| Arabpsynet | |||
|
|
|||
|
AN ARAB PERSPECTIVE Editors : Ahmed OKASHA (Cairo-Egypt) - Mario MAJ (Naples –
Italy) Co-editors: Aida Seif El Dawla (Cairo-Egypt) - Tarek Okasha
(Cairo-Egypt)
Edited by World Psychiatric Association
–June 2001 |
|
||
|
|
|||
|
q
CONTENTS /
SOMMAIRE |
|||
|
q
Preface q
Chapter 1 §
History
Of Mental Health In The Arab World / Ahmed Okasha q
Chapter 2 §
Social
Psychiatry And The Impact Of Religion / M. Fakhr El-Islam q
Chapter 3 §
Epidemiological
Studies In The Arab World / Rafia Ghubash q
Chapter 4 §
Primary
Care Psychiatry / Adel Sadek, Tarek Okasha q
Chapter 5 §
Schizophrenia
Across Arab Culture / Afaf H. Khalil q
Chapter 6 §
Depression
In The Arab World / Y. Amin, E. Hamdi, M. AbouSaleh q
Chapter 7 §
OCD:
A Transcultural Approach From An Egyptian-Islamic Perspective / Ahmed Okasha q
Chapter 8 §
Trauma
And PTSD / Sarnir Qouta And Eyad El Sarraj q
Chapter 9 §
Drug
Abuse, In Arab World: A Country Profile Of Egypt / Ahmed S. El-Akabawi q
Chapter 10 §
Child
Psychiatry In The Arab World / Amira Seif el Din q
Chapter 11 §
Attention
Deficit Hyperactivity Disorder (ADHD) / John Fayyad, Maha Sadek, Caroline
Cordahi q
Chapter 12 §
Psychogeriatrics In The Arab World / A. Abyad, A.M. Ashour, M.T.
Abou-Saleh q
Chapter 13 §
Mental
Health Of Women In The Arab World / Nadia Kadri And Driss Moussaoui q
Chapter 14 §
Social
Factors Affecting Women’s Mental Health In The Arab Region / Aida Seif el
Dawla q
Chapter 15 §
Psychotherapy
In Egypt (An Overview) / Prof Y. T. Rakhawy q
Chapter 16 §
Arab Psychotherapy / Wafaa L. Haggag q
Chapter. 17 §
Arabic Psychiatric Screening Scales / Omar
E.F. El-Rufaie, Tewfik K. Daradkeh q
Chapter 18 §
Influence
Of French Psychiatry On Arab Psychiatry / Saida Douki, M. Jamil Taktak, Driss
Moussaoui q
Chapter 19 §
Forensic
Psychiatry And Islamic Law / Kutaiba Chaleby q
Chapter 20 §
Mental
Health Services In The Arab World / Ahmed Okasha q
Chapter 21 §
Psychiatric
Education In The Arab World / Mohammed T. Abou Saleh q
Chapter 22 §
Mental
Health Research In The Arab Speaking Countries / Elie Karam, Maalouf Wadih |
|||
|
q
PREFACE |
|||
|
The
fact that all three heavenly religions originated in what rater became the
Arab region has colored the culture of this region and influenced the
behavior of its population. Seven thousand years ago Ancient Egyptians
believed in one God, the after world and that our worldly deeds will bc
balanced in the Day of Judgment. This led James Breasted to consider the
Egyptian culture as the dawn of consciousness. In the Arab culture
the humanitarian interaction with a doctor is heavily valued , if not more
than his or her technical ability or scientific knowledge. Social integration
is valued more than autonomy. The family and not the individual is the unit
of society, something that Western culture is trying to pursue in this
millennium. In many non-Western cultures, native practitioners, to whom
modern psychiatry is completely unknown, treat emotionally disturbed persons.
Such treatments are frequently the only method available in some cultures, a
fact that requires better understanding to clarify the complex ways in which
mental illness interacts with culture. Traditional treatments are
characterized as culturally compatible (healers are familiar with the
cultural value systems of the patients) and holistic (physical,
psychological, social and spiritual aspects of healing are integrated).
