Is silence about trauma harmful for children? Transgenerational communication in Palestinian families

Abstract

Style of family communication is considered important in the transgenerational transmission of trauma. This study had three aims: first, to identify the contents of family communication about past national trauma; second, to examine how parents’ current war trauma is associated with transgenerational communication; and third, to analyze the associations between transgenerational communication and children’s mental health, measured as posttraumatic stress disorder (PTSD), depression and psychological distress. The study sample consisted of 170 Palestinian families in Gaza Strip, in which both mothers (n = 170) and fathers (n = 170) participated, each with their 11–13-year-old child. Mothers and fathers responded separately to three questions: 1) what did their own parents tell them about the War of 1948, Nakba?; 2) what did they tell their own children about the Nakba?; and 3) What did they tell their own children about the 1967 Arab–Israeli War and military occupation? Current war trauma, as reported separately by mothers, fathers and their children, refers to the Gaza War 2008/09. Children reported their symptoms of PTSD, depression, and psychological distress. Results revealed seven communication content categories and one category indicating maintaining silence about the traumas. Fathers’ high exposure to current war trauma was associated with a higher level of communicating facts, reasons, and meanings regarding the1948 and 1967 wars, and mothers’ high exposure to current war trauma was associated with a lower level of maintaining silence. Family communication about facts, reasons, and meanings was significantly associated with children not showing PTSD and marginally with not showing psychological distress, while maintaining silence was not associated with children’s mental health.

Keywords

child mental health family communication Palestinians transgenerational trauma war

Introduction

How does trauma travel across generations? Can parents’ past traumatic experiences still affect their children’s mental health, and if so, why? These are the traditional questions asked by researchers studying the transgenerational transmission of trauma. The phenomenon refers to a process in which the trauma history of parents is currently negatively affecting their children by interfering with their optimal social-emotional development and mental health (Danieli, 1998; Kellerman, 2001). Research has suggested several family-related factors and processes through which parental trauma may influence children’s well-being. These include the severity of parental trauma and its psychological consequences (Bezo & Maggi, 2015; Lambert, Holzer, & Hasbun, 2014; Scharf, 2007; Yehuda, Halligan, & Bierer, 2001), disruptions in attachment representations (Blankers, 2013), parental explosive anger and harsh parenting (Rees, Thorpe, Tol, Fonseca, & Silove, 2015), together with dysfunctional family communication (Lichtman, 1984; Wiseman, Metzl, & Barber, 2006). In contemporary wars many families have experienced war trauma across multiple generations and they continue to live in life-endangering conditions. In the Middle East, for example, Kurdish, Yesidi, Assyrian, Israeli, and Palestinian families share this fate. It is therefore important to learn more about the factors and processes in families where members share both past and current traumatic war experiences. Our study contributes to this by exploring the content of transgenerational communication regarding past war events in Palestinian families and by analyzing impacts of the communication on children’s mental health.

The transgenerational transmission of trauma has been studied among survivors of the Holocaust and other genocides and survivors of national and ethnic oppression and persecution, as well as among torture survivors and war veterans. A large-scale meta-analysis of 32 studies found no evidence for a negative influence of parents’ traumatic Holocaust experiences on their children’s mental health, as indicated by posttraumatic stress disorder (PTSD) or depression, in community and other non-clinical samples. By contrast, parental past trauma has been found to be positively associated with mental health problems among children in clinical settings (van Ijzendoorn, Bakermans-Kranenburg, & Sagi-Schwartz, 2003). However, Yehuda, Bell, Bierer, & Schmeidler (2008) found that when Holocaust survivor parents suffered PTSD, their adult children were at high risk for psychiatric symptoms and psychophysiological dysfunction. Furthermore, children of traumatized parents may be more vulnerable to PTSD and depression when they meet hardships in their own lives, as has been shown in Israeli studies of cancer patients (Baider et al., 2000 ) and combat-exposed soldiers (Solomon, Kotler, & Mikulincer, 1988).

Only a few studies have been reported on the transgenerational transmission of trauma among torture survivors. A study of refugee families in Sweden confirmed that children whose fathers had been exposed to torture in their native countries, had higher levels of PTSD, anxiety and depression symptoms, and more attention deficits and conduct disorders than children of non-tortured refugee parents (Daud, Skoglund, & Rydelius, 2005). Similarly, a study of Middle-Eastern families seeking asylum in Denmark found that high levels of parents’ past torture experience were associated with heightened levels of children’s anxiety and sleep disturbances (Montgomery, 1998; Montgomery & Foldspang, 2001). With regard to war veterans, Davidson and Mellor (2001) studied the impact of fathers’ PTSD from the Vietnam war on their adolescent offspring’s mental health and on family functioning. Their results showed no impact on offspring’s PTSD or self-esteem, but paternal PTSD was associated with more dysfunctional and problematic family relationships.

Studies of survivors of collective and ethnic trauma have revealed severe negative impacts on offspring, but they have also found various protective factors mitigating such harm. A Canadian study reported that First Nations adults whose parents were forced to attend ‘Indian' residential schools reported higher levels of depression than those whose parents did not experience this trauma (Bombay, Matheson, & Anisman, 2011). The association between parental trauma and offspring depression was mediated by the offspring’s own severe childhood and adult traumatic experiences and a high level of perceived discrimination. The authors suggest that the transgenerational transmission of trauma may make the offspring more vulnerable when exposed to traumatic events in their own lives and more sensitive to the negative consequences of both earlier and current traumas. In a qualitative study of the children and grandchildren of survivors of the Holodomor genocide in Ukraine, Bezo and Maggi (2015) concluded that trauma was transmitted by negative emotions, unrecognized inner states, and dysfunctional coping strategies, shared by both parents and children. A study of adult children of Japanese-American former wartime prison-camp internees in the US found that negative ethnic attitudes and parents’ internment-related distress and discomfort contributed to problematic family relations, while awareness of personal rights and responsibilities was beneficial (Nagata & Cheng, 2003). Finally, counter to the generally negative tone of transgenerational trauma research, Denham (2008) suggested that the generational trauma impacts should rather be conceptualized as resilience transmission. Her ethnographic study of a Native American family across four generations revealed growth and resilience to be possible when family narratives are framed in empowering ways, aiming at integrating ethnic and individual identities.

Clinical observations and psychodynamic literature suggest a ‘conspiracy of silence' to be a central risk factor for mental health problems and problematic human relations in Holocaust and other survivor families (Ancharoff, Munroe, & Fisher, 1998; Danieli, 1998; Nagata & Cheng, 2003; Scharf, 2007; Sorscher & Cohen, 1997). Accordingly, trauma is passed on across generations through the interplay between the parents’ unconsciously displaced emotions and the child’s unconscious mind (Katz, 2003; Rowland-Klein & Dunlop, 1998). Subsequently, children adopt the roles of victims, healers, or saviors, which burden their family relationships and development. Due to the unconscious nature of the transmission, silence and denial characterize the family communication, as each member protects both her/himself and others from the painful knowledge and awareness of trauma (Ancharoff et al., 1998; Kellerman, 2001).

