Iraqi pride

Iraqies are usually very proud about their origin, when they are abroad, they wait the opportunity to say that they are Iraqies, say it and enjoy with great pleasure the reaction of others……
Abbas Cheechan, an Iraqi poet, writing in the Iraqi slang language which is mainly arabic but mixed with some words of Sumerian, Aramy, Ashurian, Persian, Turkish and other words, his poems were subject of many arguing between Iraqies about their country and political changes….
In psychiatry we say that we the form of thought is more important to us in mental exam of person than the content of his/her thought…and when I was seeing this poet telling his poems on air without reading from a paper I was amazed by his form of thought, of his body movements, and of his voice and reaction of his typical Iraqi face…
Look at all the pride he is showing in his body language….his words were full of pride of being Iraqi, and were sad because of the bad luck of this country after its golden era of Abbasid ended….
Abbas Cheechan, we hope all that our Iraq will heal its wounds and hold us back all in it with all of our divercities and races and religions…all of we are Iraqies inspite of the diversity of our thought content, but our thought form seems similar...….

When he appeared in TV all of we sat silently hearing his words….some did not liked his words due to some causes but they cannot help to stay hearing what he says, his clever use of words, creating new meanings, and playing with meanings, but still make it easy for even the simple people to understand, and more vital is to feel….
Some of the words he said I did not agree on, but, I cannot help to prevent the hair in my forarm to erect….
Am proud am Iraqi…

mama am coming home

Since long time, when I was about 13, (13 again ? I think about 13 toomuch these days), I heard for the first time Ozzy Osburne singing MAMA AM COMIN HOME, and I was living with my familly and my mom offcource was there and she liked the song too (she is an ex-fan of Jacque Brel, Yeve Montant, Pierre Bachlet, Edit Piaf, and others, but she I think she quit hearing and enjoying songs since more than 15 years), anyway....I liked that song of Ozzy Osbern when my mom was living with me, now , it is since 2002 and I didnot see my mother (just for 2 months in 2004), and it seems that we will meet in the coming months....and that song ..of Ozzy...is in my mind....yeah...unfortunately I don't have the song here now...but it is in my mind....always...these days....
I was going to my room after a day of work that rendered my mind dizzy, when I saw throught the window these three cats playing with their mother...(we are three , me and my 2 sisters, were called by names of cats by my mom before, me was MENE, my old sister was MINO, and the youngest sister is MENETTE), and I saw how that small cat was jumping over their mother and biting her and she bit them in her turn in a great joy of play.....I remembered when someday at the start of school me and my old sister got some insects in our scalp, head lice (in arabic called GAMUL) my mother was so angry and distressed and every day she let us put our head on her thigh while whe search our head for these insects and put some drugs given by doctor...and we really like that...even after that insects gone, (actually they are not insects maybe they are type of parasites), we always complaint to our mother about some itching in our head so that she let us sleep on her thighs....
Mom I really miss you.....

13

New doctors came to our hospital, old ones left, it is october where new resedent doctors start their career in different specialities and old ones got their degrees and leave....this time the coming doctors are more than the leaving....so hospital need more rooms for doctors on call...you know what...the first thing the managers did was to tell the new doctors that they will have a room...that room was the psychiatrist on call room....the cheif resedent doctor came to me and asked me whether their is a psychiatrist on call daily, I was surprised, I asked him: What do you think?...He start to be defensive and asked me: what do you mean? I told him: You are the chief resedent doctor..what do you think? is there a resedent doctor in psychiatry in the hospital you are chief in it?.....He found himself in a situation that no more denial can help....he murmured things....then left.....

Why they are like that? Do they think there is no emergency in psychiatry? do i need to send them an aggitated patient at night to be violent on them and break things around and insult them like some patient do to me frequently to feel that my existence in useful?....

You know what..my room number is 13.....


When I go back to my room from my work I don't want to hear too much sounds....so i draw this sign on my door....

When I Come...When I Go...

When I come to the internet cafe I walk for about 3 to 6 kilometers...I take it as the sport of my evening....What I like to see in my comming to the net cafe is that airplain which is always there in the sky below the moon making some white lines with its smoke....


