Medical Orientalism and the War on Terror: Depictions of Arabs and Muslims in the Psychodynamic Literature post-9/11
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This paper surveys the psychodynamic literature on suicide bombers to demonstrate a publication bias against Arabs and Muslims. First, Edward Said’s concept of orientalism is situated within medicine as a hermeneutic for cultural critique. Next, select texts are analyzed to show how discussions of suicide bombers often include questionable sociological assumptions about Arabs and Muslims. Finally, conclusions and solutions are offered regarding the values of current psychiatric knowledge. By interrogating psychodynamic writings for their truth claims, we can investigate how scientific literature aspires toward an objective universalism while embedded within a particular social, political moment.
Keywords: suicide bombing, terrorism, Islam, Muslims, orientalism, War on Terror
Critics have increasingly questioned who benefits from the discourse on terrorism permeating American life since the second Palestinian intifada of 2000 and the War on Terror declared by American President George W. Bush in response to the 9/11 attacks. The field of critical terrorism studies has challenged current knowledge about terrorism and elucidated current biases in publications (Smyth, Gunning, Jackson, Kassimeris, & Robinson, 2008). A terrorism industry has developed in which politicians, bureaucrats, journalists, entrepreneurs, and academics overestimate the threat of terrorism for profit when the actual risk is minute and unpredictable (Mueller, 2006). A recent study of the most-cited experts on terrorism reveals a close-knit “invisible college” with overlapping academic, governmental, and research relationships that advance state narratives (Miller & Mills, 2009). Since most terrorism industry authors have ties to the government through direct employment, funding, or consulting, their publications tilt toward a tangible counterterrorism agenda with concrete policy recommendations (Al-Rasheed, 2009). This focus on problem-solving and policy relevance has restricted the impartiality of the field (Jarvis, 2009) since it has not originated from the reflexive location of the university (Burke, 2008).
This article examines the stigmatization of Islam and Muslims within the psychodynamic literature through dubious generalities about Middle Eastern societies. Medical scholarship has not received significant attention for its representations of minorities despite the fact that psychologists and psychiatrists frequently comment on the motivations of terrorists for the government, media, and public (Kershaw, 2010). In a review of the medical literature from 1966 to 2005, Laird and colleagues (2007) have shown that certain biases recur: being an observant Muslim poses health risks; Muslims remain backward in tradition; and Islam creates “problems” for service delivery. In a comprehensive review of the mental health literature on suicide bombing, Aggarwal (2010) observed that these researchers often locate the pathology of suicide bombers to problems within their host societies. This article extends those insights by providing textual examples of stereotypes to appraise the misuses of culture within psychiatry.
Orientalism, Medicine, and the Relationship Between Power and Knowledge
Edward Said’s book Orientalism (1978) serves as the theoretical background for this analysis. Said begins his account as the construction of the European “Occident” against the Middle Eastern and South Asian “Orient”:
I shall be calling Orientalism, a way of coming to terms with the Orient that is based on the Orient’s special place in European Western experience. The Orient is not only adjacent to Europe; it is also the place of Europe’s greatest and richest and oldest colonies, the source of its civilizations and languages, its cultural contestant, and one of its deepest and most recurring images of the Other. In addition, the Orient has helped to define Europe (or the West) as its contrasting image, idea, personality, experience (Said 1994, 1-2).
For Said, the British-French-American presence in the Middle East from the late-eighteenth century onward produced a voluminous scholarship that reinforced stereotypes of the Middle East, Islam, and Arabs. Medicine’s supporting institutions, the vocabulary of psychiatry around instincts and motivations, and the psychodynamic scholarship also define Muslims and, in turn, define the Western Self as its cultural contestant. In other words, medical scholarship constructs a Muslim Other.
Crucial to the Orientalist enterprise lies the power disparity between the Occident and Orient:
My contention is that without examining Orientalism as a discourse one cannot possibly understand the enormously systematic discipline by which European culture was able to manage – and even produce – the Orient politically, sociologically, militarily, ideologically, scientifically, and imaginatively during the post-Enlightenment period. Moreover, so authoritative a position did Orientalism have that I believe no one writing, thinking, or acting on the Orient could do so without taking account of the limitations on thought and action imposed by Orientalism. In brief, because of Orientalism the Orient was not (and is not) a free subject of thought or action (Said 1994, 3).
