“I couldn’t feel the right side of my body. I don’t know how I managed to call the Red Cross. Then I lost consciousness and ended up in the emergency room,” Sara* said, recounting the day she had her first panic attack.

Two weeks before, she had visited her parents in her home village, Nabatieh, in the country’s south. On April 13 and 14, Iran launched an unprecedented attack on Israel, which responded by pounding Lebanon.

“The strikes were getting closer and closer,” Sara said. “I was terrified. Since then, I’ve decided to travel less to the south. I already have too many layers of anxiety to deal with in Beirut, between the economic crisis, the daily violence and just merely being a woman.”

Cross-border exchanges of fire between Israel and Hezbollah erupted when Hezbollah launched a “support front” for Hamas after its Oct. 7 attack on Israel. This was the latest in a series of ordeals that have plagued Lebanon for five years now.

From the financial collapse and the pandemic to the explosion at the Beirut port, the Lebanese have not had a moment to catch their breath.

“This war is having an atrocious effect on the psychological well-being of the Lebanese,” said Elina Dirani, a psychiatrist at the NGO Embrace. “The uncertainty and fear it provokes come on top of the economic and political problems that have already made the population psychologically unstable.”

With more than 90,000 people displaced, entire villages destroyed and hundreds of civilians and combatants killed, the people of the south are on the front line of this new disaster.

Yet most of them are not letting on. Naama, 26, was forced to flee the southern border village Boustan with her family and has been living for several months in a school turned into a camp for displaced persons in Sour.

“We had 400 goats; only 100 survived the bombing or the phosphorus pollution. We have lost almost everything, but we must remain strong,” she said. “Our lives are in God’s hands.”

Beside her, Rawane, 18, whose house in Aita al-Shaab was destroyed by an Israeli strike, is no less stoic. “If I let myself go, everything will go wrong. I don’t want to admit defeat,” she said.

Resisting until the last breath

“Stay strong.” This was what Sara’s father used to tell her during the bombardments of the 2006 war between Israel and Hezbollah. “Why are you afraid? We have to face up to it and resist.”

She was 9 years old at the time.

“I’m torn between understanding that it’s politically important to be tenacious in the face of the enemy and being angry that I didn’t have the space to express my feelings,” she said, with the hindsight offered by several years of psychotherapy.

“People who manage to give meaning to their pain, whether ideological, religious or cultural, are to some extent protected from potential post-traumatic stress disorder,” said Dirani. “Otherwise, the amount of suffering would be atrocious.”

The cause of resistance, combined with a deep-rooted faith, enables most southern inhabitants to endure.

“We have faith. It helps us stay calm, even when we’ve lost everything,” said Hassan Charafeddine from his new living room in the southern suburbs of Beirut, after fleeing his home in Taybeh along the southern border.

Until the shell cracks

“One of my patients from the south recently asked me, ‘Is it normal to be afraid? We’re part of a cause, we’re not supposed to be afraid,’” said Dania Dandashli, a psychoanalyst based in Ras Beirut. “Under the surface of resistance, there is pain.”

Sometimes all it takes is a little scratching to reveal it.

In a faded classroom in Sour, 15 women sat in a circle on school chairs. They come from Aitaroun, Yaroun and Aita al-Shaab.

Opposite them, Hoda Hassouna, a psychotherapist from the Lebanese NGO Amel, which provides care for displaced persons in two schools, offered them a chance to talk and do exercises to curb the depression that threatens them all.

“You might get to the point where you tell yourself that your life has no meaning,” Hassouna told the gathered women. “So when you wake up, you must love yourself, tell yourself you’re beautiful and set goals. Achieving them will release serotonin, which will make you feel good.”

A woman spoke up, almost shyly: “Sometimes you want to love yourself, but you can’t.”

Next to her, a slender woman dressed in black admits to hitting her five children since her husband died; another smoked heavily and said she had no taste for anything. A third confessed to only dreaming of returning to a past that no longer exists.

All have been affected, but not to the same degree.

“Some are showing signs of suicidal thoughts, and we’re going to start individual sessions with them,” said Hassouna.

The post-traumatic reaction varies in intensity and duration, and it can also be influenced by genetic predisposition or the social environment of the affected person.

Individuals may suffer from post-traumatic stress disorder (PTSD), depression, anxiety disorders or substance addiction.

“Finally, there is the healthy post-traumatic reaction where, after a period of stress and anxiety, the situation returns to normal,” said Dirani.

The shock of war was compounded by the trauma of displacement.

“Our two psychotherapists have been conducting around 160 consultations a month since Oct. 7, up from about 90 before, showing the high demand among displaced persons,” said Rana Mazraani, head of mental health at the Amel Health Center in Sour.

Many consultations focus on managing anger, stress and anxiety.

“But there are also marital disputes and irritability that can lead to violence against children because the loss of stability causes great psychological distress among the displaced,” she added.

