Middle East (Karim et. al., 2008). The study embarked on by Karam et. al. conclusively established that 25.8% of their working sample qualified for one or more criteria for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) at one point in their lifetimes. The resulted garnered from this research study illustrated an unmet and substantial need for early detection and identification of DSM-IV symptoms for effective treatment. The results were also substantial enough to indicate to the relevance of war exposure and its role in increasing the susceptibility for the first onset of developing mental disorders. Martyrs’ Crossing is a book/novel by Amy Wilentz that details the triumphs and tribulations that take place between Palestinians and Israelites in the daily struggle for survival, acceptance and recognition. The book is a work of fiction, but it is reflective realistic and true events that occur on a daily basis between the two countries as occasioned by her stay in the region as The New Yorker’s correspondent. The conflict between Palestine and Israel can be traced back to the unanimous approval by the League of Nations, currently the United Nations, to create a sovereign nation of Israel. The occupation of Palestinian held territories and other regions belonging to predominantly Muslim holders began in 1948, and thus the Palestinian-Israeli conflict was born. Palestinians are composed of 99% Muslims and the other percentage is left for other religious denominations, while Israel was formed based on Jewish religion or Zionism as Palestinians and other quarters of the world’s society might occasionally refer to the Jewish religion. Apart from the significant religious differences between the two people, the occupation by Israel of territories and lands that Palestinians claim as their own does not alleviate the antagonism that exists between the two. The Middle East has been a hotbed of sporadic conflicts between member countries, all of which can be related in some to the ever-raging conflict between the states of Israel and Palestine. This is attributed to the fact that each of the two warring parties has allies from all over the world with stakes in the region based on ideological, economic and religious inclinations. Peace in the Middle East has been the talking point of many career diplomats and governments for decades with no viable solutions being formulated as of yet. The problem is compounded by the fact that each of the two states refuses to recognize each other as a sovereign state, thus making it difficult to apply internally recognized and accepted protocols that are aimed at conflict resolution. The deadlock in conflict resolution between the Israeli and Palestine can be construed to be due to a myriad of factors all of which are grounded on the brutal Israeli occupation of Palestine and the intransigence of Palestinians with regard to political resolutions that exist (Kass, 2004 p76). According to Kass, there are elements of cognitive disconnecting between the Israeli and Palestinians that hinders successful conflict resolution between the two parties. These cognitive disconnections are characterized by diverse communication styles and language structures that result in different negotiations styles and understanding of terms (76). The maximalist approach of both Palestinians and Israelis leaves little room or opportunity for compromise, which is sometimes an essential ingredient in conflict resolution. Kass points out that the behavior patterns of both parties during crisis moments tends to lean towards radical political leadership that in most cases prefers to adopt policies that will ultimately eliminate each other. The cultural differences between the two nations because of their religious and socioeconomic principles also work to affect the decision making process of the two people. In Wilentz’s book Martyrs’ Crossing the two main protagonists in the story come both sides of the Israeli-Palestinian conflict, who have both had their fair share of war exposure for a significant portion of their lifetimes. The Martyrs’ crossing upon which the title of the book is derived from is based on an Israeli checkpoint situated on the Ramallah road through which Palestinians must pass for them to gain entry into Jerusalem. The two protagonists are Marina Hajimi and Lt. Ari Doron, who are a Palestinian-American mother and Israeli checkpoint commander respectively. The plot of the novel begins on an ordinary evening at the Ramallah checkpoint where there are the usual protests by Palestinian youths that escalate into a confrontation between the Israeli Defense Forces at the checkpoint and the stone throwing protesters. The Israel soldiers are forced to use teargas canisters and sound bombs in order to quell and disperse the growing number of protestors, whose aggressive intensity was increasing by the minute. The protests can be construed to be because of the complete closure of all entry points into Jerusalem from the West Bank due to two recent bus bombings in Jerusalem that had killed fifty people. Even though the protests were a common event that occurred daily like clockwork according Doron, that day’s protests had risen in intensity as characterized by his use of sound bombs and his ascent on the use of heavy firepower on