The Dakhla Oasis: Stories from the ‘field’: Bahariyya, Farafra, and back to Giza

By the time I reached Bahariyya Oasis, I realised that setting off from Cairo at 8 o’clock in the morning was not a wise move. Three and a half hours and three hundred and fifty kilometres later I was standing in the scorching sun with a further hundred and seventy kilometres to Farafra Oasis. I decided this was a good time to have a break. Just beyond Bahariyya lies a small village, El-‘Heiz, comprised of a few wells, palm tree gardens, and a number of houses just visible from where I stood in the middle of the road. On the other side of the road was a rectangular purpose built ‘café’ baking in the noon sun, a structure that served as the main source of income and residence for a small family. As I stepped inside and into the shade I was immediately struck by the number of people in the place. A large group of tourists on their way back to Bahariyya from the desert were scrawled along the floor mats on one side of the café enjoying the lone electric fan. On the other side of the café, sitting around a couple of tables, were the group’s four guides and two of the café owner’s children; a boy of about six and a girl of maybe twelve or thirteen. Right in the middle, and seated behind a table covered with bits and pieces – gum, small clay sculptures, scarves, hand-made leather bags, earrings, crisps and biscuits – was a middle-aged woman, the café owner’s wife.

I ordered a tea and sat around one of the tables, within viewing distance of a laptop one of the guides had on. He was playing a video clip of Dina, a famous Egyptian belly dancer, shaking semi-naked to the beats of the ‘Darabokka’. Among the audience seated around the laptop were the two young children. I noticed that the girl was wearing a ‘hijab’ (head scarf) while her mother was not. The guide engaged me in conversation, initially mistaking me for a tourist, not because of my looks which are evidently Egyptian, but because I didn’t throw the customary greeting – Assalamu ‘alikum – as I entered the café. The tea arrived at the moment the entertainment was changed, this time a video clip for a female singer – Haifa’ Wahbe – who is famously known as a surgically enhanced Lebanese bombshell. In this clip she was swaying provocatively to some non-descript song. A few minutes later and at the insistence of the two bored children, the guide played what they evidently found a more exciting video: two American women in bikinis wrestling in a rink surrounded by an audience in the hundreds. The children where laughing and jeering and thoroughly enjoying the show.

As the conversation slowly picked on with one and then all three of the guides, they came to know that I am a doctor, and enthusiastically informed me of the name of the doctor who runs Farafra general hospital. One of the guides thought I should hook up with him when I arrive to Farafra as, in his own words, “our minds would meet”. I asked them about the current state of development in the Oases, they were able to comment on Bahariyya and Farafra. Farafra, one of them said, is growing steadily. More and more people are moving there from the big cities along the Nile – El-Minia, Asyut, Cairo – capitalising on the cheap, fertile land and finding their livelihood in growing crops. The oasites – they all agreed – mainly work the land, with a few owning a small shop here and there. A large number of able young men have taken to the steadily increasing – and profitable – tourist trade, escorting groups in to the White desert and beyond to the ‘Gilf El-Kebir’, a sea of dunes on the Eastern edge of the Sahara desert. As to the ethnic composition of the population, the traditional distinction between Bedouins and Egyptians seems to be slowly collapsing. Intermarriage and decline in the nomadic life style meant, as one of the guides said, that no real Bedouins exist anymore in Egypt, with the possible exception of Siwa Oasis (fifty kilometres from the Libyan border) and the Sinai Peninsula.

The conversation was cut short as the guides together with the tourist group had to leave. I remained with the café owners and their three children (a two year old had appeared by now). A third man – a friend of the owner – had also showed up midway in the wrestling video. Left in silence for a moment I found myself contemplating what seemed to me glaring contradictions – young children, semi-naked women, a twelve year old veiled girl, her unveiled mother, Bedouins who are no longer Bedouins, a greeting that defines identity, the same identities (Bedouin and Egyptian) that are in flux – yet judging from the relaxed conduct of everyone there, I couldn’t shake the thought that the contradiction might only be in my head.

I was cut short by the café owner – the woman – asking me, as a doctor, if I can advise her on her two year-old’s peculiar skin discolouration. After informing her that dermatology is not my speciality she told me how a number of doctors have failed to cure her son. The other man in the room interrupted, saying that he knows a local Sheikh who cures skin problems by rubbing a mixture of pigeon droppings and other secret ingredients on the discoloured areas, a cure that works, he said. The child’s father quickly responded: “that’s all superstition”. His wife nodded her head in agreement, looked in my direction and added in a tone of slight embarrassment: “but customs and traditions are beautiful”. The man who suggested going to the Sheikh for a cure then added that, in any case, the child must have received a “very bad eye”. The parents agreed, and the mother recounted an incident where a woman, a distant acquaintance, commented on the beauty of the boy. A few days later his skin flared with these dark lesions.

