Friday, June 18, 2010

In Need of a Listening Ear

“Charlotte,” she calls out. “Charlotte, shoufi,” look at me.

I turn towards her and she stands there in the middle of the room, a seductive smile on her face as she dances to the sound of Egyptian pop. She’s feeling the rhythm with eyes half closed.

“Like this, see?” she says and puts her hands on her hips for emphasis, swaying back and forth to the beat. She motions for me to join her. “Come here, try it. Leave your jacket.”

I get up off the couch, and join her in movement. She regards me critically as I attempt to imitate her movements, then laughs. “Hey, come and see!” She calls out to people walking by outside. “Charlotte’s belly dancing!”


I first talk to Rachida one Wednesday morning, two days after her hospitalization. On the day of her admission she’d been wearing a black Saudi-style abaya* with matching headscarf; twenty-four hours later, the Islamic clothing has been replaced by a leopard-print track suit. Diamond studs across the chest spell out “Chanel.” She has joined the other patients’ regular grooming activities, and now walks around with her hair blown out into large curls, her lips painted a deep pink, and her eyes accented with heavy lines of kohl.

Within ten minutes of meeting her, Rachida has filled me in on the pertinent parts of her biography. She lives in a southern Moroccan town with her husband and three children, and she is a housewife. With regard to that last fact, there are three things I need to know. First of all, that she is highly intelligent – she could have pursued a higher education, had she been given the opportunity. Secondly, that she is a great cook (which prompts her to describe, in elaborate detail, the particular dishes she’s mastered). And thirdly, that she hasn’t lifted a finger in the house ever since she fell ill, now three years ago. “Je fais rien – du – tout,” she summarizes for emphasis.

She doesn’t know how or why she got sick. It simply happened one day, mysteriously and suddenly. For three long years she was incapacitated – but she’s definitely feeling better now, she lets me know. She tells me she’s “farhana,” happy, on the ward: everyone is nice, there’s always someone to talk to, and everything is taken care of (though the food doesn’t compare to what she whips up at home, of course).

She’s invited me to her room, and we sit on her bed as she shows me pictures of her family, describing each of her loved ones in the most positive of terms. I casually remark that her husband bears a striking resemblance to her late father: both were military men who seem to fulfill all the requirements of ideal Moroccan masculinity. She’s spoken of both with tenderness in her voice. But here I seem to have overstepped some boundary. “Not at all!” she exclaims with a vehemence that makes me fear I might have sullied someone’s image. Her father was a great man, she assures me; a truly great man. Her husband, on the other hand, is revealed to be a jealous grouch. Like all men from the south, he is conservative and traditional; it’s because of him that she stays at home, wears a headscarf, and keeps her distance from unknown men.

And suddenly she suggests that this stifling home environment is the actual cause of her malaise. She isn’t happy in her southern town, she explains; she feels quite literally like a fish on dry, desert-like land. She would much prefer to live in a place like Rabat, where women have jobs, and go to the beach whenever they like. She’s glad to be far away from her husband for the time being. He’s not allowed to visit her (doctor’s orders), but she doesn’t mind one bit. This way, she says with a smile, she can truly relax and get better.

Rachida’s eagerness to talk compels me to recruit her as a research participant. And she is indeed happy to be interviewed – yet the conversations that ensue are not nearly as rich or productive as I had hoped. The thing is that Rachida’s stories are a bit like a pre-recorded message; no matter what questions I ask, she tells me this same basic narrative over and over again. Behind this story is a mental wall that I simply cannot manage to break through. She repeatedly tells me that she is entrusting me and my recorder with her deepest secrets, but I get none of the subjective detail or emotional depth that I had expected to find.

It takes me a while (and quite a bit of self-doubt about my qualities as an interviewer) to realize that this is the very source of Rachida’s problem. It seems that she may have been right on the money when she blamed her environment for her illness. Rachida has lived her life in a time and place that discouraged women’s freedom to express their personal feelings and desires. She is hermetic about what goes on in her mind not because she does not want to share, but because she quite simply never learned how to do so.

Nevertheless, everyone needs an outlet – everyone needs to vent. And so in the absence of words, Rachida communicates with her body. Her malaise manifests itself to her as fatigue, depression, or a momentary lapse in consciousness that she explains as a neurological anomaly. She is a hypochondriac, and her medical file contains three inches worth of lab reports, x-rays, and MRI scans that all come to the same conclusion: her problem is mental, not physical.

Her inability to communicate verbally also explains her need for attention and tendency to seduce. Stuck in an impossible position, between a lack of words and the uncontrollable need to finally be heard, Rachida craves human interaction and a bit of understanding. But unable to ask for it directly, she’s learned to attract it by using the physical power of her femininity.

Rachida is, in a word, hystérique. The days of Freud are long gone, and the term “hysteria” no longer appears in the international diagnostic manuals currently in use – but it is alive and well in Morocco. The women’s ward always houses a few patients with hysteria; women just like Rachida, who have no other way to speak than through their bodies.

The doctors are stern with Rachida. She is taking anti-depressants, but the dominant aspect of her treatment involves a kind of behavioral therapy. Rachida must learn to be more emotionally independent, and she must learn to talk about her feelings. The doctor meets with her every day, and patiently yet persistently attempts to break through her mental wall. But women like Rachida are never allowed to stay at the hospital too long. This so as not to indulge in the ‘secondary benefits’ of hospitalization. Being a patient means being confirmed as being ‘sick’ – and that label entitles one to all kinds of special care and attention. Most patients cannot wait to be cured and discharged. But les hystériques? They couldn’t be happier, right here on the ward, being taken care of by everyone else. In order to ensure that such women still retain some motivation to get better, the staff tries to make hospitalization slightly less attractive – by cutting off certain privileges. This is why Rachida isn’t allowed to have visitors. She’s also not allowed to keep her cell phone with her, and although the staff encourages her to talk, they make sure not to be too available to her.