The concept of the conspiracy of silence has been highly influential in research on the transgenerational transmission of parental past trauma. Strategies of maintaining silence are believed to constitute a risk factor, whereas parental disclosure and open family communication regarding past collective and familial trauma are believed to be associated with the positive mental well-being of children (Danieli, 1998). However, research findings are not unequivocal regarding the effects of parental silence versus disclosure about past traumatic experiences on their children. As examples of studies providing evidence of the harmfulness of silence, an interview study (Braga, Mello, Marcelo, & Fiks, 2012) and a questionnaire study (Lichtman, 1984) both identified multiple communication content characteristics and patterns among adult offspring of Holocaust survivors settled in Brazil and Israel. These include: parents’ frequent and willing disclosure of past traumas involving both their own emotional experiences and factual information as a part of everyday communication; indirect communication, such as guilt-inducing messages and non-verbal conveyance of fragments of past trauma in everyday life; and secrets, silence, and a lack of narratives about the family trauma. Both studies confirmed that indirect, non-verbal, and fragmented parental communication formed a risk for children’s mental health. Specifically, Lichtman (1984) showed significant associations between these dysfunctional communication patterns and depressive, anxious, and somatic symptoms in offspring in a sample of Holocaust survivor families.

Yet, some research findings contradict the negative view of non-disclosure of parental trauma. A study of Middle-Eastern refugee families in Denmark showed that parents’ communicating about imprisonment and torture was associated with high anxiety in their children (Montgomery, 1998). Similarly, a study among Bosnian refugee families settled in Sweden found that parents’ intensive communication about family’s past traumatic war experiences was associated with children’s mental health problems (Angel, Hjern, & Ingleby, 2001). Children’s own high levels of war-related stress further exacerbated the negative impact of intensive parental communication. These findings suggest that communication strategies of not telling about traumas may also protect children, perhaps especially when children themselves are also exposed to traumatic events of war.

A systematic literature review by Dalgaard and Montgomery (2015) further specified that the way in which parents communicate about their past traumatic experiences to children seems to matter more than open disclosure or silence per se. The right timing and developmental aptness of parents’ communication about the trauma was found to contribute to children’s positive psychological adjustment, indicated, for instance, by a lack of anxiety and depressive symptoms. The term ‘modulated disclosure' characterizes a parental style of communication that is sensitive to the child’s psychological readiness, cognitive capacity, and emotional needs. In this case, parents adapt the style, content, and timing of disclosure, according to their children’s particular developmental stage, personality, and family situation.

Research confirms that modulated disclosure is associated with children’s good psychosocial adjustment, mental health, and development. Measham and Rousseau (2010) studied African refugee families and found a positive association between parental modulated disclosure and children’s creative play. In a qualitative study of three refugee families from the Middle East, Montgomery (2004) found a complex association between parental communication and children’s psychosocial adjustment. The concepts of ‘stories lived' and ‘stories told' illustrated the ways in which parents talk with their children about their traumatic past, the former referring to their own and family members’ real experiences of torture and organized violence, and the latter referring to the ways that they made sense of these events. When the stories told were in contradiction to the stories lived, children experienced ambiguity and uncertainty. Also, when stories were fragmented and contradictory, they were likely to lead to feelings of confusion and powerlessness among children and to paralysis in family relations. By contrast, when parental stories provided reasons, meanings, and comprehensive narratives for making sense of the family’s traumatic history, the communication strengthened family relationships. Telling the family history in a coherent, informative and logical manner contributed positively to good family relations and children’s well-being. Although research thus suggested that a modulated approach should be recommended, little empirical evidence is available about the specific contents of what parents tell their children regarding the family’s traumatic history and how these contents are associated with children’s mental health. Our study sought to address this issue.

The participants in the present study are Palestinian families from the Gaza Strip. Palestinians have a history of past national trauma of war and deportation and families in the occupied Gaza also currently live in conditions of war and military siege. In 1948, Palestinians lost their homeland when the state of Israel was created, which Palestinians refer to as the Nakba catastrophe. In the 1967 Arab–Israeli War, Palestinians living in the West Bank and the Gaza Strip fell under Israeli military occupation, resulting in a second national trauma. Two national uprisings against the foreign military occupation, the First Intifada (1986–1993) and the Al Aqsa Intifada (2000–2004) were harshly suppressed. Palestinian history, literature, and art all provide rich accounts of these national catastrophes and traumas (Suleiman & Muhavi, 2006), but scientific research is scarce regarding what Palestinians communicate about these events to the next generation.

The parents and children participated in this study in the aftermath of the Gaza War 2008/09 (which the Israel military refers to as ‘the Operation Cast Lead' and Palestinians refer to as ‘the Al Furgan battle'). The 23-day war on Gaza resulted in 1,440 Palestinian deaths, 5,380 injuries, and the destruction of 11,000–15,000 houses (UN, 2009). Approximately 100,000 people fled from their homes, seeking refuge in the besieged Gaza Strip (UNRWA, 2009). The unit of analysis in our study is the family with triads comprising a mother, a father and one 10–13-year old child. Both parents reported about their family communication of the major Palestinian national traumas of 1948 and 1967 wars, and the children reported their mental health problems. All three family members also reported their personal exposure to the events during the Gaza War 2008/09.

Specifically, the present study focused on the thematic contents of what parents (the second generation) were told by their own parents (the first generation) and what they tell their own children (the third generation) about past traumatic experiences. It also examined whether the association between the thematic contents and maintaining silence versus disclosing, is associated with children’s mental health.

The first research task was to identify the thematic contents of transgenerational communication about two past Palestinian national traumas, the War of 1948, Nakba and the 1967 Arab–Israeli War, marking the beginning of the military occupation. A qualitative method was applied to categorize emerging themes and categories of parental communication contents, and quantitative analyses were used to examine the frequencies of these content categories and to detect underlying dimensions of transgenerational communication. The study also examined whether the contents of communication differed between what the mothers and fathers (second generation) were told by their own parents (first generation) and what they themselves tell to their children (third generation) about the national traumas. The second research task was to analyze how current maternal and paternal war traumas (Gaza War 2008/09) and family demographic characteristics are associated with the contents of transgenerational communication. Based on literature reporting on parental trauma causing deterioration of family relations, including communication (Davidson & Mellor, 2001; Kellerman, 2001), we hypothesized that a more severe parental trauma exposure would be associated with more negative communication content. The third research task was to examine how the transgenerational communication content is associated with children’s mental health, as indicated by the occurrence of PTSD, depression, and psychological distress. Based on literature on family communication (Lichtman, 1984; Montgomery, 2004), we hypothesized that negative communication content of the past national trauma would be associated with children suffering from PTSD, depression and psychological distress at clinically significant levels. As research hitherto has been inconclusive, we did not propose hypotheses concerning parental silence versus disclosure in relation to children’s mental health.

Method

Participants and procedure

The study sample consists of 170 Palestinian families living in the Gaza Strip. Both mothers (n = 170) and fathers (n = 170), and one of their children (n = 170) participated. The 170 children were 10–13 years old (M = 11.2, SD = 0.8), and 50.6% (n = 86) were boys and 49.4% (n = 84) were girls. Parental age ranged between 25 and 56 years for mothers (M = 37.4, SD = 7.4) and between 28 and 65 years for fathers (M = 42.1, SD = 7.2).

The family sample is a sub-sample of a larger randomized intervention study that examined the effectiveness of the Teaching Recovery Techniques (TRT; Smith, Dyregrov, Yule, Gupta, Perrin, & Gjestad, 1999) program in alleviating children’s mental health problems in the aftermath of the Gaza War 2008/09 (Qouta, Palosaari, Diab, & Punamäki, 2012). The current sample derives from the intervention group of 242 children, and comprises families where both mother and father responded to the three open-ended questions concerning transgenerational communication of past Palestinian traumas (N = 170, i.e., 70.2% of the 242 families). The children’s data are the baseline measurements before participating in the TRT in May 2009 and the parents’ data were collected the following week.

