Knot of the Soul

Madness, Psychoanalysis, Islam

Stefania Pandolfo

• Publisher: University of Chicago Press
• Year: 2018
• Print ISBN: 9780226465081, 9780226464923
• eBook ISBN: 9780226465111
• Topic: Social Sciences
• Subtopic: Psychoanalysis
• Index: Social Sciences

Through a dual engagement with the unconscious in psychoanalysis and Islamic theological-medical reasoning, Stefania Pandolfo's unsettling and innovative book reflects on the maladies of the soul at a time of tremendous global upheaval. Drawing on in-depth historical research and testimonies of contemporary patients and therapists in Morocco, Knot of the Soul offers both an ethnographic journey through madness and contemporary formations of despair and a philosophical and theological exploration of the vicissitudes of the soul.
 
Knot of the Soul moves from the experience of psychosis in psychiatric hospitals, to the visionary torments of the soul in poor urban neighborhoods, to the melancholy and religious imaginary of undocumented migration, culminating in the liturgical stage of the Qur'anic cure. Demonstrating how contemporary Islamic cures for madness address some of the core preoccupations of the psychoanalytic approach, she reveals how a religious and ethical relation to the "ordeal" of madness might actually allow for spiritual transformation.
 
This sophisticated and evocative work illuminates new dimensions of psychoanalysis and the ethical imagination while also sensitively examining the collective psychic strife that so many communities endure today.

Part I

Psychiatric Fragments in the Aftermath of Culture

ONE

Testimony in Counterpoint

The lines of force, having crumbled, no longer give direction. In their stead a new system of values is imposed, not proposed, but affirmed, by the heavy weight of cannons and sabers. The setting up of the colonial system does not of itself bring about the death of the native, autochthonous culture. Historic observation reveals, on the contrary, that the aim sought is rather a continued agony than a total disappearance of the pre-existing culture. This culture, once living and open to the future, becomes closed, fixed in the colonial status, trapped in the joke of oppression. At once present and mummified, it testifies against its members.1

—Frantz Fanon

Begin by not assuming that you understand . . . It is precisely for having always radically misrecognized, in the phenomenology of pathological experience, the dimension of dialectics, that psychiatric clinic has been led astray. If you understand, so much the better, keep it to yourself, the important thing is not to understand, it’s to attain the truth.2

—Jacques Lacan

A late morning in May 1999—the grassy area around the emergency ward where visitors had been waiting in little groups is now empty and burned by the sun, while the narrow hallway of the prefabricated ER building is packed with patients and their families waiting their turn to be received by the psychiatrist on call. Amina arrives late, escorted by her father. Cutting across the thick line of patients, she approaches the head nurse at the reception counter and demands to see “her doctor,” Dr. N. The head nurse tells her that she’ll have to come back another day, she doesn’t have an appointment in “post-cure,” and doesn’t seem to be in need of urgent care. Her father comes up to the counter to plead; he looks old and exhausted, says that they have come from far away, have traveled since dawn in a long-distance bus. A nurse recognizes the young woman: she’s been hospitalized here before. She comes from the backcountry, a village next to Sidi Slimane, in the Gharb region; “a familiar face,” he says. By complete chance Dr. N. happens to be walking through the hallway; I am with him and we are in the midst of conversation. He sees her. “A former patient,” he tells me. “She’s come a long distance, we can’t send her back.” He turns to her with a smile of recognition, welcomes her. She smiles back. He explains to me that she had been his patient two years before, in the locked ward, where she had remained for over three months. He directs her to a room, and invites me to come in with them.

These were the last few months the old ER building was in use. In 2000 the emergency unit moved to a new building outside the compound of the hospital proper, and adjacent to the new substance abuse center (Centre de prévention et de recherche en toxicomanie) that opened the same year. The old ER had been a temporary addition on the grounds of the hospital founded in 1963, which included four pavilions built in the exposed concrete architecture of the modernist 1960s in Morocco: two locked wards, one for men and the other for women, and two open wards (cliniques), one for men and the other for women, where patients in less acute condition and who could pay were cared for. There was an administration building, which had been the original nucleus of the hospital, built by the French prior to Independence in the neoclassical colonial style, a cafeteria open to the patients, and, far at the end of the hospital grounds, in the middle of the garden, the prefabricated building of the ER (al-mustaʿjilāt in Arabic, les urgences in French). It only had a few rooms, which fulfilled the double and heavy purpose of urgent care and post-cure. There were no beds, and the patients admitted in emergency were sent directly to the wards. The new ER was instead a semiautonomous unit of the hospital, with its own team of psychiatrists and nurses, and dormitory-style rooms where patients were kept in observation until they could be moved to the hospital ward or discharged. My fieldwork, which had started in 1999 in the old ER building and the wards, was resumed in 2001 and lasted until 2003, in the new emergency unit, the wards, and the staff meetings. But the impact of the first encounters in the old ER building remains indelible, as is the voice of Amina.

