Psychoanalysis today

Jalil Bennani

2007-07-07T12:32:00.000-07:00

Welcome on my blog

" Civilized society is perpetually menaced with disintegration through this primary hostility of men towards one another." Sigmund Freud

Culture, openmindedness and tolerance

2007-07-07T11:33:00.001-07:00

International Society of Pharmacovigilance
Conference, 8 october 2003, Marrakesh

Jalil Bennani

First of all, I would like to thank the organisers for inviting me to speak at this conference. It’s in the spirit of open-mindedness that we, as professionnals in our respective fields are here today. It is widely believed that science constitutes progress but we must always remind ourselves of its limits and the danger in seeing it has an absolute truth.
Being a psychiatrist and psychoanalyst and not belonging to the same discipline as you, I would like to look at science from a different angle. I myself am also a member of the scientific community, and I am concerned in my work with the neurosciences. However, as a psychoanalyst, human science allows me to view the other science from a different standpoint.

Science and tradition

Magic, religion and development of science

In agreement with the organisers, I will talk to you today about Moroccan culture and go on to speak about the notion of culture in general. I am going to start by talking about traditional medicine in Morocco and its cultural implications.
Here in Marrakesh, it’s easy to forget that even today some people regard the mentally ill as being « possessed », that is to say, victims of magic or sorcery. Even today, healers known as gnaouas – former slaves – probably originating from Sudan, are called for to exorcise demons or take the so-called « possessed » to the tombs of holy men to perform miracles.
Illness, mental and physical, were considered to be a sign of being possessed by demons or genies. The role of this demon is very important and considered the major cause of the victim’s illness. Traditional medicine has his own logic. It uses saints, magicians, sorcerers and clairvoyants to cure the victim and answer questions that scientific medicine doesn’t ask. For instance, in response to the question : « why me ? », a demon can always be blamed. The family and social environment was, and is still there, to help the victim overcome his/her demons. In traditional societies, tribal members feel the need to look for social, psychological or supernatural reasons for an illness.
When traditional medicine fails, the patients consult a modern doctor and when modern medicine fails they go to see a traditional healer. But often they see both types of doctor.
Psychiatry, psychoanalysis and the different psychotherapies as they are taught in Morocco, Europe and United States start from the same point as traditional medicine, in that they try to find the cause of the illness. The treatment however differs and the answers are not the same. The patient may use whatever means at his disposal to be cured, even if he or she uses both means, basically scientific or traditional means.

There are many examples like this, but one which I particularly remember is directly related to culture –one mysterious form of superstition is related to fear of what is known as the ‘evil eye’. This evil eye can affect the health, well being or a person’s property or belongings. If someone seems wicked or harmful, or if one is fearful of someone, the evil eye can be projected on them. Very often the fear alone can make someone ill. This tradition dictates that it is someone else who makes you ill –for the psychoanalyst however, the evil is the fear in itself and projected onto another person.

From traditional to modern therapy

It is useful sometimes to look at the etymology of words. If we do this, we can in this way avoid any conflict between tradition and modernity and analyse things they have in common.
We can also see that tradition can enrich modernity shedding light on universal processes starting from specific cultural data from a small area of the world. Each culture can enrich another with its different knowledge.
Getting back to the etymology of words, the Arabic word “psychotherapy” is known as “ilaj an-nafs” which means “treatment of the soul” The soul in arabic – ‘an afs’ relates to multiple psychic aspects of being – internal stability of the individual and the dynamic of bonds with others. An analagous relationship is established between the individual, their psyche, language, the body and the environment in which they live. This expression ‘an-nafs’ not only is semantically rich but is steeped in history – that of human suffering as it has always existed, and how it was described before the advent of Western science. Each culture possesses in fact, its own representations of mental illness and these precede modern psychiatry.

In Morocco, and more generally, in Africa as a whole, we can find the origins of psychotherapy in religious magical practices which are the cultural patrimony of a people and the living memory of it. It would be too simplistic to claim that these practices operate by persuasion or suggestion alone. These practices lead the patient to talk, to ritual and put them into a trance –sometimes all at the same time. The healing represents only a part of the symbolic ritualistic process. The Holy men are the representives of venerable institutions called Zaouia and are respected because their only interest is in healing and not financial or personal gain. Others take advantage of human suffering by their healing, to have power or to make profit or material gain.

I must point out that other people still consult traditional healers today probably because they are geographically cut of from the town or they cannot afford to consult a modern doctor. We mustn’t lose sight of the fact, however, that modern medicine has made great strides here in Morocco over the last 30 years or so. Modern medicine, as we all know, depends largely on pharmacology and great progress has been made but it isn’t a panacea. People also need something else –for example, they need someone who listens, advises, who is supportive who is company, and for this, they will seek help in traditional medicine. This brings me to the main theme of my talk today which about ‘Tradition and Modernity’. I will also talk about tolerance and give some personal views on the specific and universal notions.

Tradition and Modernity

My thinking is based on whether or not an individual is ill, they will seek refuge in the common ethnic or cultural traditions. This confirms group membership which can support a subjective identity. However, all this is changing with the advent of modern medicine and a rejection of belief in magic. Having said that, traditional society is opening up, but remains to a certain extent, attached to certain customs which have their basis in traditional customs.

