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.


Madness & Society: Pathways to Reconciliation

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On the 10th of July 2019 I delivered the Annual Lecture of the Lived Experiences of Distress Research Group at the London South Bank University. The title of the talk was Madness & Society: Pathways to Reconciliation.

Thank you to Professor Paula Reavey for the invitation, and thank you to Seth Hunter for the introduction.

The talk explored three main questions:

  1. What is reconciliation?

  2. What are the challenges to societal reconciliation with Mad activism?

  3. What can be done about these challenges?

Click on the following links for:

Transcript of the talk (pdf)

Audio recording of the event

Slides (PowerPoint)

 

Best of 2018 Philosophy List by Oxford University Press

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Check out Oxford University Press’ list of articles chosen from across its journals to represent the ‘Best of 2018’.

My article In Defense of Madness: The Problem of Disability is included under the entries for the Journal of Medicine and Philosophy.

For other articles, I enjoyed reading Roger Scruton’s Why Beauty Matters in The Monist.

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In Defense of Madness: The Problem of Disability

By developing a perspective on the social model of disability and by appealing to the concept of intelligiblity, I respond to arguments against Mad Pride activism. You can access the articlm_covere HERE.

The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 44, Issue 2, April 2019, Pages 150–174, https://doi.org/10.1093/jmp/jhy016

 

Abstract: At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently disabling: the first arises from the normative nature of disability judgments, and the second arises from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism, the applicability of the social model to madness, and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter.

 

Mohammed Abouelleil Rashed, In Defense of Madness: The Problem of Disability, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 44, Issue 2, April 2019, Pages 150–174, https://doi.org/10.1093/jmp/jhy016

Mad Activism and Mental Health Practice

On the 6th of August 2018 I delivered a live webinar that was part of a Mad Studies series organised by Mad in America. The aim of the webinar was to explore ways of incroporating ideas from Mad activism into clinical practice. The full recording of the webinar and the accompanying slides can be found below.

 

More Things in Heaven and Earth

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For a few months in 2009 and 2010 I was a resident of Mut, a small town in the Dakhla Oasis in the Western desert of Egypt. My aim was to become acquainted with the social institution of spirit possession, and with sorcery and Qur’anic healing (while keeping an eye on how all of this intersects with ‘mental disorder’ and ‘madness’). I learnt many things, among which was the normalness with which spirit possession was apprehended in the community: people invoked spirits to explain a slight misfortune as much as a life- changing event; to make sense of what we would refer to as ‘schizophrenia’, and to make sense of a passing dysphoria. It was part of everyday life. The way in which spirit possession cut across these diverse areas of life got me thinking about the broader role it plays in preserving meaning when things go wrong. To help me think these issues through I brought in the concepts of ‘intentionality’ and ‘personhood’. The result is my essay More Things in Heaven and Earth: Spirit Possession, Mental Disorder, and Intentionality (2018, open access at the Journal of Medical Humanities).

The essay is a philosophical exploration of a range of concepts and how they relate to each other. It appeals sparingly, though decisively, to the ethnography that I had conducted at Dakhla. If you want to know more about the place and the community you can check these blog-posts:

The Dakhla Diaries (1) : Fast to Charing-X, Slow to Hell

The Dakhla Oasis: Stories from the ‘field’ (0)

The Dakhla Diaries (3): Wedding Invitation

Old Mut, Dakhla

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

And this is a piece I published in the newspaper Al-Ahram Weekly (2009) voicing my view on some of the practices that I had observed: To Untie or Knot

 

On Irrational Identities

(Excerpt from Chapter 10 of Madness and the Demand for Recognition. OUP, 2018)

In Chapter 7 I raised and examined the distinction between failed and controversial identities. I began by pointing out that every demand for recognition – all gaps in social validation – involves the perception by each side that the other is committing a mistake. Given this, I formulated the question we had to address as follows: how do we sort out those mistakes that can be addressed within the scope of recognition (controversial identities) from those that cannot (failed identities)? The implication was that a failed identity involves a mistake that cannot be corrected by revising the category with which a person identifies, while a controversial identity involves a mistake that can, in principle, be corrected in that way. The issue I am concerned with here is no longer the identity-claim as such but the validity of the collective category itself; the question is no longer ‘what kind of mistake is the person identifying as x implicated in?’ but ‘is x a valid category?’. This question features as an element of adjudication for the reason that some social identities can be irrational in such a way that they cannot be regarded as meriting a positive social or a political response. As Appiah (2005, p. 181) writes:

Insofar as identities can be characterised as having both normative and factual aspects, both can offend against reason: an identity’s basic norms might be in conflict with one another; its constitutive factual claims might be in conflict with the truth.

For example, consider members of the Flat Earth Society if they were to identify as Flat-Earthers and demand recognition of the validity of their identity. They may successfully demonstrate that society’s refusal to recognise them as successful agents incurs on them a range of social harms such as disqualification. Yet it is clear that their identity does not merit further consideration and this for the reason that it is false: Earth is not flat. A similar predicament befalls some Creationists; Young-Earth Creationists, for example, believe that Earth is about ten thousand years old and was created over a period of six days, a belief that stands against all scientific evidence. It is not unreasonable to suggest that neither the Flat-Earthers nor the Young-Earth Creationists ought to have their identity-claims taken seriously, as the facts that constitute their identities do not measure up to what we know to be true, given the best evidence we now possess. To put it bluntly, whatever else might be at stake between us and the Flat-Earthers or Young-Earth Creationists, the shape of the Earth, its age, and the emergence and development of life on it are not.

Who does ‘us’ refer to in this context? To those who regard scientific rationality as an important value to uphold in society. By scientific rationality I mean an epistemological and methodological framework that prioritises procedural principles of knowledge acquisition (such as empirical observation, atomisation of evidence, and non-metaphysical, non-dogmatic reasoning), and eschews substantive convictions about the world derived from a sacred, divine, or otherwise infallible, authority (see Gellner 1992, p. 80-84). In rejecting the demands of Flat-Earthers and Young-Earth Creationists, we are prioritising the value of scientific rationality over the value of an individual’s attachment to a particular identity. We are saying: we know that it matters to you that your view of the world is accepted by us, but to accept it is to undermine what we consider, in this instance, to be a more important value. Note that such a response preserves the value of free-speech – Flat-Earthers and Young-Earth Creationists are free to espouse their views. Note also that refusing to accord these identities a positive response is a separate issue from taking an active stand against them (an example of the latter would be government intervention to ban the teaching of creationism in schools).[1] What we are trying to determine here is not who should receive a negative response but who is a legitimate candidate for a positive one. Owing to the irrationality of their constituting claims, Flat-Earthers and Young-Earth Creationists are not.

