El Jadida, Morocco – After the mass-massacre that was committed by a mentally ill patient in Sebt Sais, we now hear a lot of rising voices in Moroccan press asking questions on the infrastructure of mental health in Morocco. The minister of health, el Ouardi, combated for the closure of Bouya Omar because of the alleged inhuman conditions the mentally-ill patients lived in only to throw them in the cruel hands of a gloomy destiny. Newspaper reports come up with shocking figures and heart-tormenting accounts about the filthy conditions of some Moroccan mental hospitals, and the irresponsibility of some medical staff exhausted by the overwhelming number of patients, endeavouring to dispose of most of them to the streets in order to ease the crowded conditions of the asylums.
Here we ask the question: why have we closed Bouya Omar? Is this governmental decision backed up by a research-based approach or is it a security based-approach as usual? If the health minister had consulted a scientific community specialized in ethno-psychiatric cure, he could have brought forth a better alternative than closing Bouya Omar and the door of other similar shrines. It is a pity that Moroccan psychiatry is nascent and is not oriented towards the investigation of the cultural resources of local psychodynamics though this type of research is well conducted by European and American ethno-psychiatrists in Morocco.
If thousands of Moroccan people go to shrines, they are not stupid or ignorant as EL Ouardi and some of his colleagues may think about them. He should consult scientific research on the role of the maraboutic institution in mental health care, and how Morocco can benefit from traditional health services despite the existence of a small number of pharmacologically-driven asylums that can hardly meet the needs of the population, and are culturally alienated by the indigenous population as dungeon-prisons of the mad.
Moroccan society is deeply rooted in maraboutic cure and traditional healing of mental sicknesses, which requires a serious dialogue between modern psychiatry and traditional cure, for without this methodological blend, Morocco will suffer a schizophrenic cultural identity characterized by the coexistence of a disparate imported alien health care system and local cultural etiologies. The West has its own local therapies and is already advanced in exploring other ethno-psychodynamics. In the same vein, hundreds of articles and books are written on Moroccan traditional cure while very few domestic scholars are aware of the debate. There are well-cited references on Moroccan ethno-psychiatry written by a number of American and European psychologists and anthropologists, not to mention the classical work by Vincent Crapanzano on Hamadsha and Tuhami, the work by khadija Naamouni on Bouya Omar and my work with Philip Hermans on Ben Yeffu.
Holland and Belguim where psychoanalytic anthropology is very advanced has incorporated traditional healing in the institutional health care system as an alternative therapy, the fees of which are partly reimbursed to enable Moroccan and north African patients who consult faith healers to be therapeutically treated by licensed traditional practitioners while Morocco, the domestic cradle of traditional healing, denies its system of magical beliefs and shuts its eyes to its maraboutic social background, boasting of its transparent glass-facade modernity, and closing society’s improvised cultural asylum shrines, then sending people to the streets to get nature’s cure.
The maraboutic institution specialized in curing mental illnesses in the form of jinn possession (such as Bouya Omar, Ben Yeffu, Sidi Masoud Ben Hsin, Sidi Boubid Sharqi, Sidi Ahmed Dghoughi, Sidi Ali Ben Hamdouch, Chamharouch, Moluay Brahim… the list is endless because it includes major and minor saints) resembles the prison institution Foucault delineated in Discipline and Punish. “The human body [is] entering a machinery of power that explores it breaks it down and rearranges it” (1977, p. 138). The maraboutic discipline reproduces docile subjects who display the most abject forms of submission in front of power symbols. They are drilled into kissing heads and hands, bowing or prostrating themselves on the ground in submission to the saint, and murmuring their wishes in silence. They are also drilled in being patient, acquiescent and unrelenting in their faith in the power of distributing centres of baraka.
It is a technique of dressage that excludes every sign of indocility. After being exorcised, the patients begin to obey whatever they are ordered to do; their obedience seems to be prompt and blind. By the end of the process of jinn eviction, patients undergo an emotional collapse, a state of catharsis. They discharge their accumulated hostilities and traumatic experiences.
At the maraboutic institution, jinn eviction is the most common means of behaviour control. Every misconduct or moral default is attributed to jinns. If people fail in marriage, trade, exams, or employment, they are thought to be jinn possessed. They are not liable to blame. Very little guilt appears to occur. The individual and the collective are
set free from accountability. Shame and disgrace are inflicted upon the jinni who assaults the innocuous individual. The stereotype of the jinni resembles the goat that is symbolically burdened with the sins of the Jewish people and sent to die in the wilderness to cleanse the Hebrew nation of its iniquities. The burden of shame is also thrust upon some stereotypical figures living in the individual’s environment and believed to threaten the coalition of the collective by casting upon it the evil eye or charming it with magic spells.
These figures are usually blamed for being the inciters of jinn attacks. So, saint-goers take it for-granted that jinns have the capacity to ruin their lives, which, accordingly, obscures the relationship between the State’s political and economic choices and the social malaise the individual endures. No institution in society, be it the family, the school, or the government, is held (at least partly) responsible for the individual’s failure. Even the individual himself is exempt from being accountable for his own deeds. There always appears to be a jinni haunting him and controlling his actions, a jinni that must be evicted if the individual is to regain self-control.
In short, this discourse that works by image, habit, symbol, ritual and myth represents an extremely effective form of ideological control. The effectiveness of this control is enhanced by the success of maraboutic cures discovered by ethno-psychiatric research. This does not mean that magic in itself works but the context where it is practiced and the diverse cultural communication strategies implemented can improve the condition of the patient or at least his perception of his own health condition.
