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from the August 2008 issue

The Psychiatrist

My new position gave me contact with refugees from various communities in Copenhagen. Three municipalities had engaged me to study the cases of ordinary patients or ones whose health conditions were hard to classify. The assignment culminated with my analysis and appraisal of the patient's mental health and then my written report, which the municipality would use for a number of different purposes. Most refugees need assistance and treatment, even if they aren't conscious of it. When it's hard for them to come to me and keep their appointments due to their mental or physical condition, I hold the sessions where they live. Most of the time, after our conversations, I pass them on to one of the mental health clinics in Copenhagen, where treatment generally proceeds on the basis of a mixture of drugs, talk therapy, and massage, even though occasionally my recommendations conflict with the budget and priorities of the municipalities.

My new job has made it easier for me to advance my studies in the field of psychoanalysis. I had been waiting for an opportunity like this, both to specialize and to acquire a more profound understanding of the field. Since few Danes have experience dealing with refugees, I thought that working and studying in this field should assure me a bright future. I was exceptionally eager to begin this type of study.

Marwa al-Basri had submitted a request to her Social Services case worker for a lengthy sick leave on the grounds that she was exhausted by the municipality's job-training program. We met in her room.

* * * She began with Basra, where she was born. My rudimentary information said it was one of the great, ancient cities of Iraq, in the South, close to Kuwait.

She sat on her bed and shifted her body back so she could lean against the wall, cradling the cup of tea in her hands. With face turned toward the small window and eyebrows raised, she plunged into her narration.

"The long-awaited Thursday arrived. Without any enthusiasm I was preparing a plate of biryani to celebrate the occasion. Then they told me—I was a child—not to fix rich food for Nahla, because she would die if I fed her meat or fish. She had to hear the news on an empty stomach, so they said. How could I understand? How could I digest an album chock-full of wise saying and beliefs? I was bewildered. What could I give her to eat? What would Nahla think when her plate lacked a piece of meat or fish? Especially on a joyful occasion like this! How could we hide the gown from her? Where do you suppose she would spend the night? I watched her, hoping I wouldn't be chosen to break the news to her. Scarves covered her head, but some yellow strands of hair had escaped from their ribbons: some curly and some straight according to the amount of moisture they had retained and the hair spray, which dulled the brilliance of her hair. Nahla's golden hair and fair complexion have been her passport wherever she settles. I trembled when I placed a glass of water on the ground before her. When we were young we trembled the same way whenever we carried water to my father for fear he would be angry if the water spilled. Her legs, which were stretched out on the ground, reminded me of those of my older half-sister Narjis. I observed her thoughtfully again for a time. She was oblivious to everything around her. Various feelings competed for control of me, since I didn't know which was appropriate. All of Nahla's comical gestures made us laugh, creating a commotion among the girls in the class. Indeed, virtually all the girls of Basra's preparatory school recognized that about her. She would sit on the ground like an ignorant, ill-educated, old woman—like Narjis. For a long time she would imitate how Narjis sighed, exhaled, and sang. She also was an excellent performer of the gypsy girls' dances at the midday programs on Fridays, especially the finale of their programs. Except for the two of us, the courtyard was empty. Everyone else had disappeared on account of the news. The sun had begun to shift its light to the other side. No one was peeking out or standing nearby." * * *

The tape recorder's red light showed that the reels had ceased turning. Marwa looked at me with little emotion. She drank the rest of her tea and stood up. The two chairs in her room weren't comfortable for more than half an hour. All the same I welcomed her choice of the room for our sessions. I plan to hold them in my clinic once I gain her confidence. The air was stifling from the humidity and the smell from her oil paints and cigarettes. She didn't like to open her room's only window, which overlooked the street. She was afraid of the cold, she said. Her assertion that she regards September as the end of summer and beginning of winter piqued my interest, but I was unable to pursue this topic with her. There were many subjects she refused to discuss, from time to time casting me the same despairing look my daughter gives me, assuming I don't understand. Whether I do or do not does not influence her decision to remain silent.

But I was eager to continue the session because it was furnishing me with material helpful to my study, especially since the cases chosen for my research project relate to refugees, particularly those who have been tortured or come from countries where governance, either in the state or family, is authoritarian, and where democracy and a feeling of security are absent. Everything I had heard became relevant now. Deep inside I was also beginning to feel somewhat apprehensive. I was colliding with other worlds I had never considered before. I was perplexed. The symptoms I was recording were known. Human nature is one, and man generally follows the same type of conduct wherever he is, with similar reactions and motives, but Marwa was sketching for me the particulars of an environment that was alien to me and that forced me to admit it held things unknown to me. For my diagnosis to be valid, these things would need to be factored in.

