Purring (with) Demons

The sign over the door read “Animal Shelter.”

It tipped our fragile determination off the center of its balance. Had we misunderstood the directions? They had been fairly cryptic – which had seemed only fitting to the nature of our quest. Or was this a clever ruse, perhaps – were we about to engage in something so taboo that a simple unmarked door was not enough disguise? … would we then need a special password to penetrate this curtain of appearance?

My nervous thoughts were interrupted by the sound of keys turning in the lock. The heavy iron door opened to reveal a young girl in pink headscarf and pajamas. She smiled sweetly, and gestured for us to come inside.

I hesitated for a moment, confused by the unexpected normalcy of this encounter. Then, in an attempt to reach out and restore some semblance of balance, we whispered the blunt statement that would yank away the shroud – and either confirm or deny the reality of the mystery we had come in search of.

“Uhm… We’re here for the exorcism?”

The girl nodded again, her expression unchanged. “Right this way,” she said with an encouraging smile, and ushered us in. We were led down a sterile, eggshell hallway; windows along its right-hand wall revealed a patio-turned-terrarium-turned-site of feline urban sprawl. Hundreds of cats darted in, out, and between the iron-grid walls of a metropolis constructed of animal cages.

“You don’t mind cats, do you?” The girl asked, inevitably rhetorically. “We run a shelter for stray animals here.” She turned left, and gestured toward a bare-walled sitting room down the corridor. “He will be right with you.”

With another polite smile she left us there, and returned to her cats. For a moment we stood there silently, awkwardly in the doorway, and regarded the room in front of us. Though perhaps less fancy than usual, it was a Moroccan sitting room like any other. Brocaded sdader (1) lined all four walls, a well-worn rug spanned the sea between them, and a mobile coffee table stood at attention in the center, ready to be rolled to any of the four corners. An overeager, high wattage bulb hung from a wire in the ceiling and boldly shed light on every crevice, depriving the space of any intimacy. This room, too, was populated by a citizenry of cats. A group of kittens huddled, close together, in the corners between couch cushions while their older, more adventurous cousins chased each other around the room in games of adventure and daring. Underneath the coffee table, a few others were enjoying a dinner of fish carcasses – all the while keeping a wary eye on potential thieves.

We took the plunge; stepping over slithering tails and writhing mounds of fur we made our way to a corner of sofa, and carefully sat down. Silently we waited, though not quite knowing for what. Across the room, an older cat tirelessly jumped from one cardboard box to another, in a game of its own invention. It became ever wilder in its jumps, their force propelling the boxes all over the room. Claire and I looked at each other and laughed at the thought that had crossed both our minds:

“You think that cat’s possessed?”

With a broad smile and a “bon soir,” the exorcist then made his entrance. A short, thin, big-bearded old man dressed in white of ambiguous meaning: traditional sarwal down below, Nike dry-fit t-shirt on top.

We returned his greeting with an ambivalent smile: nervousness down below, eagerness on top. Once again, we uttered that strange sentence that seemed so unexpectedly out of place here: “we’re here for the exorcism?”

“Yes, yes,” the man responded nonchalantly. “Marhba, marhba.” Welcome.

“Other foreigners have come to my exorcisms, too,” he continued, in fluent French. “They’re very interested. And of course I’ve spent a lot of time in Europe, myself. But they don’t like Moroccans in Europe. Yes, I’ve been to France, Switzerland; I even studied in Sweden. My father was a diplomat; I had a diplomatic passport. I have a son, now, who studies in France. Oh, but despite that diplomatic passport, I had so many issues at airports. I was always searched. Of course back then, I didn’t understand why. …”

So began an hour-long monologue; a mental voyage back in time, around the world, and – as we had hoped – into the mysterious world of spirits and possession. He wove his theories into the fabric of his stories as though the topic was no more surreal than the hundreds of cats crawling around us. I sat perched on the edge of the couch, my mouth perpetually open in an attempted question – but the man tirelessly spoke, seemingly deaf to our occasional comments.

Meanwhile, the normal activities of an animal shelter continued around us. A family of three had come in and was now being tended to by the girl in pink – undoubtedly the exorcist’s daughter. At their request she picked up and displayed a sequence of cats, helped them choose the perfect pet, packed it in an aerated cardboard box, and then sent the family on its way with all requisite materials.

“… Of course, possession is extremely common in Morocco,” the exorcist continued. He had pulled up a stool and seated himself in front of us – back turned to the daughter, who was now covered in crawling cats. “At least 80% of all Moroccan women are possessed.”

He had anticipated the surprise in our eyes. “Yes, really,” he said. “It’s the parents’ fault. They go see a sorcerer, thinking that they’re protecting their daughters against extramarital sexual encounters, but once the time comes to get them married off, they discover it’s not that easy to get rid of a demon.”

The exorcist’s daughter seemed oblivious to the surreal stories her father was telling us. Her attention was claimed entirely by the throng of unruly cats climbing across her shoulders. Gently she attempted now to instill some discipline, picking each one off her body to administer a dosage of medication and releasing it onto the floor – only to have it crawl back up her legs.

I managed to interject a question. “Does possession always occur through a sorcerer?”

“Not always,” the exorcist responded. “There’s also the evil eye. But most of the time it’s a sorcerer (2). They’re all charlatans. They’ll do anything for those poor naïve parents, as long as they pay – but they’re playing dangerous games. By the time the daughter’s old enough to get married and you need him to undo the spell, the sorcerer will be gone, or dead, and there’ll be no way of finding out where he buried it (3). And then they come to me, in the hopes that I can help them out.”

“And do boys get possessed too?”

“Yes, yes, sometimes parents do it for boys as well. But most often it’s girls. Of course, I’m possessed. I have been, since childhood. I found out because someone told me. Some people can see demons, you know, just like they can see human beings. This person saw my demon – he saw him, with horns and everything – and he told me, ‘you have a demon up there on your shoulder.”

The exorcist leaned down, gently purred at and petted the cat that had nestled itself in between his feet, then continued. “I can see them, too – but I usually see them wrapped up in sheets. I can’t see their face.

“I’ve been possessed since I was six, but for a long time the demon didn’t bother me. It wasn’t until I became more religious that he tried to conquer me. Demons can’t stand prayer, or the Qur’an. But I dealt with it, I still prayed.”

The exorcist here segued into a tangent about his religious credentials, and described what it was like to be the only Arab in a Saudi Arabian class on Islamic theology (4). In terms of piety, he explained, he had been somewhat of a late bloomer.

His stories were only marginally disturbed by the entrance of a tall young man. Thin as a rod, he regarded us shyly with sallow, sunken eyes and announced his presence with a soft and polite “salam aleikum.” Behind him followed a woman, his mother: half as long and three times as wide as he, wrapped up in scarves and jellaba. The exorcist briefly acknowledged them both with another “marhba,” and gestured toward a spot on the sofa. He had just been telling us of the many other foreigners he had had at his exorcisms, and now wanted to know what had brought us to Morocco.