When I go back to the hospital....I see only the lights of cars...it is also nice...

an octopus in my stomach

Every wednesday, our senior who got an MRCPsych, take us for a session where we discuss a case from a book of PMP (Patient Management Problems), which is written as a preparation for the MRCPsych exam cases....and it is usually very helpful, every thursday we take our ward patient and discuss their management...
Last wednesday it was a really important case were we all fail (i mean all resedent doctor) fail to do the proper management and it was like this, in a summary: a man with a known history of schizophrenia, disorganised type, came to the emergency unit of the general hospital were you work (you means the psychiatrist), saying that there is an angry octopus inside his stomach hitting the walls of the stomach with his 8 legs causing severe pain, and the patient was shouting and aggitated...
I was the first to say with a feling of confidence: somatic hallucinations...
All others resedent doctors agree....but our senior stay silent...we know there is something wrong in our answer...the senior asked me: what would you do? and i was less confedent but I decided to answer: admit him in the ward and start antipsychotics...
Our senior still unsatisfied and little unhappy with my answer asked me to let me rethink: which ward? to which ward you gonna admit him?
I knew that it was clear that I wanted to admit him to the psychiatric ward, but the senior is trying to tell me that am wrong, so I asked the senior, (whome I like and respect very much): sir I don't know what to do else....

He closed the book infront of him and took of his spectacles, took a sigh, and asked me: would like to do something in the emergency room?

I took a deep breath, feeling my failure...

He asked me again: any exam you would like to do?

I thought that he wanted me to exlude a medical condition, and by that the first thing i will think of is confusional state so I answered: a mental state exam to exclude delirium (means confusion) of medical causes....

Our senior asked the others: any one with other Idea?

There was a silence which really made us feel that either we are all (we = resedents) wrong, or our senior is not clear....but hear what he said to us: would you like to do an abdominal exam for him?

We look at each other, I thought in my self this way (an abdominal exam? for what? looking for octopus?)....

I wont bother you by telling you all the details of the rest of the session, but you know what, that man was having a perforated doudenal ulcer presented with acute abdomen, and he was on his way to be in a state of shock from loosing blood, in internal heamorrage, having a history of schizophrenia do not prevent one from having a medical illness.. the problem is that some people with mental illness when present with physical illness they tell the story in a way that is colored by their ideas and delusions and misconception, so that man was percepting the pain in his abdomen as an octopus hitting with his 8 legs the walls of the stomach...

Thanks God that was a lesson not in true life, but from a book, thanks God again and again...we really must take more care...that day I read about medical illnesses in the mentally ill and it is a really long complicated subject, but I will concentrate on it more...here some of my summaries...


Medical comorbidity in psychiatric patients

The psychiatric patients got an unhealthy life style, and 20% shorter life time, (20-40% of schizophrenic commit suicide).
Type II D.M. is 2-4 times more frequent in schizophrenics than in general population.
A study showed that about 20% of schizophrenics between 45-64 years olf got D.M., while non schizophrenics of the same age the prevalence is 5%
Since 1920 scientis found the link between DM and schizophrenia, and since 1950 found that antipsychotic drugs got some diabetogenic effects.
In jasnuary 2004, the amarican associat of DM redefined blood glucose levels:
- normal fastin < or = to 100 mg/dl (not 110)
- diabetic > 126 mg/dl
- 100 -126 is impaired.

Glucose tolerance: after 2 hr. of 75 g must got <> 200 this means DM.

History of psychiatry (part 6)

Phrenology

When I first graduated from medical school my uncle was very skeptical about my medical abilities, and I really wanted to have the chance to made him change his point of view on me. One day we were alone, me and him, where he asked me suddenly: can you know the personality of a person by examining his head?
I don't remember what I mumbled but I remember that I made him feel sure that am a bad doctor, and I made myself sure that I should not try to change his mind…

But I remembered my uncles question when I read about phrenology when I was reading about the history of psychiatry.

Franz Joseph Gall,

a doctor from the 18th century who was interested in anatomy and physiology of the brain as well as psychology, in his childhood he was having a friend with good language and memory abilities and large protruding eyes, so Gall thought since then that there may be a link between the shape of the head and the mental abilities.