I tried to prevent her from having any inkling of what was going through my mind or from thinking I would be lenient if she ended the session. I continued to drink my tea and fuss with my papers.

She was laughing in a way that transformed her face. She looked at me, making me feel even more perplexed. I asked, "Have I done something wrong?"

"No, I'm laughing because I'm distressed by the situation. From remembering Narjis, who is my half-sister. She was almost the same age as my mother but always denied that fact as long as she lived. She called my mother èal-Hajjiya' or èFather's wife' to make it clear that she was younger than my mother."

"And you—what did you think of her?"

A little smile appeared at the corner of her mouth as she replied, "She would sit in the courtyard before noon sewing buttons on a new blouse while singing èO Emissary of Love,' which the Egyptian vocalist Najat al-Saghirah made famous. Narjis' vibrato Southern rendition lent the song a regional, Southern flavor that expressed her deprivations with the outpouring of her mysterious passion for an unknown person. Her Southern accent displaced rosy, dreamy Najat from her own songs. I remember how she eyed me; her look unexpectedly transferred to me everything she had suffered throughout her life."

"When you were a child?"

"Has the child in me ever grown up? I feel that the child Marwa still lives inside me. How old do you think I am now?"

She laughed, turning her face from me. Then she quickly continued, "But I'll tell you as simply as I can that the child in me has, ever since I was a girl, sympathized with her and felt sorry for her, no matter how impatient I was with her and despite the hidden currents of my environment and the declared and undeclared wars around me. When you're young, life's nothing but a bunch of contradictions."

It seemed to me that Marwa was sneering at my presence and making fun of me when she rose to remove her caftan. I suddenly noticed that she had outlined her large eyes with kohl in a way that required precision and a steady hand. As always, she rarely maintained eye contact with me for long. Her face was small and delicate, with sharp features. She looked short in her cotton house shirt. Its straps exposed both the twin circles of her soft, naked shoulders and very broad hips, making her slender top seem out of proportion with her lower half. She pointed toward her tunic while making an apologetic gesture—at least that's how I construed it—as she compared my attire to hers. I tried to assure her that she had a total right to act as she saw fit, but she interrupted me to attend to her thick hair, which she had liberated from her hat, at the back. She disappeared behind a room divider into the kitchen. * * * I enter hasty observations about Marwa al-Basri's condition and her older half-sister Narjis. I review the documents pertaining to her and quickly read through the summary before me. Another session in her room and still she hasn't touched on the events recorded in her file. She hasn't referred to her family members who were executed. She hasn't mentioned what she and her siblings experienced at the hands of the security agencies there. Indeed, she has said nothing about that period.

I feel she wants to be liberated from her symbols. So I've been forced to change my strategy for working with her. I've abandoned my proposed daily plan of action and have decided to allow the discussion to flow unimpeded; perhaps I'll achieve better results this way.

She prepares tea and brings the tray with trembling hands.

"Will you describe Nahla for me?"


"Yes, Nahla. You've talked about nothing else."

"I'll tell you about Nahla, my friend, Nahla the child of that environment, the mother of ease, the chatterbox, kubbat al-hamudh, and authority on Hudhayri's songs and the neighbors' quarrels, known for the contemporary camouflage of her vocabulary and attire, enviable skin, bright eyes, free-flowing blonde hair, and French perfume. She and I were alone then. I tried to remember the kind of advice women give. I believe I was overwhelmed by fright because I sensed how ignorant I was. I was responsible for handling her trauma. It was my duty to prepare her for the situation. Children younger than I had expertly handled much trickier matters. Women's customs didn't come easily to me; I might laugh. What madness afflicts me that I'm obsessed by a feeling like this? The poor, suffering young woman was waiting for an answer from me while I shuttled back and forth from the kitchen to my room, attempting to avoid her. I would walk around the courtyard once or twice before returning to her. Given my social awkwardness, when I approached her in this difficult situation, my only advice for her was to stretch out for a rest or to drink the remainder of the water in the glass while waiting for them to bring us the news. It had been corroborated. They said that someone had contacted them and confirmed the news, which had also reached the guests. Oh, if I tried to describe my feelings then, I would fall back on Narjis' heartbreak whenever life became too difficult for her and all she could do was wail inconsolably, èHali, ya-dhullam.'"

