War cannot be made psychologically safe

An article in American Psychologist describes how the US and Iraqi governments have responded to the mental health problems created by the invasion of Iraq. It was given as an address by the winner of the American Psychological Association Award for Distinguished Early Career Contributions to Psychology in the Public Interest. He has been involved in initiatives both to build a modern mental health care system for the Iraqi people and to improve mental health services for US veterans of the Iraq war.

Iraq has gone through a period of insecurity, violence, destruction, displacement of the population and increased reported deaths. Its problems have spanned generations, including the 1980-88 Iraq-Iran war, UN sanctions that followed Saddam Hussein's invasion of Kuwait, the 1991 Gulf War as well as the extreme insecurity following the March 2003 invasion. Maybe 10% of the population have fled the country. Furthermore, the day-to-day life for the majority of the population of Iraq has been associated with multiple deficiencies in the supply of basic necessities like electricity, water, sanitation, food, employment, and access to health services, beside the continuous threats of violence which cause stress for individuals and families.

Combat and other war-related violence increases rates of a variety of mental health problems, including anxiety (eg. post-traumatic stress disorder), depression, substance misuse and other symptoms not necessarily meeting formal diagnostic criteria. Respondents to a nationwide mental health survey in Iraq in 2006-2007 reported exposure to shootings and bombings, internal displacement, being a witness to killing and being accused of collaboration. Over 11% have seriously considered suicide in their life, and these are just the people identified as having a mental disorder. Men have a higher frequency of suicidal ideas compared to woman in all diagnostic categories, except substance use disorder.

The negative mental effects are not inevitable and some who have experienced such painful realities adjust well. Despite the colossal psychological damage wrought by the war, there is an enormous amount of resilience in Iraq.

Psychiatry cannot provide peace, employment opportunities, healthy food and potable water, supportive social and family networks, and the meaning of life for people. Even the best quality mental health services in Iraq cannot make everything right in the end.