Power in Medicine: Psychiatry in the Middle East—Interview with Christopher Dole
On 11th and 12th April 2019, the workshop “Power in Medicine: Interrogating the Place of Medical Knowledge in the Modern Middle East” will take place in Berlin. It is organized by Edna Bonhomme, Shehab Ismail, (both MPIWG) and Lamia Moghnieh (AUB, EUME) and will be convened by Europe in the Middle East—Middle East in Europe (EUME) and the Max Planck Institute for the History of Science (MPIWG). The workshop will examine the history and politics of medicine and psychiatry in the Middle East from the 1800s until the contemporary period. Please find the workshop program here and the poster here.
Christopher Dole is one of the workshop’s participants. Lamia Moghnieh conducted the interview.
How would you describe your scholarship? Tell us about your work, research and most recent book.
I am a medical anthropologist with broad interests in the relationship between suffering, healing, and politics. Turkey has been the principal setting for my research, and my current work extends a long-standing interest in religious and psychiatric forms of therapeutic care, the production and distribution of vulnerabilities in society, the intimacies of political economy, and ethnographic and literary accounts of human flourishing.
I am currently completing a project concerned with humanitarian psychiatry and the affective remains of catastrophe in Turkey. The project began with an interest in emerging models of psychiatric care in Turkey and developed, over time, into a project focused around the psychiatric response to a massive earthquake that struck western Turkey in 1999. Based on ethnographic research with earthquake survivors and a group of Turkish mental health professionals who provided humanitarian psychiatric care in the wake of the earthquake, the project examines the relationship between transnational forms of psychiatric expertise and long-term experiences of loss in a context marked by catastrophic destruction. Through tracing the effects of the earthquake and its psychiatric response in the lives of survivors, this project opens to a wider set of urgent questions regarding the sorts of lives forged—and forge-able—in contexts being profoundly remade by the combined influences of environmental and geological precarity, medical and technical forms of expertise, and shifting rationales and realities of governance.
My interest in post-disaster psychiatry grew out of earlier research that explored religious forms of therapeutic care within economically marginalized communities in urban Turkey. This work, which was the basis of my first book Healing Secular Life: Loss and Devotion in Modern Turkey (University of Pennsylvania Press, 2012), explored the ways in which religious healing and secularism in Turkey can be understood as overlapping projects of world and subject making. Grounded in long-term ethnographic and archival research, the book approaches stories of healing and being healed as settings for examining the everyday social intimacies of secular political rule. With the completion of Healing Secular Life, my research interests in therapeutic care expanded into clinical, psychiatric spaces. This was, in a sense, a very organic transition, in that there is a great deal of exchange—from the point of view of patients—between religious and psychiatric therapeutic traditions. As such, the new project not only complements my previous work, but also fills it out in important ways.
The PIM workshop aims to bring scholars in anthropology and history together from different places in the Middle East to bridge theoretical and regional scholarship on medicine and psychiatry in the Middle East. What has your work in both disciplines taught you? What kinds of conversations have emerged from working in both history and anthropology?
There are at least two ways in which my research stands at the disciplinary entanglement of history and anthropology. The first is specific to my current project. The research for this project began quite literally in the ruins of the earthquake. At the time of the earthquake in 1999, I was conducting my dissertation fieldwork in Turkey. Although my current project wouldn’t begin in earnest until several years later, the seed for it was planted with the earthquake and has continued to grow, on and off, for nearly 20 years. This has made the project much more historical than I had initially anticipated. The span of this project has both allowed for a number of unexpected insights (I’ve been able to watch, for instance, as the earthquake has been transformed into an historical event) and presented a number of challenges (especially given the dramatic political transformation in Turkey over recent years).
Beyond the specific conditions of my current project, I also see my research as embodying a far deeper disciplinary entanglement between anthropology and history. There’s a lot to be said here, but I’ll just note that it is no coincidence that one of the most significant and influential theory courses I took as a graduate student was taught by an historian. Given how much anthropology and sociology feed off of one another, yet also challenge one another, this workshop is an extraordinarily exciting and important opportunity for anthropologists and historians to think, together, in systematic ways about what we can offer one another.
Based on your expertise, what are some of the debates emerging from historical/anthropological research on psychiatry in the Middle East? What is unique about that field of study?
In many ways, my work emerges out of a lasting, mutual fascination—and suspicion—between anthropology and psychiatry. This relationship, built out of our shared interest in the remarkable variability of human experience, has given rise to a rich and complex conversation that has spanned generations of anthropologists and psychiatrists. Although this conversation has waned in recent decades—for many reasons, in both fields—the history of this relationship is important, and offers a range of insights for imagining a different future for both fields. (Bhrigupati Singh, a workshop participant, has recently offered a set of compelling questions for enacting such a future: http://www.medanthrotheory.org/read/8083/uncritical-encounter-anthropology-psychiatry).