Marwa pauses and nods. "All the same, Narjis didn't think of running away to free herself from the life imposed on her or of rebelling and abdicating her responsibilities in favor of whatever her body would have chosen for her instead. This Narjis . . . nightmares, convulsions, and nervous breakdowns, from which she repeatedly emerged only thanks to sedative injections and sleeping pills. She was just another Nahla, who rebelled, pleaded, beguiled, and threatened. She chose a sweetheart who was rejected by everyone. èShe's still a child,' her mother said. èHer future education,' shouted her sister's husband. èShièah, foreign, Communists,' objected the paternal uncle. The maternal uncle was summoned, and then she screamed, èNo one's going to speak for me!'"

Marwa suddenly inclines her head toward a painting, saying that, inspired by The Thousand and One Nights, she has chosen for it a title she likes: "èColors of the Fourth Night.' It's a sketch for a monument that may someday find a small space over there; to occupy one of the thousands of spots where statues of the leader stand."

She rises and gently lifts the picture from the floor, placing it on a chair. "Fish are portrayed vertically in a pool of water; they twist like a tree, their heads down. The fishes' faces grin widely. The tank's water covers half of their bodies. Their tails are raised, entwined. They'll be different bright colors. They symbolize the peaceful coexistence that has vanished from human communities in that region of the earth."

I don't grasp what she's getting at in her painting, but it reminds me of a statue I passed one day. Thus it confirms for me the separation of a man's thought from his culture, over the course of time, everywhere.

Marwa steps back to contemplate the painting. She continues, "I was alone, waiting for someone to rescue me or to help me calm her agitation that day. I placed the silver nail polish in front of her and then examined my nails. She's delighted with my insistence on taking a nail file and polish with me wherever I settle, but Nahla can't stand the rasping sound of the file on fingernails." I open the window, because her smoke disturbs me. "The house is where my father, mother, brother, and my brother's wife reside. I think I should change my everyday dishdasha to a better one and fix my braids, which are pulled back, before anyone else arrives. I have severe abdominal cramps and consequently stay in the bathroom for a long time. Even so, I offer her a plate of the biryani I've made to celebrate the occasion. That's a duty. She won't die. I can't help thinking she'll need the food's energy to endure the news, despite all the advice they gave me. I wouldn't have been able to prepare anything else then, since waiting for the women paralyzed me. You may not be able to imagine this, but biryani's blend of spices, in which the smell of curry predominates, penetrates beneath the fingernails and leaves a yellow stain that won't wash off. That smell makes it hard for me to breathe whenever I inhale it."

Marwa hides her face and weeps painfully. As I gather my papers I feel relieved and confident about her reaction. She doesn't glance at me. She's looking for the packet of tissues on the bed. I quickly seek to profit from the occasion and search for another excuse for conversation. "Your reaction is natural."

"There wasn't enough time for me to feel awkward or to retreat into myself. With eyes downcast, I was stammering, embarrassed that I might mess up the compliments repeated on such occasions. I didn't know what to say, because I'm not good with such matters. I was cursing my involvement with them. I sensed her hunger too. Nahla, more than any of the other girls, can't wait, whether in front of the school's cafeteria or when she visits someone. That's how she is; of the whole group she's the one most driven by personal wants. She's the one who insists on responding to her needs. She imposes her wishes on us and we accept. She's the one who frees herself from the group's obligations; so she comes and goes when she wishes. She makes me feel I'm falling behind while she surges forward."

"Did the two of you ever talk about that?"

"When I asked Nahla about Rida, she told me, èThis time is different, Marwa.' She repeated, èThis time is different.' She told me he wanted her passionately. That was a surprise to me. I expressed my anxiety in phrases like èBe careful this time' or èThat's the way it seems to me,' with reference to a stage in a person's life, the early twenties. We weren't stingy when it came to giving each other loads of advice, assuming the role of those who had gone before us, except that I privately speculated—on the basis of the limited world known to me—that desires occasionally may be all we need to make important decisions and defend them. All the same, the extent of my naïveté did not change a thing in this situation. So I assumed that either love or material possessions could have been responsible for the agreement. I don't know whether her desires alone made her pursue a multifaceted affair and plunge into the hazardous adventure. Another time she told me that I'm slow, indeed, in continual retreat, so that whatever I have is stolen from me; and that's how it's been since I was a child. Despite all the blaze of emotions and tears, I assumed that the decision might have been made according to the last petal of a daisy. It's these simple disparities that suddenly place us at a turning point. Are adolescent love and mature love actually two different entities? Or was the woman smitten by both? Piecing these bits of information together still eludes me. For this reason my bewilderment persists like a chronic malady. I might just as well not have been raised and grown up in the same place." * * *

