By Sadeq Rahimi
Routledge, 2015, 248 pages
This book is issued by “The International Society for Psychological and Social Approaches to Psychosis” series, which aims at enhancing the dialogues between social scientists and practitioners, especially in the fields of trauma, attachment relationships in the family, in social settings, and with professionals. Rahimi manages to cover all these issues in detail, analyzing the cases of three schizophrenia patients in Turkey and relating these to historical and social dynamics, ideological debates, and clashes within the country. This rather ambitious project is based on interviews with the patients, their family members and their clinicians in three hospitals in Istanbul. The author is mainly interested in how the patients interpret their own illness experiences. In addition, Rahimi conducted ethnographic research in order to produce “thick cultural analyses” (2), which provides the necessary background information for the analysis of each patient’s case.
Rahimi defines schizophrenia as “one of the most idiosyncratic modalities of subjective experience” and contends that it consists of a “highly private experience” that can nevertheless be associated with the larger political, cultural and historical dynamics (1). Rahimi’s understanding of political subjectivity through the interaction of meaning and power is the key in his analysis of the patients’ narratives, especially in terms of their main themes’ connections to common political and cultural discourses. In his evaluations of “systems of meaning”, Rahimi justifies “certain associations of signifiers” or “certain patterns of associations of concepts” as “more accurate or more truth bearing, and thus more legitimate or more desirable than the others”, rather than firmly establishing and singling out particular associations. This relativistic approach brings out a unique sophistication in Rahimi’s analysis. Thus, he aims to establish the configurations or maps of meaning, which are shaped by the “collective memories, narratives, and fantasies, such as histories, myths, folk beliefs and other collective products” (9). Subscribing to contemporary theories (such as Lacan’s theory) of subjectivity, Rahimi suggests a semiotic approach in which subjectivity is based on the interactions among power, meaning, desire and memory. He borrows Voloshinov/Bakhtin’s dialogic views of selfhood and subjectivity, as well as heteroglossia, which includes a “fundamentally liberating understanding of discourse as multilayered, multitemporal and multidimensional” (17). The author argues that schizophrenia is the most appropriate psychosis for such an investigation of subjectivity, since it includes moments of “crisis when the individual is struggling to use the most elemental tools available to him or her to organize, or reorganize a sense of meaningfulness and selfhood” (23).
Before analyzing the three patients’ cases, Rahimi provides a sweeping historical account on the Turkish nation and identity. He particularly focuses on the 20th century during which the political transformation from Ottoman Empire to Turkish Republic took place, along with the efforts to erase the Ottoman “political, religious and cultural traditions from the collective memory” and inculcate a modernist and Europeanized identity from the top-down (25). In this framework, he provides a list of the wide-ranging changes in the 1920s and ‘30s, such as the laws on appropriate clothing, religious practices, adoption of European laws and legal systems, Christian calendar and workdays, and the Roman alphabet, along with the accounts of public resistance to these changes. Relatedly, Rahimi talks about the resistance movements to the Kemalist project of nationalism and modernization, including the Kurdish revolt in 1925, led by the Naqshbandi Sufi order’s leader Sheykh Said, which was brutally crushed. In his reading of the later decades of the Turkish Republic, the author emphasizes the crucial role of the military in politics, especially in terms of initiating coups, and AKP’s conservative, Neo-Ottomanist and neoliberal agenda which prevailed in Turkey since the early 2000s.
The way Rahimi narrates Turkish history informs the patients’ identity issues and sense of belonging. However, in this historical account, a crucial term between 1983-1991, in which Turkey was run by the Turgut Özal’s central-right party ANAP, and which laid the foundations of the AKP’s political and cultural agenda, was largely omitted. This problem causes a rather dualistic reading of history of Turkey between the Kemalist elites and religious groups oppressed by them. This dualism also affects the analyses in the following chapters, since they are often related to the dualisms between religious/secular ways of thinking and living, being powerful/powerless and feeling/not feeling a sense of belonging to the family/community/nation, rather than having a more nuanced reading on the hybridization of these seemingly contrasting concepts. For instance, Rahimi often quotes Islamic texts, rather than taking into account those texts’ popular/folk interpretations, i.e. how those texts were read, internalized and interpreted by the religious or non-religious people in different periods of Turkish history.