Said calls attention to the West’s production of the Orient through science and ideology. The weight of history and politics determines collective trends binding individual writers. For example, media representations of Palestinians as terrorist suicide bombers disguise the role of Western interests and discount violence as resistance (Morton, 2007). From this angle, the only academic paper in a recent search of the mental health literature not to condemn suicide bombing as pathology or terrorism came from an Egyptian professor of psychology in Kuwait who highlighted the sociopolitical context of previous writers (Aggarwal, 2010). The authoritative position of the West in producing the Orient politically, sociologically, and ideologically continues scientifically.
In Said’s estimation, orientalism resonates politically, as an attempt to comprehend and control the Other, not directly but insidiously:
It [Orientalism] is rather a distribution of geopolitical awareness into aesthetic, scholarly, economic, sociological, historical, and philological texts; it is an elaboration not only of a basic geographic distinction (the world is made up of two unequal halves, Orient and Occident) but also of a whole series of “interests” which, by such means as scholarly discovery, philological reconstruction, psychological analysis, landscape and sociological description, it not only creates but also maintains; it is, rather than expresses, a certain will or intention to understand, in some cases to control, manipulate, even to incorporate, what is a manifestly different (or alternative and novel) world; it is, above all, a discourse that is by no means in direct, corresponding relationship with political power in the raw, but rather is produced and exists in an uneven exchange with various kinds of power, shaped to a degree by the exchange with power political (as with a colonial or imperial establishment), power intellectual (as with reigning sciences like comparative linguistics or anatomy, or any of the modern policy sciences), power cultural (as with orthodoxies and canons of taste, texts, values), power moral (as with ideas about what “we” do and what “they” cannot do or understand as “we” do (Said 1994, 12).
Said cautions us from assuming that science can exist without geopolitical influences creeping into scholarship. Psychological analysis, the object of inquiry here, serves to define and dominate the Other, distinguishing it from the Euro-American Self in the process. Power intellectual and power moral pervade the psychodynamic literature on Arabs and Muslims as writers interpret characteristics of these populations and then disown these thoughts and behaviors as belonging to the Other.
Recently, orientalism has provoked critical inquiries into the relationship of power and knowledge within the medical humanities. As practice, medical discourse can be seen as orientalism in that clinicians and researchers create expertise by conceptualizing disease categories and interpreting experiences without patient input (Aull & Lewis, 2004). As content, orientalism spread throughout Europe’s colonies, as nineteenth-century British physicians in India wrote extensively on the differential effects of symptom and organ pathologies based on race, disseminating this information to medical students as science in Indian schools (Harrison, 2009). More recently, Laird and colleagues have evoked orientalism to show how medical writers attribute the “positive” elements of Islam to Judaism, Christianity, or Greek/Aryan thought (Laird et al., 2007). Here, I wish to unearth psychiatric orientalism: as practice, by interrogating how mental health researchers construct authoritative knowledge on the Muslim Other; and as content, by tracing Western determinations of suicide bombing to characterizations of Arab and Muslim societies. By suspending belief in the truth claims of psychodynamic texts and adopting doubt as a hermeneutic, we can question how Western academics essentialize violence to religion against alternate explanations.
Psychiatric Orientalism and the Suicide Bomber as Indigenous to Muslim Society
Below, I examine a representative sample of psychodynamic texts with orientalist attitudes toward Arabs and Muslims. These papers come from a search for all years since 2001 for the terms “Islam,” “Muslim,” “suicide bombing,” and “suicide bomber” in PsychInfo and Psychoanalytic Electronic Publishing (PEP) Web. A service of the American Psychological Association, the PsycInfo database hosts over 2.5 million international references from psychology. PEP Web is the largest psychoanalytic database in English with over 1500 volumes and 65,000 articles from 1871 to 2006. Like Said, I cannot undertake a complete account given the enormity of text involved and must assume that this selection reflects a larger whole (1994, 16).
At this point, a disclaimer: While many accounts of terrorism and suicide bombing attempt to avoid condemnations of whole Muslim societies, the following samples do not. The goal is not to vilify psychodynamic theories altogether. Rather, it is to ask who wields psychodynamic theories, toward what purposes, and with what conclusions. Said differentiates between the strategic location of an author’s position in a text and the strategic formation of relationships among texts aggregated to form reference points within a particular culture (1994, 20). The texts are individually studied and considered together for common themes.
