Psychiatry, politics and propaganda

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I wrote an article for Mada on the unethical practice of diagnosing politicians from a distance.

Dr Okasha in a TV interview

I get irritated when I see psychiatrists, some of whom taught me the profession, using the stigma of mental illness to strike low blows at political opponents, instead of using their social and scientific knowledge to educate people about mental health and advocate against discrimination.

Over the past four years, renowned psychiatrists have been invited on television talk shows to discuss everything but mental health, yet using the language of mental health. They have been asked to comment on current affairs and the behavior of certain politicians or political groups. In a context of deep political polarization, many of their comments have revealed their political biases and lack scientific merit.

What’s even worse, is that influential psychiatrists have suggested and backed potentially disastrous policies, using psychiatric explanations that lack any evidence, thus supporting the crackdown on political space and stifling the quest for democratic governance.

Analyzing politicians

In October 2013, psychiatrist Ahmed Gamal Abu Al Azayem was asked by a morning show on ONtv to analyze the personality of now President Abdel Fattah al-Sisi. Abu Azeem deduced from the tone of Sisi’s voice in one of his speeches, and his seeming indifference to applause, that he is truthful, humble and pious.

Following a highly publicized incident of sexual assault during a public gathering to celebrate Sisi’s advent to power in the summer of 2014, Mohamed Abdel Fattah, a psychiatrist at Al-Azhar University and the Police Academy, said that when Sisi visited the assault survivor in hospital, he played the role of a psychiatrist alleviating the pain of her trauma.

During one of Sisi’s visits to Russia, psychiatrist Hashim Bahary assured Egyptians that the president is an individual driven by the interests of his country.

Ahmed Okasha, former head of the World Psychiatric Association and Egypt’s most renowned and influential psychiatrist, announced last week that the general mood and mental health of Egyptians improved after Sisi came to power. He attributed public confidence in the president to his credibility, responsibility, perseverance, willingness to sacrifice and team spirit. These are all qualities that the Egyptian military possesses, he asserted.

Ahmed Okasha

Ahmed Okasha

Psychiatrists sympathetic to the Muslim Brotherhood perceive things differently. Mostafa Mahmoud diagnosed Sisi as suffering from a psychopathic personality disorder and described him as a megalomaniac, after listening to an unverified leaked audio recording of the president.

Mostafa Mahmoud

Mostafa Mahmoud

Former President Mohamed Morsi also had his fair share of psychiatric labeling on television.

In February 2014, Amgad Khairy suggested that Morsi lived in denial and suffered from a “sticky” personality as a result of epilepsy. Khairy’s comments make us wonder how he found out about Morsi’s condition, and if he was ethically allowed to disclose such information. Equally importantly, why was he stigmatizing patients with epilepsy?

At the same time, a psychiatrist on Al Jazeera Mubashir claimed Morsi was stable, calm and firm during a court appearance, which he deduced from the way the former president buttoned up his jacket. For a different doctor watching the same edited video footage of the trial, Morsi's smile and firm stance indicated a state of internal anxiety.

Meanwhile, following Morsi’s ouster, Okasha suggested presidential candidates should undergo psychiatric examinations, asserting that this may have saved Egypt from Morsi’s presidency. He blamed the shortcomings of Morsi’s aborted term in office on a dysfunctional frontal lobe as a result of brain surgery. The frontal lobe, according to Okasha, is necessary for good conscience, noble character and morality.

Yet Okasha is aware of the questionable ethics of his comments. In an interview with Al-Sharq Al-Awsat in 2011, he said psychiatric ethics prohibit him from “professionally analyzing any public or political figure without carrying out psychiatric tests and investigations, which are subject to doctor-patient confidentiality.” He added that when he analyzed former President Hosni Mubarak's appearances in court, he did so as an “expert in human behavior.” Paradoxically, during his presidency, Morsi honored Okasha with the Nile Prize for scientific achievement.

Okasha’s wishes were granted, when, in 2014, Interim President Adly Mansour introduced a requirement that presidential candidates undergo physical and psychiatric examinations, in order to determine their readiness to perform the role of president of the republic. The requirement, however, does not stipulate which characteristics or conditions are desirable, nor who should conduct the examinations.

The Presidential Elections Committee (PEC) assigned the task of examining candidates to the General Administration of the Specialized Medical Committees (SMC), run by the Ministry of Health. The SMC picked none other than Okasha to examine the candidates, including Sisi. Okasha conducted the examinations with other staff from his private hospital present. Following the presidential election, Sisi appointed Okasha to his scientific advisory committee.