Religion plays an important rote in symptom phenomenology, attribution (God's
will) and management in the Arab culture. Islam is the religion of the
majority in the Arab region- Islam is essentially geared to a theocratic
society, in which the state and the individual are of value only as the
servant of the revealed religion. This
book is a crosswalk through the different ways in which Arab culture colors
the discipline of psychiatry, starting from its history, to the symptomatology
of disorders, to the social factors that color that symptomatology, the
impact of culture on treatment methods, foremost psychotherapy and the
existing legislation, services and educational bases serving the discipline.
It is a collective product of a number of Arab colleagues from seven Arab
countries, each from his or her own perspective and experience have presented
their insight into the impact of Arab culture on our specialty. My
sincere thanks goes to my colleagues and assistants Dr. Aida Seif El Dawla
and Dr. Tarek Okasha without whose help in revising, proof reading and
contributing their chapters, this book would not have been finalized. My
enormous gratitude goes to Mrs. Jennifer Okasha for her meticulous proof
reading of this book.
Prof. A. Okasha Prof.
M. Maj |
|||
|
q SUMMARY / RESUMES |
|||
|
q Chapter 1 §
History Of Mental Health In The Arab
World / Ahmed Okasha CONCLUSION : Mental Health has been identified
as an essential component of a person's health in general ever since the time
of the Pharaohs. That extent was important enough to place therapy within the
divine boundaries of the spiritual and religions. Since those days through
the Islamic era to the present day, psychiatry and mental health services
have come along way. The development of knowledge, the introduction of
pharmacotherapy, the continuos development of neuroscientific diagnostic
tools and instruments, did not exclude other actors from assuming
responsibility for people's mental health. Traditional healers in our region
continue to play a crucial role in being the first line of defense
against unexplained psychological symptoms that people fail to place within
the domain of medicine. Culture is a major determinant that does not only
color the of health and disease, but also colors the disease and determines
when and where help is sought. Although we have 22 Arab countries in the Arab
League, yet mental health services that arc provided in those countries show
several variations. Economic, political, social and cultural factors seem to
play a major role in determining the state of the psychiatric profession and
the access of citizens to the service. q
Chapter 2 §
Social Psychiatry And The Impact
Of Religion / M. Fakhr El-Islam INTRODUCTION: Social Psychiatry comprises all
contributions of human interpersonal factors and human togetherness to
psychiatry. Cultural Psychiatry is the part of social psychiatry related to
the social heritage of shared values, beliefs, attitudes and practices which
are passed from one generation to the next. The term transcultural psychiatry
is sometimes used to describe social psychiatry in non-Western countries in an
attempt to find out why social contributions to psychiatry in the West are
not global. The Arab family is the main social institution that has inputs
relevant to clinical psychiatry. It contributes much more than the Western
family to mental development, illness behavior, illness pattern and illness
management. The roles of schools and out-of-home care institutions are more
significant in the West. Recent budget realignments in Western countries
drastically compromised their social welfare system, and services for the
elderly, the poor and the sick had to be taken over by "someone
else". Western mental health professionals rediscovered the role of the
family in this respect, which had long been abandoned for the sake of
individuation of human beings. The family care, which was phased out through
industrialization and communism alike, is now actively re-sought (1). The Arab family runs the
affairs of its healthy and sick members alike. Although extended family
households have been largely replaced by nuclear families, the latter have
maintained a 'functional' extended family by frequent visits, telephone
contacts, business and property partnerships and arrangement of marriages
within their bigger family network. The functional extended family provides
substitutions for parental loss or absence, mediation in conflicts (including
marital and intergenerational conflicts), preferential (nepotistic)
employment of kin and help with expenses of health care. The fore- care and
after-care of the sick are family responsibilities in Arab countries.
q
Chapter 3 §
Epidemiological Studies In
The Arab World / Rafia Ghubash CONCLUSION: Large-scale community surveys are scarce
in the Arab world. Despite the available resources that exist in the Arab
countries collaborative multi- national cross-sectional and longitudinal
studies have not been produced. However, there is lack of reliable
epidemiological psychiatric base line data. This is partly related to the
very concept of mental disorder itself, which may vary widely in divergent
cultures (32), and to the methodological problems of assessment and
evaluation. There is scarcity of valid, reliable and culture relevant Arabic
psychiatric research instruments. There are doubts about the scales, which
were originally designed for use in other cultures, due to problems relating
to the linguistics and conceptual equivalence (33). This emphasizes the need
for culture relevant psychiatric instruments designed by Arab experts, and
tested in various centers in the Arab world so as to agree on final versions.
