Psychiatry as institution, science, and mode of care has been arguably under-researched in the Middle East. This is despite its wide-ranging and multifaceted historical presence in the region, beginning with the late 19th century establishment of asylums and the employment of psy-concepts and practices in diverse social fields and forms of knowledge production, like pedagogy and colonial ethnography to name a few. Ever since, psychiatry has played a major role in the reconfiguration of normality, subjectivity, and governance, amidst the various social and political transformations that shaped the region.
This panel aims to contribute to recent studies that have begun to fill this lacuna (e.g. Keller 2007, Schayegh 2009, Pandolfo 2009, Mittermaier 2011, El Shakry 2014, Behrouzan 2016) by examining modern and contemporary psychiatry in the Middle East from the 19th century to the present. As these researchers, we also take lead from scholars of psychiatry in the West who have approached it from multiple points of view, documenting its history, scrutinizing its current practices, and critiquing its interventions. Examining the history of psychiatric institutions, therapies, and psy-sciences in the Middle East constitutes a critical site for analyzing how global diagnostics and scientific-moral practices are transformed, contested and appropriated in peripheral places. More recently, psychiatry has moved from the asylum to the clinic and the humanitarian field, further shaping the lived experiences of subjectivity and mental illness. Humanitarian psychiatry (Fassin & Rechtman 2009) became a new form of mediation that adopts psychiatric interventions to treat refugees from violence, displacement, and war. Furthermore, psychiatric care has been legislated with new laws becoming the target of debates on notions of culture and the rights of mental health patients.
This panel investigates psychiatry as an institution, a science, and a mode of care drawing from various anthropological and historical accounts of the Middle East. Collectively, the panel’s papers raise questions like: What is the history, forms, and trajectory of psychiatric institutions in the region? How has the institutionalization of psychiatry transformed understandings and practices on insanity and madness? What ideological and societal roles did (and does) psychiatry as a science play in the region? What contestations to such claims of scientificity have surfaced and how did they have shape the practice and position of psychiatry in the Middle East? What are the modes of care that psychiatry offers and what are their effects on the remodeling of normality, (disordered) subjectivity, and governance?
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Dr. Chris Sandal-Wilson
With the development of ‘moral treatment’ at the beginning of the nineteenth century in Europe, occupying the mentally ill became considered key to their recovery. By the early twentieth century ideas about the importance of work were being systematised as occupational therapy. While one recent collection, edited by Waltraud Ernst, has sought to explore the history of this development, including in colonial contexts, the role of work as an element in the treatment of the mentally ill has been neglected by historians. This paper seeks to develop this growing awareness of the role of work therapy by examining its importance in a number of institutional contexts in the Middle East from the late nineteenth century to the middle of the twentieth. The lack of any provision of employment for the institutionalised mentally ill was one of the major critiques made by the British of the Abbassia asylum at Cairo before F.M. Sandwith assumed control of the institution in 1884, and once in control, Sandwith and his successors stressed the mental, social, and economic benefits of putting patients to work. At Asfuriyeh in Beirut, too, work was central to the experience of the patients, who actually helped in the construction of the hospital and landscaping of the site. Their employment was considered to bring many benefits, both to the patients and the institution itself, but putting patients to work was far from uncontroversial, being resisted by ‘lazy and phlegmatic’ – as hospital authorities saw it – patients themselves, and protested by their relatives. Finally, the case of government mental hospitals and prison mental wards in British Mandate Palestine offer something of a counterexample to the other institutions. Employing patients in these institutions appears to have been of much less significance, and this paper explores why, in spite of numerous connections between these institutions and those at Cairo and Beirut, ideas about the importance of work to the recovery of the mentally ill were not taken up and put into practice in Palestine.
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Dr. Lamia Moghnieh
Starting from Europe’s first modern humanitarian intervention in response to the 1860 massacres of Mount Lebanon, I explore in this paper how psychiatric sciences emerged as part of humanitarian projects of modernization against, and governance of violence in Ottoman Syria, a cosmopolitan site of glocal reconstructions and exchanges. First designed to save the Christians, the European humanitarian intervention transformed into a full-on political, social and cultural reorganization of Syria in the name of preventing future violence and clashes between communities. The 1860 massacres allowed for an expansion of missions and charitable groups that went on to do work beyond rescuing, like education, religion and health. Theopilus Waldmeier, a Swiss Quaker missionary, joined the British Syria Mission in 1868, settling outside Beirut to run schools in 1874. In 1896, he relinquished his position to promote a new project for European funders which he deemed essential for the region: establishing a psychiatric asylum hospital for the insane. The Lebanon Hospital for the Insane (popularly known today as Asfouriyeh hospital) was founded in 1900, becoming an exemplary psychiatric institution frequented by people from Malta, Greece, Persia and the Levant and, later on, one of the main psychiatric institution in contemporary Lebanon, until it closed in 1982. Based on the hospital’s archival records, this paper will address how modern psychiatry became central to humanitarian projects of re-organizing Lebanon in the aftermath of massacre and violence. It will also explore and introduce the ways in which different diagnoses were used to medicalize social transformations and violence in late 19th and early 20th century Ottoman Syria.
