Sunday, October 3, 2010


For the staff of the open women’s ward much of July was spent in frustration over a young woman by the name of Maria.

Maria suffered from a sizeable list of vague physical pains and symptoms. She spent her days inexhaustibly in pursuit of any doctor she could find, beseeching him or her to order her some medical tests. Every fifteen minutes, she’d knock on the door of the doctor’s office with another question. At first the denials were friendly, accompanied by a well-intentioned explanation. But as her persistence grew, doctors’ responses became curt, revealing a mounting vexation. At our regular Thursday morning get-togethers, Maria would raise her hand every time another woman had finished her story – and every time, the psychiatrist would pre-emptively cut her off:

“Do you want to contribute to the subject under discussion, or do you want to talk about yourself?”

“I want to talk about myself,” Maria would respond in a feeble voice, visibly shrinking away from what she knew would be the reaction – and the doctor would politely but curtly tell her to wait her turn.

Maria had been hospitalized for the treatment of depression, but after a few weeks of this behavior, her treating psychiatrist had concluded that she must be suffering from some kind of delusion.

“There’s nothing wrong with her,” he sighed one day, after having nicely but firmly sent Maria out of his office for the tenth time that morning.

“The medical tests come back negative every time, but she’s never satisfied. She’ll simply find a new symptom to complain about.”

One of Maria’s most persistent symptoms was her sense that she lacked a stomach. There was no place in her abdomen for food to go, she complained; consequently, she felt neither hunger nor thirst. She expressed a haunting sense of numbness that no doctor seemed able to help her with. Every mealtime became a torturous ordeal; every day was spent in the fruitless pursuit of some kind of feeling – some reminder, perhaps, that she was still alive.

Maria was discharged at the end of the month, without any real improvement in her condition; there simply was nothing more the doctors could do for her.


One morning, three weeks later, Maria was back on the ward for a consultation with her doctor. It was the third day of Ramadan. She saw me sitting on a bench in the courtyard, and came over. When I asked her how she was, she sighed.

“I’m still not hungry,” she reported, the tears she was holding back clearly audible in the quiver of her voice. All I could think of to respond was that I was sorry to hear she was not feeling any better. Then, wanting to add at least something of a thoughtful nature, I wished her a “Ramadan moubarak.” Once again she sighed.

“Kansawm,” she said – I’m fasting. “wa lakin kayderrni.” It hurts me.

“Why does it hurt?” I asked, wondering as much about why she was fasting as about why fasting would hurt someone who feels no hunger.

“Ana mrida,” she explained, her tone betraying a sense of urgency. I’m sick.

“Do you have to fast, even if you’re sick?”

She shrugged. “My husband says I have to.”

As she said this, she wandered away; she had spotted her doctor and was off to catch him before he had a chance to leave the ward. She left me sitting on that bench, both confused and intrigued about the seeming paradox between the two things she had just shared with me. If she felt no hunger, why would fasting be difficult for her?

By the end of that day I began to realize that Maria herself had already provided the answer in her explanation: she’s sick.

The Qur’an states that a person suffering from illness is not obligated to participate in the yearly month-long fast.* And indeed, not a single patient on this ward refrained from eating or drinking.** The meal cart came and went at its normal non-Ramadan hours, and the women walked around the ward with cigarettes, coffee, and water bottles as though it was any ordinary day of the year.

Before the start of the month, doctors had explained, with a smile, that Ramadan would divide the women on the ward into two categories. There would be patients who’d beg to go home; who would assure their doctor they were well enough to participate in the full experience of Ramadan with their families. On the other hand, there would be patients – the côté hystérique – who would emphasize their illness and their right to exemption from fasting, as yet another way to claim a kind of special treatment.

However, the women I talked to on the ward expressed both sentiments at once. They expressed frustration over the fact that their hospitalization prevented them from sharing in the experience of Ramadan. This holy month carries incredible cultural significance in Morocco; participation is often as much a religious obligation as it is a way of reaffirming (and showing) your membership of the community. These patients missed their families, the traditions, the general spirit of the month.

On the other hand, however, the women also seemed to understand their isolation as a kind of refuge. Not participating in the fast became, in some ways, a way of underlining their special status, and thus their rights to special treatment. For these patients, in other words, the Qur’anic exemption mentioned above translated into the idea that one’s behavior during Ramadan becomes a visible marker of one’s identity as either healthy or sick. Not fasting constitutes a new way of asserting one’s status as being truly ill – and by extension, not being obligated to fast means that one’s sick role is accepted by the environment, and thus declared legitimate.

Conversely, being obligated to fast thus automatically implies that your illness is denied; that your suffering is not legitimate.

A lot of the patients on the ward suffer from this sense of denial. They feel misunderstood; they complain about their family’s inconsideration for their illness. Of course it isn’t always possible to ascertain whether a patient’s family really is as inconsiderate as she claims, but I do have the sense that mental illness can be a difficult thing for the average Moroccan woman to talk about with her loved ones. Some of these patients come from an environment that does not allow women to talk much about personal feelings, nor to complain about hardship. Some of them are stuck in loveless marriages, and some of them bear sole responsibility for the survival of a large number of family members, without any hope of assistance from anyone else.

I think it might be this sense of denial that makes fasting so painful for Maria – and I think it might be this denial that underlies her sense of numbness in the first place. Whether or not the numbness is ‘delusional’, I think it could be possible that this is her way of expressing a fundamental sense of isolation and disconnect from the world. Maria has no role to play in the public sphere: she is a housewife whose responsibility lies in the home. But there, too, she lives her life unnoticed. Her husband and family members are far-off figures from whom she does not seem to receive much at all in the way of affection. During her four weeks at the Clinic, not once did they come to see her.

Maria is not seen, and not heard, by those around her. Perhaps she has internalized this sense of isolation; and now it is she who can no longer feel. Her husband’s insistence that she fast is another manifestation of his denial, and thus a further deprivation of sensation. It is this that is painful to her. What she seeks, with her pleas to the doctors, is simply a sense of reconnection. A sense of understanding, a listening ear – a sign that she is perceived by the world, which might in turn reignite her own capacity for perception.

We all deserve to be seen. Without it, we might all wither in numbness like Maria. Perhaps that medication might help Maria with her delusion. But mostly, I hope she succeeds in finding a listening ear.

* And in some ways, fasting is a logical impossibility: taking medication already means that your body is ingesting something. Even if you were to stay away from food or drink, a pill taken on its own already breaks the fast. Nevertheless, I was told before the start of the month that for some patients, it might be possible to adjust the dosage of their medication in such a way that they would be able to refrain from ingesting anything during the hours of fasting, thus enabling them to participate.

** I was told, however, that a fair number of male patients at the hospital were, in fact, participating.