Epidemiological studies in the Arab world should inevitably focus on the
health problems commonly encountered in this part of the 'world and on the
development effective strategies for evaluation taking into consideration the
pertinent ethno-sociocultural influences. Reliable epidemiological data of
such local health problems is only the initial step for effective long term
solutions. The nature of psychiatric clinical presentation among local
patients of this area, and the impact of such presentation in making a
diagnosis and on management is another area of investigation. Clinical
phenomena like somatisation, which is a local chronic problem leading to prolonged
morbidity and negative impact on the available resources and patient's life,
is far from being understood and addressed. The response to psychotropic
agents, and in which dosages, also seems to be influenced by ethno-socio
cultural factors and needs to be looked at. A final crucial point is
that no rational planning for future psychiatric services, education and
research can be done without a reasonable, relevant psychiatric data base. As
psychiatric epidemiology is expected to make substantial contributions toward
better understanding of mental disorders more rigorous work that utilizes
well defined goals, appropriate designs, valid instruments and the
contemporary classification systems in psychiatry is needed. The work that
has been done so far should stimulate researchers in this part of the world
to conduct further valid and well controlled studies within the domain of
psychiatric epidemiology. q
Chapter 4 §
Primary Care Psychiatry / Adel Sadek,
Tarek Okasha CONCLUSION: The increased awareness of primary care
physicians of psychiatry is mandatory. It is estimated that 80% of all mental
patients seek their help either from the GP or traditional healers. Many
studies have shown that depression is under-recognized, under-diagnosed and
under-treated by GPs all over the world. The promotion of mental health
services especially in developing countries, where human resources are
limited, is not through increasing psychiatric beds, or numbers of
psychiatrists, psychologists and psychiatric nurses, but by better education
and continuos medical education to our primary care physicians. q
Chapter 5 §
Schizophrenia Across Arab
Culture / Afaf H. Khalil CONCLUSION: The future policy of the Arab countries
for the management of schizophrenia should allocate more resources, both
human and financial, to the provision of mental health services addressed to
schizophrenic patients. There is a need for the development of a practical
guide specifically tailored for Arab countries to conform to local needs,
resources and socioculturel perspectives. A comprehensive management of the
problem of schizophrenia in the Arab region calls for the design of an
integrated program by policy makers to develop comprehensive mental health
policies and legislation which reflect local cultural situations and which
respect and protect the human rights of patients with schizophrenia. q
Chapter 6 §
Depression In The Arab World /
Y. Amin, E. Hamdi, M. AbouSaleh CONCLUSIONS: There is a large literature on depression
in Arab patients that have accumulated over the years despite the recent
entry of modem psychiatry to the Arab World. Unfortunately, research reports
are patchy and difficult to compare with each other due to different design
and methodology. In some areas like the translation and application of
assessment instruments there is a plethora of trials. When it comes to actual
comparative research within the same study, the contributions of Arab
investigators are minimal. There is an apparent lack of communication between
researchers so that at some point there were three different translations of
the Present State Examination in its 9th revision in use. More
important, the patchy research endeavors makes the drawing of conclusions
about the characteristics of Arab depression even more difficult. Still few
trends emerge. Depression appears to be as prevalent if not more prevalent in the Arab
culture compared to other cultures. The excess seems at least in part to
arise from the willingness of Arab patients to stress their suffering and to
somatise it. With that in mind, depression, like the Western variants of it,
seems to go more with
poverty and other social ailments that have been well documented
elsewhere. Arab patients tend
to respond better to open-ended interviewing with plenty of encouragement and
revisiting of important areas. The moods associated with the depressive syndrome are either muted or
overshadowed by somatisation and irritability. Guilt is not a distinctive
feature, and actual suicidal acts are less common though the thoughts are
there with high frequency The special history of the
Arab region and its peculiar social fabric created situations in which
depression might flourish. These include the rapid process of acculturation
that affected certain regions and the aftermath of the tragedies of war in
several parts of it. A legitimized form of infidelity taking the shape of
