Public Mental Health Across Cultures: The Ethics of Primary Prevention of Depression, Focusing on the Dakhla Oasis of Egypt

(Introduction to a chapter I wrote with Rachel Bingham. It will be part of the volume ‘Mental Health as Public Health: Interdisciplinary Perspectives on the Ethics of Prevention’, edited by Kelso Cratsley and Jennifer Radden.)

 

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For over a decade there has been an active and ambitious movement concerned with reducing the “global burden” of mental disorders in low- and middle-income countries.[1] Global Mental Health, as its proponents call it, aims to close the “treatment gap”, which is defined as the percentage of individuals with serious mental disorders who do not receive any mental health care. According to one estimate, this amounts to 75%, rising in sub-Saharan Africa to 90% (Patel and Prince 2010, p. 1976). In response to this, the movement recommends the “scaling up” of services in these communities in order to develop effective care and treatment for those who are most in need. This recommendation, the movement states, is founded on two things: (1) a wealth of evidence that medications and psychosocial interventions can reduce the disability accrued in virtue of mental disorder, and (2) closing the treatment gap restores the human rights of individuals, as described and recommended in the Convention on the Rights of Persons with Disabilities (Patel et al. 2011; Patel and Saxena 2014).

In addition to its concern with treatment, the movement has identified prevention among the “grand challenges” for mental and neurological disorders. It states, among its key goals, the need to identify the “root causes, risk and protective factors” for mental disorders such as “modifiable social and biological risk factors across the life course”. Using this knowledge, the goal is to “advance prevention and implementation of early interventions” by supporting “community environments that promote physical and mental well-being throughout life” and developing “an evidence-based set of primary prevention interventions” (Collins et al. 2011, p. 29). Similar objectives have been raised several years before by the World Health Organisation, who identified evidence-based prevention of mental disorders as a “public health priority” (WHO 2004, p. 15).

Soon after its inception, the movement of Global Mental Health met sustained and substantial critique.[2] Essentially, critics argue that psychiatry has significant problems in the very contexts where it originated and is not a success story that can be enthusiastically transported to the rest of the world.[3] The conceptual, scientific, and anthropological limitations of psychiatry are well known and critics appeal to them in making their case. Conceptually, psychiatry is unable to define ‘mental disorder’, with ongoing debates on the role of values versus facts in distinguishing disorder from its absence.[4] Scientifically, the lack of discrete biological causes, or biomarkers, for major psychiatric conditions has resulted in the reliance on phenomenological and symptomatic classifications. This has led to difficulties in defining with precision the boundaries between disorders, and accusations that psychiatric categories lack validity.[5] Anthropologically, while the categories themselves are associated with tangible and often severe distress and disability, they remain culturally constructed in that they reflect a ‘Western’ cultural psychology (including conceptions of the person and overall worldview).[6] Given this, critics see Global Mental Health as a top-down imposition of ‘Western’ norms of health and ideas of illness on the ‘Global South’, suppressing long-standing cultural ideas and healing practices that reflect entirely different worldviews. It obscures conditions of extreme poverty that exist throughout many non-Western countries, and which underpin the expressions of distress that Global Mental Health now wants to medicalise. On the whole, Global Mental Health, in the words of the critics, becomes a form of “medical imperialism” (Summerfield 2008, p. 992) that “reproduces (neo)colonial power relationships” (Mills and Davar 2016, p. 443).

We acknowledge the conceptual, scientific, and anthropological critiques of psychiatry and have written about them elsewhere.[7] At the same time we do not wish to speculate about and judge the intention of Global Mental Health, or whether it’s a ‘neo-colonial’ enterprise that serves the interests of pharmaceutical companies. Our concern is to proceed at face-value by examining a particular kind of interaction: on one hand, we have scientifically grounded public mental health prevention campaigns that seek to reduce the incidence of mental disorders in low- and middle-income countries; on the other hand, we have the cultural contexts in these countries where there already are entirely different frameworks for categorising, understanding, treating, and preventing various forms of distress and disability. What sort of ethical principles ought to regulate this interaction, where prevention of ‘mental disorders’ is at stake?

