pull the panty down

In Iraq, when people got a psychiatric disorder, they usually will not visit the psychiatrist first. They visit the traditional healer first usually. I know some docotrs in medicine who took their relatives to traditional healers and not to psychiatrist for the first time. They even sometimes come to the psychiatrist telling him that the traditional healer want you to see this patient, and actually I sometimes feel good that the traditional healer believes in our benefit and existence. I remember a patient sent by a traditional healer with the request of doing electrical shock to the shoulders of the patient!!!
Traditional healers are respected and valued from the society because the reflect and reinforce the culture of the community. They share the same value system, norms, and symbol systems. There is cultural congruence between the healer and the patient, producing a close healer-patinet relationship, which is rare in western scientific medecine.
Some traditional healers believes that every psychiatric illness is due to a Genie (a spiritual being looking like human and not visible always to them) entering inside the body, and they treat that by hitting the patient's body with a stick or something else, and shout out for the Genie to made him go out of the body of the patient.
Lately I heard a strange story about a traditional healer who likes to abuse women sexually while intending that he is trying to heal them, and it was really a strange way, he put an old pig panty (I don't know if female's or male's one), connected by a piece of clothes up to the cieling above his head, in case you are not sure what I mean, look, he sits at the floor, and above his head you can see a piece of underwear (a panty) connected to the cieling by a thread or piece of clothes....the patient comes and sits infront of him, after some conversation he told the patient (if she is a woman) PULL THE PANTY DOWN, he do that as a test, if the woman understand what he really wants and seems to agree, you know what will happen, if the woman sounds angry and not what he thinks he can do with her, he will clarify, "clarify", I MEANT THAT PANTY ABOVE MY HEAD IT CONTAINS A GENNIE.....

my umbulicus had fallen

In the traditional belief system of the Iraqi culture some disease (or states) are cause by a fall of the umbulicus...yeah...a fall of the umbulicus...but how? when? where it falls? nobody knows nor seek for an explanation...and it is treated by many manouvers...
One man, married from six months, having impotence since the first day of marriage was diagnosed as a case of a fallen umbulicus by his traditional healer...and was treated by a strange way..the healer stands behind the man and took the man's upper limb and twist them in a painful but healing way..after that that man feels great sexual energy and goes fastly to his new wife and they sleep together in a very warm successful way, as he says to my friend when he consulted him, (my friend is a neurosurgeon ), but his problem is that the healer lives away from his house and the effect of that treatment lasts only short time and he cannot keep going to him every now and then...
My friend told me that story last night, this morning I wake up little tired, when finnish my work I sat alone infront of the closed TV and just let my mind do what it want...wants.....my friend come and told me: if you are tired why don't you sleep? I told him I don't want to...he talked to me but I was not attentive...he asked me what is wrong with you today? I told him: MY UMBULICUS HAS FALLEN.....(I didn't mean that I got impotence!)...

6 days 7 nights (free association part 4)

make a wish, you are alone in an island, and want 3 other people with you, whom you will chose?... that was part of the mental state exam for child psychiatry...for me...all the people I really love, I don't want them to spend life isolated in an island...so...will I stay alone there?...in that island....well...I think I will notify the people I love about my place and go alone...and give them the chance to visit me...that will be good...yeah...I was thinking about that when I was watching that film of Harrison Ford...6 days and 7 nights...when he works as a pilot taking a woman to some island but they fall on the wrong island...and they spend some nice hard time there...here is there first meeting...where she asked him to take her...

tey flew

they fallthey querrel

yeah.....i was sitting alone in the dark seening that film....remembered that lady I felt I love to her when I knew her online...and I asked her that question before sometime....she asked me that question too...well...i told her that i will go there alone and put a boat on the river which passes through her city and she can visit me when she wants..she remained silent and did not answer...i told her i will bring George Michael to the island...(she likes him very much)..then she agreed to pay me a visit

if she comes...i want a snake to go inside her short...and she cries for my help...and i go and rescue her.....how nice..

attachment to place

After the morning work I usually don't go anywhere but my place in the doctors house, a room, shared with 3 other doctors, but they don't stay in it usually after 4 p.m., and a collidor where there is a TV, and a bath...I usually get connected to places, sometimes love places more than people I think....there is a theory called ATTACHMENT theory talking about the importance of the special relation between the care giver (usually the mother) and the child, for the child's development and well being....I think attachemtn also occur to places....since the last 6 months I live here...and am attached to it...well..not so strong...just some simple attachment...the place am really missing now is the home i grew in it....it is in Baghdad...i hope i can visit it soon...

