Once, the immense and seemingly timeless surge of fear that arose within him was followed by muscle soreness that lasted for three days. His body trembled, convulsed, struggled. The only relief, he found, was running in circles for hours. His body, severely exhausted afterwards, needed 72 hours to recover. What kind of fear must that have been?
Hussam Naggar, born in Aleppo in 1971, was in the middle of his community service in a home for the disabled in Markgröningen near Ludwigsburg in Baden-Württemberg in the early 1990s when he experienced psychosis for the first time. Naggar looks after a residential group with 13 to 14 residents, all of whom have severe physical and mental disabilities. He is supposed to put one of the residents with progressive muscular dystrophy in his wheelchair. The resident has to work in a workshop for the disabled, the service manager insists on this agreement – immediately, now! He, Naggar, just in his early 20s, feels that two people are being forced against their will to do something they don’t want to do. “I defended him, saying that he has free will and also the right to become ill.”
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What Naggar experiences that day acts like a trigger. Mainly because it is difficult for him to subordinate himself anyway. The stress at work is enormous. On this day it’s enough, his psyche is looking for redemption. While others quit, complain to the works council, take refuge in sport or perhaps alcohol, and only do their job according to the rules, for Naggar it is the spirit that says goodbye. He experiences an astral journey, an out-of-body experience in which he floats in space, viewing the world from above and looking at the Kaaba, the black cuboid in the interior of the Holy Mosque in Mecca.
What initially sounds completely silly to people who don’t have anything to do with esotericism was, at that moment, a real experience for Naggar. The psychosis is the escape point from the stress he is experiencing. “I found myself in euphoric states and at the same time was afraid of people and believed there were conspiracies everywhere,” Naggar says of that time today. He falters for the first and only time when he wants to talk about what this first psychosis actually looked like. We are taking a break. Naggar goes for a smoke.
Religious hallucinations are not uncommon in schizophrenia. Naggar was raised Islamic by his father and prays five times a day. In personal crises one is often confronted with fundamental questions of existence, and these play a special role, especially in religion. A study from the 1980s shows that people with religious socialization are more likely to have such delusions than non-religious sufferers. His father, a Syrian doctor who completed his specialist training in Hanover in the 1950s, is a supporter of the Muslim Brotherhood. »I was raised very pious and traditional. Not secular in any way. And there was constant politicization at home, even from childhood.”
Naggar’s father becomes aware of his son’s unstable condition and arranges for outpatient psychiatric treatment. “In the acute phase, it is important to have attentive relatives who can sense whether you are available for help – otherwise you will remain trapped in the delusional system,” says Naggar. He is given neuroleptics and released for the remainder of his community service. “Despite all the stress, I enjoyed working there,” says Naggar.
After the end of the treatment he becomes severely depressed. Nothing unusual after a flare-up. Nevertheless, he managed to complete a medical degree after the treatment. But instead of writing a doctoral thesis, he enrolled at the art academy for two semesters. During this time he does not experience any further attacks.
Schizophrenia is probably one of the most mythologized illnesses, partly because so little is known about how it occurs. It has nothing to do with a split personality, as is often assumed. “There is the clinical picture of dissociative identity disorder, which was previously also called ‘multiple personality disorder’,” says Robert Bittner, senior physician and deputy head of psychiatry at the University Hospital in Frankfurt am Main, in an interview with the specialist magazine of the Polytechnic Society Frankfurt. “This is a very rare clinical picture and has nothing to do with schizophrenia at all.”
In fact, schizophrenia translated from Greek means “split consciousness”, but this refers to the coexistence of unusual behavior such as delusions, while language and motor skills remain relatively unimpaired.
“The stigmatization and discrimination of those affected, which is based on prejudices and a lack of or incorrect knowledge about schizophrenia in the population and is repeatedly fueled by undifferentiated media reports, increases the burden and promotes social exclusion and isolation,” says a health monitoring report by the Robert Koch Institute (RKI).
If the disease is reported at all, it is usually in connection with violent crimes. Specialists and the RKI point out that most patients are never violent. Although there are individual cases in which people become aggressive during psychosis, factors also play a role that have nothing or only indirectly something to do with the illness, such as alcohol or drug abuse. It’s usually the other way around: people who suffer from psychoses are disproportionately likely to become victims of violence. When it comes to schizophrenia, the “nd” also often reports on police violence against those suffering from the disease (sometimes even resulting in death).
Hussam Naggar tells of an episode at Stuttgart Central Station in 2002 when – this is his version – he “pushed” a woman who he heard speaking “double-tongued” and therefore thought she was the devil. He was arrested by the federal police. A five-month stay in an open psychiatric hospital followed. That’s where the literary template for the 26-page text “Forced Instruction” was created, in which it says: “He could only misunderstand the dispersing world because his mind dissolved into madness…” Naggar doesn’t want to relativize, but explains: “It is happened, but it didn’t happen for baser motives, rather the action was a transference of one’s own fear onto other people.«
Naggar also writes in his diary about the ambivalence that characterized his stay in the clinic: “There was a need and there was a need for action out of far-sighted compassion. A writhing, cringing and refusing person. Absolutely inaccessible. He saw the medical staff’s coercive measures as a threat – he was terribly afraid and no amount of affection could alleviate this.” But he also writes about five-point restraints and how he spent hours, completely sedated with medication, alone on a stretcher in a dark hospital hallway lies, asks for drinks, but no one hears him. »The good, brutal nurses with sweetened coffee and milk in the social room. An eerie silence in a now sterile expanse – chrome bed frame.”
How schizophrenia develops is still not medically understood. However, the following picture is put together from many individual pieces of the puzzle: If a certain genetic predisposition encounters unfavorable external environmental influences (critical life events – the episode at the Stuttgart train station occurred shortly after Naggar’s separation from his wife and after 9/11), this combination can cause schizophrenia trigger psychosis. Most of the time these are delusions, false perceptions or loss of reality such as fantasies of omnipotence.
Around one percent of people worldwide suffer from schizophrenia. The peak of the initial illness is reached in the age group of 20 to 25 years in men and between the ages of 25 and 30 in women. About a quarter of those affected experience a single psychotic episode. Just over half of those affected experience a relapse within two years of their first acute psychosis. About another quarter suffer from permanent psychotic phases.
Hussam Naggar hasn’t had an attack in ten years and has developed what he calls a “self-learning program” for himself: He is still undergoing therapeutic treatment, avoids situations that he perceives as warnings, takes medication, and goes to the gym every day Stepper in gym, practicing sitting meditation and doing art.
Living freedom is the most important thing in life for him, he says. That’s why he doesn’t allow his art to be taken over by institutions, which is well expressed in the fact that he has now converted the derogatory label of “hobby artist”, which was given to him by a lecturer at a party in 2003, into an award for himself. As a “retired hobby artist,” he regularly posts collages on Facebook and Instagram: pieces of packaging waste – the abundant waste in Berlin-Wedding, which he collects, glues together and puts together into a puzzle using black and multi-colored textile insulating tape.
Naggar replies to an email at the very beginning of our week-long exchange, in which we want to arrange a meeting point: “In fact, I receive 600 euros in occupational disability pension and avoid the so-called art system as much as possible so that I don’t have a ‘name’ for myself < make."
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