I leave the café, head to the car, and drive off to Farafra. On arrival and having settled down I sought some entry point to my research. Since my main goal is to study psychopathology in the area, I thought a visit to the local hospital might provide some initial links. Farafra general hospital is a two storey building with a small A&E department that handles minor cases and a number of clinics in the main branches of medicine, in addition to a few wards. There was no psychiatry. The hospital deputy director had no information to give me on psychiatric cases in the region. I decided to head off to the health authority, and was granted an audience with the only General Practitioner in Farafra; he knew more. Over the past fours years he had only seen two cases of what he thought was schizophrenia. He was quick to explain that he has no special knowledge in psychiatry; the presentation of one of those two men, as he described it, was as follows: “persecutory and grandiose beliefs, disturbed and dangerous behaviour, talking to self”. That was all he could remember. He recalled sending this man to the main mental health hospital in Cairo. “There are no psychiatrists in El-Wadi El-Gedid” he said, “the nearest being 550 km in Cairo, or in Asyut” [1]. I asked him if he thinks cases of ‘madness’ are rare in Farafra, or – alternatively – if the people handle these cases in a totally different framework, thus not appearing before medical professionals. He endorsed the latter view, and suggested that I link in with local traditional healers to find an answer for my question.

I returned to the small hotel where I was staying and struck a conversation with one of the young men working there. He was from Dakhla oasis and returns there in the hot summer months as tourism drops then. “Psychiatrists,” he said, “are the last resort, if you need a psychiatrist then you have truly hit rock bottom, and here this is a disgrace – ‘eib[2], and is to be avoided if possible”. People in the oases, he continued, go to Sheikh’s who specialise in healing, some of whom are proficient and some are charlatans – daggaleen. According to him those healers are not short of work; in the oases jinn possession is quite common due to the prevalent marshes and darkness, places and situations where the jinn tend to reside. He advised me to speak to an acquaintance of his, Sheikh Ali, a Cairo based healer who has treated many a case of possession in the Oases and abroad.

As night approached I retired to a seating area at the hotel entrance, where a cool breeze was finally blowing, and started reading a book. I was interrupted by two hotel staff, ‘Adel and Hussein, who were attracted by the same rare breeze and we struck a conversation. What followed was a spontaneous chat that – without any prompting on my behalf – steered in the direction of the supernatural and was dominated by talk about jinn. ‘Adel was explaining how certain Sheikhs have the power to enslave jinn and use them to “pull” treasures buried deep under the ground, treasures such as Pharaonic statues, gold, and red mercury, an extremely rare and valuable substance that was used for mummification. A proficient Sheikh is not only able to “pull” treasure from a certain site, but can also do so from a distance. Furthermore Sheikh’s differ in their “pulling” power; some can “pull” at a depth of fifteen kilometres, others at five, and others can only fix a treasure’s place in the ground. As for the jinn they inhabit the different layers of the earth and have the power to possess people. Once possessed, a person would behave in bizarre ways, and would return to normality only when the jinn leave their body. At that point I interjected and asked them what, if any, is the difference between possession and gonoon. “The jinn can make a person mad – magnoon – but there is also madness – gonoon – that is not due to possession” ‘Adel answered, “this is when a person’s mind becomes loose – yefawwet. If after excorcism is attempted the person remains weird – gharieb – then something must be wrong with their mind and in this case they need a doctor, but that is the last resort”.

At that ‘Adel recounted a story of a man who used to lock himself in a public bathroom and talk to himself. ‘Adel found him there once, and asked him to get out. A voice responded: “leave him alone”. This, ‘Adel explained, was no doubt a jinn talking through the man. ‘Adel threatened the jinn with a beating if he doesn’t leave; a few minutes later the man opened the bathroom door, was crying and left the building. Hussein gave support to this anecdote, confirming that the possessing jinn could leave the body after the possessed person is beaten. He said that a beating is directed, essentially, at the jinn and the person feels nothing. By the end of the conversation I felt that I must visit Sheikh Ali. I left Farafra the following morning.