At this point in the argument someone could object to the premise of assessing the rationality of identities. They could object on two grounds: they could say there is no stance from where we can make such assessments; or they could say that even if such a stance exists and it is possible to determine the rationality of an identity, such a determination is always trumped by the demand for recognition and by individuals’ attachment to their identities. Both positions could further argue that as long as an identity is neither trivial nor morally objectionable, it ought to be considered for a positive response. We can recognise in the first position a commitment to cognitive relativism; in the second position we can recognise an extreme form of liberal tolerance. Both positions are problematic…

[1] For an example of what an active stance would look like in such cases and the problems it raises, see Appiah (2005, pp. 182-189) for an ingenious thought experiment based in the mythical Republic of Cartesia. The regime in Cartesia encourages the creed of hard rationalism and actively seeks to transform any deviations from rationality among its citizens.

Madness & the Demand for Recognition

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After four years of (almost) continuous work, I have finally completed my book:

Madness and the Demand for Recognition: A Philosophical Inquiry into Identity and Mental Health Activism.

You can find the book at the Oxford University Press website and at Amazon.com. A preview with the table of contents, foreword, preface, and introduction is here.

Madness is a complex and contested term. Through time and across cultures it has acquired many formulations: for some, madness is synonymous with unreason and violence, for others with creativity and subversion, elsewhere it is associated with spirits and spirituality. Among the different formulations, there is one in particular that has taken hold so deeply and systematically that it has become the default view in many communities around the world: the idea that madness is a disorder of the mind.

Contemporary developments in mental health activism pose a radical challenge to psychiatric and societal understandings of madness. Mad Pride and mad-positive activism reject the language of mental ‘illness’ and ‘disorder’, reclaim the term ‘mad’, and reverse its negative connotations. Activists seek cultural change in the way madness is viewed, and demand recognition of madness as grounds for identity. But can madness constitute such grounds? Is it possible to reconcile delusions, passivity phenomena, and the discontinuity of self often seen in mental health conditions with the requirements for identity formation presupposed by the theory of recognition? How should society respond?

Guided by these questions, this book is the first comprehensive philosophical examination of the claims and demands of Mad activism. Locating itself in the philosophy of psychiatry, Mad studies, and activist literatures, the book develops a rich theoretical framework for understanding, justifying, and responding to Mad activism’s demand for recognition.

 

The Motivation for Recognition & the Problem of Ideology

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[Excerpt from Chapter 4 of my book Madness & the Demand for Recognition, forthcoming Oxford University Press, 2018]

 

In the foregoing account of identity (section 4.2) there is frequent mention of the demand for recognition (indeed, the title of the book features the same). We have made some progress towards understanding the nature of the gaps in social validation under which such a demand can become possible: individuals who are unable to find their self-understanding reflected in the social categories with which they identify and who are demanding social change to address this; what motivates people to seek this kind of social change – what motivates them to struggle for recognition?

4.3 THE STRUGGLE FOR RECOGNITION

4.3.1 The motivation for recognition

There are, at least, four possible sources of motivation for recognition. One of these sources has already been identified in the discussion of Hegel’s teleology (section 3.5.1). In accordance with this, the struggle for more equal and mutual forms of recognitive relations is driven forward by the telos of human nature which is the actualisation of freedom: if that is the ultimate goal, then the dialectical development of consciousness’ understanding of itself will lead to an awareness of mutual dependency as a condition of freedom. But this account has been considered and rejected on the grounds that positing an ultimate, rational telos for human beings that tends towards realisation is a problematic assumption, with connotations to the kind of metaphysical theorising which Kant’s critical philosophy had put to rest. The metaphysical source of the motivation for recognition must be rejected.

Another possible source is empirical and has to do with the psychological nature of human beings. In the Struggle for Recognition, Axel Honneth (1996) provides such an account through the empirical social psychology of G. H. Mead. According to Mead (1967) the self develops out of the interaction of two perspectives: the ‘me’ which is the internalised perspective of the social norms of the generalised other, and the ‘I’ which is a response to the ‘me’ and the source of individual creativity and rebellion against social norms. It is the movement of the ‘I’ – the impulse to individuation – that shows up the limitations of social norms and motivates the expansion of relations of recognition (see Honneth 1996, pp. 75-85).

In a later work Honneth (2002, p. 502) rejects his earlier account; he begins by noting: “there has always seemed to me to be something particularly attractive about the idea of an ongoing struggle for recognition, though I did not quite see how it could still be justified today without the idealistic presupposition of a forward-driven process of Spirit’s complete realization”. Honneth thus rejects the teleological account that we, also, found wanting. He then goes on to render problematic his earlier proposal that seeks to ground the motivation for recognition in Mead’s social psychology:

I have come to doubt whether [Mead’s] views can actually be understood as contributions to a theory of recognition: in essence, what Mead calls ‘recognition’ reduces to the act of reciprocal perspective taking, without the character of the other’s action being of any crucial significance; the psychological mechanism by which shared meanings and norms emerge seems to Mead generally to develop independently of the reactive behaviour of the two participants, so that it also becomes impossible to distinguish actions according to their respective normative character. (Honneth 2002, p. 502)

In other words, what Mead describes is a general process that is always occurring behind people’s backs in so far as it is a basic feature of the human life form. His theory explains how shared norms emerge and why they expand but deprives agents’ behaviours towards each other of normative significance. They become unwitting subjects of this process rather than agents struggling for recognition. To struggle for recognition is to perceive oneself to be denied a status one is worthy of, and not to mechanically act out one’s innate nature. And this remains the case even if our treatment by others engenders feelings of humiliation and disrespect. To experience humiliation is to already consider oneself deserving of a certain kind of treatment, of a normative status that is denied. Such feelings, therefore, cannot themselves constitute the motivation for recognition, rather they are symptoms of the prior existence of a conviction that one must be treated in a better way.

If the motivation for recognition cannot be accounted for metaphysically (by the teleology of social existence), or empirically (by the facts of one’s psychological nature), or emotionally (by the powerful feelings that signal the need for social change), then it must somehow be explained with reference to the ideas that together make up the theory of recognition. These ideas include specific understandings of individuality, self-realisation, freedom, authenticity, social dependence, the need for social confirmation, in addition to notions of dignity, esteem, and distinction, among others. To be motivated to struggle for recognition is to already be shaped by a historical tradition where such notions have become part of how we relate to ourselves and others, and the normative expectations that structure such relations; as McBride (2013, p. 137) writes, “we are the inheritors of a long and complex history of ethical, religious, philosophical, and, more recently, social scientific thought about the stuff of recognition: pride, honour, dignity, respect, status, distinction, prestige”. It is partly that we are within the space of these notions that we can see, as pointed out in section 3.5.2, that living a life of delusion and disregard for what others think, or a life of total absorption in social norms, is not to live a worthwhile life, for we would be giving up altogether either on social confirmation or on our individuality. We are motivated by these notions in so far as we are already constituted socially so as to be moved by them.