We are witnessing a break with the traditional family and customs and a questionning of values and taboos. This change is linked to increased freedom for the individual and a certain acceptance of outside influences and ideas. Personal identities are emerging which can be in conflict with a collective, traditional identity. When this emerging personal identity is stifled by lack of freedom of speech, for example, the individual can suffer mentally and become physically ill. Even in religious practices which appear to be uniform, the rapport the individual has with their beliefs is personal and not only collective as it appears to be to the outsider.

You could ask the question – why am I, a psychoanalyst, who treats individual cases, talking about collective phenomena ? The psychoanalyst takes into account speech and culture. It is well known that there is a direct correlation between individual and collective psychology.
Love and hate are the basis of societal bonds and are directly linked with each other but the very existence of human society is based on the repression of destructive instincts.

Culture and Tolerance

Why intolerance ?

What are then, the origins of intolerance and alienation ? When we are confronted by illness, death or danger, there could be a ressurgence of what anthropologists or Freud would call a primal background which exists in each one of us. This aspect is essential because it questions the very notion of civilisation. Does civilisation depend for its existence on civil law, education or moral issues ? –Does it depend on the suppression of destructive instincts ? -Suppression leads to sublimation. Civilisation depends on both civil law and destructive instinct. These are internal and external factors which can be perturbed when we are confronted by certain events such as war, death and other violent situations and deep anguish comes to the fore leading us to take refuge in the irrational. This is when intolerance takes root which leads us to blame others for our situation.

Tolerance leads on the other hand, to acceptance of those we call strangers / foreigners. Accepting others as they are, means accepting different cultures, languages, ways of thinking and creativity wherever a person comes from and overcoming our deepest fears. Tolerance, therefore means benefiting from a sort of universal patrimony –living in harmony with others.

We see today the situations where tolerance hate and destruction prevail. These are crowd instincts when individuals are influenced by fanatics and the individual loses his or her capacity to reflect on a given situation. It’s as if they are hypnotised by a leader. Let us get back to this idea of patrimony and examine the local culture.

Some History

If we look at Marrakesh, this ancient town always fascinates visitors. It’s a town full of legends through the ages which is situated between tradition and modernity. It is considered to be a peaceful place, a place where intercultural dialogue takes place (for example, the GATT talks were held here a few years ago, today the International Movie Festival). In fact it is the ideal place for the type of subject that I’m talking about today.
Marrakesh was for a long time the capital of a vast empire –under the Almoravide Dynasty in the eleventh century and then in the seventeenth century under the Saadians. It is recognised today as a world cultural heritage site especially for its medina and its famous Jamâa El Fna square. In the square you can see all kinds of entertainers –violinists, snake charmers, story tellers, acrobats and vendors –and even if it is Morocco’s most popular destination for tourists, it still retains its unique character.

Morocco itself is, of course, mainly a muslim country but it is well-known for its tolerant attitude, coming into regular contact with other cultures and religions. Morocco is a place of open-mindness and tolerance.

Morocco is at the crossroads of different cultures –with Spain to the North and around it other Muslim countries with oriental and African traditions. It has a strong desire to modernise.

Here the past is closely linked to the present. Morocco’s rich traditional inheritance is combined with a desire to live in peace and tolerance. We have people here descendants from Africa and Europe, Blacks, Whites, Muslims, Christians and Jews. The routes which merchants, slaves, pilgrims and soufis took not so long ago are still in the collective memory and the need to open up to other cultures is still strong.

Moroccan Culture

Moroccan culture comprises both Berber and Arab cultures. Several languages are spoken –Arabic, Berber or Amazighe, French, Spanish and English. It must be recognised that French remains the most useful language (considering our important trade links with France). English is of lesser importance but, of course, it is an international language. If we take Arabic, we have the Moroccan spoken dialect known as derija (?) and the standard or classical written Arabic. Taking Berber, the main dialects are Tachliht in the south, Tamazight in the centre and Tarifit in the north. French is viewed either as a colonial language to be rejected or as a language which belongs to Morocco too. After all, French gives us an opening to European cultures. Therefore, it could be seen as a language to adopt, in so far as it is useful and helpful for getting inside another culture –this can only be an advantage for us as we seek to be open and tolerant towards other cultures.
It is probably more apt to speak about culture, rather than tradition if we are thinking about young people in the suburbs of the cities and if we take into consideration the migration of people from the countryside to the big towns and to other countries.Elements of the new environment are assimilated but as can be constantly observed, those who integrate best are those people who integrate but do not forget their own culture. Those who refuse to recognise their origins possibly have more trouble trying to acculturate when they go elsewhere.

Young people in Morocco

In Morocco today the young who form the majority of the population are confronted by a variety of choices : adult or child status, Moroccan culture, Middle Eastern or Western cultures, tradition or modernity. We have already seen that we shouldn’t oppose tradition and modernity but benefit from the interaction of both of them. We must be careful when we are talking about tradition. As soon as one culture comes into contact with another there is no going back. Recreating what we see as tradition risks making a caricature of it and creating historical amnesia.

The traditional touchstones have changed and the generation gap between parents and children has become wider. Customs and traditions are undergoing a profound change.
Patriarchal authority is diminishing in certain areas. A teenager today has more say in what he or she wants to do and they feel more free to express new ideas. The traditional united group is gradually disappearing, but young people and society in general here will probably see a new one take its place with a new dynamic, a new united tradition with new horizons and aspirations.