The red light on the small recorder has turned on, but I don't want to interrupt her when her excitement shows so clearly on her face. I'm not certain, because the melody of her voice, her body language, and her facial expressions frequently contradict what she says. The topic of Nahla is the only one she allows me to investigate. She has yet to mention any of the events recorded in her dossier. I clearly remember her social worker's expression of despair and incomprehension on handing me that file.

For a long time I've focused on facial expressions to gauge people's reactions. I suspect that there is a mocking ring to her voice when she says with a mysterious smile, "She asks me to attend to all the details of her wedding. Thus I gain the right to entertain her. And her nuptials, which we all participate in, adorn my room. I spray the tulle generously with starch and water. I spread the gown on my bed. I pleat its train with my fingers and fearfully plant the needle in the fabric. I gather the pearls, arrange the large beads and the tiny ones, and collect the hairpins. I fetch the hair dryer and look for the extension. I have the honor of styling her hair, plucking her eyebrows, setting out her shoes, her satin purse, and . . . . I hear her grumble, èOh, Marwa, where by God have you put the Qur'an and the mirror?' Oh, Thursday, the promise of nuptial Thursday, appointed occasion for love—this is Thursday, which is reserved for vows and resolving problems, Rida's Thursday. I fuss with the air conditioning, starting it that morning, hoping the room will be cool enough for her. The air conditioner increases the humidity, ruining her hair and creating havoc with her things. That noon, even the water added to my perplexity when it stopped flowing through the plates of compressed hay, and the massive body of the air cooler let me down, spraying out annoying, stinging air from its rusty depths in puffs."

"What exactly did you fear?"

"I had to do something but knew nothing about herbal teas, roasted seeds, or dried apricots. I thought of fixing her a salty, iced yogurt drink to help her mask her shock. When I was a child I was told erroneously one day on my way home from school that our house was on fire. Narjis sat me down on the bench in the kitchen and washed my face with cold water. èYour face has been spirited away,' she said. Then she quickly fixed tea for me to drink. I complained, èIt tastes strange.' She replied, èThat's because of your fright.' Was it her embrace or the strange-tasting tea that dissolved the terror in my heart? A perennially terrified child lurks inside me. I felt angry, perspired freely, and beat my head against the wall when Nahla wasn't looking."

Marwa fell silent then. I imagined that her body actually trembled as she spoke. I kept my eyes on my sheet of paper so she would continue her monologue.

"Why was I given this responsibility? My premonitions frightened me. I imagined that Nahla would tug on her hair and tear her gown. Then I thought, èNo, no; I'm merely reacting to my own intense alarm and that of the people around me. That's making me think things will end badly.' Do you know: everyone there is terrified when a woman's scream suddenly rips through an area, emerging from a distant location as if to warn them they will certainly lose a loved one or relative? Consider Narjis' apprehension about her father's death or my mother's wail when she saw the body bag containing my brother. I wonder how the child in me derives guidance for a reassuring explanation of the calamitous images that have been imprinted in my memory since childhood. Suddenly the telephone rang. I hurried to lift the receiver before it could spread alarm. Why didn't I shield myself by appealing to my heritage? Where would the words come from? What should I say? What expressions should I choose? Instead of a bridal procession, I pray that a delegation of women will arrive and rescue me. But then I will be obliged to kiss them, one after the other, twice on each cheek, and we might cross to the left and right sides with three or four kisses. This black cloud approaches me; there will be the familiar words to which I must respond with even more gracious phrases, moist, importunate kisses that would be delivered full-force, not to mention the sun's blaze, our profuse perspiration, and their panting breath against my cheek. Meanwhile she sits, feeling annoyed by the dryness of her tender thighs and legs, choosing an approach that isn't like her. She is evasive, not wanting to know, borrowing the moisturizing cream from me again. That morning she had received a special, therapeutic cream that my brother's wife advised her to use her first night. Nahla and I believe this won't be her first night. At that time, when she suddenly glances at me, I look away for fear I will divulge her secrets. She anoints her skin repeatedly, haughtily displaying her riches without meaning to. Her long neck, her small, milk-white breasts, and the edges of her large, dark, circular nipples emerge casually from the wide opening of her tunic, which she selected for the ease with which it can be removed without damaging her hairdo or makeup. I observe her and hide my trepidation. She has forgotten she's hungry. She doesn't attempt to ask me about anything at all. Why is she with me? Because I'm her friend? Because I'm brown and she's fair? I'm thin and she's plump? Because I need her? Who has helped prepare her party? I may have been bewitched by her, as Narjis says. In spite of myself, I'm tempted by the thought of running away." * * *

