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Notes on mental health after watching Soqoot Horr
 
 

This is not a review of Ramadan serial Soqoot Horr (Free Fall), but some partly articulated musings around mental health using the show as an anchor.

Nelly Karim plays Malak, a woman charged with the murder of her husband and sister. She is catatonic and unable to remember what happened. The court declares that she wasn’t responsible for her actions and after some time in the criminal ward at Cairo’s public Abbasseya Hospital, she is transferred to a private center.

Scripted by Mariam Naoum and Wael Hamdy, Soqoot Horr follows in the footsteps of Naoum’s previous shows focused on women and dealing with “gritty” issues — an adaptation of Sonallah Ibrahim’s Zaat (2013), Women’s Prison (2014) and Under Control (2015), which was about addiction and had women protagonists.

There appeared to be a wave of interest in psychological issues this Ramadan, but my thoughts are largely tied to Soqoot Horr as it made a serious attempt at laying out some mental health issues. And if it follows in the pattern of Naoum’s previous works and statements she has made, it has a didactic function — to teach us about mental health or help us develop empathy.

I make reference to two other shows: Fouq Mastawa al-Shobohat, which stars Youssra as a mentally disturbed woman who commits a murder and will stop at nothing to cover her tracks, and Al-Khanka, in which Amira, a teacher accused of sexually harassing a student, devises a plan with her lawyer to be diagnosed as mentally ill to avoid prison.

Notes on some of the strange things therapists said

Doctor: Those voices are just in your mind

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Walid is a doctor focusing on Malak’s case for his dissertation. He and Malak develop what is portrayed as a productive relationship. Here, Malak tells Walid that she hears voices telling her to kill herself. She says she is scared. Of what, he says impatiently. She says she constantly hears voices telling her things that she doesn’t want to hear. When he asks if they are voices of people she knows and she says no, he says, so why are you scared then? Malak tells him they’re telling her to kill herself as she doesn’t deserve to live because of what she did. He responds: These voices aren’t real and are just from your mind, you know that right?

Anyone with knowledge of mental health issues knows that what is in the mind is also real. But this fictional doctor appears to have nailed hallucinations and delusions — symptoms of several conditions — with an ingenious treatment method: tell the patient they’re not real.

This is the level of conversation and lack of empathy of someone who is not only a layperson but also has had no experience of mental health issues, and has limited capacity for empathy to top it off. Yet Soqoot Horr presents Walid as not only a trained doctor, but the one who is able to get through to Malak.

When Malak tells him the voices are telling her to kill her mother, he looks deeply uncomfortable, as he generally does when talking to patients.

Doctor: Let’s distract you from your problems

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he patients go on a trip. Shady, hospitalized as a result of trauma suffered in the aftermath of the Port Said stadium massacre in 2012, tells Walid the night before that he doesn’t want to go. Walid responds, again, like an obtuse parent (his tone was: why on earth don’t you want to go?). Shady tells him that it reminds him of the bus he took to Port Said. Here, on the bus, another patient tells Walid that Shady isn’t doing well, and Walid deals with this by offering distracting chitchat about the scenery.

Again, the “good” doctor behaves like a layperson uncomfortable with emotions: trying to distract the patient in a bumbling way. He pressurizes the guy into coming on the trip, then refuses to deal with his experience of it. If doctors refuse to engage with their patients’ realities, what they are offering cannot be called treatment.

Walid’s supervisor Aida, the hospital’s director, also fails to treat her patients empathetically, and this too is not presented as problematic. She tries to pressure Nadia into accepting treatment from male doctors when it’s obvious Nadia is disturbed by interaction with men and has probably been subjected to sexual violence. Aida exclaims that she cannot understand why she won’t speak to men, and Nadia, unrealistically given Aida’s manner, proceeds to tell her about when she was gang raped. Aida asks her to stop, apparently because she is disturbed rather than out of concern for Nadia.