Putting the issue this way may raise concerns. By grounding the motivation for recognition in the subject’s prior socialisation, it becomes harder to establish whether that motivation is, ultimately, a means for the individual to broaden his or her social freedom, or a means for reproducing existing relations of domination. As McNay (2008, p. 10) writes, “the desire for recognition might be far from a spontaneous and innate phenomenon but the effect of a certain ideological manipulation of individuals” (see also McBride 2013, pp. 37-40; Markell 2003). Honneth (2012, p. 77) provides a number of examples where recognition may be seen as contributing to the domination of individuals:

The pride that ‘Uncle Tom’ feels as a reaction to the constant praises of his submissive virtues makes him into a compliant servant in a slave-owning society. The emotional appeals to the ‘good’ mother and housewife made by churches, parliaments or the mass media over the centuries caused women to remain trapped within a self-image that most effectively accommodated gender-specific division of labour.

Instead of constituting moral progress (in the sense of an expansion of individual freedom), recognition becomes a mechanism by which people endorse the very identities that limit their freedom. They seek recognition for these identities and in this way “voluntarily take on tasks or duties that serve society” (Honneth 2012, p. 75). There is a need, therefore, to see if we can distinguish ideological forms of recognition from those relations of recognition in which genuine moral progress can be said to have occurred, since what we are after are relations of the latter sort.

4.3.2 The problem of ideology

I first consider, and exclude, some ways in which the problem of ideology cannot be solved. It may seem attractive to find a solution by appeal to a Kantian notion of rational autonomy, where the subject withdraws from social life in order to know what it ought to do. If such withdrawal were possible, we would have had an instance of genuine recognition in the sense that an autonomous choice has been made. But as argued in section 3.2, withdrawing to pure reason can only produce the form that moral principles must take, without those principles thereby possessing sufficient content that can guide action. Moral principles acquire content, and hence can be action guiding, through the very social practices that Kant urged us to withdraw from in order to exercise our rational autonomy. Somehow then, the distinction between ideological and genuine recognition, if it can be made at all, will have to be drawn from within those social practices, as an appeal to a noumenal realm of freedom where we can rationally will what we ought to do cannot work. This is further complicated by the fact that both genuine and ideological recognition – being forms of recognition – must meet the approval of the subject in the sense that both must make the subject feel valued and are considered positive developments conducive to individual growth. Hence, the experience of the subject cannot help us here either. Ideological recognition then consists in practices that are “intrinsically positive and affirmative” yet “bear the negative features of an act of willing subjection, even though these practices appear prima facie to lack all such discriminatory features” (Honneth 2012, p. 78). How can these acts of recognition be identified?

The key seems to lie in the notion of ‘willing subjection’ and the possibility of identifying this despite subjects’ pronouncements of their wellbeing. The judgement that particular practices of recognition are ideological in the sense that they constitute acts of willing subjection must therefore be made by an external observer. The observer needs to perceive subjection, while at the same time explaining away the person’s acceptance of the situation as an indication that he has internalised his oppression in such a way that he willing subjects himself. The case of the ‘good mother’ is a case in point; by voluntarily endorsing that role, she remains uncompensated for her work and many other opportunities in life would be foreclosed to her. Now the observer, in this kind of theoretical narrative, is no longer concerned with the quality of interpersonal relations or the subject’s experience of freedom and wellbeing. What is at issue here seems to be that the observer disagrees with the values and beliefs that structure those relations, rather than the quality of those relations being relations of mutual recognition. A contemporary example can further clarify.

Consider the claim, often heard in certain public discourse, that Muslim women who cover their hair – who wear a hijab – are ‘oppressed’. Frequently, the claims made do not require that the women in question report any oppression, and hence concepts such as ‘internalised oppression’ are invoked to explain the lack of a negative experience. Of course, some women are coerced into wearing the hijab, and given the right context they would remove it and see it as an unnecessary imposition on them. For others the hijab is about modesty and has religious connotations. In this sense, it is not a symbol of their oppression and may even be regarded as a feature that can generate positive recognition as a pious and religiously observant person. An observer who claims that the desire for recognition in such cases is ideological – that women who cover their hair are willingly (and subconsciously) subjecting themselves to existing norms – is making a statement about his or her views on the cultural context: the problem the observer has is with the religious weight placed on clothing, or the fact that it is mainly women who have to observe such practices. Some women who wear a hijab reject this account since it bypasses their own understanding of what they are doing and the value they attach to it (in fact such an account can itself end up being a form of misrecognition). Not surprisingly, the exact claim is made in reverse by some Muslim women who argue that ‘Westernised’ women who dress ‘immodestly’ are oppressed by a dominant, male culture that subtly forces them to show their bodies. Those who believe that dressing in this way is an expression of freedom and secularism have simply internalised the values by which they willing subject themselves to existing norms.

The point of presenting this case from both sides is to show that once we bypass people’s accounts of what they are doing, and put aside their reported experience of freedom and wellbeing, we can see that what is going on is an ideological conflict between two worldviews. This conflict can itself be described within the framework of misrecognition as a continued devaluing of agent’s identities under the cover of an interest in their wellbeing. Of course, people are not always right about what they are doing, and our psychological depth is such that we can deceive ourselves and accept an abusive situation, even more not be able to see that it is abusive. We may convince ourselves that a particular role is exactly right for us, whereas others can see that it is obviously limiting our lives. But psychological depth and the possibility of self-deception go both ways; if that person over there is not transparent to himself then neither am I, even if transparency admits of degrees. Hence, if we are going to argue that a person is willingly subjecting herself, we also need to account for our motivations in making such an argument and what we are, in a sense, getting out of it in terms of validating our worldview, our take on what matters.

This perspective on the idea of ‘willing subjection’ should not be interpreted as a call for inaction; what it is, is a call for personalising and contextualising our moral and political responses and analyses of the lives of others. This means that if we are inclined to persuade individuals to change their understanding of their situation, then we cannot simply bypass their experience of wellbeing and their specific circumstances. In other words, sweeping judgements that take the form ‘group x is oppressed’ are not helpful; clearly there are all sorts of possibilities and the only way to sort these out is to be aware of this complexity, without losing sight of ‘structural’ discrimination in a particular community. With this in mind we will find that the spectrum of oppression includes the following: some in group x are oppressed and are already fighting to change that; some do not consider themselves oppressed but change their take on the situation once they are presented with a different analysis of it; some do not consider themselves oppressed – despite clear evidence to the contrary – yet no amount of persuasion can get them to see this; some consider your interest in their freedom as an attempt to oppress them; others consider themselves perfectly free and empowered.