From the Specific to the Universal

After these reflections on our society here in Morocco, we mustn’t think too much about compartmentalising cultures. Identities are plural today as are cultures. By focusing too much on the specific we may alienate others. On the other hand, if we focus too much on universality we are in danger of effacing interesting differences between cultures. If we can learn from what is specific to a given culture and use it as an opening – it is something useful for us and humanity at large.
We can use what is specific to a culture then, to learn about different countries or regions and their languages which all form part of a universal heritage. We can go beyond what might be considered ‘cultural resistance’ to our own ideas and realise that each culture forms part of a whole and one culture can enrich another.
I have come to these conclusions through my own experience in my own field –an idea based on the ‘universality of psychic structures’, so to speak. Ways of expressing oneself, symptoms and behaviour certainly have their idiosyncrasies. But these are expressed on a conscious level by individuals. At a subconscious level, everyone has the same psychic mechanisms. They are universal. As for the question of knowledge, we can always reappropriate, rearticulate knowledge acquired elsewhere and use it in our own cultural context. In this way, knowledge is enriched and disseminated by contact with other cultures. We just have to accept the notion that no one has a monopoly on knowledge. If it comes from elsewhere, it is still part of our universal, human heritage.

The phenomenon of migration

People travel today more than ever before for whatever reason. Migration, emigration or immigration may be imposed or voluntary leading to exil and separation. This subject has given rise to passionate debates and feelings. It concerns the themes of identity, hospitality, of being welcomed or rejected and of tolerance and imposes a choice of community, language, culture and religion. It is often when we are displaced –in another country that our cultural identity comes to the fore. We will probably suffer culture shock at some stage and want to ressert our own cultural values.

To conclude

I would like to conclude my talk with a few words by Seneca, quoted by Brutus which are very relevant today –

“Suffice it to think that when leaving for exile that one is free to take with oneself our virtues....In so far as the whole planet has become a place of exile, let us consider that wherever we go, that will be our home –by travelling the world, we will not find a place of exile”

For Seneca, that renowned philosopher, ‘Exile is changing places’ . He wrote this two thousand years ago.

Activities

2007-07-07T10:59:00.001-07:00

Jalil Bennani
Psychiatrist, psychoanalyst

Professionnal and Scientific Activities

1977-1981 : Consultant for the North African immigrant at the Minkowska Center as well as in the French department of Essonnes.
1984-1986: Co-founder & President of "The Freudian Text" Association in Rabat.
1990-1992: Secretary General of the Morrocan Society of Psychiatry
1992-1996: Co-Founder & President of the Moroccan Association of Psychotherapy
2000-2002 : Vice-President of the Moroccan Association of Private Practice Psychiatrists
2001 : Co-Founder & President of the Moroccan Society of Psychoanalysis
2003 : Co- Founder et Honor President of the « Association Internationale Alternative Fédérative des Psychiatres Privés » (ALFAPSY)

-Member of the Moroccan Society of Psychiatry
-Member of the international scientific committee for the review : 'Santé Mentale au Quebec"
-Member of transcultural psychiatry section in the World Psychiatric Association
-Member avec the Psychanalytic School of Strasbourg
-Director of the collection : "Cultures Psy", Le Fennec publishers; Morocco

1997 : Prize winner of the Tunisian President Award of the North African Society of Medecine
2002 : Prize winner of the International award Sigmund Freud of the city of Vienna
July, 2002, 30th, Decoration by the king Mohammed VI of the National merit medal

Centre of interest

• Psychoanalytic history in the arab and Islamic word
• Exil and migration
• Adolescents, their symptoms and the socio-cultural unrest
• Bilingualism and plurilingualism

Scientific presentations

In Morocco
1983-2005: Moroccan Society of Psychiatry
1984-1986 : The Freudian Text
1988-1991 : The Moroccan Association of Aid to the Mentally Handicapped
1992-1995 : The Faculty of Medecine of Rabat & Casablanca
1992 : 2001 : The Moroccan Association of Psychotherapy
1995-2001 : The Moroccan Association of Psychiatry in Private Practice
1990 -2005 : The Faculty of Arts of Rabat
1996 - 2004 : The french institutes of Rabat, Casablanca, Fez, Marrakech and Oujda
2001-2005 : The Morrocan Society of Psychoanalysis
2002-2004 : Jacques Berque Centre of Rabat
2005 : Prologues Association

In international level
1984 : The International Cultural Center of Hammamat
1989 : The Tropical Institute of Amsterdam
1996 : The Arabe World Institute of Paris
1997 : The International College of Philosophy of Paris
1999 : "Le temps du Maroc" in France (the Book Caravan)
1999 : University of Witwatersrand, Johannesbourg
1999 : “La mission locale” of Bordeaux
2001 : Paul Valéry University at Montpellier
2001 : Sophia Antipolis University at Nice
2002 : 3rd Congress of Psychotherapy (Vienna)
2003 : The Tunisian Association of Psychiatry in Private Practice
2004 : European Federation of Psychoanalysis, Strasbourg
2004 : Three Cultures Fondation, Séville
2005 : UNESCO Palace, Beyrouth
2006 : The Arabe World Institute of Paris
2006 : The psychoanalytic school of Strasbourg
2006 : The College of Psychoanalysts-UK, London
2006 : International book exhibition of Tanger, debate with Elisabeth Roudinesco
2006 : Sofia Antipolis University, Nice
2006 : Meeting of La criée Association, Reims
2006 : Study sessions of the Arab Speaking Group for the Advancement of Psychoanalysis, Rabat
2007 : Seminar at the Centre of Freudian Research and Analysis, London
2007 : Sofia Antipolis University, Nice
2007 : Vth meeting Francopsies, Alfapsy, Neuchâtel