Back in Cairo I called Sheikh Ali, I explained the purpose of my research and he was very welcoming and keen to receive me. His office is located in a narrow alley off El-‘eshrein road, an inconceivably long road in one of the busiest districts of Giza. After walking for about twenty minutes, all while dodging cars, people, mini-buses, bicycles, motorcycles, goats, cats, and Chinese motorised tricycles, I found him waiting for me at the agreed upon meeting point. Sheikh Ali is a man in his fifties; originally from Aswan he settled in Cairo, opened an Estate Agent office and practices what he calls ‘Spiritual Healing’ on the side. He treats people in Cairo and regularly travels to the Western desert where he finds tens of people bringing their ill children, friends, and relatives. His competence also brings him foreign patients from Gulf States, who occasionally invite him abroad to cure a difficult case.

Sheikh Ali treats people possessed by jinn. But he also identifies other categories of illness which he calls ta’ab nafsi (‘self-distress’) and gonoon (madness) in addition to bodily illness which is in the rightful domain of medicine. He considers possession and ‘self-distress’ to fall within his domain of competence, while gonoon is more of a medical problem. (The jinn can make you mad – magnoon, but once they are removed you should return to sanity). The distinction between these three categories relies on discerning a number of symptoms, the course of the condition, the effectiveness of certain treatments, comprehensibility of the patient, and more generally – as he explained – on the healer’s clinical sense, experience, and intuition. When first hearing about a case he tries to answer three questions: (1) is it possession, ‘self-distress’, or madness? (2) Would long-distance treatment be possible or does he need to see the person face to face. (3) What are the causes; specifically is magic involved or not? In a way possession is the presumed category until proven otherwise.

In my interview with him he listed the most common symptoms a possessed person could present with:

  • Frequent dreams and nightmares, especially of being followed and persecuted.
  • People (voices) talking to the person.
  • The feeling of being controlled and directed by someone or something.
  • Involuntary movements of the limbs.
  • A feeling of something moving up and down the body.
  • Fears of being killed.
  • Pain travelling along the body.
  • Feelings of suffocation.
  • Back, shoulder, and stomach pains.
  • Irritability and sudden loss of temper.
  • Poor memory.
  • Sometimes complete mutism for long periods of time.
  • Sleep: could be much more or less than the average for the person.
  • Appetite: increased or decreased.
  • Sometimes sexual arousal.
  • The course is usually cyclical, with the person being unwell when possessed and regaining complete lucidity and mental well-being in between such episodes. The duration of the episodes, however, could be anything from a few days to a few years.

Sheikh Ali contrasted such a course with that of ‘self-distress’ which is usually more long lasting, stable, and does not display such cyclical changes. Occasionally some people fake the symptoms of possession, for reasons to do with attention seeking, or to force their family to get them what they want. Through subtle differences in presentation (such as an incoherent constellation of symptoms), Sheikh Ali is usually able to distinguish the malingering from the real.

As to the causes of possession, these could be divided in to two categories:

  1. Where no magic is involved, but – for a variety of reasons – the person is weak and vulnerable to the jinn:
    • Falling in a place where the jinn are known to reside. These include bathrooms and door steps at the entrances of houses.
    • Visiting a house or room that had been locked up for a long time.
    • Dark areas.
    • Looking at mirrors for a long time.
    • Having many photos in one room.
    • Coming too close to fire.Social isolation stemming from sadness after any major loss; the isolation renders people vulnerable.
    • Women at the time of menstruation, as they are ‘impure’ – mesh tahreen, do not have the protection of angels, and hence are vulnerable.
  1. Magic has been perpetrated against the person:

– Magic could be done on a person with the purpose of directing jinn at them. In this instance the jinn are usually by definition evil – jinn soflee – and particularly hard to get rid off.

Treatment proceeds by removing the possessing jinn and, if appropriate, undoing the magic. Successful removal of the jinn depends on many factors. Sheikh Ali described a variety of jinn: you have the powerful and the weak, the Muslim and the Christian, male and female, good and evil, and so on. Male patients are usually possessed by female jinn, and the converse also holds. The exorcism process is essentially a struggle between the power of the jinn and the powers of the healer, where the healer is the tool through which the power of the Qur’an and ultimately God is unleashed. Sheikh Ali mainly treats his patients by reading specific verses from the Qur’an while talking to the jinn and urging them to leave. He describes how he usually manages to talk directly to the jinn through the patient, who in this case would have an altered voice. This helps in diagnosis and treatment for two reasons: first it is a direct confirmation of possession and second the jinni might indicate its power and religion, which determines which verses would be effectual.

