In As Long as the Lemon Trees Grow, mental health is foundational to the plot and character arcs. Because the novel takes place during a war, PTSD and mental struggles are commonplace. Tragedies affect them deeply, causing symptoms like Yusuf’s muteness and Salama’s hallucinations. With the introduction of Khawf and his visions, Salama’s mental stability is called into question. But being read in medicine, she readily admits Khawf is likely a product of her head injury and PTSD: “He was a hallucination who had come to stay. One who, every night for the past seven months, has cruelly plucked on my fears, breathing life into them” (15-16). This framing makes him a character with his own personality and arc, in which he will change and grow like Salama herself. If she didn’t see Khawf as a tangible character, no matter if he was real or not, she wouldn’t have learned to overcome her own fears—including leaving Syria or facing enemy soldiers. The power of her internal world created an embodiment of fear to protect her and keep her alive. In the end, Khawf’s origins, his reality, are left to interpretation, as he claims he is with everyone, everywhere.