Much later, I am writing in the margin of that voice, on that day and many other days, over the span of the several months during which I met with her, her psychiatrist, and her family on the grounds of the hospital. My words are woven in interstices of her own recitations, recollections, and silences, in the hiatuses of the biographical, medical, and juridical narratives that were and could be told of her, attempting to register in the writing, as well as in the analytic reflection, as a form of listening and of response, the impact of Amina’s presence and her absence and the enigma of what she called her madness. I attempt to register the performance of her voice and the multiplicity of other voices that can be heard through hers, those to which she bears witness, unawares, and the voices of those for whom she wills to testify, the emblems of a generation choked off and violated, casualties of modern life that can no longer speak in their names. They are shadow presences summoned to the scene of our conversations, other voices and echoes that exceed the terms of the psychiatric contract and the economy of the institutional encounter, where illness and pain can only be authenticated as standardized and atomized suffering. At a time when the narrative and cinematic representations of traumatic events are central pieces in the construction of evidence and cultural reality, occupying the core of medical and juridical institutions and rationalities, human rights practices, and media markets, I attempt here to carve a space for reflection, translation, and research that might drift aside, in an “untimely” fashion. Drifting aside, as well, from the still crucial debates on how trauma, witnessing, and biography exemplify and deploy strategies of global power, or how, in a related sense, they become enabling or disabling idioms within larger logics of the state, as grounds of appeal, compensation, recognition, or inclusion.3 It becomes important then, for an anthropological ethics of listening, and what I call registering, to ponder Benjamin’s reflections on how translation is a practice of alterity, and to keep in mind Lacan’s warning that the other can be “reconnu” (recognized) but never “connu” (known); that difference between recognizing and knowing scans the possibility of encounter.4

It will then be a question of a singular life, apprehended within the particular and constraining frame of an encounter within the physical space and discursive terrain of the psychiatric institution; apprehended as well in the back and forth of an exchange that I attempt to capture here in the mode of performance—the only one that might grasp the taking place of an utterance, the said and unsaid of a dialogue, the moments of opacity, and prove capable of describing the stakes of subjectivity and culture at a moment of questioning. I choose a strategy that might be called miniaturist, for I think that in following the meanderings of particular lives one might better apprehend the articulation between heterogeneous and even clashing vocabularies and registers of experience, whose continuity is lived with violence and is illegible in a representation of culture, for belonging itself poses a problem.

Amina is perhaps twenty-five. Dressed in a dark blue jelaba with a white headscarf tied under her chin, urban style in the countryside, she has green eyes and an intense expression. At our first meeting in the emergency unit, the psychiatrist asks her father to leave us and wait outside. He addresses her: Does she recognize him? She smiles. Of course! He is Dr. N., her doctor (ṭabīb dyālī, my doctor). She says that she’s glad to see him. Speaking Arabic with the intonation and turns of phrases of her local vernacular, she tells a story I follow with some difficulty, in which the frightening image of a man chasing her with a knife is intertwined with an account of the solitary pleasure she takes in listening to songs on a cassette player. “You want the truth? I’m afraid of a guy, a killer of souls” (nʿawdlik l-wāqiʿ? kankhaf min waḥd ddri qātil r-rūḥ).5 She tells us that she’s still a virgin (ʿazba), begins to cry, and then addresses me directly—me, a woman with an uncertain role, seated a few steps from the psychiatrist. She is still a virgin, she repeats; it’s visible just from looking at her, right? The other day a man approached her by the side of the river in her village and insulted her, accusing her of being fāsda (defiled, a prostitute). She answered that this wasn’t true, that she was an honorable woman, that she didn’t work in the orange tree plantations anymore, and that she took her medications every day. At this point she begins to cry and implores Dr. N. to give her a prescription.

Dr. N. remembers her story and the context of her previous illness; he asks some standard questions in order to assess her orientation to time and place. He explains to me that Amina was hospitalized two years earlier for three months (a long time in this hospital and according to the law that regulates psychiatric hospitalization),6 in response to a state of severe confusion linked to a traumatic event: her repudiation on the night of her wedding. In her fragmented account today, Amina summons three scenes that keep coming back like a refrain during our conversations over the coming weeks: her “expulsion” the night of her wedding ceremony, her confinement within the enclosure of a saint (sayyid, a saint and a sanctuary), and her arrival at the hospital in an ambulance of the protection civile, the paramedics of the emergency rescue. “Her story is incoherent but is not unreal,” Dr. N. tells me. He attempts to weave the pieces together, and insists that although her experience is painful and fragmented and might even be delirious at moments, it remains anchored in reality. That violent reality must be acknowledged. At the time of her first hospitalization, Amina received a diagnosis of “bouffée delirante” (acute psychotic episode), under the rubric of what was then described as a hysteric personality. Dr. N. was her psychiatrist then, and that had been his own assessment at the time. But now he defers his diagnosis, cautiously limiting himself to pointing out the role of trauma in her symptoms and experience, as well as in his own interpretation of the patient’s state. He opens the door and beckons her father to return.

