There are addicts in socialist utopias: In search of a language for psychic suffering
The closing essay to our mental health series, "Neither pathologization nor romanticization"
 
 
 
Courtesy: Rana Rafik
 

A colleague compliments me as editor of Mada Masr’s series inviting contributions from readers about their mental health experiences, but mentions that perhaps the title, “Neither pathologization nor romanticization,” is the worst one ever. It’s barely even possible to pronounce. I am a bit defensive in the moment, but I think he may have a point. I had used the clunky title as a kind of get-out. In writing the series’ introduction, I was trying to say something and struggling. In the end I framed it as a question:

What does it mean to acknowledge that the world is crazy? Not as a rhetorical device, but as recognition that to be socially adapted entails a certain degree of dysfunction. What does it mean to acknowledge this without dissolving less visible forms of suffering and struggling, the truths of survivors, as well as those who don’t survive?

I felt that if we were going to invite readers to “share pieces of writing, whether in the form of prose, poems, or in between, and pieces of art that come out of their mental health struggles,” then Mada needed to stake a position an open position. I ended up defining it by telling our readers what we were trying not to do: we wanted neither to pathologize nor romanticize.

I made no reference to Egypt in the introduction. Globally, we seem to be in an era in which the language of mental health is on the ascendant, and that means the language of dissent as well. I have lost count of articles headlined with some variation on “neoliberalism is making us sick.” In this mode of speaking, many feminist arguments can be reframed as descriptions of how patriarchy and its associated traumas make us sick. And in Egypt, of course, we have a particular form of this: the death of hope is making us sick.

In other words, “trauma has become a major signifier of our age,” as Didier Fassin and Richard Rechtman argue in The Empire of Trauma (2009), a magisterial book historicizing the rise of the concept and its effects through attention to social history: “Trauma has created a new language of the event.”

There has been some research into political trauma among Egypt’s activists. Vivienne Matthies-Boon has interviewed 40 activists to explore their mental health trajectories in relation to political developments in the country. She draws on and develops a political, social and collective understanding of trauma both in its genesis and in how it is then resolved or not resolved, informed by Ronnie Janoff-Bulman’s work on how trauma shatters assumptions about the world assumptions such as “that the self is worthy, that social relations are meaningful and that the world is benevolent.”

I also tried to explore mental health trajectories in relation to revolution and counter-revolution, in a much more modest way, in a Mada article. I sought to interview activists who not only perceived the military’s 2013 ascent to the forefront of power as the defeat of the 2011 revolution, but who also had mental health struggles pre-dating 2011 or saw their mental health trajectory as reaching back to before then. I suppose I am less interested in the effect of assumptions shattered due to a political event or process than by those who could never develop such assumptions or lost them as children: Someone whose relationship to food or sex has long been “disordered,” someone who has never had the luxury of feeling safe in their body or in the world, someone who isn’t sure whether to trust themselves because sometimes they feel fine and other times their thoughts seem very dangerous. How did an already “disordered” internal process interact with an outside becoming rapidly more disordered than it was?

Mada has addressed mental health sporadically over the years. All these attempts have been sideways attempts, somehow: their explicit social, political or cultural lenses delineated what we could see. Several of us who work at Mada are personally invested, however, and we did make other attempts that never made it to publication. So with this series, we decided to open the gaze and invite readers to talk about their mental health experiences. On the day we started, World Mental Health Day 2017, we also released multiple infographics about access to mental health services in Egypt — as we reached toward the subjective, we also, simultaneously, grounded ourselves in a material context.

Sometimes it seems that within activist circles there is not only the usual stigma around mental health but an additional stigma tied to a critical way of seeing the world. Sometimes this is a hierarchy of suffering that designates suffering caused by political power as more real than other suffering — a kind of cause-and-effect understanding of mental health. Sometimes Michel Foucault is invoked: madness as social control, madness as a label for those who don’t socially conform, mental health treatment in a capitalist society as retraining to be a docile body and subject. Sometimes it is criticism of pharmaceutical companies and medics who seem more interested in prescribing pills than in understanding. Often it weaves certain important points into a facile, dangerous analysis stigmatizing people for their condition, for taking medication, or for invoking medical terms in relation to their experience.