polygamy creates unhappiness not much different from that created in women in
other parts of the planet. q
Chapter 7 §
OCD: A Transcultural Approach
From An Egyptian-Islamic Perspective / Ahmed Okasha INTRODUCTION. Culture is a matrix that constitutes the
background against which we should understand the biological, psychological
and social dimensions of mental disorder. No doubt
however OCD has been attracting the attention of researchers in aspects other
than its biological nature, especially that of its nosological status,
diagnostic criteria and the cultural coloring of its symptomatology. A syndrome related to OCD has been recognized for more than 300 years
(1). Early descriptions focused on different aspects of the syndrome and
reflected the prevailing culture of the observer. French phenomenologists
emphasized the importance of doubt and loss of will (2,3). The German view
focused on the irrational nature of the thoughts, linking it to psychoses
(4). Previous Egyptian studies on psychiatric phenomenology have shown a
prevalence of culturally determined symptomatology, where religion and
prevailing traditions seemed to color not only the clinical picture of the
condition, but also the patients' attitudes about their disorder (5-7). All
Egyptian OCD patients studied hitherto had religions ruminations and sexual
impulses and related issues. Ideas, images, and ruminations were more common
among university-educated patients, whereas rituals and impulses prevailed
among those of low education. Fears were directed toward diseases, death,
madness, germs, and extraterrestrial powers. Also, Egyptian OCD patients
frequently presented with symptoms other than obsessions or compulsions,
e.g., anxiety, depression, or social incapacity (8). The introduction of the Yale-Brown Obsessive-Compulsive Scale (Y-
BOCS) by Goodman et al. provided a specific measure of the type and severity
of symptoms of OCD that is not influenced by the type of obsessions or
compulsions present, and thus provides a structured tool for the
phenomenological study of OCD symptoms (9). The present study was performed with the aim of
studying the nature and severity of OCD symptoms in a sample of obsessive
Egyptian patients and to determine the impact of culture on their
symptomatology in comparison to the findings of other studies. An attempt was
made to assess the comorbidity with OCD and to investigate the premorbid
personality patterns prevailing in the studied sample. q
Chapter 8 §
Trauma And PTSD / Sarnir Qouta
And Eyad El Sarraj INTRODUCTION: Over the past few years, the study of
Post-traumatic Stress Disorder (PTSD) has become embedded within a refined
topology of childhood traumatic experiences. At the same time, however, this
association of PTSD with childhood trauma has been highly criticized. Such criticism has highlighted the
fact that focusing on a set of symptoms tends to minimize the child's
experience of trauma and violence, that PTSD does not have diagnostic
specificity, and that PTSD focuses on specific past events while disregarding
the potential that the trauma may be ongoing. As most research and data about PTSD has been generated in the
West, an intense debate has arisen as to whether or not a PTSD model can be
applied to non-Westem countries. Those in favor of the application of this
paradigm to areas beyond the West cite the experience of many Southeast Asian
and Central American refugees who have fallen within the parameters set by
the DSM-IIIR and ICD-10 and met the diagnostic criteria for PTSD. Others have
similarly argued that a psychotherapeutic approach applying the PTSD model
and focusing on the trauma should cut through cultural differences.
Furthermore, inasmuch as the PTSD model forces the psychologist to search for
psychophysiological and neurobiological abnormalities, it should be
independent of ethnocultural factors. That is to say, people anywhere will
exhibit the same responses to traumatic stress. Those opposed to a non-Western application of the PTSD model argue
both that the refugee trauma experience is usually protracted and repetitive
and that a PTSD perspective pathologies what may actually be a normal
psychological process. The latter idea, which suggests that everyone exposed
to traumatic stress will develop PTSD, has been rejected by Friedman and
Jaranson (1). They
cite large-scale epidemiological research done in the United States which
shows that many people exposed to trauma do not develop PTSD. Rather, there
seems to be a point at which pathological grief is transformed into an
affective disorder; for traumatic events that cannot be psychologically
integrated, chronic post-traumatic syndrome follows. q
Chapter 9 §
Drug Abuse, In Arab World: A
Country Profile Of Egypt / Ahmed S. El-Akabawi CONCLUDING REMARKS: Reviewing
information that pertain to drug use in Egypt and Arab countries, one might
draw an insight into that which underlines cultural perspectives and predicts
future trends. 1- Compared to developed
countries, it is obvious that types of drugs widely used in our part of the
world are mainly either central nervous system depressants or hallucinogens.
