Interview: Ana Maria Vinea and ‘Between the Psyche and the Soul’
Ana Maria Vinea is a Ph.D. candidate in Anthropology at the Graduate Center at the City University of New York. In 2010 she received a Dissertation Fieldwork Grant to aid research on ‘Between the Psyche and the Soul: Mental Disorders, Quranic Healing and Psychiatry in Contemporary Egypt,’ supervised by Dr. Talal Asad. For this installment of the WGF blog interview, we’ll take a step into the world of Quranic healing and Vinea’s work tracing the boundaries of and treatments for ‘mental disorder’ in contemporary Cairo.
I’d like to start with some scene-setting. What is Quranic Healing, and what other kinds of healing practices does it share space with in contemporary Egypt?
Quranic healing—in Egyptian Arabic, al-‘alag bi-l-Qur’an, which translates literally as therapy or treatment with the Quran—is a popular healing method in contemporary Egypt, which, as the name indicates, centers on the Quran as the main therapeutic tool. In grounding their practices, Quranic healers draw on centuries-long traditions of using the Quran for healing, alongside other methods, all the while reworking and systematizing them in new forms. Quranic healers, as many Egyptians, are convinced that the Quran, as the Word of God, can cure any disease including physical and mental ones. In their daily practice however, they concentrate on a restricted number of afflictions, deferring for the others to physicians and psychiatrists. These afflictions are jinn possession (mass), black magic (siḥr), and the evil eye (ḥasad), with the first two being considered the most widespread and serious ones. Both these afflictions presuppose the ability of jinn—a type of sentient, invisible creatures whose creation by God from fire is mentioned in the Quran—to harm humans, either directly, by entering their body and possessing them, or indirectly, from the outside.
What distinguishes jinn possession from magic is that in the first case the jinn possesses the person out of their own will, while in the second they are sent by a sorcerer. According to Quranic healers, the only religiously correct way of curing these afflictions is by exorcizing the offending jinn. This is achieved through reciting what is Egypt is known as the ruqya, namely specific verses of the Quran considered to have such a powerful effect on the jinn that they, willingly or not, leave the possessed person, or, in extremis, are killed. To help in the exorcism process Quranic healers also recite various invocations and supplications (ad‘iya/adhkār), some employ cupping (ḥijāma), as well as certain plants and aromatic substances, all of which are practices recorded in the body of literature that recounts the sayings and actions of the Prophet (hadith). The Quran is used not only for exorcizing the jinn, but also in putting a diagnostic (by forcing the jinn to come into presence on the possessed body), as well as in the strengthening practices needed during convalescence. Additionally, the Quran is also seen as a form of prophylaxis against these afflictions since, in the healers’ conceptualizations, the human becomes vulnerable to possession and magic if not cultivating the ethico-religious behaviors and sensibilities of a pious Muslim, for which reading and reciting the Quran are central. Therefore, the treatment regimen of Quranic healers includes an entire series of practices that the afflicted persons themselves need to perform from the obligatory and recommended worship and devotional acts (e.g., praying the five obligatory prayers at their time, reading the Quran every day) to additional therapeutic actions most significantly drinking and washing with water upon which the Quran was recited.
This is of course only a brief and rather schematic summary of the practices of Quranic healers which, moreover, are far from being standardized or lacking in internal debates. Despite this diversity, what brings them together is the emphasis on exorcizing the jinn and on Quranic recitation, as the only religiously legitimate therapeutic methods. Connected with this, Quranic healers also share a central preoccupation with eliminating what they perceive as religiously illicit healing practices foremost among them the use of amulets and any forms of dealing with jinn that involve their appeasement as happens, for example, in the zār ritual. They are also opposed to practices usually associated with Sufism which have a healing dimension, like saint’s tomb visitations. All these therapeutic practices are designated by Quranic healers as forbidden innovations (bid‘a) and/or as instances of idolatry (shirk) and unbelief (kufr) because they do not follow the practice of Prophet and his Companions (sunna) and because they involve placing intermediaries between the believer and God, or having recourse to other beings, like jinn, for help. In contradistinction, Quranic healers assert that their practice draws exclusively on the Quran and sunna. The therapies not recorded in these textual sources are seen as not contradicting their principles, like the practices their fight to eliminate. The many discussions among Quranic healers around specific therapeutic procedures (such as certain forms of interacting with jinn) suggests however the difficulty involved in demarcating what is permitted from what is not and also point to a certain lack of clarity around what counts as ‘proper’ Quranic healing as opposed to other, different practices. This is especially so since most of these ‘other’ practices also involve Quranic recitation and draw on the power of the Word of God. Nevertheless, it is through this double movement of criticizing certain practices and proposing in their stead others (such as exorcism), that Quranic healing became a distinctive therapy in contemporary Egypt locally recognized as such. The emergence of Quranic healing can be traced back to the 1980s, with the 1990s seeing an increase its visibility and popularity. A similar phenomenon—the spread of a therapeutic practice that identifies others as religiously impermissible and attempts to replace them—was noted in other parts of the Middle East and the Islamic world. However, with a small number of exceptions such as the work of Stefania Pandolfo among a few others, it was rarely studied by anthropologists. In Egypt the spread and popularity of Qur’anic healing needs to be put on the backdrop of the Islamic revival and particularly one of its strands—the Salafi movement and school of thought which is followed by many, but not all, Quranic healers. In fact, some Egyptians almost equate this therapeutic practice with the Salafi movement, an identification which can prove misleading in certain situations. Leaving aside the accuracy of this identification, most Qur’anic healers do share with the Salafis the concern with teaching people the proper understanding of tawḥīd (God’s absolute oneness) through eliminating those practice that contradict it, as the healing practices that Quranic healers try to replace.
