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“ID please,” the cashier said, holding out his hand.

I dug my driving licence out from my purse and passed it over. He glanced at it briefly, acknowledged my 2001 year of birth, and, satisfied, slid a box of matches towards me. After paying, I pocketed the box and hurriedly left the shop. Later, motivated by pure curiosity, I looked up the legal age for buying matches. Sixteen. Did I really look that young?

Apparently, the answer is yes. To this day, aged 25, I still cannot buy paracetamol from a supermarket without my ID being demanded, despite being qualified enough to prescribe the very drug. I encounter the same situation attending comedy shows and cinemas, and perhaps most frustratingly, when seeing patients in my clinic. (“You look too young to be a doctor!”) Often, disbelief at my haggard age is followed up by a quip about my genetic luck: “You’ll appreciate it when you’re older.”

Having a ‘babyface’ has almost become a part of my identity — I was once told by a friend that they could never imagine me without my smooth cheeks and unwrinkled forehead. Bar the removal of an unsightly moustache and the loss of some puppy fat, my teenage and adult faces remain indistinguishable from each other. Perhaps that’s why, when my first grey hairs sprouted last year, my parents were desperate to remove them by any means. One grey hair turned into two, three, four, and now I sport a cluster of silver threads on one side of my crown.

My greys are coarse, wiry. When they’re short, they stick up from my head like little zig-zagging antennae, making themselves known to the world. When they’re long, they peek out from between my jet black locks and glint mischievously in the sun. My parents insist on plucking them out, or disguising them with dark brown dye, but for now, I refuse. I secretly cherish them, those little reminders of the passage of time, emblems of a fading youth. A reminder that, one day, even my seemingly eternal babyface will succumb to old age.

*

A cultural obsession with youth pervades our society, and I often find myself wondering why. In some traditions, ageing is valorised, with white crowns and wrinkled hands symbolising inherent wisdom and an elevated status. But with the growing influence of social media, the appearance of youth has become something to aspire to, especially amongst women. My online algorithms send me ad after ad on retinol serums and botox injections. Family members around me desperately mask their thinning hair with transplants and fibres, chomp away on collagen supplements that promise to halt the steady march forward of time.

Youth represents choice, freedom, possibility. A time when our individual stories have not yet been written, and the world unravels before us like an endless carpet. To age is to grow out of this illusion, to settle into the paths that have been carved for us, to feel the weight of the decisions we have made. The grey strand represents the irreversibility of this process, the inability to claw back the years no matter how despairingly we try. Perhaps that is why we try so eagerly to mask them — a futile attempt to shield ourselves from the truth of the whittling time we have alive.

On the geriatrics ward I work on, the signs of age are all around. Octogenarians with brittle bones, failing eyesight, and fading memories line the bays, the decades of their lives reduced to mere scans, reports, and results. I stand at their bedsides, listening to hearts that have pumped blood for almost a century, holding wrinkled, trembling hands that were once as smooth as mine. I hear, from silver-haired grandmothers with false teeth, tales from a childhood that resemble my own, and realise with a silent clarity that these patients represent a future version of myself.

*

One day, I will buy paracetamol without being asked for ID. I will greet patients and lead them into a room, my clinical authority remaining unquestioned. The smooth skin around my jaw will wrinkle and droop, my cheeks will lose their apple-like roundness, and my hair, once dark, will transform into a wintery crown.

One day, I will sit in a hospital bed, my eyes clouded by cataracts, my lungs struggling to expand. A young doctor will bend over me and carefully slide a cannula into a thready vein. And in my state of frailty I will smile, maybe laugh, as I remember how my own unblemished hands clasped that needle many summers ago, all while the world around me fretted over a few grey hairs.

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I first heard of autism through watching Arthur, the Canadian children’s TV show. In one episode, George, the series’ beloved anthropomorphic moose, meets a spectacled, train-loving rabbit boy called Carl. After being accidentally startled by George’s toy puppet, Carl begins to quiver and scream, covering his ears with his hands. A bewildered George subsequently discovers that Carl has autism, or more specifically, Asperger’s syndrome. This triggers a fantastical sequence where our moosey friend, decked in a spacesuit, appears on a foreign planet to learn more about the condition. “Imagine you’ve crash-landed on an alien planet…” the narration begins.

