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.

Al Rashad Wisdom

On the main door to the house of doctors in Al Rashad you find that one of the doctors had written what he called as " Al Rashad Wisdom":

The Monument of Liberty & Jewad Selim

I have mentioned Jewad Selim "or typed Jawad Selim" in my last post. I called his monument as the Freedom Monument, but I found lately that it is called as "The Monument of Liberty".

The monument is made up of 14 separate units and comprising 25 human figures together with a horse and a bull.




I found an article about the Munument of Liberty in the journal of Gilgamesh, the first issue in 1987. These following lines are taken from the article written by Jibra I. Jibra:

"He worked throughout 1960 on the clay figures. He sent them to Pistoia to be cast in bronze. Each figure was divided into parts in order to facilitate their shipment to Baghdad in carefully marked crates.
Late that year, Selim returned to Baghdad to supervise the installation of the figures on the complete frieze.
In Baghdad, the bronze pieces were taken out of the wooden crates welded together and raised on to the marble structure.
Selim never stopped supervising the work being done properly. He was always on site, together with his colleagues and a crowd of curious people watching the gradual unfolding of the dramatic figures.
He was busy supervising the erection of the second unit when he had a heart attack. He was hurried to hospital. Around his bed gathered the best doctors in town trying to help him pull through. But the attack was so severe that he died on January 23, 1961, not yet 42."


I found some interesting sites talking about Jawad Selim, and here are some links.

http://baghdadtreasure.blogspot.com/2005/09/treasure-in-baghdad_11.html

http://attawie.blogspot.com/2008/01/my-exhibition-salute-to-jawad-salim.html

Between Salim's Freedome and Kahramana's Jars hide all my personalities

Those were pictures of the freedom monument made by "Juad Salim" as far as i can remember the name as my father used to say his name over and over to me and to his friends. The monument contain many symbols, each one with a story, that my father can tell you. Unfortunately I cannot remember them so good. It is here that my first contact with monuments started. My father used to take me here every time he got free time to talk a walk. It was here that I knew that my country got great artists. Juad Salim, as far as i remember the name, took a well known award from Italy, as my father was repeating. My father would add something like: "Italy, Italy, you know what is Italy? they gave him an award! Italy gave him an award"..

And I feel so proud of my father and of my country when I hear that.
My father had a friend who lived in an apartment in al Sadoon street. Al Sadoon street was loosing its importance in Baghdad. During the 80s…. during the Iraq-Iran war…. Al Sadoon street started loosing its significance as a centre of attraction. During the Iraq-Iran war, which lasted 8 years, men were taken to the battle field. Baghdad was running out of working hands. Men from Egypt mainly, and Sudan to a lesser degree, came to Baghdad to find job. Many of them found shelter in cheap hotels of Al Sadoon street. They tended to crowd in small rooms. Al Sadoon street was changing its mask from a one that was symbolizing Iraqi originality and art, into a centre providing low price shelter for strangers. My father was always arguing with his friend trying to convince him to leave the area and find a better area. I cannot remember what was that friend answering my father in detail, but it was something about that “he doesn’t want to”.
That friend was always using some perfume that I can still find some traces in my nose memory. An odor that is not feminine at all. An odor I found strange by then. Like some smell of alcohol, cigarette smoke, and sweating mixed together, but then imagine that the man with this odor take a shower using a very sweet smell shampoo. When he came out you will smell some traces of alcohol and cigarette smoke but now they are so sweet. That was how my father’s friend odor was. It was very special. He was white and little puffy. He had no moustache. The area between his nose and upper lip was big and shining. I cannot remember what he was working. I think I never knew. I never asked. But that man represent, in my mind, the symbol of an Iraqi from the good days.

Battaween is a quarter were there are old houses. Their architecture is a special one, similar to that of Al Wazeerya. It is called by lay people as “Jewish houses”. They mean by that that they were built by the Jews. When the Jews left Iraq, there were no new Jewish building. A whole school of architect was lost in Iraq.