The meaning of prevention with which we are concerned in this chapter is primary, universal prevention, to be distinguished from mental health promotion, from secondary prevention, and from primary prevention that is of a selective or indicated nature. Primary prevention “aims to avert or avoid the incidence of new cases” and is therefore concerned with reducing risk factors for mental disorders (Radden 2018, p. 127, see also WHO 2004, p. 16). Secondary prevention, on the other hand, “occurs once diagnosable disease is present [and] might thus be seen as a form of treatment” (Radden 2018, p. 127). In contrast to prevention, mental health promotion “employs strategies for strengthening protective factors to enhance the social and emotional well-being and quality of life of the general population” (Peterson et al. 2014, p. 3). It is not directly concerned with risk factors for disorders but with positive mental health. With universal prevention the entire population is within view of the interventions, whereas with selective and indicated prevention, the target groups are, respectively, those “whose risk for developing the mental health disorder is significantly higher than average” and those who have “minimal but detectable signs or symptoms” (Evans et al. 2012, p .5). While there is overlap among these various efforts, we focus on primary, universal prevention. Our decision to do so stems from the fact that such interventions, in being wholly anticipatory and population wide put marked, and perhaps even unique, ethical pressure on the encounter between the cultural context (and existing ideas on risk and prevention of distress and disability) and the biomedical public mental health approach.

It is helpful for ethical analysis to begin with a sufficiently detailed understanding of the contexts and interactions that are the subject of analysis. With these details at hand, what matters in a particular interaction is brought to light and the ethical issues become easier to grasp. Accordingly, we begin in section 2 with an ethnographic account of the primary prevention of ‘depression’ in the Dakhla Oasis of Egypt from the perspective of the community. The Dakhla Oasis is a rural community where there is no psychiatric presence or modern biomedical concepts yet – like most communities around the world – there is no shortage of mental-health related distress and disability. It is a paradigmatic example of the kind of community where Global Mental Health would want to action its campaigns. In section 3 we move on to the perspective of a Public Health Team concerned with preventing depression in light of scientific and evidence-based risk factors and preventive strategies. Section 4 outlines the conflict between the perspective of the Team and that of the community. Given this conflict, sections 5 and 6 discuss the ethical issues that arise in the case of two levels of intervention: family and social relationships, and individual interventions.

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Notes:

[1] See Horton (2007), Prince et al. (2007), and Saxena et al. (2007).

[2] Most recently there was vocal opposition to a ‘Global Ministerial Mental Health Summit’ that was held on the 9th and 10th of October 2018 in London. The National Survivor and User Network (U.K.) sent an open letter to the organisers of the summit, objecting to the premise, approach, and intention of Global Mental Health.

[3] See Summerfield (2008, 2012, 2013), Mills and Davar (2016), Fernando (2011), and Whitley (2015).

[4] For debates on the definition of the concept of mental disorder consult Boorse (2011), Bolton (2008, 2013), Varga (2015), and Kingma (2013).

[5] For discussions of the (in)validity of psychiatric categories see Kinderman et al. (2013), Horwitz and Wakefield (2007), and Timimi (2014). Often, the problem is framed by asking whether mental disorders are natural kinds (see Jablensky 2016, Kendell and Jablensky 2003, Zachar 2015, and Simon 2011).

[6] See, for example, Fabrega (1989), Littlewood (1990), and Rashed (2013a).

[7] For example: Rashed and Bingham (2014), Rashed (2013b), and Bingham and Banner (2014).