The father reports that Amina has lost her mind again—“that thing came back to her, the madness came back again” (arjaʿ lah dak shī, arjaʿ lha l-ḥumq). In Moroccan Arabic, l-ḥumq7 is a figure of raging madness, beyond all symbolic mediation by the jinn or the other beings with whom it might be possible to relate or engage in combat. In its radical generality, l-ḥumq evokes the junūn of Qurʾanic resonance,8 a concept in Arab medicine,9 and a figure in poetry: madness beyond treatment or return. In the vernacular understanding, l-ḥumq is recognized by its intractability in interpersonal relations, as in the saying l-ḥmāq kaydrib b-l-ḥajar (“the mad person throws stones”). It indicates a loss of agency and a state beyond thinking; as such, it is different from delusion or obsessive seclusion in an inner world, states conveyed by other metaphors and vocabularies of madness.

The father contradicts his daughter’s story, explaining that the hospital was the only option after she threatened her mother and sisters with a knife. Amina begins to cry once again. Dr. N. proposes a stay at the hospital: Naʿsi? Would you like to sleep here, rest a bit? The expression is commonly used to indicate hospitalization, but here, in Dr. N.’s voice, it carries a comforting, caring connotation. After a moment of hesitation, she declines, and he scribbles a prescription—Nozinan, a neuroleptic (“to sedate her,” he explains later, suggesting that he doesn’t think she is actually delusional), and Tegretol, a mood regulator. He schedules her for an appointment the following week. Amina asks me if I’ll also be there. She has, she tells me, a photo to show me. I promise to come. With this exchange she establishes the rules of a game so to speak, suggesting that, however imperceptibly, she will be the one directing during the following months, pulling invisible threads and diverting the institutional configuration of the therapeutic relationship. A game in which we will all become entangled and where no one, psychiatrist, patient, or anthropologist, will remain in their assigned place, but is involved as an interested party, in the events and their making.

Amina showed herself to be caught in a web of losses that had the repetitive, tragic scansion of a fate. In the institutional space of the hospital, and in the clinical encounter as she experienced it (at least as she conveyed that experience to me once I became a factor in the story), at issue for her was the possibility of bearing witness—at once to the injustice that had become her fate and to her pain. Of bearing witness, as well, as Dr. N. and I came to realize, to the fate of an absent collectivity, a vanished people or a people to come, the dead and the unborn, for which she offered her antiphonical call. (Antiphony, Nadia Serematakis tells us, is the back and forth of a lament, which “hears” and “speaks” on behalf and in the voice of the dead, creating reciprocity and connectedness for both the dead and the living.)10 The scattered form of her narration mirrors the dismembering of a life, echo of other losses, Amina’s own, as well as those of a generation for which she elects to become the voice. It is “the new generation,” she says, the youths “who went to school but failed,” and to whom she keeps returning in our conversations; the youth who give themselves to death, “take their lives” (intaharū), in the river by the side of her village. Amina casts herself as their “representative,” in an act of mourning that is also a testimony in a court of law: “To ‘witness,’ ‘suffer for,’ and ‘to come out as representative for’ are narrative devices in laments that fuse jural notions of reciprocity and truth claiming with the emotional nuances of pain. ( . . .) The concept of trial here evokes the ‘judgement of the dead,’ the notion of ordeal, and the last opportunity to be witnessed and represented by the living.”11

Her story and her life elude anthropological and even psychiatric exemplarity: they unfold in the mode of reverie, the mark of an experience of fear, where the criteria of truth become uncertain. And yet in her telling, as if by the gesture of a reverse hagiography—one that writes catastrophe in the place of miracles12—Amina speaks a truth of a different order, beyond the circumstantial sequencing of events, and offers her life as the exemplar of a historical condition—that of a collectivity from which she knows herself to be banished—and yet on behalf of which she is perpetually mourning. The “injustice” that determined her fate overflows her individual life, becoming transfigured as the cipher of a collective dispossession. Her lament is at once an attestation of loss, and a poetic gesture of repair.

Amina poses the question of the present—one out of joint and dismembered—through her search for “evidence” and an appeal for testimony, a word and concept to which she turns in its multiple semantic and juridical configuration. Al-shahāda, from the verbal root shahida, to testify—in the sense of being present, of seeing with one’s own eyes, of having a personal experience of something, of attesting to that experience with one’s life—is the same word from which the legal term for witness (shāhid) and the modern administrative term for certificate are drawn.13 Shahīd is also the classical (and modern) term for martyr, ultimate testimony of faith in the sacrifice of self. Most importantly here, the shahāda is also the utterance of the formula ashhadu an lā ilāha illā llāh, “I bear witness that there is no god but God,” by which one becomes a Muslim.

In this story, the testimony in question is the hybrid progeny of this constellation. It emerges in the quasi-juridical establishment of a truth of the self through the intermediary of the modern state’s techniques of veridiction (official papers, certificate...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Contents
• introduction
• Part I. Psychiatric Fragments in the Aftermath of Culture
• * Interlude. Islam and the Ethics of Psychoanalysis *
• Part II. The Passage: Imagination, Alienation
• Part III. The Jurisprudence of the Soul
• Acknowledgments
• Notes
• Index of Characters
• Index of Qurʾan Citations
• General Index