Returning to our original question – the distinction between ideological and genuine forms of recognition – it appeared, to begin with, that the idea of ‘willing subjection’ held the key to that distinction. However, on having a closer look at this idea it emerged that what it communicates is a conflict of worldviews rather than a view on the quality of interpersonal relations as relations of recognition. As argued earlier, whether ‘ideological’ or ‘genuine’, if the relations in question are to be relations of recognition then the individuals concerned must feel valued for who they are, and be able to see existing relations as contributing to their personal growth and fulfilment. In this sense the distinction between ideological and genuine recognition cannot be drawn using the notion of ‘willing subjection’. What this notion brings to light are the very real, and very deep, disagreements in beliefs, values, social roles, and life goals that exist across contexts and ideologies. And while it certainly is of importance to debate and negotiate these differences, in order for such disagreements not to end up themselves generating conditions for misrecognition, it is necessary not to lose sight of the individuals involved, including their take on what they are doing and their experience of freedom and wellbeing.

Response to Order/Disorder, Kai Syng Tan’s UCL Institute of Advanced Studies Talking Points Seminar

5th December 2017

Title of seminar:

Order/Disorder – The artist-researcher as connector-disrupter-running messenger? 

by Dr Kai Syng Tan

My response:

Thank you very much for inviting me today.

I was pleased when I received this invitation, not only because it meant I can return to the IAS where I spent a year a couple of years ago, but because Kai’s work is hugely important, as well as being relevant to my work in philosophy and psychiatry.

For too long there has been a gap between, on one hand, social and professional understandings of mental health conditions and, on the other, individuals’ own understanding of their experiences and situation. There wasn’t much of a conversation going on, or if there was, it was framed in terms that emphasise disorder and deficit.

For some time, activism in mental health has been trying to change this, by demanding that people are heard on their own terms.

But then how do we bridge this gap, how do we create the possibility for generating shared understandings of the various mental health conditions? Just what do we to do? Well, we do what Kai is doing: inventive projects that bring people together, engage them in creative activities that unsettle some of their assumptions and broaden their  understanding, perhaps even their sense of empathy. For this kind of progress, it is not sufficient to give people information; they need to have an experience, and as I see it, Kai’s work provides both. 

*

There is a point I would like to make and to have your opinion on: it has to do with the distinction between order and disorder.

I came to this distinction first as a doctor and then as a researcher in philosophy and psychiatry. In philosophy, the concept of mental disorder has been the subject of many search and destroy as well as rescue missions over the past twenty-five years.

The key point of contention was whether or not we can define disorder (or more precisely, dysfunction) in purely factual terms, for instance as the breakdown of the natural functions of psychological mechanisms. The goal in such attempts was to define dysfunction in terms that do not involve value-judgements.

These attempts were not successful: at some point in the process of describing the relevant mechanisms and their functions, value-judgements sneak in.

Now demonstrating the value-ladenness of the concept of disorder does not mean that it suddenly disappears; and it does not mean that the boundary between order and disorder vanishes into thin air. It just means that it has become a much more controversial boundary than previously thought, and the distinctions it involves are difficult ones to make.

My point is that making qualitative distinctions among behaviours and experiences – whether our own or other people’s – is not optional: it is part of how we understand ourselves and understand others as psychological and social beings. 

That being said: even if the distinction between order and disorder – or between whatever terms you wish to use – even if that distinction is inevitable, it is one that we continually ought to attempt to transcend.

 Why should we attempt to overcome it? Because there might be order in what appears to be disorder, and disorder in what appears to be order; because in attempting to transcend this distinction we can grasp what it is that we share with others and not just what sets us apart; and because there’s no telling on which side of that distinction any of us is going to fall one day.

 It is precisely this paradox that we need to be conscious off and work with: the paradox of accepting the inevitability of a distinction while at the very same time seeking to transcend it. And I wonder what you think of this?

*

The other point I want to make has to do with the relation between our research and the activism that is connected to it. I must admit that in my own work I’ve frequently thought about this but I have not yet arrived at a satisfactory view. The question of course is broader than our area of research and applies to the humanities in general: to what extent should a researcher commit to the social cause they are researching, and what does this mean for the objectivity of what they are producing. What kind of balance do we need to strike here? And have you thought about this in your work?

The Meaning of Madness

mandess cover

Excerpt from Chapter 1 of my book “Madness and the Demand for Recognition”. Forthcoming with Oxford University Press, 2018

Mad with a capital m refers to one way in which an individual can identify, and in this respect it stands similar to other social identities such as Maori, African-Caribbean, or Deaf. If someone asks why a person identifies as Mad or as Maori, the simplest answer that can be offered is to state that he identifies so because he is mad or Maori. And if this answer is to be anything more than a tautology – he identifies as Mad because he identifies as Mad – the is must refer to something over and above that person’s identification; i.e. to that person’s ‘madness’ or ‘Maoriness’. Such an answer has the implication that if one is considered to be Maori yet identifies as Anglo-Saxon – or white and identifies as Black – they would be wrong in a fundamental way about their own nature. And this final word – nature – is precisely the difficulty with this way of talking, and underpins the criticism that such a take on identity is ‘essentialist’.

Essentialism, in philosophy, is the idea that some objects may have essential properties, which are properties without which the object would not be what it is; for example, it is an essential property of a planet that it orbits around a star. In social and political discussions, essentialism means something somewhat wider: it is invoked as a criticism of the claim that one’s identity falls back on immutable, given, ‘natural’ features that incline one – and the group with which one shares those features – to behave in certain ways, and to have certain predispositions. The critique of certain discourses as essentialist has been made in several domains including race and queer studies, and in feminist theory; as Heyes (2000, p. 21) points out, contemporary North American feminist theory now takes it as a given that to refer to “women’s experience” is merely to engage in an essentialist generalisation from what is actually the experience of “middle-class white feminists”. The problem seems to be the construction of a category – ‘women’ or ‘black’ or ‘mad’ – all members of which supposedly share something deep that is part of their nature: being female, being a certain race, being mad. In terms of the categories, there appears to be no basis for supposing either gender essentialism (the claim that women, in virtue of being women, have a shared and distinctive experience of the world: see Stone (2004) for an overview), or the existence of discrete races (e.g. Appiah 1994a, pp. 98-101), or a discrete category of experience and behaviour that we can refer to as ‘madness’ (or ‘schizophrenia’ or any other psychiatric condition for this purpose). Evidence for the latter claim is growing rapidly as the following overview indicates.