“Ah, the Clinic, yes, I know it well!” The exorcist exclaimed, upon learning the topic of my research. “Yes, I used to live right there, I know some of the doctors (5). Of course, psychiatrists are all charlatans. All they want is money. In fact, hardly anyone really has a psychiatric illness. 90% of the people at that hospital aren’t sick at all; they’re possessed. Psychiatrists can’t help them. In fact, psychiatric medication does more harm than good. You know, those anti-depressants can even increase the risk of suicide. Is Dr. Chikri still there at the Clinic? Yes, he’s the biggest quack of all.”

He now eyed the pair that had been quietly sitting on the sofa for upwards of 10 minutes. “This young man, for example. He was hospitalized at the Clinic for a while. But they couldn’t do a thing for him. He’s not sick; he’s just possessed. That’s why they come to see me, now. I’ve been treating him for a while. His mother, too. Last time they were here and I recited the Qur’an, she began to cry; this means that she’s probably possessed, too.”

The exorcist now got up from his stool, and began to rearrange the cushions by a particular corner of the sofa. He was preparing for his treatment, he clarified. He would have us all sit down right there, so that we could look into his eyes as he recited from the Qur’an.

“Now, demons cannot stand the Qur’an,” the exorcist explained as he worked. “So when they hear my recitation they’ll rebel, and this will lead the possessed person to react violently. Don’t be afraid, come and sit here, and look into my eyes while I recite. If you feel anything – anger, or sadness perhaps – you might be possessed. Possession isn’t as common in the West, but you never know. I’m going to assume you are possessed, because I always do, but let me ask you a few questions, first.”

The exorcist proceeded to take a brief history. “Do you ever have any trouble sleeping? Any nightmares?”

We shook our head in denial, and with a bit of relief.

“Do you ever see any strange shadows?”

Again, we denied.

“Are you married?”

Our negative answer this time constituted a potential warning sign. “Hmmm,” the exorcist responded. “How old are you?”

My revelation raised his eyebrows. He looked at me for a second, as though looking for something in my eyes, and then turned away. “Well,” he then decided, “let’s see how you react to the Qur’an.”

He headed to the other side of the room, and finished up his preparations by unscrewing the top off a 2-gallon-size water bottle that had been placed on top of a wooden dresser. Behind them, a grey kitten sat perched atop a neat row of books - Qur’ans alternated with literature on the proper care of cats. “This water burns the demons,” the exorcist explained as he pushed the kitten’s outstretched nose away from the bottle’s mouth. Along with his recitation, these bottles were meant to render the living room a severely hostile climate for any demon present.

The exorcist then collected the cats present in the room, and exited. The young man’s mother turned to us and smiled, gesturing politely toward the makeshift treatment chair. “No, no,” I responded with a polite smile of my own. “We’re just here to observe today. Please, go ahead, tfeddli.”

“You were at the Clinic?” She then asked, eagerly. Her eyes were soft, tired. I nodded, and explained that I work there.

“My son spent a few weeks there,” she then revealed, in echo with the exorcist. She cocked her head to the side, implicitly gesturing toward the young man beside her.

“Were the doctors able to help him?”

She nodded. “It was good,” she explained, her story now diverging from that of the exorcist. “He got better. And the medication helped. He took Nozinan?” (6). The question mark in her expression and tone sought recognition. I nodded again; “Yes, I know that medication. I’m glad it helped your son.” She smiled, then sighed.

“But the hospital is far away, and those pills are expensive. So now we come here. This is good, too.”

The exorcist now walked back in, his wet forearms suggesting that he had just performed the ritual ablutions required in preparation for any reading of the Qur’an. With an outstretched hand he invited us to take our seats. We politely but firmly declined, explaining that today, we would just be observing.

“Are you sure you don’t want to come and sit here?” He urged again, smiling seductively. “Don’t be afraid!”

We declined once more, and he moved on to invite mother and son. He helped them settle in, adjusting cushions and encouraging the mother to lean back, take a load off. He then placed a hand flatly on top of her head, locked eyes with her, and simply began.

His recitation was melodic; a calm trickling stream of words that seemed instantly to soothe his two patients. They drifted back into the cushions, limbs visibly releasing muscle tension, and their eyes gradually fell shut.

I looked around the room as he recited. Its bright light snuffed out any hint of ceremony. In fact, the exorcist had done nothing to mark the occasion of a ritual. Other than the washing of his forearms, nothing signified any departure from the ordinary flow of day-to-day activity. Through the open living room doors, we could hear the exorcist’s daughter tending to her daily responsibilities in the kitchen; cats settling squabbles over in their feline village. An open window sent in the sounds and smells of the busy street below. Cats wandered in and out, settling down on the carpet and joining in on the recitation with a baseline of purrs.

The exorcist occasionally broke up the steady flow of his words with unexpected bursts of volume or tone. But even these vocal surprises failed to trigger the kind of reaction that he was looking for. His patients remained frustratingly calm. After about 10 minutes of unsuccessful recitation, he stopped.

“Do you feel anything?” He asked. Mother and son shook their head in denial, never losing eye contact with the exorcist. “Nothing?” He asked again, to verify. “Any anger, sadness?” Again, a negative response. He turned to us with the same question; we, likewise, could only deny. The shaking of my head gave expression to my silent sense of relief.

And so the exorcist continued, returning to the calm cadence of Qur’anic Arabic. The two patients sank back into the cushions, closed their eyes, and drifted off once again. A group of cats had now begun to stir. A creature or two secured the grappling hooks of their nails securely in the fabric of the sofas, and proceeded to climb up, down, and across the cliffs and rises of its cushions.

With a jolt, the young man suddenly sat up and opened his eyes.

A kitten had made a leap from the couch cushion behind him, and landed with a thud on the young man’s shoulder. He looked down at the creature, bewildered. Then picked it up, and put it down on the sofa beside him. He tried to settle back into his groove, but his concentration was gone; the cats’ invasion of the sofa was irreversible.

The exorcist continued, seemingly oblivious to the feline interference. He coaxed and pleaded with the demons he believed to be present, playing good-cop-bad-cop with a voice that alternated between soothing recitation and violent syllabic bursts.

When, after 30 minutes, he still had not produced the desired response, the exorcist finally gave up. “Nothing?” he asked, once more. His patients once again shook their heads in denial, their expression almost apologetic. They thanked the exorcist with a shake of the hand, and left the apartment as silently as they had come.

The exorcist turned back to us with the same question. “Nothing?”

We, too, shook our heads in synchronized denial. We scootched forward on the sofa, eager now to end this evening and return to a sense of reality.

“I’m sorry that tonight wasn’t more interesting,” the exorcist continued. “Sometimes recitation just doesn’t work. I know why; it’s those sorcerers, they make… what do you call those? That you hang around your neck?”

“talismans?” Claire offered.