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

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Marriage and Reputation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Dakhla Diaries (3): Wedding Invitation

Place: Dakhla Sports and Social club

Time: 10pm to 3am

Dress Code: What’ever

Setting and Behaviour: A rectangular green space with a small platform in the North-Eastern corner. Six, long cables dotted with small light bulbs (that go on and off in some sort of coordinated medley of colours) radiate from a central, wooden mother-pole to daughter-poles at the periphery of the green space. You will find several rows of wooden benches arranged in two piles; if you are a woman please occupy the left, otherwise bear right. Remember that early on in the night, many of the benches on the left side will already be occupied by large groups of women. Boys may clamour around the edge of the wedding space and wait for events to unfold. Men, of course, will be dressed in unassuming, unpretentious clothes, but women may make some effort: the obligatory veil of course, but with a tighter waist, a sized down dress, a slightly smaller skirt than the usual (you get the point: a subtle increase in bodily definition). Teenage boys are allowed, as long as they limit their participation to sustained visual ogling of the arriving females, hungry eyes optional.

Entertainment: A band will arrive by 11pm. They will jam for what seems an indefinite amount of time, and there will be a perpetually lengthening singer-is-arriving-moment, for him to actually arrive when you no longer care he does. Massive speakers will dominate each corner and deliver extremely loud music. The band will consist of two tablas, a dof, re2, keyboard, and an unbelievably camp compere who will address you, dear attendees, and urge the women to deliver some zaghareet. We assure you that the band will be more sophisticated than any you’ve heard at other weddings, a fact that may pass unnoticed in the infinite reverberations of the sound system.

Preparation: Unless you are one of the seven V.I.P.s (small-town, insignificant – in the bigger picture – local politicians) who will be sitting at the back and served tea, no drinks or anything will be on offer. You are advised to bring your own cigarettes. If you think that Beer or Hashish will be going around then you are seriously lost: this is Dakhla not ‘Ard El-Lewa you idiot. Notwithstanding the absence of drugs, you will notice five teenagers hanging at the back of the wedding looking seriously wasted. Do not rejoice, this will not be the effect of Hashish; look around for empty pill-blisters. We advise either that you leave any sense of music appreciation at home or wear extremely effective ear-plugs: the band will play continuously for several hours and with such frenzy that – preparations bypassed – we guarantee absolute manic-excitement to infect everyone at the wedding.

Key Moment: Just after 11pm two cars will arrive, yes two (it’s a double wedding), bedecked with flowers and colourful ribbons and preceding them will be a gang of motorcycles, all vehicles honking their horns rhythmically. The couples will slowly descend and will be immediately surrounded by numerous individuals. A man will take charge of an extremely unusual small box – perhaps the size of a Nokia-6600-Phone Box – that emits a tiny firework with each shake. The necessity of shaking the box means that the firing trajectory will correspond to the movement-range of the shoulder joint thus increasing the risk of a firework launching horizontally with potential loss of eyes and other facial bits. Be careful.

Warning: We hope you enjoy today’s wedding and entertainment. Please remember that the groom must not be compromised on his entry-night; any person seen shaking the groom’s hand will have his palms examined for suspicious traces of Musk, Saffron, and – God forbid -Deer’s Blood.

Khalil Gibran

On Love
“For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning. Even as he ascends to your height and caresses your tenderest branches that quiver in the sun, So shall he descend to your roots and shake them in their clinging to the earth. ”
“But if in your fear you would seek only love’s peace and love’s pleasure, Then it is better for you that you cover your nakedness and pass out of love’s threshing-floor, Into the seasonless world where you shall laugh, but not all of your laughter, and weep, but not all of your tears. “
On Marriage
“..But let there be spaces in your togetherness,
And let the winds of the heavens dance between you.
Love one another but make not a bond of love:
Let it rather be a moving sea between the shores of your souls.
Fill each other’s cup but drink not from one cup.
Give one another of your bread but eat not from the same loaf.
Sing and dance together and be joyous, but let each one of you be alone,
Even as the strings of a lute are alone though they quiver with the same music.
Give your hearts, but not into each other’s keeping.
For only the hand of Life can contain your hearts.
And stand together, yet not too near together:
For the pillars of the temple stand apart,
And the oak tree and the cypress grow not in each other’s shadow.”