- Hafid al-Qadhi is one of the most precarious places in
the new Baghdad. Gangs, brothels and piles of rubbish fill its dark, unelectrified
alleys, where kids play around lakes of green sewage. It has been known
for decades as the crazies' neighbourhood, not only for the eccentricities
of its inhabitants, but also because since the late 50s it has been home
to the country's most celebrated psychiatrists.
-
- One of Baghdad's best-known shrinks has his clinic in
a crumbling, two-storey building there. The stairwell leading to his clinic
is a dark, sinister space. Lighters in hand, visitors tread carefully on
the steps, plaster falling in big lumps on their shoulders as they climb
to the upper floors. The letters on the doctor's nameplate have been lost
a long time ago. In the small waiting room, men and women crowd around
a small table where a young woman struggles in the darkness to find patients'
history in three big volumes of names and details. An old TV sits idle
in the corner, and a piece of cloth separates the waiting room from a small,
stinking toilet, lit by a candle.
-
- Beneath the doctor's British diploma hanging on the wall,
Fatima Aziz, a thin, tall woman in her 40s, is sitting with her sister
on a pair of threadbare green armchairs. Her black scarf is falling back
from her head, her hand held firmly by her sister and her eyes fixed on
the floor. The doctor, an old man in his 60s, pleasant, soft and reassuring,
sits behind a big wooden table. The only light in the room comes from the
big window behind him, making his white hair glow and giving him the air
of a genie. He glances at the white card passed to him by a male nurse
and whispers "ECT".
-
- Iraqis these days like to look back and tell each other
stories of the good old days when everyone was happy and people weren't
at each other's throats over every issue. Clearly the memory is a rosy
one, but there is no doubt that depression and psychiatric illness are
on the increase in today's Iraq. The worsening security situation has led
to more and more people with serious mental health problems, though the
withdrawal of the UN and international aid agencies means information about
the scale of the problem is elusive; both the International Red Cross and
MÈdecins Sans FrontiËres say they have no data on the psychiatric
effects of the war and its aftermath on Iraq's population. (A 1999 report
by MSF into psychological damage in Sierra Leone after a period of intense
violence found that 99% of respondents showed levels of disturbance equivalent
to severe post-traumatic stress in Europe.)
-
- With limited availability of medicines and counselling
therapies, some doctors are increasingly relying on electroconvulsive therapy,
or ECT, to treat Iraq's mentally ill. This involves passing an electric
current through the brain to induce a fit and in the UK is used, under
general anaesthetic, only to treat severe depression and psychiatric illness,
and then only after other treatments have failed. The irony is that in
Iraqi cities, with their intermittent electricity supplies, even this therapy
is not always available.
-
- "So Fatima, tell me what's wrong?" asks the
doctor in a fatherly manner. Her sister answers on her behalf. "She
is not sleeping very well. She speaks harshly to everyone. She remembers
old quarrels and picks fights with everyone." Fatima is looking at
the floor.
-
- "My daughter," asks the doctor, "do you
feel that people are talking about you? Every time you go to bed do you
hear someone whispering in your ears?"
-
- "Yes," says the sister. "She won't have
any food cooked in the house, she says we are trying to poison her."
Fatima is still looking at the floor.
-
- The doctor starts writing something in a white notepad
and says: "She is suffering from an acute depression." He looks
at Fatima again. "Fatima, my daughter, do you tell yourself that maybe
if I die things will get better?"
-
- Still looking at the floor, she speaks for the first
time: "Yes, but then I look at my kids and say no."
-
- "Doctor, every time the door is knocked, she starts
screaming and fighting," adds her sister
-
- "Why is that my dear?" asks the doctor in his
soft voice.
-
- "It is all these things around us," says Fatima.
"The Americans, the booby-traps. No security, I can't let the kids
go play outside because of car bombs and fighting." She raises her
head for the first time, looks at the doctor and says: "Doctor, you
are a learned man. Why can't you stop these car bombs and explosions?"
-
- The doctor giggles and looks at the ceiling, raising
his palms. "But how can I? I am like you, scared of these things."
-
- Ibn al-Rushud is Iraq's psychiatric hospital, built in
the late 70s with oil-boom money. The hospital, a white concrete modernist
structure with long slit windows, is squeezed into a cul-de-sac with a
Presbyterian church.
-
- Dr Hashim Zaini, the hospital's director, is bald, spectacled,
slightly eccentric, and clearly a little despairing. "We have 74 beds
and two doctors," he says. "We receive 250 to 300 patients a
day and we are supposed to serve a nation of 25 million people." He
is followed by half a dozen people as he walks to inspect the wards - patients
looking for more tranquillizers, a contractor who's here to fix the hospital's
generator, a couple of employees asking for leave. They follow him into
his office as he continues to sign papers and write prescriptions pushed
under his nose by colleagues.
-
- In a conservative society with strict moral codes, visiting
a shrink or having any psychiatric consultation is anathema. Having a mentally
disturbed person in a household can mark an entire family as damaged, prompting
gossip to spread rapidly through extended family networks. People with
psychiatric illnesses such as depression or acute anxieties will often
be told to read the Qur'an or pray more, or will be threatened by a husband,
father or family members. "Psychiatric consultation is so stigmatised
here, it is only when the family cannot tolerate the patient any more that
he will be brought here," says Zaini. "This is why it will take
a long time to figure out the real impact of violence and war on the people."
-
- But according to Zaini and other experts, it is children
who are experiencing most acutely the impact of Iraq's descent into violence.
"We are witnessing a gradual change in the psychology of the children
- they are living in a state of constant fear. When the teacher comes every
few days and tells the children, 'Don't come to school tomorrow, there
is a terrorist threat,' what do you think will happen to those kids? This
is why the best business in town is the market for toy guns.
-
- He would love it, he says, to be able to spend more time
listening to his patients and forming a proper diagnosis, instead of turning
to electric therapies after five minutes' consultation. "But for us
Iraqis, tired and impatient, and especially for the families who want to
see a direct result, we can't stop using ECT. For them it is an effective
way to calm down the patient, and it is a speedy fix."
-
- And so back in the darkened surgery in Hafid al-Qadhi,
the doctor calls to his nurse, "Mustafa, prepare for an ECT."
The nurse goes outside, and after a few minutes the muffled roar of a generator
comes from the balcony. A faint current of electricity, enough to light
only a few bulbs, flickers into life. The nurse comes back and opens a
door leading to a small adjacent room smelling of burning plastic. "Doctor,
I don't want to go through this again," says a visibly agitated Fatima.
"But you want to get well, right?" he says, leading her to the
other room as her sister holds her firmly.
-
- They lay her on the leather bench, and take a metal headset
from where it has been soaking in an aluminium bowl filled with water.
Two wires lead from the headset to a brown wooden box. The doctor switches
a plug on the wooden box. Her eyes close tightly as she starts to fit,
shaking and trembling. Her sister holds her feet; the nurse puts his thumb
under her chin to stop her from biting her tongue.
-
- Back in the room and behind his desk as Fatima lies unconscious
next door, the doctor is inspecting the white card of another patient.
"The conditions in the surrounding environment, the fear, the anxieties
of war and violence and the deteriorating security situation - all work
as a pressure factor, that keep chipping away people's resistance."
-
- He opens the door to let in the next patient. "Of
course, some people are already neurotic and have a low threshold of tolerance.
People like Fatima, who break faster than others."
-
- Guardian Unlimited © Guardian Newspapers Limited
2005
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- http://www.guardian.co.uk/Iraq/Story/0,2763,1428207,00.html
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