Gall was especially interested in studying individuals who demonstrated extreme behaviors -- those who were especially gifted, or criminal, or insane -- and considered their particular skull prominences and depressions as representing those parts of the underlying brain that were over- or underdeveloped relative to their special characteristics
He identified 27 discrete brain "centers" of behavior, 25 of which have never been confirmed to exist. The two that he managed to hit on concerned language and word memory.
He is credited with being the first to clearly separate and identify grey (neural components) and white (conductive) brain matter functions.
Gall was the first to emphasize the principle of cerebral localization, in one of his books he said:
"There exists a form of partial insanity limited to the faculty of speech ...(a phenomenon) impossible if the faculty of spoken languagewas not the function of a particular part of the brain."

But it was Gall's student, Dr. Johann Gaspar Spurzheim (1776-1832),


traveling and working with Gall throughout northern Europe, who gave phrenology a name, a language, a system, and a literature, publishing extensively on the subject.

Dr. Battie symbolisation

I have published something about Dr. Battie, the first physician who chosed psychiatry as his field of speciality, and after that I suspected that his name got other some symbolisation, (suspected? am I paranoid?) I suspected that from one of the comments, (thanks to Tracy who sends me that comment and who always gives me feedback about my posts with her nice comments), and It was just by accedent that day when I was reading a book about history of psychiatry were the writer tell us how the word BATTY came to mean CRAZY in english language and he suspects (suspects?) that it came from that psychiatrist's name... He also states this: "it is generally believed that the term comes from the saying Bats in the Belfry, referring to having something amiss in the top story or head".
At first I thought and why they specify BATS in that qutation, but then I remembered that Bats have very poor vision and they make there way by making sounds and hearing where there sounds make echo, (like a radar), so if a huge bell in the belfry will ring....they will loose there way...yeah..that was a nice qutation...

nonclinical paranoia

It is said in the arabic literature that suspeciousness is a sign of cleverness (in arabic it got a rhyme: sou2 il thun...min husn il fi tun), and I have seen many normal people, most of them are clever, who are suspecious, actually some of the best psychiatrist I've seen in my life are so suspicious...actuallyI think the scientific mind may be highly suspecious...but social suspeciousness is really sometimes unhealthy and bad...before days I have read an article talking about the nonclinical suspeciousness (suspeciousness is called Paranoia in psychiatry)...and this is a summary of it:


Six questionaire assessments were completed by 1202 individuals using the internet. Paranoid thoughts occurred in approximately a third of the group.

Normal people were assessed for the not only paranoia for other things using many questinnaires, paranoia scale was used to assess paranoia, with it coping style questionnaire was used also which ask people how they would react to worries (they were given a list of paraoid worries) and 4 types of coping styles were identified, 2 adaptive styles (the rational coping and the detached coping styles) and 2 maladaptive coping styls (the emotional and avoidance coping styles).
Higher levels of paranoia were associated with emotional and avoidant coping, & less use of rational and detached coping.
Also high levels of paranoia were associated with negative attitude to emotional expression, submissive behaviours and lower social rank all assessed by scales.
Suspiciousness is common and there may be a hierarchial arrangement of such thoughts that builds on common emotional concerns.

In psychiatry the term paranoia is an old term, now it is used for referring to a type of schizophrenia were the suspeciousness is way far from normal..hear the story of this man who came before somedays to the hospital very aggitated (offcourse he did not come be himself, his 4 brothers bring him by force)..he was aggressive against his neighbours saying that they are abusing him, when I asked him what did they do to him he start to talk fast with a loud voice and all his body was moving while he told me this story: Mr. A and Mr B (he gave me their actual names and they are his neighbors as I knew later) were travelling around the world holding a syring, they went to the Soviet union, South Africa, France, England and many other countries holding their syring and gathering women from all these countries and taking some fluids from there genital areas (actually he said it in slang Iraqi language with means the vulva) and when they got enough of that fluid they came to me to inject me with that so that I get hypnotised then they cut my penis (he said it in Iraqi slang language) and take it to Israel to make some whitchcraft there...