The subgroup of 170 did not differ from the remainder of the original sample (n = 72) in terms of fathers’ or mothers’ education (respectively χ²(3) = 1.93, p = ns. and χ²(3) = 2.15, p = ns), place of residence (χ²(1) = 1.78, p = ns), children’s age (χ² (3) = 1.38, p = ns) or children’s gender (χ² (1) = 0.99, p = ns.).

The original sampling of the children involved four phases. First, two regions from the Gaza Strip were selected that were severely bombed during the Gaza War 2008/09, these being the North Gaza and Gaza City. Second, participating schools were selected using a simple random sampling algorithm (eight schools from 160 potential schools located in the two areas), but taking into consideration that girls and boys have separate schools. Third, in the eight schools, one of the sixth- and one of the seventh-grade classes were randomly chosen, resulting in 16 classes. Finally, from the total of 16 school classes, every second class was randomly selected and placed either in the intervention or control groups (n = 242 and n = 240). In the control group, the data were not available concerning the transgenerational communication questions and the present study therefore concerns only the intervention group, although intervention data are not included here.

The ethics boards of the Palestinian Ministry of Education and the Gaza Community Mental Health Program (GCMHP) reviewed and accepted the study protocol and measurements, and permission for the study was received from the school authorities. Information sheets were provided to children and their parents explaining the procedure of the study, but parents only gave verbal consent for their child to participate in the study and in the psychosocial intervention. Six research assistants collected the children’s data in the school classes. (The intervention was an extracurricular activity). The children took the parents’ questionnaires to them to be completed in their homes. The third author (SQ) supervised the data collection.

Measures

Content of parental communication

Mothers and fathers responded to three open-ended questions regarding communication about past Palestinian war traumas. The questions were based on earlier communication research in trauma-affected families (Danieli, 1998; Lichtman, 1984). The questions were as follows: 1) What did your parents tell you about the War of 1948, Nakba, and deportation of the Palestinians? 2) What did you tell your children about the War of 1948, Nakba, and deportation of the Palestinians? 3) What did you tell your children about the 1967 Arab–Israeli War and the beginning of the military occupation? Parents responded by writing their responses. There were no subsequent prompting questions to elicit more information or narratives. The responding parents thus represented the second generation who reported what the first generation (their parents) had told them about the War of 1948, Nakba, and what they themselves told the third generation (their own children) about the 1948 Nakba and 1967 Arab–Israeli War. The children themselves (the third generation) did not report about the transgenerational communication.

The categorization of mothers’ and fathers’ responses about their own parents’ communication and their communication to their own children followed the procedure of phenomenological content analysis, as outlined by Colaizzi (1978). This analysis was chosen since it is compatable with an interpretive approach and it provides practical procedural steps in data analysis. Table 1 shows how analyses proceeded in three stages. First, the second author (SD) read all the written responses repeatedly in order to familiarize himself with their general expressions, messages, and contents. He then randomly selected 30 examples (from every fifth family) of the parents' responses to each of the three questions and translated them into English. Second, he and the last author (RLP) then independently categorized these extracts, in all 90 parental responses, to identify themes based on the content and message of the sentences and expressions. These themes closely corresponded to the parental expressions, and the two coders attempted to to ensure that the names of the themes reflect the unique meanings of the responses. Third, the two coders compared and discussed their independently-defined themes, and agreed on the final set and names of the themes. Finally, they independently grouped the agreed themes into final communication content categories, after which they compared and negotiated their grouping choices.

Table 1.

Proceeding of the content analysis of parental communication with their children about the War of 1948, Nakba, and 1967 Arab–Israeli War: Data, themes, and communication content categories.

Data: parents’ responses	Themes	Communication content categories
I told my children about the immigration of the Palestinians in 1948 and about Deir Yasir and other massacres, the displacement of us. And why it led to hatred against the Israelis because of all of what happened to us. About the killing of people, shelling and bombing, destruction of homes, and imprisonment of people.	– Killing and wounding – Committed massacres – Imprisonment and detention – Hatred towards the military occupation	Violence and aggression
I told them how Israel took advantage of the Arabs who were only engaging in their pleasures and not in defending the country. How easy it was for Jews to occupy Gaza, West-Bank, Sinai, Golan and East-Jerusalem. My mother told me that the Jews forced thousands of Palestinians to leave. Some of them were killed and others left to the camps and others flee to Jordan and Egypt and now live there as refugees. My mother was five years when she left from Jaffa with all her neighbors in trucks and they only took a few things. *I told them why we were defeated, because we did not have arms and the enemies had many weapons. Also another reason was that the spies were singing of those who resisted.	– The political situation in the Middle East – Geography of the Israeli military occupation – Palestinian unpreparedness or strategic miscalculation	Facts and reasons of wars
The suffering of Palestine and its people and shortage of food and water and the death of children, elderly and women by the hands of the occupier. I explained about the liberation of Palestine. I told them about our humiliation, shame and pains that people suffer, and how the Arab countries saw it all and were silent. *My grandfather told me how much they were humiliated and suffering, how they had to wait in rows the food, bread and thyme, and how they were not allowed to see their families.	– Witnessing death of family members – Dispersion, homelessness and sadness – Being scared and helpless – The experience of inequity and oppression	Mental suffering and humiliation
*My mother told me of the criminal and horrible acts that the occupier did. The planes were shelling, nowhere was safe, people were escaping to the basements and tunnels until they felt safe. Many were martyred or injured. My mother was pregnant at that time and when she gave birth, she named the baby Jihad, after those who were fighting.	– People had lack of food and water – Parents and grandparents fleeing and seeking safety – Fearing for own and others’ lives	Physical suffering and life-threat
They told me that both our grandfathers were expelled from their houses and Jews took our lands and nothing was left. They told us how the Israelis used to enter our village and homes with weapons and ask the families to leave or they will kill them with their children. So we had to give all and now we are dispersed as nobodies all over the world.	– Loss of position – Loss of dignity and hope – Loss of home, land, money, gold	Material and immaterial losses
My parents told me how much the people of Gaza were cooperative with the refugees when they came to Gaza and how they stood by their sides, and gave us money and offered their houses to sleep in. I told them that our original country was occupied by Israel and that one day we would return there after the defeat of the occupiers.	– People helping each others – Hope to return to homeland	Positive resources and future prospects
They told me about the courageous people who remained steadfast, and fight against the occupation. My parents told me that this defeat was not only for the Palestinians but also for the Islamic nation. I convinced them that the defeat can mean success and we are strong in spite not having weapon. I told them that the Arabs were defeated in this war because of their carelessness. I reminded them about fulfilling our duties and to not give up whatever happens. That will save us. *If all people would care for each other, we would not have been defeated and lost our homes. With respect between people we would not have been like we are now.	– Importance of integrity and courage – Emphasis on duty and respect – Human behavior underlies military fate	Political lessons and moral messages
My parents told me nothing. Learned about it from TV programs and documentary films. *I am so young I cannot remember our wars, so I did not tell anything to my children.	– Not family discuss of wars – Information from elsewhere	Maintaining silence

The coding key is the agreed result of the final communication content categories, and the first coder (SD) qualitatively coded the responses of the rest of the 140 families (both parents’ responses) using the categories that the two coders had identified with the 30 example families. If new themes emerged, the two coders negotiated and checked the responses against the existing themes and decided together whether there was a need for new communication content categories. In all, eight categories were identified (seven content and one silence categories, derived from 24 themes (see Table 1).