A few years later, aged 10, I read The Curious Incident of the Dog in the Night-Time. The novel is written through the eyes of Christopher, an autistic 15-year-old who attempts to unveil the mystery behind the death of his neighbour’s dog. Much like Carl, Christopher struggles with social situations, often finding it difficult to interpret facial expressions and respond to social cues. At the same time, he is extremely gifted, harbouring an incredible talent for mathematics, as well as a deep, obsessive interest in outer space.

I didn’t see myself in Christopher, or in Carl. For one, I was a girl. I wasn’t obsessed with trains, maps, puzzles or numbers, but I did have a fascination with reading and literature, and was an avid collector of cat-related memorabilia. I could interpret and understand body language with no issues, and could generally engage well in conversations with my peers, despite my preference for playing alone with imaginary friends. I had the odd little tendency to rock forwards and backwards at all times, but that was, of course, shrugged off by the adults around me as a habit I’d soon grow out of. I definitely wasn’t autistic, as someone once suggested to my parents, who responded with defiant refusal. I was— clearly— a normal girl.

*

In April this year, on a bright Tuesday afternoon, I travelled to a North London clinic to learn the outcome of my long-awaited autism assessment. I had spent the previous few weeks working in a London hospital with psychiatrists from the Child and Adolescent Mental Health Service (CAMHS), and had come across tens of children and young adults in crisis— every single one of them autistic. On arrival, I was led into a stuffy room where a kind-faced psychologist informed me that my case had sparked much deliberation amongst his colleagues, with my childhood traits ultimately driving their verdict. I was autistic.

I didn’t know how to respond to this news. Part of me was relieved— that the difference I had felt all my life finally had a name, that the lingering isolation that had haunted me since I first left the womb was not purely imagined. But another side of me grieved, for the child, teenager, and young adult, who sat with these feelings of rejection each night and wondered if there was something deeply, immutably, wrong with her.

The next hour of the consultation was spent dissecting each element of my autism assessment. I learnt that my affect¹ was ‘flat’, my gestures were ‘inappropriate’ to my speech, and that my responses to cliffhangers² were either absent or delayed. And that flying frogs have feelings too, ones that I supposedly struggled to identify during my ADOS³.

After leaving the clinic, I walked back to my flat. The remainder of the day was spent in bed, staring at the cracks in my ceiling until I had almost memorised their every shape and location. Hazy memories of my childhood looped in my mind like a damaged video reel. How I’d scream and cry during large family gatherings, covering my ears with my hands. How the music played at weddings and parties would bore into my skull, the colours burning into the back of my eyes. How my inability to tolerate these sensory stimuli was interpreted as misbehaviour, and I was scolded and punished for what were, in fact, unrecognised autistic meltdowns.

Then, snippets of my teenage years: never quite fitting in, no matter how much I tried. Excelling academically, but struggling to make sense of teen group dynamics. Never quite understanding why non-conformity was supposedly a bad thing. Failing to be invited anywhere, by anyone, even those I regarded as friends.

And finally, the now, the adult version of me, beleaguered and broken by six gruelling years of medical school. Crushed by the cognitive weight of a lifetime of masking. Tired by the sounds, sights and smells of the hospital wards I traipsed daily. Floating around helplessly in a spacesuit, in an orbit entirely of my own.

Nothing about me had changed since receiving my diagnosis— if anything, I now had an explanation for the profound isolation that had plagued my entire life. Large group situations eluded me; I would watch conversations between strangers flow, as seamless as water, from my own quiet corner of unease, never quite knowing when to participate or what to say. An immunity to peer pressure, combined with a vehement opposition to anything that resembled ‘groupthink’, made building relationships with peers and colleagues difficult, especially amongst women my own age. Literature and the arts became substitutes for human connection, and as much as I told myself I was perfectly content with this, a piece of me yearned to belong to one of the matcha-drinking, café-hopping brigades of young women that dominated my social media feed.