At that point I was to ask him whether they want his thing to make witchcraft on it, or by it...but I guessed that that won't change my diagnosis of paranoid delusion and it may only let him tell me other details that may make me smile or laugh (these kind of patients are very sensitive to your facial expression which may make them loose their confidence in you), so I decided that what I heard is enough to give him a diagnosis of paranoid delusion...and start antipsychotic while the patient is admitted... He will gain his insight soon I hope...and that will give me and his family and himself the real big smile....

A Walk In Mosul (part 2)

It was a long time since I went out for a walk in Mosul. These days many gun fights occur in the streets nearby so am avoiding it, and above all am fasting and that make you function at a low level of energy, preferring to stay unemployed. Dr. Wisam told me that he will go to take the board which bears his name from the calligrapher; he will open his new clinic these days and will put this board on the street near his clinic so that people know about him.
I felt happy that I will go out with him, especially that the calligrapher's shop is in the old city, so it was an opportunity to take pictures…yeah..and here are the pictures….


Look at Wisam holding his name in the board…..

This is the word psychiatry in Arabic…


This is his rosy clinic, how nice…

history of psychiatry (part 5)

William Battie (1703-1776)

was the first physician who made insanity his full work. He wrote a book named "a treatise of madness"...








Johann Reil (1759-1813)

was the first to use the word PSYCHIATRY, and founded the first psychiatric journal. He is considered the founder of rational psychotherapy, recognizing the therapeutic value of institutional surroundings, music, psychodrama, and occupational therapy. He published "Rhapsodies about the application of psychotherapy to mental disturbances (1803)".

communication

since i was an adolescent and i make some judgment on people by ovserving the way the talk or they act...i remember many argument with my dad about someone who said something...my father usually take the words and what they mean...and i usually take how that person say it and how his body acted while he/she say that...and we argue and argue with the final result that am a very complex person as my father said..and my dad is very simple as i said..anyway...as i get older...i knew that my father had some right...we got to make our actions with people regarding what they say...in words not in body language...cause verbal communication got clear meaning..more clear than the body language...and also..if someone ask us why we made that decision regarding someone, it is not acceptable to say that we did that because he put his hand on his nose when he said that and that means he was lying...it would be really unacceptable...we got to stuck to words...yeah..but still body language can help...

I was reading in the behavioral sciences pretest when this question came:

What is the kind of communication with the greatest impact on a message?
a. verbal
b. vocal
c. intonation
d. facial
e. eye contact

verbal (7%)….vocal (38%)…..and facial (55%)….than answer was (d) facial

history of psychiatry (part 4)

James Braid (1795-1860)

James Braid was the one who coined the term HYPNOSIS, and was the one who separated hypnotism from animal magnetism and began to study the hypnotic phenomenon more scientifically.

He wrote a book name NEURYPNOLOGY; or the rationale of nervous sleep in 1843. He put hypnosis in its right way.

history of psychiatry (part 3)

Franz Anton Mesmer (1734-1815)

This is the one who I was searching for...I always asks myself why the word MAGNETISM comes when we want to talk about hypnosis...the is the man who made the combination...in 1779 he wrote one of his famous works: memoire sur la decouverte du magnetism animal....where he showed that when a mental therapist used the so called ANIMAL MAGNETISM, it could cure cases of psychiatric illness; this led to the discovery of hypnosis.

look at him in these pictures believing that that barrel and the silks going out of it will have some electromagnetic effects on the psyche... and also he believed that moving his hands in that special way will hypnotize the patient...most of his patients were women...

A Genie In Our Ward

It is believed in arabic culture that diseases are caused by Genie (spiritual being) entering inside the human body, especially the psychiatric illnesses. Before days I was late at night in the ward when women in the last far room start to shout, they were four women, 2 patients and 2 members of patient's families, all of them shouting...the rural patient and her mother was screaming that there is Genie in their room, the other patient from centre of mosul and hre sister was also afraid and saying that there is someone annoying them...

All of them went out of the ward, the mother of the rural patient said that something is going out and in from the wall, the woman with that patient from Mosul expalined that someone is hiding somewhere and saying "pssssssst" for them to frighten them...

I went alone to that room...it was dark..I turned on the light...then heard a long "psssssst" that really made me afraid...I keep looking from where the sound is coming and look what I found...

It is the oxygen opening leaking some oxygen....