The occurrence of these final communication content categories of both fathers’ and mothers’ responses to the three questions (0 = no; 1 = yes) were then entered into SPSS to be further used in quantitative analyses. In the data entering each communication content category was given a variable name, and the entered values refer to the number of how many of the content categories occurred in the mother’s and father’s responses to the three questions (what they were told about War of 1948, Nakba, what did they tell their children of the War of 1948, Nakba, and about the 1967 Arab–Israeli War). The values of these variables thus varied between 0–3 (0 = the communication content category was not present in any reponse; 1 = the category was present in one response, 2 = the category was present in two responses; 3 = the category was present in all three responses). Combining the parental responses across the three single variables was due to the need to condense the information and there are thus eight summarized variables with values ranging from 0 to 3, for the mothers and father respectively.

Post-traumatic stress disorder

PTSD symptoms were measured with the 13-item Children’s Revised Impact of Event Scale (CRIES) (Smith, Perrin, Dyregrov, & Yule, 2003). The scale covers symptoms of re-experiencing (four items), avoidance (four items), and hyper-arousal (five items). The children indicated on a six-point scale how often they had had each symptom during the preceding two weeks (0 = not at all; 5 = often). The total sum thus ranges from 0 to 65, and a score of 30 or above is considered to indicate a probable PTSD diagnosis (Perrin, Meiser-Stedman, & Smith, 2005). The CRIES has been found to be valid among war-affected children in Palestine (Kolltveit et al., 2012) and in Bosnia-Herzegovina (Smith, Perrin, Yule, Hacam, & Stuvland, 2002). In this study, the Cronbach’s α reliability was .61, which would be considered rather low in relation to an individual score, but can be accepted as adequate for use with aggregate statistics. The construct of PTSD was therefore retained in the analyses because it is a core mental health consequence of traumatic events (Friedman et al., 2011). The choice of using cut-off scores (of 30) for PTSD instead of a continuous variable of post-traumatic stress (PTS) symptoms follows the established practice in research on war-affected children (Attanayake et al., 2009; Perrin et al., 2005).

Depression

The Depression Self-Rating Scale for Children (Birleson, Hudson, Grey-Buchanan, & Wolff, 1987) is a 18-item self-report assessment of cognitive, affective and behavioral dimensions of depression. Children estimated on a three-point scale whether they had had each symptom during the preceding two weeks (0 = not at all, 1 = sometimes, 2 = all the time). The depression symptoms sum score (ranging 0–36) had a Cronbach’s α value of .78, and a cut-off score of 15 (Birleson et al., 1987) was applied to indicate clinically significant depression. Cut-off scores for depression were chosen rather than continuous variables because of our interest in severe depression (Attanayake et al., 2009; Perrin et al., 2005).

Psychological distress

The Strengths and Difficulties Questionnaire, SDQ (Goodman, 2001) assesses emotional, behavioral, and relational problems, hyperactivity, and prosocial behavior. Each of the five dimensions consists of five descriptions. On a three-point scale, children rated how well the description fit them (0 = not at all, 1 = somewhat, 2 = yes, fit well). The SDQ has previously been used among Palestinian children in Gaza, showing moderate reliabilities, but good validity (Thabet, Stretch, & Vostanis, 2000). A total sum score of psychological distress was constructed omitting prosocial behavior, having a Cronbach’s α value of .71. The scale ranged between 0–40, and a cut-off score of 12 was used to indicate clinically significant psychological distress (Goodman, 2001). The choice of cut-off dichotomies instead of full symptom scores was again following common practice in trauma research among children (Thabet, El Sarraj, & Vostanis, 2007).

Family experiences of current war trauma

The 14-item measure of traumatic events during the Gaza War 2008/09 involved experiences of losses, destruction, and violence common during the war. It was specifically constructed for the present study, using items partly derived from earlier Palestinian studies (Thabet et al., 2000). Examples include ‘Have you been shot at?'; ‘Has your house been bombed or shelled?' and ‘Has a member of your family died as a martyr?'. Mothers, fathers, and children separately reported whether they had experienced these events (1 = yes, 0 = no). Three separate sum variables were constructed, i.e., for the two parents and the child. They were combined when indicate family experiences of current war trauma.

Demographic variables

Parents reported family’s monthly income in New Israeli Shekels (1 = less than 1,000; 2 = 1,001–2,000; 3 = more than 2,000), type of family (individual; extended; tribe), level of education (1 = elementary; 2 = secondary; 3 = polytechnics, 4 = university), and type of work and working situation (open question, scored for fathers: self-employed, worker, blue collar, unemployed; for mothers: works at home, self-employed, blue collar, other). Children reported number of siblings (family size) and the place of residence (urban area, refugee camp, village), while the family’s civic status (refugee, citizen) was scored from school information.

All questionnaires were in Arabic. The Arabic versions of CRIES-R and Birleson Depressive symptoms are from Children and War Foundation (http://www.childrenandwar.org /measures) and SDQ psychological distress from Thabet et al. (2000).

Statistical analysis

Crosstabulations with χ² statistics were applied to analyze the categorical demographic variables (education, work situation, place of residency, family income and family type) and the representativeness of the subsample of 170 families. In comparing the occurrences of the eight identified family communication content scales (summed across the three questions) between mothers and fathers, pairwise t-tests were used. To examine whether the communication content scales differed between the first and second generations, pairwise t-tests were applied. Here we compared separately fathers’ and mothers’ eight communication content scales that were formed across their responses to the three questions (what parents were told about the War of 1948, Nakba, and what they themselves told their children about the 1948 and 1967 wars, the values ranging between 0–3).

To reduce the data for further analysis, and to identify the potential family-level underlying dimensions of parental communication contents, an exploratory principal components analysis (EPCA) with varimax rotation was applied to the identified transgenerational communication content variables that counted all together 16 (eight communication content scales for both mothers and fathers, ranging between 0–3 for both). The best solution was based on eigenvalues >1 and loadings >.40. The following analyses used the established factor scores (regression-derived) as the family-level transgenerational communication content dimensions.

To answer the research question about the roles of current war trauma and demographic characteristics associating with transgenerational communication content dimensions, one-tailed Spearman correlation analyses were used when the independent variables were linear (exposure to current trauma, family size, and parental age). Multiple analyses of variance (MANOVAs) with univariate tests were applied when the independent variables were categorical (parental education, family income, and residence). The dependent variables of transgenerational communication content dimensions were the factor scores resulting from the EPCA.

To answer the third research question, we used hierarchical binomial logistic regression analyses, where children’s PTSD, depression and psychological distress (all with cut-off scores of clinical significance: 0 = no; 1 = yes) were the dependent variables. In the first step, as control variables, some demographic factors (child age, gender and family income) were entered. In the second step, also as control variables, the current family trauma exposures (mother’s, father’s and child’s separate reports of their traumatic experiences of the Gaza War 2008/09) were entered. Finally, the third step included the factor scores of family-level transgenerational communication content dimensions. Wald-statistics indicated the significance of each predictor (odds ratio, OR with 95% CI = 95%), and pseudo R² of Nagelkerke –values indicate how much each step accounts of the variability of the dependent variables. The overall-likelihood tests were applied to ascertain whether the dichotomous comparisons significantly differed between ‘no’ and ‘yes’ clinically significant symptoms. The χ² statistics were used to analyze the associations between maintaining silence vs. disclosure (dichotomous variable) and children’s PTSD, depression and psychological distress.

Results

Descriptive statistics

A majority of the 170 families (86%) lived in urban areas and the rest lived in refugee camps and villages. Parental gender was associated with the level of education; almost a quarter (23.4%; n = 39) of fathers, but only 7.8% (n = 13) of mothers, had a polytechnic or university degree. However, 28.7% (n = 48) of fathers and 37.1% (n = 62) of mothers had secondary education. Half of the fathers (50%; n = 85) were unemployed, which corresponds with statistics concerning Palestinians in the Gaza Strip during the Israeli military siege and international economic blockade (UN, 2009). Ninety-two percent of the mothers (n = 157) worked at home, which is higher than reported from epidemiological data for Gaza (UN, 2009). The families were generally poor, with about two thirds (64.7%; n = 108) reporting their monthly income to be less than 250 US$. A third (33.5%; n = 57) lived in extended families and 7.1% in a tribal setting, and 59.4% lived as a nuclear family. Families were relatively large, the number of children in each family ranged between two and 13, the mean being 6.2 ± 2.4.

