strawberrian shadow

I never wanted to publish a name of a person without telling him/her in advance. But how can I meet her now? What life had done to her? Where is she now? Is her huge crowded family house still there? Is that Grindeizer big poster still hanged at the back of one of her many brothers room door. Were all those children in that house her sisters and brothers? They were all welcoming her back with great happiness. When we took her to her home I felt that her sisters, brothers and parents were waiting us to go so that they can really welcome her, embrace her, and ask her about the days she spent in our house.
We were taking her to her home every two weeks as far as I can remember. She spent few days there, less than 3. And we go back there to bring her. Was she going sometimes to her home on her own? Did she comeback someday on her own? I cannot remember. I was just a child below 6 years. Wasn't at school yet. My parents had to go to their work. She must come to take care of me and my young sister in their absence. She used to take care of my baby sister but I was treated differently. I knew that she was not a physical beauty since I first met her. I remember that my female cousin did not like her. I was treating my cousin as my older sister.
One day we were examining our stamps together. There was a series of stamps telling the story of Jesus. They were stamps from the United Arab Emirates. I asked:
- Who is this?
She started to tell me about him. She wanted to say more and more but wasn't encouraged by some as I can remember faintly.
So when the other day my cousin invented that rhyme and told me to sing it to her I felt so happy to annoy her. A wicked evil smile draws itself in our faces, me and my cousin.
I still remember how she just came inside smiling when I, in the existence of my silent cousin, stood and sang: "Mariam Al Athraa, tateer fil sahraa" (mean: the Virgin Mary, is flying in the desert). I felt while I said that that my cousin, who was behind me, went to the kitchen down casting her head hiding a smile , while her….she looked at me with a wounded look, turned as fast as she can, my smile faded in my childish stupidity, she walked, she run out of the door she just came in from, my heart sank in a newly discovered sorrow, I could see her face crying, my eyes opened wide in a stunted feeling of guilt, fear, sadness, and anger mixed all together in my growing brain.
I asked her for forgiveness. She accepted to forgive me after just saw how I looked so sorry. I loved that Christian girl, I discovered for the first time that my cousin can make terrible mistakes; I knew that I can take another point of view different from my cousin's.
I even stopped telling my cousin about what happens between her and our boy neighbor who loved to talk to her under that huge strawberry tree shadows. And we started to have some secrets. I was against her frequent increasing meetings with that boy. She felt annoyed because I was so alert on her. My cousin was asking me more and more intensely about those meetings under that tree. I was becoming more silent and angrier on her when she went to meet him. She used to wait for him sometimes behind the nearby fence. I used to become irritable and start making some actions to annoy her. She told me then about that "STAR WAR" thing. She claimed that a war will happen between the stars and that the whole universe will explode and all of we will die. She knew how afraid I felt. She kept telling me that till her boy came. And since then, every time I tried to annoy her when she waits for him she would start talking about that STAR WAR.
Our alliance started to be threatened by the continuous interrogations done by my cousin with me, trying to make me confess. Till one day something happened and those meetings were stopped by themselves. I confess to my lady about the secret talking between my parents about her. They were not happy about the way she acts. I did feel how sad she felt. It was Iraq-Iran war, the weather was gloomy, and lights in our silent small house were faint. I took the stamps and told her to tell me the story again….
One day she told me:
- Oh I miss Sami.
- Sami? (I said smilingly confused).
- Yes, I love him.
- Who is he? (I asked annoyed).
- Sami our neighbor.
- …….(if I was sitting, then I think I stood up).
- He got huge muscles, his biceps is the biggest I ever seen.
- I got muscles too, see!!!
- Naaa, his muscles are of a man, you are still a kid (she said that and laughed as far as I can remember).
She didn't repeat that "Sami" story very often. A fact that made me hope that this was a faked story.
- We had taken you many times to your home.
- Yes, how much I miss my home.
- And I can remember that poster of "I am a disco dancer".
- Yeah, how much I like this film, Indian films are really romantic.
- I can remember I saw the hero wearing a red clothes in his head.
- Yeah.
- I can remember the picture of Grindizer in your brothers' room door, and I can remember your brothers' names.
- And sister?
- And sisters' names too. But there is something I cannot remember.
- Which is? You big rememberer?
- I cannot remember a man named Sami in your neighborhood.
She felt sad. I felt great. After a while I was sad too. I asked my father to accept that we play that cassette in his huge JVC recorder. He agreed. "I am a disco dancer" started its dancing rhythm and she agreed to dance with me again that day.

Presentaion of Depression in Iraq

I am in my final year of my study. To fulfill the criteria of fellowship to the Iraqi board of psychiatry, I should do a research. I have chosen I subject I found myself fond of, cross-cultural psychiatry. "presentation of depression in Iraq" or "symptom profile of major depressive disorder in Iraqi patients" is the title of my thesis. I have gathered till today about 65 patients. It is time to start writing the introduction. It is not easy at all. I have changed it many times since I have started writing it before 2 days. This is my introduction as I chose to make it today. Please I would feel grateful if any got an idea to make it better. I started before two days only and I want my introduction to be much longer than this, but this will stay, as I think, the main skeleton on which I will add.

Introduction

"Depression is one of today’s most common, and most commonly misdiagnosed, psychological illnesses."

Gorden Parker, Dealing With Depression

"90% of DSM-IV categories are culture-bound to North America and Western Europe"(1)

A drowning shirt in Al Rashad hospital:

Depressive illness is common, painful, and dangerous. Untreated depressive illness can lead to personal, familial, and social disasters. Depression can be lethal. The ability to recognize depression may be a matter of life or death. Failure to recognize depression is a global problem.

Depression involves a different combination of symptoms and reveals itself in slightly different ways. Different authors have commented on different aspects of these disorders, and variations in their incidence, symptomatology and course have aroused widespread speculation regarding possible cultural influences on aetiology and clinical picture.

Socio-cultural aspects

A rosy neglected jacket in Al Rashad hospital

Mental illness is called generally as "Jinoon" in Arabic. A word that is derived from the word "Jin" which refers to supranatural beings believed to have the ability to possess a human.
Cases of "possession" are said to be less common in western countries. It seems that there is a negative relationship between civilization and reported cases of "possession". If you work as a psychiatrist in Iraq these days, you will still be able to see some of those "possession" cases. Unfortunately there is no recorded prevalence rate of such cases. More commonly you will encounter different cases of various mental illnesses that will attribute their illness to a "possession".
There is a belief that a man or a woman who unwittingly steps on a Jinni (Bazzouiand Al-Issa,1966) or across his path is seized by this particular spirit in act of revenge manifesting itself in manic or depressive states, depending on the nature of this Jinni. Is this believe still existing, and to what degree? This is one aim of this study as patients will be asked about what they think is the cause of their illness.

The fast strides of change in the new millennium are affecting people's beliefs and values. How many cases of depression in Iraq are still believed that their illness is due to a "possession"? Internet and satellite channels are invading our homes with their various contents. People in Iraq usually use these media resources for entertainment. But recently a more and more percentage is trying to open a window to see the world through it. Educational satellite channels are succeeding in attracting more viewers. Educational websites in Arabic are still not that much developed but still they do make some change. Many patients are aware these days of the names of mental illnesses. Depression, Schizophrenia, Obsessions, Autism, Hyperkinetic child, and some more terms are used by people more than before.

Traditional healers, on the other side, are still visited very often by those who feel psychologically upset or abnormal. Visiting a holy shrine is still a commonly used way to treat the mentally ill by people of Iraq.
Are the average Iraqis still psychologically naïve like Dr Widad Bazoui had stated in his studies on psychiatry in Iraq between 1966 and 1970? This is another aim of this study as the patients will be given time to express themselves, and to comment on what they think had caused they state they are in, and what do they call the state they are in, and what treatment they believe can help.

