Proving that I can write about things other than the Spanish flu …
In the summer and fall of 1883, the newly-installed Anglo-Egyptian government faced its first public health crisis when cases of cholera were reported in the Nile Delta and rapidly spread throughout the country. The government’s response was based in part on long-standing European prejudices about the “Orient” as the origin of plague and pestilence and “Orientals” as people who did not understand health, science, or hygiene, and were unconcerned—even fatalistic—in the face of life-threatening illnesses.
To the contrary, Egypt had, over the course of the 19th century, developed a basic national health system, which had earned praise from European observers prior to the British occupation in 1882. The prejudices expressed by British occupation authorities also elides the British government’s own stance in ongoing debates among European scientists about contagion and the appropriate methods for preventing the spread of diseases like cholera.
The Anglo-Egyptian government’s response was based on imperial policies, racial prejudices, and scientific understandings that failed to adequately deal with the pandemic at the cost of 50,000 Egyptian lives.
It’s taken me longer to produce the next post in the grad school survival guide, and there’s a rather simple explanation that I posted about on Twitter.
In personal news: I’ve been having a prolonged bout of depression this summer. I’m done with the Ph.D. and unemployed for the first time since I was 14. I’m functional, but some days emptying the dishwasher requires a massive amount of willpower.
So, there it is. A couple of weeks ago I realized I wasn’t okay, in the grand scheme of things, and that it was more than just me being bored.
What didn’t surprise me was the number of “Me too” responses I got. In fact, I was prompted to make this admission when a friend, Ian Morris, discussed his own bout with depression on a recent episode of the Abbasid History Podcast (it’s in the last three or four minutes of the episode). I figured if someone as brilliant as Ian could do it, I could too, and maybe if more of us say something, we can begin to normalize discussion about it.
Enough patting myself on the back.
The point, dear readers, is that mental health problems often present themselves in graduate school, and there is nowhere near enough discussion about it nor about what one should do. It’s time to change that.
The following post is not even close to a comprehensive listing of dos and don’ts, but random thoughts based on my own experience.
While mental health issues can hit at pretty much any time, they seem to cluster:
At the beginning of your program
Between the end of coursework and comprehensives
After comprehensives
After the dissertation defense.
What all four of these have in common is that they’re all major changes to the way your life is structured. The first usually involves trying to adjust to the change (especially if you’re returning to academia); the last three involve that feeling of drifting–when you’re going from a very structured, high pressure environment to having very little structure, pressure, or deadlines.
When you get to graduate school, assess the mental health services available to you.
It probably goes without saying that this is best done before you need such services, but I’ll be the first to admit I’m not that prepared. If you have the opportunity to assess these before you accept an offer of admission, even better (but, again, I’m not that on top of it. I actually thought my institution had a medical school when I enrolled. It doesn’t. Oops.)
Is there a student health center, and does it include mental health services? If there is not, what arrangements exist to address student needs?
Is there a student disabilities office, and if so, are mental disabilities included? (They should be, but policies differ from place to place). As an instructor, I have sent a number of students to the one on my campus because anxiety, depression, and test anxiety were all conditions that “counted,” so to speak.
If you’re a teaching assistant or assistant instructor, are you eligible to use your campus’s employee assistance program? This is a service that students often overlook because they don’t know that they’re eligible. If you’re employed by the university, an EAP can often help you find a counselor who accepts your insurance, which saves you a lot of extra research.
Avoiding Drift
There’s probably a better name for this, but it’s what I call that feeling when you’re suddenly on your own to read for comprehensives, or researching, or writing, and you’ve gone from meeting friends and colleagues on a regular basis with very little effort to being on your own, sometimes in a completely different city, without a support network.
During comprehensives and writing, if you’re stationed in your home base, a reading or writing group can help. Set up a regular meeting with friends or colleagues and discuss what you’ve been up to.
The caveat here is that this is likely to be most helpful if it’s more of a check-in with other people; if the way you’ve structured your group becomes something that requires you to do additional work above and beyond what you’re already doing, it quickly becomes an annoyance that you or your colleagues will start trying to avoid.
For that reason, I was pretty resistant to doing this during the writing stage–I work best on my own, and the idea of adding to my workload by agreeing to read others’ work and offer feedback on a regular basis was just a non-starter for me. If it works for you great, but, again, knowing your own working style will help a lot here.
And, if all else fails, a regular lunch or happy hour date once a week will get you out of your head for a bit. All work and no play only ever boosted Jack Nicholson’s career, and let’s face it: we ain’t Jack.