Identifying parental communication contents

The content analysis of parents’ reports of what they were told and what they themselves had told their children about the past Palestinian national trauma revealed seven categories of communication and one non-communication category. Table 1 presents the themes and categories with examples.

In the violence and aggression category, parents told about horrors, wrong-doings, killings, and massacres targeting their families and about the eviction and deportation of Palestinians. Their reports do not tell about the feelings or behaviors of the victims or survivors, but instead predominantly about the acts of the enemy.

The facts and reasons of wars category involves discussions about the reasons for the losses, wars, and the deportation of Palestinians. Typically, parents informed their children about the countries where the refugees settled, the arms superiority of Israelis, the defeatist attitudes and conduct of Arabs, and the personal, familial, and national strategic miscalculations.

The mental suffering and humiliation category involves feelings of helplessness, submission to overwhelming power, and defeat. The stories revealed the humiliation of being homeless, of begging for food and water from the enemies, and of being forced to witness atrocities. Parents expressed a variety of emotions, including shame, guilt, rage, sorrow, disgust, and fear. They communicated about weakness and the lack of future prospects, and they did not communicate any consoling aspects or possibilities of political and armed struggle.

In the physical suffering and life-threatening events category, parents told predominantly of physical suffering, losses of lives, and fear of death. The stories did not contain messages about the human consequences of war, but typically depicted actual events and concrete documentation of horrifying scenes.

The material and non-material losses category involves parents’ stories about destroyed or confiscated homes, olive groves, and fruit orchards, stories which were told simultaneously with the loss of human dignity. They often described how the once respectable way of life in Palestine unexpectedly ended, and how the loss of land and the deportations due to the War of 1948, Nakba, were a great shock. The category also involves the loss of homes, family relations, and land due to the 1967 Arab–Israeli War, and describes the profound humiliation of living under foreign military occupation.

The positive resources and future prospects category covers parental stories of war and trauma that indicate hope, compensation, and the satisfaction of being on the right side of history. The communication also involved memories of people helping Palestinians, and neighborhoods and villages caring for each other materially, mentally, and symbolically.

The political lessons and moral messages category comprised stories of war and trauma that indicate hope, a necessity to struggle for justice, and a determination to gain victory over the enemy. Parents emphasized individual and collective responsibilities to cherish the Palestinian national heritage, values, and goals. They encouraged their children to struggle and supported their stamina and persistence.

The last identified category was maintaining silence, referring to parental non-communication and a lack of disclosure about trauma. Parents also gave reasons for not telling their own children about past Palestinian traumas, such as ‘I did not want to make them worry and feel helpless' or ‘I wish that my children would have a different life’.

Frequencies of parental communication contents

Table 2 shows the distribution of the eight identified parental communication categories among mothers and fathers. The percentages are the occurrence of that scored category across parental responses to the three questions: (1) What parents told them about the War of 1948, Nakba, and what they themselves told their children about (2) the War of 1948, Nakba, and (3) the 1967 Arab–Israeli War.

Table 2.

Parental communication content categories^a: Percentages and frequencies among mothers (n = 170) and fathers (n = 170).

	Mothers^b		Fathers^b
	%	n	%	n
Violence and aggression
Yes	18.2	31	20.0	34
No	81.8	139	80.0	136
Facts and reasons of wars
Yes	22.9	39	20.6	35
No	77.1	131	79.4	135
Mental suffering and humiliation
Yes	11.8	20	10.6	18
No	88.2	150	89.4	152
Physical suffering and life-threat
Yes	3.5	6	5.9	10
No	96.5	164	94.1	160
Material and immaterial losses
Yes	5.9	10	5.9	10
No	94.1	160	94.1	160
Positive resources and future prospects
Yes	4.1	7	6.5	11
No	95.9	163	93.5	159
Political lessons and moral messages
Yes	13.5	23	11.7	20
No	86.5	147	89.3	150
Not telling anything
Yes	21.8	37	22.4	38
No	78.2	133	77.6	132

Notes: ^aThe communication content gategories were counted across the parents’ responses to the three questions of: 1) what did their own parents tell them about the War of 1948, Nakba; 2) what did they tell their own children about the War of 1948, Nakba?; and 3) what did they tell their own children about the 1967 Arab–Israeli War and military occupation? These accounts resulted in continuous parental variables ranging between 0–3 (0 = the category was not present in any reponse; 1 = the category was present in one response, 2 = the category was present in two responses; 3 = the category was present in all three responses).

^bThe percentages refer to formed dichotomous variables: Yes = the category was present in 1–3 responses; No = the category was not present in any of the three responses.

Results show that two categories, one indicating negative communication and the other more positive communication, were the most common, namely the violence and aggression category (20%) and the facts and reasons of wars category (23%). Maintaining silence was a similarly common category, as about a fifth (22%) of communication contents indicated that family members did not tell anything about past Palestinian traumas. Around a tenth (11–13.5%) reported stories of mental suffering and humiliation or political lessons and moral messages. A few responses (3.5–6.5%) involved communication about physical suffering and material and non-material losses, and just as few communicated about positive resources and future prospects.

Mothers and fathers did not differ in the frequencies of the communication scales, indicated by non-significant paired t-tests on their linear variables accounting the occurrence of the category across the three responses (varying between 0 = the category was not present in any response; 3 = the category was present in all responses to the three questions). The paired t-values ranged from zero to 1.02 (df = 169).

Concerning the question whether there were differences in communication content categories between the first generation (what parents were told by their own parents) and the second generation (what parents themselves told about the national traumas War of 1948, Nakba, and 1967 Arab–Israeli War to their children, paired t-test results revealed statistically significant differences in the level of communicating about material losses reported by both fathers (t (169) = 2.49, p < .01) and mothers (t (169) = 2.02, p < .05), and about positive resources and future prospects reported by mothers (t (169) = −2.26, p < .03). There was a near-significant difference between generations in maintaining silence about the past trauma, as reported by fathers (t (169) = −1.86, p < .06). The first-generation parents told more about material losses than the second generation to their children. The second-generation mothers told more about positive resources and future prospects to the children, and fathers (marginally) maintained less often silence about the Palestinian national trauma than their first-generation parents.

Data reduction: Dimensions of transgenerational communication

Exploratory principal components analysis (EPCA) was conducted to detect possible family-level dimensions of transgenerational communication and to reduce data for further analyses. Table 3 shows that the final model explained 68.83% of the variation of mothers’ and fathers’ separate communication content scales and revealed the following four dimensions: I: Father communicating about violence, suffering, and loss; II: Both parents giving reasons and meanings; III: Mother communicating about violence, suffering, and loss; and IV: Both parents maintaining silence. The communalities were good, except for the facts and reasons of wars scale (Father), H²< .30. All the 16 scales of communication contents loaded sufficiently high on one factor only, except the violence and aggression category (Mother) which loaded on two factors (the difference between the two loadings <.20). The regression scores of the EPCA of the four (uncorrelated) dimensions of transgenerational communication are used in the following analyses.

Table 3.

Rotated component matrix of exploratory principal component analysis (EPCA) for communication content classes.