Both point to drug taking in our culture as means of an escape from rapid
societal upheaval during a phase of national change and from stability and
conservatism to an unknown contemporary modern society. Available models of
developed societies are threatening and frightening for a nation that had an
historical backlog of civilization. The nation is negotiating an identity
crisis hand in hand with challenges of development. 2- Linked to the above point, it is predictable to expect a trend of
drug use increase in the cultural context Basically, the patriarchal-conservative character of societies, in the
region, are shaking and one would say fighting the erosion and disintegration
brought about by the rapid worldwide contemporary changes. Changes are
continuously infusing society which is ambivalent towards them. The
patriarchal society produces via its families and cultural organizations,
young people who share characteristics that mount to a prototype of Arab
Youth. An
Arab young person is basically submissive, suggestible and a follower. Such
traits make the youth subculture mainly docile andeasyto rnanage and lead.
However, another trait of passive aggression in face of stressing seems to bc
a national denominator. During the present phase of transition, one would
expect the young to bear the brunt of the confusion. Escapism through drug
taking behavior and the often repeated accusation of the young of being
careless and not serious enough are probably the major symptoms of whai one
could call "Developmental Crisis of the Young" as part of the
National Identity Crisis that the whole of the region is negotiating. A decade
or more seems necessary to pass through these rough waters. Symptoms, thus,
seem to have more chance to increase rather than to disappear. 3- From changing patterns of use, success of law enforcement efforts
and the already rising share in the market of licit psychoactive drugs; it is
expected that both locally cultivated sativa plant and more illicit
manufacturing of addictive medicines would increase to dominate the scene. 4- In Egypt and some other Arab countries, democratization and
capitalism will bring about in their wake a degree of societal polarization and
economic problems conducive of a fertile soil for drug use to spread. 5- Priority of provisions to control licit drug dispensary is a must
in the next two decades. 6- Prioritization
of primary preventive interventions is of paramount importance in a society
that is, and will probably, continue to bc, for a few decades, a young
population. On the whole, in Arab countries those under 15 years old are
about 50%. Concerted rational actions to equip the young with staining,
knowledge, and behavior to say "NO" for experimentation are the
safeguard for a nation to protect its tendo Achillis. 7- Extension of mental health services to primary health lever and
school and university health services is a national need with economic gain
at present and in the future. 8- In view of world changes viz. globalization and iinpleinentation of
the GATT, the problem of drug use inoves to the forciront as a national
security problem for each of the Arab States. q
Chapter 10 §
Child Psychiatry In The Arab World
/ Amira Seif el Din SITUATIONAL ANALYSIS: Children
in the Arab World constitute around 45% of the total population. General constitution
of the families in the Arab World, is the extended families emotionally more
than physically, this develops a better bond and support to the family
members. It is more prevalent among rural than urban families. Usually the discipline in
the families in the Arab world is in such a way that the parents are
overprotecting their children and the children have to obey the order of the
parent as a discipline system. This dynamic system raised lack of
communication between children and their parents particularly among
adolescents as mentioned in the study done by Seif El Din et al. where 57.5%
of the adolescent sample confirm the lack of communication between family
members (1). The awareness about psycho-social development of children and
adolescents is lacking among the majority of parents where in a study done by
Seif El Din et al. (2) using the standardized Arabic version of behavioral
checklist questionnaire (B.C.L.) developed by Graham in 1977 (3). This study
portrayed the number of pre-school children having behavioral problems were
nearly one fourth of the total sample (23.35%) and fifty percent of them were
reported to have temper tantrums, followed by sleep problems mainly
difficulty to sleeping on their own and over activity. This study showed
disagreement between (B.S.Q.) and (B.C.L.) as regard sphincteric control
where Egyptian parents are very strict to exercise their children to control
sphincters particularly the bladder and sometimes they use aggressive ways to
control sphincter reaching the degree of physical abuse (4).
q
Chapter 11 §
Attention Deficit
Hyperactivity Disorder (ADHD) / John Fayyad, Maha Sadek, Caroline Cordahi IN SUMMARY : In summary, the phenomenology and
clinical profile of ADHD in Lebanon, and by extension, in the Arab world, can
bc easily recognized if the proper diagnostic procedures and tools are used.
