The Ultimate Lebanese Medical Taboo: Mental Health, Not Demons. Psychiatry, Not Exorcisms

“Tell me I have cancer please,” she said as I stood next to her in the Emergency Room. “Tell me I have cancer,” she repeated again as if repetition would make it true. “I have cancer, yes I do. But I’m not insane.”

1 out of 5 Lebanese will have a mental disorder during their lifetime. This is in sync with international averages, which is interesting given the proficient history that serves as precipitating factors galore that we’ve had. But be sure of this: we all know someone who has or will have a mental disorder.

50 is the approximate number of registered and licensed psychiatrists that could potentially treat these patients. 50 for slightly less than one million. We have incredible shortage and yet it doesn’t show to everyone. Why? Because we simply don’t talk about mental health.

0 is the number of local insurance companies that cover for psychiatry. People don’t care enough about the issue in order to pressure them to make it included with their healthcare bundle. It will never happen, they’d say. It only happens to other people, just like every other serious illness I suppose.

A patient my age thought she was living inside a snake on Mars. That was where she was when she presented for hospitalization with bruises all over her body.
Her family denied knowledge of those bruises at first. But they were too systematic to be coincidental. She had bruises over here wrists, torso and legs. Her parents still didn’t budge.
The patient in question was living on Mars for a few months now. She wasn’t brought in earlier because her family thought she was possessed. A religious man had tried to perform an exorcism. We live in a country where it’s more acceptable to say demons are inside a family member than to say he was admitted at a hospital and is on a few meds.

That patient wasn’t the first nor the only one I saw who had attempted many exorcisms at the hand of religious figures before finally deciding that what was wrong wasn’t, in fact, spiritual as much as it was simply biological and chemical. It’s always that way: demons, not disease. Exorcisms, not medicine.

Wasn’t it at the times of our great-great-to the power ten-grandfathers that illnesses were associated with evil spirit?
That seems to still be the case today in Lebanon, and many other countries around the world, when it comes to mental health. The way we view mental health is also that of a taboo whereby we try to hide from it, shut it away as something not to be talked about. Even the suicide of Amina Ismail, sensational as it was, didn’t turn in the media into a discussion about mental health. It was a discussion about her private life. We have it among family members but instead of looking at those family members as sick people, akin to any person with any chronic illness, we look at them as burdens who got themselves into the mess they are in. My family is no exception to the statistics. And I’ve seen both ends of the spectrum: the cancer patient is seen as the sick one. The mentally ill patient is seen as the spoiled one.

The extent that mental health is a taboo in this country is best manifested when you observe the way people act around the possibility of a mental disorder diagnosis. Some of them exchange their names with numbers as identifiers. You can name me thirteen if you want to. Others would panic when psychiatric people are called in for a consult. “I’m not crazy, get out of my room.” Few are the people who are open about the idea of possibly going to the psychiatric ward. Even fewer are those who actually present voluntarily. The least of all people are those who are open about any possible mental disorder they might have and who actually view such disorders the way they view any other illness. You should also see the reaction that doctors who are specializing in psychiatry get every time they tell people of their plans.

Then there are the diseases which have been ridiculed by people to the extent that few seem to actually see them as illnesses anymore. Schizophrenia becomes split or multiple personalities just because Hollywood says so. Substance abuse becomes an issue that doesn’t concern us because we have willpower. “Tu deprimes today?” becomes the reference for depression.

I have a friend who was diagnosed a while back depression. Treatment has greatly improved his entire lifestyle and approach. And I’ve been thinking lately how lucky my friend was to be surrounded by people who viewed his diagnosis and treatment as a true medical case, not him being a wuss. If his case had been the latter, he’d have probably never improved and he would have never known that there is a better view of life than that of a person who was always sad, who had decreased interests, decreased appetite, guilt, suicidal thoughts.