Nevertheless, when one looks to anthropological interest in psychiatry in the Middle East, the literature is, unfortunately, uneven. From where I sit, the most sustained anthropological attention to mental health issues in the Middle East have been in the name of trauma and PTSD. There is a sizable body of research here—much of it not anthropological—examining the politics of trauma and, relatedly, therapeutic and humanitarian efforts to address the psychological effects of political violence. On the one hand, this work has been important in pushing research away from simplistic, essentialized models of “culture” and “mental illness”. On the other hand, unfortunately, this attention to trauma and PTSD perpetuates the geopolitical narrative of the Middle East as a setting of unrelenting violence and conflict. There are signs, however, that things are shifting. A recent issue of the journal Middle East–Topics & Arguments (https://meta-journal.net/) and a special section of Medical Anthropology Theory (http://www.medanthrotheory.org/issue/vol-2-3/) were both devoted to thinking “beyond trauma” in the Middle East.
I would add, though, that this trend—the way that trauma and its treatment has overshadowed other topics—has also contributed, in complex ways, to a decreased interest in (and funding for the treatment of) other forms of psychological or emotional distress in the region. As I see it, this points toward an everyday terrain of psychiatric care, psychopharmaceutical use, and subjective experience that needs to be more expansively examined. In Turkey, for instance, one sees curious trends in psychiatry when looking beyond the field of trauma-focused psychosocial interventions (which are, not surprisingly, widespread in refugee camps and displaced Syrian communities in Turkey). What one finds, as the historian Fatih Artvınlı has observed, is a rapid expansion of “community-based” approaches to mental health care happening alongside—literally at the same time as—the building of new, large psychiatric hospitals in the provinces. What to make of these seemingly opposed trends—this simultaneous de- and re-institutionalization of psychiatry? While it can perhaps be read as a telling symptom of the current political situation in Turkey—with its brutal and dispiriting convergence of neoliberal policy and authoritarian politics—this dynamic nonetheless raises a range of important research questions for anthropologists and historians interested in psychiatry in the region.
The last thing I’ll add here is that, along a very different line, there has been a recent surge of interest—among anthropologists and historians—in psychoanalysis and psychoanalytic theory in the region. I’m thinking specifically of Omnia El Shakry’s The Arabic Freud (Princeton University Press, 2017) and Stefania Pandolfo’s Knot of the Soul (University of California Press, 2018). Although psychoanalysis continues to be an under-utilized therapeutic approach, it has nonetheless given rise to an exceptionally rich set of questions and confrontations in the region. Perhaps unexpectedly, this has also been a place where religion has entered into scholarly conversations about psychiatry in interesting ways. This is most certainly a relationship—between psychiatry and religion—that is in desperate need of further attention.
What are the intellectual and political stakes of studying the history and contemporary scientific and medical discourses around healing in Turkey?
I’m going to offer an answer here that is somewhat askew of the question. In my research, I have been fascinated with the political life of psychiatric interventions that emerged out of a context of large-scale disaster. The earthquake in Turkey would prove to be an important moment for the development of new models of psychiatric and psychological care. Indeed, a lot of what we see happening in Turkey today—especially in the way that psychological discourses have become increasingly important for the management of social and political lives far beyond clinical settings—can be traced back to the earthquake. And here, there are a range of intriguing intellectual and political stakes converging around these psychiatric technologies.
There is of course a history to this convergence. Looking to the past, for instance, there were very few mental health professionals in Turkey prepared, clinically speaking, to treat the sort of emotional suffering that the earthquake precipitated. Those most prepared turned out to be a group of relatively marginal (in relation to mainstream psychiatry) mental health professionals, namely a group of leftist psychiatrists who had conducted research on the traumatic effects of police torture and a group of feminist psychologists who had worked with survivors of gender-based violence. In my work, I have been fascinated with how these political stakes of psychiatry transformed as they passed through the earthquake. In turn, the psychiatric response to the earthquake would have a series of surprising political afterlives—as the instruments and techniques developed in the earthquake traveled to eastern Turkey following another earthquake to mediate conditions profoundly disordered by both the earthquake and a history Kurdish dispossession and Turkish state violence. And a few years later, these same instruments would be used by psychiatrists taking part in the Gezi Park uprising to document the psychological effects of police violence, and from there they would move into the refugee camps along Turkey’s Syrian border. My point here is that the intellectual stakes of studying psychiatry in Turkey has brought into view a range of political stakes that weren’t imaginable at the outset of this project. As such, there’s much to be learned about the contemporary moment in Turkey by tracing the histories and lived realities of these sorts of therapeutic encounters. In certain regards, this can be read as a different articulation of the central argument of my first book—that healing and politics are overlapping projects of world and subject making. This, in turn, brings to mind yet further questions about the political stakes of this sort of research—or, for that matter, any research being done in Turkey right now. Given the unprecedented repression of academics in Turkey over the past several years—with our colleagues and friends being fired from their positions, arrested, and imprisoned—what does it mean to do this sort of research today, and, perhaps more importantly, how will the political stakes of the present deform the intellectual stakes of future generations of scholars?
Christopher Dole is Professor of Anthropology at Amherst College whose research and writing explores the intersection of suffering, healing, and politics. His publications include Healing Secular Life: Loss and Devotion in Modern Turkey (University of Pennsylvania Press, 2012), The Time of Catastrophe (co-editor, Routledge, 2015), and articles that have appeared in the American Anthropologist; International Journal of Middle East Studies; Culture, Medicine and Psychiatry; Ethos; and International Migration and Human Rights. He is currently working on a project concerned with humanitarian psychiatry and the affective remains of catastrophe in Turkey.