Statement of Academic Şahika Yüksel

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Prof. Dr. Şahika Yüksel, who has been working in the field of psychiatry and retired from the Department of Psychiatry at İstanbul University, is one of the academics who have been charged with "propagandizing for a terrorist organization" for having signed the declaration entitled "We will not be a party to this crime" prepared by the Academics for Peace.

In her sixth hearing held on December 12, 2018, Şahika Yüksel has been sentenced to 1 year and 3 months in prison along with eight other academics on charge of "propagandizing for a terrorist organization" as per the Article 7/2 of the Anti-Terror Law (TMK). The court board ruled that the announcement of her verdict shall be suspended.

We are publishing the statement of Prof. Dr. Şahika Yüksel, which she presented at her second hearing that was held at the İstanbul 32nd Heavy Penal Court on December 22, 2017. Şahika Yüksel presented her statement by emphasizing, "I am not making a defense."

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Esteemed High Criminal Court,

This is my statement concerning the lawsuit filed against me for signing the declaration "We will not be a party to this crime." As far as I can understand, the court would like to know the reason why I undersigned it. To answer this question properly, first, I need to talk about myself.

I want peace as a human rights defender, as a citizen, as an academic and as a physician who wants conflicts to be ended. I work in the field of health and mental health. I have worked for 41 years at a public institution, Department of Psychiatry, Faculty of Medicine (Istanbul University), to be specific. I set off as a junior assistant, becoming later a specialist, academic and head of department. As a healthcare expert, retiring meant having more time for sharing my knowledge, experiences and spending more time with young volunteers. I have continued my research and studies with great pleasure outside the academia. This is something invaluable because my expertise, experience and knowledge involve "psychosocial problems and disorders that traumatize individuals in the cases of violence, oppression, discrimination, etc." Working alone in this field is nothing other than attempting to do the impossible. You cannot make much progress if you are on your own because this field of work requires teamwork. I have the opportunity to work with energetic and sensitive professionals who can provide psychosocial support in the same field. I am so happy to know that there are mental health experts in this country who are aware that disorders such as depression and anxiety cannot be solved within ten minutes. Sadly, in the newly introduced "Health Transformation Program", patients are compulsorily given an appointment at every ten minutes regardless of the cases their being simple or complicated.

It is a known fact that treatment of health problems is very costly today, as all economic indicators show. The priority must be on preventive healthcare services for humanitarian as well as economic reasons. We should be aware of environments and conditions that create risk groups and give rise to diseases. If preventive conditions are established people will not suffer, undergoing a treatment process either at home or hospital, and thus both the individual and public budget will be protected. Preventing is cheaper. Becoming a patient or treating diseases, however, is difficult and costly.

Since I completed my psychiatry education I have been trying to deal with people who have been physically and/or psychologically wounded in earthquakes and accidents, soldiers and survived the recent bombings and their relatives as well as the relatives of victims killed in these incidents so as to evaluate them psychologically, intervene to resolve the psychological damages and disorders and provide psychosocial first-aid and treatment.

Your Honour, I was demanded to provide my defence before the end of 2017. You might ask yourself what has preventive healthcare got to do with the public prosecutor's 17-page criminal charge. At first glance you may be right. However, I am not to discuss the criminal charge which I fail to figure out what it is about, why it is there and how it concludes that we are guilty; that part will be covered by my defence attorney. I am not providing a "defence" per se. I would like to relate my experiences in January 2016 as a physician and as a human being living in Turkey.

War, isolation and torture damage health and psyche, and engender illnesses. The best remedy is peace. Humans and animals alike prosper in an atmosphere of peace and nature is not ravaged in times of peace.

One of the problems that physicians frequently confront is the question where their task begins and ends. In the face of the war, which is a reality of our region as well as the whole world, defending and fighting for peace is the social responsibility of the medicine and preventive medicine.

When the peace declaration was submitted for signature, I thought of all civilian citizens who were sick—children, the aged, women, men—living in our country, especially those in the south-east. I asked myself the question "What can I do as a retired physician or and academic?" I am not a politician; I have no authority in a public institution. There is one thing I have known and said again and again for years and I wanted to say it once again: "the existence of barriers to such basic rights (nourishment, accommodation, healthcare, education, etc.) threatens social health." And what the declaration expressed was exactly this.

I am not expressing my own eccentric, romantic thoughts when I refer to restriction of basic human rights and isolation.

As indicated in the definition of Post-Traumatic Stress Disorder (PTSD) according to International Classification of Disease (Diagnostic and Statistical Manual of Mental Disorders-5), I am not interested in other people's traumas only. I have myself witnessed these traumatic experiences every day like other citizens of Turkey. (The person has witnessed death, the risk of death or threat of death, or experienced a serious wounding or the wounding of somebody else or an incident that threatens the lives of others) (Supplement-1). I myself too have been subjected to violence as a witness of these incidents through visual and print media. On one hand, I could have remained silent, pretending not to have seen anything; on the other hand, I could demand for peace. Shutting one's eyes to these incidents would have dire consequences; I would see myself as a cheat and liar.