Self-care on the research year
I’ll discuss the details of my own research year in a forthcoming post, but let me offer the tl;dr version here: I had no funding and crammed it all into six weeks, and I absolutely exhausted myself mentally and physically. I had been in London for almost two weeks before I left my rented flat for a purpose other than going to the grocery or to an archive.
I cannot overemphasize this enough: do not do this to yourself.
While having a set schedule on research leave does help (get up at normal time, be at archives when they open, etc.), I did this six days a week–and that only because everything was closed on Sunday, or I would have done it seven days a week–and I failed to see the signs of burnout until I moved from London to Geneva and just couldn’t deal. I was only in Geneva for eight days … eight miserable days … but the change in routine, operating language (to French, which I can read but not speak), and the massive increase in the cost of everything caused a mental shock that I could barely deal with.
Part of the mistake here was the eight day bit. I wasn’t in Geneva long enough to really have the motivation to do much other than power through. Had I been there longer, I could have put in more effort to meeting people and getting out more. I’m an introvert, so that can be a bit difficult for me.
As it is, I have a very funny (to me) story about the Museum of the Reformation that I may share someday. (“The presentation on predestination is beginning. You don’t want to miss it!”)
If you’re on a fellowship provided by a local institution, you may well find yourself with a cohort of other fish out of water to form a social group with.
Don’t forget the existence of Meetup.org — need to find other expats? There’s probably a group for that.
But again, all work and no play … makes for a very lonely research experience. If you’re in a new place, remember to take time and smell the roses.
Be open and honest
This brings me around to the reason I posted about dealing with depression on Twitter in the first place: a lot of these battles happen behind closed doors, and there is a taboo around speaking about them.
Mental health resources were not discussed at my own graduate student orientation (either of them). It came up in conversation, and I only knew the answer because I was also a full time staff member.
Be open with yourself–this seems kind of self-explanatory, but, honestly, I didn’t really figure out what was going on until a few weeks ago. I’ve been in a funk since May; it’s now July. And, honestly, part of the issue is that my mental issues usually involve anxiety–depression is new, different, and weird to me.
Be open with those who need to know–your adviser (dissertation supervisor, if you’re at that level) should be in the loop.
If you’re still in coursework and don’t feel like having this conversation with multiple instructors, student disability services may be able to help–again, your situation may be different, but at the campus I’ve taught at, part of SDS’s job was to notify instructors formally of these things and we got a lot of training on confidentiality (‘Please do not approach the student in class and say, “SO! I hear you’re suffering from an STI!”‘)
And I’m pushing my own agenda here, but I really do feel like the more we talk about this, the more normalized it’ll become, and we can start moving away from the issue of mental health in graduate school being such a taboo subject.
I know, not the best title for my first blog entry, right?
A couple of months back, I presented some of initial findings on epidemic and epizootic disease in Egypt during the first World War at a symposium. (Ok, I’ll tell you the symposium was at Oxford. Yes, you may touch me.) I was flattered to be asked, especially since, as an ABD candidate, I got to be part of a two-panel session with speakers like Khaled Fahmy and Marilyn Booth (I’m still not entirely convinced I didn’t embarrass myself and everyone else, but that’s impostor syndrome for you).
The paper–which you can read here–is a short synopsis of human suffering during the war, especially among the poor, rural classes in Egypt, which are largely undocumented. It’s a works-in-progress presentation, very much based in preliminary findings, as one does at this stage in writing.
My dissertation focuses on breakdowns in public health during the war–the topic sentence could be summed up as “1918 was a deadly year for the Egyptian populace.” Even if one heeds Roger Cooter’s warning about reifying a positivist relationship between war and disease[1] –and I’ve compiled statistics for nearly a decade before and after the war–the demographic anomalies in Egypt between 1914 and 1918 are unmistakable. Four times as many Egyptians died of disease during the war than from military actions.
1918 also saw the birth rate decline to its lowest rate in a quarter century.
source: Annual Reports of the Department of Public Health, Ministry of the Interior, 1911-1919.
I described a number of issues: food shortages that were documented as early as 1916. As residents complained about shortages of soap, eggs, cheese, and meat the Anglo-Egyptian administration, concerned with keeping the protectorate profitable, maintained a positive trade balance, exporting goods that were dearly needed at home. The cost of some basic household items rose over 200% between 1914 and 1918.
Likewise, relapsing fever and typhus cases increased substantially — both are louse-borne diseases, which can likely be tied to the increased movement of troops and support staff (including the men of the Egyptian Labour Corps). The war ended with the “Spanish flu” outbreak, which killed almost 140,000 Egyptians in just under three months.