There is a body of literature in philosophy and psychiatry that critiques essentialist thinking about ‘mental disorder’, usually by rebutting the claim that psychiatric categories can be natural kinds (see Zachar 2015, 2000; Haslam 2002; Cooper 2013 is more optimistic). A ‘natural kind’ is a philosophical concept which refers to entities that exist in nature and are categorically distinct from each other. The observable features of a natural kind arise from its internal structure which also is the condition for membership of the kind. For example, any compound that has two molecules of hydrogen and one molecule of oxygen is water, irrespective of its observable features (which in the case of H2O can be ice, liquid, or gas). Natural kind thinking informs typical scientific and medical approaches to mental disorder, evident in the following assumptions (see Haslam 2000, pp. 1033-1034): (1) different disorders are categorically distinct from each other (schizophrenia is one thing, bipolar disorder another); (2) you either have a disorder or not – a disorder is a discrete category; (3) the observable features of a disorder (symptoms and signs) are causally produced by its internal structure (underlying abnormalities); (4) diagnosis is a determination of the kind (the disorder) which the individual instantiates.

If this picture of strong essentialism appears as a straw-man it is because thinking about mental disorder has moved on or is in the process of doing so. All of the assumptions listed here have been challenged (see Zachar 2015): in many cases it’s not possible to draw categorical distinctions between one disorder and another, and between disorder and its absence; fuzzy boundaries predominate. Symptoms of schizophrenia and of bipolar disorder overlap, necessitating awkward constructions such as schizoaffective disorder or mania with psychotic symptoms. Similarly, the boundary between clinical depression and intense grief has been critiqued as indeterminate. In addition, the reductive causal picture implied by the natural kind view seems naive in the case of mental disorder: it is now a truism that what we call psychiatric symptoms are the product of multiple interacting factors (biological, social, cultural, psychological). And diagnosis is not a process of matching the patient’s report with an existing category, but a complicated interaction between two parties in which one side – the clinician – constantly reinterprets what the patient is saying in the language of psychiatry, a process which the activist literature has repeatedly pointed out permits the exercise of power over the patient.

The difficulties in demarcating health from disorder and disorders from each other have been debated recently under the concept of ‘vagueness’; the idea that psychiatric concepts and classifications are imprecise with no sharp distinctions possible between those phenomena to which they apply and those to which they do not (Keil, Keuck, and Hauswald 2017). Vagueness in psychiatry does not automatically eliminate the quest for more precision – it may be the case, for example, that we need to improve our science – but it does strongly suggest a formulation of states of health and forms of experience in terms of degrees rather than categorically, i.e. a gradualist approach to mental health. Gradualism is one possible implication of vagueness, and there is good evidence to support it as a thesis. For example, Sullivan-Bissett and colleagues (2017) have convincingly argued that delusional and non-delusional beliefs differ in degree, not kind: non-delusional beliefs exhibit the same epistemic short-comings attributed to delusions: resistance to counterevidence, resistance to abandoning the belief, and the influence of biases and motivational factors on belief formation. Similarly, as pointed out earlier, the distinction between normal sadness and clinical depression is difficult to make on principled grounds, and relies on an arbitrary specification of the number of weeks during which a person can feel low in mood before a diagnosis can be given (see Horwitz and Wakefield 2007). Another related problem is the non-specificity of symptoms: auditory hallucinations, thought insertion, and other passivity phenomena which are considered pathognomonic of schizophrenia, can be found in the non-patient population as well as other conditions (e.g. Jackson 2007).

Vagueness in mental health concepts and gradualism with regards to psychological phenomena undermine the idea that there are discrete categories underpinned by an underlying essence and that go with labels such as schizophrenia, bipolar disorder, or madness. But people continue to identify as Women, African-American, Maori, Gay, and Mad. Are they wrong to do so? To say they are wrong is to mistake the nature of social identities. To prefigure a discussion that will occupy a major part of Chapters 4 and 5, identity is a person’s understanding of who he or she is, and that understanding always appeals to existing collective categories: to identify is to place oneself in some sort of relation to those categories. To identify as Mad is to place oneself in some sort of relation to madness; to identify as Maori is to place oneself in some sort of relation to Maori culture. Now those categories may not be essential in the sense of falling back on some immutable principle, but they are nevertheless out there in the social world and their meaning and continued existence does not depend on one person rejecting them (nor can one person alone maintain a social category even if he or she can play a major role in conceiving it). Being social in nature they are open to redefinition, hence collective activism to reclaim certain categories and redefine them in positive ways. In fact, the argument that a particular category has fuzzy boundaries and is not underpinned by an essence may enter into its redefinition. But demonstrating this cannot be expected to eliminate people’s identification with that category: the inessentiality of race, to give an example, is not going to be sufficient by itself to end people’s identification as White or Black.

In the context of activism, to identify as Mad is to have a stake in how madness is defined, and the key issue becomes the meaning of madness. To illustrate the range of ways in which madness has been defined, I appeal to some key views that have been voiced in a recent, important anthology: Mad Matters: A Critical Reader in Canadian Mad Studies (2013). A key point to begin with is that Mad identity tends to be anchored in experiences of mistreatment and labelling by others. By Mad, Poole and Ward (2013, p. 96) write, “we are referring to a term reclaimed by those who have been pathologised/ psychiatrised as ‘mentally ill,'”. Similarly, Fabris (2013, p. 139) proposes Mad “to mean the group of us considered crazy or deemed ill by sanists … and are politically conscious of this”. These definitions remind us that a group frequently comes into being when certain individuals experience discrimination or oppression that is then attributed by them as arising from some features that they share, no matter how loosely. Those features have come to define the social category of madness. Menzies, LeFrancois, and Reaume (2013, p. 10) write:

Once a reviled term that signalled the worst kinds of bigotry and abuse, madness has come to represent a critical alternative to ‘mental illness’ or ‘disorder’ as a way of naming and responding to emotional, spiritual, and neuro-diversity. … Following other social movements including queer, black, and fat activism, madness talk and text invert the language of oppression, reclaiming disparaged identities and restoring dignity and pride to difference.

In a similar fashion, Liegghio (2013, p. 122) writes:

madness refers to a range of experiences – thoughts, moods, behaviours – that are different from and challenge, resist, or do not conform to dominant, psychiatric constructions of ‘normal’ versus ‘disordered’ or ‘ill’ mental health. Rather than adopting dominant psy constructions of mental health as a negative condition to alter, control, or repair, I view madness as a social category among other categories like race, class, gender, sexuality, age, or ability that define our identities and experiences.

Mad activism may start with shared experiences of oppression, stigma and mistreatment, it continues with the rejection of biomedical language and reclamation of the term mad, and then proceeds by developing positive content to madness and hence to Mad identity. As Burstow (2013, p. 84) comments:

 What the community is doing is essentially turning these words around, using them to connote, alternately, cultural difference, alternate ways of thinking and processing, wisdom that speaks a truth not recognised …, the creative subterranean that figures in all of our minds. In reclaiming them, the community is affirming psychic diversity and repositioning ‘madness’ as a quality to embrace; hence the frequency with which the word ‘Mad’ and ‘pride’ are associated.