the surging protestors. Amidst the protestors were people inline queuing for a chance to get to the checkpoint and be allowed into Jerusalem for various reasons some of them genuinely important. As it would be expected, Jerusalem had better of everything, so it was typical for Palestinians to want to visit Israel to access entities that were not readily available in Palestine or were inferior quality. Marina was married to a Hamas activist who was in an Israeli prison, and they had a 2-year-old son named Ibrahim, who was asthmatic. On the particular day the novel starts, Ibrahim’s asthmatic condition had deteriorated, and his Palestinian doctor had recommended to Marina to take her son to Haddasah Hospital. This hospital had better and superior equipment to handle Ibrahim’s conditions adequately and efficiently which needed a nebulizer and drips that were not available in Palestine. Getting into Jerusalem from the West Bank at the Shuhada checkpoint was not a simple or easy affair for it was characterized by frequent denial of entry for lack of proper documentation or purpose to warrant entry. Unlike other times where the checkpoints were usually meant to screen for radical elements, women and children were allowed easy passage. The two bus bombings had compounded the problem for Palestinians wishing to gain access to Jerusalem because even an illicit route used to gain entry was sealed off causing a total shutdown. Marina’s dual-citizenship equipped her with an American passport which accompanied with Ibrahim’s medical file from Haddasah Hospital eased her process of entry into Israel compared to other hopefuls who only reason was to look for employment. Ibrahim’s condition worsened by the minute as they waited for their chance to reach the checkpoint, and upon arrival, they were denied entry into Jerusalem despite Marina’s genuine reason to take her son to the hospital. The author to harbor conflicting emotions and perspectives about Palestine and his duties at the checkpoint illustrates Doron who was responsible for the checkpoint and determined who gained entry. In one part, Doron wishes that Palestinians did not exist; this can be explained by the grief that Palestinians bring onto his country and his job as a checkpoint commander. On the other hand, he just wishes that his superiors could only allow everyone entry and alleviate the motions of both mental and physical suffering that everyone undergoes at the checkpoint on a daily basis. Doron denies Marina entry due to the ongoing closure of the checkpoint after the bus bombing. Marina’s son Ibrahim dies while awaiting Doron’s indecision as whether to disobey explicit orders from his superiors on what he regarded as a genuine case that deserved an exemption among others. Marina seems to blame Doron’s indecision for the death of her son, a situation that establishes the plot of the story henceforth. Palestinians blame Lt.Ari Doron for the death of Ibrahim, which creates an opportunity for the Palestinian Authority to use as a rallying point in their castigation of Israel. The opportunistic Palestinian Authority, an aspect that further exacerbates Marina’s grief and Doron’s guilt, elevates Ibrahim to a martyr’s status. Traumatic bereavement is manifested at the individual level which it unique and different for every case. Marina exhibited a classic example of grief that was confounded by traumatic bereavement that created the possible for the development of post-traumatic stress disorder and depression (Mikulincer, Shaver & Horesh, 2006). Marina exhibited non-age specific manifestation of bereavement, which can be exemplified by her father Dr. George Raad, who also illustrated similar behavioral manifestations. Traumatic bereavement is also influenced by factors such as social support, personality and gender. Marina illustrated trauma associated manifestation of attachment to her son after his death at the Shuhada checkpoint as a typical function of anxiety buffering with regard to close relationships. Attachment to close relations is regarded as a regulative function of emotional attachment and a source of individual differences in psychological resilience, adjustment and emotional regulation. According to Mikulincer, Shaver & Horesh, (2006), attachment plays a critical role during traumatic events and posttraumatic adjustment. Attachment theory emphasizes on the significance of interpersonal experiences, as a source of individual differences in social and psychological adjustment, regulation and resilience. In this light, attachment can be construed to contribute significantly to emotional regulation during traumatic events and posttraumatic adjustment, and the potential role of attachment related processes in posttraumatic disorders. Humans are born with an innate psychobiological system, which predisposes them to search for proximity to key attachment figures, in times of need, as a means of protecting themselves from distress (Mikulincer, Shaver & Horesh, 2006). Marina’s father plays the critical role of the attachment figure in Marina life, while Col. Daniel Yizhar fulfills this role with Doron, albeit sparingly. Relationship with attachment figures, who are supportive and available during emergencies, is needed to promote a sense of attachment and security that fosters a sense