An alternative response to accounts of psychic suffering is an activist impulse — to create communities of care. We do need to to do this, it is true, but not all suffering can be eradicated through concerted human effort. I worry that this is the activist form of a common impulse to propose solutions to mental health issues, stemming from difficulties accepting the reality and depth of internal suffering.

Having said all this, in the introduction to the series I felt it was particularly important for Mada to stake a position on what our approach to mental health might be, not just because we were asking readers to trust us with accounts of their experiences, but because we try to be a progressive institution, and what a progressive position on mental health (an unsatisfactory shorthand I know) might look like isn’t necessarily obvious.

I have struggled to find out there in the world or to articulate myself a language to talk about mental health that is not apolitical or asocial but doesn’t reduce mental struggle to the demands of social critique.

 

What reader of this series could fail to notice that the majority of contributions to it, though not all, were written in English, most came from women, and that many discussed anxiety? None of these observations should come as a surprise, though we should be careful not to read too much into them. The question of language is linked to class, of course: members of the middle classes are more likely to invoke mental health in seeking to understand their lives. Meanwhile there is a long history of association between madness and womanhood, and of valorizing women’s voices only when they speak personal, painful stories — the female confession. In general, the constructs and demands of masculinity make this kind of speech less accessible to men.

As for the preoccupation with anxiety, this could be taken as a reflection of the anxiety-inducing times we live in, globally and specifically in Egypt, but I suggest that it is linked more to the social acceptability of certain conditions compared to others. Anxiety and depression are perhaps less associated with behaviors families see as shameful, unlike addiction, schizophrenia and psychosis — conditions that are harder to see as variants of normality. While it is true to say stigma is attached to mental health issues, it is more accurate to acknowledge that more stigma is attached to some mental health issues than others.

I wanted to address the theme of different experiences of medication and I included this in a list of five questions formed through brainstorming with a couple of other people. The idea was to send the questionnaire — around topics ranging from experiences of medication to mental health struggles affecting romantic relationships — to everyone who contributed to the series to answer if they wanted to, and then publish some of the answers, question by question, in a separate series. I tried but this did not work out, and I apologize to those who put emotional labor into answering those questions.

Many of the contributions do address naming, diagnosis and medication. They make it obvious that any abstract position regarding medication or diagnosis, whether pro or against, is nonsensical. The narrator of Time traveling through disorder” describes the dual nature of diagnosis — that it felt simultaneously like a relief and a death sentence — before dealing with the burden of friends’ and family’s the disbelief because “I know how to deflect my decay in dapper costumes.” M. Qady writes that many people don’t believe in the existence of dissociative identity disorder, and then states matter-of-factly, “My parents started believing when they realized I still scream in corners the way that five-year-olds do, at the age of 21.”

The recurring theme is less that of naming than of how to relate to the actual thing, which also happens to have medical names. The narrator ofWho is who and which is which” describes endless black holes of self-monitoring as they try to map their triggers, thoughts and fears, confused about how to distinguish between “their own” thoughts and “OCD thoughts” — “How long did I have it for? What is me and has always been me and what was the subtle creation of OCD before revealing itself with such intensity now? Who is who? And which is which?”

Like others, this narrator goes from trying to defeat their condition to a different kind of relating: “Little did I know, there is no conquering, there is no winning and there is no end. There is me and it and we have to co-exist.” The notion of learning to befriend an unwelcome visitor recurs in the texts, as does the idea of learning to take in all parts of the self. One person chooses to write a letter to their OCD, telling it, “I had to scream a thousand silent screams just so that no one could hear you break me.”

 

In 2015, I was thinking of doing a PhD researching 12-step fellowships in Egypt (the biggest here is Narcotics Anonymous). I wanted to understand communities of recovery and looked forward to exploring socio-political themes in relation to mental health. Through popular culture, even people unfamiliar with the term “12 steps” recognize aspects of these meetings: “I am So-and-so and I am an alcoholic.” Established in the mid-1930s in the US, Alcoholics Anonymous (AA) is the oldest 12-step fellowship. Other fellowships have since been established for other addictions and for relatives of addicts, taking on AA’s understanding of addiction as a three-part disease — of mind, body and spirit — as well as the 12 steps and 12 traditions that guide it. Today we have Narcotics Anonymous, Overeaters Anonymous, Cocaine Anonymous, Gambling Anonymous, Adult Children of Alcoholics Anonymous, and so on.