On top of these complex feelings, the relative ‘relief’ (if you could call it that) provided by diagnosis was counteracted by a discomfort with labels of any kind. I was aware that diagnostic labels often came with a sense of liberation for some, as well as access to supportive community and a deeper understanding of oneself, but I had simply read too much Foucault to not be cautious around such categories. Leading up to my assessment, I had purposely avoided reading any online threads discussing experiences of neurodivergence, lest my subconscious internalise the diagnostic criteria before I had even reached the clinic. Legal protection under existing equality laws was what had primarily driven my pursuit of diagnosis— I was terrified of underperforming as a future doctor and losing my job— but even this seemed somewhat fraudulent, and I found myself spiralling into self-doubt. What it truly means to be autistic, beyond a shallow diagnostic checklist, is still something I do not know the answer to, but continue to explore nonetheless.

*

The day after my assessment, I returned to the CAMHS office. I was informed that a teenage boy was waiting in A&E to be seen by the mental health team after being found in crisis, so I hastily joined one of the nurses to assess him. I wore a silly pair of socks featuring a cowboy cat riding a horse, and my ears were bedazzled by grey cat-shaped studs, which together seemed to cast a grin across his face. When he told me he was autistic, I said “Me too”.

¹ The external, physical expression of a person’s inner emotional state

² Sentences specifically designed to elicit a probing question from a conversational partner

³ Autism Diagnostic Observation Schedule— the observation tool used as part of a diagnostic assessment

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It’s been almost two months now since I left Belsize Park, the leafy North London suburb I called home for the final three years of my medical education. My flat in London sat on the top floor of an ornate, red-bricked Victorian manor, overlooking a row of haughty terraces that lined a leafy neighbouring street. Living there, I quickly became accustomed to the sight of parked Porsches, of yummy mummies wheeling designer prams, and dogs so small I feared accidentally treading on them. Organic everything was the norm, as were £5 cups of specialty coffee, olive baguettes and small-batch produced jars of kimchi bought from the farmer’s market.

It wasn’t long before my senses became attuned to the middle-class habits of my neighbours. Wheeling a shopping trolley down the aisles of my local Waitrose, my eyes were caught by any jar labelled in a squiggly font and promising a locally produced delicacy. My tongue learnt to differentiate between coffee beans based on their note profile and country of origin, and I borrowed my taste in clothing and interior design from the curated boutiques that decorated nearby Primrose Hill.

After completing medical school, I carried these newfound tastes and trends back to the small Yorkshire town I grew up in. Much like the rest of the region, my town was bludgeoned by the politics of austerity that governed the 2010s. Clusters of old textile mills— remnants of a bygone industrial era— lie abandoned across its hilly contours, while on the high street, sunken-faced shopfronts crouch together like weary beggars. The town centre, remembered through the rose-tinted glasses of my childhood as a bustling community hub, now harbours next to nothing but gambling venues and vape outlets.

*

Class in Britain works in a funny way; everything from the way you talk to your choice of breakfast cereal is a coded signifier of your cultural capital. Like most people from my town, I have always described myself as working class, but since returning from London, equipped with a shiny new medical degree, I have felt an increasing disconnect from my roots. A quiet friction has emerged between me and the people I grew up with; the undercurrent of each casual conversation carries an unspoken tension, an acute awareness of perceived class difference, and with it, an aching self-consciousness.

I’m unsure if a penchant for oat lattes and a ‘Dr’ title are enough to firmly cement my position in the middle classes. I don’t boast the privileges of generational wealth or a long family line of physicians— the pursuit of financial stability was why I entered medicine in the first place— but my crisp London accent and cultural interests noticeably set me apart from the people who surround me. I find myself subtly trying to retrain my tongue into a Northern lilt, censoring my weekend plans lest I get branded as shamefully out of touch.

Culturally, the idea of a ‘working-class doctor’ appears oxymoronic. In some communities especially, doctors have always been held with a special kind of reverence— entering Medicine is a sign that you have ‘made it’, so to speak. (“You’ll be set for life,” my dad would say, in his persuasive efforts to sell me a medical degree.) As medical school intakes diversify, rents soar, and the nation’s economy crumbles, I suspect more working-class doctors like me, grappling with the ‘in-betweenness’ of social mobility, will arise.

