The Politics of Madness

Existing in isolation was not entirely out of my willingness. These four walls framing emptiness are driving me insane and I am slowly vanishing. During her weekly visits, my therapist tries to console me with words I can hardly believe, “think of it as a rehabilitation period till you’re back in the outside world.”

At that time, I lost the ability to distinguish between what is real and what is an illusion. Loneliness was no longer my greatest fear, but rather, I grew to identify with isolation. A visualization of the room resembling my mind, and I’m sitting in it, trapped forever. I felt a reality as serenity crept in sometimes, and a voice whispered, "Come on, this is the right time for us to leave."

The voices disappeared relatively, and I went back to the outside world, but I didn't perceive it the way I used to before. I wasn’t the same anymore.

Over the years, I developed an interest in exploring notions of mental health and mental ill-health. I became invested in digging into its history to understand how various factors such as culture, politics, and socio-economy intersected in shaping different peoples' experiences and perceptions of mental health and mental ill-health. I was invested in understanding how it has changed over the years producing language, terms, and standards for what is considered a “normal,” “abled,” and “valuable” body and mind, in such a way that everything existing outside those standards and norms becomes invisible and disposable. This led to exploring how these notions and perspectives had an impact on shaping the policies and practices within institutions, especially mental health institutions that produce and reproduce systems of violence and oppression, and transcended stigma, discrimination, and exclusion to the point of murder.

My interest in these notions was motivated by several reasons that stemmed from a personal experience that began nearly seven years ago. At the time, I had the privilege of having the needed support to facilitate my understanding of how to deal with what I was experiencing – experiences which at times disrupted my life partially and at other times disrupted it completely.

I repeatedly tried several times searching for documented experiences of people with mental ill-health, to understand what their suffering was like. How do they describe their pain in a non-medical language, how do they coexist in public, private, and intimate spaces? Did they heal and experience life differently, or not? What is healing to start with? Experiences written in Arabic, experiences that disrupt the intensity of my isolation, or perhaps teach me how to write without falling into the trap of stripping my personal experience from the political and social context, or vice versa. Having my immersion in the broader context cancel the individual particularity of my experience. Few were the writings that I found originally written in Arabic.

I rethink the political economy of healing. What constitutes it in the framework of structural violence, state violence, and its social institutions? Who are the people most vulnerable to ill-health, stigma, and exclusion? Who has access to support networks, treatment, and medication? Who has the privilege to comprehend the experiences and voice them out loud? To be heard and validated? All these questions ran through my mind as I searched for and thought about the forgotten, exiled, disabled, and departed ones.

During certain periods of such a never-ending journey, I reflect a lot on the common features of complete isolation, ones that are experienced by choice and others, not at all. In her description of forms of isolation, Basma Abdel Aziz writes in one of her articles,1

"There are two aspects for isolation, there is a material aspect which targets the body first and foremost, and a moral aspect which leaves the body unconstrained, but in truth, there is overlap between the two." On that spectrum, I sat in the middle.

I am neither writing about victory or defeat, nor about resilience or surrender. I despise those reductionist binaries, but there’s a part of me that rages with so much anger contained between my ribs and crudely beginning to unravel. Anger with which I don't know how to cope. I don’t know how to cope with this amount of violent anger, except by writing, and other techniques that I am experimenting with within the purpose of letting that anger go. My anger is directed at medical institutions, the psychiatric industry, and their hegemony over mental health discourse and practices that reinforce the individuality of suffering and its medicalization. An industry that depoliticizes and reduces the issue of mental health by framing it as an individual responsibility. A not-so-different logic from the seventies mental illness started being explained as a physical state rather than the supernatural explanations associated with demonic or divine possession that prevailed before. However, none of those explanations encouraged compassion; they rather implied that this impaired physical state was self-inflicted, consequently justifying punishment and confinement in public jails, general hospitals, and private asylums.2 I write with a desire to let loose of my confusions and uncertainties and my attempts at exploring and reimagining alternatives to the medical establishment.

***

Are there sources of information on mental health and illness, different practices, or alternative spaces for support beyond the medical establishment?