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Mr. Filippo Maria Marranconi
Lebanon is hosting one of the largest numbers of Syrians who flew the conflict. This context of acute crisis is a known risk factor for social distress and mental health problems but little research has been conducted on experiences of Syrian displaced, their strategies of coping, and their perceptions of the mental health services. Our main goal is to explore and analyze the gaps, regarding the implementation of Mental Health and Psychosocial Support Services (MHPSS) at three levels: The Syrian refugees’ own experience with the services, the stakeholders/service providers level, and the conceptualization of the services at the policy level. Through a multi-situated ethnography, we will investigate individuals’ lives of persons benefiting from MHPSS services.
In this context, psychiatric discourse on psychopathology formulates the relationship between the individual and the living condition marked by political instability. Psychiatrists, by taking a naturalized notion of the individual and of the illness as a main object of their knowledge, modify the individual’s experience of suffering and, as such, transform social relationships. Indeed, declaring someone as “having a mental illness”, may lead to forms of exclusion and subordination. Psychiatric discourse may also on the other hand represent a tool by which the individual redefines legitimately his social personhood against ascribed social statuses.
In light of the above, we may question how psychiatry – as a normalizing discipline – contributes to build knowledge on a vulnerable population, in this case, the Syrian displaced people. In a broader sense, what are the politics of otherness involved in the psychiatric discourse on Syrian displaced? How does it shape the experiences of suffering of the Syrians? How does it apprehend the collective history in which an individual’s experience of suffering is encrypted in and therefore which kind of politics of memory does it involve?
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Ana Maria Vinea
In April 2009, after six months of debates, the Egyptian Parliament passed a new Mental Health Bill, Law for the Care of Mental Patients, meant to bring Egypt in line with international standards and to replace the existing obsolete legislation dating back to 1944. The law was followed by two sets of implantation regulations issued by the Ministry of Health, before and after the 2011 uprising. While the initiative of the new law came from the then director of the General Secretariat for Mental Health (the Ministry of Health division in charge of mental health), its drafting was a collaborative process between this body and the Egyptian Initiative for Personal Rights, a well-known Egyptian NGO interested in questions of human rights to health. Indeed, the concern with the rights of mental health patients was paramount in this new legislation. But the law and the implementation guidelines were not unequivocally applauded. On the contrary, their passing has stirred waves of discussions and contestations.
In this presentation I focus on the debates raised by the 2009 law, taking them as a window into understanding some aspects of the practices and conundrums of psychiatry in contemporary Egypt. As in other countries where similar legislations were promulgated (e.g., Davis 2012), among the most controversial points of the new law were the issues of the involuntary confinement of patients and their consent for treatment, issues which expose psychiatry’s double-bind of control and care, autonomy and treatment. In Egypt, these topics, as the entire law more generally, have been approached through the lens of their “suitability to the Egyptian context.” More specifically, critics have maintained that a law copied from the UK, as the 2009 was to some extent, cannot be applied in Egypt due to both the absence of the necessary supporting legislative and psychiatric infrastructure and to the presence of a “different culture.” These psychiatrists have defined this “culture” as characterized by deficient patient autonomy through the insertion in familial decision networks, which, when combined with lack of awareness about mental disorders, give rise to reluctant psychiatric subjects. My analysis suggests that what is at stake in the debates around the 2009 law are conflicting understandings of the role of culture in psychological healing, diverging assessments of the political and therapeutic role of psychiatrists, and no less significant, different imaginative horizons of the future of Egyptian society at a moment of revolutionary upheaval.
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Mr. Mac Skelton
In Iraq's Hiwa Cancer Hospital, the first with a full service palliative care unit, idioms of psychiatry permeate the discourses of both oncologists and their patients. Oncologists increasingly understand their profession as intertwined with psychiatry. "We are all psychiatrists" is a common refrain in their professional meetings. Meanwhile, patients formulate etiological models that relate war-related fear and the resulting 'psychiatric disorders' to the onset of cancer, and they cite psychological well-being as the key mechanism of healing. I analyze these idioms as part of two historical processes: First, beginning with the first cancer pain management unit in Mosul during the 1980s, I track a gradual shift from the language of 'pain management' to that of 'palliative care' in Iraqi oncology professional discourses. This shift has broadened notions of cancer pain from the physical to the social and psychological among oncologists. Second, I analyze the widespread discourse of generalized war-related psychological distress, which has increasingly become central to cancer patients' explanatory models of illness. This discourse of war-related psychological distress among patients has not, however, figured prominently in the increasingly psycho-social notion of cancer pain among oncologists. Building on the longstanding engagement of anthropology with psychiatry and medicine generally, I ask how oncologists' and patients' divergent usages of the language of psychiatry shed light on the emerging notion of the palliative and, more broadly, the experience of illness and dying in contemporary Iraq.