One frequently occurring model dichotomizes the “West” and the “East”. Consider Benjamin’s Terror and Guilt: Beyond Them and Us, a more conciliatory paper on Islam and Arabs after 9/11. Benjamin traces the growth of religious identities among Muslims to history’s failure to provide them with a movement like the Enlightenment:
If the human condition requires us to confront our drive for omnipotence and the impossibility of truly asserting control, then surely this is a problem that has not been solved in the West, even as it has been left untouched in the East. Splitting is everyone's problem. That said, it would be naîve to dispute the dominance that fundamentalism is now enjoying in the Arab world or, as Malcolm Slavin has pointed out, that the Muslim world never went through the lengthy process of Reformation and religious wars that, in Europe, culminated in the Enlightenment (2002, 476).
Here, no geographical borders delineate “the West” from “the East”. No communication seemingly occurs between these two discrete entities. Without a Reformation like the Europeans, the Muslim world is unreformed. The East, Islam and Arabs, is constructed as ignorant against [E]nlightened Western peoples. The will to understand Arabs and Muslims results in powers intellectual and moral.
Unclear boundaries continue to mark "us" and "them”. In a review article, Psychoanalytic Reflections on 9/11, Terrorism, and Genocidal Prejudice: Roots and Sequels, Wurmser further opposes the Islamic world with the West:
They have opened a deep rift of understanding, separating the United States not only from much of the Islamic world, but from much of Europe as well: large segments of the population believe that the CIA or the Mossad engineered the attacks. This profound gap in interpretation, this radically different perspective, accompanied by widespread schadenfreude, calls for analysis (2004, 911).
Wurmser compares categories without equivalence. The United States and Europe are both geographical signifiers, but “the Islamic world,” a phrase indicating religiosity, presumably stands in for the Middle East. No consideration is given to Islamic worlds within the United States and Europe, i.e., flourishing native Muslim communities. The secular orientation of the West contrasts with the religious salience of Muslims. Power intellectual propels the author’s analysis.
Some authors neatly disentangle "the East" from "the West," but others warn of Muslim population growth in Europe. Consider Reshetnikov's Visions of the Future: Social Processes and Terrorism in Europe that theorizes from Francis Fukuyama's understanding of the nation's constituent parts:
[A]ll too often integration is seen in terms of granting equal opportunities to those who accept our values while marginalizing those who do not, as we can see from the problem of racial integration in America or from the attitude to Muslim minorities in Europe. As long as Muslims are a minority we can continue to avoid this problem and to insist that they integrate our values but what will happen if they become a majority? (2008, 658)
The author develops a European Self to the Muslim Other. Muslims present a "problem" regarding values. The rhetoric of discipline is employed as we "insist" on their integration. The anxiety of the majority manifests through religious xenophobia. "European" and "Muslim" identities reside in conflict without reconciliation. Beyond the desire to understand lies the power to control, manipulate, and potentially incorporate.
For some, the disordered nature of Arab and Muslim societies begins with their ethno-genesis. In The Psychological Make-Up of a Suicide Bomber, Lachkar diagnoses Arab society as borderline:
There are two recurring myths in the Bible and the Koran that have significance in fueling the Arab-Israeli conflict. The first myth is the belief that Jews are God’s “chosen people” (a narcissistic diagnosis), and the second that the Arabs are an “orphan” society, the “abandoned” children of God (a borderline diagnosis). The latter can be viewed as a reenactment of the Biblical experience of abandonment – Ishmael abandoned in the desert – indicating a borderline condition with its shame components (2002, 17).
The passage differentiates between “Arabs” and “Jews,” conflating “Arab” with “Muslim” in reference to the Qur’an. The historical allusions come from the Judeo-Christian tradition without contemplation for how Arabs and Muslims might possess their own forms of history. This original trauma replicates continuously, explaining current events. The disorder of Arab Muslim societies differs from the normative (re: normal) Christian audience. The Orient defines the West through its contrasting image.
The distance between the Arabs and Jews has prompted questions on whether “the Arab mind” can be knowable. In a chapter with the same title from the book Fratricide in the Holy Land: A Psychoanalytic View of the Arab-Israeli Conflict, Falk debates the validity of studies on “national character”. Eventually, he concludes in the affirmative:
With Glidden’s caveats in mind, from a psychoanalytic viewpoint the personality traits of the Arabs discussed by Hamid Ammar and Sadiq Jalal al-Azm are those of a narcissistic child who is unable or unwilling to face the difficulties of its life, internal and external. The child unconsciously falls back on emotionally regressive defenses such as denial, projection, and externalization, being dishonest with both itself and the outside world. The effects of such character structure on the Arab-Israeli conflict are disastrous (2004, 157).