I went to Al Sadoon street for some work which I failed to complete due to some lack in my papers. I went walking down the street. I had my camera in my pocket but I didn't like to bring it out. I didn't feel safe to hold my camera in my hands there. Somebody may think I am a journalist, and this is dangerous. Or somebody else may think I am preparing for something bad, who knows, may be an explosion. We are getting paranoid and this is normal. Baghdad is not that safe that you can hold your camera and take photos.

Al Sadoon street starts with a square and a big monument, and ends up in a small square and another nice monument. The first is about freedom, and the second is about 1000 nights and a night and kahramana.

My father used to take me for long walks here. But it is changed now. I was containing the largest cinemas in Iraq. With the most numerous doctors and lawyers private offices. Now they are closed. Not here anymore.

In al Bataween lived the lady that was taking care of me when my parents aren't home. She educated me in her way. She talked to me about Al Bataween and about Sami, a man with a name like mine whome she was deeply in love with. She talked to me about how strong and brave he was. And how hadsome. She talked to me about cinemas and Indian romance films. And she was christian, so she talked to me about christianity. I remember once, a young woman, who didn't like that lady who took care of me, taught me two lines of rhyme and showed me how to sing them. It was something about the Virgin Mary. She told me to sing it for her (the lady that I don't want say her name but her name is written in my heart) and that she would be happy. I went to her and sang that song, she started crying while the woman who taught me started laughing loud. I knew it was something bad. I knew i just humilated my lady and her religion. My lady took me away, I started crying.

I intered Al Mada publishing company and my eyes were caught by a book at the far top of the wall. The worker was busy showing some old men some books written by "Hadi Il Alawie". I started walking around in the big book store. I didn't like anything but that cover of that book up there. I went back and stood like a statue with my neck hurting while I was looking up at that nice cover. I even couldn't saw the cover in detail. It was so far. So high. But the colors were telling me: "come and get me, you should read me, you should have me in your hands".

The old men went out and the worker came to me and I told him that I need that book. He brought his stairs and went up. I added at the moment he touched "my" book: and I want to see that next book, Presto and I? Platero and I? what is that?

The worker asked me: this brown book?

I said: yes, the brown book please.

I came home with Dr. Jekyll and Mr Hyde of Robert Louis Stevenson and Platero and I by Juan Ramon Jimenez.







I didn't know them both before. But now I know that I should have know them both earlier. Anyhow it is not late to know them.

Jekyll and Hyde is about a man with multiple personalities. If somebody had told me about this book i would have travelled earlier to Al Sadoon Street to buy it. But it came just by accedent. And what an accedent. I just fall in love with the book from the first sight with no clear cause. I think the single cause was the cover and how it is different from other book's covers. Another possible explanation is that I have read the title somewhere else and had known that it is about multiple personalities but that this information had passed with time from my conscious to my unconsious. Does Elton John have a song with "Jekyll and Hyde" in it?

When I took a pause from reading Jekyll and Hyde and was thinking about how it was a happy accedent to buy this book, I thought about me myself and whether I may got a double personality. do that exist? I said to myself. And how it would be if I have another personality, what kind of personality it would be?

Then my thought stream reached an area where I start thinking about the other book, Platero and I by Juan Ramon Jimenez. Why I chosed it at the last moment and i didn't know about it anything. (I still don't know anything about it cause I didn't read it yet). Then an idea came into my mind saying: "both these book talks about 2 identities, one is clear to the other, the other is hidden or mystic,..., if I have another personality, could it be a donkey?... that could be, actually I hope so.... to be an animal with no much worries.... that would be so nice and easy,...., but I got to wait till I read Platero and I and see what it means,....., i may change my mind, i will read it and write another post, till then see you soon all of you and all of your personalities, old ones, new ones and coming ones...."