In Defence of Madness: The Problem of Disability

My essay, about to be published in the Journal of Medicine & Philosophy.

I write defending mad positive approaches against the tendency to adopt a medical view of the limitations associated with madness. Unlike most debates that deal with similar issues – for example the debate between critical psychiatrists and biological psychiatrists, or between proponents of the social model of disability versus those who endorse the medical model of disability – my essay is not a polemical adoption of one or other side, but a philosophical examination of how we can talk about disability in general, and madness in particular.

You can read the essay here: IN DEFENCE OF MADNESS

And here is the abstract: At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently disabling: the first arises from the normative nature of disability judgements, and the second from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter

Response to the commentary on ‘A Critical Perspective on Second-order Empathy’: Phenomenological psychopathology must come to terms with the nature of its enterprise as a formalisation of folk-psychology (and the permeation of this enterprise with ethics)

[A response to the commentary by Jann Schlimme, Osborne Wiggins, and Michael Schwartz on my essay published in Theoretical Medicine Bioethics, April 2015 (36/2).]

In a recent polemic against certain increasingly dominant strands of phenomenological psychopathology, I launched a critique of the concept of ‘second-order’ empathy. This concept has been proposed by prominent psychopathologists and philosophers of psychiatry, including Giovanni Stanghellini, Mathew Ratcliffe, Louis Sass and others, as a sophisticated advancement over ‘ordinary’ or ‘first-order’ empathy. The authors argue that this concept allows us to refute Jaspers’ claim that certain psychopathological phenomena are un-understandable, by demonstrating that theoretical sophistication allows a ‘take’ on the these phenomena that reveals them as meaningful in the context of the person’s ‘life-world’. In my essay I argued that, given its philosophical commitments, the second-order empathic stance is incoherent, and given the constraints it places on the possibility of recognitive justice, it is unethical. The commentators take issue with both these points, to which I now respond.

First critique: ‘Psychopathology is not first philosophy’

In a succinct yet accurate summary of the first part of my argument the commentators write:

Rashed first addresses the issue of the feasibility of psychopathologists engaging in second-order empathy with persons with psychotic experiences/schizophrenia … [He] marshals textual evidence that psychopathologists can only make their case for second-order empathy by showing that it requires the performance of the Husserlian ‘phenomenological [transcendental] reduction’. Then, by citing phenomenologists such as Merleau-Ponty, as well as developing his own arguments, Rashed maintains that phenomenologists themselves do not agree that the phenomenological reduction is even possible. Assuming now that this conflicting reasoning demonstrates the impossibility of performing Husserl’s reduction, Rashed concludes that second-order empathy is impossible (because such empathy presupposes the successful performance of an impossible reduction).

Now their critique: the commentators begin by pointing out that the “‘transcendental reduction’ is designed to reach the level of a ‘transcendental consciousness’, which is the subject matter for a ‘first philosophy’ (namely, transcendental phenomenology) [that] can supply the foundation for all of knowledge”, a characterisation with which I am in agreement. I would go further and state that I consider, together with a long line of modern philosophers from Hegel to Wittgenstein, that such a project cannot work: we cannot get behind knowledge in order to establish the grounds for certainty of knowledge. As Hegel put it in his Logic, to aim to investigate knowledge prior to attempts to know the world is “to seek to know before we know [which] is as absurd as the wise resolution of Scholasticus, not to venture into the water until he had learned to swim”. The commentators then go on to state, in criticism of my essay, that psychopathology is not ‘first philosophy’. To examine, as I do, the “quarrels among phenomenological philosophers about the founding level of phenomenological inquiry” and the possibility of the transcendental reduction, is to burden psychopathology with irrelevant problems. Hence, they write, psychopathologists “can breathe a deep sigh of relief”. I suggest they hold their breath. Psychopathology is not ‘first philosophy’ – I whole heartedly agree with this statement – but in order to establish its basis and validity, phenomenological psychopathology helps itself to the entire Husserlian philosophy, and therein the problem lies.

What is psychopathology? It is a formalisation of abnormal folk psychology : it is the meticulous documentation of mental states and their connections – or lack thereof – and in this sense has no special claim to expertise on mental states except in so far as meticulous documentation can be illuminating. Put differently, psychopathology cannot overstep the soil or ground from which it arises – namely, folk psychology – and claim knowledge of the supposed ‘true’ nature of ‘abnormal’ mental states. But that is precisely what contemporary phenomenological psychopathology wants to do. It is not content with psychopathology being a formalisation of folk psychology and hence dependent on it; it wants psychopathology to be a ‘science’ that exceeds folk psychology and from which the latter can learn. In order for psychopathology to be a ‘science’ it claims a theoretical basis that is not available to folk psychology. It establishes its credentials as a ‘science’ by helping itself to the entire Husserlian philosophy: it helps itself, in particular, to the concept of the ‘transcendental reduction’ without which the proposal for ‘second-order’ empathy as a mode of philosophically articulated understanding of others would not work. (I argued this final point in detail in my essay: achieving second-order empathy requires as a first step that one suspends the natural attitude and grasps that the sense of reality with which experience is ordinarily endowed is a phenomenological achievement, a move which presupposes the possibility of the transcendental reduction.)

Shorn of its theoretical ‘transcendental’ basis, psychopathology falls back to earth as the discipline which meticulously documents mental states and their connections in accordance with the implicit rules and principles of a particular folk psychology (particular since the rules and principles in question are normative and subject to, among other things, the influence of ‘culture’). Psychopathologists may be better in this than others, but that is because they have made it their vocation, and not because they have somehow ventured beyond folk psychology. Indeed, somewhat ironically, the commentators’ own account of how understanding works proves my argument that all we’ve got is ‘first-order’ empathy, of which the qualification ‘first-order’ can now be removed as there is nothing left to contrast it with:

 Jaspers realized that, in order to apply the phenomenological method (in this less demanding sense), I first need to ‘evoke’ the perspective of the other in my own consciousness. This evocation is not some kind of (‘mysterious’) self-immersion into the other’s psyche, but a meticulous and often strenuous (and necessarily imperfect) hermeneutical reconstruction of the other’s mental life (i.e., drawing on my own experiences and elaborate narrations of the pertinent experiences in order to get a ‘feeling’ for the other’s mental life).

Indeed: empathic understanding involves a “hermeneutical reconstruction of the other’s mental life”, a reconstruction in which I draw upon “my own experiences”. It seems then that the commentators’ disagreement with the first part of my essay is not as intractable as it first appeared to be. However, the important point to reiterate is that phenomenological psychopathology faces a dilemma: either it holds fast to its basis in transcendental philosophy and hence becomes theoretically incoherent, or it abandons its pretentions to be a ‘science’ and hence, as indicated, rest content with what it is: a formalised folk psychology. In my view, given the arguments of the original essay, only the latter option is available. And contrary to what it may seem, that is not a bad position to be in; far from it. The documentation of the various states of the mind, their description and the search for connections among them, while that is a vocation that cannot exceed folk psychology, it can certainly make available for the ‘folk’ certain possibilities of human experience and belief of which they were not explicitly aware, and therein its value may lie.