Here, one sees a rhetorical sleight-of-hand where the author can reference through psychoanalysis certain personality traits discussed by Arabs themselves. As children, the Arabs are depicted as developmentally arrested. Their reactions to the world consist of primitive defense mechanisms. Childish traits compose the “character structure” of a whole society. As an interesting contrast, the author disclaims in a chapter entitled “The Jewish Mind” that dispersion and diaspora over two millennia preclude accurate speculation on the psychology of the Jews (2004, 174). The immature, irrational Arab contrasts with the adult, rational West. The elaboration of geopolitical interests combines with psychological analysis to form power intellectual, the power to understand.
The theme of disordered children recurs in a different way when authors discuss Arab Muslim family dynamics. In a rejoinder to a critique of their article by Turco, Olsson and Khalid assume the pathological nature of childhood in Muslim societies:
It is in fact possible that there may be increased possibilities of narcissistic injuries for children in Muslim cultures. In Muslim cultures rigid rules are often obeyed without independent-minded questioning by children or adults. Marriage is experienced by most Muslims as a contract rather than an emotional attraction and subsequent attachment (Turco 2006, 532).
The passage is remarkable for a number of reasons. First, Muslim societies around the world form a homogeneous tradition without local variation. Second, the conflation of religion and society enforces “rigid rules” without the ability of Muslims to exercise choice. Third, the marriage ritual is depicted as cold, contractual, and distant against the warmth and love of marriage otherwise. The implicit message contends that the Muslim family inherently inherits and transmits psychopathology. The contrasting image of the Orient defines the Western experience as the authors exhibit powers intellectual and moral over their subject.
In an interesting twist, some papers employ Arabs or Muslims who then utilize orientalist discourses on psychodynamics. In Middle East Crisis: Psychoanalytic Reflections, Silverman and Parger present the case of a Palestinian who attempts to rationalize the actions of suicide bombers:
In a successful resolution of the Oedipus complex, the superego develops through identification with the father. However, in many Arab families, the father is seen as an object of repressed hatred and becomes the source of violence, both in fantasy and in reality. A complicating socio-economic factor in Palestine is that the father is often seen as not being able to live up to his role as provider, and as a disappointing and humiliated object who brings shame upon the family. The son remains obedient to the father outwardly but secretly despises him, torn between feelings of rebellion and dependency. Since the younger men have to repress their anger out of fear, they ultimately direct their anger on to themselves. Killing oneself is also killing the hated internalized object. If this act of hatred is also sanctioned by the community and can be projected on to another authority figure—the ‘other’—it is even more likely that the suicide can be executed without guilt feelings (2004, 1266).
This formulation belies a culturally specific form of knowledge, the Oedipal complex, applied to an entire society. Although unspecified, nothing in the article suggests that the author has conducted systematic research to qualify the statement about "many Arab families". The discussion funnels from Arabs to the geopolitical awareness of Palestine. The theme of the authoritarian father becomes redeployed. In this setting, violence serves as the only answer for shamed, despondent sons. The disordered Arab family contrasts with the stable "Western" family and psychological analysis provides the way for powers intellectual and moral.
Authoritarianism also taints the relationship between Muslim parents within the family. In Psychoanalysis and Terrorism: The Need for a Global “Talking Cure”, Baruch attributes suicide bombing to the inherent inequalities of Muslim societies:
In societies that are antisexual and misogynistic, the separation of boys from mothers, and from women in general when those boys grow up, is often forcible and violent. Paradoxically, the Muslim veiling of women in an attempt to hide their sexuality has the opposite result: One can never forget about their sex. At the same time an infantile attachment to mothers remains, as in the case of Mohamed Atta and probably Osama Bin Laden (2003, 698).
In one fell swoop, Baruch faults an entire civilization. She cannot locate agency in a Muslim woman who chooses to veil herself. She aggregates Muslims as diverse as Eastern Europeans, Africans, South Asians, Southeast Asians, and Americans into one category. Moreover, an assumption is propounded that repression of women entails sexual repression, leading to violence. The image of chauvinist Muslims implicitly contrasts with the progress of Europeans and Americans. Psychological analysis of the repressed Muslim woman leads to powers intellectual and moral.