There were also epizootics of both cattle plague (rinderpest) and foot-and-mouth disease that lasted over 18 months in large swaths of the country. Is there a relation between this and the soaring price of meat? It’s almost certainly the source of much of the protein that was sold on the black market in major cities.
As I said. Cheerful stuff.
During the break that followed my panel, a member of the audience approached me, identifying himself as a member of the landholding class from the Sharqiyya province in the Nile Delta (for the record, he is not an academic).
He insisted that I was completely wrong about nearly everything that I had said.
“We had hygiene!” he declared. “People didn’t die from these diseases in the 20th century!”
He suggested that I extend the dates of my study by decades in each direction; for example, he inquired if I had I looked at the number of deaths incurred through the construction work on the Suez Canal (1863-69), or knew how many more people died of disease in Egypt in the 18th century.
I won’t lie. This was my first outing with this material, and this was … not the sort of feedback I had hoped to get. The more I tried to explain the nuance of my argument, the more pushback I got. Having spent 3 months mapping the country from cataract to Delta, I tried to change the subject and ask where he was from–meaning where, specifically, in Sharqiyya. He looked at me as if I might just be the stupidest man on earth and responded, “Egypt?!”
As you can tell, I’ve let this episode roll right off my back.
However, I think there is something significant in the greater picture about his defensiveness, one that pushed me to think about the puzzling collective silence in nearly every history book about what I’m looking at. Even the Spanish flu is described in only two medical reports from the time; I’ve seen it mentioned nowhere else.
The notion of Egyptians dying in elevated numbers from disease was clearly distasteful to him–largely, I suspect, for the reason that it was undignified. People—at least not those of his class—did not die from disease in high numbers in the early 20th century.
In short, Egypt was modern. If it had not ascended, as the Khedive Ismāᶜīl had optimistically pronounced in 1869, to being among the ranks of countries which should be considered European, it had developed more rapidly than much of the Arab east, which languished in such a state that one scholar discussing the “Spanish flu” influenza pandemic in the Arabian peninsula (1919) could legitimately wonder whether medical officials in central Arabia were capable of distinguishing the influenza apart from other diseases with similar symptoms, such as typhoid.[2]
Indeed, my interlocutor is correct about that hygiene and medical care had been introduced under Muhammad Ali Pasha in the mid-19th century as part of a national campaign to improve public health. This has been described by LaVerne Kuhnke and Hibba Abuguideri (although the project had peaked in the 1850s and all but vanished under British administration).[3]
I struggled to explain in my response that afternoon that my interest was the significance of the war’s anomalous blip in the statistical record. The public health scheme in Egypt had, to a certain degree, brought epidemic disease under control, which is why the fact that infection and death rates soared during the war comprise a factor of interest. So, too, do the numbers of registered prostitutes in Egyptian cities, as well as the number of reported cases of venereal diseases, both of which increased substantially during the war and comprised their own crises in both medical and social health
During the first world war, Egypt was a nation at war. Its citizens were recruited into the war effort, and many of those citizens faced bodily harm and death fighting for the Union Jack in far-off lands. Those who remained at home suffered from shortages of basic supplies–although production rates decreased slightly, they dropped nowhere near as much as consumption rates. They were forced to eat tainted meat that they purchased at high prices. They died of disease whose effects were exacerbated by malnutrition. Some turned to prostitution or other illicit activity to make ends meet.
There is nothing heroic about the fight against a virus, perhaps. As the first World War and the 1919 uprising became enmeshed together in the national historiographic project celebrating the nationalist movement and Egypt’s strive for self-determination, there was no space for sympathetic portrayal of poor women desperate to feed starving children and elderly relatives, and those who, in sheer desperation, turned to extreme measures to support themselves.
The commemorations held in Egypt from 2013 onward to celebrate the nation’s contribution to the First World War recognize only one of these groups.
I’m hoping to recognize the second.
[1] Roger Cooter. “Of War and Epidemics: Unnatural Couplings, Problematic Conceptions.” The Journal of the Society for the Social History of Medicine 16, no. 2 (2003): 283–302
[2] LaVerne Kuhnke. Lives at Risk. Vol. no. 24. Comparative Studies of Health Systems and Medical Care. Berkeley and Los Angeles: University of California Press, 1990; Hibba Abugideiri. Gender and the Making of Modern Medicine in Colonial Egypt. Ashgate Publishing, Ltd., 2013.
Christopher S Rose 