PTSD in Mosul

This is doctor Salem Al Hakeem, a psychiatrist from Iraq, in his study of PTSD in Mosul city (Post Traumatic Stress Disorder), he took a sample of about 396 persons, randomly, and found that PTSD prevalence is 25.88%.... Most of them are not diagnosed...

you are what you eat

These are the meals I eat in Ramadan,

the first one is at 4 and 30 mintues a.m. and this is it:

The next is after 14 hours at 7 and 15 p.m. and this is it:

At about 8 p.m. and 9 p.m. i drink tea (twice):

At about 11 p.m. I eat this:

well i don't finnish all that meals....(why am studying anorexia nervosa these days?)....

Anorexia Nervosa

Anorexia nervosa
Let me be
A. H. Crisp


Our senior psychiatrist who has an MRCPsych and some training in the UK says that in the UK he was seeing daily about 3 new cases of anorexia nervosa, but during the last 30 years he practicing psychiatry in Iraq he saw only 3 cases...

For me I did not see any case till now...that is why I find it difficult for me to read the anorexia nervosa chapter in the texts.... I think I am waiting for the first case to see, then I read about it... (ofcourse I have read it once, and I know how to diagnose it, but, don't have details..)

So I was so happy when another senior psychiatrist give me this book when she knew that am not that interested in anorexia nervosa..the book is written by Crisp, one of the first to write about that disorder, (i think he was the one who coined that term, is he? am not sure)...and this is part of my summary for that nicely written book which made me interested in the subject:

The majority of children do not seem overly concerned with their shape unless it is strikingly abnormal. Very fat children are usually teased and may become very self-conscious. They may come to consider that any inadequacies they feel they have are due to their fatness.

Pubertal girls (and their parents) first become aware of their breast development. Such development can, especially if achieved early, become a source of acute embarrassment and, for instance, stops such girls from going swimming or participating in communal sport. Excuses usually take the form of feeling generally unwell, tummy pains, etc.
For the first time food becomes equated with this new dimension of body weight, volume and shape- henceforth anorexia nervosa is part of the repertoire of possible morbid responses to maturational problems.
The disorder emerge within the context of puberty.

the book also contains many drawings by some patients, this is an example where some patient drawing herself while she is gaining some whiet and how she thinks other people are looking at her when she eat...

the 25th hour

C. V. Gheorgheu in his novel THE 25th HOUR, took me with the main character, Moritz from Romania, to Hungary, then to Germany then to France in a travel of suffering in the 2nd world and all the suffering he got was due to the other's misinterpretation of his race and religion.
To the European reader this novel may seem part of a far almost unbelievable history, but to me as an Iraqi, it may seem like talking about the days am still living..
Can societies learn from each others? Unfortunately, I don't think so.

origin of tea

There is a nice story about that, and it is that, Bodhidharma, who founded the ZEN school of buddhism, and after meditating in front of a wall for 9 years, he accidentally fall asleep....when he woke up he felt angry at hisself because he slept, so he cut off his eyelids, they fall on the ground, and the first tea tree grew....

caffeine withdrawal

fasting these days of Ramdan means no tea for 14 hours...I used to drink tea three times per day...first in the morning, second in the afternoon, and third on the evening...i think most Iraqies do that...we drink black (red) tea....tea, like coffee, contain caffeine, and when you get used to it, it is hard to quit it, in DSM IV, the diagnostic and statistical manual of mental illness, there is no diagnosis of caffeine dependence nor withdrawal, but some other diagnosis like intoxication and something else i cannot remember....but i think they should include the caffeine withdrawal as a diagnosis cause it really cause headache and fatigue...
They say that the signs of withdrawal appear after 12 to 24 hours from the last intake...and i forgot to take my usual dose for one 2 days....i spend many of the time of the next day lethargic and sleepy....
you may find this big tea pot not nice, it is from before ramadan, when we was having tea in afternoon after lunch...you can see part of our lunch...and our tea pot...if you don't like it, be sure I like it...actually I wanna kiss that pot which I really miss very much...

These days of holy Ramadan, I see that pot and drink tea at 8 pm and then at 4 am, when we wake up for the last meal of the day before fasting...They offer us this meal at 4 am...if you cannot understand what you are seeing, it is tea, one egg in oil, 2 pieces of triangular cheese, some other dairy product (something like butter), and i don't know how they call that last think, it is confiture i think...something sweet...i usually can eat nothin if i sleep and wake up, so i try not to sleep, or to sleep and wake up at 300 am or 3 30 am so that i have time till i can eat... the most important is to drink tea...