“Yes, talismans. They protect the demons against the Qur’an, so my treatment doesn’t work. Anyway, you must come back some evening; hopefully next time it’ll be more exciting. Marhba, Marhba.”

We had, subtly but surely, managed to stand up and inch our way out of the living room. We moved as though we were trying to slip out unnoticed, an abrupt goodbye seeming like too rude a gesture after this man’s generous though bizarre form of hospitality; too rude a rupture to the natural flow of his stories. We walked to the door with the exorcist in tow, soliloquizing; until our hands on the door knob harmonized with another “marhba, please come back,” and the click of the door unlocking put a final period behind this evening’s odd experience.

(1) Moroccan sofas

(2) Between the evil eye and a sorcerer, the exorcist here suggested that possession always occurs through the interference of a willful, flesh-and-blood agent. As far as I know, this theory is a departure from the general popular lore on spirits – which holds that possession could occur any time one crosses a spirit the wrong way.

(3) Implicit in this account is a theory that I’ve heard elsewhere: sorcerers employ physical objects in the casting of their spells. These objects are then buried in a secret location; finding that location is the key to undoing the spell.

(4) The exorcist discussed his religious education, but never actually gave himself a title. But, given his methods and knowledge of the Qur’an, I assume that he would be considered a fqih.

(5) The exorcist used the word “to live;” he specifically did not use the word ‘hospitalization’, but I wonder if that is what he meant.

(6) Nozinan is an anti-psychotic.

Beating the Odds?

I’m writing a second piece on the same patient, for a change – because Soukaina’s story isn’t finished. In the weeks since I posted my initial description of her, she has truly and amazingly come alive. She has cast off her shadows, and seems to have beaten the depressing psychiatric odds with which I ended that first post.

It began with laughter. A kind of bubbling energy she simply could not keep inside. An entire Thursday morning meeting once played itself out to the underlying soundtrack of Soukaina’s bursts of hilarity. Like a steady rhythm, she accompanied other patients’ words, sighs, and tears with her own uncontrollable snorts, giggles, and whinnies. The same impulse would get the better of her when out and about on the ward; the tiniest odd sound could set her off. She tried to hold it in, she really did – hands shielding her mouth like a prison door, the head pressed tightly into her knees, she did her best to maintain an internal sense of order. But to no avail; she seemed beset by an effervescence too large for her small frame.

Her laughter then paved the way for words. Cautious utterances at first: a tentative “mezyane” (good) or “nglis?” (can I sit?). But with every passing day, her voice grew stronger and her communicative overtures bolder. And last week, this development culminated in an actual conversation. She and I sat side by side on a bench in the sun, my hand in hers, as she asked me question after question. Where was I from? Where were my parents? Did I have brothers and sisters? Where did I live now? Did I live alone? What was my job at the hospital? How old was I?

This conversation likewise had its own laugh track. Everything I said prompted a burst of giggles. Maybe, I remember thinking self-consciously, it’s my horrible pronunciation of Arabic. Maybe it’s my strange blonde hair, or the way I look at her. But maybe it’s simply her own joy at the lifting of that mental cloud – and maybe it’s all of those things at once.

But mostly, I remember, I simply had the urge to giggle along with her. I responded to each of her questions with one of my own, and I reveled – as she sat there with her eyes full of recognition; as she revealed her self to me. I reveled in the possibility of being able to actually listen to her.

There was an urgency to it all. We talked as though we were making up for lost time – or perhaps as though we were afraid this window might close up just as quickly as it had opened. But the next morning, when I found her again in the courtyard, our conversation simply continued.

This time she requested to see photographs of my family. I took her with me to the doctor’s office, opened up my laptop, and showed her a collection of pictures. Again, her reaction was strong and fizzy. It was the details that seemed to strike her most – the color of my sister’s dress, my father’s glasses, a can of coke in the background somewhere. It all met with an explosion of laughter, and constant, repetitive requests for me to explain what was shown in the picture.

After lunch on that same day, it was she who dragged me back to the doctor’s office. I once again opened up the pictures of my family – but that’s not what she wanted, this time.

“Show me pictures of the king of America,” she now demanded.

I smiled, toyed briefly with the idea of interpreting that creatively, then connected to the internet and searched for a few pictures of Barack Obama.

Soukaina showed a decided preference for a set of photos depicting the president along with his family. Old wedding pictures, or professional portraits of the Obamas with their kids. Again Soukaina responded with laughter, and endless requests for me to identify each individual in the frame.

Her favorite photo of all showed Obama’s two young daughters, gleaming on a stage somewhere – a snapshot moment during the campaign trail, no doubt. Soukaina stared at it for a while, as though caught by something; then pointed to Malia’s dress and looked me in the eyes.

“what do you call that color in French?”

“Rose,” I responded. “Like your pajamas.”

Soukaina looked down at her own chest, looked back up at the picture, then turned to me.

“Rose,” she repeated, and once more burst into laughter. She leaned in, hugged me close, then kissed me on the cheek. I couldn’t help but laugh with her. I was mystified by the connection she had just somehow made, the recognition she had found in that picture of two unknown girls –

… but I loved it.

And I hope with all hope that she holds on to this clarity and joy…

An impossible Choice

Wherever the action is, there you’ll find Soukaina. She spends her days strolling along the ward’s courtyard, observing life as it is lived by her fellow patients. Not yet 15 years old, she is always dressed in the same stained pair of pajamas; her feet drag along a pair of pink plastic slippers, and her hair is haphazardly covered by a disheveled headscarf. She makes her rounds at a steady pace, arms swaying heavily by her side, shyly looking around at her passers-by. She halts in the occasional doorway, quietly watching as other women are having coffee with their visitors. Then she moves on to investigate what’s going on at the end of the hallway there, where her doctor is conversing with an anonymous face. She makes a u-turn, stopping briefly to poke her head inside the nurses’ office, then fixes her attention on what the gardeners are doing to the bed of roses in the courtyard. She finally ends her tour by settling down beside the group of women seated on a bench, basking in the morning sun.

Soukaina always maintains a bit of distance. She does not like to be touched; any well-intentioned attempt to shake her hand, or make an offering of candy, invites a subtle dance of evasive shifts and shakes of the head. Soukaina has a voice, but prefers to parcel out her words in great moderation; any verbal overture is shyly answered with a quick and tiny smile. At every Thursday morning ijtima’, Soukaina’s doctor performs the ritual of trying to coax out a phrase or two. “Kif bqiti?” she’ll ask, her voice sweet as honey – how have you been? Each week, these questions hang suspended in the air, lonely and heavy with awkwardness, until a few other patients decide to speak up on Soukaina’s behalf. “Oh, the other day she was so chatty!” they’ll say. “Soukaina loves to talk with me, we were laughing and crying together all afternoon!”