Affective Illness Across Time

Runing trousers, lost in time in Al Rashad hospital

Affective illness is not a new entity in the medical history of this land. Although sometimes its description is primitive. The Sumerians had mentioned mental illness in their writings. Avicenna, in his Canon of Medicine, described cases that share many aspects with the modern concept of depressive disorders a thousand years ago.

The black bile theory of Hippocrates was the explanation for this phenomenon for those doctors who lived in Baghdad since one thousand years ago.

A strongly held belief, that may still exist so strong, is that depression is due to weakness, and specifically, being a "not enough" believer in God.

Biological causes of depression is not that understood, if wellcomed, by people other than the psychiatrists. Even doctors from other branches of medicine do not seem to believe in "Biological" cause of depression. This maybe due to that basic sciences researches are not functioning at all in the field of psychiatry. We never did a cerebrospinal fluid chemical analysis for those who got a mental illness for example. Evidences of biological causes of depression, and other mental illnesses, came just with textbooks from the "west". Some doctors find it easier for them to feel emotionally detached from those biological theories.

So the spiritual east is refusing the biological theories strongly and till now.

Iraq the multi-ethnic

Multi-colored blues

Iraq has a heritage of diverse cultures. Since 7000 years and civilizations are flourishing one time, and then fading again. Multiple ethnicities and religions shared this land. But they share some common values. It is not rare to see a Christian patient visiting a Muslim traditional healer who may use the holy Quran verses while trying to offer therapy. And you can see a Muslim woman in a church asking for being healed from a disease.

Is there a difference in the presentation of depression among different ethnicities and religions in Iraq like Dr. Widad Bazzoui had stated in his study "Affective Disorders in Iraq" in 1970? Dr. Widad Bazzoui had found that Iraqis who are not muslim presents with higher rates of "Guilty feeling" while depressed than the musilms. It is one of the aims of this study to find out wether this is stronly evident.

Somatizing depression/ idiom of distress

The main aim of this study is to find out how Iraqi patients with depression present themselves. It is much stated between psychiatrists in Iraq that Iraqi patients somatise their symptoms. That they do not present with the congitive symptoms as they do more with the physical ones. The aim in this study is to meansure the frequency of each of the Diagnostic and Statistical Manual - forth edition (DSM IV) criteria in Iraqi patients. And to compare the results to studies done on the United States and some other studies done in Asia.

That was the main aim at the start. But as it was found that in Dr Widad Bazzoui study in the 1970s, found that many Iraqi patients with depression presents with other symptoms not mentioned in the DSM IV, other questions were added to the questionnaire.

Questions about: "headache (100% positive answers till now); pain anywhere in the body (100% positive till now); Gastrointestinal symptoms; Respiratory symptoms; Cardiovascular; Neurological; and others)

Questions have been added on paranoia: "ideas of reference, ideas of persecution, ideas of infidility, suspicions and wether they are delusional".

Another question was added on violence and aggressive tendencies and wether it is verbally or physically expressed mainly.

All these were added because they were found to be common in Dr Widad Bazzoui's study.

The prevalence of depression in asia has been reported to be lower than in the west. This has been attributed to somatization. That is to say, that people from asia with depression tend to present themselves with somatic symptoms rather than psychological symptoms. Another explanation was the concept of alexythemia. That is to say, people from non western countries, are less aware of their psychological status, maybe due to ignorance.


Another explanation for presenting depression with physical symptoms is that the diagnosis of depression, and mental illness as a while, is regarded as morally unaccepted and as a weakness a good person must not suffer from.

Arthur Kleinman, a professor of cross-cultural psychiatry, has pointed in his paper "culture and depression" to the experience of depression in the Chinese society where the expression is rather physical than psychological and had stated that: "Culture confounds diagnosis and management by influencing not only the experience of depression, but also the seeking of help, patient-practitioner, communication, and professional practice"(3)
Kleinman, has described somatic symptoms as an “idiom of distress” that is prevalent in culture where psychiatric disorders carry great stigma.
Somatization can be viewed also as a defense mechanism against the awareness of the psychological distress.

Facultative somatization/ a ticket of admission

Patients may feel that reporting a physical complaint is more acceptable as a complaint to a doctor. Many doctors may have answered patients with psychological distress with the answer: "you have nothing wrong; it is all in your head". A commonly used answer in the face of somatization rendering people over time not to complain to doctors about their psychological distress. This has been called "facultative somatization", in which the patient is not in denial, but thinks that physical symptoms is a ticket of admission to the care clinic.
It is a common story to admit a patient with physical symptoms in a hospital in Iraq, then the patient will tell the nurse about a psychological distress. They tell the nurse because they feel him or her more culturally close to them. Doctors are more physical, they are called "physicians", aren't they?
A psychiatrist is a doctor after all and a patient may use facultative somatization with psychiatrists too.
Widad Bazzoui had stated in 1970 that: "In general, the average Iraqi patient describes his depression as a sense of oppression in the chest, a feeling of being hemmed in, or in other cases, a hunger for air. On being asked if he feels sad, downcast or depressed, one is struck in many cases by the unawareness of the patient of his mood. The disorders, especially depression are usually conceptualized not as emotional disturbances but as physical abnormalities affecting various organs of the body. The chest, head and abdomen are frequently considered to be the core of the troubles. Very often the patient describes his complaints in metaphors and similies in an effort to bring his strange experiences within his grasp." (2)

To what degree this is still valid nowadays?

See how this Iraqi patient with schizophrenia expresses himself

On the teared peice of paper he wrote: "the name: unknown, THE IDENTITY". I don't think he is psychologically naive.

NOTE: these pictures won't be used in the thesis paper, nor the comments on them.

-----------------------------------------------
(1) Kleinman A. (1997) Triumph or pyrrhic victory? The inclusion of culture in DSM-IV. Harv Rev Psychiatry. 1997 Mar-Apr;4(6):343-4

(2) BAZZOUI, W. (1970). Affective disorders in Iraq. British Journal of psychiatry, 117, 195-203.

(3) Kleinman A. (2004) Culture and depression. N ENGL J MED 2004 September 2, 31;10

Al Mishwar Restaurant

"Winters cityside Crystal bits of snowflakes all around my head and in the wind"

Going to Al Mishwar restaurant in Al Mansour was my favorite tour with my father and mother and young sister. That big screen in that restaurant and all those songs filled my heart with passion. Steve Wonder called just to declare his love while Lionel Richie answered with his magical heart melting hello. European final countdown to a modern talking were making brothers going louie louie louie letting A-Ha hunting high and low alone.


"I had no illusions. That Id ever find a glimps of summers heatwaves in your eyes"

I was crazy loving Susana who had just graduated from the Art school to sit on the sofa while the music was way down low while my mother was protesting helplessly: "you're too young for this, go do your homework". I took my copy book and wrote: when I look back upon my life, it is always with a sense of shame, …. It's a sin. A boy came from a pet shop and took my copybook and went west.


"You did what you did to me, now its history I see. Heres my comeback on the road again"

Boys in Al Mishwar restaurant were looking at girls' legs from behind. I was thinking they were looking at the girls' shoes. I still remember that I liked red shoes with high heels. I took a bite from my hamburger and took a look on her red shoes with an eye of a little tiger who survived the torture of his older teenage female neighbor and smiled. My mother told me to stop.


"Things will happen while they can. I will wait here for my man tonight, its easy when your big in japan"

The Cheri cheri lady in red took chris de burg out of his mind and scream: I'll never be Maria Magdalena, while Sandra took Madonna the innocent to la isla bonita where they worked as dancers in Kaoma band dancing the lambada leaving me viewing a song in the Iraqi second channel by 2 unknown singers singing in some unknown language "FELICITA"!!!

