Living Amid Bombings in Iran: How Fear Impacts Mental Health

TEMPO.CO, Jakarta - Iranians are living in a war zone. Attacks by Israel and the US are not only targeting Tehran, but many places across the country. Shortly before the war began, people took to the streets to demonstrate against the theocratic regime. The Islamic Republic cracked down brutally on its citizens, whose protests for freedom and democracy cost thousands of them their lives.

Iranians continue to live within the constraints imposed by a government that tolerates little deviation from its interpretation of Islam. It dictates what clothing women are allowed to wear in public, and the slightest deviations can be severely punished. In addition, the sanctions against Iran make the economic situation difficult for many people in the country.

What effect does such constant stress have on a person’s mental health?

Being on High Alert Increases Risk of Mental Illness

"The incidence of mental health conditions—particularly post-traumatic stress disorder, anxiety disorders, and depression—is higher among people who are chronically exposed to violence," says psychologist Dana Churbaji, who researches the effects of war and displacement on mental health at Germany's University of Münster.

When it comes to affected individuals, "a shift in perception can be observed regarding how safe the world is and how people view their own lives."

Someone suffering from cold, fear, or hunger has a much lower stress tolerance, and minor conflicts and disagreements in personal lives can escalate quickly. For those living with existential uncertainties—such as power outages, food shortages, or the loss of digital communication—basic needs come to the forefront, according to Churbaji.

"When these basic needs aren't met, there are more frequent outbreaks of violence within the family," the psychologist told DW. "This takes a toll on social relationships which are actually the number one factor in resilience."

In other words, those with stable social connections, who have people to confide in, have a lower risk of developing post-traumatic stress disorder (PTSD). If this protective factor is absent, the risk of developing the condition increases.

When Does Post-Traumatic Stress Disorder (PTSD) Develop?

In an acute stressful situation, many people do not have PTSD symptoms because their brains are in survival mode. When they have to flee their homeland to bring themselves and their loved ones to safety, they focus on the immediate emergency. PTSD usually only develops afterward, explained Churbaji.

"When the brain tries to come to terms with the past, PTSD symptoms appear. And these symptoms stand in the way of a person’s efforts to rebuild their well-being after a refugee experience," she said.

What Are the Symptoms of PTSD?

People with post-traumatic stress disorder often have the following behaviors and symptoms:

•     Avoiding thinking about the experience

•     Extreme reactions to certain triggers (e.g., hiding under a table when fireworks go off)

•     Flashbacks: For those affected, memories feel as if the traumatic experiences are happening all over again. These are also referred to as intrusive memories that cannot be resisted

•     A change in mindset, leaning toward distrust and cynicism

•     Intense feelings of guilt, so-called "survivor's guilt"

•     Sleep disturbances and difficulty concentrating

In an environment where those affected cannot talk openly about mental health issues, psychological stress also manifests physically, says Churbaji, in the form of headaches, backaches, menstrual cramps, or fatigue.

The Impact of Ongoing Stress in Iran 

It also makes a difference whether one has experienced a single traumatic event, such as an assault, or has been living with war and violence for a long time. "The political persecution [of dissidents] in Iran has been going on for a very long time. Protests against the regime are repeatedly and violently suppressed," clinical psychologist Rita Rosner told DW. "Iranians are directly affected by this long-lasting traumatic situation."

This ongoing fight-or-flight state can be a greater source of stress than experiencing a one-time traumatic experience, such as a serious car accident. "One-time events have a lower probability of stress reactions developing," says the professor at the Catholic University of Eichstätt-Ingolstadt. "With every [traumatic] event that adds to the mix, anxiety, depression, and post-traumatic stress disorder become more likely."

Churbaji also notes that a cluster of traumatic experiences—such as those experienced by people living in a war zone—is dangerous, "especially when multiple areas of life are affected." Someone who, in addition to bombings and political repression, also experiences domestic violence and sexual harassment at work is, for example, particularly vulnerable to PTSD.

What Helps People Who Have Experienced Trauma?

Conditions such as PTSD can be treated with psychosocial support. This includes group or individual therapy with mental health professionals. But the social environment can play a supportive role too. Churbaji said that local doctors, teachers, and religious leaders are being trained to support their patients and those in their care as they cope with trauma. 

When in-person help isn’t available—for safety reasons, or if there aren’t enough specialists on site—there are also online resources available. Rosner points, for example, to the World Health Organization (WHO). Under the title "Problem Management Plus," the WHO provides a document in 23 languages designed to help people cope with stressful situations.

These steps may alleviate symptoms but none of these methods can erase the traumatic experiences of war from memory.

"You can’t assume that what happened can be undone," says Churbaji. "But the majority of people can lead fulfilling lives again."

Read: UN: 4.1 Million People Now Refugees in Four Middle Eastern Countries

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