Organization of international meeting

• Psychotherapies de patients maghrebins , International seminar in Casablanca, April 23-24 1992 ( co-organized with Driss Moussaoui)
• Migrations, psychothérapie et Cultures, International seminar as part of the Moroccan Association of Psychotherapy with the support of the Cultural Service of the Frensh Embassy as well as the Spanish Embassy (director of the seminar)
first meeting : May 10-11 1996
second meeting : December 12-13 1997
• Espaces enfants : organizer of lectures and seminars at the French Institute of Rabat :
« L’enfant et le livre » with Marie Bonnafé and Olivier Douzou, December 13-14 1996
« L’enfant et la thérapie », with Philippe Mazet, Claude Boukobza & Michel Guichard, February 24-25 1997
« L'enfant et l'insertion », April 25-26 1997 with Franck Chaumon & Maurice Titran
• Le temps des ados : organizer of lectures and seminars at the French Institut of Rabat :
-first meeting : « about Françoise Dolto » : February 13-14 1998, with Catherine Dolto-Tolitch, Alain Vanier
-second meeting : « adolescence, drugs and AIDS » : March 13-14 1998
with Alain Braconnier & Jean-François Solal
-third meeting : « art & adolescence » : April 24-25 1998
with Bernadette Chevillion and Jean-Luc Delrieu
• Délires et cultures : co-organizer of the first international meeting of the Moroccan Association of Psychiatry in Private Practice, Marbella 1999, may, 6-7.
• Les conduites à risque, International meeting of the Moroccan Association of Psychiatry in Private Practice, Roma, 24-28 march 2000.
• Psychiatries 2002: nouvelles approches cliniques et transculturelles, réalités pratiques, International Meeting of the Moroccan Association of Psychiatry in Private Practice, organised with the partnership of the French Association of Psychiatry in Private Practice, Marrakech, February, 2002.
• La psychiatrie : aujourd’hui et demain : co-organizer of the 6th congress of the Moroccan Association of Psychiatry in Private Practice, Fez, 2000 february, 25-27.
• « Les conduites à risque », Moroccan Association of Psychiatry in Private Practice, march 2001
• « Les nouvelles rencontres psychanalytiques de Rabat», organizer of the meeting, Institut Français of Rabat, october 2001
• « Inconscient et transmission » : Moroccan Society of Psychoanalysis with Pierre Lembeye, Patrick Guyomard, march 2002
• « Le choix de la psychanalyse» : Moroccan Society of Psychoanalysis with Jean Cournut, Jean-Pierre Winter, may 2002, Casablanca
• « Psychanalyse et cultures » : Moroccan Society of Psychoanalysis with Guy Rosolato, december 2002, Marrakech
• « Logique des passions», Moroccan Society of Psychoanalysis with Roland Gori, march 2003, Fès
• « Passeur de frontières», Moroccan Society of Psychoanalysis with Patrick Chemla, september 2004, Tanger
• « Naissance et renaissance de la psyhchanalyse», Moroccan Society of Psychoanalysis with Gérard Pommier, october 2004, Casablanca
• « Psychanalyse, transmission et lien social», Moroccan Society of Psychoanalysis, annuel meeting, november 2004, Rabat
• « L’autorité et la question du père aujourd’hui», introduction to the conference, Christian Hoffmann, French Institute of Tanger, octobre 2005, 1st, Moroccan Society of Psychoanalysis
• « Pratiques cliniques et malaise dans la culture », introduction to the conference, with Bertrand Piret, Jean-Jacques Moscovitz, Georges Zimra…, november, 12, 2005, Moroccan Society of Psychoanalysis
• « Les fils de l’histoire », introduction to the conference, with René Major and Chantal Tallagrand, september, 15, 2006, Moroccan Society of Psychoanalysis
• « Abords psychanalytiques de la topologie », with Erik Porge, september, 29, 2006, Moroccan Society of Psychoanalysis
• « The sexual difference », Study sessions of the Arab Speaking Group for the Advancement of Psychoanalysis, Moroccan Society of Psychoanalysis, November, 9-12, Rabat

Teaching work

• 1985-1987 : Seminar about “Wolfman”, Le Texte Freudien Association
• 1992 : Seminar about “Five psychoanalysis”, Ibnou Rochd Psychiatric Centre
• 1992-1996 : Entertainment of the psychoanalytic commission, Morrocan Association of Psychotherapy
• 2004 : Seminar about “The identification”, Morrocan Society of Psychoanalysis
• 2006-2007 : Seminar about “The transmission of psychoanalysis”, Morrocan Society of Psychoanalysis
• May 2006, may 2007 : Students of professional Master of psychologie, Intercultural psychopathology and clinic psychology of crisis situations. Nice. Chair : Mohamed Ham.

