Feminism and Psychiatry in Lebanon: an Introduction

صورة العدد لزينا عمار

This issue constitutes one small piece of many years’ worth of private and public interactions with psychologists, psychiatrists, physicians of all specializations, friends, family members and strangers - but also, importantly, a continuous search for answers in (often misinterpreted) published materials. Sawt al Niswa and The A Project have come together in an attempt to materialize contemplations on and personal experiences with mental health and illness, ones that happen behind closed doors and are often repressed by public trends.

Sawt al Niswa and The A Project are two Beirut-based groups working on producing feminist knowledge and reclaiming narratives and practices around our lives and bodies from patriarchal structures, including the highly influential and intrusive medical system. We have also teamed up with independent individuals who have contributed to this issue as well as our public talks and meetings, most notably Cynthia Kreichati who has accompanied this initiative since the beginning and added a new lens to our critique, that of the political economy of the mental health industry.

We have taken a special interest in mental health as more and more conversations are held around this topic in Lebanon, and yet little is heard on the matter in the public sphere from people who are neither psychologists nor psychiatrists. Through this issue, we have created a platform for people who grapple with mental illness on a daily basis, whether as a lived experience, a witnessed experience or even as a concept they engage with theoretically and politically. We wanted to think together about what it means to speak about bodies and our suffering beyond the system of biomedical psychiatry and how to reclaim and privilege our own voices as women, migrant workers, non-normative people and patients in this process.

In Lebanon, psychiatry is a long-standing institution that dates back to the 19th century and has a specific history, practices and ways of diagnosing and treating us. Psychiatry here monopolizes both knowledge on mental health (through research, conferences, advocacy, etc.) and the practice of healing illness (through the normalization and promotion of medical treatment). The problem with this monopoly is it leaves little room for critiques and reinforces itself constantly. There exists an unsettling conflict of interest here where the same group of people defines the problem on the one hand and appoints itself as its solution on the other.

This is where we come in.

A feminist reading of mental illness recognizes that this concept is variable across time and societies. What may be seen as symptomatic of a mental disorder at one point in time may subsequently be reclaimed as completely legitimate behavior. A classic example of this would be homosexuality, previously seen as, at best, maladaptive and unhealthy, and currently reframed as a sexual orientation with no medical value attached to it, at least in the realm of psychiatry. It was politics not medicine that allowed for the inclusion of homosexuality in the DSM and it is politics not medicine that allowed for its removal from the DSM. With this in mind, it seems highly inadequate to tackle the concept of mental health in terms that are purely medical and devoid of political analysis.

 

A feminist critique is a form of knowledge that offers a way of seeing things. While psychiatry redefines people’s suffering along biomedical terms, it provides a way of labelling this suffering through the Diagnostic Statistical Manual (DSM). This and alleviating it through medical treatments and psychotropic drugs. A feminist perspective however can provide an alternative understanding of suffering and healing. It can offer a lens through which one can see the power dynamics in a therapeutic relationship, and identify the systemic ways in which sexuality, women, race, and other marginalized communities in Lebanon are diagnosed and treated.

Feminism recognizes trends by analyzing who is considered normal and who is viewed as pathological by psychiatry in various times, contexts and histories and under distinct economic systems. Some examples of feminist critiques have focused on  how midwives in the 1950s (Metzl 2004) or how black protesters in the 1970s (Metzl 2009) in the United States were diagnosed with specific disorders like depression and schizophrenia in certain periods of time. More work needs to be done to document similar  trends in Lebanon and the region, as we know from lived experience that problematic patterns of pathologization of marginalized groups are abundant. We know of the public case of May Ziade, a famous lebanese-Palestinian writer of the early 20th century who was incarcerated in Asfourieh hospital based on her brother’s recommendation.We also know of diagnoses, treatments, forced hospitalizations and incarcerations of people whose gender, race or sexuality is seen as inferior, threatening or outside the norm.

 

A feminist lens, as shown in these examples, reveals that these trends are not caused by individual malpractices in psychiatry (or the idea that certain individual psychiatrists are sexists or racists) but is the product of a systemic and structural healing system that determine the pathological. Psychiatry‘s definitions of what is mental illness depends greatly on how society and certain economic systems understand normality, and what they perceive to be as threats to the current social and economic status quo.

Another important discussion to have here is the problem of agency and mental illness. There does not seem to be any way out when one is under the psychiatric gaze. If you become a patient and you refuse a certain a diagnosis, you are accused of being “in denial” and you are more likely to get a second diagnosis, probably related to you “personality disorders”. If the treatment does not work, then you are “resisting the treatment” and you might drown more and into the psychiatric system, described multiple medications and might never get out. The loss of agency is severe. All your emotions, expressions and ways of being become under scrutiny. The psychiatrist always knows more than you no matter what you say, even after seeing you for five minutes and listening your abridged summary of your life.  We want to argue that this loss of agency is multiplied when the person’s gender, race class and sexuality do not correspond with the social norm. A feminist critique has the ability to provide a voice and agency for patients; something that has been neglected and ignored in psychiatry.

Our call for contributions was met with enthusiasm and interest from people with different stakes in mental health. The contributors are inviting you to challenge the biomedical view of mental health and the role of medicine in dealing with it, reflect on the question of gendered, racial and political diagnosis, revisit the history and political economy of the mental health industry in Lebanon, and ground national policies and strategies in the realities of the concerned individuals rather than international trends.

We have chosen to preserve each contributor’s language, style, approach, tools and methods, as this diversity reflects the numerous angles from which one may engage with this topic, and this stands in stark contrast with the monotonous biomedical narrative that misses out on the nuances of human experience.

We hope that this issue launches a well needed public debate and feminist engagement with psychiatry in Lebanon and the region. Let this be the start of a much needed conversation.

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