We see therapists pontificating throughout Soqoot Horr. If I didn’t have a sense of what real-life therapists offer and watched this show, I’d be convinced that it’s a scam. Its doctors claim expertise, yet offer little more than impatient pats on the back and pep talks.

Therapist: Get into the water and remember happy things

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A therapist opens a group session at the pool. “Water is the thing that most gives us a sense of security and relief,” he says, “because we were water creatures before we were born. The water carries us even if we don’t swim and pats our backs.” He asks each person to focus on the feeling of the water and remember a time when they felt safe and psychologically comfortable, a moment without fear, tension or pain.

Perhaps this doesn’t seem objectionable, but there are basic rules of running a therapy session that aren’t being met here. The therapist is being very commanding (you must think of happy things) when his priority should be to create a safe space where anything participants feel is ok. If it were so easy for patients to switch to feelings or memories void of fear, tension or pain, they may not be in treatment. For many people struggling with mental health issues, one thing that characterizes being unwell is precisely not being able to switch out of states of mind or feelings.

Doctor: Patients are taking a holiday from responsibility

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Walid talks to Aida about the dissertation topic he has chosen. He starts by talking about “patients who complain of physical pains for which there is no physiological cause, and the physical pain enables them to avoid the problems and responsibilities that they have. The brain directs the body to feel pain, so they complain and get sick, so they take a break or holiday.” Aida says this has been studied a lot. That’s just his starting point, Walid replies. He suggests that a patient can escape by means of psychological, not physical, illness. “The unconscious gives the patient the option of psychosis,” he says. Aida tells him of theories, suggesting psychosis is an unconscious attempt to deal with crises creatively. Walid says he is thinking of something like that, in which case psychosis is a choice, not a conscious choice, but a choice — a haven or defense from a crisis. Aida glows, telling him to get started immediately.

Walid here is reiterating things we already know (as Aida says, there are theories that posit psychosis as a kind of unconscious choice), but in a really problematic way. What he offers as a new theory is a basic definition of psychological trauma — that the individual’s ability to integrate their emotional experience becomes overwhelmed. But what’s worse than presenting common sense as insight is the language he uses, which stigmatizes those facing mental health problems. The complex relationship between physical and psychological suffering cannot be explained by a desire to take a “break or holiday” from reality.

We do make choices on unconscious levels all the time. There’s a lot to say about this, but if you’re not careful, you end up saying that people choose to be unwell, and the next logical step is: if you choose it, you are responsible for it. This is throwing the weight of people’s sufferings on their own shoulders, as if they didn’t have enough to deal with.

If someone unconsciously makes a choice to hear voices that taunt them or fear that the people they love are trying to kill them, the question isn’t about choices or holidays. The question is more to do with what other options are available to them, what debilitating fear must they be living with and what monstrous memories are they escaping.

Related to the idea of choosing sickness is the idea that you must choose to be well. Choice is undoubtedly important here, but this too is complex, not a simple idea to be thrown around.

You don’t simply decide to be well and then start getting better, but this is what Soqoot Horr would have us believe. We see that with Malak’s mother. She is mean, incapable of expressing affection, highly anxious, and can barely communicate without fighting. But once she starts therapy, she recognizes she has a problem and radical improvement is seen. Before long, she is well-adjusted and happy. If healing were that simple, there wouldn’t be a problem. This implies that all people need to do is try.

A note on confidentiality and resources

The same doctor sees Malak, her mother (without Malak’s apparent knowledge) and Walid, when he finds himself anxious on learning that his wife is pregnant. Walid talks with his wife about his patients, including their names. Also, Walid informally comes up with a diagnosis for Malak’s brother-in-law, although he is not a patient, and shares this hypothesis not with him but with Malak’s family.

Incidentally, in Fouq Mastawa the fear that there’s no such thing as confidential is played out to dramatic effect as recordings of sessions end up in the hands of a manipulative murderer and the public prosecution.

On the bus trip discussed above, Walid is the only doctor present. That this irresponsible understaffing — at an expensive health center, no less — is not problematized is another sign of the inattentiveness of Soqoot Horr’s makers to the realities of both mental health and health care. Equally unrealistic, but in the opposite direction, the director at Abbasseya apparently has the time to follow the progress of each patient on a daily basis.