Reading any academic work on 12-step fellowships I could get my hands on, I largely encountered what I had found elsewhere: texts that either captured the traumas and actions that brought people into these rooms, or interesting discursive and social analyses that failed to grapple with the traumas themselves — but rarely works that did both.

I feel a sense of betrayal that writing inspired by social justice principles finds so little space for psychic suffering. I feel hurt somehow, having been witness to and shaped by a mental health struggle all my life, as a mostly helpless but complicit witness to pain, suffering and striving that did not fit easily into the boxes of social critique and analysis. I learnt about 12 steps and recovery through my sister, Laila.

The recovery movement — that is, the growing phenomenon of self-help literature, self-help groups and associated cultural products such as television shows — has its roots in 12-step fellowships. In an insightful examination of the cultural history of AA and the recovery movement, Trysh Travis writes that therapeutic recovery culture can best be understood as a hybrid blend of 12-step ideas, identity politics and psychological insights. It may be surprising to see identity politics in this list, but as Travis describes, the key factor in the development of therapeutic recovery culture was the growth of the addiction treatment industry in the 1980s as the focus shifted to previously neglected communities, particularly women, minorities and those who were multiply addicted.

Radical critics have railed against self-help, arguing that it depoliticizes, that it transforms social problems into individual ones and, further, that it does so using the pathologizing language of disease. Recovery, they charge, advocates not the changing of society but the changing of the self. As such it actively elides political and social inequality.

Heidi Rimke goes so far as to argue that self-help not only “exalts the individual over the social,” but also “negates the inherent sociality of being,” thus hollowing out citizenship. Employing a Foucauldian analysis, Rimke identifies self-help as “one of the latest additions to a long and erratic psychocentric history of concerns surrounding the care of the self.” As a technology of the self, self-help produces subjects “who are psychologically ‘healthy’ inasmuch as they are governable, predictable, calculable, classifiable, self-conscious, responsible, self-regulating and self-determined.” Self-administered exercises including questionnaires, surveys, inventories, assessments, scoring keys, checklists and rating scales are disciplinary practices through which people believe they are gaining self-knowledge, but the “self-helping confession’s promise to reveal our deepest truest selves becomes so appealing that it is difficult for the self-helper to see or to break from the web of power relations in which the promise is rooted.”

Recovery is largely populated by women — in groups or as consumers of self-help literature. Increasing numbers of women describe their pain through the language of personal healing rather than a collective narrative of oppression and struggle. It comes as no surprise then that self-help has come in for heavy criticism from various feminist scholars. Elayne Rapping, for instance, argues that the recovery movement borrowed what was good about feminism — particularly breaking silence on abuse and in a format she argues is similar to consciousness raising — and then voided it of its political content and goals. It has been argued that the recovery movement is essentially anti-feminist because it encourages women to see themselves as the problem, and as sick, rather than naming patriarchal/capitalist society as the cause of their suffering.

Rimke also cites several examples of prominent self-help figures who make deeply problematic political remarks, such as Morgan Scott Peck, who “thinks that to discuss oppressive forces in society rather than individuals is childish.” Rhonda Byrne’s best-selling The Secret (2006) makes similar arguments. Now, I share Rimke’s take on this — but it is problematic to dismiss all recovery out of hand, as the radical critics do.

I agree with Travis that “just because a set of critical tools and vocabulary is not readily cognizable, it does not mean they do not exist” and that, regarding recovery culture, we need to take into account “the kinds of individuals it seems to produce, as well as the nature of the communities that they combine to form.” She notes that this culture “offers its adherents strategies for negotiating their ways in the world and even for effecting change within it.”

A rare exception to the general lack of nuance on the movement is an ethnographic book by sociologist Leslie Irvine of a 12-step fellowship in the US called Codependents Anonymous (CoDA), Codependent Forevermore: The Invention of Self in a Twelve Step Group (1999). Unlike other 12-step fellowships such as Alcoholics Anonymous or Narcotics Anonymous, people are not there because of a substance but a particular behavior — codependency — and so it is particularly susceptible to some of the critiques of 12-steps about disciplinary selfhood.