This was one of the pressing questions for me, as I read about the history of mental illness and moved along different ages and eras. I proceed through articles and studies, health laws, and policies that try to ensure a standard quality of minimum humane interaction with people suffering from mental ill-health. I witness the monopolization of the psychiatric perspective of health and illness affected by what is considered socially acceptable and unacceptable. A perspective influenced by the political and economic structures, producing violent crimes, stigmatization, discrimination and exclusion, and a lot of exploitation and abuse in dealing with patients. These abusive practices varied from one era to another till the emergence of the anti-psychiatry movement in the 1960s as one of the political movements that protested the systematic violence executed by mental health institutions on patients, and sought to radically redefine the approach and practice at the time.3

Critical medical anthropology recognized the roots of Western political ideology in modern medicine.4 In this context, psychiatry was the sole source monopolizing the production of knowledge, and systematically eliminated any other forms of healing practices unrelated to modern medicine and its methods by questioning them and accusing indigenous practices from different cultures of ignorance. Its role was not limited to treatment but it also imposed ways of thinking and practices that enforced a hierarchical dynamic between the therapist and the patient within societies.

In defining what is an illness and what is a treatment, the "Diagnostic and Statistical Manual of Mental Disorders" was produced as a primary reference to diagnostic categories of mental disorders that are periodically reviewed, revised, and updated to accommodate new findings; it is modified by a committee of mental health specialists who decide according to a set of criteria what is a mental illness and what is not, according to which they prescribe treatment methods that depend largely on medication. Many have addressed problems within the evidential findings in this manual, which are not necessarily medical, but rather political.

One of the most famous examples of this was the inclusion of homosexuality as a disease in the manual and then its removal in the 1970s. In both cases the reasons were political rather than medical. In another example, in her book "Trauma and Recovery,"5 Judith Herman expands on the need to find a new perspective on diagnoses that takes into account the political and social context of the systematic violence to which people are subjected, and concludes that the classifications of this guide for example are inappropriate for survivors of violence, along with other disastrous reasons related to the vision and ideas of those who produced this knowledge. Herman also pointed out that the writing and updating of the manual had no representation of women therapists until the fourth version of the manual published in the first half of the twentieth century i.e after protests were held against the committee's proposal to add a new diagnosis called masochistic personality disorder, which applies to those who stay in relationships where they are exploited or abused in any way. This is not the first or the last incident that happened of that sort. Many incidents incited condemnation towards the practices of the medical institution which only became more oppressive whenever the person’s gender, sex, or race didn’t conform to the “norm.”

Finding a language for pain entails a lot of power. It holds a sort of recognition and validation of the experience of pain that renders it visible. I don't care about the diagnosis and I don't trust its process, but I do care about naming what I'm experiencing. I wonder how possible it is to find a language that describes psychological pain in non-medical terminology that reduces it to standardized and de-contextualized terminologies concerned solely with making sense of, assessing, and treating pain.

I think about this question and go back to reading what I wrote in the beginning, I notice how many times I've used words like illness, disorder, suffering in my questions regarding the issue of healing. I don't know the alternatives that can refute the meanings of such words and terms that reinforce the idea that there is something wrong that needs to be fixed. This idea is rooted in a culture of ableism that believes in the duality of normal and deviant minds/bodies and sees the latter as violent, irrational, dependent, and burdensome.6

We hereby emphasize the importance of language as a form of resistance and its potential to bring about a change in the form of our perception of reality, ourselves, and our experiences and thus of how we show up in this world. Shaida Kafai,7 influenced by the works of Gloria Anzaldúa, re-uses the word madness as an alternative to mental illness by recounting her experience with madness and reclaiming the word. She also tries to debunk the duality of sanity and madness by creating a gray area that she sometimes inhabits, moving from it to the edges of that spectrum, and returning again to that grey area.

***

"The world starts from my body and I don't know where it ends. It identifies and dissolves in other bodies, it melts until its features disappear. Signs are what remind me of my body’s presence, consistent parallel lines next to each other distracting me from my unbearable pain. I often tried to tame my body and control it, perhaps glimpsing any boundaries to it; I pinged food, ate voraciously everything I wanted, whenever I liked and forced it back.  Was I Purging food or pain? Burying anger, loneliness, fear, and all that I cannot comprehend. I can't bear this much pain."

I contemplate the years of attempts, failures, and re-attempts to understand what I am going through and get to its roots, where does my responsibility begin and where does it end, what caused the shame attached to it, to be convinced that it's "real," what do I do with all these realizations? In her article,8 Naira Antoun talks about a hierarchy of psychological suffering, which defines suffering associated with political power as more realistic than other forms – and everything else is invisible, and therefore unreal. It reminds me of Rob Nixon's concept of slow violence;9 invisible violence that is not visible or fatal, but cumulative, whose repercussions have been postponed for decades, draining violence that is not seen as violence at all… I am interested to see what happens in the shadows, the violence of suffering that does not dare to appear, and its ability to shape and reshape the relationship of our bodies, with the political-social realities, engaging with them and disengaging, by dismantling this complex dynamic relationship.