Existing within this middle space can be uncomfortable— on more than one occasion I have felt the need to explain my accent, or justify my habits and expensive tastes. I want so desperately to prove to my patients that I share their realities, yet I fear that any effort to underline my class identity appears disingenuous, as if I am merely cloaking myself in a working-class costume for the sake of performance. Additionally, spending three years living amongst the affluent has hyper-sensitised me to the indicators of deprivation etched into every wall of my hometown. The closed-down shops and abandoned sports centre serve as stark reminders of the regional inequalities that not only pervade the nation, but show no indication of resolving. The ‘Northern Powerhouse’ promised many a prime minister ago seems nothing but a hollow, fading fantasy.

*

What do I do with this liminal space I find myself in? I am 160 miles away from London, living once more in the town where I was born and raised, yet I am haunted by a piercing sensation of unbelonging. I would like to believe my roots allow me to better advocate for patients who would otherwise be stereotyped and ignored, but in reality, I feel held hostage by my fellow working-class Northerners’ labels and unfair assumptions. Part of me— most of me— yearns to flee back to the South and hide away in the anonymity of London once more, single-origin coffee in hand. But for now, I remain here, untethered and unsure, caught between the raptures of the beating life I left behind, and the arduous weight of a home I have outgrown.

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Coarse liver echotexture with irregular margins. Multiple lesions are noted, likely multifocal HCC. The largest lesion measures 6.8 x 4.7cm. Portal vein shows tumour thrombus.

“Is it curable?”

My mum frowned, examining my face for signs of concern. Since starting medical school five years ago, I had become my family’s foremost medical authority.

I scanned Nano’s report again. Three letters blinked at me from the page, unmoving: HCC. To most, a quiet, unassuming little abbreviation. To me, something else entirely.

HCC. Liver cancer.

My throat dried. This was a situation I had encountered so many times during my training— the invitation to a quiet room, the ‘warning shot’, the gentle breaking of the news (“I’m really sorry to tell you this…”), the box of tissues slid routinely across the table. But now, language escaped me, and the entire performance crumbled. I simply shook my head.

I was two when I met Nano, my mother’s mother, for the first and last time. I have no memory of my trip to Pakistan to visit her, but the photo evidence remains: little me feeding goats, clambering up the side of a motorcycle, and sitting in my Nano’s lap, an exaggerated grin plastered across my face. Growing up, Nano’s voice was a constant feature of my Yorkshire household, where my mum called her daily. My own interactions with her never extended beyond polite niceties— an inherited love expressed through broken, heavily accented Urdu and awkward smiles delivered over video call. When she fell unwell, I was brought closer to her in a way I never expected.

The doctors had given Nano just six months to live. By the time my mum flew to Pakistan, she was already bedbound. Having just started my final year of medical school, I remained in the UK. Throughout the day, I received a steady stream of medical updates from my family abroad, which I hastily reviewed in between lectures and ward rounds. I was the only person they knew— the only person they trusted— who could translate the alien language of drug lists, radiology reports and blood test results into something comforting, something that made sense.

But to me, nothing about Nano’s care or illness made sense. A mistrust of Pakistani healthcare meant that she was being cared for at home by her children, none of whom were medically trained. Over video call, I watched my aunts and uncles insert cannulas, set up IV infusions, and draw up injections without a sterile field in sight. Whilst her children fumbled over her, Nano’s emaciated figure would lie unmoving on the bed, her head propped up against a pillow to aid her strained breathing. Even through the blocky pixels of my phone screen I could make out her changed body: eyes a highlighter-yellow, abdomen tight and swollen, bones protruding. Needles pricked the back of my eyes. There was my Nano, reduced to a set of clinical signs and symptoms. My Nano, a page of a textbook.

Later, I discovered the reason behind my family’s distrust of Pakistani healthcare. A prior hepatitis infection, caught from a reused hospital needle, had led to Nano’s cancer. With horror, I learnt of how the infection became chronic, then cleared once antivirals became affordable almost a decade later. By then, the damage was done. The sequence of biological events that would ultimately lead to her death had, unbeknownst to my family, been set into motion. A single plastic needle— a couple of rupees’ savings— had sealed Nano’s fate.