What kinds of critiques were made of Quranic healers, by psychiatrists or others? How did your informants respond?
The emergence and growing popularity of Quranic healing in contemporary Egypt went hand in hand with various contestations of this practice, especially on the part of psychiatrists and some religious scholars. In fact the same period has seen growing debates bringing together these groups of actors first on the pages of newspapers and, in recent years, on television screens. These debates have been animated by a number of questions, a central one being how to define a particular pattern of behaviors and emotions—is it jinn possession or schizophrenia? Black magic or anxiety disorder? Or perhaps just a skillfully used deceit? Other questions that have been discussed in these debates are the causes and best treatments of mental disorders, especially in what concerns the connection between faith and mental health, as well as the meaning of the generally accepted notion that the Quran is a cure. In many cases, these issues have been approached through the prism of the relationship between ‘science’ and religion,’ with what can and should be included under each term and the proper relationship between the two being also debated. Through such discussions, psychiatry and Quranic healing, as well as afflictions such as mental disorders and jinn possession, have been practically and discursively drawn together and articulated in relation to each other in contemporary Egypt. They are also constantly linked by patients who oftentimes have recourse to both types of practitioners, either in parallel or in sequence. In this sense, it is difficult to fully understand Quranic healing without also having a grasp the critiques leveled at it in such debates.
Perhaps the main point of contention between Quranic healers, on one side, and both psychiatrists and some religious scholars, on the other side, concerns the reality of jinn possession. As I have mentioned above the practices of Quranic healers presuppose the ability of jinn to possess a human, but, despite the conviction of many Egyptians, this ability is contested both within and without the Islamic tradition. All religious scholars, including, albeit reluctantly, Quranic healers, recognize that the question of jinn possession was and still is a debated issue in Islam due to the lack of clear textual indicants (dalīl, pl. adilla) that can conclusively prove its occurrence. From this starting point, some argue that in such a situation one should defer to experts such as psychiatrists, while most provide their own interpretations of various verses from the Quran and hadith as a proof of the impossibility or the possibility of jinn possession. At their turn, psychiatrists maintain that jinn possession has no place in a scientific mode of reasoning and cannot be harmonized with the present knowledge of the human. In addition, religiously-inclined psychiatrists also invoke similar arguments as those of religious scholars, drawing at their turn on the Islamic tradition to counteract the claims of Quranic healers. Bu this denial of the reality of jinn possession creates the need of an explanation for the phenomena that Quranic healers treat under this name. These explanations, mentioned by both psychiatrists and religious scholars, include several aspects. At one extreme, the patients of Quranic healers are seen as suffering of one or another mental disorder, from schizophrenia to mild forms of anxiety and adjustment disorders. At the other extreme, they are treated as skillful manipulators who draw on widespread beliefs and customs, like that in jinn possession, to achieve some specific goals. Since jinn possession does not happen in reality, Quranic healers are, from the point of view of these critics, charlatans who either consciously take advantage of people or, at best, who naively believe in what they do. A few psychiatrists argue that the therapeutic techniques employed by Quranic healers might have a temporary positive effect by relieving the symptoms of depression and anxiety, but without providing a real cure for the underlying problem. Moreover, Quranic healers are criticized for espousing a faulty understanding of Islam and spreading it among people, which perhaps constitute the biggest sour point for Quranic healers. Hence, in counteracting these critiques Quranic healers first and foremost insist on the reality of jinn possession, by quoting specific Quranic verses and hadiths which are interpreted as proofs of jinn possession. They also quote the opinion of old and contemporary religious scholars who support this interpretation. But when leaving the field of textual arguments, Quranic healers also maintain that they do not deny the reality of mental disorders and do not claim that all mental disorders are in fact cases of jinn possession or sorcery, as they are sometimes caricatured by opponents. They also admit that there is a perceived overlap between the symptoms of some mental disorders and jinn possession which they take as one of the reasons mentally ill people might have recourse to them instead of psychiatrists. For Quranic healers this implies that their job is distinguishing between the two afflictions and referring the necessary cases to psychiatrists, which I have seen several healers do. Similarly, they also recognize that some of their patients pretend they are possessed. More interestingly however, Quranic healers also employ an additional affliction category—wahm (self-deception, illusion), whereas a person by becoming convinced she/he is possessed, without being so in reality, exhibits real and painful possession symptoms—which complicates the question of what is real and what false. Finally, Quranic healers also emphasize the spread and dangerousness of charlatans, as I have mentioned in the first question, but they are against the type of generalization made by their critics for whom any healer is always already a charlatan.