My sessions with Marwa continue, although they differ in length, depth of content, and level of response. I have never adjusted to the smoke-laden air of her room. Each time I begin to converse with her, I feel I am forgetting the plan I have taken such great pains to devise. She stands near the closed window, facing away from me, complaining of back pains caused by drying neck vertebrae. I try in vain to jot something down. She keeps going around in circles, trapped inside a certain incident or era, without being able to conclude the narration. She complains that she is suffering from a bad headache and stops suddenly. But I continue recording what she says, remembering what passes through my mind and collecting cassettes of her remarks. It seems she has confronted me with a challenge I don't understand.

"Don't you ever think about the future?"

"What shall I do with that nagging homeland . . . my country, my birthplace, the land of my grandfathers, my roots? Do you realize it needs someone to classify it? I want to describe, draw, reshape, and carve it so I can escape from its bitterness, from my hatred and scorn for it and for myself."

"Why do you grieve then? What happened next?"

"Don't ask me. Those alleys, where houses protrude, giving people names and prescribing their daily routines, seem suddenly blocked and destruction looms. Sunset casts its melancholy across the room's contents. The electricity goes off. Raiding airplanes search for light. We're not a target. No one is looking down on us. The women don't come. We continue to nestle against each other. Nahla, who is halfway through adorning herself, is struck dumb. She collapses against my shoulder submissively. Her cheek and strands of her hair press into the flesh of my neck. The lantern's heat increases and reveals how very close we are to each other. I wish one of the women would take my place and stroke her hair or allow her to cry. I doubt that the quality of my sorrow is adequate. That's always the way it is with me. So I remain silent. They tell me that Sunni women don't slap themselves in despair the way Shièi women do and that they retain their elegance while they grieve. Like the Christians, they style their hair when they attend funerals. They whisper together while their faces remain expressionless and then sip coffee silently. So how do Jews mourn? Suddenly the apparition of a swarm of women replaces me as they begin tearing their free-flowing garments. The light that issues from the lantern appears and disappears at the center of the dance floor to which they descend in the courtyard, as if they have retained a perennial passion for performing. The moment that death calls someone, sympathy inundates them and they quickly gather to play their role again with deftness and skill. There are two circles, one advancing and one retreating. Hair is allowed to flow freely and shaken till disheveled. Abayas fall to the ground, and head coverings are trodden under foot. Bra straps slip and black stockings slide down as women pound the earth to the beat of the elegy. Like a set of Russian dolls, the pain revealed consists of a series of pains nested inside each other. The beat is rapid, and the dance comes in repeated rushes until the women are overcome by the most extreme forms of intoxicating grief."


The municipality notified me of Marwa al-Basri's sudden disappearance. No one opened her door the last time I knocked on it, and her name had been removed from the mailbox, replaced by another name that was difficult to read. She had no new address registered at the public records office.

I was paid my fees, even though I had not finished my assignment. I saved her papers, my observations, and the cassettes that were still not transcribed, but devoted a lot of effort to examining one aspect of the case that I treated in depth so I could complete my research project. The number of times that Marwa used words like "fear," "terror," "death," and "nightmare" attracted my attention in a disquieting way.

I finished my study of the other new cases of male and female refugees of different nationalities. In it I presented my appraisal, with which I was satisfied; but Marwa al-Basri's file stuck in my mind. Its contents were left open. Key features of the case suggest a diagnosis of Post Traumatic Stress Disorder (PTSD), and this is a troubling diagnosis, especially given her two failed attempts at suicide. She cannot continue without treatment or assistance.

From èIndama Tastayqidh al-Ra'iha (Damascus: Al-Mada Publishing Company, 2006). Copyright Duna Ghali. By arrangement with the author. Translation copyright 2008 by William Maynard Hutchins. All rights reserved.

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