A flame, red and searing, swelled up in my chest. The situation was unheard of in the UK, where clear guidelines and protocols dictated patient care. ‘Free at the point of delivery’ was the driving principle of the NHS, but in Pakistan, profits took precedence over lives. I thought of the hospital wards I attended each day, with their shiny floors and freshly packed sterile equipment, and a haze clouded my mind. The makeshift hospital room where Nano lay dying was dingy in comparison, slowly filling with sewage water as Pakistan battled heavy floods. I thought of how my British passport was the only thing that protected me from a similar destiny, and felt the bitter guilt pierce my stomach.

As Nano deteriorated further, it appeared to me that profit may have been a factor in some of the interventions suggested by doctors, as there was no clear clinical reasoning to support their use. I was consulted over each decision, and spent desperate hours scouring the internet for NHS guidelines and medical publications, for any sort of framework of care to cling to. Despairing, I realised that such guidance was pointless in a country where money dictated which care was possible, and for whom. By this point, repeated glucose measurements had left Nano’s fingertips roughened and scabbed (an alternative way of monitoring was, of course, too expensive), and nobody knew if her morphine dose was sufficient enough to allay her pain. The flame in my chest roared larger and larger.

“How much longer do you think she has to live?” my mum whispered to me one day over the phone. It was six weeks after her diagnosis, and Nano had stopped eating, drinking, and urinating. It did not take a medic to understand that she was now hovering between life and death. Her jaw hung loose, her breath rattling against the flimsy oxygen mask my uncle had sourced from a nearby pharmacy. I had taught him how to measure Nano’s oxygen saturations, how to adjust the flow rate of the device. Did it make a difference? I found myself wondering. Had anything I tried?

I remembered my mum’s question. The conditioned, ‘exam’ response surfaced in my mind, but I shooed it away. My eyes and ears and throat were on fire. What use were careful words now? Nothing in my medical training had prepared me for this. No amount of knowledge or clinical language could explain what had happened, or why. No words could hold the weight of my heartbreak.

This article originally appeared in Volume IX, Issue I of the RUMS Review and won the SPA Best Science or Tech Piece Award in 2024.

In the living room of his West Yorkshire home, Sheikh Hakim* attends to a young female patient. Her parents watch on, pale-faced, as the Sheikh mutters Arabic prayers over her stiffened body. Reaching into a glass vial, he wets his fingertips with water, then brings his hand to the patient’s forehead. The girl flinches at his touch. Then, she lets out a scream.

Since starting college, the young woman had become prone to sporadic fits of anger. College counselling did little to resolve her violent outbursts, and antipsychotic medication only intensified her mood swings. Distressed by her unpredictable behaviour, her parents had brought her to Sheikh Hakim on the recommendation of friends. At first, they were sceptical— stories of fraudulent and abusive healers were well-known within their local Muslim community. Now, they waited, desperate but hopeful, as the 55-year-old Islamic exorcist attempted to remove a malevolent spirit from their daughter’s body.

“The girl was not fully possessed,” the Sheikh told me after the ritual concluded. “It is easier for me to remove the jinni if it has not fully attached itself to a person.”

In the Northern, industrial town of Halifax, Sheikh Hakim currently treats no fewer than five cases of spirit possession a week. As the leader of a local mosque, he is a respected and trusted healer, and year on year, he has witnessed the demand for his service soar. “Sometimes I don’t even have time to eat because my phone is constantly buzzing,” he joked, as his phone rang for the third time within an hour. But this change has not been welcomed by the Sheikh, who sees it as a sign of deteriorating mental health within the community he serves. “People with mental health difficulties are much easier for a jinni to attack,” he later explained. His concerns are supported by data from the NHS, which reveal Muslims as having the lowest psychiatric recovery rates out of all faith groups in the UK.

A lack of culturally-sensitive care, compounded with stigma surrounding mental illness and low levels of mental health literacy, have barred many Muslims in the UK from accessing professional psychiatric treatment. As a result, they remain underrepresented in NHS Talking Therapies referrals, despite evidence that suggests being Muslim is a risk factor for depression. For Salim Kassam, a Muslim mental health campaigner, the “elitist, white and male” nature of psychiatric practice is itself to blame for these health inequalities. “As long as the mental health industry— and the media around it— are predominantly white and culturally normative, I fear that many Muslims will still prefer exorcisms to cognitive therapy,” he wrote in The Independent.