Oh Hilla I Miss You (free association part 3)

In 2002, I graduated from medical college, and was waiting the time I satrt working in the city I live in, Baghdad, but I was shocked to know that I can not work in Baghdad because I don't have enough marks to do so...So I must go to another governerate, I thought about Baquba, were my aunt lives, but to my surprise, they said I cannot work there eather with my marks...my marks was average, what is wrong, anyway I asked the man sitting next to me, what is the best close city to baghdad left to me, he said AL HILLA, and I took that...

In al hilla I learned to be really a man...before that I was dependent on my parents to live...at first i disliked that city, but after 6 months, I was in love with it, and refused to go back to Baghdad when the opportunity came to me...after 2 years I travelled outside Iraq in an attempt to leave my country forgood, when I was abroad, i missed al hilla too much...I went back to Iraq after 4 months and back to hilla this time again....this time i was walking the streets of this city while i feel totally relaxed and trustful that this is what i want...i want to walk in al hilla streets...and sit on the side of its great river THE EUPHRATES...one of the 4 rivers of heaven as the old tastament says..

al hilla is the city where Babylon was......i hope piece will come back to my country and i can travel inside it freely and revisit that dear city....

They Only Talk About Sex

When a new rotator doctor come to our ward to work in it for 2 weeks, when they go to other departments they work alot, but when they come to our ward they don't find too much work, cause we do by ourselves the main bulk. Some rotators find it interesting to talk with us asking about this and that, and some find our ward an opportunity to spend time chatting with other rotators and just killing time...
I usually sit with them and try to stimulate there interest, but sometimes I fail.. Some rotators are not respecting psychiatry at all...
One of the rotator doctors who seemed interested in talking with us, went to another ward after finnished working with us and when they asked her about our ward, told them: they are only talking about sex!!!!

Take Him To Jack Abboud

take him to jack abboud is proverb said in some Iraqi cities (I heard it from a man from Mosul), when they see a man/woman who is very happy to an intense degree...
Most don't know about the origin of the proverb they use, including me, but regarding Jack Abboud, I know him...I remeber hearing his name the first time when I told an old man in Baghdad that I want to be a psychiatrist, he made sure that I meant I want to be a doctor to treat the mental illness, then he opened his mouth and remebered something that made his eyes gaze into the sky and said: aha...you want to be like Jack Abboud Shabi...., then he examined my face with his eyes searching for something, I asked him, who is Jack Abboud Shabi?, he told me that he was the first psychiatrist in baghdad, that old man don't use the word "psychiarist", he use instead of it "a doctor for the diseases of the mind"....
I searched for information on him in the internet but I failed, I only found one site, saying that he was a jew, and he was treated by the Iraqi government in the middle of the 20th century as a dangerous not wanted man, and cut his telephone line so that he don't make phone calls to MOUSHI DAIAN, and wanted him to leave Iraq because they feared he may do something dangerous to the country....but all that is told by a comment of some unknown man responding to an article published in MIDDLE EAST jouranl talking about Iraqi jews...I don't know if what he sais was correct, but that was the only thing I found in internet...
I asked my senior about him, he told me that Jack Abboud Shabbi own a hospital in baghdad and that it was taken from him when he left Iraq to London...
Any body knows about him??? please send comments if you do...

Madani Salih Died in Baghdad (natural causes)

Loved by his students in Baghdad university because he present them kindly and friendly to philosophy. He even wrote philosophy for children in his well known work "Suad the philosophe", and Suad is a name of a female child who loves philosophy, and it is rare to have such books referring to females in arabic.

Names in arabic got meanings, and his name got a nice meaning: Madani means civil man, Salih means a good man and loves doing good things. He was said to be proude of himself and he sais that he talks to himself, or sometimes he says in the middle of a lecture: that what my friend madani salih told me!..

He was a man with great respect to himself and to others and to humanity and philosophy. He was clever enough to present the difficult subjects in simple words and shining phrases....

Its good for your heart (part three)

Albert Ellis and religion
Accepting oneself and others

Alber Ellis, one of the most influencial psycholgist in the 20th century, and founder of the type of therapy called rational emotive therapy, a reality based congitive re-stucturing by leting the client to examine his/her beliefs, which then led to the cognitive theory and therapy, says: " I get people to truly accept themselves unconditionally, wether or not their therapist or anyone loves them"...