Multidisciplinary treatment including medication and involving the ADHD
subject's school and patents can bc successfully implemented with encouraging
results. The use of the stimulant Ritalin in Lebanon is safe as well as
effective in targeting the core symptoms of ADHD. Other stimulants should bc
introduced and become available to those who do not respond well to Ritalin.
Attention must be paid to the comorbid psychiatric conditions often present
with ADHD as they do impact choices of treatment. Much work remains to be done to increase awareness in our schools and
in the community about ADHD. Early intervention can avert many of the
secondary complications students encounter like school failure, poor peer
relationships and low self-esteem. -Early identification can also prevent
adolescent outcomes of delinquency and substance abuse. Advocacy work is needed at all levels to meet these goals and judging
by what has been accomplished in Lebanon in the last 1 0 years with Ritalin
becoming available, the development of a Ritalin registry at the Ministry of
Public Health, the increasing awareness in schools and the formation of the
ADHD Association, we can be optimistic about the future and what it holds for
children, adolescents and young adults with ADHD. q
Chapter 12 §
Psychogeriatrics In The Arab
World / A. Abyad, A.M. Ashour, M.T. Abou-Saleh INTRODUCTION: The population of the world is aging
rapidly. It is currently estimated that more than half (58%) of all
people who are 65 years and older live in developing nations. The world's
older population experiences a net increase of 1.2 million each month, 80
percent of which occur in Third World nations (1,2,3). It is projected that
by the year 2025, the total elderly population will reach 976 million with
72% living in developing regions (2,3,4). Also, as in the west, the growth
rate is fastest for the oldest old, those most likely to have chronic
diseases and be in need of health services. It is apparent that the problems
of the frail elderly and the development of geriatric health programs are
international concerns (5). The Arab World will have a rapidly aging
population within the next few decades. Many factors have contributed to the
increase in the elderly including improvement in living standards, the
curbing of communicable disease, and the latest breakthroughs in medical
science. The region is passing through the "Health Transition Phase,"
which is characterized by an unprecedented increase in both number and
proportion of adults and elderly persons. Improvement of health care has been
achieved by a combination of technical advances, social organization, health
expenditure, and health education (6,7,8,9). Rapid urbanization and
industrialization have occurred across Arab countries. The epidemiological
consequences of these changes will lead to an increased rate of death from
cancer and circulatory disorders. In addition, an increase in chronic
disorders of old age and the aging of the population itself will put enormous
demands on the health care system. As yet, there is no satisfactory geriatric
care available for the elderly in the Arab World. Different countries have
started different programs which tend to be rudimentary and fragmented with
no programs at the National level (8,9). q
Chapter 13 §
Mental Health Of Women In The
Arab World / Nadia Kadri And Driss Moussaoui CONCLUSION: Women, in developed or under developed
countries, have frequent and various occasions of stress, because of
different roses and tasks they have to .assume in the society as mothers,
spouses, daughters, employees and because of their unequal status as compared
to men. q
Chapter 14 §
Social Factors Affecting
Women’s Mental Health In The Arab Region / Aida Seif el Dawla CONCLUSIONS: : When women's position in Arab society is
examined it is clear that there are sufficient causes in current social
arrangements to account for the surfeit of depression and anxiety experienced
by women. Reviewing existing data concerning the prevalence of risk factors
to psychological distress in women, requires a serious attempt to attack the
sources of female suffering and to provide services that deal with the
negative consequences of gender inequality. The social roots of poor health
for women, discrimination in employment, education, food distribution, health
care and resources for economic development are critical variables that have
to be addressed by mental health workers or, shall we say, mental health
activists. Those social roots of poor mental and physical health for women
are numerous and deeply entangled; hence the strategies needed to address the
problem must be multifaceted. There is a necessity to view health and disease
as social constructions and not only as biological ones. Often the needs of
women are perceived as almost exclusively related to their reproductive roles
or their needs are defined in general terms without considering and
