Wednesday, February 25, 2009

a letter of love to psychiatry

Students of medical college asked me early this morning about why "I" consider anxiety as a disease. It took me some time to talk about the concept of disease, disorder, illness, pathology, suffering, cost-benefit balance of treatment, and quality of life. I asked them if they consider a "fracture in the leg due to car accident" as a disease. I asked them whether they think "pregnancy" is a disease. Should we call a man with a fractured leg as "patient"? Should we call a pregnant lady a "patient"? And what is disease after all? Can you define it?

Anyway I am sensitive these days from those who are skeptical about psychiatry. I don't feel respected in my daily life. I saw a specialist in ENT (Ear, Nose and Throat) from Hilla today and I like him very much. He likes me very much too. We kissed each others like we usually do in Iraq and started talking about some shared memories. He asked me before we departed:

- Are you STILL with psychiatry?
- …..? with?
- Didn't change … I mean…. Still sure that you want to be a psychiatrist?
- Well, what to do else? I like it.
- God may help you my friend and make success in your way always.
- Thank you dear, same for you. Byebye.
- Byebye.
Soooo he is kind but, like them, what is wrong?

In that small room he said to his companion with a loud voice as if trying to see what would be my comment: "our thesis in psychiatry is just nonsense, do you believe that someone can really work and do a thesis? Just lies". They laughed anxiously while looking at me. I smiled to them and went out to the outpatient clinic.

A teenage with obsessive compulsive disorder was waiting me in the outpatient clinic. He astonished me by his knowledge of his disorder and he told me that he chat online with a psychiatrist from the USA. He told me that he reads websites talking about obsessive compulsive disorder. Dealing with him made me realize that I am not in a world of ignorant.
After him came three clients, one after the other, all having social phobia, all were university graduates and very clever.
Then a lady from a rural area, no schooling, with marked psychomotor retardation, anhedonia, insomnia, early morning awakening and history of resistant depression came alone. She was enough insightful to say: "I really don't want to come to you doctor, but I got to force myself, cause when the episode will go away I would think this is what I should have been done, coming to you". I asked her about whether she finds life worthy. She told me about her suicidal attempts and showed me her previous wrist and neck wounds. I told her she must be treated inside hospital for few days maybe. She asked me to consult her family and that she will come on the next days.
A lady with a card written on it: "paranoid schizophrenia on zyprexa 10mg/day" came to ask me about zyprexa. She said: "I don't want to go back thinking those strange ideas doctor, I have hurt my daughters enough on the last episode, I want to continue on zyprexa, is this dangerous? Is zyprexa addictive?"

The last client was a small family. Father, mother and her, the most beautiful princess with hearing difficulty and attention deficit hyperactivity disorder. She turned the room upside down on our heads. She wrote me a letter and drew me a painting.

When they went I felt I am much better and that I like my profession no matter what. Those people I saw today in the outpatient clinic know about psychiatry more, and respect psychiatry more than medical students, ENT specialist, and some other doctors. It is for their sake, and for my sake, that I will continue enjoying studying and practicing psychiatry. Those ideas were coming in my head while I was preparing to go out of the outpatient clinic. The king, father of the princess came to me with the princess who was frowning at her father who said: "please doctor, can you write something for her, I mean anything in a white paper, I am sorry but she wants to take the prescription paper you already wrote and she might tear it, can you just give her a paper with anything written on so that she stop her temper?".
"sure" I said and took a white paper and wrote something like her lines on it and gave it to her. She smiled and hold it up in the sky and yelled at her father: "hay hay!!". Her father kept saying "sorry doctor" and I kept saying "it is ok" we smiled to each other and went out.


3eeraqimedic said...

Dear Sami
You are spot on, the reason we do what we do is the patients first second third and last.
And don't think it is just psychiatry that is misunderstood, many very well informed people still ask me why I didn't choose something less miserable than caring for people with cancer, ultmately I also cannot understand why anyone would choose to spend their days putting people to sleep!! the most interesting bit of the job is getting to know the patients (sorry I am old fashioned I cannot get my head around the whole clients stuff)
By the way I loved your previous two posts.
Take care

Laura said...

I second what 3eeraqiM says, the satisfaction is from working with patients, first, foremost and forever. And watching people heal--or at least, be able to make use of treatment-- is what makes it worthwhile. (I call the folks who see me patients, too. The root of the word patient is related to suffering. The one who suffers. The root of client is related to the word dependent. Folks come to see me because they are bearing pain, not to be dependent on me, the patron. If you have a chance to hunt up James Hillman's essay on the subject, I think you'd enjoy it. If you can't get it, let me know. I'll track a copy down for you).

Sami, your essays are always a pleasure to read. Especially the ones about psychiatry. Thank you.

saminkie said...

