Disturbing Spirits

Mental Illness, Trauma, and Treatment in Modern Syria and Lebanon

Beverly A. Tsacoyianis

• Publisher: University of Notre Dame Press
• Year: 2021
• ISBN:
  9780268200749
• Topic: Geschichte
• Subtopic: Geschichte des Nahen Ostens

This book investigates the psychological toll of conflict in the Middle East during the twentieth century, including discussion of how spiritual and religious frameworks influence practice and theory.

The concept of mental health treatment in war-torn Middle Eastern nations is painfully understudied. In Disturbing Spirits, Beverly A. Tsacoyianis blends social, cultural, and medical history research methods with approaches in disability and trauma studies to demonstrate that the history of mental illness in Syria and Lebanon since the 1890s is embedded in disparate—but not necessarily mutually exclusive—ideas about legitimate healing. Tsacoyianis examines the encounters between "Western" psychiatry and local practices and argues that the attempt to implement "modern" cosmopolitan biomedicine for the last 120 years has largely failed—in part because of political instability and political traumas and in part because of narrow definitions of modern medicine that excluded spirituality and locally meaningful cultural practices.

Analyzing hospital records, ethnographic data, oral history research, historical fiction, and journalistic nonfiction, Tsacoyianis claims that psychiatrists presented mental health treatment to Syrians and Lebanese not only as a way to control or cure mental illness but also as a modernizing worldview to combat popular ideas about jinn-based origins of mental illness and to encourage acceptance of psychiatry. Treatment devoid of spiritual therapies ultimately delegitimized psychiatry among lower classes. Tsacoyianis maintains that tensions between psychiatrists and vernacular healers developed as political transformations devastated collective and individual psyches and disrupted social order. Scholars working on healing in the modern Middle East have largely studied either psychiatric or non-biomedical healing, but rarely their connections to each other or to politics. In this groundbreaking work, Tsacoyianis connects the discussion of global responsibility to scholarly debates about human suffering and the moral call to caregiving. Disturbing Spirits will interest students and scholars of the history of medicine and public health, Middle Eastern studies, and postcolonial literature.

NOTES

INTRODUCTION

1. Malek, The Home That Was Our Country, 189.

2. See Rogan, “Madness and Marginality”; Fahmy, “Women, Medicine, and Power in Nineteenth-Century Egypt,” 35–72; and Mayers, “A Century of Psychiatry.”

3. See Drieskens, Living with Djinns; El-Zein, Islam, Arabs, and the Intelligent World of the Jinn; and Awn, Satan’s Tragedy and Redemption.

4. Rothenberg, Spirits of Palestine, 42–46. In this section “Possessed or Mentally Ill?” Rothenberg cites Esther Hecht’s July 26, 1996, Jerusalem Post article, “Therapy for Society,” that states Dr. Sarraj believed political conflict negatively affected people’s mental health. Most of his patients went to vernacular healers before seeing him, and he dismissed vernacular treatment as misguided and detrimental. Hecht notes that in certain instances, however, the GCMHP “tries to enlist the help of traditional healers and religious leaders” when working to assist survivors of torture, domestic violence, and drug abuse. Hecht notes that between 1990 and 1996 the center in Gaza treated more than 8,000 individuals and families, though nearly all patients sought out vernacular treatment first.

5. Heaton, Black Skin, White Coats, 198.

6. Reverby, “Inclusion and Exclusion,” 110.

7. Epstein, Inclusion; and Epstein quoted in Reverby, “Inclusion and Exclusion,” 112–13.

8. Mahone and Vaughan’s 2007 edited volume Psychiatry and Empire includes numerous case studies in Africa, the Middle East, and beyond that critique simplistic arguments of colonial psychiatric institutions as coercive spaces for social control.

9. I thank Ahmed Ragab for helping me consider these ideas in email correspondence, April 2011.

10. See Cooper, Colonialism in Question; Chakrabarty, Provincializing Europe; and Mitchell, Questions of Modernity.

11. Deeb, in An Enchanted Modern, 122, points to “vehement debates” on the validity of jinn, evil eye, and vernacular cures, and their dissonance with “authenticated Islam” and “text-based” forms of religion. See also Grehan, Twilight of the Saints, esp. chap. 5, “Haunted Landscapes.”

12. Schayegh, “ ‘A Sound Mind Lives in a Healthy Body,’ ” 182. On “antidote to backwardness,” see Scott, Seeing like a State, 331, where he notes “a certain understanding of science, modernity, and development has so successfully structured the dominant discourse that all other kinds of knowledge are regarded as backward, static traditions, as old wives’ tales and superstitions. High modernism has needed this ‘other,’ this dark twin, in order to rhetorically present itself as the antidote to backwardness.”

13. Cleveland and Bunton, A History of the Modern Middle East, esp. 187–89: “This dualism had a divisive effect on society as a whole. There had . . . always been a wide gap between educated officials and the population at large. But as the educated officials came increasingly from Westernized schools, the gap widened. . . . As the nineteenth-century transformation brought certain advantages to Egyptian and Ottoman society, it also brought economic hardship, social disruption, and political exploitation.” See also Makdisi, “Ottoman Orientalism”; Deringil, “ ‘They Live in a State of Nomadism and Savagery’ ”; and Moaddel, “The Study of Islamic Culture and Politics,” esp. 372–74, on “cultural duality” and “state culture” theories.