To see some wonderful pictures about Jakyll and Hyde visit this site http://en.wikipedia.org/wiki/Strange_Case_of_Dr_Jekyll_and_Mr_Hyde

Shaddow Contemplation

When I first visited Al Rashad mental institute in 2005, the guards stopped me and asked who I am. After they knew that I am a doctor they asked me if I carry a camera. After I told them that I don't carry a camera, they asked me if my mobile phone have a camera. My mobile by then was having no camera. I asked them why they did ask those questions, and they told me that it is prohibited to carry any kind of camera inside Al Rashad institute.

Since then and I know it is very sensitive to take a picture to a person with a mental illness. I never did took a picture to a person without his concent. And never thought of taking a picture for a person with mental illness.

But when I started my training course in Al Rashad institute before about 6 months, nobody asked me if I ever have a camera. I even saw some kids walking inside the hospital with their mobile phone cameras turned on on a window of patients while police was standing nearby. I thought about talking to them, but they knew the police and the policemen know them, yet no body knows me at that time. So I just shut my mouth.

During my training I saw that some patients are pictured and sometimes video camera is used during some occations that even psychiatry seniors were attending.

I get less sensitive from my mobile camera during the last months of my training and I started to use it when I think it is an appropriate time and place.

I never took a picture to a face of a patient. But I think, this patient's contemplating moment in the shaddow worth to be recorded.

My kiNdergarten loVe stoRy

I made some "silly" face and "silly" movement which was more like a clown dance. Her grandfather laughed, but she only smiled with some fear in her eyes then she run away to hold her grandfather hands. She didn't trust that I can be so close to her. She was little frightened from this "clown" in his white coat who just came from the outpatient clinic with his red cheeks, uncombed hair, white small papers fills his pocket and show themselves in an irregular way and sweat drops in his forehead.

When her grandfather took her away I kept looking at them as they were leaving. His legs are so long. He was walking at ease while she was running. I kept looking at them till he finally stopped and hold her up into his arms and started walking faster. I went inside, I locked the door, took a white paper and wrote this piece about what can I remember of her, that lady I loved when we were both 4 years old in the same kindergarten.



I loved her like I loved the ice cream
Her image walked with my nights like a moon
When she wore that white dress
I imagined her as my bride

I wore a mask of a silly child
And proposed that game of acting
I took a role of a clown
She was the princess
In her father’s castle

I approached her and said: I love you….
Her companions laughed
I smiled
She furrowed her little brows
“You clown, how dare you,
Do you want me to tell my father about you?”

I felt so sad, so small
An idea jumped in my mind
I said with a wide smile in my lips
And tears in my eyes
“I can do some funny acrobatics”

She did not answer
Her fellows applauded
I run as fast as I can
I felt myself a jaguar
I was sure all were impressed
I jumped high like a bird
All opened their mouths wide
I flipped
I fell
They all laughed
Her cheeks turned into red
I thought it was for me when she shouted
“Here he comes”

The prince came
He was clean and neat
He was confident
The party continued while I was forgotten

The teacher came with all her pride
She brought us a cake with a delicious aroma
They all ate
I didn’t
“Don’t you like my cake?”
“I’m not hungry”
“Don’t you like its aroma?”
“I like her smell more”
“Who?”
“The princessssss”

“He just said he likes your smell”
She looked at me and shouted:
“You’d better smell your ass”
A wave of laughter made me drown in my tears

She took a blind stone and hit me in chest
I walked as confident as a king and said
“This party was for you”…

ACHEWS, sorry I am allergic to happiness

Dysthymia is one of the mood disorders that I never did diagnose till I bought this book. It is so easy how this book make it:

"2 of these 6, with depressed mood, for 2 years sugnify dysthymia:

Appetie disorder
Concentration deficit
Hopelessness
Enegry deficit
Worthlessness
Sleep disorder

The dysthymic patient is "allergic" to happiness; hence, the mnemonic refers to a dysthymic patient's (misspelled) sneezes (achoos) on exposure to happiness".