“Madness is like gravity, all it takes is a little push,” the famous saying goes. Except “madness” is nothing like gravity and it takes more than just a push to get there. It’s a collection of genetics, biological predispositions and psychological stressors – sort of like any other disease, really. A mark of the development of a society is the way they view mental health. Lebanese tell their friends who are truly depressed to suck it up. They’d rather seek out exorcisms and justify diseases with demons than with simple facts. A person who develops substance abuse is weak-minded, his abuse never seen as an actual disorder. That patient who wished she had cancer has been “living with a demon” in her house for 6 years. She had brought in a priest every month. She still doesn’t know nor does she accept that the problem is probably with her and it could have been fixed 6 years ago. I guess some people would rather find solace in demons and live in Mars in the process because society thinks a Martian habitat is better for people like them than to acknowledge the simple and yet vitally important fact that it’s mental health, not demons. It’s psychiatry, not exorcisms and voodoo.

Why Lebanon’s Psychologists & Psychiatrists Are Now Talking on Homosexuality

You’ve probably heard a lot recently about how the Lebanese Psychology and Psychiatry associations have “come out” in the scientific favor of homosexual behavior in Lebanon.

For those of you who don’t know, the main reference for psychologists and psychiatrists, the DSM, has declassified homosexuality as an illness 40 years ago. So why is it now that Lebanon’s psychologists and psychiatrists are saying it isn’t so to the Lebanese public?

Well, I’m lucky enough to be passing through a psychiatry rotation at the country’s leading psychiatric facilities, under the auspices of one of the psychiatrists who was cited in the many press events that have taken place around the issue at hand. So I asked the question that has been going through my head for a long time now: why now, 40 years later, since the DSM update on the matter happened in 1973?

It seems the main reason behind the associations in question is because “the time is right.” What time is that?
Apparently, following the closure of Ghost in Dekwaneh, some TV stations hosted “psychologists” who proclaimed homosexuality as a disease precipitated by some forms of child abuse. This statement has absolutely no basis in reality so the Lebanese Psychology Association and the Lebanese Psychiatric Society decided that such erroneous information were not to be allowed to be propagated and that they were going to counter them.

The psychiatrist whom I asked for information on the matter was adamant to note that, contrary to the increasingly popular belief that such statements aim to get the law changed, it is not in fact their aim because “legislation doesn’t concern [Lebanon’s psychiatrists].” They are simply trying to raise awareness on the issue due to the way Lebanese media has been portraying it.

Do they hope the law gets changed one day? The psychiatrist in question said he’s personally in favor of changing the law. But it is not their job, nor is it part of their agenda. It is worth noting though, that even though Lebanon is technically “40 years late,” it’s still the “first country in the region to have such stances made public.”

Either way, based on my observations in psychiatry for the past few weeks, Lebanon has a long, long way to go regarding much of that domain.

Joe Kodeih’s Le Jocon – Review

Le Jocon Joe Kodeih

Lebanese comedian Joe Kodeih’s latest offering is Le Jocon, a play whose title is a play off the french name of DaVinci’s Mona Lisa.

Le Jocon starts with Kodeih visiting a psychatrist who immediately subjects him to hypnosis and asks him about his mother. Running for approximately 60 minutes, Le Jocon is a more or less autobiographical portrayal of some key moments in Kodeih’s life – all of which are given a comedic twist, obviously: from his moment of conception to his first days of school to growing up and going to Paris for a few days of vacation.

Those events are all done to the backdrop of a Lebanese life in Achrafieh, which makes the play very concentric. If you haven’t spent time in that part of Beirut or are not familiar with the many stereotypes associated with the people of Achrafieh, there are many jokes that you will miss.

Moreover, one of the key moments in the play which takes the biggest fraction is Kodeih’s visit to Paris which is told in three parts stretching over the three days of his visit. I personally found it hilarious because I had been to Paris but for someone who doesn’t know what Ch√Ętelet-Les Halles is (a subway station the size of Beirut’s airport) or what happens on the many different streets of Paris that he mentions, the jokes will come off flat or how difficult it is to take that infamous schengen visa picture: don’t smile, head at a 90 degrees angle, let the sadness erupt from your depth. Hilarious. Unless, of course, you were never submitted to a schengen visa picture.

