Psychotherapy in Morocco: an arduous journey fraught with exploitation and extortion

According to the only official study on mental health in Morocco¹, whose figures are still adopted today, 48.9 % of Moroccans over 15 suffer from a mild or major mental disorder. On the other hand, the supply of psychological treatments remains weak, both at the level of qualified human resources and at the level of infrastructure and capacity. Official reports confirm that the average occupancy of public mental health hospitals exceeds 100 %, and it’s overcrowded to the extent that some hospitals are at 200 % of their capacity², reflecting the big shortage of beds, which do not exceed 6.2 beds per 100,000 inhabitants, while the average in Europe is 62.7 per 100,000 inhabitants.

According to the latest figures presented by the Minister of Health last January³, the problem of psychiatrists in Morocco is chronic, and will not be overcome in the short run due to the presence of an acute shortage; the total number of persons specialized in psychiatry does not exceed 2644, of which 418 are doctors (247 doctors in the private sector, 171 in the public sector), 47 doctors specialized in child psychiatry, and 1 460 nurses specialized in mental health and 719 social workers in the public sector, which means less than one doctor per 100,000 inhabitants. This is due to the shortage of cadres in the Moroccan health system in general, which is estimated at about 97,000 doctors and nurses in all specialties⁴, in addition to the fact that mental health sector is unattractive, due to the “stigma” that goes beyond the patient to affect the doctor, and the attacks that these people can be subjected to by a patient in a state of agitation without protection or insurance, which has already caused the death of some healthcare providers, which leads them to shift to other specialties that are more comfortable and financially rewarding.

Professionals agree that the psychiatric field has been excluded in public policies, as the Ministry of Health does not allocate a special budget for mental health, although the World Health Organization recommends at least 10 % of the health budget for the psychiatric aspect, and public expenditures on mental health do not exceed two dollars per person per year.

According to Omar Buram, head of the mental health department at the Ministry of Health, about 85 % of people in need of psychiatric care in Morocco do not receive any treatment, due to reasons such as stigmatization, but also because mental care services provided do not meet the huge demand.

This situation makes the journey of psychotherapy very arduous. According to the cases heard, many families were unable to complete the treatment despite starting it, and others could not start it due to the remoteness of hospitals that remain limited to major cities, especially Casablanca, Berrechid, Salé, Tangier and Marrakech.

Ali Lotfi, chairman of the Moroccan Network for the Defence of the Right to Health and Life, said that in many cases, families find themselves forced to travel hundreds of kilometers to reach the nearest psychiatric hospital, but often return empty-handed due to the lack of a hospital bed and far-off appointments, while other families do not start this journey in the first place.

Younes shares how his family had to endure the commute from the city of Quneitra to Salé to seek treatment for one of its members who suffers from schizophrenia, but despite the worsening condition of the patient, who started to threaten with killing himself and those around him, the doors of Al-Razi Hospital remained closed with the excuse that there is no vacant bed, and because the hospital is working beyond its capacity. The family went home empty handed, just like other families that had to go back all tired and miserable. The weak offer of treatment opens the door to forms of corruption, mostly for nepotism. Younes said:

After a tremendous effort and after taking different routes, my relative got a bed at an addiction centre in Tangier, 200 kilometers away from home.When we thought that the ordeal was over, a new suffering emerged, as some of the center’s staff would call the family at the beginning of each month to get an illegal payment, while threatening to discharge my sick relative, so one of us would have to go to Tangier and hand over the money in a café or by the roadside, out of sight.

Alternative “treatments”

Difficult access to treatment in public hospitals may be the cause of other tragedies, including suicide, homelessness, committing crimes and resorting to dangerous treatment methods. "In addition to the stigma and shame, which leads many families to refrain from seeking medical treatment, the weak health system is one of the reasons that motivate families to seek traditional methods of psychotherapy instead”, Lotfi adds.

They visit pious men and shrines, and they resort to Ruqyah⁵ to remove the effect of magic or cast out the Jinn and hidden forces to which the families attribute the psychological disorder, in addition to resorting to a mixture of herbs, washing, or carrying minerals. They also resort to therapeutic rituals based on musical rhythms and dancing, or giving gifts and slaughtering animals, while other families resort to imprisoning the patient permanently, or the latter is doomed to homelessness.

Mohsen Benzakour, professor of social psychology, said there is a causal relationship between the difficulty of obtaining treatment in hospitals and the use of superstitious methods that derive their legitimacy from the generational inheritance of tales that tell stories about the recovery of people who were suffering psychologically, tales that find a foothold in the absence of awareness campaigns about the falsity of superstitious means, and the high rate of illiteracy, and that psychological treatment needs specialized doctors. This is also confirmed in the report of the Economic and Social Council⁶, which was described as”Guantánamo“, because of torture methods practiced against the mentally ill, as they are imprisoned, chained and periodically violated, in attempts to cast out”evil spirits", before the authorities closed it in 2015 after a series of scandals and atrocities that were leaked from the shrine.

