'Zelal': the dark world of Egypt's psychiatric hospitals

In a daring attempt to break taboos and open closed doors, Egyptian filmmaker Marianne Khoury and late Tunisian director Mustapha Hasnaoui explored the enclosed world of mental health care in Egypt in their 2010 documentary film Zelal [Shadows].

Their cameras roamed the hallways of two of Egypt's largest and oldest mental health institutions; Abbasiya - the largest mental health institution in the Middle East - and Khanka, both of which are public hospitals.

The internationally acclaimed film is a joint production between Egypt, France, Morocco, and the UAE. In the 2010 Dubai International Film Festival, Zelal won the FIPRESCI Prize for best documentary. It also received other awards and nominations the following year.

The film was screened in the Brighton and Sussex Medical School in Brighton on Tuesday, followed by a Q&A session with its director Marianne Khoury.

Zelal

Opting to leave out any 'intrusive' narration and soundtracks, the filmmakers compiled edited raw footage of the day-to-day life of patients in Abbasiya and Khanka, with a very limited appearance of hospital staff or psychiatrists.

The film attempts to shed light on an often marginalised vulnerable group in the society; people who suffer from mental illness and disorders. It offers a humane vision of mental illness, promoting more tolerance and acceptance of the alienated patients.

"It makes you understand yourself better, because people do not dare talk about this issue", Khoury told al-Araby al-Jadeed in an interview following the screening in Brighton.

"These people tackled topics that you would not normally talk about."

The people

Zelal opens with a father bringing his adult son to the Abbasiya out-patient clinic as a last resort after suffering with his unstable behaviour; from sexually molesting his sister and setting her new furniture on fire, to walking down the street stark naked.

"He says it's because I beat him", the father told the filmmakers. "If one of my kids made a mistake, I will beat him."

"I have too many kids, if I did not discipline them, they will make a scene!"

"Maybe if I had a proper functioning family, I would not have ended up in this hospital." - Sabry

Another interesting case was that of 22-year-old Sabry, who had been in the hospital since the age of 14.

"I came from a broken family", he said. "My father was always absent."

"Maybe if I had a proper functioning family, I would not have ended up in this hospital."

Ramadan, a middle-aged man whose brother brought him to the hospital in 1990, said he kept asking the doctor for his release when he first arrived.

"My brother then came and met with the doctor. I do not know what he told him", said Ramadan.

"After that, the doctor told me 'you will never leave this hospital, Ramadan'. When I asked him why, he said: 'do not ask questions'."

Today, Ramadan works as an unofficial hospital staff member, helping with minor tasks, such as calling the patients to bed, supervising cleaners, and carrying the keys to his own ward.

"All these years, my brother has refused to take me", he said. "For years I had hope of leaving the hospital and living my life outside, but five years ago, I lost all hope of ever leaving this place."

Others have also managed to find work within the hospital after decades of being there, such as Isaac, one of two brothers who were put away for more than forty years for supposedly being possessed by the devil. Today, Isaac makes a living by shining the shoes of patients, staff, and visitors.

We also come across several women, whose cases can be considered signs of social oppression rather than mental disorders.

"They tied me up with ropes and brought me here" - Hoda

Young Hoda spoke to the filmmakers about her abusive husband, disclosing private details about their sexual encounters.

"They tied me up with ropes and brought me here", she said.

She explained that her husband used to humiliate and abuse her, never showing her any love or kindness. She was sexually unsatisfied because her husband was always violent and inconsiderate of her feelings. He also refused to have children with her.

"He deprived me of motherhood, the most beautiful thing in the world", said Hoda.

As for Aziza, a peasant who had been in the hospital for decades, said her brother brought her to the hospital after she refused to remarry following the death of her husband at a young age.

"This is my home now", Aziza said, in reference to the hospital. "It is even better than home. I got used to it."

"How can I leave it then?"

The thin line between sanity and madness

For many viewers, most of the patients who featured in the film seem like normal functioning members of the society. One cannot help but wonder who the mentally ill people are here. Many patients seem to be victims of personal disputes and social oppression.