He found there is no problem with the moderately religious people, but he found many problems in dogmatic religionists, regarding accepting the self and others, he says: " dogmatic religionist unhealthily and conditionally accept themselves (and others) only when their God, their church (or state) and similar religionists approve of their thoughts, feelings, and behaviors."

Its good for your heart (part two)

religion, whatever it is, is a man's total reaction upon life..... that was a line from William James book the variety of religious experience, 1902, william james is known psycholgist, a pioneer in introducing the psycholgy into the laboratory in USA...

He talks about the psychological changes in the believer and sais that: the psyche relaxes and regain balance even in the time of anxiety and distress, and the psyche experience a joy, and a feeling of trust in self, in life, or whatever....

He also talks about how religious experience is like a form of self suggestion...

One of the beautiful things he sais is that religion gives us warm connection to life, while scince gives us cold connection to life...

Its good for your heart (part one)

Ramadan, the holy muslim month of fasting, has come, and I decided, after been adviced by a friend, to reexamine my bond to my religion, Islam. It means I got to fast for 14 hours a day, and pray 5 times a day, and am doing that now, and feeling a great release...its good for your heart my friend said, and it is sure really is..

When I begin reading psychology books when I was still a teenager, I was a big fond a Freud, that wonderful man who tells you the story of the mind in a rich cultivated way.... But Freud described religion as "universal obsessional neurosis", and I was a teenager, and don't want to have been diagnosed with that thing, so, you can imagine how I started to look to religion...

Now am 30, and a resident doctor in psychiatry, got all the respect to Freud, but also to a psychiatrist called David Larsen who found in many revision of studies and studies he did himself that religious people have higher rates of marital satisfaction, greater sense of life satisfaction, lower risk of suicide and substance abuse than the nonreligious...

Great thanks to all my friends who argued me and stimulated me to rediscover that piecefullness you feel when you are doing your prayers and fasting.... it is really good for our hearts...

who's working in the psychiatric ward?

apart from doctors (8 senior and 4 resedent doctor in psychaitry and 2 rotator doctors in general medecine) we don't have other speciallized personel, wehave normal nurses who are not different from other nurses, and sometimes are worst than other nurses so the hospital don't need them in IMPORTANT places like the intensive care unit or in the respiratory unit... so they gave us the least effective nurses to work for us...

i remember many times when i need the nurse to be away from the pateint, cause the nurse make the patient feels worst, and one time a nurse told me that he will hit the patient with his shoes if he keep shouting, i asked him why the patient is shouting, he answered: to not let me sleep!!!!

oh my god its a fracture!

since 2004 and am doing electroconvulsive therapy to patients without use of anaesthesia, and i did not see any complication from that apart from the fear of some patients who do it for the first time, or some cognitive impairment for one day or 2 after the course....
but before few days something bad happened, a patient can not go out of bed after i did electroconvulsive therapy for him, and he felt some pain in his left thigh, but not so severe pain, yet he can not walk at all, i did an exam for him and concluded that there is a muscle spasm..and prescribed some pain killers, but the next day he was the same, i ordered an x-ray, and the report of it says that there is some evidence of an old fracture in the left neck of femor, i ordered another x-ray, another view, and it says: NEW FRACTURE OF LEFT NECK OF FEMOR.....

oh god...i knew i did nothing wrong, i did the same thing that i did 100 times before, maybe 1000s, but this man, i think he had an already abnormal bone, or what happened, whatever happened the patient and his familly was looking at me in a way that tells me that am guilty and i felt really guilty....

in the electroconvulsive therapy room i usually ask for 2 other substaf to help me, usually one a nurse and the other is a cleaner, yes, a cleaner, the nurse holds the patients lower jaw (to prevent dislocation of the lower jaw), and cleaner put his body above the lower limbs and hold with his hands the upper limbs to prevent there dislocation....

i put the instrument and click the bottom, and then concentrate on the patiewnts face and breathing and heartbeating, using suction and oxygen when needed...

i think i need to change the menaover, i think i will ask for one nurse and 2 cleaners, if i cannot ask for 2 nurse and one cleaner..

free association (part 2)

this is not real love is the song am listening while i write this....

well...this is not a true FREE asociation, cause it is affected by the song and also am guarding myself from telling all i think of.....anyway....am trying to make as free as i can to publish in this blog....