A belief in exorcisms and spirit possession sits at odds with scientific models of illness, yet is upheld across a myriad of cultures and religious traditions. In Islam, the phenomenon of possession is attributed to the jinni, a creature described in the Holy Qur’an as “created from a smokeless flame of fire”. Lurking in the dark depths of caves, sewers and abandoned buildings, jinn live alongside humans in an invisible, parallel realm. In the unfortunate instance that a human crosses the path of a bad-tempered jinni, the unruly spirit can take possession of their body.

To deal with this problem, a number of backstreet jinn exorcists have operated across the UK’s Muslim communities for decades, steadily replacing the NHS as a popular substitute to medical care. Often, a violation of traditional cultural norms—rejecting a marriage proposal, renouncing one’s faith, coming out as homosexual— is swiftly met with a diagnosis of jinn possession, prompting widespread concerns over abuse. Sensationalist tales of manipulation and financial exploitation have dominated tabloid portrayals of jinn exorcism; rarely has the ritual been considered a valid alternative to modern medical practice.

Sheikh Hakim wants this to change. Over his 30 years of practice, he claims to have cured thousands of patients with the power of prayer. The majority of these people, he notes, had previously received NHS psychiatric treatment with little success. Upon exorcism, their afflictions were cured in an instant. According to the Sheikh, greater cooperation between religious healers and licensed NHS practitioners is imperative to attending to the unique needs of Muslim patients. “Only then, can mental health outcomes for Muslim patients actually improve,” he said. But an alliance between religion and science seems unlikely— and in the context of exorcism, potentially dangerous.

***

On a blustery day in mid-April, I met Sheikh Hakim for a second time. He was accompanied by another young patient, 21-year-old Fatima from Leeds. The Sheikh brought out three cups of tea, and together we sat in his makeshift home clinic, the thick scent of incense coating the room. Fatima* rolled glass prayer beads between her fingers. Apart from her eyes, her face was hidden behind a black veil; still, she hesitated to meet my gaze. Few people had been as badly defrauded by backstreet exorcists as she had.

Fatima experienced a tumultuous childhood. Growing up in an abusive home, her father often turned his anger towards her, the eldest of his three children. Shortly after turning 16, her parents divorced. “After that point, I started hearing voices,” she said. “I had always had some form of anxiety and depression, but things really took a turn for the worse after my parents split. I kept feeling as if I was somebody else.” After being diagnosed with dissociative identity disorder, a care plan involving daily medication and cognitive behavioural therapy was developed for Fatima by an NHS psychiatrist. Six months into the plan, there were no signs of her mental health improving, and Fatima’s hopes of recovery were dwindling. She blamed a lack of cultural awareness from the NHS as the reason behind this absence of progress, telling me that her practitioners “didn’t see her as a person with distinct cultural and religious needs.”

At the age of 18, Fatima began working in a call centre, but a series of psychotic episodes forced her to take a break from her job. Scouring the Internet for a remedy to her illness, she came across a traditional healer who claimed to offer an Islamically-approved solution. At £550 per session, his services did not come cheap— but Fatima was desperate. Convinced by his Islamic credentials, she attended six of his exorcism sessions, borrowing money from friends and relatives to pay his hefty fees. The exorcisms themselves triggered traumatic childhood flashbacks— Fatima recalls being repeatedly shouted at and demeaned, and at one point, even slapped. By the end of the sessions, her mental health had deteriorated even further.

Fatima’s story is one that Sheikh Hakim— and the police— are familiar with. In 2021, a post-pandemic surge in healing scams caused West Yorkshire Trading Standards to issue warnings to the Muslim community. “Faith healing is no more than an upfront fee scam but with a different front— it is a con that has been going on for hundreds of years in one form or another,” they told Paigaam, a local Muslim magazine. But the Sheikh, who does not charge for his service, believes that if practised correctly, Islamic exorcism can prove more effective than contemporary psychiatric approaches. Under his care, he reports that exorcism has provided Fatima with an emotional outlet, paving a path for recovery. Decades of anthropological research has further challenged Western perceptions of what the Sheikh calls “a widely misunderstood explanation of sickness and method of healing.”

