The Psychotic Gentleman in Gaza

A Mind Under Siege

About a month ago, a Palestinian colleague living in London told me that his sister, still in Gaza, had both her eyes gouged out by a gentleman living beside her, during his first psychotic episode. My colleague was inconsolable, and I spent the rest of that conversation trying, and failing, to think of the right things to say to him. It was only when I finished work that I was able to recall what was, for me, the most disturbing detail.

The gentleman had no previous psychiatric history.

How I Got to Know Psychosis

Psychosis is a condition I once became quite familiar with, though never as intimately as the patients I was treating. My introduction to the psychiatric world began in an A&T unit, working closely with patients in the throes of psychosis. The patients themselves are etched into my memory. I can still recall their faces. I still say their names in my prayers. I grew unexpectedly fond of them.

A day in the unit was relentless. The three minute walk it took me to turn in and walk through the high security unit doors, was a three minute immersion into chaos. I usually got in around 7:30am, as the night shift was ending, and immediately some symphony of moans, mutters, and sporadic screams would blast through the corridors. There was shouting, hiding, threatening, crying, pleading, throwing, obscene sexual behaviour, but above all, there was fear, so much fear. Psychosis, I quickly came to realise, is a condition defined by terror. And the eyes truly are the windows to the soul when you study the face of a psychotic.

For a moment, consider a world where nothing your senses produce can be trusted. Where every fiction your mind produces is coloured by your worst fears. Where your faculties betray you, and you are left without a single measure of reality. The reality my patients perceived was real only in its capacity to terrify. Every familiar thing became strange until nothing could be trusted. A mind untethered.

One patient, for example, was utterly convinced without so much as a shadow of a doubt that she was dead or dying (Cotard’s syndrome). She had permanently bloodshot eyes and no eyebrows (thanks to her trichotillomania) and was so convincing in the physicality of her terror, that there were moments I believed her. Not for the facts, but for the felt reality of her mortality. Every morning she would re-experience her imminent death, the cessation of her pulse. Every morning, for no longer than fifteen minutes, she would bellow and cry out that she could feel her soul tearing itself from her body. Nurses would rush into her room to administer benzodiazepines. Then, silence. A catatonic silence. The rest of her day would be spent stood still, staring ceaselessly at her reflection in the narrow windows fitted into the ward doors. As if astonished by what was staring back at her.

I began to feel a real dissonance working there. I spent eight to twelve hours on some days amongst these petrified souls, and leaving felt disorienting. The world outside seemed dulled, monotonous, without a sense of humour. Normal human behaviour warped by comparison. Because, amidst all the fear and horror, psychosis allowed for moments of unfiltered absurdity. Patients could be unintentionally hilarious, their laughter and misperceptions would cut through the darkness in ways that were both outrageous and oddly human. In my time away from the ward, my mind was captive to the hours spent inside, endlessly replaying whatever I had witnessed. Every interaction with a patient felt deeply meaningful to me. In hindsight, I was, in many ways, obsessed with them.

Fear in the ‘other’ does something strange to us. It compels us to comfort, to counsel, to provide at least a facade of safety. I think we can be more uncomfortable with the fear of another than of our own sometimes. Think of a frightened child, the impulse to reassure is immediate. It does not require thought. Stay around the terrified long enough and the ‘facade of safety’ can begin to harden. You become a counsellor by definition, by identity. That is perhaps what happened to me. It’s been years and I still think of them. I still feel some duty of care to them and their peers: psychotics.

The case of the gentleman in Gaza has, therefore, stayed with me. All the more so because he has no prior psychiatric history; a detail that has haunted me a little.

Where Psychosis is Born

Like most matters of the psyche, the experience of psychosis can only be understood within the social and relational contexts in which it developed. From a psychoanalytic perspective, psychosis arises not simply because the brain chemically misfires, but because the self’s capacity to trust its own perceptual and emotional data breaks down. In infancy and early childhood, we develop our ability to interpret sensory information into an accurate perception of reality. However, this only takes place against a rigid backdrop of social instruction. This social instruction is informed by the most compelling voices in a child’s life: what caregivers tell us is safe, what is dangerous, what is good, what is bad, what is real, what is fake. Over time, if the conclusions of a child’s real-time environmental data processing consistently conflict with what its caregivers insist is ‘true’, a child may learn to abandon any attempt to independently perceive reality, setting the stage for a pretty cataclysmic fracture between experienced reality and trusted experience.

R.D Laing wrote about this process extensively in Sanity, Madness and the Family: Families of Schizophrenics. He details eleven case studies in which children, subjected to painful or abusive family dynamics, were made to forsake their own sensory perception for the convenient realities imposed by adults, leading later in life to psychosis an schizophrenia. Some of the contradictions are not as extreme as you might think. In one case, Laing details how, after many harsh, contemptuous explosive outbursts from a mother toward her daughter, the daughter seeks to resolve the tension by initiating a conversation. The attempt is immediately foreclosed. She is told, without discussion and without the possibility of dissent, that their relationship is wonderful, that she loves her mother very much, and that the two of them are the best of friends.