The stereotype of the sexually insatiable Muslim male recurs frequently. Some attribute this characteristic to an emulation of the Prophet. In Psychoanalytic Notes on Osama bin Laden and His Jihad Against the Jews and the Crusaders, Kobrin starts with the similarities between Osama bin Laden and the Prophet Muhammad: “Osama bin Laden's father's name was Muhammad. Hence the figura of the Prophet Muhammad has weighed heavily in bin Laden's psyche” (2003, 211). After explaining how the Prophet Muhammad kept “three famous concubines—two Jewesses and one Coptic Christian” (2003, 211), she extrapolates how the Prophet offered a template for the conduct of Muslims toward non-Muslims:
The subject of women as wives, temporary wives, and concubines also serves as an important window on how Islam relates to the Other via the archetypal relationships that the Prophet Muhammad is reported to have had (2003, 214).
A number of philosophically questionable assumptions undergird this analysis. First, she posits a relationship between two people simply on the basis of name. Next, she essentializes the identities of the concubines to their religion without incorporating historical information. Afterward, she professes that Islam has constructed an entire civilizational behavior toward Judaism and Christianity. She treats Islam monolithically throughout time and space without reckoning with periods of interreligious harmony. The image of the authoritarian Muslim is contrasted against the Western man. Psychological analysis of the Muslim man leads to powers intellectual and moral.
Authoritarianism extends from the family to society in the suppositions of Lester, Yang, and Lindsay, though in a religious format. In their Suicide Bombers: Are Psychological Profiles Possible?, they virtually imply that childhood in Islamic or Middle Eastern societies leads to suicide bombing:
The Middle Eastern terrorists and suicide bombers are typically raised in very strict fundamentalist Islamic sects whose teachings they accept. They do not come to their belief systems by a rational appraisal of alternative ideologies as adults. They accept the ideology in which they are raised. They show conventionalism (2004, 291).
Here, Islam is seen to motivate militants toward violence. No first-order analysis of sects or teachings is offered, let alone a more sophisticated, second-order analysis of how some might dress political and social messages within the cloth of religion. The docile acceptance of Muslims contrasts with the critical speculation implicitly attributed to Western peoples, a true marker of adulthood. The geopolitical awareness of difference surfaces with the desire to understand. Powers intellectual and cultural are on display.
Others explain the authoritarianism in Muslim societies in reaction to a disordered society. In their Suicide Bombing: A Psychodynamic View, Khalid and Olsson are more explicit about the violent tendencies of Muslims:
Here it is possible to apply the [sic] Volkan's ideas about societal regression to radical Islamic and Arab populations. These countries and the cultures involved in them have been suffering continuous turmoil and instability for centuries.Regression is usual in such circumstances and it has its consequences. One of these consequences is the need for a strong leader to depend on—to satisfy dependency needs and the need to be protected. Enter dictators who can make the situation worse by directly preventing societal progression in many Arab/Muslim countries (2006, 527).
In their perspective, Muslim and Arab populations have suffered perpetual violence that leads to a collectively primitive defense mechanism. Whole epochs of political, economic, social, and cultural stability become discounted. Moments of Euro-American collaboration and competition are absent from this narrative. The aggressive brutality of Muslims requires a suppressive dictator in contrast to the post-Enlightenment liberality of Western societies. Geopolitical awareness motivates this psychological analysis with consequent analytical powers that are intellectual, cultural, and moral.
Finally, the irrational aggression originally located within the individual extends to whole countries. In Religious and National Radicalism in Middle-Eastern countries: A Psychoanalytical Point of View, Hasanov applies Adler to Muslim societies:
This article explores the Adlerian concept of inferiority complexes that serve as a possible source of unconscious motivation for religious and national radicalism. The Middle-Eastern countries of Iran, Iraq, Syria and Turkey serve as examples. Religious extremism and national radicalism are described as a result of the overcompensation of underlying inferiority complexes caused by belonging to ethnic and religious minorities (2005, 120).
The paper alternates between describing Sunni and Shia examples of extremism. Presumably, violence conducted by adherents of other religions such as Jews and Christians does not relate to religion since she does not cite examples of American or European governments. Islam inherently becomes associated with violence, contrasting with the peaceful, secular West. Geopolitical difference and psychological analysis unite to form powers intellectual and moral.