The jinn respond in different ways. Occasionally the jinn leave as the patient is entering the treatment room. Sheikh Ali explained that the jinn know what’s going on and some of them – the weaker ones – would dread the Qur’anic sessions and leave of their own accord. The Qur’anic verses are usually sufficient to dispel all but the most powerful jinn. With these, treatment might extend for weeks on end. Sheikh Ali recalls how the jinn sometimes respond with arrogance: “no matter what you do we won’t come out”, in which case he perseveres. In addition to reading the Qur’an he occasionally uses a second method of exorcism: a piece of cloth is set on fire then extinguished, and while still smouldering is quickly passed across the patient’s nose. The smoke, Sheikh Ali explains, is the jinn’s biggest fear; as creatures of fire, smoke signals their death. He mentioned other treatments which he generally condones but other people use: these include beating the patient at certain bodily points to force the jinn out, and burning some of the patient’s belongings.

Sheikh Ali told me of a case he had recently worked with. He was a young man in his early thirties living in Dakhla Oasis and who had been displaying very strange behaviour for the best part of two years: he would roam around at night setting fire to palm trees, apprehend people in the street (some of whom were strangers) and asking them if he could marry their daughters, standing in front of police cars and shouting, he was barely sleeping or eating. His family sent him to a number of hospitals in Cairo where he was heavily sedated only to return back to the Oasis and resume his bizarre behaviour. While in Aswan, Sheikh Ali heard about him and was able to discern that magic was perpetrated on this man, in this case the unaware man drunk a magical potion. This made him vulnerable to the jinn and he was in fact possessed. Sheikh Ali provided long-distance treatment from Aswan by invoking the possessing jinn’s consort – qareen – and reading Qur’anic verses. Over the next six days and after repeated episodes of vomiting the man expulsed the poison. With the magic undone the jinn left his body and, according to Sheikh Ali, the man returned to health, resumed work and has been well since. He explained that no amount of medication would cure or help a possessed person so long as the jinn are still there. Healing, Sheikh Ali told me, is a gift – malaka; not everyone has it. A healer must remain calm in the direst of situations and absorb the patient’s distress. A healer must be close to God and must have full faith in the elements of the healing framework. Unfortunately, he continued, unemployment and poverty have led many people to claim healing powers, when in fact all they do is read verses from books on healing without any understanding of the healing process. These he called charlatans – daggaleen.

Once the jinn are removed the patient would improve but elements of ‘self-distress’ – ta’ab nafsee – might remain. This usually takes the form of a bad mood, irritability, or sadness and is amenable to reassurance, social advice, reading the Qur’an and praying. The problem with psychiatry – Sheikh Ali explained – is that it treats every case as either ‘madness’ – gonoon – or self-distress’ ignoring the reality of possession, as such medical treatments are frequently ineffectual. The third category recognised by Sheikh Ali, madness – gonoon, is reserved for the most extreme and hopeless cases. The mad, he explained, are not possessed; their brains have ‘turned around’ – mokho laff, their minds are ‘loose’ – ‘aqlo sayeb. Sheikh Ali identifies madness through a number of signs: the most important is that you can’t reason with them, their speech is un-explicable – mesh metfassar ­– and they are not aware. By aware he doesn’t mean a grade of consciousness but awareness of the situation they are in. Alternatively a judgment of gonoon could ensue once all possible ‘spiritual treatment’ is provided over an extended period of time with no effect. In most cases, however, it is a combination of the aforementioned signs together with ineffectual treatment that leads to a judgment of gonoon. Once that occurs, Sheikh Ali continued, psychiatrists could be consulted.

At the end of our meeting Sheikh Ali informed me that now I have learnt the “theory” behind his work, the next step is to attend healing sessions with him to see how things are done in practice.


The Dakhla Oasis: Stories from the ‘field’ (I)

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Marriage and Reputation

Tariq lives with his mother in a concrete house in the old part of town. They moved out of El-Kharaba only three years ago, a fact that he declares with slight embarrassment. A month ago his wife and three year old daughter would have been living with them, but they had fallen out and she moved in with her elder brothers; he remains reluctant to bring her back home. I first met Tariq at the coffee house at El-Midan (the square dominating the old part of Mūt); we instantly became friends. Tariq’s day starts at seven in the morning: he cycles to the government site where he rents out tractors and loaders by the hour. Like most civil-servants, he is expected to sign-in at eight-thirty in the morning and not to leave before two in the afternoon, and like many government employees he tries to negotiate this in order to have more time “earning his keep” through various other jobs.

