Clinical Conflict I: The Pain of the Fee
Sliding-scale psychoanalysis in genocide
The public health service where I live in Norway provides psychological support as part of a universal welfare system that provides a minimum benchmark of care. Universal health care in social democracies takes liberal principles of justice as its premise. It blunts the edge of capitalist individuation through a notion of solidarity that safeguards the desire for capitalist exclusivism and distinction for the few. It is an idea of justice that defines solidarity through the choice to remain ignorant of how the system produces sick citizens. If a patient falls outside the standardized assessment model of what constitutes mental illness, measured in relation to the level of dysfunctionality in the labor relation, then the individual is turned away. This is why for those who can afford it, private care is the preferred mode of addressing psychological despair. I performed the symptoms of mental illness the system recognized, and moved between three unsatisfactory rounds of therapy with three different therapists, including spending a year working with a psychologist who turned out to carry racist ideas about the culture and society I hail from. As the Eastern Mediterranean became progressively more catastrophic, some years before October 7, I was at the ends of my wits. I sought therapy again. Despite my strained resources, which were becoming more and more strained and precarious as wars against my people simmered and raged, I chose a private practitioner.
I finished trauma therapy a few months before the genocide began in Gaza. My therapist had helped me process a lifetime of living in a war zone, with a history of colonial violence and civil war that goes back seven generations. We worked for three years together, and by the time I chose to discontinue our sessions, I had arrived at a place of acceptance of the impossibility of healing, and an understanding of the difficulties facing people in my interpersonal circles who, like me, are struggling to live with their traumas and the effects of systemic brutalizations on their lives. I returned to therapy a few months into the genocide. On this round, my therapist was concerned about the political economy of this crisis. My therapist asked me to accept a reduced fee for their sessions with me; some time later they removed the fee altogether. The graciousness of the offer was an act of solidarity that computed how money and the economy of catastrophe is overwhelming. They could see how this crisis would strain my finances and they could see that I did need their support as I went about my life. As a diaspora Arab, I was already living a schizophrenic reality, where the war raging back home was mostly transformed into a private crisis, not touching most of society, despite the activist work in the city where I live, and despite a general feeling that I live in a country where a good mass of people supports the Palestinian cause. This schizophrenic reality meant that my social presentation had to uphold a semblance of Norwegian peacefulness, if I am to find a way to go on making a living here. At first, I was embarrassed by the gesture, for I did not want anyone to think I am not financially capable. There is much shame in poverty, and much weakness, and our times are not merciful to the weak. I was resentful that I had to accept the offer, for indeed, they read my predicament correctly when they assumed that there is more strain on my finances because of the war, and the global inflation that it generated for all of us.
“Therapy now served the task of providing me with mastery over desperation so as to protect my community and myself from bouts of rage and loneliness so I can continue to work as an organizer and writer committed to Palestine and liberation.”
A strained financial situation is also a root cause for much of the psychological duress that brings those of us who can still afford it into therapy. Like other modes of brutalization in the system, the scramble to make ends meet generates anxiety, panic, paranoia, depression, narcissism, and many other strains of psychological dysfunction. From the very beginning of our relationship, my therapist had a sense of that. They kept a magic wand in their office and often waved it at me to make a point on how therapy cannot lift the causes of my pain. They did not believe in healing, and sought instead to connect my turbulent emotions to the world outside the clinic. In their office, I learned to untangle the internalized violence of the system from my subjective desire, and understood how shame connects to poverty, as well as how anxiety is a natural response to a precarious labor situation, how my frustration with more powerful colleagues is generated by a system of exclusion and intense competition. In those instances, I have learned to accept my “bad” emotions, and to see beyond them to their root cause in modes of brutalization. From the outset, my therapist and I discussed how this new round was not supposed to equip me with new tools to deal with the catastrophic onslaught on Palestinians, but rather therapy now was supposed to provide me with a regulated space to access my grief and diffuse the anger and frustration that erupts between friends, comrades, and family during calamitous times. Therapy now served the task of providing me with mastery over desperation so as to protect my community and myself from bouts of rage and loneliness so I can continue to work as an organizer and writer committed to Palestine and liberation.
I took the second session of therapy post–Operation Al-Aqsa Flood on Zoom in Cairo. I had traveled there in haste in order to retrieve my family from Gaza. I traveled with wads of cash there. Cash for twenty family members, that was donated by people we know and people we don’t know. Solidarity with our family was immense. The sheer number of donors deflected feelings of resentment that come up when money is exchanged between people. Now I could assign it to where in reality it ought to be channeled, against the structures of exploitation in Egypt and Israel that made the cost of survival for Gazans so high that less than 10% of Gazans managed to escape the killing fields, since the beginning of the genocide, and only a half dozen thousands have since found a sustainable resolution to their plight. There was no solidarity anywhere around the Palestinians stranded in Gaza, besides a few personal initiatives connected to the diaspora that take care of a few families here and there, through cash donations. I have become bewildered by money arriving in such stacks into my life for the purpose of saving lives. We were being extorted for our families. As late fascism becomes the political appendage to tech capital, the structural forms of solidarity that offered some relief in the liberal era are increasingly being dismantled, through new laws and the withdrawal of funding that curtail how people can show up for one another. Informal networks of solidarity exist but are of such low murmur.
These last months in therapy have sometimes been awkward. My need to grieve has to come to terms with how meaningless words have become. There is no point to repeat to my therapist what I witness everyday, for they witness alongside me. The issue of money also complicated our conversations initially, as my resentment for accepting charity had to battle with the solid trust I had with my therapist. Also, now that I no longer pay for therapy, they also became more talkative. We witnessed now together, and we felt desperate together. The relationship has gone into a new phase that is more dialogical, but what of it? I also had to reconsider my own issues with money. We have not yet talked about money with one another, but I have been thinking about my old patterning in my relationship to money. Through this modest gesture of solidarity, and my trusting of their wisdom, I had to battle with automatic reactions of shame and competition, emotions that are embroiled in how money features in my life. By accepting to stop paying for my therapy, I had to make room for another relationship with money that accepts a more collective approach to resources. My therapist modeled this approach at an interpersonal level, but it got me to think about how many of us ought to be seriously reconsidering how we use money, if we truly believe that our survival in apocalyptic times is indeed collective and not individual.