My main problem with Le Jocon, however, is – and I understand this is overly analytical from my part – the stereotyping of the psychiatry experiment which Kodeih uses as a vessel to tell his story especially that it only serves to reinforce the misconceptions that many people have about the field, one which is more or less a taboo in Lebanon still. Of course there will be hypnosis. Of course the psychiatrist will ask about his mother. Of course he will turn out to have issues with his mother. I don’t feel we are at a point where that field should be an open field for comedy yet.

In general, though, Le Jocon is an entertaining short play. Tickets are for 20,000 and 30,000LL. Only two shows remain next weekend. It will make you laugh. So why not?



Silver Linings Playbook – Movie Review

Silver Linings PLaybook movie poster

For all matters and purposes, Silver Linings Playbook is a movie that shouldn’t technically work. It struts the line of a cliche romantic comedy so dangerously close that it could wander into those realms very easily. The premise isn’t groundbreaking. Very little about it is out of the box enough for it to be as brilliantly exhilarating as it turns out to be.

Pat (Bradley Cooper) is a former history teacher who found out his wife was cheating on him and ends up in a mental institute to treat his bipolar disorder, as part of a court deal. Eight months later, his mother (Jacki Weaver) goes on a limb and gets him out. His father (Robert De Niro) is an undiagnosed obsessive compulsive Philadelphia Eagles fan. Set on getting back with his wife who issued a restraining order against him, Pat decides to get his life in order. But the disorder proves harder to control at times. It is then that he meets Tiffany (Jennifer Lawrence), a widow with her fair share of problems. The odd couple strikes a friendship where they feed off each other’s woes and troubles in a brutally honest manner, be it by enumerating the drugs they take without one stutter, by going for jogs around their neighborhoods, by making scenes on Halloween outside a local diner, by Tiffany proposing sex to which Pat objects, by Pat believing Tiffany, the self-proclaimed slut is crazier than him, or by rehearsing to a dance competition that Tiffany wants to participate in.

I was surprised by Bradley Cooper who gives a terrific performance. He portrays the disorder his character is having perfectly. The transfers between episodes of mania and depression is subtle and striking. He delivers his dialogue at a breakneck pace and never falters. His performance is energetic, never subdued, is a true revelation.

On the other hand, Jennifer Lawrence, the movie’s acting highlight, gives a tour de force performance as the deeply troubled widow with layers upon layers of concealed rage to her character. The dysfunctional chemistry she brings to the table is absolutely brilliant to watch. You forget for the entirety of the movie that the woman you’re seeing on screen is only 22. She plays a character way above her age perfectly. She portrays her character’s angst, sadness, grieving and resiliency to perfection. She delivers the movie’s funniest moments in moments that shouldn’t even be funny. In Silver Linings Playbook, Lawrence is simply spectacular and has proven herself to be, yet again, our generation’s most promising new actresses.

The movie’s supporting cast also does well. While Jacki Weaver’s role doesn’t have much character development and is more important in its subtlety as the mother who had to deal with her son’s illness for years and the wife who had to cope with her husband’s obsessive compulsiveness, Robert De Niro gives his best performance in years as the father who cluelessly believes in his son. All in all, the people of Silver Linings Playbook can act and there’s no reason three of them should not see Oscar nominations for what they accomplished here.

David O. Russell, who gave us The Fighter a couple of years ago, has to be commended for maintaing the balance that Silver Linings Playbook shows. His knack for having dialogue-driven movies works well here. However, Silver Linings Playbook is not perfect. The supremely strong first half gives way to a less stellar second half in which the movie loses focus at times as it starts juggling way too many things at once, instead of focusing solely on what was making the movie work in the first place: Pat and Tiffany.

So much could have gone wrong with Silver Linings Playbook. The portrayal of mental illness could have easily turned into a PSA. The romantic part of it could have easily become dreary. The dysfunctional family could have easily turned grating. But all of those don’t happen. Instead, the movie has a sense of rawness mixed with like-ability that makes it oddly refreshing. Silver Linings Playbook is one of my favorite movies of 2012 so far simply because it’s not a color-by-number movie. It is untidy. It’s random. It’s all over the place sometimes. But you still watch it. And you go out of it feeling happy and smiling because Silver Linings Playbook is brilliant.