A review of Subjectivity, Society and the Experts: Discourses of Madness in the Western Desert of Egypt, by Mohammed Abouelleil Rashed.
This dissertation, written by Mohammed Rashed, an Egyptian anthropologist also trained as a medical doctor, provides an original and welcome contribution to understandings of subjectivity and psychic distress among inhabitants of Egypt’s Western desert oasis (Dakhla), a place where — unlike Egypt’s major cities — Western psychiatric discourses are not only non-hegemonic, but are scarcely present. He observed first-hand local healers’ interventions with distressed clients and formed trusted relationships with unmarried men in the oasis town to paint an ethnographic portrait of a community virtually outside the psychiatric gaze or surveillance of biomedical psychiatry, despite its enmeshment in the socio-economic exigencies of a fiercely capitalist, modernizing state.
Through a narrative-based ethnographic and ethno-historical approach, Rashed travels from his more familiar Cairo surroundings to the relatively isolated desert oasis town of Mut in order to understand subjectivity in a place where spirit possession, envy, magic and faith saturate people’s explanatory models of social and psychic suffering. Moving to an isolated desert with no biomedical psychiatric services is not akin to traveling in time to a pre-modern past, but rather to a coeval place that bears the brunt of modernity’s illnesses without its concomitantly developed psychiatric regimens. In his ethnographic analysis, Rashed de-centers Western psychiatry by suspending judgment as to whether experiences of psychic distress are “really” schizophrenia “or” spirit-possession. Rashed thus directly engages in debates about the meaning and importance of cross-cultural psychiatry, following interventions made most notably by Arthur Kleinman, Horacio Fabrega and Roland Littlewood.
Rashed rejects a teleological line of questioning in which Western psychiatry forms the universal standard against which other “ethnopsychiatric” systems are measured. Rashed explores a more fruitful terrain of questions by demonstrating that the ways in which we make sense of illness are inextricably bound up with its organic manifestation and our experiences of it. Throughout the dissertation, Rashed treats his readers to fascinating and seemingly exotic vignettes, such as that of a healing sheikh inscribing protective Qur’anic invocations with gazelle’s blood to appease the jinni. Evocative descriptions of dramatic interventions that relieve clients of palpable agitation and distress are interspersed with the more mundane experiences of boredom, poverty, underemployment, chronic mental illness and small-town monotony.
The dissertation is comprised of three parts. In the first, the author focuses on his theoretical background and the context of his ethnographic site. Here (Chapter 1) we learn of heated debates over the positivist approach to psychiatry and contentions that mental illnesses and the categories of psychiatry are culturally constructed. While medical anthropology as a discipline no longer takes “schizophrenia” as a universal object to be found and identified everywhere the same, medical and public health institutions continue to operate on such assumptions.
The Dakhla oasis town of Mut (Chapter 2) is relatively homogeneous in terms of ethnicity and class with a marked gendered hierarchy. In this social world, marriage is the culmination of social aspirations and the social and sexual behavior of all young adults — but particularly women — is strictly monitored. Notably, the oasis town of Mut has no biomedical mental health services but a proliferation of local healers and magicians. In giving us a historical account of the Oasis and how it came to be modernized, we learn about social norms, particularly marriage and reputation, and how physical and mental integrity are vital for maintaining social capital. Tight norms of conduct re-inscribe social values onto individuals, and individual breaches and transgressions can endanger the whole community. A focus on mental health thus provides an essential window onto mechanisms of social cohesion, change and formations of subjectivity in this community.
The second part of the dissertation focuses on the experts/authorities who interpret and intervene in psychic distress and behavioral breaches within the context of their interlocutors within the community. Rashed suggests that spirit possession (Chapter 3) is an idiom through which misfortune, psychic distress, un-marriagiability, infertility or impotence can be articulated, ultimately reifying communitas by highlighting everyone’s vulnerabilities to social conflict or lapses in faith. Here a wide range of resources, including prayer, recitation of the Qur’an, or fasting are mobilized to resist or overcome the spirit. Rashed suggests that rather than view the category of “spirit possession” as strictly etiological, we can understand this representation more as an idiom of communication that enables the sufferer’s potential continued connectivity to the rest of the community. Thus, some families actively work to maintain the transient explanation of disturbed behavior as the product of magic or spirit possession. Such an explanation can rekindle hope and flux and the possibility of rehabilitation.
In contrast, (Chapter 4) the breakdown in behavior/function of a previously normal individual that is deemed permanent can be given an “organic” explanation (implicating that something is wrong with the brain) that would irretrievably discredit the person’s ability to function within the larger community. As for those who continue to breach social norms, it is up to family members to maintain their honor within the community by restricting the movements or visibility of their disturbed kin who they come to see as irretrievably “damaged.” It is with such chronicity/permanence of illness that Western psychiatry is associated, and Rashed suggests this as a reason why it is so feared and avoided in the oasis.