"When your big in japan, tonight, Big in japan, be tight, big in japan where the eastern seas so blue. Big in japan, alright, pay, then Ill sleep by your side, Things are easy when youre big in japan, when youre big in japan"

Those were happy days where my life was like a happy cartoon moment where Sandi Bell was walking hand in hand with Kuji who had just land on earth from his yellow space ship.


"Neon on my naked skin. Passing silhouettes of strange illuminated mannequins"

I got little older and scorpions rocked me like a hurricane. Bon Jovi was there for me when I get bored from all that screaming to offer me a bed of roses to put my biology teacher fantasy image and taste that poison offered by Alice Cooper.


"Shall I stay here at the zoo. Or shall I go and change my point of view for other ugly scenes"

Some Jazz refreshed my musical ears to let my brain FM radio find the wave of that Qween whose show must go on destroying all the pink floyd walls in front of those little dusty Beatles playing from my alarm clock at 5:30 am "yesterday" tune.


"You did what you did to me, now its history I see...Things will happen while they canI will wait here for my man tonight, its easy when youre big in japan"

Wake up so that your eyes see things green

I just woke up from a strange dream again. A panoramic dream in which I saw many things. As far as I can remember I went to Bab Il Sharjie (the eastern gate, a place in Baghdad near the liberty monument). I started looking at the churchs. There was a long church (not existing in reality) of many floors and a modern look. I knew in the dream that it has elevators (elevators in my Iraqi mind means Modernism, or maybe postmodernism. Or something that is still not firmly existing even at the era of postmodernism). Its windows were narrow as if made to let people to see though it from the inside but not to let people from the outside to see through it. I kept wondering till I saw a friend. A christian friend who left Iraq before weeks (this exists in reality, I mean this is a fact). I greeted him. He was smiling widely and sitting on a high bench. He was talking loudly (as usual) to a nearby sitting man. I asked him about the name of the church. He gazed me for a while with so cautious look then said with a low voice the name which is forgotten now. In the dream, when I heard the name, I asked my self, "is it Krimly?", becuase there is a christian school in Baghdad named Krimly school and I don't know where it exist. I only know that father Anistas Mary Al Krimly was intersted in Arabic language and wrote many books about it and about Iraq culture. I am reading a book about letters between Massignon and father Kerimly, hence why I am thinking about him in my dreams. But the name was not "Krimly". It was something else. When I asked my friend the christian (whom I talked yesterday via the yahoo chatting) about wether this church is a school, he didn't answer. I asked him wether I can take photos. It is not accepted to take photos in many parts of Baghdad. My friend said that he doesn't know really but he can help. He took the camera from me and with a fast movement he took a picture and went back smiling widely.

I went to the market. Many vegetables and meats but some few books there. They were covered with dust and their prices were high. I went to another corner of books and "pee ka boo" a relative of mine living in Algeria came from between the books. (in reality she was the one who adviced me not to read "the prophet" of jibran Khalil Jibran in 1991 because as she said he was a Jew).

The christian friend came and we started to chat. They started to talk about some thing which I failed to follow. Something about sex. I felt annoyed. the christain freind went. She asked me to accompany her during shopping.

After a while i was walking next to a kurdish psychiatrist going to the conference. The conference of all Iraqi psychiatrists.

It is late at night and the golden shrine of Emam Al Kathum is nearby. I went to take pictures of it. But was afraid that this is prohibited. I saw the church in the shadows so far. I decided to take a picture that includes the two. I kept gowin back so that I can see them both. A lady came from behind of me and I was startled and the camera moved and the photo spoiled.

The lady told me about her sister who seems frightened. Her sister, aftereating breakfast this morning, started to have things which I forgot now. She told me about those symptoms and my diagnosis was a panic attack. I told her that she need intravenous valium. To take another point of view i asked her to come with me to the conference room. The lady said "conference" with anger and redicule. As if telling me that this is a silly thing to do.

While i was explaing to my colleague the case of the lady's sister, a senior psychiatrist took the microphone and looked at me and said: "may everybody stop this joking".

I took the lady out. Felt annoyed. Came back to the conference room to find a WC door. I went inside the WC and find a long market. I was holding 2 slim books in my hands. I threw them inside the conference room on a chair, but they fall on the ground and made some noise. Everybody in the conference room stopped talking and i felt satisfied.

I reached a book shelf in the market to find a novel by a writer named "musbahi" (there is such a writer whose book is unread by me since i bought it since 2 weeks), entitled "kareem the libian" (my musbahi novel entitled ADIEU ROSALIE).

Then, i don't know how, I heard Musbahi saying to me: "wake up now so that your eyes see things green".

I woke up and saw something blue..... concentrate.....saw green lines on it....concetrate more ..... no blue nor green but a white wall of my room.

Hilla Sweat Hilla

Marjan (or Margan)is a family name. This family is known to be rich in Al Hilla city. They helped the government to open a hospital on a land belonging to Marjan family on the river of Euphrates for the tuberculosis patients early on the 20th century.

I don’t' know if the hospital belongs now to the government of to Marjan family but its name is still "Marjan teaching hospital".

It is no more for the tuberculosis patients. It is now for general medicine. And it contains many subspeciality units.

There is no such a hospital in Baghdad. It is taken for granted in peoples mind that every thing in Baghdad is better, especially the services, and the hospitals are one major example. But in Baghdad you find that people are not serious. They don't consider being responsible on one's work as a good deed. They think that one should only think of himself and not others. Being honest means you are not experienced in Baghdad. Being selfish means you are mature and will be respected.

In Al Hilla, people are still respecting and expecting honesty and truth. That is why their hospitals are more beautiful than Baghdad's.

This sight, from that window in the corridor that takes you to the neurology unit, was a common daily sight in my life when I was working there. At this window I used to stand, alone, or with a friend, to have some rest.


How long is that palm tree. How calm is the river. I swear I just want to be there. Living in calm.

This is our small house of doctors, one of the most warm welcoming house of doctors I ever found

And this waa the site of our late eveing relaxing time, having some drinkings after dinner

Hilla sweat hilla.

Iraq is like a Paella dish

Samuel Shimon told us a nice story in his book "An Iraqi in Paris" occurred to him when he met Romero, a man from a Spanish origin, in Paris. Romero was confused by the name of Samuel Shimon. The following dialogue occurred between them:

"- Are you sure it is your name?
- Yes monsieur
- The strange thing is that Jessica Tandy has told me that an Arabic young man will live at her house
- It is me
- An Arab and having a name like this?
- I am an Iraqi and not an Arab
- What do you mean (I am an Iraqi and not an Arab?) the man asked confusingly. I had to repeat the same old boring story of how iraq is composed of different races like the Arabs, the Turkmen, the Assyrians, the Armenians, the Kurd, the Mandaeans, and the Jews. And I have ended my speech by saying "you see, iraq is like a paella dish".
The man bursted into laughter "ha ha ha iraq is like a paella dish" and kept repeating that several times."



I would like to add another flavor to the dish. A flavor called "Gerjeya". Gerjeya, is a female name used in our country. It is a name of old ladies usually because it is not that commonly used these days. I have met in my life few elderly Gerjeyas, but not a young one yet.

I remember what my colleague has told me before months when I was asking about a lady named Gerjeya. My colleague did not answer my question. Instead he asked me:

- Do you know what her name means?
- Not really
- Mean a lady from Georgia.
- Oh!!!
- During the Othman empire rule of Iraq, some soldiers from Georgia region which was under the rule of Othman empire served in Iraq. Some brought their wives with them. They were very beautiful you know. Iraqi people started to name their daughters as Gerjeya, in hope that they become beautiful like the Georgians.