In many ways it seems that your project fits into a tradition of medical anthropologists writing about the intersections of “cosmopolitan” medicine and more localized healing traditions. In this regard, which thinkers have influenced you? How do you feel that your work twists or builds upon the existing paradigm?
There are, I think, several loosely defined and overlapping bodies of work within medical anthropology that look at intersections between biomedicine and non-biomedical healing traditions with what counts as such intersections being differently understood and approached. Each one of them was a starting point and a source of inspiration, albeit in different ways and degrees. Perhaps closest to my research are those studies known under the name of medical pluralism, which directly address the situation where different therapeutic practices coexist in one locale. Such studies have mainly focused on the decision-making processes involved in navigating between different medical traditions and on the phenomenological experiences of patients, while my interests centers mostly on the practitioners themselves. Their importance lies in showing that the introduction of biomedicine did not completely erase other medical traditions, opening up the question of how they coexist, intersect, or influence each other. This does not mean however that this introduction has not reshaped the medical landscape, oftentimes recasting such non-biomedical healing tradition as the negative opposite of biomedicine as well as effecting changes in the therapeutic practices themselves. In this regard, I have learned a lot from the literature focusing on colonial medicine and psychiatry and well as from studies that have looked at the modernization of ‘traditional’ medicine. Another body of work I draw on includes theoretical and anthropological approaches to Western psychiatry that have analyzed how it creates new disease categories and subjects of knowledge and intervention, like the work of Michel Foucault, Ian Hacking and Allan Young to give just a few examples; as well as those studies which have taken these concerns in the study of psychiatry (and biomedicine more generally) to non-Western contexts. This literature provided important theoretical and methodological suggestions for my study of how psychiatry is practiced in Egypt. However, in these latter studies explicit examinations of both biomedicine and a non-biomedical medical practice are not frequent.
Such explicit and implicit comparisons between psychiatry and local therapies and understandings of illness are more common however in other bodies of work, such as older ethnopsychiatric studies to give just one example. However, many times these comparisons tend to focus on non-biomedical healing practices and conceptualizations, with psychiatry remaining somehow in the background as a yardstick, but not examined in-depth in its local organization and ways of practice. What I have attempted to do in my research is to make this comparison more explicit, by devoting a similar kind of attention to both psychiatry and Quranic healing. In doing so, my starting point was how these two therapies are locally compared, contrasted, drawn together practically and discursively. In a way, my analytical bringing together of psychiatry and Quranic healing makes sense only on the basis of the way this occurs locally. In a second step, and for better understanding what is at stakes in the debates between these practitioners, I engaged in a more thorough analysis of each practice in particular. In doing so, like other anthropologists, I draw inspiration from science studies. First, I approached both Quranic healing and psychiatry as knowledge assemblages that bring together in specific ways people, practices and situated knowledge. This meant tackling both therapies with a similar set of questions, all the while remaining attentive to the practices that differ between the two. Such a method, without epistemologically privileging any of them, allows for an investigation of their specificities, but also their interactions, intersections, as well as their differential positions and power-effects. Second, my analysis is influenced by those studies which have shown how objects and subjects of knowledge do not preexist but emergence in scientific practices and I have hence paid attention to the objects, beings and kinds of people shaped and enacted in psychiatric and Quranic healing therapeutic practices. Such a lens, affords one to move away from studies of ‘different treatment methods of mental disorders,’ which, despite the richness of the analyses, oftentimes unwittingly assume that the objects of therapy are the same, only differently interpreted and understood.