Like most men in Dakhla, Tariq shares the responsibilities of the land with his brothers. A few days a week he has water duties which involve moving around the panels that regulate water supply to guarantee that others have their share. On Sunday and Thursday evenings he coaches table tennis at a modest ‘youth centre’ on the edge of town, a feat that involves a few informal strokes with high school students interspersed by several cigarette breaks. On Friday and Saturday mornings, his days off, he works a shift at a coffee-house that belongs to his friend, ‘Ali. I frequently accompanied Tariq to the fields helping him with the water, to the youth-centre for a few informal table tennis strokes, and on those early week-end mornings I joined him at the coffee-house where I would prepare my Turkish coffee and utilise the rarity of patrons to chat with him. On one such morning I first learnt that he had been married once before.

It would be hard to overestimate the importance of marriage. In my first week of field work I attended Friday prayers at the “big mosque”. The topic of the sermon was marriage and the imam was listing its benefits: “to marry is to complete your religion; marriage is half your faith. It provides you with companionship and offspring. It is the natural progression of life”. For the men and women of Mūt it is frequently their only sexual outlet. Hussein, a resident of the village of Asmant, told me when I visited him to talk to his mentally unwell and unmarried sister, Fayza, that spinsterhood is a mosiba (disaster).

Tariq’s first marriage was not consummated; they signed the contract but she continued living at her father’s house. Tariq was not pleased with her conduct: she did not ask his permission before leaving the house, she met her brother-in-law with her hair uncovered,[1] and on occasion he saw her conversing with male cousins and relatives in the street. Tariq did not receive the expected support when he approached her father complaining of his daughter’s conduct. “Until you’ve entered,”[2] he told him, “the final word remains with me”. Tariq refused to accept this and his mind was set on divorce but not before “teaching her a lesson” and leaving her “hanging for a few weeks”. He stopped visiting them at home, cut all contact, and took no steps towards a divorce. The bride’s family contacted his mother urging her to convince her son either to return or to divorce their daughter, and not to leave her in this disgraceful situation. “Don’t give them a reason to hurt us”, Tariq recalls his mother warning of the possibility of retaliatory magic: “divorce her now, and find another woman who can make you happy”. He finally complied.

A couple of years later he married his cousin and had a child with her. She moved in, as custom dictates, with him and his mother. Over the few years of their marriage it became apparent that they did not get along well. Their life was dominated by frequent quarrels, disagreements and fights usually over trivial matters. Sayyed, Tariq’s friend, believes their personalities do not match: “they are both hot-blooded”. On several occasions she would leave the family home and return to her brothers, only this last time he vowed not to make any effort to get her back. Despite reconciliatory interventions by her brothers he remains reluctant. “The very act of leaving the house like this,” he told me once, “is unforgivable; here it’s a big thing and could lead to divorce”. Both Tariq and Sayyed think the situation would have been different if her father was alive: “no one in the family has the authority to tell her to return home; this is something the father should be involved in”. A common story, one that I have heard several times and which I finally learned refers to Sayyed’s second cousin, drives the point home:

My relative has been having problems with her husband and returned to her father’s house. She asked for a divorce, and a meeting was arranged. I was there, and the father, brother and husband. The father asked his daughter: ‘I will divorce you from him right now, if you can do one thing: strip naked here in front of us’. The girl was shocked, and couldn’t understand why her father was saying this. Then he suddenly stood up and tore the dress off her. The girl, screaming, ran to her husband and took cover in his arms. The father then looked at her and said: ‘Your husband, and not me or your brother, is your satr [shelter/protection]; you must return with him.

His wife’s brothers, who also happen to be his cousins, played a role. One of them urged Tariq to treat her gently, to take her out for walks more frequently so she does not feel “suffocated” at home. Another, who happens to be more conservative, was opposed to the idea of divorce since it is religiously permissible but discouraged (abghad el-halal). The third raised the possibility that someone, probably the estranged first wife or her family, had sought a magician to prepare an ‘amal (hex) to separate them; the infamous ‘separation magic’. In fact, he had taken steps and visited a magician who confirmed the above and requested to see Tariq. I asked him in the presence of Sayyed whether he would go: “I don’t want to go down this route; its haram (prohibited), we must always refer back to Islamic teaching and engaging in magic is haram”. I said he would not be engaging in magic, only undoing it but he was not convinced: “the magician is probably a charlatan”. Sayyed interrupted him saying that magic is mentioned in the Qur’an and definitely exists. He suggested consulting a Qur’anic healer: “go to Sheikh Rayyes and he will read on you, there is nothing haram with that!” Tariq refused all our suggestions. At this point Sayyed looked at me and said: “he has decided, he doesn’t want her, he wants to change, it’s been three years now and he is bored; we shouldn’t try and solve the problem, we should find him a new wife”. Tariq was silent, but smiled at us meaningfully, a smile of complicity.