A note on gender and the social aspect of “madness”

Soqoot Horr, like the other two shows, portrays women with mental health problems. This focus on women is clearly an editorial choice, as even when Malak is at the mixed private hospital, we encounter more women characters. Some conversations also touch on the relationship between being a woman and being mad.

A fellow patient tells Malak, “Women should have jobs. If they don’t work, they’ll go mad or die young.” Elsewhere, Malak asks another patient if she knows what happened to her young roommate. Malak says she can’t think of what would break a girl of that age. “Our lives are full of things that can break any girl and at any age,” the other woman says, voice and eyes full of emotion. The implication is that one casualty of a patriarchal society is women’s mental health.

In case this isn’t clear, the patients point to this phenomenon in different ways. Anan is being forced by family and church representatives to stay with her abusive husband. Malak’s roommate attempted suicide after her family refuse a marriage proposal from the man she loves. Nadia was gang raped on a train. Hannah, who is transgender, is being treated for depression and a suicide attempt resulting from society’s refusal to recognize this. Interestingly, there is surprisingly little reference to abuse or sexual violence.

Malak has a lot of anger toward her mother, whose harshness to her we see in flashbacks. In her mother’s therapy sessions, we learn why she is so harsh: Internalizing gendered ideas about respectability, she didn’t allow herself to consider remarriage but instead devoted herself to mothering and working. It was a society-mandated mother’s sacrifice and she ends up resenting her kids.

I agree that women’s mental health — along with their physical health and bodily integrity — is one of the casualties of patriarchy, but reducing mental health to social and political aspects is as misguided as ignoring its social, economic and political aspects. There is no direct causation between the social and our internal realities, things are a bit more complicated than that.

The other patient we get to know at the private hospital is Shady, hospitalized after witnessing the Port Said massacre, also a political and easily identified cause.

Many who have never had to deal directly with mental illness wrongly believe there must always be an identifiable cause. When people are wedded to this notion they often don’t give credence to a person’s condition until they know a cause, and if it is sufficiently distressing — gang rape, a massacre — only then will they emphasize.

A gendered approach to mental health is important, but this is different from positing that patriarchal society simply leads to mental health issues for women in some automatic way. Also, if we want to understand how the patriarchal nature of society affects its members, we need to look at all those members. The fact that suicide rates for men are in most places higher than for women is probably also related to patriarchy.

Lastly, it’s frustrating when most depictions of mental health focus on women because this is already a stigma embedded in patriarchal society — that being irrational and mad is something that women do. This feminizes mental health, making it a women’s issue when it isn’t. And among its myriad results is that severe medical conditions are often identified late in women because doctors dismiss their concerns as hysterical.

Malak’s brother-in-law Selim is labelled as having paranoia, but that is right at the end, and I doubt that when viewers remember the depiction of mental health in the show that they remember him before Malak, if they remember him at all.

A note on violence

There’s a commendable effort in the script to counter the association of being mad with behavior such as walking around the streets ripping your clothes. But undermining this effort is the fact that the show portrays Abbasseya as an equally dramatic pantomime: the patients are either delusional — imagining they are a prophet or doctor for example, shouting at figures we don’t see — or quivering in fear when another patient goes off.

Soqoot Horr’s story revolves around a brutal and intimate murder, and we encounter several women who have killed in Abbasseya. In Fouq Mastawa, the main character is manipulative, cruel and casually commits murder. It is eventually announced that she is mentally ill and has either borderline personality disorder or anti-social personality. In Al-Khanka, a nurse paid to have Amira killed seeks to do so by drugging her and then putting her in a room with a patient deemed dangerous. The woman jumps on her. It’s like being put to the lions.

People who suffer from mental health problems are more likely to be on the receiving end of violence than to be perpetrators of violence. Yet popular culture, these shows included, would have you think the opposite is true.

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Naira Antoun