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‘Insanity’: Egypt’s psychiatric history, developments and stigmas

While there are still many stigmas associated with mental illness in Egypt, psychiatric hospitals have come a long way since the Abbasseya lunatic asylum was established by the British in 1883.

For decades, this infamous institution subjected thousands of patients to 19th century psychiatrics. Individuals were often admitted involuntarily, and usually there was no guarantee of future discharge. Abuse of patients was common, and so was neglect —even self-destructive people were left to their own devices in barred rooms. Such practices were also routine in other asylums, including the facility in Khanka

According to psychiatrists, these old asylums are largely responsible for stigmas associated with mental illness that permeates Egyptian society to this day.

“Views regarding modern psychiatry have never really had sufficient opportunity to integrate themselves properly into most local Egyptian communities,” says Nasser Loza, current managing director of Behman psychiatric hospital. “Stigmas make it difficult. Many people still believe psychotic disorders are related to satanic possession or insufficient belief in God.”

Over the past century, however, the system has improved. One change was semantic: for decades, psychiatric establishments were administered by the Ministry of Interior's “Lunacy Division,” a name that hardly conveys compassion for the mentally ill. In the 1940s, responsibility for the division was transferred to the newly-formed Ministry of Health. Other reforms involved the legal system. One of the most recent and significant changes to Egypt's mental health legislation occurred in 2009 with the passage of Law 71, which helped protect patient rights.

The previous legislation, Law 41 of 1944, was notorious for depriving patients of power. It permitted involuntary admissions without legal proceedings, and often there was no time-limit or established discharge date. Admission rulings were usually made by a single doctor, and sometimes even a sole nurse could make such a decision.  

“We needed to legally empower the patients to a certain degree as well as shift the institutions from asylum based to community based,” says Loza, who was secretary general for mental health at the Ministry of Health when Law 71 was passed.

The law established stricter criteria for admissions and multiple assessments — a key protection for patients. However, Loza admits that implementing the revisions required a struggle, partly due to Egyptian doctors’ resistance to a more liberal practice that gives them less authority.   

But despite achievements, stigmas about mental illness persist in Egyptian culture. When I told my taxi driver where I was going for research in Abbasseya, he looked at me with concern. “Is everything okay with you?” he said, after ten minutes of concerned glances through the rear view mirror.

Psychiatrists say that there remains a general lack of education regarding psychiatric illness. Stereotypical portrayals of the mentally ill in Egyptian media —particularly in film —have compounded the problem.

“For many people in this society, the symptoms are very embarrassing,” says Loza. “If someone’s son has cancer, the family will naturally sympathize with him, but if he takes off his clothes and tries to direct traffic, this can be socially embarrassing and most families have no idea how to talk about it, let alone address it.”

As a result, family members once admitted relatives with inadequate cause, such as the individual not living up to communal expectations. Though Law 71 has made this more difficult, many still try.

“There are cases of families dropping off relatives to the institutions, and then changing their addresses and phone numbers so that nobody can track them down,” says Basma Abdel Aziz, director of the media department at the General Secretariat of Mental Health (GSMH).

Another issue is that patients who have spent decades in psychiatric institutions may no longer have any sympathetic relatives. Even those with supportive families face difficulty reintegrating into society.

“We still can’t seem to discharge patients who were admitted in the 1970s,” says Loza. “I don’t know what is less humane: keeping them in Abbasseya or letting them go sleep under a bridge?”

Meanwhile, there is still a problem of abuse for political purposes.

According to Basma Abdel Aziz, director of the media department at Egypt’s General Secretariat of Mental Health, it was not uncommon during the time of former President Gamal Abdel Nasser for people to be admitted into mental institutions for political reasons. Cases include the Marxist writer Ismail El Mahdawy and poet Naguib Sorour, both of whom were institutionalized in the 1950s after their writing angered the regime. Mahdawy remained in a psychiatric institution for 17 years.

Even today, there are echoes of such practices. The court-appointed lawyer of Maikel Nabil recently made a case during a military trial for his client to be institutionalized. Abdel Aziz considered this to be a dubious practice, and he brought the issue to the attention of the media.  She believes that this helped prevent Nabil’s admission —and also discouraged subsequent attempts at political admission.

But this act was not welcomed by Amr Helmy, the health minister at the time, who chastised Abdel Aziz for undermining his authority. “Thankfully there is nothing in the law that forces me to commit to the minister of health,” says Abdel Aziz.

But both Loza and Abdel Aziz agree that the new regulations concerning admissions make it much easier to scrutinize cases of abuse. According to them, the real challenge lies in overcoming social stigma. One tactic is joint publicity campaigns involving psychiatrists, the Ministry of Health, advertisement agencies and pharmaceutical companies.

The goal is to promote the idea that mental illness is recognizable, diagnosable and curable just like any other disease. It's also critical to inform people that psychiatric problems are nothing to be ashamed of. This has been met with great relief by families who now know how to help loved ones. For some others, modern psychiatry merely represents a hindrance to getting unruly family members locked away.

“Issues of awareness and social stigma’s take a long time to address as there are no fast routes,” says Loza. “But eventually the legislations in place, alongside the campaigns, should pave the way.”

For now though, Abbasseya psychiatric hospital will have to remain located — in stigmatic fashion — on the "Street of the Insane Asylum."

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