Isn't iraq a paella dish?

By the way, Samuel shimon mother's name in the novel "An Iraqi in Paris" is Gerjeya.

By another way, today my neighbour brought me this dish of rice and some many other things on it, like a Paella, but a real Iraqi one.

They also brought me a dish of Kuleicha on the first day of the Eid, here is its picture

When I ate today the Iraqi Paella dish I felt so happy and held my Ud and played an Iraqi song from the 1970s of Fadhil Awad. Its lyric says:

"Hey you with that Sumerian beauty

Babylonian are your looks

Your sight is an EID for me

And I light your candle with my hands"

This is my Ud sits below one of my father's paintings of a Sudany person. Isn't it wonderful?

Iraq, from inside, from outside

Many left my country since the 1970s. Many writers. Most, if not all, were unknown to us. Us, the insiders. We, the insiders, were subjected to an intense media censorship. Books, magazines, newspapers, radio, satellite channels were all filtered by the previous regimen. It was only after the 2003 war when we start to know some of those Iraqi writers living abroad. Al-Kamel publications is a publishing company started in Germany by an Iraqi and developed to be one of the known publishing companies to the Iraqis after 2003. most of the Iraqi writers were unknown to me. Going to Al-Kamel publications in Bab-Al-Muathaam in the centre of Baghdad is always an adventure of discovery for me. I hold many books and start reading the notes on the back cover and few lines from the introduction. One day I bought two books.

I never heard of the writers before. Samuel Shamon was the first name to catch my attention. His book is entitled “an Iraqi in Paris”. It caught my attention because of the name of the writer. The name sounds like a name of an Iraqi Jew. They were a treasure those people. Most of them are productive people for the society. The first psychiatrist in Iraq was a Jew, dr. jacky shabi abboud. We lost them because our politicians were careless, or may be ignorant, or both.
The other book caught my attention because of its title “Juma’a is going back to his country” by a writer, I knew later he is the founder of Al-Kamel publications, named Khalid Al Ma’ali. Juma’a is a very lovely name to my heart. It means Friday.

The two books were biographies. Both about a young man leaving iraq and starting the life again from zero abroad. Sometimes maybe from below zero. Below zero means they got to erase what has been stuck into them from iraq to start again living. To format their brains out from the old retarded system and install a new version of windows so that they can live in harmony with their new society.

Samuel shamon tells us in his book about how he was a focus of attention and suspicion from the security system of the first few countries he tried to start to live in when he first leave iraq. He was interrogated and tortured. Isn’t this a start from below zero?

The story of his living outside iraq was the orchestral work upon which he played the concerto of his memories of life inside iraq. I think that the value of his book lies strongly on his narrative flow of memories of inside iraq. The first page of his book started from the last scene: the day when he reached the US, and finally be close to his dream of visiting Hollywood and starting his film making, in 2004. the next page heralds the start of his journey out from iraq in January 1979. this part contiues till page 195 (the whole Arabic version is a 311 pages book). In page 195 another chapter of his book starts. The concerto of his childhood in Iraq.

The first part of the book was written between 1990 and 2003, while the second part was written in 1989 as a scenario entitled "nostalgia for the English time".

"juma'a is going back to his country" is written by a poet, a modern one. Khalid Al-Maalie is referring to himself by a third person "Juma'a". his book is presented by 60 chapters. Each chapter is of about 5 pages. If I dare to say that Samuel shamon's book is a concerto, then I don't what to say really about Khalid Al-Maalie book. Is it a poetical realistic biography standing at the edge of dreams? Is it a new age music or maqamat? (maqamat is the plural of maqam which means a scale of notes played by traditional Iraqi musical instruments. There are about 100 maqam). Or is it intervened by some Hacha'a rigorously dancing musical pieces? (hacha'a is a dancing musical style in iraq. The word hacha'a came from the verb ihcha'a which means sit a half sit so that you are prepared to jump high, and it is believed that the names is associated with this dancing music because one usually yell "ihcha'a" to the dancing group so that they prepare themselves to the jump together). So was khalid al-maalie's soul playing some primitive hacha'a rhythms from south iraq to let our heart sit a half sit-down before it jumps racing its lyrical poetry? Some of his lines are so realistic to a degree that make you think it is a newspaper report, or a documentary one some Iraqi flavored relationships, till the words start march together, a little by little, to the edges of some kind of musical poetical Sufism which were my preferred lines. Well after all that can we say that Khalid Al-Maalie book is a concerto where the reality is the symphony and the poetry is the solo?

Finally to know a book you must have it and read it. What are unsaid remains floating between the lines. It is in the unsaid that we remain floating, or diving, in. I don't dare to say that I was logically presenting the books to you. I can say I was illogically presenting them to an area in your dreamland hoping that you can dream of what is iraq. And let me not stop talking and present you to those two men.

The two men are in black. shamon is to the right, Al Maalie is in the middle. The picture is taken from a very interesting arabic/english written blog http://imtidad.blogspot.com

....and Shahrazad is mute

The night in Baghdad is a hostage
Music played by drowsy flute
and Shahrazad’s mute

For all those musicians and singers who left Baghdad.

Pilgrimage To Hilla

Because my file “a file that contains information about my professional life (C.V.)” is present in Babylon Health Directorate, and because I cannot move the file to Baghdad until I finish my training as a board student, because of that I need to go to Hilla every now and then. For the last 3 years I never visited Al Hilla due to security causes.

There was some error in my salary. The clerk told me that she feels sorry that I must go to the place where I was working from 2002 to 2005 to bring some papers. My face stayed expressionless while my heart whispered to my ears “hilla!”. The clerk looked at my face and said: “I am sorry, we cannot fix it here. You must bring paper’s that…”
I interrupted her hesitant voice and said: “If I take there papers to Al hilla they can fix the problem?”
The clerk said: “sure”.

I went to my colleagues after few minutes and asked one of them to work instead of me for the next day. He agreed, he signed the papers of the OFF DAY and I gave it to the director of our hospital.

The next day I woke up very early and very energetic. There was a smile, an involuntary smile drawn itself on my face. I went to the garage.

“Hilla…Hilla….Hilla..” the driver standing near his KIA 11 passenger minibus is yelling with a lovely accent. I looked at all the faces for some longer than usual time while I greeted them “salam alykum” while I was taking my seat. They are the faces of people going to Hilla. Faces of calm and kindness. I swear they are.

I reached Al Hilla after running fast between palm orchards that I always fantasized of being having a lovely adventure in between. I thought about writing a novel of a lost child in the orchards found by the people there where they will let him grow. Fantasized about having a love story with a woman who lives there in a small house between the orchards. How it would be to sit there by the time of dawn to have some chatting and what it would be about? Fantasized about being a doctor to those poor people and having the opportunity to learn from their wisdom and to show them how much I care and love them.

I reached Al Hilla. There is a new building here. A huge one at the cross road. The police men here are more serious. They treat you with marked respect. Their attitude is really of security men. I liked how serious they are. In Baghdad the policemen are not that trustworthy as in Al Hilla.

The policeman at the gate of the hospital welcomed me very kindly: “hello doctor, we missed you, how are you”. He walked with me to the inner gate where there were new police men. He stood and said loudly so that the new police men hear him: “come in doctor come in!”. The new police men stood up and welcomed me. He did that so that the new police men don’t stop me. How kind.

I was walking in the corridor behind her. A cleaner whom I was wondering if she forgot me. She stood to take something. I greeted her by her name. She looked at me confused and then she put her hands on her cheeks and said: “oh God…..YOUUUUU…..” she hold my forearm with her strong fist and took me aside to let a wheel chair holding a patient to pass from behind of me.

