1. Introduction

SILENCE is a protection against too intense pain experience, and also the feeling of total impotency, which mostly is accompanied by SHAME and guilt feelings, even though the person was a victim and not the aggressor. The repression of unbearable memories from violent exposure might be a strategy for survival from traumatic events. As psychologists we must be aware how difficult and delicate our therapy work shall be, and we have to consider the resistances against the therapy as ‘normal’, as a defense mechanism in order to protect the subject from too much suffering, when he or she is remembering the traumatic event. Never push a person to speak, if silence is necessary, and stay beside of the person in an empathic way of containing the silence, sharing the struggle for words.

Psychoanalyses was called ‘talking cure’ [1], and we know that the therapy is based on remembering, repeating and elaborating the life experiences which had to be repressed, isolated from consciousness. Our work is to listen to the silence, until the stumbling of the first words might break the silence, maybe together with emotional catharsis, but maybe also in a ‘cold’, distant way. There is no ‘solution’, no response possible, except of just to be there, as close as the person can stand it and wishes to stay. The dialogue between the psychotherapist and the patient includes the risk, that the patient feels again put in the situation of impotent dependency, like in the situation of torture, of violation or any other situation of humiliation. The shame feelings will act as a blocking, a covering up of the blessed soul and body. We have to be as patient as possible.

With the method of psychodrama [2], we are focusing a group method, which includes other possibilities of working through the traumatic events. Using the ‘surplus reality’, we can enact and dramatize situations of fear and shame, without that the patient him/herself has to expose directly. With the method of “Playback Theater” [3] or in mirroring during a psychodrama, the victim of violent human treatment might look at the scene that is repressed. The therapist together with the whole group gives the containment and helps the patient to overcome the resistance and to look at the terrified experience, first like in a surrealistic theater.

This is a long and complicated process, and mostly first comes the body expression and the movement in the group, as expression of pain, suffering and shame, before the patient can find the words and begin to talk [4]. During the 16 years that Maja Hess and myself from ‘medico international Switzerland’ are giving the Training Workshops at the GCMHP, we can evaluate this method as highly appropriate for the situation in Gaza. I am using this method also in other contexts of violent and traumatic situation (El Salvador, Nicaragua, México, Costa Rica, Cuba) with very good results [5].

Also in this method we never push a person to be protagonist, only when she or he wants to be protagonist and work about an issue, and the group is mainly identified with the theme, we start a psychodrama process. By the end, during ‘sharing’, the individual experience of the protagonist is transformed to a collective group therapy, because every participant shall talk and share his/her own experience. During this process, together with direct therapeutic effect, also the process of collective memory is important, in order to search for the real truth in individual and social life history. Shame and guilt feelings cover up the truth and give the way free for false interpretations of the history. Impunity can only be transformed into the knowledge about the real facts, if the protagonists of the action talk about [6].

To overcome shame feelings and break the silence is a painful and complicated process, which is only possible if we can build up a relation of confidence and honesty. If the therapist comes from another culture and is from the opposite sex of the protagonist, there are additional difficulties, conflicts and possibilities to work on. Transference process is based on an unconscious repetition of infantile feelings and experiences, with the significant adult persons like mother, father, grandmother, grandfather, brother, sister etc. In our case, we are European women, we are representatives from “the old colonialist world”, which nowadays is repeating unjust and coward attitudes towards Palestine [7]. What influence does this historical background mean in the collective unconscious of the participants of the therapy? If we are able to make it conscious, and give names to the violent history, we can become real partners in the relationship. But if this matter isn’t verbalized and recognized, it might lead to a situation of re-traumatization [8].

The goal of this paper is to point out, how difficult is psychotherapy work in the context of violence and war, and how important is the issue of counter-transference, which means that the person of the therapist also is a subject to include in the process. By that means it can be possible, that violence turns into hope, that ‘the other’ is not only experienced as enemy, and that ‘myself’ and ‘we together’ can become more human [9].

2. Silence and Shame -Suffering and Liberation

I would like to come to some concrete experiences, most of all in the case of Palestine and Gaza [10]. There are different sides to consider: Politically the victims and the aggressors in the time of occupation, and of course the cultural issues as structural frame in conscious and unconscious behavior. Beside of the external reality we have to consider the complicated inner psychological processes, which includes always love and hate, ambivalent feelings, as well as the risk to suffer ‘repression’ beyond situations of stress.

