A suicidal painting by a psychotic patient. After putting his suicidal thoughts into a painting a patient said he was relieved (photo by Mona Abouissa)

Back in the 1920s – also in a mental asylum but not under Cairo's heat – in Switzerland, a psychiatric patient and artist Adolf Wolfli would inspire both artists and psychotherapists. However, art would remain a mysterious companion for the subconscious until the Second World War whipped the world off balance. The war's aftermath reformed people's mental states and gave a push toward both art and psychiatry. Doubts about orthodox psychotherapy returned, perpetuating the evolution of art therapy. Now Wolfli is in history books. However, in Egypt art therapy is just seeing its early days in the mental health sector.

“I paint therefore I exist”

Art therapy can help anyone from cancer patients, to frustrated teenagers, to

The late Dr. Magdy Refaat with visitors at his art studio. He was one of the pioneers of art therapy in Egypt (photo by Mona Abouissa)

psychotic patients and drug addicts. Very few mental institutions in Egypt include art therapy in their program, though. It is an unconventional method, but it could create miracles with people who find themselves mentally and physically incapable to express themselves; when words fail. Carol Hammal, an art therapist from a mental hospital, told me that art therapy has a different effect with different mental states. In addiction, it is drawing and talking about troubling issues. With psychotic patients (like bipolars and schizophrenics) it is a means to express what they feel and even help to restore a sense of existence. And for patients with special needs, it is mainly a means of tracking their development. Dr. Osama Ahmed, another experienced art psychotherapist, said that one may even alter the personality of the patient and even stabilize it with art therapy. However, that requires experience and knowledge from the therapist himself.

“I paint therefore I exist!” said Dr. Refaat when I first visited his private art studio in downtown Cairo. He welcomed not only his former patients, but anyone who sought an explanation. There I met Khaled, a student of engineering. He was unsure whether or not to stop his medication, Abilify, which he had been on for two years. It dulled his brain, he told me. But Khaled worried he would return to the mental institution.

Khaled spoke of himself couple of years back as a completely strange person. He was admitted to Behmen Hospital with a diagnosis of ‘drug induced psychosis’ caused by the use of drugs by someone who is predisposed to psychotic episodes. His first try of cannabis triggered a psychotic syndrome lasting over a month. “I was feeling frustrated and disappointed in people and life, so I needed to feel an alternative.” Khaled told me about how deceptive the mind can be. “The mind is very tricky: when I was having all these panics, aggression, hyper-activity and delusions thinking that my life is threatened, that there is a whole web of conspiracies against me, it never occurred to me that I was acting strangely.” It took time for Khaled to overcome his fears and draw. He said art therapy sessions helped him to get a grip.

Now Dr. Refaat's studio is closed, and his place in Behman hospital has been taken by a young art therapist. Dr Refaat died in a tragic car accident in May this year. During his life, he combined psychiatry practice with his 60-year experience in art and was said to be the pioneer of art therapy in Egypt. He believed that words are mostly “insufficient and limited” for describing emotions, and so did his many visitors. “The Chinese say that 1000 words can’t reach a glimpse of a feeling, but an image gives it directly.”

In a safe place

Dr. Shaun McNiff, an international pioneer in art therapy studies, used to say that art therapy is

Behman Private Hospital, one of the Egyptian mental hospitals that introduced art therapy into psychiatry (photo by Mona Abouissa)

“letting go in a safe place”, which could explain why art therapy took root in Egypt. “Within this culture it is not threatening, as it creates a comfort zone – a safe zone – since it is different from traditional psychotherapy,” said Carol Hammal. She used to be Dr. Refaat's assistant, and recently took his place at Behman Hospital. The first time she experienced how art therapy can help in a cultural context with Egyptian youth was when she ran art therapy classes in a high school in 2004. Students learned how to channel negative energy as stress in order to create something positive – a concrete art work.

“We are not used to psychiatry and psychology as part of our health system,” continued Carol, “what helps with art therapy is that traditional people who still believe that psychology and psychiatry are a reference to the word “crazy” may feel less threatened when they work with an art therapist as what we do is draw.” However, communication is an important part of the therapy, but it is optional if a patient refuses. Currently Carol is preparing to travel to the US to study a masters in Creative Arts in Therapy at Drexel University in Philadelphia.

Dr. Ann Shafer has a different point about art therapy's potential in Egyptian culture, “ In my opinion, the sacred arts have a deeper history in Egypt, rather than the Western expressive arts. But, of course, for the last century at least, the West has had a major influence on the arts here.” Dr. Shafer added that there has been a lot of confusion in the process. As a result Egyptians could be not interested in using art as the therapeutic tool it was in ancient times. “This has to do with conceptual habits and stigmas about the role and making of contemporary Art, about psychology and psychotherapy, and about East-West cultural relations.”

Dr. Shafer has a Ph.D. from Harvard University in the History of Art & Architecture, and also holds a position of Art Program Director at American University Cairo. “In the West, since the early part of the 20th century, its purpose has been understood as expressing emotions or emotional issues, whether it be from the point of view of the individual artist, or from society as a whole.” Dr. Shafer said that with careful study, therapists learned how art can be a treatment tool letting a person express what they otherwise cannot, which helps them to deal with their problems. “It allows individuals to 'speak', and it allows them to see themselves – at this point, they can either change or accept who they are, or a little of both. Art is like a mirror, in that sense.”

What all art therapists agree is that art therapy is a powerful and expressive method, and whatever the conscious or subconscious struggle not to reveal will eventually come up on paper. From my own experience, a quite scary effect to feel – being revealed.

Art of insane

Dr. Refaat showed me some exhibited artworks by one of his bipolar patients. He drew skillfully his

The work of visitors to the late Dr. Magdy Refaat's studio (photo by Mona Abouissa)

delusion of grandeur, common among bipolar patients, and his indictment against psychiatrists and drugs, accumulated from his experience as an inmate of an Egyptian asylum. Bipolar disorder is known to be a companion to genius. He drew himself as a magnificent crocodile on whose back Cairo rested, being terrorized by hospital's doctors trying to inject him with drugs. Doctors and drugs shut the crocodile's mouth through which the Nile found its path, they shut down his creativity. I knew from Dr. Refaat that he mounted an exhibition. However, not every mental patient can have such an opportunity.

“I always find it very encouraging and brave when people are open about their conditions,” Carol believes, adding that there is nothing wrong in mentally ill painters signing their works if they want to. “It may promote higher self-esteem and show other people going through the same dilemma as this patient how to overcome it.” Dr. Osama Ahmed, a treating art psychotherapist and head of the Art Therapy Department at the Psychological Medicine Hospital in Cairo, said. “Because of their mental disorder, they have this high level of creativity, they are all artists!”

However, not every hospital in Egypt is eager to reveal their patients identities beside their art work. Like Behman Hospital, Psychological Medicine Hospital arranges group exhibitions of their patients, but only patient's initials are allowed on the paintings. “I personally usually discourage a patient when they want to put their names on their paintings. It is for their own sake,” said Dr. Ahmed. So if someone recognizes the patient, they may mock their mental condition rather than admire their artistic expression. Mental illness is “needless” to be revealed in the doctor's opinion.

But if so, then there would be no Wolfli, no surrealists, no so-called Outsider Art movement illustrating extreme mental states, and no art therapy in the first place. All would stay hidden behind mental asylum walls.

Mona Abouissa for RT