Now, I will present to you some examples of national and international studies based on scientific evidence that focus on how traumatic environments both in social and domestic settings affect human psyche adversely. Violence, aggression, isolation and conflict affect people of all ages in the short or long term. Among these are trauma-related disorders such as Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) —both specific to trauma— and other psychological disorders such as depression, anxiety disorder, somatic problems, pain and so on.

Long since under invasion and blockade, Palestine provides striking scientific findings in this field. Palestinian Minister of Health clearly states that in Gaza, where isolation, blockade and insecurity has a long history, psychology of all children and women living in the area have indelibly been affected.

In the interviews carried out with 1775 Palestinians aged 12-18 who have witnessed various political oppressions in the Gaza Strip, Al-Krenawi et al. (2017) observed that as the number of exposure to violence increased the youth exhibited more anger, hostility, aggression and their parents suffered more psychological problems when their children were subjected to violence.

Another study in Palestine (2017) was carried out by the Finnish psychologist Prof. Dr. Punamaki, known for her studies on children and adolescents, and her team of fellow Palestinian psychologists. This study can be summarized as follows: Children are attached to their parents in order to survive. Living in violent and insecure settings affects children's future. Secure and balanced attachment protects children against the negative effects of trauma, while the ability to cope with trauma provides the ability to recover from it. Violent events and trauma (war-isolation) attack attachments and disfigure them. War trauma effects everybody either soldier or civilian and it particularly damages mother-child attachment. It also harms brain architecture (hemisphere laterality, plasticity, balance, integrity, the ability to recognize, distinguish and organize mimics and gestures). It renders it difficult for the caretakers to understand the child's feelings such as fear, anxiety, sadness and the need to provide for such needs as security and soothing and deal with each one by one. Trauma impairs children's physical, psychological and social development and their learning skills; it is more likely to turn them into individuals running riot, feeling helpless and unable to control their anger. Not only psychological but also physical development of children is deeply affected in traumatic settings. Even the rates of low birth infant weight are directly proportional to the extent of violence: while the rate of infant weight below 2.5 kg was about 15% when violence peaked, it was only around 6% in times when violence was low in Gaza. Infants had smaller head circumference and they were much shorter. The rate of PTSD among pregnant women in Gaza is 8-11%. In their study dwelling on efficient basic measures to ensure recovery to be taken in social traumatic incidents/massive attacks either immediately after or in the medium term. Hobfoll et al., who did many studies in various parts of Israel and Palestine, consider sense of security, maintenance of peace, being active in society, existence of bonds and hope as the main factors for attaining desired results.

Going back and to the period when this call for peace was made, I would like to summarize what I saw in the press in late 2015 and mention a few relevant incidents. I will do this simply because I would like all of us to remember and visualize these traumas embedded in our memories.

Abundant news and social media articles covered rather long curfews (SY kendime not control etup to 6 months), which I believe block people from having access to their basic needs, the killings of women, children and the elderly and dead bodies of people, which ought to be treated as sacred even in times of war... All these incidents that I heard from various people whether it be soldier or civilian have shocked me profoundly as a person working in the mental healthcare. Could I have turned a blind eye on the reports issued by my colleagues from TMA's, Diyarbakır Medical Chamber and HRFT, of which I am a founding member? Here are three examples. We read such news stories as: "Elderly has a heart attack: an 80-year-old citizen, whose house was cross fired, died of a heart attack; the dead body of 59-year old Taybet İnan, who was shot dead in her garden, remained in the street for seven days before it could be could be taken to the morgue on December 25, 2015; everybody in the neighbourhood, including children and her immediate family, could see her body, though no one could go near her; Egit Kaçar, 22-year old mentally challenged youth, was wounded after being shot by security forces in his neighbourhood on December 20, 2015".

Well, I undersigned the declaration with a demand for peace for I felt a deep sorrow after reading the news in various media about long curfews during which people could not have access to their basic needs, women, children and elderly people being killed, their bodies left to lie in the open for days, their relatives throwing stones from their windows at birds and dogs lest they eat them.

As a person asking herself the question "What can we do for peace as physicians and psychiatrists?" how could I have ever shut my eyes off to what was going on then? Ask me the question; How could I ignore this text in an atmosphere that fertilises diseases? If I had not undersigned it, how would my conscience stand it? How could I ever look in the mirror? How could I ever look my friends and students in the eye? Could I divide myself into two?

What is more, there are things to be done in an multi disciplined manner in the peace process. For instance, we carried out psychosocial support counselling in Adapazarı for years to help people recover from the trauma of the 1999 Marmara earthquake. We wrote about our experiences in the book ADASTEP. We made use of what we learnt from these experiences in the earthquakes such as Van-Erciş. What we learnt in these natural disasters helped us provide faster and more efficient education and psychosocial support. We all live and realize that conflict and isolation do not bring solution at all. If only an atmosphere could be established in which we could join hands to overcome the difficulties within our differences.

To conclude, I participated in the signature campaign for this declaration to support the demand for peace both as a physician with a sense of professional responsibility and as a person and academic with a conscience.

As an academic working in the field of trauma, my greatest wish and demand is the establishment and maintenance of peace so that mental health of all the people, women and children in our country could be protected and that everyone in the world could live in peace. Based all these reasons and the conviction that the trial concerns not the signature text but the demand for living together I request to be acquitted immediately.

(ŞY/SD)