Second critique: ‘Distinguishing methodological from ethical value’

 In the second part of my essay I considered the ethical dimension of the second-order empathic stance. I asked if an attitude which emphasises radical difference – as required by this stance – is the right one to hold towards persons diagnosed with schizophrenia. My answer was that it is not, but the reason why this is so is important and deserves restatement. An attitude which emphasises differences is not the right one to hold, not because such emphasis is bad in itself; I would, for example, consider an attitude which emphasises similarity as also potentially problematic. This is because the issue at stake is not the nature of the attitude, but the degree to which the persons who are at its receiving end have had a say in its construction. The reason such a consideration is normatively significant has to do with the necessity of reciprocal relations of recognition for identity formation and self-realisation. To have an academic discipline launching discourses about others cloaked in the technical jargon of phenomenological philosophy, and possessing of the prestige and authority of scholarly argument in general, is to give those others no real chance and no say in how they would like to be represented. This is not a call to ban certain words or discourses – of course not! But it is a call to appreciate that there is no ethically neutral discourse or methodology. Unfortunately this neutrality is precisely what the commentators seem to be arguing for in critique of the second part of my paper.

They begin by stating that emphasising differences is important as this may ultimately enable the psychiatrist to understand his or her patients:

On the contrary, we assert that psychopathology emphasizes difference in order to encourage the examining psychiatrist to keep on going in the attempt to understand even when such understanding seems to have ‘reached a brick wall’. Examining psychiatrists should keep on going even when they fear that they have hit a limit inherent in understanding the patient.

Now this argument seems to rest on an assumed value being attached to understanding others. They restate their point again as follows:

It is valuable to be aware of the differences of persons with psychotic experiences/schizophrenia and typically ‘‘normal’’ persons, and consequently, to persist in the task of understanding.

They go on to describe the value in question as a ‘methodological’ value and distinguish this from the “ethical value of the person with psychotic experiences/schizophrenia [which] is the same as the ethical value of the rest of us”. I admit I find such a pronouncement somewhat unusual, as it implies that our methodological approaches towards others can be disentangled from our ethical evaluations towards them as long as we insist that they are our equals. If only it was this easy.

Understanding others is not merely of ‘methodological’ value: it is ultimately a core issue in any normative moral theory, and hence much broader. The distinction drawn by the commentators between methodological and ethical value suggests that it doesn’t matter what approaches we adopt towards others as long as we are motivated by understanding them, and never lose sight of the fact that they are our equals. Once seen as a concern with how we should treat others, such a picture appears naïve. For one thing, over and the above the need to understand, lays the wishes of those we are trying to understand: they may wish to have a say in how they would like to be understood, and in the language and method which they consider more representative of who they are. All this is to say that there is no domain of human interaction that lies, as it were, beyond the ethical. Phenomenological psychopathology cannot hide behind this claim to ethical neutrality, irrespective of whether or not it is methodologically valuable.

Mohammed Abouelleil Rashed – May 2015

Spirit Possession, Personhood, & Intentionality: Perspectives for the Philosophy of Mental Health

Summary of an essay I completed recently.

Spirit possession is a common phenomenon around the world in which a non-corporeal agent is involved with a human host. This manifests in a range of maladies or in displacement of the host’s agency and identity. Prompted by engagement with the phenomenon in Africa, this paper draws some connections between spirit possession, and the concepts of personhood and intentionality. It employs these concepts to articulate spirit possession, while also developing the intentional stance as formulated by Daniel Dennett. It argues for an understanding of spirit possession as the spirit stance: an intentional strategy that aims at predicting and explaining behaviour by ascribing to an agent (the spirit) beliefs and desires, but is only deployed once the mental states and activity of the subject (the person) fail specific normative distinctions. Applied to behaviours which are generally taken to signal ‘madness’ or ‘mental illness’, the spirit stance preserves a peculiar form of intentionality where otherwise behaviour would be explained as consequence of a broken physical mechanism. Centuries before the modern disciplines of psychoanalysis and phenomenological-psychopathology endeavoured to restore meaning to ‘madness’, the social institution of spirit possession had been preserving the intentionality of socially deviant behaviour.

The Dakhla Diaries (2) : Making Friends

Men, men, men, everywhere, nothing but men.
Dark and tanned, short and tall, toned and plump, mostly moustached.
We bond over caffeine and cigarettes, talking endlessly, telling stories, and making sense of a senseless world. Justifying the unjustifiable and debating the local cosmology.
My prick, he argues, is subject to my moods, my whims, and nothing else, NOTHING else.
His opponent attacks: Be wary of pig, it faggotises your prick.
People, I finally say, surely you can be tied to a Jinni, who turns your dick to a weenie.
And on your wedding night, the night of your coronation, instead of Salaheddin you become an embarrassment. Ironic.

The Dakhla Diaries (1) : Fast to Charing-X, slow to hell

Back in the fifties when the modern political entity that is Egypt gained its independence from combined British/Monarchic rule, the army assumed control of the country, and consistent with the burgeoning nationalism that was to plight our nation for the foreseeable future and the paranoia that nationalism inevitably engenders, military airports were constructed outside most Egyptian towns. Asyut airport is one of them. The first leg of my journey to Dakhla was an hour’s flight from Cairo to Asyut. It’s not really an airport, rather a landing strip and a small building that houses the military intelligence office. As I took my first step outside the building I was accosted by an Asyuti man offering his limousine services to any destination I desire. As expected he was annoyingly savvy and obviously disingenuous, littering his non-stop barrage of words with statements like, “we just want to serve you ya Basha”. In any case I expected this to be the last encounter with the sweet-talking Nile-dwelling Egyptians who usually want to charge you as much as they can, while making you feel – all the time – that they are doing you a service. The people of the Western desert are famous for their down-to-earth nature, their directness and honesty, and that was where I was heading.
Between my present spot and Dakhla, however, lay 450 km of scorching heat and cracked asphalt: the famous darb-al-arba’een road. Up till the late 1800s, so the story goes, this desert track was a major caravan trade route connecting Darfur in Southern Sudan with Kharga Oasis and beyond to the Nile-valley. Today it’s frequented by the dilapidated buses of the ‘Upper Egypt Transport Company’, and the occasional private vehicle. The journey was hell. I was reassured, initially, when I read on the information board at the bus station that the service is air-conditioned. It turns out the A/C is switched on the first and last half hours of the journey (to save fuel?). This meant suffocating heat in the midst of fleas and the occasional whiff of smelly feet and other more problematic aromas. Adding to the general feeling of torture a young child vomited in the corridor of the bus in the first half hour, and we had to live with that for the next five. To add pain to insult, my fellow commuters were reluctant to open the windows, under the excuse that dust and sand may enter the bus.

