Attacks on thinking: experiences of providing collegial support for surgical healthcare teams in Gaza

This article examines how extreme humanitarian conditions, such as those encountered by surgical healthcare teams working in Gaza, can compromise clinicians' capacity to think, reflect and process experience. Drawing on the authors' experiences and reflections from developing and implementing collegial support for healthcare workers before, during and after deployment in Gaza, the article considers the consequences for team functioning and for clinicians' subsequent reintegration into their personal and professional lives. It explores how collegial support, informed by psychoanalytic theory, may help preserve the capacity to think under pressure and support the processing of overwhelming experience. Particular attention is given to Bion's account of containment and theory of thinking, and to Melanie Klein's depressive position as a framework for integrating conflicting emotions, acknowledging limitation, loss and moving towards mourning and reparation. The article emphasises that such attacks on thinking and regressions to more primitive forms of interacting with the world are understandable reactions to the scale of human suffering and should not be pathologized. These responses, however, can be understood as defensive mechanisms, protecting against deeper fears of powerlessness, hopelessness, or annihilation, and require a model of collegial support that provides space for these responses to be understood and worked through.