***

Soukaina has been on the ward for as long as I can remember. She was there when I first arrived in November and has been a stable presence ever since, quietly strolling through the corridor as other patients come and go around her – like a fixed point of light within a changing image. Over the course of these long months she and I have made slow but steady progress in the buildup of a communicative routine. By January she began to return my greetings with a smile; by February she developed the habit of sitting down beside me as I wrote up my notes, occasionally stretching out a cautious but pioneering finger to get a physical impression of my notebook. By March she began to ask me for the time – always a rapid whisper, barely audible, but words nonetheless! – and by April, she took to following me as I made my own rounds across the ward.

It was around this time that Soukaina was briefly discharged. Her absence did not last long, however; she had spent not four weeks at home with her family before she returned to the hospital and once again took up residence in her old room, as though nothing had ever changed.

Yet something had changed.

I had always thought of Soukaina as an empty notebook; as a set of pages without a story. Beyond the smiles, her eyes were blank – an infinite whiteness that led me to see Soukaina as a moving body without emotions, a conscious mind without thoughts.

This new, re-hospitalized Soukaina remained mute, but now the light seemed to have been turned on behind her eyes. The blankness of before had made way for images, for bright colors in broad brush strokes. I saw an abstract painting, now; a palimpsest of stories each racing out to envelop the beholder.

For a few days, the entire ward reveled in what we thought of as a very pleasant change in Soukaina. Her smiles had become broader, her voice more solid, and her eye-contact more eager. Real communication had begun to seem like a possibility.

Then, from one day to the next, the smiles disappeared. I arrived on the ward one Monday morning to find her sobbing in the courtyard. She saw me as I entered, ran over, and grabbed my hands. For the next three hours, she refused to let go. She dragged me along as she walked restlessly through the corridors, drawn mostly toward the exits – as though she was waiting for someone, or something. The stories in her eyes had become jarring, glaring, frightening in their blackness.

Apparently it had been this way all weekend. “Meskina,” the nurses sighed. “The poor thing – she’s suffering from horrible anxieties and hallucinations.” Whatever had turned on the light behind Soukaina’s eyes had also unleashed something sinister – a monster seemed to have emerged from the shadowy recesses of her mind and now haunted her without reprieve.

Whatever it was, it had exhausted Soukaina’s small body; whenever I managed to sit her down for a moment, her head would begin to loll with the heaviness of sleep, her entire body heaving in yawns of primordial force. Yet she refused to lie down in her bed for a nap, no matter how sweetly our coaxing – and how potent the sleeping pill she’d been made to swallow. It seemed that circling around the ward was Soukaina’s only source of comfort at the moment.

As she pulled me along, I tried to ask her what the matter was. “Yak la bas?” What’s wrong? And Soukaina would simply look at me, a heart-wrenching urgency in her eyes. Her mouth would move, but the sounds remained stuck in her throat. Breathing heavily with the weight of anxiety, she simply pulled me closer, grabbing my forearms now, as the tears ran down her cheeks.

***

Soukaina has schizophrenia, but the autism she was born with has pushed the mute button on her suffering. She is haunted by terrifying delusions and hallucinations that she is unable to communicate to the outside world; she is imprisoned in the tower of her own mind, with a monster in her cell.

Soukaina had always been on Clozapine, a relatively old anti-psychotic drug usually prescribed only as a last resort for those who don’t respond to anything else – because while highly effective, Clozapine comes with a high risk of potentially life-threatening side effects. The drug had pulled a heavy blanket of sedation over what little communicative ability Soukaina had had. But at least, her doctor reminisces, it had gotten rid of the hallucinations - and it had left her calm, content, “gérable."

Soukaina’s parents, however, had not been satisfied. They remembered Soukaina as she had been before illness laid claim to her mind – peculiar, yes, but nevertheless talkative, receptive, capable even of going to school. Hoping for a better outcome, her parents had convinced Soukaina’s doctor to re-hospitalize her and try a new approach to treatment.

“But do you see what happens when you mess with something that works?” The doctor sighs. “All we’ve managed to do is de-stabilize the patient.” Hopefully, she adds, the parents will now realize that Clozapine really wasn’t all that bad.

***

What I find saddest of all about Soukaina’s story is that the doctor has a point. While it may be tempting – worthwhile, even – to dream of perfect cures, there are times or cases in which the reality of psychiatric treatment forces one into an impossible choice between two very imperfect options. While listening to the doctor talk, I had the urge to protest. Could “calm and manageable” ever be a desirable outcome for anyone, given the beauty and creativity that the human brain is capable of producing? Is it ever acceptable to accord someone a fate of diminished mental capacity, if the trade-off is a reprieve from psychiatric symptoms?

It isn’t. Yet I realize that this is not what the doctor is arguing for. She does not see “gérable” as the ideal end-result of Soukaina’s treatment. Not in the least. But in her capacity as a psychiatrist, she is nevertheless compelled to play the role of the realist. And the heart-wrenching reality of this situation quite simply is that Soukaina has to choose between freedom from hallucinations, and freedom of communication.

Freedom of Expression

It is Thursday morning, and the patients and doctors of the open women’s ward are gathering in the lounge for the weekly ijtima‘ – an hour or so of sharing stories, experiences, and impressions of life at the hospital. As the women take their seats on the couches – traditional design, but with a modern twist – the hum of excited whispers hangs in the air. There’s been conflict in the corridors this week, and the patients are expecting the issue to come to a head at today’s meeting.

This morning I sit next to Nadia, a woman in her fifties who has been hospitalized for treatment of depression. She’s been here for a few weeks now, and is clearly doing better. She no longer isolates herself in her room, and she’s become more talkative of late. She’s gotten back into the habit of applying eye make-up in the morning, and the curl has returned to her short, auburn hair.

She is slightly restless this morning as she listens to her fellow patients’ stories. The group’s anticipation has been satisfied; the two women engaged in conflict have indeed brought their issue to the meeting. It’s a dispute over religious freedom: whereas one party claims her right to religious expression (in her case, the vocal recitation of Qur’anic verses in the ward’s corridors), the other argues for her right of protection from religious indoctrination (especially at ten o’clock at night, when she would prefer to be sleeping). With building emotion, the two women explain their viewpoints to the group; the doctors are barely able to maintain a sense of order.

It is a heavy topic for any group of Moroccan women to stomach on a given Thursday morning. Yet it’s not the content, but the form of the argument that prompts Nadia to lean in and whisper a question in my ear.

“Can you follow all this Arabic?”

I smile, make a gesture with my head to imply that I’m getting the gist, and suggest we try to listen. But Nadia isn’t done yet. She leans over again, seeking understanding in my eyes.

“I have a really hard time understanding Arabic,” she confesses. “I’m not used to it at all.”