integrating their own experiences of health and illness so that the health
system is able to respond in a culturally appropriate and gender sensitive
manner. It is important to reinforce the view calling for a holistic approach
to health service provision one that defines health in terms of the sum total
of the physical, environmental, social, psychological and political influence
on women's lives. q
Chapter 15 §
Psychotherapy In Egypt (An
Overview) / Prof Y. T. Rakhawy CONCLUSION: As previously noted, most of
our practice is eclectic. Needless to say that eclecticism is not, or should
not be a way of escape from practical or theoretical commitment. lt refers to
some holistic responsibility, allowing the conscious and unconscious frame of
reference of the therapist to do whatever is useful to his particular patient
in a particular time. This is judged by realistic evaluation of practical
facilities and objective monitors to judge the march and outcome, both
quantitatively and qualitatively. q
Chapter 16 §
Arab Psychotherapy / Wafaa L. Haggag INTRODUCTION: Throughout
history, many authors tried to describe the personality of Arabs, emphasizing
certain behaviors and lifestyles that, they thought, represent the national
character of the Arabs. Among those authors had been Ibn Khaldoun who is
considered the real founder of the science of sociology (1). Since the Arab culture is very heterogeneous,
with characteristics that vary from one community to another, so the validity
of a generalized concept like a unitary national character can be- easily
doubted. The current trend adopted by anthropologist and social psychologists
is to avoid using terms like "national", "ethnic" or
"racial" in terms of psychology and psychotherapy. Kardiner et. AI.
developed the concept of " basic personality type" that is shared
by a group of people in a particular culture. They declared that the concept
does not correspond to the total personality of the individual but rather to
the projective systems or the value-attitude systems, which are basic to the
individuals' personality configurations. Thus, the same basic personality
type may be reflected in many different personality configurations (2). Psychotherapy
can be broadly defined as a "talking" treatment in which a trained
person deliberately establishes a professional relationship with a patient
for the purpose of relieving symptoms. Language, as the main cultural
instrument of communication creates meanings in a special way. Spirituality
and religion are at the heart of Arabs creating meanings and purpose of
living and also the commandments concerning interpersonal relationships,
which represent values and expectations different from those round in other
societies. So for the issue of psychotherapy we can succinctly use the term
"Arab" to denote all peoples of the Fertile Crescent and North
Africa who adopted Arabic as their tongue and believe in Islam. A systematic approach to the interdependence of culture (1) the
therapist (2) and the patient (3) should be developed in order to broaden the
horizons regarding the heating interpersonal exchange that can be
characterized as psychotherapy. q
Chapter. 17 §
Arabic Psychiatric Screening Scales
/ Omar E.F. El-Rufaie, Tewfik K. Daradkeh CONCLUSION: Over the past 2 decades, there
has been remarkable increases in the number of institutions of medical services,
education and research in various parts of the Arab world. Useful psychiatric
publications are now emerging, and there are various post-graduate studies
and residency training programs which include psychiatric research
dissertations in their final examinations. It is interesting to note that
psychiatric topics are also chosen for examination dissertations in
specialties other than psychiatry, e.g. family and community medicine. It is
inevitable that there is continuos need for reliable, Arabic, culture-oriented,
psychiatric screening instruments. Psychiatrists involved in research should
address the type of psychiatric screening tools which would be appropriate
for this area. Specific
questions include whether to use transported, translated instruments, or to
amend such instruments according to local needs, or to develop entirely new
ones. It is obvious that it would be irrational to ignore well-established
instruments developed in other cultures, taking into consideration that many
phenomena and concepts are common in different cultures. In addition, using locally developed
entirely new instruments will limit valid comparability of local findings
with other worldwide research results. These points represent only some
aspects which necessitate critical, careful evaluation before using
psychiatric instruments for the purpose of high quality research in this part
of the world. Although all the research experience discussed in this article
was in PHC settings, it is felt that it will also be relevant and useful to
psychiatric research involving the use of Arabic screening instruments in
other settings.