Luckily I am not a member of the staff, and I can be as available to Rachida as I want. Perhaps I can be a listening ear that doesn’t probe for uncomfortable details, I decide. And so I give up on diving into the depths of her mind, settling instead for easy interaction. Aside from our interviews I hang out with her on the ward’s courtyard, relaxing in the sun. As we sit side by side, she’ll turn to me, put on her nicest smile, and ask, “Comment tu me trouves?” What do you think of me?

I’ll turn, and look at her. And before I get a chance to answer, she’ll hint at the particular kind of compliment she’s looking for that day.

On this particular afternoon, she runs her fingers through her hair and poses a rhetorical question.

“I have nice hair, right?”

I express my agreement, and she continues. It’s perfectly curly, she explains. And no matter what she does with it, it always looks great. It’s just too bad she’ll have to cover it back up with a headscarf as soon as she leaves the hospital…

And off she goes; she has launched herself into another rendition of her biography. I lean back in the sun, put a smile on my face, and simply listen.

* basically, a long, formless black dress


jake hajer said...

You Belly danced?! Was that out of empathy or were you eschewing repression with physical communication? Have you read 'The Man Who Thought his Wife was A Hat" it's a book about neurological case studies outlined by a doctor. Good stuff. I like your update!, I'm going to read all of your blog updates!

Charlotte said...

Good question :-) I think it might have been part empathy, part curiosity, part being swept up in the moment... who can resist a belly-dancing woman, really?

I have read that book - and those case-studies could be an interesting comparison to what I'm seeing on the ward. Thanks for the suggestion!

I'm glad you liked the update; looking forward to reading more of your comments :-)

hamid said...

I found your last three entries very moving and powerful!

I hope this isn't too pedantic!
They did also raise questions, for me, about the institutionalization and practice of psychiatry in Morocco; its vestigial relationship, as a "western" inheritance (its etiological discourse, nosology, use of pychotropic drugs,...) to the colonial experience, which frames it as a cultural transfer, a science, rooted in modern rationality; more importantly as a rupture ("cesure epistemologique" perhaps?) with the traditional practices of mental health and their articulation of the subject. And this is important in that women play an important role in the latter, both as practitioners, patients and cultural relays. Here they are primarily "patients", and the concept of "prise and charge", weaves into the process of hospitalization, questions of gender: the place of women in the institution (as "corps hysteriques", nurses, but much less as doctors), and in society at large (protection laws). There is still much to say, and I have used way too many run-on sentences, parenthesis and quotes!! I love your posts for the touching portraits and the thoughts they raise. Thanks!


hamid said...

Correction: "prise and charge" should read "prise en charge"

Charlotte said...

The questions you pose are interesting - and actually fairly central to the entire setup of my research project. Though at this point in my research I won't yet venture to posit answers to any of them, I can tell you that the situation is much more complicated, and much less black and white, than one might think. For instance, psychiatry in Morocco is not simply a colonial inheritance or a foreign science. Because in the 80+ years that 'modern' psychiatry has been practiced in Morocco, it has developed, morphed, adapted to the history, practices, experiences, and notions of the 'subject' that are current in its environment. I'm not saying that psychiatry is 'authentically' Moroccan, either - but what is 'authentic' anyway, in this globalized world of hybridity?

Nor is psychiatry a complete 'rupture' with what people refer to as 'traditional' practices of healing. Though most agree on the juxtaposition of 'psychiatry' to everything that is considered 'traditional', the latter is a huge group of many different practices, each of which is evaluated differently - and some are seen as closer to psychiatry than others. In addition, 'traditional' ways of understanding illness find recognition among Moroccan psychiatrists (one of the ways in which psychiatry here has developed over the years) - if anything as a culturally particular way of expressing universal symptoms.

And finally, the role of women is not so radically different between 'traditional' and 'modern' mental healthcare. Yes, women have played an important role as both patrons and providers of traditional care. But the same is true of psychiatry. Half of the attending professors at this hospital are female, and at least 75% of the residents in training are, too. Among nurses, on the other hand, the majority is male (a common occurrence among psychiatric facilities the world over, I am told). A gender balance that makes discussion about the role of women all the more interesting...

Thanks for your comments!

hamid said...


Thanks for the thoughtful reply! "Complicated and much less black and white" are critical. I agree with your nuanced response, and I should have been less Manichean in my questions. Jalil Bennani, in his "La Psychanalyse aux pays des saints", says the same thing. Though, re "authenticity", I would say that I wasn't aiming for any sort of othering in time: and "hybridity" should not foreclose the need for an archeology and a genealogy.

With regard to your last point (women in the profession), I am pleasantly surprised, and quite curious to know if the stats are representative across the board (I am assuming this is a women only hospital)?


John Cowan said...

The only true authenticity, one may say, is false authenticity; or more trenchantly, all culture is fake culture. When Joyce ends A Portrait of the Artist as a Young Man with the line "I go to encounter for the millionth time the reality of experience and to forge in the smithy of my soul the uncreated conscience of my race", the term smithy induces us to read forge as meaning 'work as a blacksmith', but it also means 'create a false representation', as in forgery. "The poet never affirmeth", and so never tells lies either.

I think your informant's problem would be described in DSM-IV language as borderline personality disorder, though I hasten to add that I am not a psychiatrist.