Cairo, Egypt - Egypt can sometimes seem like a land haunted by revolutionary trauma - from those who witnessed Coptic protesters being flattened like road kill during the notorious Maspero massacre, to the terrified women set upon by gang rapists in Tahrir Square.
Over the summer it was the turn of young children at Cairo's Rabaa al-Adawiya sit-in - those who sat next to piles of bloodied corpses following the massacre of Islamist demonstrators.
A UN report, published last month, suggested these cycles of violence and instability are having an indelible effect on the nation's mental health.
The paper effectively concluded that Egyptians were among the most depressed on Earth. Out of 156 countries surveyed, the country ranked 138 in terms of overall happiness.
And the pendulum of horror recently swung back again when four people, including an eight-year-old girl, were killed at a Christian wedding in Cairo by gunmen on a motorcycle.
With the amount of changes and upheavals and challenges, I expect it to have an impact on the mind. The exact nature of the impact awaits to be seen.
According to psychiatrists who spoke to Al Jazeera, the seemingly perpetual state of unrest has left a deep impression - most noticeably on the nation's young.
"It's unprecedented what we've been through," said Dr Suaad Moussa, a professor of psychiatry at Cairo University and a child psychiatrist. "With the amount of changes and upheavals and challenges, I expect it to have an impact on the mind. The exact nature of the impact awaits to be seen."
Moussa said during the course of Egypt's three-year period of political turmoil she has noticed more clients arriving at her clinic with complaints related to the deteriorating security situation. Many were children between the age of six and 14 who had become anxious about their safety.
"There have been an increase in young people presenting with fears and worries about their security," she said. "They are worried about being kidnapped or subjected to attacks by thugs or thieves. These are things we didn't come across as often before 2011."
Moussa noted how important feelings of security have always been for the development of children. Yet she also cautioned against assuming any psychiatric trauma would necessarily have lasting negative effects.
"After working with children for 26 years, they never cease to amaze me with how resilient they are," said Moussa.
Many are not so lucky. Last month's UN report focused on the general levels of public happiness and mental wellbeing - yet disturbing individual cases have also emerged during the upheavals of Egypt's three-year revolt.
Psychiatrist Sally Toma told Al Jazeera about one case involving a male patient who was detained by Egypt's military police following a protest in central Cairo. After suffering a serious sexual assault, his mental health began to deteriorate.
"He was totally disconnected and detached," she said. "Soon afterwards he became delusional and developed psychosis. He started going in and out of hospital."
Another case involved the spate of gang assaults against women in downtown Cairo. Toma counselled one young girl who had been seized near Tahrir Square, strapped naked to the roof of a car and then driven through the streets of the capital for 15 minutes until eventually being released.
The problem in many of the cases is that victims do not have closure, she said. Police marksmen who have killed protesters are still in their jobs. Troops who flattened civilians in their armoured cars are still at large.
|Protesters clash with riot police Al-Azhar University [Reuters]
"With post-traumatic stress disorder [PTSD] you need closure," Toma said. "You need to convert the trauma into a memory narrative, not see it as something which is happening to you now."
In the case of the Rabaa al-Adawiya killings in August, closure was particularly difficult because of the prevailing anti-Islamist climate. "Nobody is supporting those victims. Nobody is cheering for them."
Those who remember the elation and hope of Egypt's "18 Days" - the period between the first mass anti-government demonstrations against Hosni Mubarak in 2011 and his eventual overthrow - know the outlook was not always so bleak.
"I remember a feeling of such euphoria," said Mona el-Shimi, a graduate student at the American University in Cairo. "It started from the moment we realised how big our numbers were on January 25, and every time we crossed the barricades of the security forces on the march to Tahrir Square."
But it was not long before pessimism began to seep in. "Up until the fall of Mubarak was the most hopeful moment," said El-Shimi. "It kept getting worse and worse after that."
One of Egypt's most eminent psychiatrists told Al Jazeera that it was the contrast between the highs of Tahrir Square and worries about the current political turmoil and security issues that have contributed to much of the public malaise.
"Because of the high expectations, people are now feeling a sense of despair," said the psychiatrist, who asked his name not be used by Al Jazeera, calling it a "biased" news organisation.
"On a public health level, a lot of people have very mixed feelings; on the one hand they are relieved that they are no longer governed by a religious regime, on the other hand they worry lest the promised secular system turns into a military one."
Not everybody has reason to feel pessimistic. There was widespread jubilation when the military ousted President Mohamed Morsi on July 3. The reaction was a signal of how huge numbers of the Muslim Brotherhood's opponents felt an overwhelming sense of relief following the army's intervention.
There will be a better life for Egyptians when legitimacy is returned. It is not possible to erase the Muslim Brotherhood in six months when we have been in Egypt for 85 years.
"People are hopeful now that the army have got rid of the Muslim Brotherhood," said Dr Ahmed Okasha, a professor who runs a psychiatric health resort on the desert fringes of Cairo. "The military are part of the community and always with the people."
Even some of those youths who might have greatest cause to feel despondent have found it within themselves to hope.
Islam Tawfik, a 27-year-old journalist who wrote for a Muslim Brotherhood newspaper before it was closed down, said dozens of his friends were killed during the massacre at Rabaa al-Adawiya - yet he told Al Jazeera he was still "optimistic" about the future.
"I'm sad because I lost 27 friends there. Of course I'm depressed about that. But at the same time they are martyrs," Tawfik said.
"There will be a better life for Egyptians when legitimacy is returned. It is not possible to erase the Muslim Brotherhood in six months when we have been in Egypt for 85 years."
Yet there is evidence that a wider sense of unease prevails. The most recent polling data from Gallup, published in August, revealed that 80 percent of Egyptians felt the country was "worse off" in the summer than before the fall of Hosni Mubarak.
The same survey revealed that huge numbers of people had negative feelings about the country's economy. More than two-thirds of people said they felt employment opportunities were worse in 2013 than before the 2011 Egyptian revolt.
The poll was conducted shortly before the July 3 coup - and attitudes may have changed considerably since. Though it is unlikely that feelings about job prospects have altered to any considerable degree.
Tales regarding the divided state of the nation are now legion. Once-friendly neighbours who can no longer bear to speak to each other; couples divorcing because the husband is an Islamist but the wife loves General Abdel Fattah el-Sisi, the army chief.
Maha Maamoun, a rights activist who recently visited southern Minya province to investigate the psycho-social effects of the summer violence, said long-standing tensions among Christian and Muslim families had been exacerbated by the recent turmoil.
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"They are not on good terms," said Maamoun. "They deal with each other as if they are different creatures. As if they are not humans, or they don't exist."
For some young Egyptians, the tumult of the past three years - coupled with a sense the country has swung full circle since Mubarak was toppled - has left a bitter taste in their mouths.
"Now everybody is supporting either the army or the Muslim Brotherhood," said Mina Ezzat, a 23-year-old doctor. "There is nothing in between. That's why I'm not feeling very optimistic about the revolution. The revolution is dying."
Follow Alastair Beach on Twitter: @Alastair_Beach
Source: Al Jazeera