Fourteen djinns migrate across the ocean

Abstract

This case study of an eight year old boy of Canadian-Egyptian origin and his family involved the interventions of a child psychiatry day treatment team, his school, and traditional healers from both Canada and the Middle East. Constructing meaningful interventions for this family involved a shifting location of illness meaning at the intersection of psychosocial, historical, and religious factors integrated in systemic formulations of trauma intervention. The treatment team positioned interventions between individual (intra-psychic, identity or personality factors), family systems (marital and child issues), and socio-cultural agendas (host Canadian culture, culture of origin, djinn possession, dynamics of culture change, religious and historical legacies) as the treatment evolved. Cultural camouflage (Friedman, 1982) with intertwining emotional and psychodynamic agendas of trauma and djinn possession states (El Khayat, 1994) placed the unraveling of cultural metaphors at the heart of the therapeutic process. Friedman has (1982) hypothesized that culture does not supply the determinants of family dynamics, but rather is the medium through which family process works its art or camouflages its emergence. Kleinman has (1991) similarly argued that healing in the realm of the psyche is enacted through symbols of the patient's cultural context. In this family, the cumulative trauma determinants included their experiences of domestic violence, marital infidelities, downward socio-economic status, culture change, family deaths, medical illnesses and sexual abuse. Djinn possession was integral to the family mythology and is deeply rooted in ancient, medieval and modern Islamic Egyptian experience. According to Michael Dols (1992, p. 213): created of smokeless flame, whereas humankind and angels-the other two classes of intelligent beings in the sublunar world-were created of clay and light, but their purpose was also to serve and worship God. Prophets were sent to them from God, so that they may be either believers or unbelievers. On one occasion, it is reported that some djinn became Muslims after having heard the Qur'an recited by Muhammad. The unbelieving djinn might go to hell, but it was not stated explicitly that the believers might go to heaven. Furthermore, it was commonly believed that everyone had a personal djinn, like the classical daemon, or genius. According to a late Muslim tradition, the Prophet's djinn became a Muslim and instructed him to do only what was right." The narratives of the family members in our case study shifted in meaning and content, as the family processed their trauma with members of the therapy team. The building of a therapeutic alliance was a slow process informed by previous treatment failures and an understanding of stigma factors silencing family discourse. In the course of treatment, we understood the central role of djinn possession in the family's post migration life in Canada. We worked with significant family resistances, initially reflected in their hopelessness that treatment could ever effect a change in their suffering. Our child patient, eight-year-old Abdul, was admitted for a five-month period to our child psychiatry day treatment program with an intensive family therapy component. On discharge from the program the family had follow-up intermittently for a year, with ongoing family treatment, intermittent school consultation, and a brief youth protection involvement. While the psychiatric literature on trauma treatment emphasizes the definitions of the DSM IV (APA, 1994) criteria for posttraumatic stress disorder and psychopharmacological interventions grounded in a perspective of subjective suffering, this story underlines that intercultural and systemic affiliations or relationships are essential to proposing formulations of meaning and intervention. The symptom bearer was the identified child patient while the sources of distress were uncovered within traumatic disturbances in his family. The underlying motifs of medieval Islamic society and a post-modern world were collaged across generations, forming the basis of identities that shifted and reframed meaning over the course of therapy. Family therapy appeared to function as a container and holding environment (Winnicott, 1966) that allowed the family to realign their personal mythologies and create emerging options. © 2007 Springer Science + Business Media, LLC. All rights reserved.