All the staff remember me. Even those who were not saluting me before they did this time because we didn’t see each other since 3 years. I was happily confused. I ended my job there so quick. I hoped that it would take longer. I went to a walk in the market. I sat by the river. Shat il Hilla is a branch of Euphrates. Euphrates branch into two rivers at the north o Babylon. Tigris does the same but not in Babylon. The 4 branches were regarded by the Sumerians as the rivers of heaven. Some say that “the heaven” is a Sumerian concept that went out into other religions.

So I sat near my holy river. I was wearing off white clean trousers. I hesitate to sit on the floor near the river. But eventually I sat. A lovely donkey approached me.


And said:

- sami, you know nothing about al hilla till you get naked and jump in the river.
- To swim
- No, to suicide.
- …..
- Off course to swim you idiot. To swim. And you can hunt a fish if you want. Do you like fish?
- Yes, I will hunt one and we eat it together.
- Ehha ha haaaa…eat it? I don’t eat fish you human. I like to live with them. Actually I wanna be one. A colored one with an electric tail.
- Oh you like to be a fish.
- Sure. My theory about life is that we become what we want when we die. And I will become a fish swimming in Shat il Hilla someday. What do you like to be?
- Me?
- Yes you?
- Well….a donkey?
- Ehhee hhe haaaa…
- A donkey in Al Hilla carrying children and running till they burst into laugher.
- Hmmmm and would you carry women? Hmmmm?
- Only secretly.
- Ehhhe haaa heeee
- Ahhhe hooo heee
- Hey sami would you carry merchandise for the rich?
- No I will only bit there fatty asses.
- Funny sami…. I can say you are member of my group
- Your group?
- The group of…
- “hey come ..come here….hey”
- They are calling me my friend. You will go back to Baghdad?
- Yes, do you want me to bring you something when I come back from Baghdad next month?
- Yes, Taha Hussein novel “Shahrazad dreams”, see you.

Gujarat

I was in Al Hilla in some hot summer in 2004 when I felt I need to talk to someone new. I went at the peak of the noon to an internet cafe to find it empty. I entered the Yahoo chat/ religion room, and found an Indian qween. She was so kind. She told me about India in a way that opened for me a new window to take my head out of it each time I feel I need to imagine and smell the fresh weather. The qween told me about the area where she lives in and that was Gujarat.

It was so hot in Baghdad especially when there is no electricity so that you beg the air conditioner to give you some fresh air. The windows are closed to get rid of dusty storms mixed with hot dry wind. It was 7 00 pm I went to sit near my neighbours so that we start together our symphony of complaining of electricity, noisy baghdad, the too much cars and bad drivers, the army, the parlament, the US army, the new laptop computers from china, the increase in prices.... I reached them then showed me a deep red juice and said : "drink gujarat!"...

I was still not in that state that I can know that they said this word "Gujarat". All I heard was something like "bujgraad" or maybe "sindibad"...What was taking priority in my mind is to taste the juice. It was cold and acidic. Something I really like. With some bitter/sweatness. WOOW.

- what did you say its name? (i asked)
- Gujarat!!
- Really? It is in India?
- Yes this one is from India.

I took another sip and opened my nose wide to smell the juice. The next day I bought Gujarat to make it at my home. It opened me a new window to look at my day. It can be served hot, like tea, or cold, like juice.

Baghdad: Moons and Whales

“Hey you sculptured whale
Leave our moon soon
And if you don’t leave it
We will strike for you with a tray”

I was preparing to present a paper entitled ‘affective disorders in Iraq: by Widad Bazzoui” when I thought about using some photos representing Iraq culture because the paper was about the cultural differences between western and Iraqi culture. I typed “Iraq” in the Google image search and all I saw was war. I typed “Iraq culture” and all I saw was war again. Hence I thought about publishing something talking about Iraqi culture.

They were waiting for the lunar eclipse. And because Baghdad these days is so much religious they only talked about how should they do the lunar eclipse prayers. They forgot about going into the houses’ roofs holding metallic trays and spoons to sing that song:

Hey you sculptured whale
Leave our moon soon
And if you don’t leave it
We will strike for you with a tray

The words in Arabic don’t go in rhyme as one may expect. Songs and poems which have no rhymes are the strongest. They are the most primitive. The most childish. The most true. Aziz Ali a very famous monologist in the early 20th century in Iraq had included this song in one of his monologues. Here is a picture where Aziz Ali is standing in the back. Picture is taken from an Iraqi Arabic internet site (www.alforat.org/showthread.php?t=21250) in the link you will see very nice pictures representing Iraq culture:

The origin of this song is a very complex one. First let us go to a visit to my friend Mwnqithe who will tell us: “There was a scientist living in Baghdad in the 11th century AD when the Mongols invaded Baghdad .They killed all famous men and women. That scientist I am talking about said to the chief of Mongols:

- Don’t kill me, I am a scientist and I can help you, I can know the weather during the coming days.

- And how I can that you are not lying on me?

- I know exactly when the coming lunar eclipse will happen.

The scientist told the Mongolian chief about that day and the chief ordered his guards to put the scientist in jail till that day. If a lunar eclipse will happen then the scientist will be free. If not, he will be killed.
That day did come and a lunar eclipse happened. The scientist told the guards to tell the Mongolian chief. The Mongolian chief was asleep; they told him and added that he doesn’t want anybody to wake him up. The scientist said loudly:

- Oh then it is the last time we will see the moon.

- What? (the guards asked frightened).

- There is only one way to safe the moon.

- Which is?

- It is a difficult thing to do…

- What should we do?

- The army should strike on its drums heavily urgently….NOW!!!

They did that. The Mongolian chief woke up and knew what happened. The scientist was released.”

- So the scientist did that to wake up the chief? (I asked Mwnqithe with a childish smile drawing itself on my face).

- Yes he did (Mwnqithe answered with a smile of a wise man).

Mwnqithe also told me that that scientist’s tomb is in al Kathumiya in Baghdad. He told me his name but I forgot it. I searched for it in the internet in vain. I phoned Mwnqithe hundred times but all in vain. His mobile phone is switched off. He is preparing for his final examination to have a Ph D in dermatology and be a fellow in the Iraqi Board of Dermatologists in few weeks. I thought I should not wait to publish this. The name may be added later.

I searched the internet in Arabic for Baghdadi traditions and what people do think about lunar eclipse. And found very wonderful stories. Here are two of them published in an Arabic forum by someone (http://www.shattalarab.com/vb/shatt120360.html). I don’t know how much they are true:

People from (kanbar Ali, an old quarter in Baghdad) think that the moon was searching for his lover (the moon in Arabic is masculine). He lost his way between deserts and mountains where the whale (a feminine in our language) was waiting for him. She swallowed him.

While people from Al Fathil (an old quarter from Baghdad) says: “oh no, the lady Amsha Um Sattoury, had seen the moon on summer night coming down to drink from the river Tigris. The whale came from the water and swallowed him. Amsha started yelling but people of Baghdad was drunk that day because they drunk ARAK of HIBHIB (Arak is an alcoholic drink classified as a spirit; Hibhib is a quarter in the governorate of Dyala).