14. See Hakim and Jude, “Les Troubles Mentaux les Plus Généralement Observés à Damas”; Al-Mālikī et al., “Baḥath Ijtimāʿī ḥawl Mustashfa Ibn Sīnā wal-Amrāḍ al-ʿAqliyya”; John Racy, “Psychiatry in the Arab East”; and Khalaf, “De l’Assistance Psychiatrique en Syrie.”

15. Jenner and Wallis, Medicine and the Market, chap. 1, “The Medical Marketplace.”

16. Khalaf, “De l’Assistance Psychiatrique en Syrie,” 39–41. The World Intellectual Property Organization holdings of the Syrian Penal Code (law number 148, from 1949) and Syrian Civil Code (Decree Number 84 of May 18, 1949) show similar language, as in Article 230 of the Penal Code, “yuʿfi min al ʿiqāb man kān fī hālat junūn.” Individuals who attempted suicide were (in theory at least) to be hospitalized rather than imprisoned. Hereafter reports from the Lebanon Hospital for Nervous and Mental Disorders at Asfuriyeh (frequently referred to in the reports simply as “Asfuriyeh”) are identified as LH Annual Report. LH Annual Report 33 (1931–1932), 17, shows some patients who attempted suicide were then sent to the hospital. The Lebanese government hospitalized some people with pending criminal charges to ascertain mental competence prior to deliberating on cases, LH Annual Report 27 (1925–1926), 1. LH Annual Report 38 (1936), 22, notes that “all those referred to as not insane in the statistics [for the year 1936] have been criminal cases awaiting trial or prisoners serving sentences. This testifies to the fact that people are not brought to hospital unnecessarily.” Ibn Sina Hospital also received patients directly from prisons; file templates list prison as one of three locations (home, prison, or temporary shelter) from which patients were usually brought.

17. Scalenghe, “Being Different,” 259.

18. MAE Nantes, Syrie–Liban 1er versement cote 2018 (1941–1942) 858/SP, October 12, 1942, letter from Philippe David, delegation auprès de la Republique Libanaise. The note spells Sulh’s surname as Solh.

19. Mahone, “The Psychology of Rebellion”; ʿAbd al-ʿĀṭi, Ṣuhufī fī Sarāyat al-Majānīn, esp. 35–42, where ʿAbd al-ʿAṭi describes the “medical detention” (maʿtaqal ṭibbi) of a patient (case 1998) who spent more than twenty-five years in Khanka Mental Hospital (March 6, 1949, to June 9, 1974). He was hospitalized as paranoid after anti-monarchy activities in the 1940s, and after a five-year battle in court petitioning for release he won his case and discharge.

20. Heaton, in Black Skin, White Coats, 194–95, writes, “The new cross-cultural psychiatry . . . created a space within psychiatric discourse to talk about the ways that disease and illness categories were themselves socially and politically constructed and that, as a result, these categories were likely to be distinctly different as social and political circumstances changed across space and over time.”

21. On the opening, see the letter from Theophilus Waldmeier to the Lebanon Hospital secretary, August 13, 1900, reprinted in LH Annual Report 2 (1898–1900), 18–19. On the closing, see the Lebanon Hospital description in the SOAS Archives Catalogue, http://archives.soas.ac.uk.

22. LH Annual Report 10 (1908), 26–27.

23. Al-Atassi, “Wāqiʿ al-siḥḥa al-ʿaqlīyya fī sūrīya,” 74–102, based on a lecture to medical students, likely in the late 1950s or early 1960s.

24. See Gelman, Medicating Schizophrenia, esp. 1–20, on “medication and progress.”

25. Abo-Hilal and Hoogstad, “Syrian Mental Health Professionals,” 92.

26. Brewer, “Coming Out Mad, Coming Out Disabled,” 11.

27. See the February 2019 roundtable in the International Journal of Middle East Studies on disability studies and Middle Eastern studies, facilitated by Sara Scalenghe.

28. Jenner and Taithe, “The Historiographical Body,” 187–200.

29. Kleinman, Writing at the Margin. See also Fraser, Cognitive Disability Aesthetics.

30. Donaldson, Literatures of Madness, 3–4, refers to PhebeAnn Wolframe, “Going Barefoot: Mad Affiliation, Identity Politics, and Eros,” in the same volume, 31–50, where “mad people undermine the fixing of madness as identity, instead carefully nego...

Table of contents

• Title
• Copyrights
• Contents
• Acknowledgments
• List of Abbreviations
• A Note on Transliteration
• Introduction
• One Vernacular Healing in Greater Syria
• Two The Origins of Greater Syrian Medical Institutions
• Three Medical Missionaries and the Lebanon Mental Hospital, 1899–1983
• Four Secular Healing and Ibn Sina Mental Hospital, 1922–2018
• Five Literature, Civil War, and (Ef)facing Syrian and Lebanese History
• Conclusion: On Pain, Surviving, Coping, and Healing
• Appendix
• Notes
• Bibliography
• Index