Texts

2007-07-06T12:07:00.000-07:00

The marginality of migrant workers

Culture, openmindedness and tolerance

The marginality of migrants workers

2007-02-08T13:19:00.000-08:00

Article based on a lecture given at the 5th South African Qualitative Methods Conference (SAQMC) on Normality and Psychopathology at the end of the 20th century in South Africa,
University of the Witwatersrand , Johannesburg
7 September 1999

Jalil Bennani

Abstract –This text concerns the practice of psychoanalysis in the case of the North African manual workers in France. The author shows the importance of a universal approach which goes beyond cultural particularities. He emphasises the fact that it is important not to oppose tradition and modernity by listening to the analysand. He shows that there is no barrier or frontier in the unconscious mind.

Key words : migration – psychoanalysis –marginality – sinistrose – culture – identity

Introduction

Migration, emigration, immigration : of these three terms I prefer that of “migration” because this notion designates a change, a displacement from one place to another. It opens larger perspectives than those of “emigration” or “immigration” which refer to a place of departure or arrival.
Migration, exile, separation, uprooting: are notions, usually linked to geographical displacements, and at first associated with the interior journey and with intrapsychic questions.
In their practice, psychotherapists are concerned with these displacements, their duration, their motivation and their consequences. They themselves are called upon to travel and they cannot ignore the advancement of ideas and knowledge. Crossing frontiers can reveal or cause trouble and suffering but also be enriching and lead the migrant to be creative. From one country to another, from one culture to another, from one language to another mutations take place. New symbolic fields are discovered, reinvested, rejected or highlighted.

Why associate migration and marginality ?

Migration is certainly not synonymous of marginality. It could effectively concern all categories of the population. Certain forms of migration are, however, the fate of the underprivileged classes. For them , departure is above all justified by economic motivation. This being the case, the problems encountered through this category reveal certain particularities that I would like to address here. Although migration could be the bearer of hope, creation, and mutation, psychological suffering is frequent in the population category that I would like to cite. Suffering is either generated by migration, or revealed through it.
I am concerned here mainly with North African migration to France, as it is the one I know best and because it seems to me to typify situations of migration and marginality that one encounters elsewhere.

The North African migrant in France and psychological consequences

Here I would like to examine a situation particularly representative of the suffering of the North African migrant in France: that of “sinistrose”.

“Sinistrose”
According to Brissaud (1908)(1) “sinistrose” consists of a very special inhibition of the will as in a person who has suffered a physical injury, and who is long since recovered, and who will not necessarily make an effort to start work again immediately at the cost of a little discomfort. They will possibly seek compensation first.

From this moment onwards, defenders of this theory feel obliged to analyse possible “simulating”, “demanding” or “hysterical” tendencies of the patient.
It is quite remarkable to note the origin of the concept itself. It was at first attributed to Portuguese migrants and then to North African (Tunisia/Algeria/Morocco) ones or French people on the fringes of society. That is to say that its attribution concerned marginality, whatever its origin was, as if the particularity of this concept became linked to marginality.
It is otherwise quite striking to note that this notion of the “sinistrose” was taken up again by an Algerian psychiatrist, Antoine Porot, during the colonial era the French North Africa, when he himself tried to define other concepts for the Algerians.
I have examined Brissaud’s concept and the developments which I brought about had an echo beyond France .(2) I have attempted to show that the psychiatric order has its roots in the history of societies and the exclusion of their deviants. The use of concepts today forms a part of this order.
The patients suffering from “sinistrose” pose problems for medical and psychiatric institutions. Multiple medical examinations reveal very few or no organic problems and the usual medical therapies for pain are not effective. As for classical psychiatric therapy, it quite often proves to be ineffective with patients - the anxiolytics and anti-depressants are often useless. Verbal therapies such as psychoanalysis, encounter great resistance from patients. This is not to say that psychoanalysis or the psychotherapies that it inspired are not adapted to these patients and I would like to explain myself regarding this point.
Faced with successive failures it frequently happens that one sends these patients to therapists with the same cultural background as the patients in order to attempt to help them better, in their language and their culture.

Psychotherapy and psychoanalysis of the Maghrebian patient
The choice of the therapist
While practising in France, I was called upon by French institutions to see the Maghrebian (North African) patients suffering from “sinistrose”. Two situations thus presented themselves. In the first one, the patient spoke only a little of the host country’s language and was happy to meet a compatriot to whom they could express their suffering in their own language and culture.
In the second case, the patient preferred to address a therapist of the host country because they were more certain of fulfilling their desire of acculturation this country and in certain cases they preferred to address a demand to this therapist. This situation is indeed frequent when a patient wishes to obtain recognition or treatment after suffering an accident. In these cases the complaints are centred on the suffering body, personal space, interior space, space of imprisonment and solitude. It represents the last link with the social aspect, the last space to live in, even if they are suspected of simulation, hysteria, imagined illness or “sinistrose”.
Thus I protested against the systematic attitude which consisted in sending a Maghrebian directly to a Maghrebian therapist when one did not succeed in treating the patient or when the latter continued to complain. Such an attitude could have represented a new rejection of the patient by the curing institutions, reflecting what they experienced in the host society when it rejected him.
Listening to the patient in the place where their demand was first formulated (even if it was at the general hospital where their treatment started), leaving the patient free to choose their therapist, respecting the distance that they themselves could have established with their country of origin, is by nature, being attentive to their desires, regarding the host country and their break with their origins, or on the contrary with their desire of returning to the latter, even if it was imagined, or with the establishment of new relations between the host country and the country of origin. This latter case is quite often the best.
It must be borne in mind, however, that a therapist of the same cultural origin must also be able to hear a speech that asks to situate itself beyond the inter-individual relation; they must be able to hear this demand and restore it and respect it.
Finally, let us underline what the therapist of the same cultural background can bring. They could be used to inform, to increase awareness of culture and allow enlightenment of the case history of an ill person during the course of the synthesis by therapists. The therapist who shares the same language or the same culture as the migrant can thus take part in the treatment without necessarily being the consulted therapist but they could also be the latter, respecting the demands of the patient - while maintaining relations with another therapist . Thus we can avoid rejection and discrimination against the patient in which those who cure can participate to varying degrees. Thus a multidisciplinary work can be accomplished in which the cultural problem has its own particularity.