Psychological thinking focuses on human relationships, as individuals, as collective processes, always within a specific cultural and social frame, which uses to regulate our behavior without that the moral and religious values become conscious. Only through therapy work or social investigation, these unconscious values might become conscious and by that mean also questionable, which is the condition for making changes. We need a critical distance in order to be able to recognize our own unconscious behavior, the automatic repetition of behavior and thinking values. We know about the transference of prejudices from generations to generations, and how these values may become an iron law, this mostly in patriarchal societies where the monotheist religion might strengthen authoritarian cultural and social structure [11].

The problem of shame and silence in victims of violent aggression, suffered from another human being, beside of the individual traumatization, is socially and politically a very important issue, because it touches the problem of impunity. For this reason, we propose that the traumatic event suffered within a political context shall not be considered as an isolated psychological problem, or even less as a sickness or a pathological symptom. We try to understand it in the context of war, of collective struggle for justice and peace, and for this reason as psychotherapist we try to help the person/victim to speak about the situation. The crime has to be denounced and the violated person is the first testimony of the facts [12].

Of course, we have to be very cautious and patient, because if we push it means again a violent act, and also the situation face by face with the therapist might re-traumatize the victim. The situation of torture or violation was a human experience with another person; the prisoner was mostly alone with the aggressor. For this reason, I consider the situation of group therapy very useful, because the sharing with other colleagues from the same culture might help a lot to be a protagonist. The patient might feel safer, but also the shame will be stronger, because the group symbolizes a ‘public space’, and the painful experience such as the violation might turn around in a way, that the violated woman becomes the guilty person and is looked at by the other participants in the group as a ‘bad woman’.

Later on, I shall point out some special issues about the method of Psychodrama.

In El Salvador where I am working with traumatized women who were active social fighters during the long enduring war, the main theme was the feelings of guilt, being a mother. Many of these women had to leave their children or even babies with parents of friends, while they had to flee to the mountains. Years later they came back to civil life, but the revolutionary goals could not be fulfilled. At least there was an ‘agreement of peace´, and instead of the criminal and brutal dictatorship was installed a civil government. When the women faced their families and the children, many tragedies happened, because they were strangers, and some of the social voices made feel them guilty. Even the own children reproached them, that they had abandoned them. Why they went to fight for a better society? They say: We fought for you, for our children and your future! But the children only felt the pain of being left behind like orphans. Many families didn´t find the way to come together again, loneliness and bitterness fills their hearts, instead of solidarity and understanding. But impunity went on, until a leftist government now can change this policy and put an end to the silence.

Therapy means also to facilitate the encounters in such a situation, which suffered thousands of families during the dictatorships in Argentine, Uruguay, Chile, El Salvador, Nicaragua, Guatemala, and Honduras. The ´peace agreements´ can be a very important step forward for justice, if the impunity is broken, and if the victims are able to speak and denounce the crimes. Our work is to help them to overcome the silence, which is a protection from feeling, judged, misunderstood, laughed about. And of course, speaking about the traumatic event means to re-experience the pain, the suffering, the loneliness, the fear, the anger and the impotency. Every patient I know, mostly women, was asking: Shall I be understood? Will my family expulse me for what happened? Is it not better to keep silence?

For this reason, it is not enough to make an individual therapy with the victim of violent crimes, but it is necessary to work with the families and the social group. And of course, it is important to participate in movements for political change, to take part as intellectuals.

This leads us to the other part: The complicity of shame and silence. Many times as psychotherapists we might feel a secondary traumatization, because we are listening to very violent events, which our patients are telling us, and we need supervision in order to get over it and to control our counter-transference. The risk is that we over-identify with our patient or in the contrary, that we build a wall around our own feelings, in order to protect ourselves. That means we are experiencing something similar like the patient: How to talk about the unspeakable horrible events? How to stand the feelings of shame, guilt and impotency, facing our patient? We need support in this work, for two reasons: for our own mental health, and for the need to process the information in a way, that we don’t fall in the role of complicity with silence. The professional secret, the necessity of absolute discretion and respect, the understanding of the shame feelings of the patient can become a conflict, mostly if the therapist also is part of the same cultural and political situation, as it is the case in Palestine. Our training in Psychodrama faces the very important supervision work with the therapeutic staff, to enable them to listen to their patient; especially if the patient talks about a similar situation they suffer themselves. One of our woman colleagues was in her mourning process considering the recent murdering of her eldest son, whose crime was to be young and to be blamed with the suspicion to be a terrorist! He was killed together with other two twenty-year-old friends, on the way to their work. His mother, - our colleague -, who is a brilliant psychologist and already trained as psychodramatist, suffered severe depression, felt emotionally blocked and without any energy for working. Fortunately, our group work together could help her to overcome the worst moments of her traumatic experience! How possibly could she listen to another mother, whose son was killed, without having had the opportunity to get her own therapy?