What kind of sites did your fieldwork bring you to? Were there any particularly memorable or striking experiences?
Because this project concerns not only Quranic healing as an isolated therapeutic practice, but the complex ways in which this therapy and psychiatry are practically and conceptually connected and separated in contemporary Egypt, my research required dedicating an approximately equal amount of time for investigating each of them.
My field research among psychiatrists consisted of interviews and observations. The first brought me to the psychiatrists’ private clinics, but also sometimes to hospitals and university halls. Through these interviews I tried to get a sense of the different opinions of psychiatrists in what regards non-psychiatric therapeutic practices and patients’ reliance on them, with an emphasis on Quranic healing, as well as of their views concerning the role of faith and ethico-religious practices in mental health. At the same time, through them I collected information about the organization of the Egyptian public and private mental health system. However, because I was interested not only in the expressed opinions of psychiatrists and other mental health professionals, but also in observing their therapeutic practices, I explored different possible research sites for engaging in such observations. With the help of the friends and acquaintances I made while carrying out interviews I was lucky enough to get permission of conducting research in one of the governmental mental health hospitals situated in Cairo. There I first spent time in the outpatient clinic observing psychiatric interviews and the interactions between patients, nurses, and doctors; as well as interviewing and informally discussing with them. Later, I based myself in one of the female inpatient wards, all the while visiting other sections. In this ward, I followed the work of psychiatrists, psychologists, social workers, nurses and orderlies and the lives of patients so as to better understand the routine activities that shape the patients’ lives and their responses to them. While most of the interviews with psychiatrists were carried out during the first months of the research, I have continued to go to the hospital throughout my stay in Cairo. This allowed me to have a continuous feedback between my observations in the hospital and in the Quranic healing sessions.
It is also with the help of acquaintances that I met Quranic healers and, as in the case of psychiatrists, I first spent some time conducting multiple interviews with each of them, afterwards attending the healing sessions of a few. My encounters with Quranic healers usually took place where they were seeing patients, including their houses, offices, or spaces adjacent to mosques. Other Quranic healers went themselves to the patients’ homes and I accompanied one of them on several occasions. It is not only the space dedicated for healing that differed among Quranic healers, but also sometimes the entire organization of the healing sessions. For example, in the case of one healer whose session I attended regularly, the arrangement resembled to a great degree the one I have seen in the private clinics of psychiatrists in the sense that he had a separate office, a waiting room, and a secretary to take care of appointments. In another case, the healer was holding his sessions in the kindergarten adjacent to and managed by a mosque, sessions which consisted of what is known among Quranic healers as ‘group therapy’ meaning that several patients are seen at the same time. In an adjoining room those waiting their turn were chatting, praying, reading the Quran, scolding their children, and eating. This arrangement worked to my advantage because it allowed me to meet and discuss with patients when I was not observing the healing sessions themselves. I established a closer relationship with a few people encountered in this manner, as well as with a few patients met in the hospital and I visited them at home. In addition, the ‘sites’ of this field research also included the Al-Azhar’s university halls and mosque, as well as bookstores were I browsed for books related to the topic of this study and any television screen where I watched shows dedicated to it. As often happens, even my encounters with Egyptians not directly connected with either psychiatry or Quranic healing proved to be revealing since almost everybody I discussed with had an opinion on the subject pointing to its relevance and prominence in contemporary Egypt.
Initially at least, you were interested in the ways in which Quranic healing could a gendered practice. How did this bear out during your research?
While my research never had gender as its main focus, I did plan to pay attention during my field research to the gender dynamic of Quranic healing. This interest was stirred by the secondary literature on spirit possession and related therapies in the Middle East I consulted. With the risk of reducing a rather rich body of work to a few main traits, one could note that oftentimes in this literature jinn possession was treated as an overwhelmingly women’s phenomenon, a way of escaping or negotiating the predicaments of patriarchy and an expressive means for articulating complaints and ideas not communicable otherwise. In this literature, albeit with different emphases, jinn possession appears as a form of gendered resistance and subaltern discourse. What draw my attention was less one or another analytical interpretation, but the apparently strong link between women and jinn possession. It is not that the claim was made in this literature that men cannot be possessed by jinn, but, with some notable exceptions like in the work of Vincent Crapanzano, their possession was rarely the focus of analysis.