Loosening of association

Most of the DVDs where used. I found "The Vally of Elah" lost in the box of the old films. I noticed that the DVDs nylon cover is very clean. I opened it, "it is not used", I murmured to myself. At home I was so alert watching the film in the darkness of my room's vally whose lights are shut off deliberately due to some tension headache claims.
Tommy Lee Jones looked at me with his eyes. His gaze was intense. I stopped drinking my Tamarind juice holding the glass with my confused hand. He said: "Sami, I used to be like you, an energetic clever young man"…

"hey hey wait…" I yelled, putting the glass above some papers in the table "I am not energetic, and I am sometimes very stupid….remember how I lost her friendship? I shouldn't said that to her…she is married and we were friends…why do I always fall in love with married woman? Is this a fear from commitment? A fear from marriage? A fear from real love? Am I afraid that love may destroy me?"
"hey hey now you stop shrink" he yelled.."what the hell are you talkin! Put all your shrink trash in your papers and let us talk about life….or death maybe cause what is happening in the valley of Elah is really depressant…"
"Tommyyy com on I thought that you are a flag-waving man" I said…
"forget about the flags"…he said then he stopped looking into my eyes…he looked really depressed

"tommy…we need to forget about our problems.." I said while I retake my glass of juice and took a sip and contiued: "I lost a friend…you lost a son…flags are.."
"DON'T EVERR..NEVERR MENTION FLAGS AGAIN!!!" he yelled and then shout suddenly "UNDERSTAND!!" I droped some juice on my pijama..
"okay man?" I said….he ended his second episode of intense eye contact by looking in the nowhere sadly.... "I ….I was just…..I…" I noticed that he tried to look into my eyes again and he did… but this time his eye contact was benign…so I continued with my "I"s: "i….i….that story of the valley of Elah, was about David? King David? Prophet? Hmmm?" before he tried to look into my eyes again the electric power was shut off….i was in complete silence for few seconds… then an old woman with a beard and three broken teeth in her hand came walking till she stopped in front of me. I pul my chair backward. "They are three DAVIDs I want you to remember" she said while she sat at the bed which lies behind me. I turned my chair to face her. She continued: "David the first" then an overhead projector light shined from her eyes to the wall near us. I saw this picture:

"He looks like me...he he heee"...she said smiling then added "ihm ihm...let us talk seriously...Psychiatry is lucky in having a movement of criticism called "the antipsychiatry" . The term "antipsychiatry" was coined by a psychiatrist called David Cooper.

In "Oxford handbook of psychiatry", the mention of these critics was preceeded by the following words: " They are presented here for historic interest and so that the sources for modern-day advocates of these ideas can be identified."

Oxford hadbook of psychiatry also states that: "All psychiatrists should retain this healthy scientific scepticism and be prepared to question their beliefs about the causes and cures of mental illness."

She shut her eyes and the photo dissapeared. "That was the first David I wanted you to know about. The second one is....." She opened her eyes wide and an overhead projector light shined from her eyes again focusing itself on another wall revealing this picture

"Rosenhan....David Rosenhan.....I respect those antipsychiatrists because they dare to be so. I remember and mention always an experiment done by David Rosenhan, a psychologist. An experiment that is very famous and is mentioned by the wikipedia like this:
"Rosenhan's study consisted of two parts. The first involved the use of healthy associates or "pseudopatients," who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. The second involved asking staff at a psychiatric hospital to detect non-existent "fake" patients. In the first case hospital staff failed to detect a single pseudopatient, in the second the staff falsely detected large numbers of genuine patients as impostors"....

She blinked and the light was gone...

"The third David...." while she said that I sighed...

"you must be bored…then I should go now…" she started to be transparent a little by little till she dissapeared.
The next day I was walking. My foot took me to the library and stopped in front of a shelf of old books. My eyes looked at that book entitled "The Divided self/ Ronal David Laing". One of my hands took the book and put on the table. My mouth, with aid of some other organs talked and said: "may I have a paper, please.". the librarian brought a paper and put it in front of my body. my hands started copying from the book the following lines:

"in many schiaophrenics, the self-body split remains the basic one"

"in its final form, such complete disintegration is a hypothetical state which has no verbal equivalent"

" a certain amount of incomprehensibility of a schizophrenic speech and action becomes intelligible if we remember that there is the basic split in his being……"

"the individual's being is cleft in two, producing a disembodies self and a body that is a thing that the self looks at, regarding it at times as thought it were just another thing in the world. The total body and also many "mental" processes are severed from the self, which may continue to operate in a very restricted enclave (phantasying and observing), or it may appear to cease to function altogether (i.e. be dead, murdered, stolen)."

"yet these irreducible difficulties are practically certain to be much increase, at least in one's first encounters with the patient, by his or her deliberate use of obscurity and complexity as a smoke-screen to hid behind. This creats the ironical situation that the schizophrenic is often playing at being psychotic, or pretending to be so. In fact, as we have said, pretence and equivocation are greatly used by schizophrenics. The reasons for doing this are, in any single case, likely to serve more than one purpose at a time. The most obvious one is that it preserve the secrecy, the privacy, of the self against intrusion (engulfment, implosion). The self, as one patient put it, feels crushed and mangled even at the exchanges in an ordinary conversation. Despite his longing to be loved for his "real self", the schizophrenic is terrified of love. Any form of understanding threatens his whole defensive system. His outward behaviour is a defensive system analogous to innumerable opening to underground passages which one might imagine would take one to inner citadel, but they lead nowhere or elsewhere. The schizophrenic is not going to reveal himself for casual inspection and examination to any philandering passer-by. If the self is not known it is safe."



"the self at the same time longes to be understood; indeed, longes for one whle person who might accept his total being, and in doing so, just "let him be". But it is necessary to proceed with great caution and circumspection. "don't try", as Binswanger puts it, "to get too near, too soon".

When I complete copying I started starring at this picture of R D Laing, which started to be smaller and less clear

Then the picture above transformed into another picture, and R D Laing now is Antony Hopkins....waooww..

Have you ever seen how Antony Hopkins is great? Did you see that film when Antony Hopkins behaves like a gorella? He is a great man....and do you know that during my teenage years I fall in love with Judie Foster? But the problems started when one day I saw this series in the Iraqi first channel I fall in love with Cybill Shepherd from the first sight. Judie foster get jealous. And the war begins between these two ladies on me.... And you cannot believe it, they are really wild..... Judie Foster got a psychological trauma and wanted to separate from all human beings after our sad sad bitter story. She said that she don't want any contact with any other human, but her father, as she said. She chosed a very strange career, she chosed to be an astronaut!!!

That's what happened to Judie after our stormy love. What happened to Cybill is unspeakable.

Finally, all my apologies for my Loosening of Associations...

A last thing, just see how beautiful Cybill Shepherd now...

treating my homophobia

I knew about homosexuality when I was in my teenagers. Those who were homosexuals at my school were disgusting for me. They were abused by many as I can remember, and they were behaving like prostitutes. They got multiple partners, and they seemed always to be happy and showing a silly smile that made me irritable in their existence. We thought, as many Iraqi doctors still think, that the problem is in their anus, and not in their brain. They are described in the Iraqi slang language as “having worms in their anus”.

Today I have seen the first case of gender identity disorder as a psychiatrist. He was born as a male. He believed since he was 5 years old that she is a woman entrapped in a body of a man.

He is very polite. Presented with disturbed sleep. He accepted to be presented by one of my colleagues in a case conference. I thought at first that he likes to show himself. As if searching for a handsome man to have some affair with him. He came to the conference today putting a lipstick. I said to my self “he is impolite” when I first saw him.

As the conference reached the point of asking him some questions, I noticed how polite and clever he is. He told us about his suffering. He told us about his trials to change his feelings. About his feelings of guilt. About his prayers to God. He has only one partner at time being. He dreams about being a female and marrying to a man and having a baby.

He respects himself in spite of the guilt he has. He made us respecting him. It was very important for me to feel that I am not irritable next to someone who is homosexual. What helped me in that were his neutral eye contacts, respect, and politeness.