Those were the few lines about dysthymia in this magnifisant book. I looked for the book to take a picture of it. I thought I may found it next to a nice thing so that the picture will be nice. I found it lying above other books turning his face away from them. "You are special!" I said to it.

Stefan Zweig

Today I bought the newspaper from Al Rasheed Street. They don't sell newspapers in some areas in Baghdad, like in the area where I live and the area where I work. So I felt happy that I can buy a newspaper. They even gave me a free edition of Stefan Zweig novel "Chess". I didn't know about Zweig. I only heard his name and I cannot remember anything about that. Today I knew how wonderful are (is) his writings. He was talking about 2 types of intelligence in that novel. It was great.

Riding Jeeps

This is another picture for these Jeeps that take me to my working place. The driver won't start driving his car till it is full of passengers. The car is not considered really full unless 2 or more young men are standing on the back. I don't like to consider myself as different from most of my society, so I decided that I must stand at the back one day. When I did that one day I was holding a nylon sac with some books inside. I put it between my legs and was ready for the ride. The street is not well paved all long. Believe me I was afraid. I decided I never repeat that. But one day the car was full and the driver stopped for 2 women. The young man who was sitting in front of me stood up, walked to the back, stood there. I knew that it is my turn to go and stand at the back to let the 2 women come inside. I and that young man were sitting on the last seats near the back, so it is we who should stand on the back if women came. I stood on the back and I was having a sac full of books and some clothes. The driver went so fast. I decided that the woman who took my place should hold my sac for me. I bent so that I can talk to her. Before I finished my asking she smiled and said "sure my brother". She took it from me. I felt that we are really brothers and sisters suffering from difficult time hoping that the future will be better and that these Jeep cars will be of history. But I am already missing them, that is why I am taking photos for it just to keep them in mind.

Condalisa Rice with 2 pens and a tooth

When he knew that I will leave soon he told me he wants my pen as a souvenir and that he would give me 2 pens instead of it as souvenir. I agreed. He went running and came back with those 2 pens.




I gave him my pen, thanked him and went walking toward the female ward where they wanted me to do an ECT "Electro Convulsive Therapy". I met the patient. She was frightened. The senior had requested ECT for her. She is frightened of it. She doesn't want it but she is an inpatient in Al Rahsad hospital, and patients here don't have the right of refusing treatment. Their families sign a paper at the first day of admission giving the permission of an ECT at anytime the doctor prescribes it. She was clearly depressed with marked irritability. I didn't make a long interview with her because all what she was saying is that she doesn't need an ECT. We don't have anesthesia for ECT. So she will be awake till it starts. But she will not feel anything till it ends. The fright of being "electrified" is understood. But what can I do. I started telling her that it is not called an ECT anymore, but it is called nowadays as Electro Stimulative Therapy. And that it is easy and she won't hurt and that I will do it with my hands and she doesn't have to worry. They changed the word "Convulsive" into "Stimulative" because when they use anesthesia no convulsion will appear on the body, the convulsion will be recorded only via the EEG "Electro Enchephalo Gram". But in our case it is still an ECT. But I was trying to show her that it is a treatment and not a punishment and she was feeling. I noticed the bad health of her teeth. I asked the nurse whether a dentist saw her; the nurse answered me that they didn't come since March when the gun fights started again around the hospital's area. I asked the nurse if she thinks that a tooth may fall while we do the ECT and she answered that this same patient had received an ECT before short time with no problem. I asked the patient if she got a tooth that is not stable, I mean moving. She said: yes. But she showed me a tooth that is stable. The tooth that I was worried about was not mentioned by her. I looked at the other nurse standing near the cleaner preparing the bed. It is not a bed; it is a big piece of sponge put on the floor with the ECT instrument next to it, with a mouth piece prepared to be put in the patient's mouth so that she doesn't bite her tongue. The other nurse encouraged me to do the ECT and we did it. One of her bad front teeth fell to the outside of her mouth. I thanked my God that it didn't fall to the inside where it might cause suffocation. The nurse became little shy and avoided looking at me. I blamed myself and not the nurse. Then I project my blaming to the hospital and its negligence. After few hours I started again to blame my self and I knew that this woman might have been killed by what we did for her. And we would call that as a SIDE EFFECT, when it is clearly our ignorance, neglect, and inhumanity.