In his analysis of the three patients, Rahimi successfully ties the personal issues, such as love and loss, to the political and social dynamics in Turkey. In the first patient, whom he names Emel, the readers see a case of “semiotic juxtaposition” of Emel’s brother, who is separated from the family in order to do his military service and “the boyfriend”, who did the same thing for the same purpose, in Emel’s account (52). Rahimi connects this juxtaposition to the interlinked themes of love, loss and sorrow, and argues that the association that Emel, her family, and her doctor made between the departure of her brother, whom she often mentions as her lover, and her psychotic illness is “culturally appropriate,” since feeling sorry as a result of a major loss is a central theme in Sufi interpretation of Islam. (55) Accordingly, Rahimi gives examples from Sufi poet Rumi, explaining the sorrow as being torn away from the origin and longing for the times of unity, embodied by the ney, a key instrument in the Sufi music, which was made of/cut away from the reed in order to become the breath of sorrow for the people, as well as other Sufi sources. However, it is not clear for the reader whether Emel, her family members or her doctor are informed by these Sufi sources and their popular interpretations. The fact that there are no quotes from, or allusions to, these sources may lead the readers to think that there are certain crucial gaps in the map of meanings, especially since the cultural and religious sources, beliefs and practices are highly fragmented and mutually exclusive in today’s Turkish society. Rahimi displays the connections between Emel’s troubles and notions of personal and collective identity, blood, purity and pollution much more successfully. Through Emel’s quotes, the readers can easily follow her struggles to define her identity, despite the dualism between “East and West”, which prevails in the historical and current political and cultural debates in Turkey, as well as between the Turkish/Islamic side and Western/non-Islamic sides in her family. She partly overcomes these dualisms through her belief that she has the “Turkish blood type” and the “universal spirit of Ataturk”, the founder of the Turkish Republic, running through her body (62). At the end of the chapter on Emel, Rahimi confesses that he could point to only “partial networks of ideas, of signs, and of belief structures, without synthesizing them into a more comprehensive system of anchored subjectivity”. However, I believe that this is the strength, rather than the weakness of the chapter, as well as of his other chapters, since it refers to the ever-fragmented, intangible and elusive nature of how the realities are represented, especially in psychotic patients’ illness narratives.
The second case – Senem’s story – that Rahimi covers has more direct allusions to the political tensions and conflicts in Turkey and obsessions with number 12, and red as a color of both patriotism (based on Turkish flag) and impurity (associated with bloody hygiene pads). Rahimi has a feminist reading of the story of “Senem”, where he discusses that, through the “social, political, and religious context” in which she lives she acquires a “symbolically legitimized position of power” through her “victim” position and the discourse, which is based on that victim position. This seemingly contradictory subjectivity stems from the fact that she is “deprived of any culturally endorsed claim to power or a voice in which to live her resistance” and victimhood (93). Among her life events, the researcher highlights the traumatic events, such as her first child dying shortly after birth, which caused her to have “paranoid delusions that the child is actually alive”.