The book’s first sentence reads: “This is a study of how disrupted lives can be made liveable again.” Most CoDA members are people recently out of long-term relationships. Largely through the language of dysfunction, toxicity and co-dependency, they look at their past — their 20-year marriage, their childhood homes — and in doing so many come to believe that the problems in their relationships “stemmed from traditional beliefs about how men and women should relate to each other.” This was as true for men as for women, Irvine found. She describes several men who attributed their problems to the “typical male ways of doing things” and a woman who got out of a marriage with an abusive jealous cheating man, only to enter into a similar relationship and, feeling that she had no sense of self outside it, could not leave. Through CoDA, she did manage to leave, learning how to feel okay being alone for the first time and how to negotiate more equitable relations. Addressing the criticism that codependency is a bandaid for a larger social problem, Irvine writes, “What is the social/political answer to the multidimensional problem of feeling as though you have no sense of self? Dismantling patriarchy?”

As Irvine points out, there isn’t space in CoDA’s worldview for the common material causes of a woman being unable to leave an abusive partner: not having other options. As she also notes, these people largely do recognize the social sources of inequality but they also want to build equitable relationships in their lifetimes and CoDA offers a practical means of doing so.

Often participants in such groups appear in the critical literature as dupes rather than as people navigating a world that may be hostile inside and out, and trying to make their lives liveable.

Roxane Gay’s Hunger (2017), a beautiful memoir of living in an “undisciplined” body, is a testament to many things, including how analysis and understanding, though they may be necessary, are not in themselves tools for living in her body. She understands how she responded to a gang rape at the age of 12 by seeking to protect herself through eating to try to make herself repulsive. She understands how her response was shaped by patriarchy — “even at that young age, I understood that to be fat was to be undesirable to men.” She knows now that overeating couldn’t protect her, how steeped her response was in patriarchal structures, that as a feminist she “should” feel comfortable in her body. “What I know and what I feel are two very different things,” however. “Feeling comfortable in my body isn’t entirely about beauty standards. It’s not entirely about ideals. It’s about how I feel in my skin and bones, from one day to the next.”

 

Less consumed than my sister was in a struggle to survive, I was perhaps more politically engaged, but she was too. I thought a lot about how gender shaped her eating disorder.

She once begged our father for money for a woman she met who she felt could make it with rehab but who couldn’t afford it. But sometimes I wondered if Laila was unaware of her class privilege. One day she brought it up. She was talking about some of the people she had met along her way, some in meetings, some in a homeless shelter, and she said she wished that they had the resources and chances that she had to go to rehab — maybe they would make better use of it, she said, maybe they could make it. I don’t remember what I said as an answer but I think I must have tried really hard to make sure any tears were shed inside me only.

Often attempts to be “social” in our approaches to mental health are extremely reductive — as if social forces have simple, direct and univocal effects on the psyche. I have been struggling to find and to articulate a language that can do both — account for the social and political as well as what is irreducibly personal. But even in trying to articulate what I am trying to do, my language fails me, because it is not about a both, about an inner and an outer. Stephen Frosh and Lisa Baraitser point to the “repeated difficulty of uncovering a space for bringing together the psychological and the social without postulating these two spheres as distinct from one another.” They propose instead an image of the Möbius strip whereby “underside and topside, inside and outside flow together as one, and the choice of how to see them is purely tactical, just like the decision as to whether to look at the subject from a ‘social’ or a ‘psychological’ perspective.” The social world is not something external to us, but is always already internal. They are describing a psychosocial approach to psychoanalysis.

Having scrapped the idea of doing a PhD I decided to train to be a therapist a couple of years ago, and as we started the series I had just decided on a psychosocial approach. I had been planning to train as an existential therapist — yes, such things exist — and had always been somewhat against psychoanalytical approaches. Existential therapy, which grew as its name suggests from existential philosophy, developed as a critique of psychoanalysis. Psychoanalysis is steeped in colonial, heteronormative, patriarchal and classist modes of thinking. It has largely trapped itself in an individualistic, asocial and ahistorical framework. As Joanna Ryan argues, most of the work on the scars of class comes not from the psychoanalytical literature, but anthropological and sociological scholarship, although psychoanalysis has the tools.