Taken together, the strategic formation of these texts portrays Arabs and Muslims as Other with common, recurrent arguments. Populations in the Middle East are dissolved as “Muslims” or “Arabs” without enumerating their substantial ethnic and religious diversities. Simultaneously, Americans and Europeans are known through secular terms, usually nationality or geography. Sex and aggression motivate Arab and Muslim societies at the individual, societal, and country level. Their irrational drives diverge from the values of the rational West. Major social and political movements such as modernity, industrialization, globalization, and secularism are discounted for Arabs and Muslims whereas examination of “Western” foreign policy and political economy remain absent.
The very methodology of psychoanalytically diagnosing whole societies has long been debunked in anthropology and cultural psychiatry. In the 1930s, researchers from the “culture and personality” school such as Ruth Benedict and Margaret Mead attempted to relate individual behavior and social structure to studies of national character (Kirmayer, 2007a). An opposing view from Edward Sapir (1938) argued that culture consists of the actions and behaviors of individuals who possess the agency to act differently. However, by the late 1950s, the influence of the culture and personality school waned as methodologies could not progress beyond problematically essentializing whole societies (Levine, 2001). The fact that these psychodynamic texts revert to this procedure raises questions about the ethical and political motivations of the authors, acting as armchair anthropologists and psychoanalysts removed from their subjects.
The topic of suicide bombing deserves specific attention. None of the authors above engage in higher-level political analyses of suicide bombers. No mention of colonialism, military occupation, or asymmetric military capabilities is offered. In reviewing methodologies used to study suicide bombing, Aggarwal (2009) has suggested that values around life and death are culturally determined and that current research has not unearthed these meanings for potential suicide bomber recruits. Cultural psychiatry and psychiatric anthropology must therefore grapple with the meanings and motivations propelling suicide bombers before introducing interventions. Thorough political analyses would observe how countries invoke the right to conduct violence to protect its citizenry and label all violence of non-state actors as “terrorism” though there may be little difference in actual techniques (Asad, 2007). In contrast, these psychodynamic texts assume the right of the state to conduct violence, labeling all other violence “terrorism.”
Said knew all too well the influence of orientalism on scholarship. Said wrote: “Books and articles are regularly published on Islam and the Arabs that represent absolutely no change over the virulent anti-Islamic polemics of the Middle Ages and the Renaissance” (1994, 287). These psychodynamic texts fit this description aptly. Mental health professionals have evolved an orientalist knowledge base about Arabs and Muslims by excluding them from science production and linking pathology to race.
Rethinking the Claims of Science Through its Social Values
These psychodynamic texts raise questions about the validity and reliability of their scientific claims. Two values of science interrogated by philosophers of science over the past half-century include science’s objectivity and universalism. The extent to which psychodynamic literature on Muslims and Arabs post-9/11 achieves these values can serve as a benchmark for considering whether this literature is scientific.
Many scientists attempt a disinterested objectivity within their methodology. 1996). Science becomes believable – and in turn, scientific – from objective, reproducible tests which reduce theoretical artifacts and systematic error (Kosso, 1989). Objectivity in science normally entails a detached relationship between the scientist and the object of inquiry such that general laws about the nature of an object can be formulated without the peculiar, contextual factors that give the object its identity (Nuyen, 1990). It is generally assumed that there is a fixed external reality, observations can be made on this reality, and that scientific beliefs approach accurate understanding of that reality (Sundaram, 1985). Thus, scientific rationality and objectivity come in degrees, not binaries, which good science maximizes (Machamer & Wolters, 2004). Finally, peer review determines objectivity, ensuring that an individual's data becomes subject to a social process of correction and deliberation (Longino, 1990).
Based on these descriptions of objectivity, the above psychodynamic texts would not pass the test for science. It is unclear that their method of analyzing societies could be independently reproducible given the lack of explicit process for such analysis. The writers do not speak with the detachment and critical distance between them and their objects of study. There is no method to corroborate the “findings” of psychodynamic authors with external reality. Most problematically, there is little sense of what could define “good” against “bad” science in this community. It may consequently be asked how this literature passes peer review; if so, who are the peers and what are their standards?