Ethno-psychiatric Research has discovered that traditional cure is structured somewhat like modern therapy, and shows a lot of affinities with it though the theoretical foundations of both approaches are inimical. Here are some rules of thumb in traditional medicine:
Magical Habitus: socialization to magical beliefs and values plays a vital role in endowing people with the bodily and social skills and attitudes that govern their subsequent behaviour when they are sick. As little children frequenting shrines, for instance, they may acquire their magical skills and knowledge by experience and observation—how to act in rituals and ceremonies, and how to perform traditional cure. So, when they grow up, they may share a similar magical worldview and will be bodily equipped to let the jinni speak in their voice should they ever fall ill or become haunted.
Shared worldview: possession as a symptom is diagnosed by a shared worldview between patient and healer. In maraboutic culture, possession may refer to both organic and non-organic sicknesses. It is part of a set of healing symbols that manipulates social interactions between healer and patient. These social actors both understand healing symbols used for sicknesses, and share similar worldviews. Hence, patients hold faith (niya) in healers’ powers, whether “legitimate” or “non-legitimate,” and respond positively to the cure.
Group support: arriving at the shrine, people may be helped and assisted by other visitors. They chat together, advise one another and relate encouraging stories and miraculous cases of cure. The patient’s family also plays an important role in this solidarity network.
The patient’s mastery of his problem in the curative process: the patient participates in his cure. He is assigned a task to drink and wash himself with sacred water, use talismans, take certain herbs or incense and fumigate himself. All this gives the patient the idea that he can do something for his problem and probably enhances the placebo effect.
Ritual of sri’: a channel of emotional discharge for patients: it is the acting out of interpersonal problems; the jinni being an image of unsocial thought and behaviour gets burnt by prayers (prayers vs. desire; order vs. disorder). Sri’ becomes a ritual of moral organisation of society. Symbolically, desires are first acted out and thereafter punished or controlled so that the social order is restored. The child going against his father and the woman against her husband may play out their illicit desire and are afterwards “beaten” into submission. Exhibitionistic sexual desire is disciplined, and naked people are put into the dungeon (khalwa). Forms of transgression are regimented. Differences are exorcised and re-assorted into recognizable identities.
Cult membership: The patient becomes member of a cult or maraboutic order. This endows him with a new social identity, makes him strike new relationships, see life differently and enrol himself in a maraboutic mode of life.
Placebo effect: People get hope at the shrine in contradiction to the modern doctor who may say: “I have no cure for your sickness.” The healer always gives hope. He says he knows everything, and avows that the power of the saint is great. There are no problems the saint has not solved. Also, there is in the last resort always Allah who can and will make you better if He wills.
The placebo effect is the effect that occurs when doctors administrate a medicine that has no active ingredient (for instance because there exists none); this medicine all the same produces a positive effect on the patient. It seems that the belief the patient holds that indeed creates the positive effect. The effect seems to be even greater when also the doctor believes in it (e.g. when he himself believes that he is giving potent medication). This has been studied in modern medicine in different experiments. They show that the idea alone of a powerful drug in itself produces decrease in pain and symptoms.
Cultural beliefs about a pill (colour of the pill, effervescence, injection vs. oral administration) seem to make medicines more powerful than they are. The exact mechanism of this effect is not yet really understood and is still the object of research. However, all the positive effects of traditional cure may be attributed for a great part to the placebo effect of healing symbols and rituals (see, Moerman, 2000). However, the systematic cure given at the shrine is not always completely effective.
The majority of maraboutic patients who are said to be cured become devotees of the saint, and either settle there forever, perform periodical visits, organize occasional trance dances (jedbas) or call for the healers whenever they do not feel well. After all, it is a vicious circle without permanent cure. What patients gain from their treatment is a temporary relief from the indelible scars of their past. Their personality does not change and their maktub (‘written fate’) is to re-enact their suffering. Some of these patients end up in a web of servitude to the saint and his descendents.
To conclude, maraboutism seems to be an historical constant in Morocco. It celebrates the intercession between man and God, venerates saints, and promotes the belief in baraka and contact of jnun with humans. It responds to Moroccans’ cultural specificity, and converts the Average Moroccan to a popular form of Islam based on down-to-earth religious symbols that have always existed in his society. Thus any project of modern psychiatry underpinned by western medicine and modern theory denying Moroccans their religious and cultural specificity may be doomed to failure and social alienation. That’s why we keep insisting on the fact that turning our shrines into traditional therapy asylums, and bringing academic interest into popular approaches to turn them into established ethno-psychiatric modes of healing is a compulsory requisition.
It is high time for Moroccan psychiatry and psychoanalytic sociology to conduct interdisciplinary research on the local cultural aspect of traditional medicine and avail the disciplines of the great potential resources of maraboutic lore, and turn local therapies into modern approaches, establishing an alternative therapy to Western therapies that are alien to our cultural background.
Up to now, most Moroccan psychiatrists are pharmacologically driven, alas denying the importance of the psychodynamic approach of traditional therapies. How can they then communicate with their patients and gain their trust if they keep away from traditional modes of healing and local cultural idioms?
It is a pity because when I published my research on Ben Yeffu in 2007, after a painful self- funded fieldwork and library research abroad in collaboration with Philip Hermans (psychologist/ anthropologist), and the work was highly praised by the scientific community in reviews in medical anthropology and was shelved as a well-cited reference on Moroccan traditional medicine, the Ministry of health does not have the least idea about the work that has been done, and to crown it all when I asked a former dean of the faculty of letters Madame (F. Z.) to purchase a copy of the work for the university library, she answered with arrogance: how can you ask me to waste public money on buying a copy of your book? This can only happen in a country named Morocco. Commenting is yours!