Last year I was sitting in a café with a friend, like me, born to Egyptian parents in the UK, and like me having spent some of his adult years living in Egypt. He told me he’d also decided to train as a therapist. He mentioned a couple of other people we know, both men incidentally, doing the same. All of us who lived through the revolution, he exclaimed, are becoming therapists. I resented it — the notion that my trajectory fit the pattern, as if I hadn’t thought about mental health before 2011. But no one’s trajectory is the same, and later I thought maybe he had a point. For years I had wanted to do an anthropology PhD and, wondering if I saw myself in academia, I’d attach to a topic before letting it go. In the final couple of years of that, the topics were increasingly related to what might be termed mental health. But ultimately I felt that researching and writing about mental health in the context of an anthropology doctorate would return me acutely to my ambivalence around academia and to existential crisis more broadly.

The revolution and working for Mada — one of the revolution’s many children — has taught me that it is possible to act and intervene in a field not just to pontificate (not that this is what academics do — I was frustrated at my own inability to live out any radical politics but only pontificate) and to do so without hopes.

And somewhere there, far away from her parents’ home country as it witnessed the height of counterrevolution, Laila left this world. That’s there in my trajectory. It was 2014. This is part of what I mean to be without hopes: my greatest hope was that Laila would make it, and my greatest fear was that she wouldn’t.

I don’t go into the profession with a savior complex — I don’t believe it is possible to save anyone. My sister told me this. In a poem called Broken Conversation, she describes a day on which I call her. She has been asleep all day, and her “spirit didn’t want to move,” she wrote. I called and she was happy to hear from me because she felt broken that night. But then she couldn’t talk and there was anger, and I say “Maybe now isn’t a good time to call.” She is quiet, “trying to swallow the choking tears,” before agreeing that maybe I should call another time. The poem continues,

“I’m sorry, I’m just scared I’ll say something mean, it’s been a hard night and I’m feeling a bit jealous thinking of all the things you’re doing and me wasting my life. It’s hard to have relationships at the moment,” comes tumbling out with a gasp and sob.

That sounded all wrong.

You don’t say anything.

There was a time when you would attempt to rescue me but after all I’ve said and done, I think you’ve learnt you can’t save anyone.

There was a time when I tried to save her. There was a time that I thought it was all my fault. There was a time when I thought that if I failed to save her I had to save everyone else (I was 16). At some point, I must have thought there was some sum total of suffering in our family, so I starved myself thinking maybe I could take it away from her. Other times I ate and ate my mother’s food while Laila was upstairs so that my mother wouldn’t feel she was failing to feed her children. There were years when I would say to myself I have this underlying sadness because the person I love most is hurting so much and she doesn’t deserve this. She is soft and gentle and beautiful. I felt real life wasn’t here where I was living it, but there where she was — what was important was happening elsewhere. It took some time before I realized that I used her as a hook for my own feelings that I couldn’t name. I didn’t ask until it was too late if our sadnesses had some of the same sources.

When I moved to Egypt, she gave me a note written on orange paper folded into the shape of a boat, because she was thoughtful like that. She wished me well on my journeys, she told me difficult truths about myself because she loved me and wanted my life to be easier, and after reading it I folded it back into a boat, wondering if my hand muscles would remember how. I opened it again and read it only after she was gone.

Laila had not been to Egypt since she was 15. She swore she wouldn’t go back until she spoke better Arabic. We didn’t talk about it much, but I gathered it was to do with constantly being fed — a nightmare for someone whose relationship to eating is so fraught because they stuff their many unmanageable emotions with food — and sexually objectified while being unable to speak for herself. After that trip she was too consumed with her main struggle to make it to be able to put consistent effort into improving her Arabic, which I did not think was a bad thing given that trying to learn our parents’ mother tongue beyond the basics we had developed had induced in me existential crisis, and I didn’t have to deal with suicidal ideation on a daily basis.

We spoke from time to time about her coming when I was here. In some ways, it could be safer. And living here, of course, the family kept asking me about her. Where is our cousin, where is Laila, does she not like Egypt (or us)? My family here is mostly on my father’s side, and I felt anger toward him every time I had to deflect these questions. What is she doing? “A bit of this and a bit of that. She asks after you. She will come soon, insha’allah.”