	Com- Component loadings
Categories	I	II	III	IV	Communalty
I Father about violence, suffering and loss
Violence and aggression	.74				.74
Mental suffering and humiliation	.87				.78
Physical suffering and life-threat	.90				.86
Material and immaterial losses	.88				.80
II Both parents giving reasons and meanings
Facts and reasons of wars (Father)		.72			.72
Positive resources and future prospects (Father)		.51			.27
Political lessons and moral messages (Father)		.43			.55
Facts and reasons of wars (Mother)		.77			.72
Positive resources and future prospects (Mother)		.63			.48
Political lessons and moral messages (Mother)		.62			.45
III Mother about violence, suffering and loss
Violence and aggression	(.37)		.55		.56
Mental suffering and humiliation			.59		.49
Physical suffering and life-threat			.89		.82
Material and immaterial losses			.82		.70
IV Both parents maintaining
Not telling (Father)				.91	.84
Not telling (Mother)				.92	.85
Eigenvalues	4.62	1.85	1.76	1.40
Explained variance %	33.06	13.18	12.58	10.01	68.83%

Current parental war trauma and transgenerational communication

The results of the correlation analyses failed to support the hypothesis of current severe parental war trauma being associated with negative transgenerational communication of past national trauma, such as telling about suffering and violence. Instead, a significant positive correlation was found between fathers’ experiences of current war trauma and both parents giving reasons and meanings (r = .15, p < .03, N = 170), and a significant negative correlation was found between mothers’ exposure to current war trauma and both parents maintaining silence (r = −.14, p < .03, N = 170). In other words, fathers exposed to a high level of current traumatic war events reported more transgenerational communicating involving facts, reasons and meanings that may be considered positive. Mothers who were exposed to a high level of current traumatic war events reported less maintaining silence about the trauma in their families, which according to psychodynamic view, would be considered positive.

Father’s education had a near-significant association with the dimensions of transgenerational communication contents (MANOVA, F_{Wilk’s Lambda} (12,42) = 1.69, p = .07). Univariate analysis with Tukey’s post-hoc tests indicated that in families with polytechnic- or university-educated fathers, mothers communicated less about violence, suffering and loss than in families with lower-educated fathers (F(3,161) = 3.2, p < .02, η²= .06). Other demographic factors were not associated with the dimensions of transgenerational communication contents. Father communicating violence, suffering, and loss, Both parents giving reasons and meanings, Mother communicating about violence, suffering, and loss, and both parents maintaining silence had non-significant correlations with father’s age (r-values .02,−.06, −.05, and .04, all p’s > .05), mother’s age (r-values .01,−.06, −.04, and .06, all p’s >.05) and family size (r-values .08, .03, .01, and .05, all p’s > .05). Similar non-significant results were found concerning family type (F_{Wilk’s Lambda} (8,32) = 077, p = .62), mother’s education (F_{Wilk’s Lambda} (12,42) = 0.77, p = .69), and family income (F_{Wilk’s Lambda} (8,33) = 0.72, p = .67).

Transgenerational communication and child mental health

Table 4 presents the analyses of transgenerational communication dimensions in relation to children’s mental health, indicated by clinical scores of PTSD, depression, and psychological distress, and controlled for background variables and family exposure to current war trauma. As hypothesized, the OR with CI confirmed that in families where both parents reported higher levels of giving reasons and meanings of past national trauma (regarded as positive communication), children suffered significantly less from PTSD (Wald χ² = 5.73 p < .02, N = 170), and marginally less from psychological distress (Wald χ² = 2.87, p < .09, N = 170). Yet, contrary to the hypotheses, communication about suffering and violence did not associate with higher probability of PTSD, depression or psychological distress. Finally, a higher level of both parents maintaining silence was not associated with the occurrence of children’s mental health problems. Control variables showed only near-significant associations: PTSD was more common among girls (Wald χ² = 2.94, p < .09, N = 170), depression in families with lower income (Wald χ² = 2.79, p < .09, N = 170), and psychological distress among children who reported high exposure to current war trauma (Wald χ² = 3.33, p < .07, N = 170).

Table 4.

Summary of hierarchical binominal regression analysis on children’s clinically significant^a mental health problems (PTSD, depression and psychological distress) for transgenerational communication^b, controlled for demographic factors and family exposure to current war.

	Posttraumatic Stress Disorder PTSD				Depression				Psychological distress
	B (SE)	Wald χ²	OR^c	CI	B (SE)	Wald χ²	OR^c	CI	B (SE)	Wald χ²	OR^c	CI
Step 1: Demographic factors				R²_Nagelkerke = .03				R² _Nagelkerke = .04 .03				R² _Nagelkerke = .03
Child gender	−.61(.35)	2.94+	0.55	(0.27–1.09)	−.55(.37)	2.14	0.58	(0.28–1.20)	.11(.37)	0.10	1.12	(0.54–2.32)
Child age	12(.22)	0.31	1.13	(0.74–1.73)	.07(.24)	0.97	1.08	(0.68–1.7)	−.23(.23)	0.96	.80	(0.51–1.25)
Family income	−.01(.21)	0.19	.91	(0.61–1.37)	−.39(.23)	2.79+	0.68	(0.43–1.07)	−.18(.23)	0.61	0.84	(0.54–1.31)
Step 2. Family current war trauma				R² _Nagelkerke = .04				R² _Nagelkerke = .06 .03				R² _Nagelkerke = .05 .05
Fathers	.02(.03)	0.39	1.02	(0.96–1.07)	.01(.03)	0.03	1.01	(0.95–1.06)	.01(.03)	0.01	1.00	(0.94–1.06)
Mothers	.01(.03)	0.28	1.01	(0.94–1.04)	.01(.03)	0.01	1.00	(0.95–1.05)	.00(.03)	0.01	1.00	(0.95–1.06)
Children	.02(.03)	0.36	1.02	(0.92–1.05)	.05(.04)	2.21	1.05	(0.98–1.13)	.07(.04)	3.33+	1.07	(0.99–1.14)
Step 3: Transgenerational communication				R² _Nagelkerke = .10				R² _Nagelkerke = 11 .0				R² _Nagelkerke = .11
Father about suffering and violence	.13(.16)	0.61	1.14	(0.83–1.56)	.18(.15)	1.44	1.19	(0.90–1.59)	−.07(.18)	0.015	0.93	(0.66–1.32)
Both parents about reasons and meanings	−.44(.18)	5.73*	0.56	(0.29–1.08)	−.22(.17)	1.61	0.81	(0.58–1.13)	−.33(19)	2.87+	0.72	(0.49–1.05)
Mother about suffering and violence	−.07(.15)	0.19		(0.69–1.26)	−.08(.16)	0.26	0.92	(0.67–1.26)	.21(16)	1.72	1.23	(0.90–1.68
Both parents’ silence	.04(.14)	0.0		(0.78–1.38)	−.25(.17)	2.20	0.78	(0.56–1.08)	.21(15)	2.04	1.24	(0.93–1.65)
Model statistics^d	−2Log likehood = 215.26 (N = 170)				−2Log likehood = 201.12 (N = 169)				−2Log likehood = 198.65 (N = 170)

Notes: ^aThe clinically significant cut-off points were 30 for PTSD (CRIES-R), 15 for depression (Birleson) and 12 for psychological distress (SDQ). ^bThe transgenerational communication refers to regression scores depicted from exploratory principal component analyzis (EPCA) with variamax rotation.

^cOR = Odds ratio; CI = 95% confidence interval. Significant OR greater (less) than 1.00 are associated with a higher (lower) likehood of belonging to the clinically significant symptom group.

^dThe statistical values are from the final third step of the regression analysis.

