Debating Law, Culture, and Mental Health: A View from Contemporary Egypt

By Ana Maria Vinea
Submitted to Session P4750 (Psychiatry in the Middle East: Hospitals, Science and Care, 2017 Annual Meeting
Middle East/Near East Studies;
In April 2009, after six months of debates, the Egyptian Parliament passed a new Mental Health Bill, Law for the Care of Mental Patients, meant to bring Egypt in line with international standards and to replace the existing obsolete legislation dating back to 1944. The law was followed by two sets of implantation regulations issued by the Ministry of Health, before and after the 2011 uprising. While the initiative of the new law came from the then director of the General Secretariat for Mental Health (the Ministry of Health division in charge of mental health), its drafting was a collaborative process between this body and the Egyptian Initiative for Personal Rights, a well-known Egyptian NGO interested in questions of human rights to health. Indeed, the concern with the rights of mental health patients was paramount in this new legislation. But the law and the implementation guidelines were not unequivocally applauded. On the contrary, their passing has stirred waves of discussions and contestations.
In this presentation I focus on the debates raised by the 2009 law, taking them as a window into understanding some aspects of the practices and conundrums of psychiatry in contemporary Egypt. As in other countries where similar legislations were promulgated (e.g., Davis 2012), among the most controversial points of the new law were the issues of the involuntary confinement of patients and their consent for treatment, issues which expose psychiatry’s double-bind of control and care, autonomy and treatment. In Egypt, these topics, as the entire law more generally, have been approached through the lens of their “suitability to the Egyptian context.” More specifically, critics have maintained that a law copied from the UK, as the 2009 was to some extent, cannot be applied in Egypt due to both the absence of the necessary supporting legislative and psychiatric infrastructure and to the presence of a “different culture.” These psychiatrists have defined this “culture” as characterized by deficient patient autonomy through the insertion in familial decision networks, which, when combined with lack of awareness about mental disorders, give rise to reluctant psychiatric subjects. My analysis suggests that what is at stake in the debates around the 2009 law are conflicting understandings of the role of culture in psychological healing, diverging assessments of the political and therapeutic role of psychiatrists, and no less significant, different imaginative horizons of the future of Egyptian society at a moment of revolutionary upheaval.