In all cases of illness and suffering, whether permanent or temporary, Qur’anic healing (Chapter 5) is often (though not always, and particularly if the person has been brought to the healer against his or her will) experienced as a powerful intervention in which particular forms of recitation influence the presence and effects of spirits. Rashed (Chapter 6) sets out to explain how and why certain idioms are foregrounded more than others under particular conditions and how they may be differently received and understood. This semiotic engagement allows Rashed to argue that the particular foregrounding of spirits in people’s narratives absolves them and their kin from understanding their illness as the result of intentionality or their own “bad choices.”
Part Three of the dissertation focuses on subjectivity and distress and makes the most forceful and illustrative argument for how and why narrative and interpretation of suffering are social practices that shape the experience of distress. For example, we learn (Chapter 7) of Fayza and her brother’s navigation among healers, family members, and psychiatrists (outside of town) who variously explain Fayza’s “inappropriate behavior” that is as constrained by strict gendered norms as it is by mental illness. When Fayza and her brother diverge in their explanatory mechanisms for her suffering and her brother restricts her behavior, movement and her ability to narrate her own illness, her suffering is made all the more acute. A contrasting example is that of Mahdi, who is more able to “pass” as a normal functioning member of society despite also experiencing what might be considered auditory hallucinations and paranoid thoughts because of the wider space given for male behavior and his ability to better control his own narrative and explanation as someone in a conjugal relationship with a female jinni. Rashed reiterates that how we influence or develop narratives to explain illness can directly intensify or alleviate the personal experience of distress. Ultimately, Rashed puts forward a case for a “Hermeneutic Clinic” that attends self-consciously to this power of words and meaning-making.
This work is a welcome addition to the new and fascinating accounts of subjectivity in Egypt, particularly works by Amira Mittermaier on the world of dreaming, that seeks to de-center Freudian analyses of the unconscious in the Egyptian context of dreams-as-messages from the spiritual world; Sherine Hafez on the religious, secular and political forces forming gendered subjectivity; and Charles Hirschkind on the effects of cassette sermons, circulated outside state networks, on the formation of subjects who attempt to bring themselves into a closer relationship with the divine. This work also speaks to the vibrant interest in the anthropology of social and psychic suffering, as seen in works by Angela García, on the social and psychological distress that accompanies land dispossession among the Hispano community in New Mexico; Tanya Luhrmann on the ways in which psychoanalytic approaches to mental health gave way to biomedical pharmaceutical emphases, in part to render it “morally neutral”; and Emily Martin’s work on people with bipolar and their own negotiations of their psychiatric diagnoses, pharmaceutical regimens and popular representations of mania. The rich ethnographic sources on which the dissertation relies will contribute productively to conversations about the “protest psychosis” developed by Jonathan Metzl — to what extent is psychiatric illness a manifestation of social oppression? To what extent is psychiatric diagnosis punitive action against transgressors of social and political norms? What can we make of the increased biomedicalization of various subjective forms of feeling and behavior, such as the pathologization of shyness (Christopher Lane) and sadness (Allan Horwitz and Jerome Wakefield) as well as the increased pharmaceuticalization of affect (Joseph Dumit, Kaushik Sunder Rajan, David Healy)? How do narrators who have been given (and themselves adopt) psychiatric diagnoses assert their own agency within psychiatric norms? (e.g. Kay Jamison, William Styron). Given the heated political debates about the benefits and drawbacks of increased psycho-pharmaceutical intervention, Rashed’s rich description of an alternative reality of mental illness that has escaped its purview has much to add to these crucial debates. We are sorely in need of enriching our frames of analyses in the interpretations of and experiences of psychic distress in an era that increasingly relegates subjectivity, affect and psychic experience to neuro-chemical transmission and the firing of neurons. Thankfully, Rashed’s analysis and ability to capture his interlocutors’ narratives of their experiences provides an important source of reflection and re-thinking about our ability to understand and heal psychic distress and vulnerability.
Sherine F. Hamdy
Department of Anthropology
Ethnographic participant observation in the oasis town of Mut (on everyday life, the frequenting of a coffee house, and healing sessions, and long term contact with four individuals who fulfilled the DSM-IV criteria for schizophrenia)
One-time semi-structured interviews with 56 members of the community (11 women, 45 men)
Two focus groups on the topic of similarities and differences between mental illness and possession
Interviews with 8 healers in the village of Mut
University College London. 2012. 271 pp. Primary Advisors: Simon Dein and Roland Littlewood.
Image: Photograph by Mohammed Rashed.