Discussion

Classic psychodynamic views posit harmful consequences of family members being silent about past national traumas, but current research emphasizes the importance of the ways in which generations communicate about traumas (Dalgaard & Montgomery, 2015). Our findings are consistent with the view that the content of what is communicated may be more important than the silence or disclosure itself for children’s mental health. Similar to many other persecuted national groups, the participating Palestinian families still suffer from the consequences of the past national trauma and they continue to live in life-threatening war conditions (McNeely et al., 2015, Rabaia, Saleh, & Giacaman, 2014). Yet, importantly, mothers’ and fathers’ reports provided both positive and negative contents of transgenerational communication about the 1948 and 1967 wars in the aftermath of the Gaza War 2008/09.

Variety of transgenerational communication

Our first aim was to analyze what Palestinian parents were told by their parents (the first generation), and what they themselves (the second generation) tell their children (third generation) about past national traumas. The content analysis revealed a variety of both negative and positive themes concerning the War of 1948, Nakba, the deportations from Palestine, and the 1967 Arab–Israeli War and the beginning of the Israeli military occupation. Parents described suffering, violence, and wrong-doings in four categories, emphasizing different aspects, namely mental and physical suffering, life-threatening events, material losses, and loss of social and symbolic status. Their stories further focused on enemy aggression and violence and described the victims’ experiences of loss, humiliation, and injury.

On a more positive side, in three categories parents described discussions about reasons for the wars, attempts to make sense of suffering, and an emphasis on pride, persistence, and moral conduct. Some parents also explicitly told their children about the positive consequences of national trauma, which included acknowledging increased resilience, the unifying effects of a shared political struggle, an undying hope to return to the homeland, and a trust in justice.

We also learned that the stories of the first generation involved more descriptions of material losses than those of the second generation. In addition, mothers in the second generation emphasized more positive and optimistic themes than their first-generation parents, when telling their children about the past national trauma. Results also showed a trend that the second-generation fathers were less silent about the trauma than their first-generation parents had been. We are unaware of any earlier research that has compared the contents of communication between survivor generations, and can thus not relate our findings to those of others. We may cautiously suggest that silence decreased and emphasis on resources and resilience increased across time in Palestinian generational accounts. However, future research should apply the family-systems approach, and analyze in a more sophisticated way the possible differences between mothers and fathers and between generations in characteristic strategies of handing on traumatic histories.

The relatively high number of both negative and positive messages reflects the diversity of the transgenerational trauma communication. Our findings correspond with earlier research emphasizing the broad, rich, historical, and resourceful aspects of family communication about the traumatic past (Denham, 2008; Kirmayer, Gone, & Moses, 2014). Similarly to a study on the second generation of Japanese-American internees (Nagata & Cheng, 2003), our results also revealed encouraging and resilient transgenerational communication content. It is thus important to emphasize the beneficial consequences of communicating self-respect, pride, ideological resources and the importance of justice among children in families with a traumatic national history. This is in line with findings from qualitative studies among children of Palestinian (Rabaia, Saleh, & Giacaman, 2014) and South African (Liddell & Kemp, 1993) political prisoners, revealing national pride, political commitment and a struggle for human rights among the next generation. The multitude of transgenerational trauma communication contents also accords with the research on Holocaust survivors’ families, illustrating both defeatist and hopeful, and cynical and optimistic stories, as well as philosophical and religious messages across generations (Braga et al., 2012; Giladi & Bell, 2013; Kellerman, 2001; Scharf, 2007).

Our findings concur with researchers suggesting that rather than solely transmitting trauma and negative family experiences, parents also communicate resilience, strength, optimal identity formation, and high moral values to their children. For instance, according to Denham (2008), the impact of historical trauma should be understood as resilience transmission and not as an individual psychopathology. She argues that past collective trauma can result in an integrated and healthy family foundation. Our findings indeed identified communication content categories reflecting optimistic and positive messages, consoling experiences, and collective strength, which is in the line with Denham’s (2008) findings. Earlier generations attempt to help the offspring to make sense of, find reasons for, and increase understanding of the past national trauma.

The quantitative result of how current parental war trauma is influencing transgenerational communication also provides evidence of parents transmitting resilience and resources. In families where the father experienced severe current war trauma, transgenerational communication involved attempts to provide facts and understanding, and to find meanings and explanations for the traumatic past. Mothers’ severe exposure to current war trauma was associated with low levels of silence in family communication, which may reflect positive aspects of parents’ intensified attempts to communicate about past trauma. These results reflect family resilience and provide insights into various ways of how trauma-affected parents try to protect their children. Similar to Denham’s (2008) findings among Native-American families, perhaps trauma-affected parents were motivated to frame and integrate their narratives to help children to link their personal identities to the larger family and national identity by combining the past and the present. The contents of the core messages are important when attempting to understand transmitting resilience in transgenerational communication.

These results contradicted our hypothesis, based on findings among Holocaust survivors and veterans, that parental trauma predominantly negatively impacts on family communication (Danieli, 1998; Davidson, & Mellor, 2001). They also contradict general trauma research that intuitively seeks mainly negative impacts. On the contrary, trauma-exposed Palestinian families attempted to provide facts, reasons and meaningfulness, and they avoided silence and secrecy. Similarly, another Palestinian study found that mothers’ past traumatic experiences increased, rather than decreased, their attachment capacities, caring, and emotional availability, revealing a strong motivation for protecting the next generation (Palosaari, Punamäki, Qouta, & Diab, 2013).

Our mixed-method study also provided frequencies of positive and negative transgenerational communication contents among Palestinians, in addition to the insights into these contents. Our findings demonstrated that the positive messages, such providing facts and reasons for the traumas, were among the most common, as almost a quarter of families reported this form of communication. However, the very optimistic category of positive resources and future prospects was scarce, accounting for less than 5% of all communication contents. Furthermore, in about one fifth of families, the transgenerational communication involved pessimistic, violent and aggressive contents. These less optimistic findings concur with a qualitative study among South African families of political prisoners in which children faced hardships, discrimination and non-communication, and mothers communicated about high stress and lack of community support (Hiralal, 2014).

Our results revealed that maintaining silence was among the three most commonly employed categories, as about a fifth (22%) of the families did not communicate with the children about the Palestinian national trauma. This finding is interesting for two reasons. On the one hand, the ‘conspiracy of silence’ is sometimes considered a universal phenomenon (Danieli, 1998), but its prevalence has not been empirically studied. On the other hand, everyday encounters tell us that Palestinians like to share their past trauma of the loss of homeland (Suleiman & Muhavi, 2006). In this sense the result is unexpected that as many as a fifth of parents did not tell anything about the traumatic national past to their offspring. Importantly, parents’ qualitative accounts revealed positive and caring motivations for maintaining silence: they attempted to protect their children from horrific and shameful family experiences, and liked to protect the innocence of their childhood. Although the extent to which our findings can be generalized to other populations is uncertain, they emphasize the variety both in expressions of, and motivations for, transgenerational trauma communication. Future studies should focus on cross-cultural, ideological and family-dynamic factors and processes underlying the transgenerational communication or maintain silence of past trauma. There are inspiring mixed-method studies on family dynamics and communication patterns in families of Holocaust survivors (e.g., Scharf & Mayseless, 2011; Wiseman, Metzl, & Barber, 2006), and a similar approach is to be encouraged in research on other persecuted and struggling multi-generational groups.