And indeed; when it’s Nadia’s turn to talk, she makes a point of announcing that she’d rather speak French. She cannot express herself as freely in Arabic, she explains to the doctor – whose nod of the head indulges Nadia in her request. And so Nadia begins, noticeably changing the tone of the meeting as she informs her audience, in that soft lyrical French of hers, that she had a good week. A few women shift in their seats, straightening their spines, and a subtle sense of formality seems to have impregnated the air around us. All disruptions have come to an end; even the bickering party is now silently listening. And then – just like that, in a blink of an eye that completely negates the gravity of her original request, Nadia downshifts back into Arabic, formulating her closing statements in the local dialect.

***

Nadia identifies herself as Moroccan, and as a Muslim; she says she is proud of her cultural heritage and of her family’s illustrious history. Nevertheless, her words and behavior always betray an apparent need to separate, to distance herself, from mainstream Moroccan consciousness. Contradiction and juxtaposition weave themselves continuously in and out of her autobiography; they are the backbone to her stories’ continuity. She was born to a conservative family and raised in Fes, that bastion of tradition – but she was educated at the French mission’s schools, and walked around her neighborhood’s streets in pigtails and short skirts. Her siblings all followed in her father’s footsteps by pursuing degrees in theology – but Nadia chose instead for a career in medicine. Arabic is the language of her country and her family – but Nadia prefers French, the language of international sophistication. And finally, her sisters have all been unhappily married for upwards of 25 years – while Nadia is a divorcée who’s had several long-term boyfriends.

The status of being divorced exerts a major gravitational pull on her narrative of juxtaposition. It is the dominant cause of her sense of difference; all other facets of her identity revolve around the epicenter of its force, twisted and bent in their own path of expression. Nadia tells me several times that divorced women are “très mal vues” in Morocco; on the scale of status, they rank lower yet than donkeys. She feels that other women – her doctor included – are both unable and unwilling to understand her lifestyle of sexual independence. Utterly incapable of imagining how that kind of freedom might taste, these women cower away in fear of transgressing such moral boundaries themselves. As we sit in the ward’s courtyard, Nadia points to a handful of other patients walking around: these individuals refuse to talk to her, she says; they treat her like a leper. “They must have been married as virgins,” she concludes with a sigh.

Men are not much more capable of comprehension, Nadia laments during our next conversation; sadly, she does not derive much fulfillment from the “amis” she’s had. Moroccan men do not understand her needs. However enlightened or “moderne” they may have claimed to be, her boyfriends nevertheless all expected to be wined and dined – “by me, a doctor, for goodness’ sake!” Nadia exclaims in lingering outrage – without providing much in the way of commitment in return.

To Nadia, Moroccan culture is the source of her illness. Her depression was born of suffocation; a case of asphyxiation by the insurmountable baric pressure of cultural mores and taboos. She spent a few years in France, and remembers it as a place of lightness and air, without a care in the world to weigh her down. The thick, winter blanket of sadness did not descend upon her until she returned to her native land, 15 years ago. I thus begin to wonder if her preference for speaking French might simply be driven by the need to breathe. Perhaps that speaking Arabic – a language indelibly linked to and thus bound by Moroccan standards of (expressive) propriety – feels to her like breathing air deprived of oxygen. Might French then be her escape hatch, a seam in the tightly spun fabric of moral codes? A helium balloon that lifts her high beyond the reach of Moroccan gender expectations?

Regardless of her feelings about Arabic, however, Nadia also speaks French, quite simply, because that is how she was trained. After an education at Morocco’s French schools, a medical degree, and a life lived in Morocco’s elite social circles, it is no surprise that Nadia is more easily able to express herself in French than Arabic.

To her, in any case, this linguistic preference in no way precludes her identification as a Moroccan woman. Though Nadia may take issue with what she sees as certain outdated standards of propriety, she eagerly joins in on conversations about local cuisine, asserts herself as an expert on traditional wedding attire, and confidently proclaims that, even if she does agree that Qur’anic recitation should be reserved for the privacy of one’s room, she believes in the Holy Book’s absolute truth. Nadia’s Moroccanness may be a little particular, a pick-and-choose sampling of the full available menu – but it is nevertheless genuine.

To other patients, however, Nadia’s frenchness signals a pollution – a threat, even, to the authenticity of the ward’s Moroccan identity. And like Marwa before her, she elicits the occasional hostile reaction.

In one such case, the hostility came from Halima, a fellow patient who happened to overhear Nadia in conversation with the parents of a newly admitted young woman. Nadia had eagerly asked the French mother of this young patient where she was from, and then began to share her own pleasant memories of time spent in that particular city. Halima had been standing nearby, and now approached to hiss at Nadia, in French:

“Stop bothering these people, they’re here for their daughter; they don’t want to talk to you!”

Nadia looked at her calmly. “I’m just trying to be friendly, Halima,” she explained. “I just want to make them feel welcome.”

The couple in question listened in slightly disconcerted silence as the two women continued their argument over their heads. Halima had retorted that this couple had no need for a welcoming committee; they’d been living in Morocco for years now. Upon which Nadia had responded that it is always nice to exchange memories of other places, and to hear about familiar cities in France.

Halima, at a loss for a witty retort, responded with an angry look and then grumbled, in the local dialect: “well, I’m Moroccan, and I’m Muslim. I’m proud of it, and I’m going to speak Arabic.”

“But that would be impolite,” Nadia responded in French, calm as ever.

“Not at all,” Halima corrected, still in the local tongue. “These people live in Morocco; they understand Arabic perfectly.” And with that, she walked away.

Nadia turned to the couple, and offered them an apologetic smile. Then she looked at me.

“Do you see these Moroccan women?” she asked. “They’re so short sighted, they don’t understand any lifestyle that doesn’t resemble their own.”

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

Chatterbox

Hafida is 57, though you wouldn't say so if you saw her. The years seem to have weighed more heavily on Hafida's shoulders than on those of others. The passage of time has etched deep wrinkles across her forehead, and her deep-set eyes betray the depth of her exhaustion. She shuffles around the ward in pink hospital-issued pajama's, three sizes too big for her skin-and-bones frame; with her back hunched forward she’s forever looking down at her feet. She always carries around a big woolen sweater, as though she is planning ahead for an upcoming departure. But other than a dubious brother and a modest pension fund, the doctors tell me there is little waiting for her at home.

"On fait avec," she answers with a sigh and a smile, every time I ask her how she's doing. "On fait avec," 'we do the best we can.' According to Hafida, her best days are behind her. She is old and tired; her life has been reduced to the nostalgic memory of opportunities and experiences that have long since retreated beyond her grasp. She believes she has exhausted her potential, and her candle’s flame has been all but blown out.

The doctors tell me that her “tristesse” is part of her illness. She has schizo-affective disorder, an illness in which the normal manifestation of schizophrenia is compounded by an extreme fluctuation of one’s mood. Yet I cannot help but wonder, who wouldn’t be exhausted after 30 years of hearing voices in your head?