smoking.....yeah smoking...sometimes i smoke..but why?...i don't know....well Freud says that smoking is a belonging to the mother's breast...silly isn't it....anyway new researches found that smoking increase dopamine in the brain....letting one feel more bettre...but ....

well...the smoke it self when fly free in air and take all these shapes is relaxing for me...i noticed that when i found myself cannot smoke in dark.... in dark....i love darkness....especially these days..am i hiding from something?....from some feeling?....i ....don't know...

in dark i can see myself bettre...i think alot in darkness... and think bettre i think...cause stimulus from surroundings decrease...and i can concentrate...some colleagues when find me sitting in my bed in darkness think am strange...(i think they say in their mind a psychiatrist!)...

i will take another cigarette...wait...

yeah....look at as dancing baby...lets danse and show them all how close we are... that was from the song am hearing....so...well it is not a free association cause am trying to hide some ideas..i will stop now....sorry

manic defence

Most of diagnosis in psychiatry is based on description of symptoms, and not on pathology of brain as we wish. We diagnose a disorder (we call it a disorder and not a disease cause we don't know the etiology in most of the cases) by finding a special combinations of symptoms for a special period of time and we call their rules as CRITERIA to diagnose a disorder…

I find myself lost in these criteria sometimes, not able of reaching a diagnosis when I meet some patients (patients?)..

Before some days a man came having all the criteria to diagnose him with a major depressive disorder which include in the criteria, feeling of worthlessness and inadequacy..

But he also noted that he WILL be the Iraq presedent!! He says that he must and he will be the Iraq presedent and that he made a plan for that but waiting for the appropriate time to put his plan into action…

I asked him about the plan he answered with a smile that it is too complex to be told….and that he did not tell anybody about it till he met me…(he told me about that plan after an hour of conversation and after I encouraged him to speak)…

At that point I started to search for other symptoms and signs of mania, but I failed, I was thinking of Bipolar disorder (manic-depressive disorder) mixed episode…but there was no other criteria of mania but this grandious delusion…(was it an overvalued idea?)…

He got family history of bipolar I disorder in 2 of his aunts… so the diagnosis ended as bipolar disorder mixed episode..

That evening I met a colleague of mine and told him about the case he smiled and stand up and asked me: what would Freud call his believe that he will be Iraq presedent?

I did not know…

My friend continued: he would call it a manic defense…sami….it is a manic defense…

A manic defense is when you feel grandiose due to your more deep feeling of worthlessness and inadequacy….

pictures from the house of doctors

not so classy......cot so clean

FREE ASSOCIATION (part 1)

well....i think i got many to say......and i was chosing the best way to say it....and that is by connecting the things in mind with things from outside and pictures by creating a post....but in this series...series of free association....i will let my mind say what it want....like it want.....

i got to tell you that am hearing now a song...by George Michael....he sais...soemthing like I've had enough of dangers, people on the street, am looking out for angels, just trying to find some piece, ......and then he speaks to his teacher...yeah...his teacher...is that teacher a male? or a female? anyway he seems to love that teacher....and i loved my biology teacher when i was 13 years old....she was a female....well....loving someone older than us when we were teenagers means that we are searching for a parent maybe....that what some says....maybe true.....i don't want to make it long especially they phoned me now want me to go to the ward because of 2 new admissions...bye...

Arab's extinction

Yesterday, the channel, AL ARBIA, made an interview with ADONIS, a poet and thinker, and he said in that interview that the arabs are facing gradual extinction, like the babylonians, and old egyptians, and old greeks, because they are not participating in the modern world and in creation.... and because their culture is a culture of being meek, and against raising questions and against freedom....
I hope he is wrong....

Hebephrenia?

was admitted to our ward after he lost his left eye in a quarrel with his father, admitted because of the mutism he got after the operation in his eye, and because of the past history of mental illness which was not documented in papers....

he was 18 , depressed, stuporous, refusing to eat... after 3 days of IV fluid we decided that we must start ECT (electroconvulsive therapy), then that evening he suddenly came at the highest level of excitation and agitation, I remember him wearing his belt over his chest and making bizzar posturs and giggling and crying enough to be diagnosed as a hebephrenic schiaophrenia without feeling you got to remember the DSM IV to diagnose...he was illogical....

But when I gave him a paper and told him to draw something he came with something logical...

he writes BEST PEOPLE ARE above the flag of japan, and below the flag ARE THOSE WHO HELP BENEFIT OTHER PEOPLE....or in other word who makes life more beautiful...