Not far from the city of Meknes, located 150 km east of the capital Rabat, lies the shrine of “Sidi Slimane Moul El Kiffan”. It is believed that visiting the shrine and bathing in the nearby spring, cures the person of the “infatuated jinn” and “magic” or other names given to mental illnesses such as depression, schizophrenia and obsessive-compulsive disorder, that are attributed to metaphysical forces, often associated with the Jinn.

Once at the shrine, located in a semi-isolated area, the voices mix between the screams of mentally ill women, zalghoutas (trills) and songs praising the Prophet (peace be upon him), in rituals whose practitioners claim to be exorcising the Jinn possessing the patient, and rid her of it. Soon after new visitors arrive at the shrine, fraudsters practicing “psychotherapy rituals” rush to offer their services and compete for the customer – Shrine-goers are of different categories, including illiterate, poor, rich and educated –, claiming that they are providing the service at the best price, and that the result is guaranteed.

To treat those coming to the shrine, small houses and tents are scattered on the sides of the valley that lies below the “Sidi Slimane Mall El Kiffan”, used as baths, where the lady who seeks treatment (patients are often women) accompanied by “female supervisors” whose task is to fetch “holy” water in buckets from the spring, and supervise the process of “bathing”, which is accompanied by the patient’s screaming fits, zalghoutas and songs by “female supervisors”.

Abd al-Rahman, one of the “fraudsters” who perform these rituals, and who offered us his services, said that the rituals of “treatment” range from one to three days, where the patient comes to bathe, and then goes up to visit the "pious man”, if the patient feels better after going home, there is no need for him to return, otherwise he is obliged to complete the treatment of three days.

The fraudster, who stressed that the price of the “service” depends on the patient’s resources, refused to specify a price for the “treatment”⁷. He added that the patient, in addition to buying incense from the stalls scattered on the sides of the shrine, is advised to slaughter a rooster in the shrine or to prepare a feast in his house, and it is preferable for the person who wishes to complete the treatment to spend the night in his house, so that he takes the “blessing” with him, and cleanses himself of “magic” or “evil spirits”. If the patient is from a distant city, accommodation is available for 100 dirhams per night (€10).

Abdel Rahman stressed that the treatment in “Sidi Suleiman Mall El Kiffan” is guaranteed because the Great Jinn Court is located there, and that in addition to mental illness, the shrine is blessed that it fulfils all desires, whatever they might be, including marriage, curing blindness and disability.

Scams are a phenomenon inherent to “treatment” in shrines, where Abdul Karim, one of the people who resorted to this treatment after a long suffering with the medical treatment journey, tells us that a person deluded him claiming that staying overnight for three days in a shrine in a remote area would treat him, in exchange for giving him a sum of money under the pretext of buying incense and performing special rituals. The scammer easily took his money.

The danger of resorting to shrines is not limited to the scams. A study on suicide in the province of Chefchaouen revealed⁸ that a patient who was taken to the shrines by her family ended up killing herself. While she struggled with depression, her family was going from one shrine to the other, believing that a Jinn was behind what was happening to the young woman. Eventually, her condition worsened and she put an end to her life in a tragic end.

"Ruqyah”, sexual exploitation and extortion

In addition to shrines, resorting to “Ruqya” is one of the most common ways for people with mental problems and illnesses, an expanding arena given the great financial gains of “commodification of religion”. An indicator of that is the spread of Ruqya performers across all neighbourhoods, and even on social media, which is one of the most important ways to attract customers. Meanwhile religious Ruqya is limited to reciting verses from the Qur’an and repeating some prayers to the patient, reality shows that it was turned into a form of blackmail, fraud and rape. It could even cause someone’s death.

In April 2023, the Tangier Court of Appeal sentenced a Ruqya performer to 10 years in prison, after convicting him of swindling, sorcery, raping and filming at least 9 women, as he provided his victims with bottles of water containing narcotics, to exploit them sexually while filming his actions.

Before that, in October 2019, the Court of Appeal in Oujda sentenced a “Ruqya” performer from the city of Berkane to 10 years, after convicting him of raping women who came to him seeking treatment. The case details revealed that he filmed his victims and blackmailed them with videos for money.

One of the victims of the “sorcerer” tells how her pursuit of treatment through Ruqya turned into a nightmare, and caused mental harm to her family and acquaintances, especially after leaking a sex tape where she appeared. The sorcerer used it to threaten her, which “broke her” as she puts it.The victim says, while fighting the tears and asking for the community’s support, that the Ruqya performer, who was frequented by a lot of women, handed them water bottles claiming they were for Ruqya, and as soon as the victim drinks the bottle she’d lose consciousness and control over her actions, then he’d sexually exploit her, film the assault, and then the extortion begins.

One of the most famous methods used by those folk healers is to subject the patient to severe beatings and torture, under the exorcising the “jinn”, a process that involves great violence, sometimes leading to the patient’s death. This happened to a woman in her fifties in the city of Al Hoceima, who died of severe injuries caused by an attempt to exorcise the “infatuated jinn”, which is the same fate of dozens of women who were subjected to torture instead of resorting to specialists.

Translated by Takwa Masadeh