But Hafida is still full of wisdom and stories. As we sit on a bench in the sun, just the two of us, she talks about the important things in life: about love, adventure, and good health. These are the kinds of values, she impresses upon me, of which you don’t realize the importance until it is too late. She advises me to love fully, and to express my feelings. Too many people have locked their hearts, she says. Little do they know that true blindness is not the inability to see, but the inability to feel.

In the same way, our ability to hear means nothing if we cannot listen. When she learns that I am Dutch, she tells me in a mixture of English and rusty German that she made her career as a professor of foreign languages. She speaks at least four different ones – but the most important language of all, she tells me, is “la communication des sourds” - the communication of the deaf. True communication, she explains, requires much more than words. One must be open to, interested in, and understanding of one’s interlocutors. One must always remain curious. In fact, this is the meaning of life: discovery, adventure, and learning. When she was younger, she says, she was like me: as I am exploring Morocco, so she explored Europe. But what you can do, she sighs, when life’s obligations curb your freedom to fly? She impresses upon me the importance of continuing my pursuit of discovery – of never allowing my heart to lock itself into blindness.

***

A few days before her discharge from the hospital, we meet once again on that bench in the sun. We are chatting in our usual mixture of Arabic, French, German, and English, when she unexpectedly turns to me and apologizes for talking so much (little does she know how much I’ve enjoyed listening to her). She wants to know, how do you say “bavard” in English?

“Chatterbox,” I translate.

She nods, and smiles. She likes this word. She is a multilingual chatterbox, she says, who has begun to lose her words. With age, her knowledge is slipping and she no longer speaks any of her languages perfectly.

“Before long,” she concludes with a smile, “I’ll just be an empty box.”

I want to tell her that she need not worry, that she still has plenty of words and stories to fill a lifetime to come – that her candle is not even close to burning out. But I keep this to myself. Nostalgia aside, I’m beginning to realize that Hafida yearns for mental quiet. She has lived a lifetime with an endless stream of verbal commentary running through her mind; I cannot help but think that the prospect of an empty box might finally bring her the relief she’s been seeking.

A Conspiracy Theorist

Whether it is day or night, Marwa always wears her sunglasses. For a while she wore earplugs, too (is she shutting out the world?), but these disappear after a few months in the hospital. She comes out of her room around 10 o’clock each morning, her head held high and her sharp nose protruding forward in a gesture of pre-emptive haughtiness. A lit cigarette in one hand and a bag or stack of books in the other, she lingers around the ward’s courtyard telling whoever wants to listen about the latest conspiracies she’s uncovered. On a good day, she talks about ongoing disputes between the stray cats that live on the ward; on a bad day she insists that the hospital is about to suffer an attack by weapons of mass destruction – or that George Bush and Osama bin Laden are secretly meeting to plan their takeover of the world.

Marwa does not adhere to the communicative rules of the ward. She cannot keep quiet during the weekly meetings, at which patients are expected to sit quietly and listen to one another as they report on how they passed their week. Despite her best efforts Marwa continually interrupts with questions, demands, and propositions. And rather than talk about her mental condition, she prefers to pose philosophical questions to the group: if one does not cry, does that mean one does not suffer? What is the meaning of silence? And should psychiatrists, in the interest of remaining morally neutral vis-à-vis their patients, be atheists?

She also refuses to speak the appropriate language. She insists on speaking French or English as she tells me about the years she spent in the US, the life she had in Paris, friends who work for big multinationals, and about how she was the first person to ever eat cereal with chocolate milk. At multiple occasions, other patients around her grumble with frustration. She’s just as Moroccan as they are, they remind Marwa; get off your high horse and speak Arabic like the rest of us! Upon which Marwa looks down her nose, tells them that “vous comprenez très bien le français,” and continues her story.

And finally, Marwa says the unsayable; she breaks all taboos. She laughs about her own promiscuity, and argues that the Prophet Mohammed was a pedophilic rapist. Her sacrilegious talk has led to numerous heated arguments with other patients, and to at least one patient’s attempt at exorcising the evil spirits that must be haunting her (while Marwa, cool as a cucumber, simply remarks that it is not she, but the exorcising patient who is really ‘possessed’).

I am not allowed to interview Marwa, lest my tape recorder become the object of another conspiracy theory. But my initial unease with her stories (how to react when someone tells you about military bases on other planets?) quickly transforms into endless fascination, and she is happy to have found a gullible listener. What I love most about Marwa is that to her, life is a reflection of literature. Her books – a collection of aged French paperbacks – are her treasure. She keeps them hidden underneath the blankets on her bed, and always carries a few with her when she’s walking around. In these books, she finds solid proof for her theories. She passes effortlessly through time and space, reality and fantasy, to expose hidden connections between certain people or events. The true mission of the helicopter from Black Hawn Down, she tells me, was the search for a pirate ship with gold. And Hitler is in reality the reincarnation of a 17th century French author. Here, she says, pointing to a drawing in one of her books. Do you see the resemblance in this portrait?

And the thing is, I kind of do. I cannot help but smile.

In turn, literature also becomes a reflection of life. Amongst her books Marwa has notebooks in which she is writing various novels. Fantastical stories they are, involving reincarnations, bodily possession, and time travel. They’re all true stories, too, she says. It’s all happened to her at one point or other, she explains as she puts a smile on her face, stares into space, and reminisces about boyfriends in Paris or international heists she pulled with the CEOs of various companies.

For the other patients, Marwa is a prime example of what it means to be “folle,” crazy. But as preposterous as most of her stories are I am increasingly inclined to wonder if she is mentally ill, or simply eerily perceptive. Her characterizations of other people (doctors, patients) are often dead-on. She imitates them perfectly, getting their gait, their catch-phrases, even the look in their eyes just right. And once in a while, her theories of hostility and conspiracy expose painful anomalies in the hospital’s daily rhythm of life – anomalies perhaps much less ill-intentioned or serious than Marwa perceives, but true nonetheless.

And so I wonder, might there be some grain of truth to her other stories as well? If we take the literalness of her stories with a grain of salt – if we look at them with unfocused eyes, as it were – and interpret them a little more abstractly, might she not be on to something?

Besides, who are we to decide what’s true, anyway? It might be worthwhile just to sit back, smile, and let Marwa take you on a ride of fantasy and excitement...

Reflections on Fieldwork at the Clinic

Tomorrow marks the end of my fourth week of research. And after twenty mornings of observation, 4 different wards, and more than 50 typed pages of field notes, I’m more excited than ever about this project.

I start each day at the réunion de staff, a meeting in which the residents and professors get together to discuss all new admissions of the day before. Afterwards I head to one of the wards, where I observe the daily goings-on. I sit in on medical consultations or meetings between nurses. I participate in recreational activities for patients, walk around the ward, look at the schedules and announcements posted in the nurses’ office, get a sense of the way in which records are kept, listen to doctors discussing treatment options with one another, or simply sit in a chair and watch. I have informal conversations with the staff, in which I’ll ask them about their method of diagnosis, their protocols for treatment, or about the backgrounds of their patients, and they’ll ask me about my research plans.