***

"Neither here nor there, I don't know where I am now ... details are faint, everything I see is unreal!"

On the edge of the madness spectrum, that is where I’ve been sitting, unknowingly. I didn't have a name for this place, but I was good at hiding my presence there. The journey of discovery helped me recognize some features of this place; the faded details, the fantasy of reality, everything seems like a dream and I lose the ability to communicate. This journey also helped me remember what it’s like to exist on the edge of sanity. I remember the details of the first time I had experienced that feeling; seeing bright colors, seeing the details, feeling the weight of my body on the ground, feeling it as if I was getting to know it for the first time. On the other hand, I recognized unprecedented degrees of pain, realizing the ugliness of reality and the surroundings, and the more I became politically conscious, the more I felt alienated. And with reviving and resuscitating the memory of my body, came along relieving heavy events and experiences that had been wiped out from my memory. I felt as if my chest was bleeding and all the muscles in my body, even my face, were in excruciating pain. But this time I was sure the pain would go away, I wouldn't do anything about it, it would last several days, several weeks, and then it would go away. This time I had the luxury of time and place to surrender to pain.

I was and still am convinced that even a breakdown in our complex realities may become a privilege that not everyone has, nor can everyone afford its physical and/or social cost, and hence, the verge of madness becomes the most familiar and the most "comfortable" place. The constant expectation of loss, of disappointment, the possibility of collapsing and not collapsing, the continuous attempts to survive – not – to live. I go back to the gray space, and slowly, to the edge of madness. My energy and ability to see gradually fade until they disappear. Maybe that's what healing means to me – to own madness.

***

I still fear being seen. I’m afraid of being exploited for my vulnerability, having this fragility being used against me. I feel threatened by stigmatization in spaces where I am constantly present, at work, and fearing the possibility of losing it, in companionship, in intimate spaces... I know it is a matter of time until I own my madness, but perhaps now is not the time. I revisit my writings over the years. They were the only consistent act I performed over time, and I think about how there could be other alternatives that would help me understand, with less suffering, cost, and isolation.

I acknowledge the importance of psychiatry as a field, and the help it provides to some extent. But its shortcomings and consequences as an institution, in theory and practice, separate the personal and political, disregard cultural, social, and gender diversity, and deny the persistent power dynamics between the therapist and the patient. These cannot be overlooked. This is what feminist criticism highlights and offers an alternative concept for. The feminist alternative calls for recognizing and understanding the power dynamics in the therapist-patient relationship, adopting an intersectional lens in methods that give space and highlight the importance10 of lived political and social realities, and rejecting discrimination based on physical and mental abilities, in theory, language, and practice.

• 1. About the weary – delirium in the streets. If not for that wall. Contemporary Image Collective, 2016.
• 2. World Health Organization. The Mental Health Context: Mental Health Policy and Service Guidance Package. 2003, p. 15. https://www.who.int/mental_health/policy/services/3_context_WEB_07.pdf EIPR. مشروع قانون الصحة النفسية: خطوة أولى على الطريق الصحيح. 2008. https://eipr.org/sites/default/files/reports/pdf/First_Step_Report_Nov08...
• 3. Foot, John. “Taking over the asylum: Critical psychiatry, Franco Basaglia and social struggle.” Verso Blog. 8 October 2015. https://www.versobooks.com/blogs/2271-taking-over-the-asylum-critical-ps...
• 4. Sholkamy, Hania, and Ghannam, Farha. Health and Identity in Egypt. American University in Cairo Press, 2004, pp. 4-7.
• 5. Herman, Judith. Trauma and Recovery: The Aftermath Of Violence- From Domestic Abuse To Political Terror. Basic Books, 1992, pp. 115-122.
• 6. Kafai Shayda. “The Mad Border Body: A Political In-betweeness.” Disability Studies Quarterly, 33(1): 2013. https://dsq-sds.org/article/view/3438/3199
• 7. Ibid.
• 8. Antoun, Naira. “There are addicts in socialist utopias: In search of a language for psychic suffering.” Mada Masr. 10 October 2018. https://www.madamasr.com/en/2018/10/10/feature/society/there-are-addicts-in-socialist-utopias-in-search-of-a-language-for-psychic-suffering/
• 9. Nixon, Rob. “Introduction.” Slow Violence and the Environmentalism of the Poor. Harvard University Press, 2011, pp. 1-44.
• 10. Wiki Gender. Feminist psychology. 2021. https://bit.ly/3G7RPv0