When her tooth fell I took it in my hands. I took a picture for it so that I won't forget her. This is her tooth.



At the evening I was really in depressed and irritable mood. I wondered if a senior prescribe an ECT for me how it would be experienced by me? I was ruminating with some ideas till my door was knocked. I found him, the same patient who gave me the 2 pens. Now he brought me another present that he had just made manually. It is a small sac made from the huge sac of rice. A sac that is very strong. He showed me that it is from the USA, and he added that it is the best quality of raw material to make strong sacs that bears heavy weights. I felt so happy. I thanked him. He felt my happiness. Before he went he added that they wrote the word "RICE" on the original sac. I wondered if he knew English. I wondered if he thinks that this is related to him because he got delusions of reference as I knew when I talked to him long ago. So I asked him: what did they mean by that? He answered quickly: they meant Condalisa Rice!!
When he said that, I struggled for a second to hide my threatening burst of laughter. He burst into laughter, and I followed by few fractions of a second. I laughed like I never did since many months. The sound of my laughter was so laud like his. I noticed that he lost some teeth from the front of the upper jaw. When I went inside I felt that that lady will go on with her life like this kind wonderful man is doing .

Maktoobi

Fate. Fate is written they say. It is already written. El Maktoob is the Arabic word for "the written". Your maktoob means your fate.

It is strange how some important events happen so suddenly, so spontaneously, without significant planning.

Taking the step of choosing psychiatry as a career was never planned in spite of my obvious liking for this specialty. It was in 2004 when I was still a rotator resident doctor in internal medicine. A colleague told me that he would chose psychiatry as a specialty. I told him that I won't chose psychiatry because of the low income of such a specialty and because of the troubled neglected patients I might met daily. I told him that I would choose internal medicine. We were in Al Hilla/ Babylon. When I want back home I went to the Iraqi Board of Medical Specialties building and stood in the line of doctors, in the row, and when my turn came, the secretary raised her head from the table she was sitting behind and just looked at me, I said 2 things, my name, followed by one second of contemplation by the word "psychiatry". She wrote my name with the word "psychiatry" below it in a file in front of her.

I went back home. I went to Hilla again to find my colleague who surprised me that he changed his mind and would like to chose another career (later he came again to choose psychiatry next year). I surprised him by my step of going and registering myself there. After few weeks I entered the exam with other 9 colleagues and all of us were accepted as students in the Iraqi Board of Medical Specialization studying psychiatry.

Another important event in my life was so spontaneous and seemed as if written before it happen. It was in 2006 when I was in Mosul. I had many nice kind colleagues. But their life was difficult because of the unstable situation of Mosul. They went home early in the afternoon and I stay alone in the ward. I felt so lonely. One day, I decided the I must go to the internet café and spent time. I usually go to the internet café to search for something and not to spent time. I usually go to the internet café having a goal. I went. Opened the yahoo chat window and to my surprise I chose the "Parneting Room". Why did I do that? Why Parenting? What I was thinking about? I was thinking about nothing…I was driven by my maktoob… I entered the room and met a person who taught me friendship like nobody else did before....I never thought that chatting via the internet can affect someone like it did to me....

Going To Work

This is a picture of the buses that I take when I go to work, the one in the far left is a mini bus named "Kia", the other one in the far right is an old Jeep car that I take as the last car to my work.

Below is another picture of one of the old Jeep cars. They were used by the old Iraqi Army in the previous regimn. Now they are colored differently by their owners. Half of them are not registered in the legal way, so they contain no numbers, and are not allowed to go outside some restricted area.



The area where the hospital lies is isolated from other areas by this concrete wall and no car is allowed to pass. The staff complete their way by walking.