Who is unbalanced here? The abusive father or his depressed son? Sabry or his family who sent him to the hospital at the age of 14? Hoda or her violent husband who tied her up and sent her to a mental institution to get rid of her? Aziza or her brother who brought her to Abbasiya when she refused to remarry?

"I made this film because I am interested in the very thin line between real life and illusion; between sanity and madness." - Marianne Khoury

"I made this film because I am interested in the very thin line between real life and illusion; between sanity and madness", Khoury told al-Araby al-Jadeed.

"People outside the hospital are the ones who are mad, not us", Hoda told Amal, a fellow patient.

"They do not have love in their hearts; they only have hatred", she added. "They think those who come to Abbasiya are insane, they do not know that we are patients who need treatment and care."

Social and political oppression

The cases we saw in the hospitals raise serious questions on how the whole mental health care system works in Egypt.

It seems that more people are admitted into mental hospitals for personal disputes and oppressive reasons that those who actually suffer from mental disorders.

Even the state is said to have used the mental health care system to banish political opponents at some point, such as the controversial cases of author Ismail al-Mahdawi and poet Naguib Sorour.

In June 2015, a guard in Abbasiya told el-Fagr newspaper that the hospital has a high-security "political" section, where no outsiders are allowed to enter.

According to the guard, the section, which is under direct supervision of the Interior Ministry, accommodates former senior state officials, and no one is allowed to even mention it.

Legal framework

In 2009, lawmakers in Egypt passed a new mental health legislation, replacing old laws that had been in force since 1944.

The new law included tight legal criteria specifying the circumstances in which a person can be detained in mental health institutions.

It also focused on the reintegration of recovered patients into the society, helping them lead a productive life rather than isolating them in a mental institution for long periods of time.

Perhaps this can apply to new patients, but for others who had been in mental hospitals for decades, leaving may not be an option. This is mainly because they have nowhere else to go.

"If I do go out, where would I go?" said Isaac.

Mental illness and social stigma

Most of the patients in Egypt's mental hospitals were abandoned by their families and rejected by an intolerant and aggressive society due to the social stigma associated with mental illness.

	Brothers Maher and Isaac were put away for more than forty years for supposedly being possessed by the devil [YouTube]

"Long-term patients like me do not even want to leave anymore", said Ramadan. "Because they no longer have any homes or jobs outside the hospital."

"A 54-year-old like me, who has never worked before coming here, will never find a job."

This alienation of people with mental disorders forced the patients to create their own communities inside the hospitals.

Zelal captures the friendships and human relations that grew among the patients in Abbasiya and Khanka. They offer each other comfort and solidarity, which they could not find in the outside world.

In one emotionally-charged scene, Hoda and Amal exchange stories of their traumatising wedding nights.

"They ripped away our love, compassion, and kindness", Hoda says in tears, while Amal pats her back and comforts her.

Religion

Religion featured strongly in Zelal, but perhaps in an unusual way. Verses of the Quran and the Bible were recited frequently, but viewers were not able to tell which patients were Muslims and which were Christian.

A Christian woman recites verses from the Quran and a Muslim man recites verses from the Bible. Another man believes he is Jesus, resurrected to guide humanity into salvation.

"This shows that religion in Egypt is cultural. This is who they are, the real Egyptian people", said Khoury.

There was also the case of a Muslim man whose widowed mother believed he was possessed by the spirit of a Christian female demon.

She said she had to resort to Quran healers and exorcists when her son refused to take his prescribed medication.

Exorcism and similar practices are common in Egypt, particularly in rural areas. They are used as treatment for mental disorders, which are often mistaken for demonic possession.

Ethics

Zelal sparked debate on whether it was ethical to film the patients. During the discussion that followed the screening of the film at the Dubai International Film Festival in 2010, Egyptian filmmaker Ibrahim el-Batout noted that the patients were not filmed consensually, as their consent was deemed invalid and irrelevant due to their unstable mental condition.

However, Khoury told al-Araby al-Jadeed that the cameras were visible at all times during the shooting, and the patients insisted on telling their stories, completely aware of their decision.

In the case of Hoda, the young woman who disclosed personal details about sexual encounters with her abusive husband, Khoury said she did not want to include her story in the film, but the woman insisted, as she wanted to be heard.