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Two dogs were barking outside in the darkness. She saw her face reflected in the window, pale and lost as it looked back at her. She stood by the window in silence. Down in the dark garden a cigarette glowed, and for a moment she saw a man’s face. She undressed and stood at the window naked. Perhaps Farid was seeing her now in his dreams. She didn’t hear the door open. The red-haired nurse came in and shook her head with pretended compassion. Then she handed Rana some tablets, put her long nightdress on her, and helped her into bed.

Al-Asfuriye, the House of Sparrows — that was the name of the psychiatric hospital. She suddenly remembered a language teacher who had once told her that in Arabic the words for “insanity”, “ghosts”, and “Paradise” were closely related. They all had to do with hiding away.

280. First Report

Dr. Salam, chief medical director. Reception report, Monday 15 April 1968, 16.00 hours.

Hospitalization: patient brought in by mother and brother three days ago, seems willing to be here, perhaps even relieved. Was here for three weeks in summer last year (I was in Paris at the time, 8th Psychiatric Congress. Little useful information from my deputy, Dr. Huss).

According to mother, has always given family cause for concern, “difficult”. Has been increasingly unwell for last two or three months, withdrawn, hardly eating, has not seemed normal. Keeps going up on the roof to spray water over neighbours and passers by. Not much further background to be gleaned from the family

Psychostatus: Young, pretty, obviously intelligent woman, father is a well-known attorney. On admission clearly aware, generally well-orientated, but expression hypotonic, physical movement restricted, body language conveys desperation, anxious, suggestion of Veraguth’s eyelid folds. Speech monotonous, monosyllabic, thought processes slowed down and inhibited, but no formal thought disturbances present. Mood despondent, possible lack of affective control. Speech reserved, confined to a few subjects: feels she can’t go on, she is a burden to everyone else, can no longer perform her domestic duties (also marital duties?), despairing. Strong feelings of guilt.

Also sense of failure regarding parents, especially father. Poor relationship with mother. Suicidal feelings allegedly present, but nothing concrete. No delusions or hallucinatory experiences. General loss of interest, weak drives, abulia. Sleep disturbances, difficulty in falling asleep, insomnia. No deep morning sleep.

Somatic condition (pending examination by Dr. Balkani): good general condition, slightly undernourished. Says she has lost 4 kilos in recent weeks.

Anamnesis: no serious anamnesic disturbances.

Heredity: great-uncle on mother’s side apparently suffered from depression. Mother also takes anti-depressants. Patient grew up in comfortable circumstances in Damascus, younger brother. No developmental problems can be traced, very good school student with excellent high school diploma (father publicly boasts of it). Had planned to study at university, but married in 1961 to cousin on her mother’s side (Rami Kudsi now a colonel). Seems to have been psychologically well balanced until her marriage. No indication of earlier depressive or manic phases.

Traditional moral upbringing, can be assumed that father especially was strict and not communicative. Mother disappointed that Rana was not a boy (obsessed with securing family bloodline). Mother/daughter relationship poor from the first.

All this in some contradiction to the mental independence evidenced by educational achievements and aspirations. Denies conflicts with her father, although I would not be surprised to find that they exist. Appears very conformist, husband certainly matches parents’ wishes. No children. Cautiously approached on subject of her marriage, she reacts with anxious uneasiness, becomes reserved, suspicious. Feels guilty towards husband but will not say why. Unclear whether reserve is to be attributed only to depression, or whether it is particularly difficult for her to speak to me, because I am a friend of her father’s. Dr. Bishara would be helpful here.

Diagnosis: initial phrase of a probably exogenous depression, with an element of anxiety. No indications of cyclothymia.

Procedure: admission to quiet room in acute ward for women. Begin with bed rest, exercise only in company of staff. Watch for suicidal signs. No visitors at first; patient to feel distanced from her family and safe.

Medication: begin with imipramine and low dosage of levomepromazine. Chloral to help her sleep. If effects insufficient, perhaps chlorpromazine.

In view of the presumably neurotic factors, Dr. Bishara to have regular conversations with her on the ward. Patient to come to my office once a week.

281. On a Distant Island

Farid was laughing at her. And as if he were an appetizing dish to eat, she found her mouth watering. When she woke up, the sky was looking in through her window. It was very early, the garden still lay in shadow, and a rooster was crowing far away. She felt strong, and opened the window. The air smelled of jasmine and orange blossom. She held the bars and breathed deeply with relief. She was free. She was feeling better every day now that she was here.

Over the last few days she had felt a curious sense of peace. Questions surfaced, could not be answered, and left her in melancholy mood. Why had Jack always been preferred to her? He had been allowed to go out into the street any time, visit his friends, go to the cinema. But every outing she wanted to make had to be carefully checked first. And when she and Jack made the same mistakes, she had always been punished more severely, on the grounds that mistakes do girls more damage than boys. And then everyone was so serious. She had always liked laughter, and as a child she loved anyone who smiled at her.

She liked the peace and quiet of this institution, so she refused to see any of her family. Dr. Salam understood, and went along with her wishes without any ifs or buts. He had even spoken angrily to her mother when she pestered him, and sent her off home. Dr. Salam said nothing about this little altercation, which had been conducted in his office. Rana heard of it only from Adnan, the nice male nurse with the glass eye. When her mother left, Dr. Salam had told Adnan that they would have to keep her in the closed ward for a couple of years.

Adnan was a joker who kept taking his glass eye out, hiding it in his mouth behind closed lips, and then putting on sunglasses. When he met anyone he laughed, and his eye would peep out of his mouth.

She didn’t want anyone to know that she had begun to feel better here after only a few days. Not even Dr. Salam the medical director. It wasn’t difficult for her to feel unwell; she just had to think of the day when her cousin had raped her in her family’s drawing room.

She didn’t have to split into two people here. For years she had been able to endure life with Rami only by leaving herself as soon as he touched her. He had her body captive, she put her mind to one side and watched, or walked through the house and quite often outside it too. And she didn’t come back until she heard him groaning in orgasm. He used to bellow and snore at the same time; he sounded like a bull. She wasn’t used to that from Farid. Farid made sounds like a little puppy yelping when he reached his climax.

She remembered one icy cold winter. She was lying in bed, running a high temperature. A cold followed by flu had left her very weak, but her husband wouldn’t take a single day off work to look after her. The President trusted him, he said, and he wasn’t about to disappoint the President just because she had a sniffle. She exploded, calling him and the President names, saying the President had enslaved him. He turned pale and went into the kitchen. An hour later he came back, drunk, and shouted at her never to say such things about the President again. Then he beat her as she lay in bed. She was afraid he was going to kill her. Finally he left her alone, and disappeared for a week. At the end of that time he came back, beaming as if nothing had happened, and called her “little pigeon” again, because he wanted to sleep with her.