 That Tariq should be bored is not surprising. Excepting minor and infrequent youthful, sexual skirmishes most men here first encounter sex on their wedding night. Frequently their spouse would be the only sexual partner they will ever have. He once told me that the novelty of sex with your wife dissipates even after the first time. I half-jokingly suggested mot’a marriage,[3] but was told that marriage in Dakhla is no longer that simple; the bride’s parents always ask for an apartment and mahr (dowry). “In the old days”, Tariq explained, “it was halal [permitted] to sleep with maids that worked at your residence, but we can’t do this now; slavery is finished”. This narrows down his options to a second marriage. According to Islamic law a man can marry up to four women but only under strict criteria which include that his first wife must know and agree; if she does not she has a right to an immediate divorce. Tariq’s predicament is complicated by the fact that he does not wish to divorce his wife, yet remains obliged to declare his intention to marry a second time, upon which she will certainly ask for a divorce. A divorce will complicate several things for him: his rights to see his daughter, financial obligations, and it will constitute a blow to his reputation: a man who has been divorced twice is hardly eligible marriage material.

Divorce and second marriages remain rare in Dakhla, and in the absence of obvious and pressing legitimating reasons are frowned upon. This was apparent in the response to Hajj Sa’ad’s marriage to a twenty-four year old girl from Kafr El-Shiekh, one of the Nile-Delta governorates. Hajj Sa’ad is in his late forties and has been married for the past twenty-five years to a lady known for her good manners and religiosity; no one could understand why he would bring her another woman. I joined him and a friend once at the coffee-house. His friend was reprimanding him for marrying a second time: “since your marriage a month ago, people in town have been infuriated”. Hajj Sa’ad reasoned with him: “people don’t know the circumstances; she wasn’t taking good care of my mother who is an old woman now, what am I supposed to do? And my children are older and busy with their life. I told her I will marry another woman and I gave her the choice; she could ask for a divorce, or stay in the house with us, or I could get her a flat and move the furniture into it. She asked to move out but didn’t mention the divorce. And now two weeks later I get a letter from court saying she wants to terminate our marriage”.

In any case the reputation of Hajj Sa’ad, a man who has sustained a marriage for over twenty years, will not be affected that much by his decision to marry again, but this is not so for a young man like Tariq or indeed for young men in general. Reputation in Dakhla, for men and women alike, is a fragile attribute, subject to various factors that may elevate or reduce ‘it’. A positive reputation in men involves desirable traits such as generosity and kindness to parents, pre-marital celibacy in addition to financial ability. In women, virginity is paramount and contact with other men problematic. With both sexes, physical integrity, mental stability, and absence of chronic illness are crucial. This is Mahdi, a twenty-six year old chicken and vegetable trader, telling me about a potential bride:

A few months ago I was attracted to this girl who works at a shop by the hospital. Day by day I noticed that every time I pass by her house on my way home and she would be standing outside she would immediately run inside. I met her at the shop and asked her why she runs away every time she sees me, have I done something wrong? She said she does that with any man passing by the house. I liked that. I went to speak with her mother and told her that I am interested in her daughter, and we agreed that we will get to know each other for a short time by talking on the mobile phone before informing the father or anyone else about my intention to marry her. This is more common now, although not everyone does it. It’s not like the old days where you wouldn’t have spoken to the bride at all. Its better this way; if we find that we are not compatible then things end without the whole town knowing about it, and so they don’t count another engagement on us. As the engagements pile on you, any future family will demand to know why the engagements failed and you could develop a reputation around town that you are a difficult, unstable person. It’s worse for the woman. It’s not like Egypt [Cairo], where you could get engaged without the whole town knowing; here news travels immediately, and your reputation is always at stake.