In Gaza, nobody can avoid to be part of the collective traumatic situation and the consequences of the siege.

What about Europe? Shame and silence is also to find in the supportive people with Palestine, who feel impotent and worthless considering the crime. They can overcome it by organizing solidarity actions and spreading out the information, which is the case of ourselves in Switzerland and the countries we live and work. But there is the big group of silent people who don’t want to see, to listen, to speak. Maybe there is also shame beyond the seemingly indifference, or is it just the denial of thinking? Are they all denigrated to objects of consuming the goods, which are produced in the third world, in order to become cheaper? Are they robots - and the results of globalization and capitalistic functioning of western world, thinking only about money, power, and individual comfort?

The collective silence and shame to talk about Palestine is a sign of cowardice and denial of looking at the world’s history. The phenomenon of alienation became ‘normal’, and most people doesn’t want to break the silence and to ask: What can I do? Maybe because he or she also feels guilt and shame about the impotency and insecurity in a society which reduces the international relationships to economic interests and marketing issues. The human beings disappear, and if they are of another culture, color, poor and full of psychological problems, most people turn away and don’t want to be involved. This is the big SHAME of the rich countries, most of it Europe, who is so much involved in the historical crime against the Palestinian people [13].

The dominant press gives a false picture about the real facts, and for this it is so important that the protagonists themselves speak, break the silence, and act collectively against the indifference.

Our method of psychodrama goes further than the verbal language, even though the aim always is that the patient finally finds words for the experiences, as terrible as they were. Then it is possible to listen, to give support, to share the traumatic event and to give feedbacks from similar experiences, so that the collective history becomes alive. Not only from the negative side, also the experience of the strength to resist, of the intelligence to understand, of the solidarity within the pain means a very important therapeutic experience. Not only the psychotherapist is important for containing the strong emotions and feelings, but also the group acts in a therapeutic manner. The body expressions, artistic ways of ‘talking’ through painting, singing, dancing, warming-up exercises help to feel the own body and to recognize the trauma within it. Where is my physical and psychological pain as a symptom in the body? How can I express it, afterwards step by step dramatize its history, and tell the truth?

The group participant’s act as auxiliary-ego’s, and through the functioning of the ‘Tele’, they experience in the role which is given to them by the protagonist, not only the feelings in the role, but their own emotions. Many times a role of auxiliary ego, like to be a mother, allows the person to remember and elaborate his/her own history with the mother.

Our aim in therapy work is: to remember, repeat and elaborate the individual and the collective history, and at the same time investigate more about the own culture, especially regarding the relationship between genders. Women feel much more shame to talk about their feelings and traumatic experiences, because they are more easily blamed by the family and social order for a crime that they didn’t commit. In the contrary, mostly the woman is the victim of conspiracy and social oppression. This is more the case, where patriarchal systems are ruling, and where monotheistic religion is coming together with the patriarchal clan system. Silence is often the only way to survive socially and psychologically for a woman, but this means a problem in mental health, because she is left alone with her shame and guilt feelings.

On the other hand, the men also are victims of silence and shame feelings, because in patriarchal culture they must be strong, repress their tears, deny the need to cry and to search for help. Many times, an aggressive acting-out replaces the need for support, and narcissistic behavior isolates the man. With the psychodrama we could experience how this problem can be resolved in the way that the man-protagonist elects a woman as his ´double´, and she can cry for him, express all the repressed feelings. During the following sharing the protagonist himself shall speak about his feeling.

Also, the experience, to change role with the aggressor, is very important. There is an unconscious psychological defense mechanism called ‘identification with the aggressor’ [14], which is very dangerous, because the person doesn’t recognize this reality. He or she thinks about ‘normality’ in the meaning that it is bearable, the painful part is isolated and expulsed, projected against the outside. At the same time, the powerful ‘other’ becomes fascinating, and the identification with him fulfills the wish to overcome the own feeling of helplessness or shameful situation. In this case, the oppressed becomes an instrument for the enemy, because his admiration and the need to get away of the own humiliating dependency makes him become a ‘traitor’. This is the aspect of the psychological problem, but of course money and other favors are most powerful too in corruption and seduction.