Hi 3eeraqimedic, thank you for your nice words. So you work in oncology unit and feel sometimes misunderstood. I remember working in the oncology unit during my rotation and I still remember some patients especially the young with leukeamia with bleeding tendency. It is really a difficult job. Take care 3eeraqimedic and thank you for your nice words.

saminkie said...

Hi Laura, thank you for that information which is valuable. The problem is little complicated for me cause in our daily language in Iraq we call the "patient" as "diseased". Sometimes the word "diseased" is an insult. That is why some don't like it.
Thank you Laura for your encouragement and nice words.

salampax said...

I was hoping to send this through an email but I couldn't find it on your blog. Sorry in advance for the long comment.

I don't think I've introduced myself before... my name is Salam, I blog under the name Salam Pax. I have been lurking around your blog for a while now but haven't found a reason to get in touch before. Now I do. A friend of mine in the UK who's working with legal aid for immigrants was asking for help regarding a report she's writing a report she's writing for an asylum seeker.
He's a patient with severe paranoid schizophrenia and it seems the authorities there planning on sending him back. She has a list of 16 questions and any answers could be helpful. I know I'm contacting you out of the blue and ask for your time. But I think it's a good cause and it would be great if you had a couple of hours free to look at the questions and see if you can help.

Keep up the good work, I enjoy your blog very much.. even the Arabic language one which you seem to have abandoned :-) leeesh?

Best regards,
Salam Abdulmunem

saminkie said...

You are welcome Salam, and thank you for your nice words. I will write an arabic post in the arabic blog in these coming few days.

Regarding what you have said about the "asylum seeker", it would be more helpful for you to contact the Ministry of Health web site and they got also a psychiatry consulation bureau.

I am still a student of psychiatry and I don't know what it is meant by "asylum seeker".

Any way you are welcomed to contact my email:

I will visit your blog.

adifferentvoice said...

Sami, what a great job you are doing! And now you've even attracted comments from the famous blogger Salam Pax. He's very well known in the UK - at least to Guardian readers! (

3eeraqimedic said...

Googled your James Hillman and spent some time trying to figure out what I found.
I could not get my head around what most of it was about
Thank you for reminding me why I chose the nice simple blood cells to study!!
Allah Ysa3idkum 3ala kul hel felasifa

sami said...

thank you adifferentvoice for your nice words, and yes 3eeraqimedic, there is a lot of felasifa in the brach but i like it.

Munqithe said...

سامي العزيز
السلام عليك ولله درك
ذكرتني مقالتك المعانية هذه بقول الجواهري رحمه الله يمدح الدكتور هاشم الوتري:
لله درك أيّ آسِ منقذٍ**يُزجي على الداء الدواء كتائبا_جازتك عن تعب الفؤاد فلم يكن**تعبُ الدماغ يهمُّ شهماً ناصبا

هذا الذي تعانيه أنت نعانيه كلنا في مهنتنا
ولا سيما بعد تحول شطرٍ كبير من الطب في العراق الى تجارة قبيحة لا يحترم فيها انسان بل يحترم فيها الدرهم والدينار

ولدينا ها هنا :إف يو آر كلفر شِفت ات تو أنذر!! بكل ما في هذه الكلمة من وضاعة وتهرب من المسؤولية

الا أنّ هذا لا ينفي وجود أطباء نبلاء من مثلك ومن مثلي ربما ومثل عراقيمديك وغيرنا من اخوانك واخواتك والأجانب منهم أيضاً من يتابعون مدونتك النبيلة الجمبلة
لله درك وابق هكذا دائماً ولنبق هكذا دائماً
وكم هو الطب النفسي في العراق محظوظ لوجود أمثالك من الأطباء المثقفين النبلاء الذين يحبون الناس أكثر من الدراهم رغم عدم تنازلهم طبعاً عن حقهم الشرعي في الدراهم
ويحضرني كلمة جيدة سمعتها من وزير الصحة العراقي الحالي وهو انسان معروف بعمق الثقافةوهو بالمناسبة طبيب نفسي وذلك في كلمته قبل أيام في حفل تخرجنا إذ قال يوصينا: ان عليكم يا اخوتي ويا ابنائي وبناتي أن تعالجوا المريض لا المرض

أدعو لك دائماً ولنفسي وللطيبين بالتوفيق والسلامة
صديقك وأخوك منقذ ماشاءالله

saminkie said...

Thank you Mwnqithe for your nice words.

tracy said...

Dear Sami,
Thank you for a most wonderful post about the absolute importance of Psychiatry. Long story. You know mine...
Thank you, my friend,

Sami said...

Hi Tracy my friend, thank you for the nice words. Friendship and few nice words make me feel much much better. Thank you my friend.