This places the daughter in an impossible position. Her lived experience, of hostility, contempt, disgust, and emotional injury, contradicts with the version of reality presented by the person who holds the greatest power in her world. If she trusts her own perception, she must accept that her mother is denying something plainly real; that her mother is wrong. But if she accepts her mother’s version of events, she must conclude that the evidence of her own senses cannot be trusted. For a child, whose survival, security, and very existence depends on maintaining attachment to this caregiver, the latter path is safer. To deny your ‘self’ is safer as a child than to deny the authority of your mother. The child learns to distrust her own immediate experience and instead defer to externally imposed definitions of reality. Over time this repeated invalidation erodes the coherence of the self.

Across the eleven case studies in the book, Laing found that whatever the child experienced in themself was interpreted, not as a real emotional response, but as a sign of illness; wherever they attempted to assert their own perspective, they were met with denial, coercion, or even hostility. In this relational context, abandoning one’s own sensory evidence in favour of an externally imposed ‘reality’ became not just understandable but necessary for survival within the family system. Psychosis, in other words, is rarely expected to appear without psychiatric history. It’s journey begins early in development. Which is why the case of the gentleman in Gaza is troubling: there was, it seems, no warning at all.

And yet, if we follow the logic of Laing’s observations, the absence of a personal psychiatric history does not necessarily mean the absence of the psychological conditions that produce breakdown. Laing’s case studies show that what fractures the mind is not simply biology or private neurosis but a sustained contradiction between lived experience and the reality that powerful others insist must be affirmed. The child sees one thing, feels another, and yet is told that neither perception nor feeling is real. Something structurally similar occurs in conditions of occupation and colonial domination, though on a vastly larger scale.

In The Settler Keeps Alive in the Native an Anger Which he Deprives of Outlet, I detail Fanon’s explanation for how colonialism produces, not only economic dispossession and political subjugation, but profound distortions in psychic life. The colonised subject, the gentleman for example, experiences humiliation, dehumanisation, loss, surveillance, violence, and restriction as daily facts of life. Anger, in such circumstances, is not pathological, it is the biologically coherent response to inflicted injury. It mobilises defence and signals that a boundary has been violated. It is healthy. But colonial powers, like the state of Israel today, do something unusual with this emotion. They provoke it repeatedly and then systematically block every legitimate means through which it might be expressed or resolved.

The result is a state of permanent psychological contradiction. Nowhere is this dynamic more visible today than in Gaza and for our gentleman. He is attacked and violated yet told that his anger is irrational. The authoritative voice insists that these experiences are either exaggerated, justified, or a symptom of his own disease. His attempts at resistance are criminalised and then used as proof of his supposed barbarity. The coloniser produces the stimulus for rage while monopolising all means of acting upon it. Anger is allowed to exist only as affect, never as force.

For many colonised subjects the conflict extends even deeper, into identity itself. When a society associates your cultural identity, language, and native features with backwardness or danger, it becomes a survival strategy and a necessity to disassociate & distance yourself from it (read Colonisation is as Much a Psychological Project as it is a Political One). The colonised individual may adopt masks, suppress parts of the self, or yield and internalise the dominant narrative in order to navigate a hostile world.

Therefore, the absence of psychiatric history in the case of the gentleman in Gaza becomes less inexplicable. It does not mean that nothing preceded the rupture. Rather, it may indicate that the forces shaping the psyche were not confined to the interior life of the individual but embedded in the structure of the environment itself. Laing showed how a family could destabilise a child’s perception of reality through contradiction and denial. Fanon demonstrated how an entire colonial system could do something similar to a population. When experience is repeatedly invalidated, when anger is justified yet forbidden, when defence is necessary yet impossible, the psyche eventually seeks another way to resolve the contradiction.

Sometimes that resolution takes the form of breakdown, of abandoning coherence altogether.

---

The Settler Keeps Alive in the Native an Anger Which he Deprives of Outlet

Colonisation is as Much a Psychological Project as it is a Political One

---

References

• Fanon, F. (1967). Black skin, white masks (C. L. Markmann, Trans.). Grove Press. (Original work published 1952)

• Fanon, F. (1963). The wretched of the earth (C. Farrington, Trans.). Grove Press. (Original work published 1961)

• Laing, R. D., & Esterson, A. (1964). Sanity, madness and the family: Families of schizophrenics. Tavistock Publications.

• Read, J., Bentall, R. P., & Fosse, R. (2009). Time to abandon the bio-bio-bio model of psychosis. Schizophrenia Bulletin, 35(3), 448–463.

• van Os, J., Kenis, G., & Rutten, B. P. (2010). The environment and schizophrenia. Nature, 468, 203–212.

---