Diagnostic dilemmas

The increasing visibility of Qur’anic healing in Cairo intersects with psychiatry’s growing foothold in public awareness, creating fertile ground for debates about affliction, care, and expertise.

Abbasiyya, Egypt's oldest mental health hospital (Photo: Ana Vinea, Supplied).

It was a puzzle I repeatedly encountered during my field research on revivalist Islamic healing in Cairo. It starts with a young person who begins to experience disturbing physical, psychological, or behavioral symptoms, especially in religious contexts: convulsions, hallucinations, extreme emotions, among others. How are such symptoms to be diagnosed? Echoing Ludwig Wittgenstein’s famous duck-rabbit image that can alternatively be seen as either a duck or a rabbit, the question has two answers in Egypt: a mental disorder or possession by jinn—invisible spirits mentioned in the Qur’an that historically have been at the center of curative practices.

This diagnostic quandary implicates primarily the patients and families personally affected and the psychiatrists and Islamic healers called to treat these afflictions. Yet, in the past decades, the jinn possession/mental disorder pair has become the focus of heated public debates at the crossway of religious and medical domains. On television screens, online, or on the pages of various publications, revivalist healers, known as Qur’anic healers and mental health professionals, alongside journalists, religious scholars, and members of the public have clashed over this diagnostic dilemma, keeping the two categories simultaneously conjoined and apart in a dichotomous grip.

Participants in these mass-mediated polemics have approached the impasse from the angle of the reality of jinn possession, each side invoking conflicting exegeses of the Qur’an and hadith and diverging over the precedence of religious versus scientific evidence. My interviews show that psychiatrists, joined by some religious scholars and secular intellectuals, assert that jinn possession is doubly unsupported, by science and religion, and, hence, ignorant twice over. Recognizing mental disorders and their psychiatric treatments, Qur’anic healers have nevertheless maintained that the religious texts that prove possession trump current medical knowledge.

What is at stake in these debates are conflicting ideas about what afflictions exist in the world and what are the remedies to address them. Furthermore, these arguments project questions of maladies and suffering onto larger socio-political discourses concerning the relationship of science and religion, the state of society, and modern citizenship.

Certainly, such tensions between medical and occult etiologies are not restricted to Egypt or the present. From miraculous healing at Lourdes in Third Republic France to hearing voices in the contemporary US, they speak about broader authoritative challenges posed by biomedicine to other understandings of affliction. Still, questions remain—why this pair and why now?

If jinn possession has been disputed throughout Islamic history and occasionally linked to psychological disturbances as understood at the time, in its current form the jinn possession/mental disorder pair goes back to the 19th century. The advent of Western-inspired medicine and psychiatry led to a familiar story throughout the African continent—the reshaping of the therapeutic landscape into the dichotomous domains of modern medicine and a heterogenous new category of “traditional medicine.” In this context, medical professionals and reformist Muslim scholars targeted practices around the jinn as the paradigm of all that had to pass for Egypt to modernize. Reframed as superstitious, but not explicitly outlawed or regulated, jinn therapies survived, and sometimes flourished, under the radar of the modern state.

In the second half of the 20th century, several transformations have intersected to push the jinn possession/mental disorder binary into the limelight. Against the background of an Islamic revival, beginning in the 1980s and 1990s a Salafi-oriented therapy of jinn exorcism gradually coalesced and gained popularity in Egypt and other Middle Eastern countries. These Qur’anic healers claim that theirs is the only “orthodox” treatment of possession that systematizes the existing curative repertoire eliminating all that is religiously unpermitted. Moreover, these practitioners have engaged in a multifaceted dialogue with psychiatry and biomedicine, both challenging some of their premises (the rejection of the invisible) and redeploying concepts and practices derived from these disciplines, such as symptoms and experimentation.

For instance, Qur’anic healers have used the notion of symptoms to devise diagnostic checklists for each possession type and subtype, while infusing it with religious meanings through emphasizing symptoms’ religious content and the context of their occurrence. Creatively embracing tools of mass dissemination, especially television with the satellite revolution of the 2000s, Qur’anic healers have pushed jinn possession into the public eye, stirring anxieties across the religious/secular spectrum.

Changes in the psychiatric domain have also contributed to the prominence of the jinn possession/mental disorders duo. Such is the turn of some mental health professionals towards an Islamically-attuned practice, the neoliberal erosion of the public health system that has left psychiatric services wanting, as well as the spread of psychiatric languages among the population aided by anti-stigma campaigns and a noticeable presence of psychiatrists on satellite television. The increasing visibility of Qur’anic healing has intersected with psychiatry’s growing foothold in public awareness to create a fertile ground for deliberations over notions of affliction, care, and expertise.

The prominent debates around the jinn possession/mental disorders pair reveal a vibrant therapeutic landscape that cannot be frozen in a secular/religious divide but remains haunted and partially shaped by it. The resistance of psychiatrists to Qur’anic healers’ attempts to impinge on their domain of expertise places Egypt at odds with the recently renewed calls of the WHO to integrate traditional medicine into health care systems. Instead of the partnerships forged in some African countries, in Egypt there is an official attempt to keep such therapies at an arm’s length, if not to eradicate them completely—a testament of how they have been framed as thwarting progress since the 19th century. The only attempts of rapprochement have come, so far, from the ranks of Qur’anic healers. Even if in public debates these practitioners have vehemently defended jinn possession to the effect of reinforcing the dichotomy with mental disorders, in their therapeutic practice they have adopted a stance of ontological multiplicity that tangles such divides. Recognizing the validity of both categories, as well as their many shared symptoms, Qur’anic healers have devised ways of telling jinn possession and mental disorders apart, with the hope that one day they would work side by side with psychiatrists.

Such fluctuations between relative flexibility and rigidity reflect the limitations of the WHO’s push toward integration, which skims over the complex historical and contextual factors that sometimes work against official cooperation. Yet, this apparent failure has its productive facets. The tensions between psychiatry and Qur’anic healing account for the vitality of contemporary debates around affliction and healing. No surprise then that these precise tensions have been mobilized by a Qur’anic healer who has conceptualized a new disease categorywahm, the affliction of experiencing real possession symptoms while being unconsciously, but falsely, convinced one is possessed. This novel malady has emerged as a third way that tries to overcome the jinn possession/mental disorder binary while keeping the reality of jinn possession intact, offering a more comprehensive understanding of the ailments that plague Egyptians.

Further Reading