I arrive to Mut at 5pm. The town was still drowning in the lethargy of the intense heat; most of the shops were closed. I sip a tea at a coffee shop near the bus stop, a couple of other patrons were sitting dazed in the shade, none seemed interested in this stranger suddenly in their midst. I walk off searching for a hotel. An old man with an unbelievably creased face points out the ‘Mut rest house’, “the rooms there are five pounds”, he reassures me, “just beyond it you’ll find ‘Al-Forsan’ hotel, but it’s very expensive, they charge twenty-five pounds for the room”. Notwithstanding the old-man’s retort, I head to Al-Forsan, somewhat surprised at how cheap it is. Checking in was immediate; I throw my bags on one of the beds, peel my wet clothes of my flea-bitten skin and lie naked on the bed under the noisy ceiling fan, and I couldn’t help thinking, “what have I done?”

Tales From a Distant Land

Take me away,
Elevate me to the green pastures suspended in the heavens,
Remove the blackthorns embedded in my skin,
Make me light, free as a feather,
Help me break through,
That great barrier,
Burn the curtains, destroy the stage,
Let there be no more actors,
And let us rejoice in the purity of our regained innocence
My downfall was insight. I always knew that I had something extra, or – maybe – that I lacked something vital everyone else possessed. It’s always difficult to know such things, in fact I spent many hours trying to find out whether I was blessed or cursed to possess so much insight, and I never reached an answer. You see, I am a very bitter man, challenge me, show me what I lack, even indirectly, and I feel like a failure. But don’t be mistaken; that doesn’t push me to work harder or change my fate for I’ve lost my drive years ago, it just fills me with hate and anger. But even in the midst of my bitterness I adorned the dizzy heights of insight. From up there I could see everything clearly, beyond the haze of the petty successes and accomplishments in the game you call life. Yes, it is a game, and you only have two options: You can either play the game or see yourself playing the game. And I chose to use my third eye. I chose to watch myself talk, act, eat, play, fuck and all those things that you do. I am an anthropologist, no, a philosopher, perhaps the only one who managed to achieve that elusive reduction, that absolute bracketing of all reality, of all the delusions you construct to make your game possible and bearable. I am above you, all of you, yet I am also nothing.

Insight, a relentless whore that pulls you to her moist insides then expels you, leaving you drowning in emptiness – that was my fetish. I chose to ignore your reality, to learn the rules of the game just to mock you – that was my fetish. You might be thinking by now: What a sick man. Yes I am sick, but only in your eyes, I am sick in your stupid game. But I am braver than all of you. I chose to give up your life. I once lived like you, life was all planned for me, and all I had to do was live it, to learn the algorithms that you employ in your everyday life, to laugh when I should, to cry when it’s appropriate. All I had to do was go from A to B. You provided me with everything I needed, you even gave me an afterlife, you promised me with heaven and when that didn’t work you blinded me with money, you terrorized me with your ads, you made me believe that all I need is what you have to offer. But I escaped your hell, I renounced your cheap thrills, your debased offers, but it wasn’t enough. I still existed inside your dome, inside the very fabric of your ugly reality and I had to get out.

It began as an experiment and became my drug; watching myself every second of the day: waking up in the morning, toasting the bread, spreading the butter, brewing the coffee. And lo! I was free; I became master of your words, of your language. I had the power to make things whatever I wanted them to be. I was no longer trapped by your concepts or even your rules- I was creating my own. I once observed a tree for a whole day, I was sitting next to it feeling its bark, smelling the wood, tasting the leaves, I was experiencing a life that I never knew existed, I was happy. But it all came at a price, creating my own reality – is that even possible?

I once had one foot in the abyss of darkness, barely holding on to the final thread tying me to this life, your life. What choice did I have, where was I to find a foothold? Where were the primary reasons that could halt the infinite regress into doubt? What am I to hold to if I give up your play? But my desire to be free was greater than my fear. I renounced the final chains and lost myself in the well of nothingness with the hope that I might, just might emerge on the other side. For years I lived in fear, I existed as a stranger in a world that lost all meaning, everything that I set my eyes on was something new, untouched, unmediated, pure consciousness. I had nothing to organise my experience, no form to magically bestow upon the world. It was an enormous responsibility. I was reborn, free to create my own reality, my own world. But I felt threatened, by you. You continued to exist in my world, as robots, automatons getting about in a predictable fashion, predictable to an extent that doesn’t permit life, for what is life but a series of spontaneous crystallisations of consciousness? You had the same dreams, fought for the same things, felt the same feelings and thought the same thoughts. But I had no place among you; I ruined the fragile harmony of your act. I was alone, singing my own Libretto, out of tune with everyone yet my voice vibrated with the strings of nature.

In time I re-established my relation with things, I was no longer limited by your classifications and categorisations; my perceptions where immediate and direct. But it wasn’t easy, I had my moments of weakness, and I learned the hard way that I cannot escape you, except by death. You set a decree upon me. I was not allowed to exist unless I pay my dues, unless I suffer for tarnishing your perfect painting. I challenged the whole edifice of your life, of your reason. I brought fear right into the depths of your being, I made you feel how cheap and pointless your life is. I was the sore that ruined the perfection of your common sense and I had to be removed. For years you locked me in your institutions, you drugged me, humiliated me. You didn’t even attempt to bring me back to your life, the life I despised. You just wanted to silence me, to shut up the voice that could topple your flimsy towers of reason, custom, and tradition, towers you erected to prevent yourself from facing the responsibility and might of life in all its glory. And you broke me, you fractured my will, you cut my tongue just to protect yourself and continue living in your filthy holes behind your mighty barriers.

And you succeeded. For years I walked with your chains inside my mind. Life became a distant memory save for the occasional glimpse of a bygone time. I was drained of any vital organising impulse to motivate my existence. And it was then that death dawned upon me as a saviour. Death would protect me from the raids dawning upon me from the depths of my chained soul. Death would relieve me of my impotence in the face of an existence that I was deprived of the power to change. But I wasn’t allowed to die. Your nauseating ‘humanity’ dictated that you save me. Yes. After killing my soul you had to protect my body so I remain another shadow, just like everyone else: A number in the dark. And it was then that I decided to retaliate. I gave you my body to save and protect and I killed whatever remained of myself. I was finally dead and if I returned to write this it was only to remind you that seeing yourself every morning in the mirror is no guarantee that you are alive. As for me I no longer need to talk or think because I know everything.
Mohammed Abo El Leil. April 2006.