The contribution of psychoanalysis

Faced with immigrant workers who are confronted with numerous social, economic, cultural and psychological problems, it isn’t suitable to psychologise the social side, but to connect with the day to day experience of the subjective interior with social laws so as to observe and analyse the way in which individual destinies are pushed over the edge in new sufferings, new rifts or, inversely, are restructured towards new equilibriums.
Also, and before any psychological care, or in parallel with the latter, it is suitable to give responses whenever possible on the sociological or economic level, to recognise physical damage, and to indemnify and avoid rejection. Individual therapies can then be undertaken without denying the individual in their other claims.
In my research, I have relied on psychoanalysis. In Morocco or in France I work with the psychoanalytical tool. Because psychoanalysis is based on language, because it allows for a refined listening to the individual, and because it relies on speech to explore cultural particularities, it constitutes an irreplaceable therapeutic tool for theorising, and a representative model of the human psyche in its variants and its cultural particularities.
Psychoanalysis is a universal praxis because the unconscious is universal. Its practice does, however, encounter resistance linked to the cultural context which could lead to review these concepts in order to develop and enrich them. We shall see that it is precisely in relying on cultural particularities that one gets to overcome cultural resistance.
The couch is certainly a privilege of the rich and not the poor. However, psychoanalysis can be operative from first interviews because it allows someone to be attentive to the symptoms, to articulate them with a structure, to enable the subject to unravel the significance of their past experiences, to analyse and to step back, in order with the transfer. We know that psychoanalysis today goes far beyond the stereotype of the couch.
Psychoanalysis highlights the importance of the body of the typical manual worker migrant. The patient places him/herself in the present in the wholeness of social relations through his/her body. In the past their body had been developed progressively and intensively since childhood. In fact, we see the importance of the relationship of the child with the mother which always endures and is updated during ceremonies such as circumcision, a trace that can be symbolised occurring at the moment of the threat of castration and giving access to the symbolical. Later the choice of the spouse goes is approved or disapproved by the mother.
The importance of the body for the North African explains the fact that the body speaks like a language, for instance depressive states are frequently manifested through physical symptoms. The spoken language there is close to its source and the break between the body and its symbol seems to be less important than in the Western subject.
For the analyst, the body is like a source of information. The work of the analyst consists in restitution in the form of words (of symbols) of a body language. The interpretation thus enables to progress towards the symbolical register.
The migrant can reveal of the structural psychic process. Each person, from their childhood, is confronted with successive separations and renunciations which impose new choices, new perspectives, new orientations. Therapists must increasingly take into account the question of displacement in their practice and theorising. This question impinges on the interior journey and intrapsychic questions. We speak of “leaving the motherland”.
To conclude, I would like to say that the role of the therapist of the host country seems to me to be fundamental because it responds to the demand of many patients. The participation of these healers otherwise enables, through intercultural exchange, to avoid exclusion and rejection that makes enclosure and the ghetto worse. Finally, making the institutions of the host country responsible, enables us to question the inappropriate response in an adequate fashion for all patients wherever they come from.
The role of the therapist of the same cultural background makes it possible to listen and to understand the patient from inside the same culture, in the same language. An ill person recounts his suffering from their points of reference, from their own experience, from their speech. They can thus express themselves in their own language, their images, their own universe, reassured by the other’s attention. It is in the mother tongue that the subject’s structure originates, there they learn the first phonemes and the first sentence constructions. The exiled can thus have recourse to nostalgia to protect themselves, to regroup and to relive lost moments.
Thus it is essential to take into account the subject’s desire in all migratory displacements.

