As a historian working with medical, literary, and cultural sources from 20th- and 21st-century Syria and Lebanon, I recognize mental health research benefits from interdisciplinary and collaborative approaches. Questions of how to be well, and of how to identify the unwell, are complex. What constitutes “normal” and “ideal” is, as historians and anthropologists are keenly aware, situational. Given the recent popularity of trauma studies, and after decades of increasingly more sensitive institutional review board processes, we now know to carefully weigh ethical concerns. What are the consequences of where we go, what we ask, and what we publish? Why, exactly, do we do what we do? In the past few decades, themes of illness, wellness, and treatment that once drew interest from scholars in a variety of disciplines now bridge conversations in disability studies, trauma studies, gender studies, and religious studies. Critical theorists and scholar-activists raise important questions about the rights of minority groups, and debates on how best to handle research in disability urge us to be mindful of action elsewhere in our overlapping spaces. It is with these comments in mind that this essay urges historians to see the benefit in approaching madness and mental illness from a disability studies perspective.

Analyzing disability in mental health is not only a question of researching non-normative bodies or minds and why, for example, schools, hospitals, or courts dealt with them as they have. Looking for voices of marginalized groups does not only tell us about the group in question. Rather, it can speak to much larger issues about social change and social values, about why a group, community, or institution identifies certain differences as acceptable or unacceptable, about how and why these differences affect one's status. We should rethink approaches to spirit possessions, the psychiatric diagnoses of schizophrenia, post-traumatic stress and anxiety disorders, and the ways doctors chose to treat, contain, or care for people living with these diagnoses. This is not merely a story of scholars attempting to determine the reasons for faith (that natural or supernatural changes to a person's body occur) or in evaluating evidence as truth (as, for example, the factual presence or absence of said spirit or the “true” origin of specific symptoms), but rather a complicated, multilayered story to be told with inclusion of voices from the inside, people who are survivors or consumers of mental health care in all its forms, as well as from the outside, people who have studied data on treatment and their effects on consumers. It is time for us to catch up with the rich scholarship on mental illness produced by our colleagues in disability studies in North America, Europe, and beyond.Footnote ¹ The traditional psychiatric history approach that focuses on institutions does a disservice to the institutionalized people who found themselves “writing … from [their] present imprisonment,” as one hospitalized man at Ibn Sina Mental Hospital wrote to a professor in Massachusetts in August 1925.Footnote ²

When I lived in Damascus for about eight months (November 2009–June 2010), I collected data on psychiatric and spirit-based understandings of mental illness from early and mid-20th-century medical sources. These include patient case files from Ibn Sina Mental Hospital in Douma and correspondence and reports from the Lebanon Hospital in Beirut, available in part at the AUB Saab Medical Library's online holdings, in part at SOAS, and at Oxford, with access to a private collection from a former psychiatrist working at Asfouriyeh.Footnote ³ On rare occasion, a patient file from Ibn Sina Hospital includes handwritten letters identifying the writer as the hospitalized person, such as the letter from 1925 mentioned above. Another file, of a forty-five-year-old Muslim man born and raised in Beirut but brought from Tadmur (Palmyra) when admitted in 1945, includes a neatly handwritten one-page letter in the first person titled “Tarjamat Hayati” (translation of my life) that refers to being three years old when his father, a doctor in the Ottoman army, died in 1903 or 1904. As a young man the writer attended “the American college” and eventually studied Arabic, Turkish, Persian, English, and French, working as a schoolteacher in Damascus from the 1920s until 1941. His arrival at the hospital came shortly after a suicide attempt and a “surgical operation.”Footnote ⁴

While these first-person letters provide rare glimpses of c/s/x (consumer/survivor/ex-patient) experiences, most of the files only hint at tragedies prior to hospitalization, and occasionally tragic results of psychiatric intervention in line with the medical model of disability where there seems to have been little effort to understand the social aspects of their disabilities. For example, there is a thirty-year-old Armenian man from Aintab whose intake notes from 1930 refer to a sister bringing him and complaining that he has become a burden to her as she struggles to care for her own young children. His file includes a note in French dated 7 June 1930 from physician Dr. Boghossian in Aleppo referring to paranoia and visual and auditory hallucinations as well as behaviors that rendered him “aggressive, dangerous, and incompatible with social life.” A second note in French dated 8 June 1930 and signed by Edith Roberts (the humanitarian who worked with Armenian survivors of the 1916 genocide who reached Syria) refers to the sister's struggles to care for her brother.Footnote ⁵ Neither the physician nor Roberts remark on trauma the man may have endured as a boy in 1916. A handful of the patient records include typed notes from British military officials describing Syrian soldiers with labels such as General Paralysis of the Insane, and one soldier's record reports a doubtful officer's complaints of the young man's exposure of his body as “crudely purposive” of discharge from military service in the 1940s.Footnote ⁶ Another patient's record notes he was only thirteen years old when first admitted. His brother said that the boy didn't eat because he was convinced his mother had poisoned his food. Sometimes he slept all day and night, and other days not at all. A police report from 1951 notes that he had been hitting himself, spoke incoherently on the street, and appeared agitated and a danger to himself and to others.Footnote ⁷ Reading against the grain for earlier periods can be difficult, but historians have begun to mine data for marginalized voices in medical records as well as in captivity diaries and memoirs.Footnote ⁸

In the 2017 edited volume The Routledge History of Madness and Mental Health, Greg Eghigian reflected on how

Disability studies speaks to all of these conversations. Geoffrey Reaume's “From the Perspectives of Mad People” in the Routledge volume is an excellent overview of what continues to remain largely a European and North American discourse. In trauma studies, as anyone who has worked on the Lebanese Civil War knows, the voice of the traumatized person remains contested when disparate collective memories champion some and force others into silence.Footnote ¹⁰ It behooves us as Middle East studies scholars to incorporate disability studies approaches not only into our studies of visible physical differences, but also into understanding “invisible” cognitive differences like post-traumatic stress and anxiety, and schizophrenia. It is a direction in which I hope to take my research, beyond medical and social models of disability studies, as I accompany these medical records with literary works reflecting on the experience of trauma, illness, and treatment.