A few weeks later he formally proposed and the father followed the customary procedure of “asking around” about him. Fortunately for Mahdi, he is neither involved in drug use, nor is he indolent; a “hard-working, honest man” is how he describes himself. The engagement went ahead. For others it may not fare that well. Mohammed Kamal is a young man who has been mentally unwell for several years; we will meet him in later chapters. A few months into my fieldwork I discussed with Hajj Khedr, the owner of a local stationery shop, whether he has a chance of getting married one day:

He doesn’t really. If he stays reasonable, calm and settled like he is now for the next five years he may have a chance of marrying, and then not from Mūt, but from the villages, where people might not know his past, or if they do, wouldn’t have seen him in the state people in Mūt have. Even his brother had to marry from outside Mūt. People here worry that problems like this run in the family – the branch extends, and they are wary of marrying their daughters or sons into the family. But there will always be men and women who for some reason or other will settle for a husband or wife with such a history; those who have missed the marriage train or those who don’t have a particularly good reputation.

Behavioural and psychological disturbances constitute such a major blow to a person’s reputation that a disgruntled son allegedly feigned ‘madness’ in order to prevent his father bringing home a step-mother:

I learnt today about a sixty year old man who had lost his wife three years ago and who recently sought marriage in order to have someone take care of him and the house. His youngest son, the only one still living with him, was opposed to this: he didn’t want another woman to replace his mother’s place and have a share in the inheritance. To ruin his father’s chances at marrying he began to behave in aggressive and bizarre ways in town, and to cause trouble. He works in a shop selling chicken and livestock fodder and he began to be rude to customers, refusing to sell to some people without any reason and causing fights when someone objected. He was frequently shouting around town, cursing the people sitting by the coffee-houses, and once took off his shirt and walked half-naked. Some thought he was possessed; the only thing that could explain this sudden change in behaviour. Tariq thought he was doing this intentionally to ruin his father’s chances of getting married. If a family think of marrying their daughter to his father they would now think twice. First they wouldn’t want her to move into a house where a disturbed man lives; this would no doubt cause her problems and grief. Second, they would worry that his father too might be unstable. Even if they think he is possessed and not mentally ill, they would take care and avoid this family. Ever since his father gave up the idea, his son seems to have stopped his disruptive behaviours.

In the quiet squares and streets of Mūt, extreme behavioural and psychological disturbances cannot be missed; they are right there for all to see and hear. A disturbed person can hardly escape being judged by others, but reputation is subject to judgment in the absence of such exotic displays. This is because Mūt is a small place; people know each other and gossip is rife at the coffee-houses, among women in the privacy of their homes, and news travels around at surprisingly fast speeds. This was demonstrated to me one night when I was chatting to some Christian youths who frequent a coffee-house on the outskirts of town. When I returned to El-Midan an hour later I was told by Tariq: “you were sitting with two Christian boys at Sayyed’s coffee-house; see? Your news reaches me”. Perhaps there was a question why, as a Muslim, I was socialising with Christians, a point I will attend to later, but the webs of gossip are most dangerous when someone commits a transgression; the threat to a person’s reputation is at its greatest.

One night while drinking tea with Sayyed and Tariq, the former suggested that we go for a picnic on the dunes just outside town. It was a moon-lit night, and the prospect of leaving town for the cool sand was welcome. Beer and mezza would sustain the night, and Sayyed offered to take the drive-of-shame to the only beer shop in town himself. I started walking with Tariq and mid-way Sayyed picked us up on his motorbike. Drinking alcohol is certainly frowned upon in Dakhla, and we had to keep our wits about us lest someone saw us. Up there on the dunes it was definitely safe. Sayyed was the least concerned about this though; he has a turbulent history of drug use, and has previously told me stories of spectacular drug-fuelled shows in town. But the concern was there nevertheless; Tariq put it this way: “the town is small and talk goes around, if someone sees us here drinking, by the time we return to town the word will be that we had women with us”.

Well into our second beer, we saw a seventies jeep coming fast down the sandy track. We expected it would continue around the dune but it veered left sharply, gained some speed and climbed up the dune adjacent to ours; we heard a woman let out a playful scream. Initially Tariq and Sayyed thought they were foreigners, but then we heard a woman addressing a child “come here!”. My companions’ interest was aroused: they wanted to know who was there and what they were up to. They left me for a brief reconnaissance trip and when they were close enough they saw two children playing in the sand a short distance from the car. The man and woman were not outside and so were obviously in the car. Tariq and Sayyed were convinced the couple were up to some sort of brief sexual liaison, perhaps an engaged couple ‘making out’ and bringing the children with them as an excuse; chaperones who are let loose to play in the sand while they have some private time. This seemed to unsettle my friends; Sayyed was surprised why anyone would “commit dirty acts on this pure sand”. I pointed out that we were drinking alcohol, but he excluded that and said “adultery? I would never do that, everything but penetration, yes, which must be halal (religiously permissible)”.