Senem’s narrative is also told as a series of unfair and discriminatory attitudes towards her, despite her love for Turkey, and that she is smart, well-educated and well-read. The narrative includes a fictive “twin”, Celal Bey, who has the same name as one of the founders and third president of the Turkish Republic whose term abruptly ended with a military coup and imprisonment. Similar to “Celal Bey”, Senem believes that her love of the country and its flag and her efforts to do “something smart” for her country, leaves a stain on her and allows her to be punished by others, according to her narrative. Senem differentiates herself from less intelligent and educated neighbors, who are “religious-traditionalist” unlike Senem who reads and understands the Turkish translation of the Quran. Senem also suspects that her husband cheats on her during his business trips in Romania, and as a result she lights a fire on the balcony, which Rahimi calls a “red-burning session”, since she throws everything red in the fire, including the blood-stained “dirty” sheets from her home, which made her suspect her husband’s affair (116). Senem’s story ends with her association of her self with Mary and her first baby (who died shortly after birth) with Jesus, which the author ties to the fact that Senem was possibly raped by her husband before marriage in order to force her to get married. He justifies his suspicions with the facts that Senem’s “strong character and sense of liberty and coming from a family with liberal tradition” do not fit her husband’s being “ultraconservative, rigid and unsophisticated as described by Senem and her mother (127) and that she saw her husband as a pig in one of her visions.
The last case the author analyzes is a young man who lives in Switzerland and who was brought to Istanbul for his treatment. Ahmet’s diagnosis is clinically more contested than the previous two cases, since the clinicians first thought that he was depressed because of his childhood difficulties and failure to adapt to Switzerland. Based on his life-story, the author argues that his difficulties of adjustments started when he was in primary school, where he was forced to read and write Turkish, instead of Kurdish, which is Ahmet’s native language. Since he went to work abroad before having his family in Switzerland, Ahmet’s father was largely absent in his life and after coming there, Ahmet moved from one place to another with his family while working in jobs only on a temporary basis, which added to his lack of sense of belonging. He encounters a Swiss woman, towards whom he feels an unrequited love, and he becomes obsessed with an emanet (the term can be translated as trust, deposit or escrow) which he left with her the last time he saw her, and which he wants to take back when he sees her again in order to “straighten everything out” (168). Along with depression, Rahimi describes Ahmet as melancholic and relates his linguistic deficiency in talking about that unclear emanet to Kristeva’s notion of Chose (Thing) that belongs to a pre-symbolic realm and is unspeakable since it “eludes signification” (172). Rahimi studies the link between madness and love with respect to its “uniquely central signifier in Turkey”: Mecnun, which means both “crazy” and “madly in love” and which has a pivotal place in Islamic oral and written literature (180). The term also connotes being affected by the jinn, which is often associated with sexual activities.
To conclude, Rahimi gives examples from each case in order to underline three basic modes of continuity: “The mutual continuity of private experience and collective meaning, the continuity of symbolic systems (and thence of culture and of subjectivity) in time, and the continuity of psychotic and nonpsychotic modes of subjectivity” (200). Although this is a thorough analysis, which applies the theoretical framework to the main themes of illness narratives successfully, the readers may like to read more of Rahimi’s comparisons among the three cases, particularly with respect to their gender and socio-economic differences. Moreover, since each case is chosen from three people who are treated in three different hospitals, namely the state university hospital of Çapa, Bakırköy, which is one of the oldest and best known state research and education hospital, and Balıklı Rum Hospital privately owned by a Greek Foundation in Istanbul, one would like to have more information on different therapeutic discourses and practices, as well as of clinical interactions in those three hospitals on a comparative basis. However, this may stem from the author’s choice to put the patients’ narratives in focus, at the expense of the treatments that they go through, although the treatments themselves (such as individual or group counseling) may also affect the illness narratives. This more macro and mezzo scale study could be covered by Rahimi’s upcoming studies. Therefore, despite its minor problems, this book is a fine example and guide on how a medical anthropologist can grapple with crucial issues of mental illness, subjectivity, culture and power. I recommend this book to medical anthropologists, psychiatrists, psychologists, as well as scholars of the Middle East and religious studies.
Ayşecan Terzioğlu is an Assistant Professor at Koc University, School of Nursing and Health Sciences in Istanbul, Turkey. She is interested in biopolitics, globalization, immigration and health. Her co-edited book The Making of Neoliberal Turkey was issued by Ashgate in January, 2016.