Critics could argue that communication about national, historical and family trauma does not reflect universal human conditions, but can only report on uniquely local phenomena. Our findings among Palestinian families suggest that both culturally-bound and universalist aspects may occur. Some observations reflect unique aspects of the Palestinian context. Three Palestinian generations have their own traumatic histories to tell, and typically the episodic and procedural memories intensively interact by evoking and activating each other. The phenomenon is evident, for instance, when Palestinians describe their current family losses, home demolitions and horrific war scenes. Without apparently noticing it, they can suddenly describe vividly similar events from earlier wars or even scenes of the 1948 dispersion and the beginning of homelessness. Universally, the phenomenon might be conceptualized as dissociation (Zoellner, Alvarez-Conrad, & Foa, 2002), but its contents and meanings reflect local Palestinian history. The layers of loss, trauma and humiliation among the stateless people involve emotions of helplessness and rage, but also determination and pride (Rabaia et al., 2014; Suleiman, & Muhawi, 2006). The deeply-grounded basic experience of being uprooted continues to form the core of the Palestinian psychological state of mind (Mossa, 2016).

Another unique characteristic of the local transgenerational transmission is the visibility and concreteness of the loss. Palestinians could visit and see their former homeland, currently the state of Israel, and thus the genesis of refugees, the War of 1948, Nakba, and the diaspora continued to be very concretely present. (The visits were possible before the building of the separation wall in the West Bank and the military siege of Gaza since 2007). There seems to be a prototype story depicting the continuation of the national trauma that has its echo in individuals and families. Here is an account from the interviews by Mossa (2016), where a 77-year-old man reported:

I went with my son after 1967 to where my house used to be, in Beersheva. We asked if we could enter what had been our home. Inside the home we even saw el-nakla, or the palm tree my father had planted. But the Jewish family now living there refused to let us enter. ‘Habibi, kan el bet ilak,’ they said, or ‘Once this home was yours’ (but not any more).

Transgenerational communication and children’s mental health

Transgenerational communication of past national trauma was not comprehensively associated with children’s mental health defined as clinically significant levels of PTSD, depression or psychological distress. Yet, in accordance with our hypothesis, the content of communication mattered, as children were less likely to suffer from PTSD or psychological distress (marginally) in families where transgenerational communication involved providing facts, seeking meaning, and explanations for the national trauma. This finding accords with research emphasizing the beneficial mental health role of transgenerational communication incorporating information and meaning-making (Measham, & Rousseau, 2010; Montgomery, 2014). This kind of family communication contributes to coherence between what the child senses and experiences within the family, conceptualized as modulated communication (Dalgaard & Montgomery, 2015). When family members share the traumatic experiences in a meaningful, positive and informative way, children are able to maintain a sense of security, a trust in justice and they gain their own agency. By providing explanations for the trauma, parents are validating the children’s own experiences, which is known to be associated with beneficial outcomes among war-affected children and families (Almqvist & Broberg, 1997).

Limitations

The main limitation of the study is the narrow qualitative content analysis that prevents a thorough and dynamic analysis of the timing or styles of parental communication of past Palestinian national trauma. It would be important to analyze qualitatively the modulated communication that may be more important than the thematic contents (Dalgaard & Montgomery, 2015). The second limitation relates to the children’s self-reports of their mental health. A more valid method would have been clinical diagnostic interviews for PTSD, depression and psychological distress. Also, our choice of using clinically significant symptom levels as mental health outcomes might be questioned since it loses dimensional information on posttraumatic symptoms (PTS) and depressive symptoms (Watson, 2005). A third limitation is that we have focused on a universalist approach of expecting similar family dynamics, communication patterns and mental health risks across cultures and between nations living in safety and peace, and those in war zones (Afana, Pedersen, Ronsbo, & Kirmayer, 2010; Summerfield, 1999). A final limitation is that our research design did not permit of assessments of mental health of the parents, although earlier research has shown parental psychiatric problems affecting both transgenerational communication and children’s mental health (Lambert et al., 2014; Scharf, 2007). Further studies are needed to empirically examine, for instance, to what extent the links between past collective trauma, parental communication and children’s mental health are culturally-bound or/and universal phenomenon. It would also be of utmost importance to compare the transgenerational family dynamics in peaceful living conditions and in war zones.

Conclusion

Earlier research on transgenerational trauma communication has predominantly identified negative impacts on the next generation which, however, may be mitigated by various family and society-related factors, such as ethnic respect and current security (Daud et al., 2005; Bombay et al., 2011; Nagata & Cheng, 2003). Qualitative studies have revealed highly insightful views of resilience and historical-cultural resources (Denham, 2008; Kirmayer et al., 2014). Our findings agree to some extent with existing understanding, and they should encourage combining both qualitative experiential dynamics and multilevel statistical analyses in further studies of transgenerational communication.

Footnotes

Author note

We are grateful to the children and their families for their participation and to the Academy of Finland #215555 for the financing of the study. Without our committed field workers, Mohmed Shame, Mohmed Motter, Amel Hossen, Reham Faed, and Ahmed Syied this study could not be realized. We wish to thank associate professor Thomas W. Teasdale, Dr.Fil. Dr.Med.Sci. for his excellent work in English editing of our manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Academy of Finland #215555.

Nina Thorup Dalgaard, M.Sc. PhD, is a psychologist and postdoctoral researcher at DIGNITY – Danish Institute Against Torture. Her research has focused on the transgenerational transmission of refugee trauma, and the mediating role of attachment representations, intra-family trauma communication and family functioning. Her current research focuses on the prevention of trauma-related violence in family therapy with refugee families.

Safwat Y. Diab, PhD, is an educational psychologist and part-time assistant professor at Al Quds Open University, Gaza, Palestine, and received his PhD from the University of Oslo. He has worked as a programs coordinator at Gaza Community Mental Health Program, psychosocial supervisor at UNRWA, and rehabilitation, research and evaluation consultant for international organizations in Palestine. He currently works as a senior researcher in an international research on infant development in war environment, and is constructing school-based psychosocial interventions for war-affected children. His research focuses on children’s trauma, academic achievement, and multiple determinants to PTSD, as well as mother-infant psychosocial wellbeing and child development in the context of war and military violence.

Edith Montgomery, PhD, DMSc, is a psychologist and senior research consultant at DIGNITY – Danish Institute Against Torture and attached as researcher at Danish Research Centre for Migration, Ethnicity and Health (MESU), Department of Public Health at the University of Copenhagen. Her research and clinical work has focused on trauma and mental health in refugee and asylum seeking children and families and rehabilitation of survivors of torture. Her current research focus on family related violence in traumatized refugee families. She is member of the Nordic Network for Research on Refugee Children and on the advisory board of the Nordic project CAGE (Coming of Age in Exile) funded by NordForsk.

Samir Qouta, PhD, is a psychologist and professor at the Islamic University, Gaza (IUG), Palestine and received his PhD Amsterdam University. He worked as the head of the Research Department at the Gaza Community Mental Health Programme and is currently the head of the department of psychology in IUG. The research by professor Qouta cover topics such as trauma, PTSD, prospects of peace and human rights. He is active developing clinical sciences for traumatized populations and his current studies deal with interventions among war-affected children and mother-infant wellbeing in risk conditions. He is an active member of local and international health and human rights organizations, e.g, the Arab-net, Association and Ranem Egypt on Association.

Raija-Leena Punamäki, PhD, is a psychologist and professor at the University of Tampere, Finland, and received her PhD from the University of Helsinki. Her research has focused on child development and mental health in conditions of war and military violence, psychosocial interventions for war-affected children as well as rehabilitation of survivors of torture and human right abuse. Her current research focuses developmental aspects of trauma impacts, including infancy and adolescence, as well as family dynamics. She is member of the Finnish Academy of Science and Letters, the Nordic Network for Research on Refugee Children.

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