For the moment I am simply an observer; apart from these informal conversations I’m not engaging in any actual interviews yet. But even just these brief mornings of watching have produced more data than I had ever expected at this stage of research. Everything I see and hear at the Clinic is material. I’m picking up data and learning new things at multiple levels, all at the same time. I’m learning linguistically: I write down the French terms for disorders, symptoms, and other phenomena. I’m becoming so used to being in a francophone hospital environment that I’m beginning to have trouble thinking of the English equivalent for words like prise en charge (care), sevrage (withdrawal), or infirmier chef (head nurse?).

At the same time, I’m learning on a medical level: I’m becoming familiar with psychiatric symptomatology, its clinical presentations, and its biological consequences. I frantically write down every snippet of general medical information that I glean from my observations, and spend most of my afternoons googling the names of medications I’ve seen prescribed, the workings of different neurotransmitters, or the DSM-IV description of personality disorders.* I’m learning about the Clinic’s procedures for admission, treatment, and discharge, as well as national laws governing hospitalizations, and am getting a sense of how clinical observations are recorded and communicated between doctors and nurses.

And finally, I’m gathering ethnographic data. I observe how residents interact with their professors, how doctors talk to nurses, and how staff communicate with patients. I’m getting a sense of how patients express their symptoms, and how doctors listen to these explanations. I’m taking note of the gender balance and how this affects the relationship between patients and staff. I’m beginning to get a sense of how psychiatric theories interact with popular belief in spirits and magic, how medical knowledge is imparted to students, and of how medical expertise lends power.

All of this data makes for almost incessant note-taking, and a bit of internal conflict sometimes about what to write down, and what to let slide. In that sense I’m also learning about myself as an observer – about what I pick up on and what I miss, what I consider important, and how I position myself vis-à-vis the people among whom I am doing research. I spend a fair amount of time talking to two other foreign women spending some time at the hospital – a student of clinical psychology and a psychiatrist. As we exchange impressions and reflections, I find a lot of my observations reinforced, but also curiously take note of differences in interpretation, or of interesting bits of information I had completely missed. Their viewpoint is valuable to me – the extra eyes and minds add more data to my notes, but also allow me an additional dimension of reflection on what I’m seeing. Their experience of clinical practice in France provides me with a valuable comparison for the things that strike me about psychiatry here, and provide me with a sounding board on which I can test some of my own budding interpretations.**

This wealth of input only makes me hungry for more, and I’ve never felt more motivated or energetic about my project. At the same time, however, the wealth of sensory input gets a little overwhelming sometimes. There is so much to take in that I feel as though I’m left without enough time to process it all, to wrap my head around it and make sense out of what I’m seeing. As far as my ethnographic work is concerned, this might not be something to worry too much about. There’s something to say, perhaps, for just diving in at this stage of the project – of immersing myself completely and just letting it all flood over me. It might even be too early to try and distill some interpretations or theories out of what I’ve seen – if I draw conclusions now, perhaps I’ll blind myself to new evidence that might contradict what I think I’ve learned?

But personally, it’s difficult sometimes to relinquish that sense of control, that sense of knowing what’s going on. And for the purposes of this blog, I do wish that I were a little bit more able to distill a few coherent ideas out of my field notes, just enough for a post or two. There is so much I want to write about – the communication between doctors and patients, the concept of ‘psychiatric expertise’ and the way in which it shapes that communication, the notion of hysteria (so outdated a term in Europe and the US, but so commonly used here), the role of gender in shaping interactions, treatment plans, and diagnoses. All of these ideas are floating around in my mind, but I just can’t seem to find enough clarity to pin them down with adequate, descriptive words. Hopefully I’ll find a bit of coherence in due course. I’ll try to keep posting about once a week – and I’ll try to return to writing about things other than my research, as well.


* This level of learning has made me particularly conscious of how much I miss medicine. How intrigued I am not just by the human mind, but by the human body as well. I don’t want to use the word regret because I don’t for a moment regret choosing anthropology, but I do regret making a choice in general; I regret having decided at some point that I wouldn’t be able to do both medicine and anthropology. It’s never too late, I suppose, and in theory I could apply for medical school once I finish my PhD. When that time comes, I guess I’ll have to ask myself what I’d rather do: start another rigorous four years of education when I’m in my early thirties, or spend the rest of my life knowing that a part of me will always miss medicine?
** In addition, I’m finding it incredibly valuable to be able to talk about what I’ve seen with others who have shared the experience. I’m observing at the Clinic’s emergency room this week, and a few of the people who’ve come in for psychiatric help have really struck me in their sadness and hopelessness. More so than on the other wards, observation this week has affected me emotionally, and it’s been helpful to talk about these observations with others who were there.

Ethnography of a Psychiatric Ward: The Meaning of Psychosis

“What’s the point?” she asks. She looks fragile as she sits in that chair, her shoulders drooping and her face nearly hidden by the pink hoodie she’s pulled over her hair. She looks at the doctor with a bit of frustration in her eyes, her hands digging themselves deeper into her hoodie’s pockets.

“It’s gone, and I feel good. Isn’t that all that matters?”

Doctor Mourad leans back, and lets out a subtle sigh. Then he responds:

“But it’s important that we talk about this, you and me, so that I can help you.”

The consultation is suddenly interrupted when the door swings open and another resident walks in. She shares this consultation room with Dr. Mourad, and she’s here to pick up her bag. As the two physicians exchange a few pleasantries, I notice the patient’s head sinking lower and lower, until it is cradled by her hands. Rhythmic tremors running through her shoulders betray that she is crying.

But she has not given in. After the female resident leaves, Dr. Mourad tries again, to no avail. He is hoping to convince his patient to talk about her experience of possession by what she calls a diable, a devil (or, in Arabic, a shaitan*). I cannot help but think that he’s doing so in part for my benefit; ever since the doctors on this ward have learned about my research interests, they are constantly calling me in to observe their interaction with patients who claim to have been possessed or cursed – an experience the doctors categorically define as a particular kind of hallucination. None have been as unwilling to discuss the subject as this young woman, and I am struck by her defensiveness.

Her next argument calls on notions of expertise and authority, as she hopes to excuse herself from the responsibility of having to explain what happened to her:

“You shouldn’t ask me,” she says. “I don’t know anything about jnoun, diables or shaitans. All I know is what it says in the Qur’an. If you want any explanations, don’t ask me. You need to talk to an expert, some kind of scholar.”

The doctor tries to explain that he’s not interested in theory; he just wants to know what happened to her. But it’s no use, and a few minutes later we escort the patient back to her room. She’s staying in the closed women’s ward: a dreary concrete courtyard where about twenty five very sick women spend their days doing little more than wandering around. Paint flakes off the walls and ceilings, there is little more than a few rusty old hospital beds to sit on in the recreational room, and a stale smell of abandonment hangs in the air. It is a far cry from the state of the art facilities where I spent my first week at the Clinic. Having moved on to a third ward at the time of writing, I’ve learned that this closed ward is by no means representative of the rest of this hospital. Nevertheless, it struck me in its sadness, and I think the difference in environment between this and other wards is worth exploring.