I wasn’t sure what to tell them, I felt it wasn’t up to me to describe her to them in ways that might make her feel more vulnerable. I thought maybe we would talk about what she would want me to say to them before she came. I didn’t want to leave it to her and I resented that this was the situation. I wondered often if we had given them a chance — if they had felt the story develop over time, if they had a chance to let go of their judgements — maybe Laila could come and spend some time with her family without the burden of explaining herself. Later when I was less angry, I understood there is a kind of caring, a fussing that refuses to recognize the extent of suffering that our father needed to protect us, and himself, from.

Before I understood the pathologies in our family, I had wondered if these things don’t exist in Egypt — self-harm, suicide attempts, starving, binging, throwing up, addiction, this dying in life.

I suppose I wished the family had heard more stories.

 

I don’t want to fetishize storytelling, although in many ways this series could be understood within such a fetishization — with our stories we bring from darkness into light, we destigmatize the stigma, we speak what has long been unspoken. In asking for any form of writing or art linked to people’s mental health struggles, I sought to make it clear that this wasn’t simply an open call for stories, that there was no burden to explain oneself.

A friend told me they were considering submitting something to the series by saying that they were thinking of coming out. As someone who is gay, they were not using the phrase lightly. Too much suffering comes from the shame of not being able to speak, and there is no denying the often transformative power of storytelling. But it is something else to go from that to an implicit insistence that it is necessarily and inherently transformative or liberating to “speak your truth.” The genre of women’s stories, about the multiple violations of living under patriarchy and more specifically the transgression of bodily and sexual integrity, as with #metoo, is in some ways a spectacle of female suffering. Storytelling is not always transformative, and sometimes it is the opposite. It is unfair to keep demanding accounts of trauma while insisting that they are transformative — that is, pretending that they are only ends in themselves and that there is no responsibility entailed in hearing a story, being witness to it. Narrators are expected to perform their trauma according to certain requirements. This has material effects — in the court proceedings for the case of an 18-year-old gang raped in Spain, photos of her passive face during the attack as well as photos of her not long after the attack with friends were submitted as evidence that she was not traumatized and thus the attack was not brutal.

“Now we know,” some men said after #metoo. Really? They didn’t before? They’re shocked? Michel Taussig writes about the shock of witnessing in I swear I saw this (2011) in a sense a meditation on the inadequacy of language and the lies of coherence and narrative, a point I will return to. “But,” he writes, “the real shock is their passing from horror to banality. The real shock is that fleeting moment of awareness as to the normality of the abnormal, which, as with a wound, soon covers itself over with scar tissue.” The banality of others’ suffering is not a constant, it is “never really achieved. Instead what exists is a situation of unstable equilibrium in which amazements keep trading back and forth with indifference. For at any moment the abnormality of the normal can spring forth, only to die away again.”

And it is into this unstable equilibrium that people are asked to throw their stories. We need more stories. But let’s not kid ourselves: it is not for a lack of stories that we find the world in the state it is in.

I chose to publish all contributions to this series. I know that some were written, drawn or composed as a response to the call and others a long time ago. I made some editorial interventions, with the writers, on points of clarity and hesitated around anything that seemed to encourage suicide or blame anyone for somebody’s suicide. But it was very clear to me that how articulate a contribution was could not be a criteria for inclusion.

Laila wrote beautiful poetry. People always told her she was so articulate; she complained about the incommunicability of suffering.

I thought of the child whose pain is not taken seriously — perhaps because as a child, she cannot articulate it. “I had depression since I was six years old and I only came to understand that 28 years later,” H.K. writes inTo my daughter: On borderline.”

Qady writes about the fragmentation of her own words: “DID [dissociative identity disorder] is not the existence of those multiple dimensions to my personality, it’s me not having any control over them — hysterical when harassed, crying when complimented. The misleading intelligence to evil and the misleading kindness to stupidity. The fragmentation of this very text as the ‘wasted potential’ I am always described as. The first time I attempted suicide was at the age of 12.”

The way those last two sentences follow one another snags my heart each time I read it.