There are a couple of interconnected issues that emerged during my research in relation to the gender issue. First, at the healing sessions that I attended the number of women coming for treatment was overall twice as big as that of men. While jinn possession was never treated as an exclusive female phenomenon, this discrepancy did not go unnoticed among the different research participants, from the patients themselves and the Quranic healers, to those who criticize their practices like psychiatrists and some religious scholars. In this way I became interested in seeing what kind of explanations these actors themselves give for the bigger number of women who get possessed and have recourse to Quranic healers—the second issue I want to mention here. These explanations are usually based on a specific, differential conceptualization of the female and male nature, with women being envisaged as weaker and more emotive and sometimes as less pious then men. Another explanation emphasizes the contextual stresses women have to bear on a daily basis as the result of wider transformations and problems in the Egyptian society. Due to their nature, the societal context, or both women are seen as more vulnerable to jinn possession, to pretending they are possessed, or to suffering from psychological disorders, depending on the perspective adopted. In the discourse of those who oppose Quranic healers’ practices, women are also seen as more vulnerable to falling prey to dishonest healers who might swindle them or, even worse, sexually abuse them. These different kinds of explanations do not map on specific groups of actors, but were put forward by all of them with different emphases. At the same time, my research also shows that the question of gender while present is not at the forefront of the preoccupations and concerns of the actors involved. As I previously mentioned, Quranic healers main concern is with educating people as to what are the religiously permitted healing practices and with instilling the proper ethico-religious dispositions and behaviors of a pious Muslim—men and women alike. Psychiatrists mainly worry about people’s—both men and women—reliance on ‘charlatans,’ and the lack of knowledge of and the stigma surrounding mental disorders. Gender is part of these concerns, but not the main one.
What further questions or issues intrigue you? How might you see this project expanding?
Because of the relevance of the question of the reality of jinn possession in the debates among Quranic healers and psychiatrists, I became interested during my research in the ways in which these two types of practitioners get to know the objects of their therapeutic intervention; in other words, in the techniques, gestures and procedures through which they read the complaints of the patients and decide on a diagnosis. To give just an example, my research showed that a distinctive feature of Quranic healers is their development of groups of symptoms for each subcategory of the afflictions they treat, which might vary in content and degree of detail, but are quite similar in their general format. These symptoms are used by the Quranic healers in the form of questions as part of the diagnosing procedure. One cannot fail to observe some similarities between this way of putting a diagnosis and that used by psychiatrists which also involve a question-answer format on the basis of standardized checklists of symptoms like DSM-IV R or, more frequently used in Egypt, ICD-10. It is by comparing such methods of approaching an afflicted person and putting a diagnosis that both the similarities and the differences between these therapeutic techniques come to light.
A second issue that I am interested in writing about in my dissertation is yet another prominent contentious point in the debates between Quranic healers and their critics. This concerns the meaning of the statement that the Quran is a cure, a statement which is found in the Quran itself and is agreed upon by believing Muslims. Quranic healers’ therapeutic practices involve two ways of employing the Quran, as a direct medium of healing by reading the ruqya over the suffering person with the purpose of exorcizing the jinn and as a source of ethical examples for moral cultivation. In their practices and conceptualization the Quran is both a literal and a metaphoric cure. Conversely, religious psychiatrists as many religious scholars see the Quran as a cure for social ills and for bad tendencies inside the human and not as a medication for physical diseases. They maintain thus that Quranic recitation has positive psychological effects and can assist in the process of healing any disorder, including certain mental illnesses like anxiety. However, in their opinion, this requires the person to reflect on the Quran’s meaning and significance and to adjust their emotions and behavior accordingly, and not to simply repeat its words. From such a perspective, the usage of the Quran in the healers’ practices is a insult to the Word of God by its reduction to something similar to a pill. This distinction between a pragmatic and a semantic use of the Quran is explicitly or implicitly rejected by Quranic healers and their patients.
There are two directions in which I would see this project expanding, both of them historical. First, I think it will be interesting to analyze in more detail than I will be able to do in this dissertation how in different periods of the Islamic history the question of jinn possession was addressed, as well as how the relationship between different therapeutic practices was conceptualized. Second, while carrying out this research I became intrigued by questions such as how the names of certain mental disorders in Arabic were selected, by whom and when. In other words, an additional area for further research might be the social and conceptual history of modern psychiatry in Egypt, on which very little has been written so far.
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