Moreover, it is suspect that this literature would pass the test of universalism. Universalism holds that a scientific concept is valid in any society irrespective of culture, (Ziman, 1996). This engenders a paradox: scientific knowledge produced locally must be relevant globally, and this can only occur through the international dissemination of and agreement over once-local theories and practices (Harbers, 2005). Many object to psychoanalysis’s universalism. Anthropologists and philosophers have charged Western biomedicine with “imperialism” and “colonization” of other cultures given that psychiatry and psychoanalysis has not been validated rigorously outside of Western cultures (Sadler, 2005). A number of cultural psychiatrists have questioned psychoanalysis as moralized Western assumptions about rationality and individual autonomy as foundational for “health” and “adaptation” (Littlewood, 1996). Indeed, psychoanalysis requires individuals to free themselves of social obligations to act in ways that are entrepreneurial under the realm of self-actualizing (Littlewood, 1993). In contrast to Euro-American views of the self as individualistic, African and Asian cultures may possess sociocentric views where relationships with others form an important part of the self (Kirmayer, 2007b). Psychodynamic formulations on their own do not account for social and cultural factors relevant for non-Western populations (Bhugra & Bhui, 1999). When they are accounted for, psychiatric histories often erroneously incorporate race, religion, ethnicity, and other demographic information for individuals who do not fit the mold of white English speakers (Knowles, 1996).
The authors of these psychodynamic texts appear unaware of these stringent criticisms about the universal applicability of psychoanalysis. Western concepts of diagnosis, selfhood, normality, and abnormality are imported without an attempt to understand Arabs or Muslims on their own terms. The standardization of norms occurs through psychoanalytic concepts and methods developed in European and American societies that have not been culturally validated elsewhere. For example, values inform judgments about the religious practices of Muslims, Arab family dynamics, diagnoses of Muslim societies as borderline and regressive, and functional impairments in social and political domains. Most significantly, no individual is actually analyzed as wholesale societies are condemned.
Does this psychodynamic literature represent science? If we believe that good science strives toward objectivity (Machamer & Wolters, 2004), then these psychodynamic writings, at a minimum, do not count as good science. However, these views do not negate the fact that an influential professional community has developed its own value systems about Muslims and Arabs. The psychodynamic literature therefore falls within the geography of contemporary global science with its universalistic claims to knowledge despite Euro-American control (Peters, 2006). Psychodynamic ethnographies of Arabs and Muslims invoke a dichotomy between the uncivilized Orient and the civilized Occident. The implicit understanding is that that they have not yet caught up to universal European, and now American, modes of lifestyle, remaining deficient.
The American Psychiatric Association (APA) hints at an awareness of the sensitive nature of psychiatric knowledge by warning that clinicians unfamiliar with cultural references may pathologize normal beliefs and experiences (2000, 34). Here, we have a different scenario where the subjects of study are not given the opportunity to speak even as differences are generalized, exaggerated, and tested against Western criteria. History repeats itself as psychoanalytically oriented authors pathologize non-Western societies, a practice common throughout the eighteenth and nineteenth centuries (Littlewood, 1996).
This article has used Edward Said’s concept of orientalism to demonstrate what can be truly called a negative publication bias against Arabs and Muslims in the psychodynamic literature. Examples of these texts have been laid out so that readers can judge for themselves how these communities are depicted as anti-modern, irrational, and pathological. The work of historians and philosophers of science has consistently emphasized the role of values in knowledge production and these concerns have been registered against psychodynamic authors. By surveying how this knowledge becomes produced, mental health researchers can detect how some cultural values become exalted and universalized while others become defamed and critiqued in the guise of science.
The cultural theorist Homi Bhabha has written on the paradox of proponents of democracy who espouse equality and justice even as they wage such evils as colonization and slavery. In gauging the War on Terror, he writes:
This war internal to democracy is a struggle between a sincerely held ‘universalism’ as a principle of cultural comparison and scholarly study, and ethnocentrism, even racism, as a condition of political practice and ethical prescription (2003, 29).
Replace the word “democracy” with “psychiatry” and we encounter a general tension within cross-cultural psychiatry. As a form of professional reflexivity, mental health researchers in cross-cultural psychiatry would benefit from the continuous appraisal of facts heralded as universal or local and the critique of values inherent in these determinations. This endeavor would mean that psychiatry, psychology, and mental health in general ethically and politically remain universal rather than the province of a few.
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