The Mad Dog’s Madhouse

TRIPOLI, Libya — At Al Razi Hospital, the only mental hospital serving western, central, and southern Libya, humor is the only medicine available in excess. Ahmed Kara, a senior consulting psychiatrist, laughs and laughs about life in Libya, before, during, and after the revolution. His average day, however, would make most Western psychiatrists cry: Today he’s seen around 40 outpatients, distributed medication at the pharmacy, and now he’s talking to the press — though every 15 minutes he’s interrupted by people asking him to sign off on a prescription or update them on a case. He jokes that due to the staff shortage, he might end his day by washing the dishes.

Tripoli is not just running out of fuel and water; it’s also running out of medicine. With 250 outpatients passing through this sprawling compound a day and 150 living in crammed rooms with metal bars, Al Razi’s pharmacy is dangerously low on drugs. Today, only 10 boxes of Leponex pills for schizophrenia remain. Once those are gone, doctors will try to give chronic cases a different medication, but there’s no way to be sure it will work.

"This is what I call cowboy psychiatry," Kara exclaims with a grin. "Yeee-haw!"

Kara studied at the Royal College of Surgery in Ireland before doing his rotations at St. George’s Hospital in London in 1986. Explaining the conditions in his home city, however, one of the most respected psychiatrists in Libya sounds almost like a patient himself. But black humor, Kara says, is the only way he has been able to cope with the deteriorating mental-health situation in revolutionary Libya.

For years, Libya was ruled by a madman, but at least Qaddafi’s subjects all seemed relatively sane, despite having to pledge allegiance to him. And yet mental illness itself was still stigmatized. The hospital did not receive as much government money or attention as others did, Kara complains, and people with mental health problems faced discrimination. Then the revolution came, and sometimes to Kara it felt like the madness was everywhere. During Tripoli’s liberation struggle, in fact, one patient broke out of the institution, guards fled the compound, and a lot of the staff couldn’t make it into work. The inpatients were frightened by the NATO bombing campaign, and nurses remember sobbing and pandemonium as inmates asked them to make the loud noises stop.

Now, with the city more stable, the doctor expects to see an upsurge in patients coming in with symptoms of post-traumatic stress disorder — just as soon as there’s enough gas available for people to drive anywhere.

Mostly, Kara’s interested in the original madman, the maniac he lived under for most of his 53 years. For Kara, unlike many Libyans, Muammar al-Qaddafi is a specimen better found and kept alive to be observed quizzically, like an exotic murderous butterfly.

"I’m dying to study this man’s personality," Kara confides to me. "I have a theory about him."

He starts drawing a bell curve on a scrap of paper on his cluttered desk. His blue pen sketches four deviations away from the norm and dots most people in the first two sections of normal distribution. Then he starts tapping out the sections further away from the mean and places Qaddafi squarely in the most extreme outlier position.

"Such a character, such a personality, doesn’t come into the world so often, maybe one every 60 to 100 years," he says almost with glee. "If we apply whatever classification we have, he doesn’t fit the diagnosis. It must be something else; we don’t see too many of these people. The moment we see them, they are killed; there’s no chance to study them — Hitler, Mussolini?"

So how would he diagnose the Mad Dog of Tripoli? Kara can’t quite decide. He announces Qaddafi was "devious," before remembering the English word is "deviating" — though both seem to work.

Certainly, he says, Qaddafi is all about "grandiosity. It means that his self-worth is guided by vibes he gets from outside — what we call social stroke — I want to show myself! I’m a narcissist! I’m grandiose! I’m a prophet! I’m God! I’m the leader! I’m the king of all kings! How can I feel it? I can’t feel it by saying it to myself, but I feel it if you say it to me."

Kara then proceeds to tell the story of how, exactly, he came to this privileged view of Qaddafi’s madness: In fact, he tells me, he treated two female members of the Qaddafi clan. In the general madness of today’s Tripoli, this is not an unfeasible claim — but it is impossible to verify.

The psychiatrist explains that he first saw Qaddafi eight years ago in Sirte, when he diagnosed one of the women in Qaddafi’s immediate family with depression and the mercurial leader ignored his clinical recommendations. He claims he later met Qaddafi in his infamous receiving tent in the Bab al-Aziziya complex in Tripoli, where the leader forced him to walk over a pile of camel dung to reach his illustrious presence.

"As you walk you have to step on camel shit, you know that? Sarkozy walked on shit! Berlusconi walked on camel shit! Tony Blair walked on camel shit!" Kara exclaims, still incredulous six years later. "Why? Because when he makes you walk on shit, that will feed into his grandiosity."

These days, Al Razi Hospital is only attending to cases that came in before the fall of Tripoli, due to its severe staff and medicine shortages. In the female section, middle-age women sit in matching flower-print dresses. The men’s section of the acute-cases ward looks like a prison cell. Patients mob the green barred doors as we walk in. Mumblings and pounding on the doors echo through the dim hallways while we tour the recreation courtyard — a plot of gray cement and sand. It’s hard to imagine Qaddafi behind bars in his capital’s only mental hospital, sitting with muttering patients on the floor. But for Kara, it would be a dream come true.