of felt security based on the expected belief that these attachment figures will be available to offer the needed help (Mikulincer, Shaver & Horesh, 2006). The lack of reliable and supportive attachment figures compounds the problem for someone suffering from psychological effects of war exposure. Negative attachment strategies are referred to as secondary attachment strategies, and they are conceptualized in two frames of mind or dimensions, namely avoidance and anxiety. Marina lacked what can be termed as her expected attachment regulatory framework from her community and society. Palestine did not offer Marina the expected bereavement patterns that she expected, and its stead, Palestine took advantage of her son’s death to make a political statement and rallying point of their continued war of words and ideology with Israel. Raad, Marina’s father fulfilled the primary functions of an attachment figure, but he failed to fulfill the secondary roles because he failed to convince her that he was also not using her son’s death a pedestal to advance the Palestine Authority’s cause. In retrospect, Mikulincer, Shaver & Horesh, (2006) claim that “The first dimension, avoidance, reflects the extent to which a person distrusts relationship partners’ goodwill and strives to maintain behavioral independence and emotional distance from partners. The second dimension, attachment-related anxiety, reflects the degree to which a person worries that a partner will not be available in times of need” (Mikulincer, Shaver & Horesh, 2006). Attachment styles begin to be formed and developed in interactions with primary caregivers during formative stages in childhood and memorable interactions with other people throughout life can alter an individual’s working relationship that shifts from one of the above-mentioned dimensions to the other. Perceived unavailability of attachment figures leads into attachment insecurity, which composites the distress aroused by the reflective knowledge that the perceived situation is still threatening (Mikulincer, Shaver & Horesh, 2006). Insecurity forces the execution of decisions based establishing the viability of further and more active proximity seeking attachments for enhanced protective strategy. The failure in part of Doron’s attachment figure in Col. Yizhar resulted in the up-regulative mechanisms of Doron’s attachment system. The up regulation was characterized by constant vigilance and intense concern for the availability of an attachment figure to be adequately available and supportive. Doron sought out Marina for absolution of the perceived blame and responsibility for her son’s death at the behest of his indecision, behavior that can be interpreted to indicate the need for attachment (Wilentz, 2001). Doron’s behavior was illustrative of hyperactive strategies used to remain vigilant or one’s position about threat related cues and signs of attachment figures’ unavailability. The more there is a focus on the need for attachment, the more there is less or more guarantee for a fulfilling attachment system that remains constantly active and effective. Hyperactivity also intensifies negative emotional responses to threats and heightens rumination on threat-related concerns, which translates to the exacerbation of and increased doubt of one’s ability to achieve relief. The manifestation of these bereavement and attachment systems are illustrative of attachment anxiety and stress coping mechanisms. Coping mechanisms and/or styles depend upon the individual, their environment and the support strategies offered by the environment amounts to effective and efficient coping mechanisms. Coping styles relate to structural and stable factors, static features, or state features of an individual’s environment that influence efforts and form in coping (Mikulincer, Shaver & Horesh, 2006). By comparison, state coping entails focusing on the process of change in stress related phenomena including certain encounters that manifest from stressful encounters. War exposure predisposes people to trait/state approaches of coping style that focuses on the problem. These efforts entail defining the problem through active recognition, its modification and elimination. Doron’s stressors emanated from the guilt that he felt about being the cause of Ibrahim’s death; thus, he needed Marina’s absolution in order to eliminate the source of his primary stressor. The cognitive appraisal and coping adopted by trauma victims plays a significant role in the development of PTSD. The use of both emotion and problem focused coping efforts are associated with high levels of PTSD depending on the values placed on the trauma experience by the victim (Benedek & Ursano, 2008). Stress occurs when an individual’s resources are overused by experiences occurring between the individual and the environment. Security based strategies are based on declarative and procedural knowledge about self and others affect regulation. Declarative knowledge entails optimistic beliefs about distress management, trusting beliefs and optimistic goodwill and a sense of efficacy with respect to dealing with threats. A state of insecurity through war exposure is instilled in a victim forcing them to seek viable attachment options of proximity as a protective strategy. The anxious predisposition