Ahmed Okasha examines an applicant with the head of clinical psychology at his private clinic

Ahmed Okasha examines an applicant with the head of clinical psychology at his private clinic (Courtesy SMC website )

The SMC did not announce the number of candidates it rejected, and only one candidate confirmed he had been disqualified on his Facebook page.

But Okasha, has since rejected the examination of parliamentary candidates for the upcoming elections, ironically claiming, “it isn’t natural and doesn’t happen in any other country.

Some psychiatrists reject the idea of examining presidential and parliamentary candidates, based on the notion that psychiatry can’t predict future mental health problems. For them, public scrutiny during election campaigns should be sufficient, as they say psychiatrists often disagree on subjective diagnoses anyway.

This requirement to psychologically examine presidential and parliamentary candidates strips away the ability of people to choose democratically who they think is fit enough to serve them.

Not all psychiatrists are the same. I have colleagues who refuse media interviews, and several competent practitioners have protested the implication of their profession in political propaganda.

When a military court referred activist Michael Nabil to Abbasseya hospital, staff issued a statement criticizing the referral of political prisoners to mental health institutions on moral and professional grounds.

Analyzing political groups

A journalist from Al-Ahram state-owned newspaper asked Abu Azeem to comment on the personality of the Muslim Brotherhood. He deduced that the group’s mentality is characterized by rote memorization and unquestioning obedience, adding that their secretive mode of working isolates them from the external world. He claimed they don’t debate and cannot alter their attitudes based on reason, and that they hold imagination as the ultimate truth.

Abu Azeem claimed there is a major gap in the organization between its leadership and the rest of its members, who he said don't know anything and live by illusions that turn them against society and give them a feeling of grandeur and mastery over the world.

He went on to assert that the Brotherhood recruits religious semi-intellectuals, who easily follow the group’s distorted worldview.

The same Al-Ahram article quoted another psychiatrist, Nahla Amin, who said that the Brotherhood avoids those who use their minds, and plays on the emotions of the poor by selecting vocal leaders.

These professionals used psychiatric terminology to give the popular dehumanizing notion of the Brotherhood as “sheep” scientific legitimacy.

In the summer of 2013, two psychiatrists offered suggestions for how to end the Rabea al-Adaweya pro-Morsi sit-in. They joined the ranks of security experts suggesting various methods by which this should be accomplished. They claimed Rabea protesters were brainwashed and weak, and followed psychopathic leaders who abused them. They suggested the arrest of the leaders of the sit-in and negotiation with the remaining followers. Around 627 people were killed in the violent dispersal of that sit-in.

Okasha appeared on TV after the massacre to assert that the Brotherhood leadership had become delusional to the extent that they were killing their Egyptian brothers. He added that “finishing them off” was the wish of every Egyptian. It's not clear what he meant by this exactly.

Analyzing wider society

Psychiatric profiling hasn’t been limited to public personalities or political groups, but has also extended to wider society.

Psychiatrists often bring up the notion of an “Egyptian personality” — a distinct set of features shared by all Egyptians. This reflects subjective notions of what makes a “good citizen,” has no empirical backing and alienates those who feel differently. Such views often oscillate between paternalism, nationalism and assimilated racism, with notions like Egyptians lack perseverance and determination necessary to build the country.

The exception to this is the military of course. Under the command of Sisi, the military is the only institution that can make Egypt great again. This is often pushed to absurd and potentially disastrous extents, such as Okasha’s suggestion that the military should conscript street children and Yehia al-Rakhaway’s recent suggestion that all children at the age of three should be sent to military camps so that the nation can learn discipline.

Brotherhood-leaning doctors have also made sweeping assumptions. One of them asked Morsi in July 2012 to deal with the “breakdown of public morals” by applying Haraba Islamic law on those who block roads — involving the amputation of hands and feet. He claimed the human psyche could only be fixed through deterrence.

What should psychiatry be used for?

Psychiatry is a branch of medicine concerned with diagnosing, treating and preventing mental health conditions. Psychiatrists are required to understand the biological, psychological and social elements of mental and emotional health. They prescribe medication and other forms of treatment, such as psychotherapy.

Psychiatry is not a branch of philosophy, anthropology or sociology. It is not interested in passing judgment.

The media should share some of the blame in its thirst for sensationalist analyses of public figures. Psychiatrists should not comment on individuals from talk shows. This is unethical. It is ignorant to make generalizations about groups of people or entire societies, particularly when there is no evidence to support such claims.

Psychiatrists should refrain from involvement in ad hominem attacks on politicians. Becoming embroiled in such propaganda erodes public respect for the profession.