‘Almost all my relatives have mental issues’

In Beirut, beneath a facade of stability that deceives no one, the collective psyche has plummeted in recent months, mirroring the collapse of the local currency.

“Almost all my relatives have mental health issues and are on medication,” said Mark Salim, sitting at a café terrace in the Badaro district. “There are people with bipolar disorder, borderline personality disorder, depression, anxiety … and I can identify with all of them.”

A strike six months ago, just a stone’s throw away in the southern suburbs of Beirut, deeply affected the 27-year-old’s mental health.

“When Israel assassinated [Hamas’ top official in Beirut] Saleh al-Arouri at the beginning of January, I thought, ‘This is it; the war that was in the south is going to spread to Beirut,” he said. “I’m going to lose my mother. The house is going to be destroyed. I had nightmares full of violence. Then, suddenly, at two in the morning, I woke up with the urge to kill my mother,” he recounted rapidly. This overwhelming urge persisted for three days.

“Having studied psychology, I realized that I had obsessive-compulsive disorder (OCD) with an impulse phobia. A psychiatrist prescribed Anafranil, which treats OCD, as well as depression and anxiety,” Salim added.

Being away from the front line in the south does not protect one from the psychological effects of the conflict.

For Sara, leaving the south has, on the contrary, brought out previously repressed troubles.

“My shrink talks about ‘fight or flight.’ In the south, I was always in ‘fight’ mode, leaving no room for fear, sadness or tears. But the traumas were piling up,” she said. “In Beirut, when I allowed my body to rest, everything suddenly came back, and the panic attacks started.”

For eight months, the Lebanese have been drowning in the deep waters of unpredictability. This has led to bouts of anxiety, which everyone deals with in their own way.

“Some tend to dramatize, fearing that every spike in violence is the prelude to a full-scale war. Others go into mania, partying all night, which can be a way of expressing their attachment to life in the face of ongoing genocide,” said Dandashli. “From a distance, Lebanon resembles a bipolar society.”

Holding up and not healing

This unpredictability makes any in-depth treatment difficult.

“In addition to medication, I’m undergoing cognitive behavioral therapy (CBT) rather than psychoanalysis, which requires a level of stability that I’m far from having achieved,” Salim said.

He added that one barrier to addressing mental health issues is financial, having attended weekly sessions at $70 an hour, “the equivalent of a salary.”

Seeing a psychiatrist is also very expensive in times of crisis, so some people resort to self-medication to cope with their nervous breakdowns.

“People who are ashamed to seek help because of the persistent taboos surrounding mental health or because they can’t afford it, go to the chemist and buy Cipralex, Xanax or Lexotanil without a prescription. But these antidepressants and anxiolytics have terrifying side effects,” he warned.

Dirani said she was not aware of any studies confirming a recent increase in the use of these antidepressants but points out that NGOs such as Embrace offer free or low-cost consultations.

Although there are no studies on the impact of the current war on mental health, a pioneering report conducted by psychologists from Idraac (Institute for Development Research and Applied Care) between 2002 and 2003 on 2,857 adults, titled “Lebanon” (Lebanese Evaluation of the Burden of Ailments and Needs of the Nation), confirmed the link between war and mental disorders in Lebanon.

According to the report, 25.8 percent of those surveyed said they were living with at least one psychological disorder: 16.7 percent suffered from anxiety, 12.6 percent from mood disorders, 4.4 percent from impulse control problems and 2.2 percent from substance use disorders.

According to the report, witnessing death or injury during wartime increases the likelihood of developing a mood disorder. Being a civilian in an area of terror increases the likelihood of developing anxiety disorders.

For the Lebanese, the current war does not represent a psychological rupture.

“Oct. 7 was not a transition from a perfect life to war; we were already living in crisis,” said Sara.

As therapy sessions progress, Dandashli's patients seem to get used to this new grim norm.

“At first, the genocide in Gaza was very present in my sessions; everyone was talking about it, much like after the explosion at the port. But gradually, that diminished,” she said, viewing it as a symptom of the Lebanese adaptability to successive crises.

This adaptability comes with risks.

“We’re certainly resilient, but we’re tired. All these ordeals leave their mark,” she warned.

It is left to the Lebanese to deal with these crises, as the response of their leaders often only adds to their anxiety.

“After each new disaster, I always ask myself: ‘Is this normal?’” said scriptwriter Khaled Soubeih in a café in Hamra.

“Is This Normal?” is actually the title of the play he has written, starring Talal al-Jurdi and Ziad Itani, set in the office of a psychiatrist who is losing his mind over the absurdities of everyday life in Lebanon.

“I remember, for example, that after the forest fires in 2021, the first reaction of a politician was to ask why the trees were only burning in Christian areas. It’s crazy!” Soubeih said.

“For years, I wondered if I was the problem,” recalled Sara. “Then I realized that this system creates crises and never solves them. As a result, it’s my mental health that’s paying the price, and I must continue to see a therapist if I want to keep living here.”