Cultural theorists have long interpreted spirit possession as an expression of power. During the 1980s, anthropologist Janice Boddy observed how women in the North Sudanese zar cult used spirit possession to avoid maternal chores. In her book Wombs and Alien Spirits, she labelled possession as an “idiom for interpreting experience,” and described how the phenomenon “can act as a counterhegemonic process enabling wives to negotiate their subordination.”

Later research by University College London analysed jinn possession as a metaphor for feelings of alienation. Amongst British-Bangladeshi Muslims in East London, socio-economic deprivation and experiences of discrimination were strongly correlated with instances of possession. The researchers found that a complete refutation of biomedicine and psychiatry by participants was rare. Rather, jinn possession compensated for what neurological models of mental health lacked— a recognition of the social roots of mental illness.

In Sheikh Hakim’s makeshift clinic, the often conflicting realms of religion and science are bridged together. Like the women of the zar cult, he finds that by attributing erratic behaviour to the workings of a malicious spirit, possession provides his patients with a means to voice their frustrations. The mischievous jinni gives their socio-economic afflictions a distinct shape and form; exorcism allows their suffering to be externalised and purged. As a form of cathartic release, the Sheikh believes that exorcism rituals can enhance the effectiveness of NHS-approved psychiatric treatments. Traditional healing, he stresses, should be used in harmony with biomedical approaches, rather than as a pure substitute to NHS care.

Whilst the Sheikh acknowledges that true cases of jinn possession exist— he claims to have come across thousands— he also admits that not all of the patients he has seen have been possessed. Some have been in dire need of professional medical intervention, but disillusioned by modern psychiatry, they arrived at the Sheikh’s door instead. Where psychiatrists fail to identify the complex origins of their Muslim patients’ distress, Sheikh Hakim believes that the trusted religious healer can step in to help.

Clinical psychologist Sanah Ahsan diagnoses psychiatry with a systemic disregard for the social origins of despair. “Society’s understanding of mental health issues locates the problem inside the person— and ignores the politics of their distress,” she wrote in The Guardian. Arguing that mental health problems are inseparable from broader societal structures of power, she advocates for an approach to mental health that diverges from current “white, eurocentric and individualistic” ideas of therapy. “Will six sessions of CBT [Cognitive Behavioural Therapy], designed to target ‘unhelpful’ thinking styles, really be effective for someone who doesn’t know how they’re going to feed their family for another week?” she asks.

The structural issues that Ahsan points to have been developing for decades. Since the late 1980s, the same time Sheikh Hakim began his practice, mental health diagnoses in the UK have increased yearly. A rise in psychiatric drug sales has accompanied this trend, allowing pharmaceutical companies to multiply in size, power and political influence. Anthropologist Dr James Davies holds these pharmaceutical giants responsible for the gradual commodification and depoliticisation of mental health. In his book Sedated, he outlines how neoliberal economic ideals have shaped society’s understanding of mental health, leading to a psychiatric discipline that encourages people to internalise their distress. In prioritising profit over people, he writes that modern psychiatric practice “has become handmaiden to the ideological needs and wants of new capitalism.”

People from BAME backgrounds, which includes the majority of Muslims, have been most vulnerable to the effects of neoliberal reforms. Despite this, Sheikh Hakim has received a steady trickle of non-Muslim patients over the years. As the cost of living crisis tightens, the socio-economic composition of the Sheikh’s patients has also seen a drastic change. Where unemployed young mothers, taxi drivers and factory workers once filled his clinic, doctors, accountants and lawyers now form a sizeable portion of his patients. Sheikh Hakim puts this down to not only a deterioration in NHS mental health waiting times, but a much deeper, intrinsic disconnection between Western psychiatry and the wider needs of the public. In transcending religious, cultural and socio-economic boundaries, the enduring appeal of exorcism exposes the shortcomings of the modern mental health industry.

As his patient base expands and diversifies, Sheikh Hakim is hopeful that public perceptions of exorcism will shift. For now, the ritual remains associated with backwardness, superstition and abuse. “There’s a lot that the NHS could learn from Islamic healers. If we all worked together, we could make a real change,” the Sheikh says, as his phone continues to ring.

*Pseudonyms have been used to protect informants’ identities.