endowed on a person by hyperactive strategies exposes someone to risk factors for a variety of adjustment and emotional problems. Hyperactive activation leads to the impairment of negative emotions and encourages strong distress, even after real threats have ceased to exist of manifest. This results to hyperactive individuals harboring prolonged intervals of uncontrollable negative thoughts and moods. This can lead to cognitive disorganization and psychopathology that is characterized by especially strong depressive reactions and losses. Personality disorders are also characteristic of war exposure where there sporadic outbursts, which are manifestations of psychological outcomes of hyper-activating strategies (Mikulincer, Shaver & Horesh, 2006). The other maxim of coping is avoidance as a coping mechanism even though they are not widely encouraged and accepted. This is because avoidance promotes the erection of a defensive facade of security that blocks access to vital emotions, which leaves them suppressed instead of their being expressed, with distress left unresolved, which has the overall outcome of impairing one’s ability to confront life’s adversities. Mikulincer, Shaver & Horesh (2006) poastulate that “With regard to procedural knowledge, the association between attachment anxiety and negative affectivity is mediated by heightened reliance on emotion-focused coping and rumination on threat-related thoughts, whereas the association between avoidance and negative affectivity is mediated by heightened reliance on distancing coping, high levels of emotional control, and reluctance to engage in support seeking. The mental health implications of attachment-system functioning are highly pertinent to understanding a person’s psychological reactions to traumatic events” (Mikulincer, Shaver & Horesh, 2006) The acculturation of PTSD is an overlooked phenomenon that hinders the advance of interventionist approaches towards alleviating the impact of war exposure. The ways an individual may experience distress must be considered within one’s social and cultural context if at all any progress could be made in alleviating the effects of war exposure. PTSD is not based solely on individual characteristics but also on sociocultural interactions over time depending on the victims coping strategies. PTSD is characterized by frequent re-occuring of the traumatic events like unwanted intrusion of trauma-related material into conscious thoughts, numbing of responsiveness to the external world, mental images and dreams, and a variety of autonomic, affective, and cognitive signs of hyper-arousal as described by the American Psychological Association (Mikulincer, Shaver & Horesh, 2006). The high prevalence of mental disorders is regarded as an increasing burden society’s resources, which can be mitigated for by seeking early treatment. This can be achieved by putting measures in place that will ensure that will create awareness on its prevalence and its impact on the wellbeing of society. The fact that war exposure increases the risk of developing mental disorders like PTSD should be regarded with the seriousness it deserves. The association between war exposure and the increased risk of developing mental disorders should be the strength upon which guidepost health policy can be framed upon in regions where like Israel and Palestine where there is prolonged conflict. The recognition and identification of unique risks and associated exposures may not be possible in wartime but since people are involved, their manifestations can be utilized as reference points for identification of wartime exposure. Identification these factors will help in improving surveillance for mental disorders, which can be used to rally international support in support of neglected regions in terms of care and policy implementation. The resolution of conflicts is always the best approach towards preventing war exposure, but since war is to human nature, interventionist approaches should be enhanced and improved in order to alleviate the impact of war exposure on the wellbeing of society. Coping mechanisms should be improved to enable victims of war exposure to cope effectively with the effects of these experiences and their potential to increase the potential for the development of mental disorders (Mikulincer, Shaver & Horesh, 2006). War time exposure should not be regarded with isolation it currently receives from relevant authorities because it poses a significant risk to the wellbeing of societies and the world at large. Works Cited Benedek, D. M., & Ursano, R. J. (2008). Exposure to war as a risk factor for mental disorders. PLoS medicine, 5(4). Karam, E. G., Mneimneh, Z. N., Dimassi, H., Fayyad, J. A., Karam, A. N., Nasser, S. C., ... & Kessler, R. C. (2008). Lifetime prevalence of mental disorders in Lebanon: First onset, treatment, and exposure to war. PLoS medicine, 5(4), e61. Kass, M. (2004). Israel and Palestine: An unbridgeable chasm for conflict resolution?. The Global Review of Ethnopolitics, 3(3-4), 75-81. Mikulincer, M., Shaver, P. R., & Horesh, N. (2006). Attachment bases of emotion regulation and posttraumatic adjustment. Emotion regulation in families: Pathways to dysfunction and health, 77-99. Wilentz, A. (2001). Martyrs Crossing. Simon & Schuster. Read More