Original culture, language

Departing from these reflections one can attempt to go further. Earlier, I mentioned that some are strangers within their own group. In the case of Morocco two essential points must be made: the group is no longer the traditional group and quite often the individual at first affirms their difference through a symptomatic expression, before stating more clearly their desire for another way of life, for a different rapport with others. The second point concerns the language : several languages are spoken in Morocco, Arabic, Berber or Amazigh and French. Within Arabic there is spoken, dialectical and written Arabic, the latter being classical; within Berber there are several dialects: Talchliht, Tamazig, Tarifit. As for the French language one can either consider it as the colonial language and reject it, or that it forms part of the Moroccan linguistic landscape. Today it remains, like other European languages, the language of access to the West, hence the necessity of adopting it, of not denying it and even going as far as reclaiming it. The depreciation of the mother-tongues, coupled with the scientific and technological domination transported by the so-called “foreign” languages explains some people’s rejection of their Moroccan identity, their denial of the self and of everything that is of local culture. This naturally doesn’t take place without the idealisation of the other, the foreigner. Many young people daily state their dream of leaving for foreign countries. But the return of the maternal and the price of this denial of identity manifests itself in the exacerbation of the identity of origin, the rejection of the other and the fanatical exaltation of local and traditional values.
Here I would like to put forward the idea that a successful exile is an exile that doesn’t deny its roots and which enables the person to integrate the familiar and the foreign, bringing the mother-tongue and the foreign tongue together.
Here we can invoke Freud’s “worrying strangeness”. Freud describes this feeling as something that had to remain hidden and that has emerged from the shadow, from repression. Here, he says, it is about a “particular variant of the frightening that goes back to the known long time ago, familiar long time ago”. With this patient, the foreign language leads back to the intimate and is mixed with it. There is a rejection of the intimate, projected outside the self as foreigner (inversely one can state that the rejection of the foreigner is interpreted as a refusal to face the resentment of strangeness, the stranger in oneself). “To exile oneself is to abandon the stifling maternal space to recreate a space that is virtually free in itself”.

Theoretical questions

Transfer in psychoanalysis and tradition
• Transfer and “baraka”
We know that the patient establishes a love-hate relationship with their therapist. This relationship also exists with a doctor, but it is in psychoanalysis that it is analysed through the notion of transfer. It is through the transfer that the cure progresses, the patient talking about their experiences, and retracing the course of them, with the help of the attention and listening given to them, and the relationship that they establish with their therapist. This relationship certainly includes individual aspects linked to the relationship itself, but also representations of traditional personalities supposed to have a power of healing and the accomplishment of miracles, even salvation. It is, in actual fact, through transfer that the patient again goes through the fine details of their experiences along with what this entails - repetition of scenes, recollections and affects.
“If you cure him, I would like to come for a ziara to your consultancy”, thus a patient expresses herself speaking of the recognition that she would have for me if I cured her son. “Ziara” generally means “visit”. This word is often used to designate the visit paid to a marabout (holy man) and it can, in this case, be accompanied by offerings to him.
The analysis of transfer is rendered as necessary, as the coming and going between a rationalist doctor and marabout is incessant. Another patient would say, like many others : “I trust in God and in Doctors”. In Islam there is no intermediary between the believer and God. Yet the marabout plays this role. “Wali” means “the one that is close to God”.
An essential element of the connection between the holy man and the doctor must be underlined: it is the notion of the baraka, which means “benediction”, a miraculous force that is brought into play with the notion of holiness and is often associated with the therapist. In Morocco religion, magic and therapy have the notion of holiness as a common pole of attraction.

Similarities and differences

Like the holy man the therapist can represent an intermediary in the healing process. Like the holy man he can be loved, respected, doubted, adulated. Like the holy man he is given a baraka by the ill person.
Unlike the holy man, he doesn’t receive offerings but money, which is not the same thing. Money is already at a distance from nature and opens the way to symbolisation. Unlike the holy man he interprets, he doesn’t conclude in a definitive way but leaves the interpretation open. Unlike the holy man he is reserved, neutral. He leaves the choice of speech, to the wish of the patient. This is an ethical decision.
Let us note a point, one of essential similarity: the question of the dream. Numerous patients dream of their healing in a dream where they receive the help of the marabout. Here the “endogenous” factor mingles with the “exogenous” one. The dream can be compared here to free associations in psychoanalysis.
Across the similarities and differences the whole question of the ethical is posed. To summarise this question of transfer I would like to say that through the words of the patients, the psychoanalyst can be brought to hear a traditional language addressed to the holy man, but it is by situating himself in another discourse, the discourse of the analyst (as it was defined by the psychoanalyst Jacques Lacan in the four discourses) that he can help them to decrypt their symptoms and analyse the transfer.
It is suitable not to oppose tradition and modernity but to attempt to connect them with the help of the transfer. In other words, it is suitable to be attentive to cultural particularities in order to bypass the resistances.

Resistance

By resistance one can understand all that obstructs healing work, all that hinders the subject’s access to his unconscious determination. For Freud resistance is a defence mechanism referable to the ego, thus at the conscious level, but also at the unconscious ; it exercises an attraction of unconscious prototypes on the repressed processes. Freud defines resistance to the analysis as the right of anyone who does not accept your solution.
I was attracted to the ideas of Jacques Derrida who paid particular attention to this question. Such a law highlights the fact that all analysis is a battle of wills, and all interpretation a combat between polémos and éros .(3) This formulation particularly challenged me because of the question of whether this “policy” is not the one that prevailed during the colonial era, the time when precisely the theory of the other was hailed as the truth. Is it therefore surprising that the refusal of the other was a factor in resistance to the colonial powers? The transfer then functions fully as resistance (on the level of the patients and later the practitioners), as a point at which the subject repeats what constitutes for him the obstacle. This obstacle will be constituted by the refusal of the interpretation, and even by the refusal of the consultation itself, when it is not through a simple fleeing from the latter or by a coming and going between this place and others, holy men, healers and magicians as we still see today. Searching for what? - another truth, another order of discourse and meaning.
Derrida goes on to say that like the resistance we encounter in analysis, this battle of wills has meaning and truth. Resistance has as much meaning as to what it is opposed to. Resistance itself has meaning and thus it is interpretable as that which it disguises or displaces.