The dreariness of this ward is matched by a complete lack of stimulation or activity for the patients. Doctors tell me that a hair dresser comes to the ward to do the patients’ hair once in a while, and nurses will sometimes hang out with the women, listening to music or dancing a little. But there is no exercise equipment like there was on the addiction ward, nor are there musical instruments, books, or a television. Nothing is allowed on the ward; in their psychosis or suicidality, a fair amount of these women cannot be trusted not to do something harmful. On the one hand, I wonder how these women make it through the day, with nothing to do. On the other, even I can see that the majority of these patients are too sick to be able to participate in any kind of activity.

Most of the patients on this ward suffer from a psychotic disorder. They are heavily medicated: each morning, the nurses enter the ward with a tray full of Haldol, Largactil,** and other anti-psychotics and tranquilizers. The medication is often administered by injection – pills can be refused, I guess. There is no privacy; each room accommodates five to six women. Without curtains or doors to hide behind anywhere, patients are injected right there on the courtyard, en plein public.

Despite this medication, the women seem truly sick. Many of them spend their days walking around the courtyard, talking animatedly to the voices in their head. They slur their speech when they talk, and jump from one subject to the next. They crowd around the locked glass door that separates the ward from the nurses’ area, and sing famous Sherine songs.*** When they notice me, sitting there with the staff, they blow me kisses, and call out that I’m trop belle. A few of them even begin to recite the Fatiha, the first verses of the Qur’an. I’m struck by this ‘strange’ lack of inhibition, and take it as a sign that these women are really sick. Nevertheless, when that glass door opens and they all come in to greet me, they are friendly, and normal, and simply curious. They just want to know my name, where I’m from, how I’m doing. The next day, I see genuine recognition in their eyes as they greet me again.

A lot of the patients, the doctors tell me, believe they have been possessed, or cursed. One of the residents tells me, almost self-consciously, that for a psychiatrist, this is a hallucination. An anthropologist might feel differently, she adds, but for her, it is part of a psychotic symptomatology. I don’t have time to respond – she’s in consultation with a patient at the moment, and simply turns to me once in a while to ‘translate’ what the patient is saying into psychiatric terms. But it makes me realize that I need to come up with a ready answer for questions such as these. I am so often asked these days if I believe in possession, or in the effectiveness of countercurses. Regardless of how I might feel about these issues, I think I’ll say “I don’t know.” True objectivity is an illusion, I know that, but I think it’s a better idea not to weigh in on these questions with the people who are participating in my research, and try to maintain some kind of neutrality.

A central question in my research, however, is what happens when two different theories about mental illness meet. What does it do to a person’s experience of being sick, when his or her belief about possession is explained (dismissed?) by a psychiatrist as a ‘hallucination’? I cannot help but wonder if this has anything to do with that young woman’s unwillingness to tell Dr. Mourad about her experience. As we talked about her reticence, Dr. Mourad explained that she might worry that her diable will come back if she talks about it. Alternatively, she might be afraid that talking about devils will lead doctors to conclude that she warrants longer hospitalization. Dr. Mourad, however, feels that she will not truly be well enough to leave until she is able to talk openly about her experience. I can see his point; I tend to believe in the idea that talking – externalizing – provides a necessary kind of catharsis. Nevertheless, I wonder what it’s like for a patient like this young woman; to be asked to open up about a very traumatic experience to someone who might not agree about what that experience meant, and who has no more than twenty minutes a day to speak with you.

All of it makes me wonder about the nature or definition of ‘pathology’. Who has the right to define what’s normal and what’s not, and who gets to decide what it all means, or what should be done about it? I’m thinking here not just about the meaning of possession. Aside from these beliefs, another problem most of the patients had in common was a history of prostitution. Nearly every patient I met on the ward had, according to the doctors, engaged in some kind of prostitution at some moment in time. This behavior was often seen as a symptom of illness: a sign of mania, or psychosis. Some patients talked openly about it all, while others denied ever having sold their bodies – a sign, for the psychiatrist, of that patient’s impaired judgment. I couldn’t help but wonder, though, whether it might not be at least a little understandable that a woman might deny having engaged in something considered to be so shameful?

In addition, I wonder how much cultural beliefs and social expectations have weighed in on the high occurrence of ‘prostitution’-as-pathology among these patients. Morocco is a modernizing country, but extramarital sex is still, and will probably long remain, highly unacceptable for a woman. Does that mean, I wonder, that the definition of ‘prostitution’ here in Morocco is broader than ours? Once, when discussing an alcoholic male patient’s extramarital affairs with girls, a resident insisted that he must have slept with prostitutes. Anything else was simply not possible, she said; any girl who has extramarital sex is by definition a prostitute. Perhaps some of these female patients had engaged in behavior that, by Western standards, would not necessarily be termed prostitution? And in the same way, I wonder if the particular unacceptability of extramarital sex might mean that doctors here are more likely than elsewhere to label promiscuous behavior as ‘pathological’? Excessive promiscuity is often included on lists of the kind of reckless behavior that the DSM-IV lists as a possible symptom of mania, or various personality disorders. Nevertheless, I wonder if cultural mores weigh in here to create this particular tendency to label people with deviant sexual behavior.

I spent a lot of my time on this ward in a chair in the nurses’ lounge, observing the women on the ward through that glass door. And as they crowded up against that door to wave or sing to me, I began to wonder: what really is the difference between me and them? Aren’t we both curiously and unabashedly observing the other? I am as interested in them as they are in me. As a foreigner I, too, don’t always behave according to the social rules. Aren’t I, then, as abnormal as they are? When the nurse pulls a screen in front of the door, I am not sure whose gaze she is trying to avert – theirs, or mine.

I had hoped to do my research on this ward, but the level of pathology might pose a problem. I can interview only those who are capable of understanding the goals of my research, and of providing informed consent for participation. I did not meet a single patient who would have met those criteria – an observation later corroborated by most of the residents. I haven’t yet visited the open women’s ward, but hope this may be a better fit. Part of me is relieved, not to have to spend a few months on that dreary, tragic ward. But the other part of me continues to think about the women I’ve met there, wondering how they’re doing now, half a week since I last saw them, wondering also where they might end up, once they leave the Clinic.


* though curiously, this woman argued that a diable is not the same thing as a shaitan. It was one of the few things she was willing to explain – though she couldn’t tell us what exactly the difference was. I continue to be intrigued by the way in which Moroccans mix French and Arabic - and her distinction between these two concepts interestingly contradicts the idea that the two languages are conceptually interchangeable...
** Largactil is known as thorazine in the US, I believe.
*** Sherine is a famous middle eastern singer. Egyptian, most likely.