I studied about gender identity disorder.
I found that it was called before as Onanism. The term came from the name of Chevalier d'Eon de Beaumont, whom I searched for his picture in the net and found that as a child I saw a related cartoon named "Lady Oscar". The picture below is from the cartoon of Lady Oscar.

I remember that I liked the soundtrack of this cartoon like many Iraqi kids did.

It is not clear whether lady Oscar and d'Eon de Beaumont are the same person or not. But it seems that d'Eon is a real person while Lady Oscar is a hero in a novel.

In psychiatry literature, the condistion was mentioned by Esquirol in 1838. This a picture of a statue of Esquirol, a french psychiatrist, but I don't know where the statue is.


The condisiton was described in more detail by Krafft-Ebing in 1886. Below are two photos, the first is for him and his wife, and the other is a cover a one of his well known books. And in the recent time, Harry Benjamin had studies the condition and he found the Harry Benjamin International Gender Dysphoria Association. Here is his picture below.

I found that there is a syndrome after his name, the "Harry Benjamin Syndrome", but it is not mentioned in neigther of my 3 textbooks "Oxford (shorter); Companior to psychiatric studies; and kaplan and sadocks". It seems that it is another name for Gender Identity disorder which is also called transexualism.

Marouf Al Rusafi

Iraq history is full of men who need more light to be shed on their dark forgotten image there in the shadows of the forgotten, if not of, ignorance.

I searched the interent for something about Marouf Al Rusafi in English and I found only one site:
http://www.saadiyousif.com/home/index.php?option=com_content&task=view&id=505&Itemid=39

from which I took the lines talking about Marouf Al Rusafi
“There is a very important tradition in Iraq of the poet as a symbol. For example, Marouf Al Rusafi was a poet who was seen by the Iraqi people as a national hero, because he was publicly against the British-imposed regime, against the monarchy. He went from being a member of parliament to a very poor man, selling cigarettes in Fallouja, being in need, without privileges.”

Her is my post

He took the book from my hands murmuring with interest: “what is this?”. He was a man sitting next to me in the bus. He started looking at the title and the picture.


I didn’t feel annoyed. He gave me back the book. Smiled. then he examined my face, as if wondering if I am angry at his movement. I was smiling. He said: “he was about to be the president of Iraq” . “and what happened?” I asked. “the English didn’t accept that”. I nodded my head with a sign which also means “I appreciate what you have told me”.

Marouf Al Rusafi lived in Baghdad in the first half of the 20th century. Between 1933-1941 he lived in Al Felluja in which he wrote his controversial book “Mohammedian Biography”.
He is known as a poet with a sardonic writing style. King Faisal refused to accept Al Rusafi to be a member of what was called as “first establishment board” of the early Iraqi government and the causes were, as King Faisal said: “…..due to his sexual perversions and living with prostitutes….”.

In this book I just bought entitled “the Iraqi message: in politics, religion and sociology” he talks about many things but what surprised me was his trial to show us the good side of some of those who are famous of not entering Islam at the time of the prophet Mohamed. They are regarded as “bad” and “evil” persons, but he was trying to show us some positive characters in them. On the other hand he was trying to show us the “bad” aspects of those early persons who accepted Islam as their religion at the time of the prophet Mohamed. These are holy people, but Al Rusafi did criticize some aspects of their behavior. And to my surprise no body hurt him much. It seems that people were respecting him in spite of that. I hope that there comes a day when we start again, in Baghdad, and in Iraq as a whole, to respect people’s views and ideas, whatever they would be, like our fathers and mothers were doing.

Dose of ECT

Electoconvulsive therapy under anaesthesia has just started in our hospital. There is a new aneasthetist who will come daily to our hspital to help giving the anaesthesia. I was confused by the new ECT instrument in this new hospital. It measures the dose by Voltage and not by millicoulombs. All the instruments I worked on before are with a milliCoulombs gauge always fixated on 225, which can be increased to 250 if the seizure doesn't start from the first time. I have only see one or two cases when we needed to increase the dose to 250 milliCoulombs, with one case we used also hyperventilation of pure oxygen prior to the second trial.

This instrument is with Voltages gauge fixated at 70 Volts. I tried at 70, and no fit happened. The nurse assured me that they usually increase the dose to 110 Volts. I remembered that I have visited the ECT unit before few days and asked the working staff about the dose and they told me that it is fixated to 110 volts. I looked at the gauge and noticed that its maximum reaches more that 110 by about three folds. So I decided it is safe to go to 100 Volts. And no siezure happened. I stopped the treatment trial and posponed it to after tomorrow.

I started searching the net about the dose of ECT (by the way, I remember a student in psychiatry, a colleague of mine, have asked a senior psychiatrist about the Dose of ECT, and she responded: Do we measure ECT in DOSES? go read that in your book!!!), and I found the following:

From the Wikipedia:
"Modern ECT machines regulate the current to keep it constant and thus the voltage may vary up to a maximum, typically 450 V, but is usually around half that level in most cases."

From a site ect.org (is it an antipsychiatry site?):
"a small electric current is passed through the brain and the voltages used are no higher than 150 volts." and "the smallest current is 0.75 amps, more than enough to kill if applied across the chest"

American Journal of Psychiatry. 134: 9, (September 1977): 1010-1013:
"ECT parameters were conventional. i.e. 130 volts for 0.3 seconds."

The Royal College of Psychiatrists advocate using dose titration to each pateint (individualisation of dose) and not using a fixed dose for everyone. There are some ways of titrating the dose according to age that is not clear to me yet.

A study published in the Psychiatric Bulletin (2000) 24: 184-187 of the British Jouranl of Psychiatry says the following:
"Clinical opinion is currently divided on what is the most appropriate method of determining the stimulus dose for ECT. A survey of ECT practitioners in the USA reported that 12% used fixed-dose strategies, 39% dose titration and 49% formula-based methods "

I know nothing, at time being, about dose titration, nor about formula-based methods. But as I continued searching I started finding some clues.

I read the following abstract of a study:
"Seizure thresholds, as measured by dose titration, varied fourfold among our sample and the average value was 105.5 mC or 16.7 J.". So we can conclude that we should estimate the seizure threshold by dose titration. It seems that dose titration means giving a low dose and see whether a convulsion will occur or not, it not we give a higher dose. Read what they did in this study regarding titrating the dose:
"At the titration session, 27% of patients had seizures after a single stimulation and 37% had seizures after two stimulations. Only one patient required four stimulations to induce a seizure."

So it seems that it is not harmful to give a dose that will not cause seizure? They continue saying :
"No patient had significant adverse events associated with the dose titration procedure. "

The `half-age' method, however, is still a mystery for me.

waves of speech

I went outside before electricity was supposed to be cut. I usually stay at home till the electricity is lost at 10 pm daily and I found myself suddenly in darkness. Today I went outside at about 9:45 pm and found my neighbours all sitting in a small garden. I joined them and the fun started. At first we started complaining at the hot whether. Then a neighbour showed me a video in his mobile of a fat drunk lady dancing in a very funny way. Then another neighbour came to tell us 2 jokes that really made us laugh from our hearts. Then we started talking about Baghdad and that it is much better than before a year. Two men started telling us about the old Baghdad. One of them asked "who say the film named ??????" i cannot remember the name. The man next to him said "Oh that was in the 1970s in cinema Gharnada" and they started remembering the film. Another man told us that one day his uncle beated him with a blow after being sad for an event he saw in the film of "Al Risala" and saw how Al Hamza had martyred. We all laughed. The joking guy started again a joke: " one day a very religious man had a familly....he didn't want his familly to watch TV because it is a devil work as he was saying....his wife suffered for years to let him buy her a TV but he said that she could only watch the film Al Risala when shown once in a year in some riligious ceremony (the film is about the begining of Islam)....she accepted....then they had children...children asked their father to buy them a video....he did but he brought them only one film....Al resala film....they kept watching it again and again for years....they grew up....then one day they asked him to take them to cinema...he took them to Al Risala film...when they were in the cinema watching, and in the screen there was Al Hamza above his horse running in the screen before the war would began...Al hamza took his sowrd and looked at the audience in the cinema and yelled: Ishlounak Abo Kareem?? (Ishlounak means how are you Abo Karem)"
We all laughed then started talking about Rashid Khayoun and his book "religions in Iraq" and one of them started talking about the Assurians and about the winged ox....and then a man brought us a soup...we ate from the same dish..with different spoons offcourse...
We were all tired and made some funny mistakes of concentration.. the most funny of which was when we were talking about Baghdad and one man suddenly asked us with a loud voice and some facial expression as if being lost: "do anybody of you know the number of ???????" he said a name of a person unkown to us... "Who is that?" one asked..."a translator" answered the questioning man... we all looked with confusion...when that man looked into my eyes I bursted into laughter and all started laughing....
I gained back my good mood....went back at home and started listening this song:

"Oh, qu'est-ce qui pique,ce hérisson
Oh,qu'elle est triste sa chanson
Oh,qu'est-ce qui pique,ce hérisson
Oh,qu'elle est triste sa chanson
C'est un hérisson qui piquait, qui piquait
Et qui voulait qu'on l'caresse, resse, resse
On l' caressait pas, pas, pas, pas, pas
Non pas parce qu'il piquait pas, mais mais parce qu'il piquait"

The music is gay and i smiled, but i don't understand the words at all.....

Emotions and Dopamine

Have you seen how emotions can prevent the manifestations of brain diseases. Robert De Nero plays in this film a case of parkisonian symptoms as a complication of encephalitis, and how one doctor find Dopamine to be effective. But after the first improvement in his case he deteriorated again. After this beautiful woman asked him to dance with her on the rhythm of piano playings, his tremor and other involuntary movements stoped, little by little....

The film name is "awakening" and it tells the story of discovery of Dopamine, a chemical substance present in the brain that affect our psyche and motor function (psychomotor function). Modulation of the level of Dopamine in the brain by many famillies of drugs helped to ameliorate many life disabling, if not fatal, diseases.

Free association (part 25)

when i first started this blog i named at as "psychiatry for all"...the naming came into my mind in seconds and that was it. after a year i changed the name into "colors of mind" and that change was impulsive too. i generally accept my impulsivity in such situations like when naming something. another episode of impulsivity drived me to change the title into "skies"....
skies, why that name? i still don't know really....
by the title i think i meant to let you feel what you can see in the skies. it is like a mirror. it is a mirror. mirror of what? earth? us? God? heavens? i think it is better to say that skies are a mirror of our imagination. you look at the sky and see what you imagine. so, is my blog about imagination? mirrors?
have you heard that song of beatles of "imagine"? you might say i am a dreamer but i am not the only one, i hope someday you will join us, and the world will be as one, imagine there's no countries, it isn't hard to do......

mirrors. mirrors are metioned in a misterious way in the Sumerian and Babylonian writings.... was it linked to witchcraft? I am not sure but it was linked to some magical things.... mirrors...they are so much used by Iraqi poets... their peotry is not that clear for me.... my first contraversy when I was learning about loosening of association as a morbid phenomenon of psychosis is that it looks like poetry...

Do you like organisation? why i don't like it? i am little messy? if Freud is here reading what I am writing he would tell me that I am fixated at some psychosexual stage of development, and if his student (i think Karl Abraham) here he will add something to it....they got a great imagination..... imagine all the people....thinking like Abraham woho waho woho....

I don't like to make any agenda...I think it is not like Freud had thought....it is just that Baghdad is disorganised, and you cannot expect what will happen during a day, so how come you can expect what will happen in a month or so ????...

So.....can you see why I chosed Skies as a name? it is more open, more circular...oh yeah circular...something without a begining and no end...circular....cannot be "ORGANIZED" into something liniar....I remember somebody had said that western thinking is linear while eastern thinking is circular....well....it was a good saying that may stay in my mind but not so true....

Cigarettes in my headache empire

When my mind feels that i am little tense, it took a medival iron made crown and put it over my head announcing me as the king of the tension headache empire. my mind would put two sticks in my hands, in my left, a stick named "easy fatigability" and my right, named "gastric upset". And I rule my empire with poor memory.

Cigarette smoking is really a bad thing to learn. Really bad smell. But with tea, or pepsi, I can rarely resist it when it is near to me. The most bad thing is that when I am drinking tea or pepsi while another person is smoking next to me. I cannot resist asking for a cigarette, or at worst going out to buy some. Then when I will come back the tea will loose its flavor.

Liberty on the Walls

Baghdad was centered around the river Tigris. Tigris was the line around which baghdadian dreams and stories were centered. Baghdadian thinking was growing in circles gathering around the river. Now Baghdad is filled with walls. Walls that run in long lines. Baghdadian thinking is now liniar, in parallel to walls....

An artisit had drawn the Liberty Monument Symbols on one of the walls... (see the picture above), so that he make us able to imagine liberty inspite of walls...

My Last Day in Al Rashad

It was my last day in Al Rashad hospital. Next day I would take my papers that say that I have finnished training there. It was afternoon when I went to visit the rehabilitation unit to take a final look at the paintings there. I saw them finnishing there training on the theatre. The training nurse welcomed me and asked that young woman to repeat the last scene so that I can see it. She went back and started her highly emotional scene that ended in crying. At the end we started applauding but she stayed crying for few seconds then said to the nurse with some childish like complain: "you always make me cry by lettingme repeat this scene". They all laughed. She laughed too.
We went after that to the painting room to drink some tea. There were about 10 inpatients and 2 nurses and one cleaner and me. I looked at the drawings in the room and knew that I will miss so much those who draw them and those who could not draw them.
I wondered if I am allowed to take a picture to the room. I said "NO" to myself. But later at the house of doctors I saw this magazine with a picture of some drawings for some patients (the picture above).

I was looking at the young woman who did that scene, she was drinking tea while her gaze was really nowhere. She was not with us. Then she started crying again saying that she misses her son.

She told us to let her cry cause she needed that as she said. After she stopped crying she came next to me and sit in the nearby chair. I remember i prevented her once from going outside the hospital and gave her an ECT "ElectoConvulsiveTherapy" twice. She always remind me of these incidenses. She hold a pencil, a colored one and took a white paper. She wondered what to do. I was waiting to see but the nurse asked her to draw him. She agreed. I interrupt like a child who knows that he will miss all this and said: I want you to draw me something please, can you?

And she drew me this:



I asked her, like a stupid psychiatrist usually do: what is this?

She moved her shoulders up in an expression which I think means "what do you think? is it that difficult?" then said: "it is a flower, to you"

I asked: "and that lady is you?"
she said: "you can say that although I am not beautiful as her"

In my ordinary state I usually say: "dear you are so beautiful" but I don't know exactly why I didn't say anything. I just looked at the young lady with my eyes full of smile and love. She understood. I will miss them all.

At the eveining I went for a walk. I didn't inter into the ward, I intered only one. I saw these patients holding their ward's big cooking utensil and walking to the big hospital's kitchen. They will bring dinner to their ward. They usually don't greet anybody. They didn't greet me. I didn't greet them but I knew I will miss seeing them walking this way.



When I passed by Al Kindie group of wards somebody called me telling me that K want to see me. I went in, K greeted me with a real smile and said: "I knew that this was your last day here and I want to give you this pillow slep that I made with my hands since sometime"



I thanked him and now I thank God that he showed me the career that I really found myself in.