If resistance is a bearer of truth, this truth must be found in the cultural particularities that must be acknowledged in order to bypass the resistance. A theory, in these cases, and in this condition, need not be rejected, but, on the contrary, reappropriated after having been deconstructed to take up the concept so important for Derrida.
We can say that in the case of Morocco deconstruction has operated from a double tradition. The first one is that of the colonial past : the psychoanalyst, like the psychiatrist, operates from a past, the one of the medical tradition. It would surely be suitable to deconstruct colonialism as knowledge. The second is that of the Arabo-Islamic and magical tradition: in immersing oneself in the language and in relying on speech, the psychoanalyst is, perhaps more inclined than the practitioner, to question this other tradition.

Migrations, psychotherapies and cultures

I would like to end this paper by considering some questions which
stem from these considerations of the notion of migration.
• It is suitable today to approach the questions of migration and exile in their link with every foundation, since the early days. In exile, the link with origins is profoundly modified. It is suitable to bring out a sort of consensus by making a connection between individual discourse and cultural factors. It should not be the one that gives meaning to the first aspect, nor should it be the one that explains the discourse and the experience of an individual. Many deviations can thus be avoided.
• We can also ask ourselves if displacements have today become the norm. They have multiplied, spread out and been imposed. The migratory phenomenon points to fascinating questions linked to society’s debates, philosophical and existential choices. It concerns the themes of identity and hospitality. The welcome in the new environment and tolerance implies the imposition of communitarian, linguistic, cultural and religious choices.
• Today we see a wavering of identities within which the psychoanalysts have their word to say on the conflicts which stem from the problem with identifying with the parental image, adopting a new language, on the rejection of the mother-tongue. Different languages and writings cross, rupture, interpenetrate and encounter each other.
I would voluntarily like the take up Yves Michaud’s expression, who spoke of “flexible identities”, “plural identities”. For this philosopher, “The future will be a future of migration and communication ”, (4) migration becomes the norm.
• Concerning hospitality I would like to cite the last remarkable work of the philosopher Jacques Derrida on this subject. He affirms that “there is not a culture, or a social link without a principle of hospitality” .(5) It is suitable, he says, to “calculate the risks” (that of unlimited hospitality), but “not to close the door” on strangers.
True hospitality is towards someone who is different in their religion, their culture or their way of being.

Conclusion

I hope that my paper gives some answers to questions which are pertinent to all of us.
Here I think of the situations of internal and external migrations in South Africa and of the psychological problems faced by workers in the gold-mines.
The question of violence poses the question of the modality of different therapeutic approaches.
The cultural and linguistic questions without doubt constitute crucial questions for the present and for the future.
In this context the contribution of psychoanalysis can be essential for listening to and treating the patients and analysing their unconscious conflicts. It can occupy an original position that does not exclude the sociological, ethnological and cultural dimensions of the society in which it is practised.

Notes

1- E. Brissaud, Feb.1908 pp114,115, « La sinistrose », Le Concours Médical , n°7.
2- Le corps suspect, Galilée, Paris, 1980.
3- Derrida, Résistances, éditions Galilée, Paris, 1996, p. 22.
4- Yves Michaud, "Des identités flexibles", in Le Monde, 24 octobre 1987
5- Jacques Derrida, De l'hospitalité, éditions Calmann-Lévy, Paris, 1997

Publications

2007-01-08T12:56:00.000-08:00

•Le corps suspect, Galilée, Paris, 1980, translated into Dutch : Het sprekende lichaam, Nabije-Oostenreeks, Houten, 1985
•"Corps, Langue, Tradition",Transitions review, number 6, editor of the issue, Paris, 1981
•Du bilinguisme, collective work, Denoël, Paris, 1985
•La psychanalyse au pays des saints, Le Fennec, Casablanca, 1996
•Les sites de l'exil, collective work, L'Harmattan, Paris, 1997
•La figure de l’autre, étranger, en psychopathologie clinique, collective work, L'Harmattan, Paris, 1999
•Parcours d’enfants, Le Fennec, Casablanca, 1999
•Le voyage des théories, collective work, Le Fennec, 1999
•Dictionnaire international de la psychanalyse, collective work, éditions Calmann-Lévy, Paris (dir. Alain de Mijolla), 2002
•Le temps des ados, in collaboration with Alain Braconnier Le Fennec, Casablanca, 2002
•Globalized Psychotherapy, collective work, Facultas Universitätsverlag, Vienne (dir. Alfred Pritz), 2002
•Psychoanalysis in Maghreb, editor of the issue, Casablanca, Prologues revue, 2005
•Islam et individuation, Cahier de recherche n°2, Centre Jacques Berque, Rabat, (dir. Nadir Boumaza), 2005
•La psychanalyse dans le monde arabe et islamique, (dir Chawki Azouri and Elisabeth Roudinesco), Saint-Joseph University Press, Beyrouth