Pam Labib directly addresses the demand to be a rational narrator of your experience. She eloquently describes the need to be eloquent even as “the solidity of things becomes questionable and I become confused and anxious, losing touch with my existence within my lived chronology and body.” She continues, “When my mind is reduced to utter nonsense you find it hard to hear me, you find it even harder to hear me after you witness my mind and cognition falter, even when time has passed and they no longer falter. I drop some names, Foucault and Derrida and I drop some words, ‘subject’ and ‘difference,’ I pray that I have redeemed myself with my intellect so you can restart to hear me.” Labib’s piece arrived to me flawless, not a single typo — I could feel her labor to be rational and eloquent in the hope of being believed. What type of listeners do we want to be?

The story of sickness is expected to offer its listener a narrative of triumph, an ugly journey maybe but one that gives way to some kind of resolution, lessons learned along the way. This is a violent expectation.

It is as if there is a political economy of stories: depending on people’s storytelling abilities, their rationality, their persuasiveness, they may earn sympathy, and sometimes treatment. The listener adjudicates or grants their pity — or maybe just the courtesy of being taken seriously.

Maged, a doctor, suffering from anxiety, describes his instability, his suicidal thoughts, his difficulty with engaging in treatment, and then asks the reader simply: “Would you go to a doctor who has mental health issues?” InRegardless of a pair of perfectly intact lungs,” Engy Ashraf wishes she could just dismiss those who cannot acknowledge the reality of what she lives — “I don’t need anyone to tell me how real all this is because that I already know like the back of my hand” — but she can’t because she worries that without support she cannot make it.

Labib’s piece takes this question of how other people relate as her main theme, as is clear from the title,The everyday practices of surviving mental health ableism.” She writes that every time she has made it past a moment she wasn’t sure she would, “I either did it on my own, or had invested in deconstructing your biases, vetting and educating you so that you could be there next to me.” In those moments, “living wasn’t a question of what I wanted or didn’t, but whether or not, by relying on my support system, I was able to get through the episode intact.”

The listener who listens carefully develops no facile notions of what support could mean. If, as somebody is spiralling, their friends suggest yoga or eating well, these friends may be missing something. As Labib explains in the same paragraph, “Schedules, routines, nutrition, therapy, writing, processing, sleep, exercise and reflection help minimize their frequency and intensity, but the cruel joke is that these are the very same things that an episode dismantles before reaching its crescendo.” Or, as Nermeen Hegazi writes in her poemNo, it’s not sadness”:

I see the hand you extend

I want to take it

I do

But I’m tired.

 

All paintings by Rana Rafik.

References, in order of appearance

Didier Fassin and Richard Rechtman (2009), The Empire of Trauma: An Inquiry into the Condition of Victimhood, translated by Rachel Gomme
https://press.princeton.edu/titles/8917.html

Vivienne Matthies-Boon (2017), “Shattered worlds: Political trauma amongst young activists in post-revolutionary Egypt,” The Journal of North African Studies, 22:4, 620-644
https://www.tandfonline.com/doi/pdf/10.1080/13629387.2017.1295855 [full text available]

Trysh Travis (2010), The Language of the Heart: A Cultural History of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey
https://www.uncpress.org/book/9781469607306/the-language-of-the-heart/

Rimke, Heidi M (2000), “Governing Citizens through Self-Help Literature,” Cultural Studies 14(1):61–78
http://www.academia.edu/202760/Governing_Citizens_through_Self-Help_Literature [full text availble]

Elayne Rapping (1996), Culture of Recovery: Making Sense of the Self-help Movement in Women’s Lives
http://www.beacon.org/Culture-of-Recovery-P248.aspx

Leslie Irvine (1999), Codependent Forevermore: The Invention of Self in a Twelve Step Group
https://www.press.uchicago.edu/ucp/books/book/chicago/C/bo3626794.html

Roxane Gaye (2017), Hunger
https://www.harpercollins.com/9780062362599/hunger/

Frosh, S. and Baraitser, L (2008) “Psychoanalysis and Psychosocial Studies,” Psychoanalysis, Culture and Society, 13, pp.346-365
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Joanna Ryan (2017), Class and Psychoanalysis: Landscapes of Inequality
https://www.routledge.com/Class-and-Psychoanalysis-Landscapes-of-Inequality/Ryan/p/book/9781138885516

Michel Taussig (2011), I swear I saw this
https://www.press.uchicago.edu/ucp/books/book/chicago/I/bo11637787.html

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Naira Antoun