Check out this interesting BBC story on Egypt’s mental health care program. It’s from 2009. It may be premature, but I really wonder whether what Egypt is going through now is in any way similar to what Iraqis went through after the fall of Saddam Hussein, when they began to deal with the collective trauma of 25 years of oppression, dictatorship and a very sudden freedom.
Here’s what I found in Iraq in 2004:
A few strains of Mozart float through an iron-barred window of Baghdad’s Al Rashad Hospital. In an empty eating hall, a woman watches an American soap opera on a television that has been locked inside a steel cage. Behind two locked doors, a flock of hunched women greet me with garbled chirps and shy, toothy grins. All in all, it’s a relatively peaceful scene for an insane asylum.
Looters and thieves had swarmed into the hospital even before U.S forces had entered Baghdad, stripping away expensive machinery and cheap bedding, and setting fire to many of the rooms. Over five hundred criminally insane patients escaped from a high-walled inner fortress and made off into the countryside. On the ground of the Zanab ward, a gaunt woman lay sprawled on the ground, sedated or comatose, no one could say for sure, while hundreds of black flies crawled across her face and body. Dazed hospital staffers in white lab coats wandered blithely past her, careful to avoid the shards of broken glass and debris that littered the grounds.
As far as mental health professionals are concerned, the country is a virtual black hole of information. What had once been a burgeoning mental health care system was essentially stopped dead in its tracks after Saddam took power. The regime deliberately suppressed or modified statistics on mental health in many cases. Reliable data on sensitive or potentially damaging issues like alcohol and drug abuse have never fully surfaced. Hundreds of highly qualified Iraqi psychiatrists and psychologists fled the country. Those who did remain were ordered to trim their studies to the needs of security services, or trash them altogether. “Psychiatry in Iraq was better in 1979 than it is today,” said Dr. Sabah Fakhuredin, a British-trained Iraqi psychiatrist, and national advisor to the Ministry of Health on mental health care, “The situation is grim. The problem is huge.” There is not a single qualified psychotherapist working in Iraq today, and there are only two hospitals, both of them in Bahgdad, for a population of 25 million.
Demand for therapy is intense. At the Ibn Rushd Hospital, a beleaguered staff receives between 250 and 300 outpatients a day complaining of depression and anxiety, but also of severe trauma and psychosis. In a spare room on the hospital’s second floor, Wahaida Jameel, 35, struggles with the memories of the war last spring when she and her 10-year old daughter faced the bombing alone. But it was when the bombing ended that the sadness began. Every day as the sun set, she would begin to cry uncontrollably. Shortly after, she started to fear simple things like food, air and water. As Baghdad became increasingly dangerous after the war, she developed a fear of open places, then traffic. When she stopped sleeping, she finally sought help. Now she’s on medication. But the societal fractures created by the war and its aftermath have opened the floodgates of long suppressed emotions. Sitting with a resident psychiatrist last week, Jameel fingered the lace fringes of her hijab and lamented her situation. “I never used to get depressed,” she said to the resident, welling up, “Now I’m afraid of food, I’m afraid of water and breathing, I’m afraid of dying.”
Electric shock therapy is still standard procedure at Ibn Rushd for depression. One day, I watched nurses give a woman named Mona 10 mg of Valium (far below the generally accepted standards for anesthesia) and hold her down while she convulsed from the shocks.
Group therapy hasn’t yet been widely implemented, but doctors agree it would likely be very successful in the Arab world where people enjoy social gatherings and tend to be more family and group-oriented. “The extended family is extremely important here,” says Dr. Abdul Karem Salman Al-Obeidi, who has focused on children in Iraq, “They act as psychotherapists themselves. This is different from the West.”
Obeidi estimates that some 2 million children are suffering from depression now. Doctors have already reported that their waiting rooms have become their own talk therapy centers, with patients avidly discussing what they’ve heard from other people during their own sessions. After hours, in the darkened psychiatric wing of Medical City, nurses hang back to talk to their patients. “Once they start talking they don’t stop,” said Dr. Al-Jadiry.
In any other place, a war on the scale of the one last spring in Iraq would have led to large-scale diagnoses of post-traumatic stress disorder, as it did in New York and Washington after September 11th. But the last 30 years of Iraq have been so consistently traumatic that doctors here find diagnoses difficult, even irrelevant. What may begin as a conversation about the traumas of the past often segues quickly into one about the war, the treatment at the hands of U.S soldiers or simply feelings of hopelessness and despair about the future. Jameel Wahaida, who is not insane, just terribly sad, is a case in point. “We are the victims of Saddam,” she begins, trying to describe how she feels; she finishes with a fitful description of how she has come to fear the soldiers who a year ago she welcomed: “They will kill us without any reason.” The confusion of years of trauma is only now beginning to surface. “You can’t pinpoint one major event in Iraq following which there was morbidity that you had to deal with,” says Dr. Fakhuredin, “It has become a chronic mental health problem. To deal with such an issue as PTSD as it applied [in New York] after September 11th does not apply in Iraq.” The type of regressive behavior that usually characterizes individual pathologies is taking place on a massive, societal scale in Iraq. “It is like a regression to an earlier stage of development,” says Dr. Zainy of Ibn Rushd, “There is a collective need to be nurtured by a father figure.
In some cases, long exposure to stress has made Iraqis more resilient to hardship, even as anecdotal evidence suggests an increase in PTSD cases over the last year. “It changed Iraq, and it changed Iraqis,” says Dr. Hashim Zainy, Ibn Rushd’s director.” Patients who have come to Zainy’s private clinic have complained of chronic low mood, inability to plan for the future and indecisiveness – all key indicators of clinical depression, even as their material situations and salaries have improved. “People used to be spoon-fed,” he says, “Now they’re not able to test their lives, they don’t know what to do about their future.” At the same time, doctors haven’t been able to pursue long-term psychotherapies with patients. “It’s very difficult to use psychotherapy for 250 patients a day,” says Zainy, “Most people want to get their drugs and just go away.”
– Baghdad, 2004