Perhaps what struck me the most in this incident was my friends’ inconsistency. While they complained of the gossipy nature of their brethren they simultaneously partook in the surveillance of others, and with an intention to expose them if they had known who they were. Several men here have told me with visible pride that they have previously caught couples ‘making out’ in El-Kharaba or other hidden ‘hot-spots’ in Mūt, the same men who have disclosed in confidence that they have previously stolen a kiss or a hug from a girl they once knew. One evening when visiting Hisham at the Dakhla youth-centre I was expected to intervene and ‘catch’ a couple who were kissing in the dark. While waiting for him to finish some errands, I saw a young man walking towards the gate followed shortly by a girl. He was turning periodically and shouting at her “walk, quick!” Half a minute later came the night-guard panting: “catch these two!”

The speed with which news travels around town is guaranteed by the tendency for gossip and the fact that most people know each other, and its efficacy is maintained by the ever present worry of the implications of a tarnished reputation. To me this presented a serious constraint on personal freedom, a view that others did not share. Tariq asked rhetorically: “what would you want to do behind people’s back, sex? If you do this here it will be known, you will know people know without them having to tell you; you will see it in the way they look at you. It’s a good thing that people know each other and news spreads; it keeps the dirtiness at bay”. A quintessential example of such ‘dirtiness’ and the power of the mechanisms to counteract it were demonstrated to me over the course of my stay through the developing story of a Christian boy and a Muslim girl who were caught in the act.

I first heard about them on a visit to Youssef at his office in El-Sha’arawy primary school. We were discussing the details of a lecture on mental health I was about to deliver to school teachers two days later. The school guard came to his office and asked us if we had heard: “an hour ago a young man and a girl were found at the back of a store, they were undressed and the man was taken to the police station”. The following evening I overheard an independent update on the event. The girl wears a niqab (full face veil) as a decoy, her husband had been working in Saudi Arabia for the past three months and the consensus was that she was looking for sex. A month later I learnt that her husband had divorced her and she was forced to leave Mūt and live in one of the villages where people might not know about the scandal. The boy was placed under surveillance, the purpose of which was to protect him: the incident had enraged Muslim men. While this incident demonstrates the serious consequences of sexual transgressions in general, the seriousness of the transgression in this instance was amplified by the fact that the man was Christian and the woman Muslim. What happened was an affront to Islam, and Islam for the people of Dakhla is the global basis of their identity.

[1] This is problematic since, not being a brother or uncle, he remains permissible in marriage.

[2] This refers to the wedding night when bride and groom move to the marital abode and experience their first moment of intimacy.

[3] The literal translation of mot’a is enjoyment or pleasure. A mot’a marriage is a temporary marriage conducted in order to legalise and render permissible the union between a man and a woman primarily to facilitate temporary sexual relations. Nowadays it is rare and is generally frowned upon.

Culture, salience, and psychiatric diagnosis: exploring the concept of cultural congruence & its practical application

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Culture, salience, and psychiatric diagnosis: exploring the concept of cultural congruence & its practical application. Philosophy, Ethics and Humanities in Medicine (Journal)

This article is part of the series: Towards a new psychiatry: Philosophical and ethical issues in classification, diagnosis and care

Abstract

Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct.

The article distinguishes symbolic from phenomenological conceptions of culture, the latter expanded upon through two sources: Husserl’s phenomenological analysis of background intentionality and neuropsychological literature on salience. It is argued that culture is not limited to symbolic presuppositions and shapes subjects’ experiential dispositions. This conception is deployed to re-examine the meaning of (in)congruence. The main argument is that a significant, since foundational, deviation from culture is not from a value or belief but from culturally-instilled experiential dispositions, in what is salient to an individual in a particular context.

Applying the concept of cultural congruence must not be limited to assessing violations of the symbolic order and must consider alignment with or deviations from culturally-instilled experiential dispositions. By virtue of being foundational to a shared experience of the world, such dispositions are more accurate indicators of potential vulnerability. Notwithstanding problems of access and expertise, clinical practice should aim to accommodate this richer meaning of cultural congruence.