In psychodrama, we go into the role of the oppressor and discover our own need for power, maybe even sadistic impulses, without the need to act it out in reality. But if we focus on the harm that impunity is doing for individual and collective mental health, we must also talk about the own aggression. For this on the surrealistic scene in psychodrama, playing the role of the enemy, gives us much possibility of understanding better how the dynamics of violence are functioning, and also, we can have some catharses and relief ourselves from anger and hate, which can lead to psychosomatic sicknesses [15].

To facilitate catharsis of anger and hate I use the ‘batter’ (a stick), that allows to express anger with the body and bio-energetic movements, using also the voice to shout, to get out repressed aggression on the stage. The group helps as ‘doubles’, and very often the psychodrama gives way to become a sociodrama, and the whole group is acting on the scene. The relief to experience that the others have similar feelings helps to overcome shame, and of course the collective working through of traumatic events strengthens the relationships and the confidence among the participants. This is especially important and productive in training groups as we are realizing it in the Gaza Community Mental Health Programm (GCMHP), also in El Salvador, in Cuba and Mexico, within an institutional frame. The respect and understanding for each other grows, and also the relationships between men and women colleagues can become more ‘natural’. During the psychodrama process the protagonist changes role with other persons, and by that means experiences the identification with the other gender, the feminine or the masculine part in a new way. First this is a strange experience in cultures like the Palestinian, where the social roles for men and women are strictly separated. But soon the resistances can be overcome and the humor and creative acting allows the individuals and the group, to expand their self and to strengthen their identity.

This happened with a colleague in our group who was chosen in the role of an eight-year-old girl. Himself a man, he felt ashamed and said that it is impossible for him to play this role. But in order to help the protagonist he overcame his shyness and shame, and after a while, he felt very good in the role, discovering new creativity within himself.

In the ‘Sharing’ part, when every participant talks about his or her personal experience during the psychodrama, we work out cultural issues as well as individual history. This gives much material for social and cultural research, beside of the therapeutic and training aspects.

Body expression in the group work also is very important, focusing self-esteem problems, especially in women who have been traumatized by violation. To repair the traumatic event is impossible, violence and the war experiences leave terrible wounds in the self-image and in narcissistic feelings. But we can reach with our psychotherapeutic work, that the patient is enabled again to experience her or his body in a positive way, and also might regain desire of sexual pleasure. This is a victory over shame and silence, and means that the energy of life can win over the culture of death and impunity.

‘WE ALSO HAVE A DREAM IN GAZA’ [16], is written on a poster from the Human Rights Office. In fact, we put very much importance on the dream work, which is fascinating and at the same time most effective for therapeutic goals. Within every dream is hidden the desire to live, to have pleasure, to overcome terrible life situation. Dreams are a source of energy, and cultural and individual symbols give us the keys for creative working on it, which is most fascinating with the method of psychodrama [17]. Dream interpretation is like surrealistic theater, we have to find the hidden meanings and to understand the disguised messages, which the dreamer him or herself gives. It is the synthesis of art and science, and within the violent situation of being hold in a big prison, which Palestinian people are suffering in Gaza, imagination and fantasy as well as other artistic expression are most important, because they allow to go on living with free minds, which is the first condition for what we call ‘mental health’.

The occupation forces might use any force and violence in order to control the people, but meanwhile dreams are possible to dream and to share, and children can draw and write their story, there is the possibility of resistance and dignity.

Dreams want to become reality, and people want to be free! For this in our therapy work the patients express their wish to be a bird or a fish, to fly and to swim, to cross borders and to ignore the walls. This is a triumph over shame and a fight for dignity and freedom, and a very important instrument in our psychological work, in order to break the disaster of the siege, and to reach with the fight for justice also the possibility for mental health and happiness. Let’s go on building bridges for our dreams, so that they become reality, to create a social network for people to reach other people, from person to person, from men to women.

Personally we do it from Gaza to Switzerland, to Costa Rica, to Mexico, to Cuba, to El Salvador, to Bolivia and Uruguay; we’d like to build bridges of peace and friendship with the whole WORLD! [18].

Competing Interests

The author declare that there is no competing interests regarding the publication of this article.