q
Chapter 18 §
Influence Of French Psychiatry On
Arab Psychiatry / Saida Douki, M. Jamil Taktak, Driss Moussaoui CONCLUDING
REMARKS: The
influence of French psychiatry remains strong in some Arab countries and in
our view; it has its good aspects. It definitely has a clinical richness,
which stiff could serve psychiatry worldwide. It has also a humanistic and
somewhat subversive tradition, for it was founded by doctors who were also
interested in philosophy. Of course, it is out of the question to either
oppose models or defend strongholds. At a time of globalization, which is overtaking psychiatry as well,
the "French cultural exception" is still there and can represent a
precious asset. It actually contributes to modulate the irresistible
attraction of our discipline towards simplistic explanation of mental
disorders by neuroscientific approach, and the exclusive treatment by
psychotropic medications. What we are striving for is a universal psychiatry
medicine, a human science combining art and technique, shrewdness and rigor
("esprit de finesse et esprit de rigor") and the French tradition
can help in this endeavor. q
Chapter 19 §
Forensic Psychiatry And Islamic Law
/ Kutaiba Chaleby INTRODUCTION: In order to understand the meaning of
insanity in Islamic law, it is important to understand the concept of mental
competence and legal capacity of a free Muslim citizen. Competence (ahlia) in
Islamic law includes entitlement to rights and duties by virtue of being a
human, a state referred to as themma (1). For example, the fetus while inside
the mother's womb is entitled to receive an inheritance, carry the father's
name, be the subject of a will, receive appropriate medical care, and so on.
Competence of entitlement also obliges the individual to fulfill certain
duties regardless of his or lier comprehension of these duties. For example,
a person of any age or mental function is obliged to pay blood money for a
relative who has committed homicide or manslaughter. In addition to competence of entitlement, there is also competence of
performance which involves legal capacity to carry out certain activities or
perform a certain task. It is stated in Islamic law that everybody who
reaches the age of maturity is mentally competent unless he or she is
declared otherwise. The mentally competent possess reason ('agil), are fully
responsible (mukallaf) and capable of deliberate intent ('amad) (2). The
majn'an lacks reason ('adim al'aqil) and deliberate intent and is therefore
liable to interdiction or legal incompetence. q
Chapter 20 §
Mental Health Services In
The Arab World / Ahmed Okasha CONCLUSION: In planning for mental health, we should
be guided by the general principles that should guide a formulation of a
mental health policy. Such policy should be based on decentralization of
service, an integration of mental health policy into the general health
policy, comprehensiveness of the policy outcome and equity. People should
have equal access to the health care, which dictates an equitable
distribution of resources and, maybe, a legislative matrix that promotes the
social values and protection of mental patients. Such policies should be
sustainable. The main element in securing sustainability is the participation
of the stockholders in its formulation. Community and civil society
participation in the formulation of their health policies in general and the
mental health policy in particular is mandatory to the credibility of such a
policy and its support by its target beneficiaries: our patients, their
families and the communities in which they live. A mental health policy
should target the prevention and treatment of mental disorders and their
associated disabilities, ensuring availability of minimal mental health care
to vulnerable and underprivileged, the use of mental health knowledge to
improve general health care and the application of mental health principles
to improve the quality of life (5). To implement these objectives we should raise the awareness of the
population regarding mental health and mental health problems, have a
comprehensive data base of mental health morbidity, have a planned budget,
train and update available human resources and maybe generate new resources
and redistribute our bed strengths. Because of the very tight budgets and
limited resources available at this time and as a transitional period, the
best plan for developing countries, our region being no exception, is to
train and update GPs to look after the chronically ill patient and the
families. This will give a better and lasting support and care than in
hostels or day hospitals. We have abundant GPs as compared to psychiatrists
and as previously mentioned, the more orientation of GPs to mental health and
the preference of patients and their families to attend the GPs and the
natural course of the referral system and the family role of support can give
a better service for mental patients in developing countries than the present
system of community care in industrialized ones. q
Chapter
21 §
Psychiatric Education In
The Arab World / Mohammed T. Abou Saleh INTRODUCTION: The
Arab world comprising 17 countries occupies no less than 12 million
kilometers with a population size of 300 million in two continents. Although
apparently diverse its countries share many common features in terms of
ethnic composition, history, cultural, heritage, religion, political
traditions, social values, customs and most importantly the Arabic language.
At the same time a wide variety of political institutions exists and
countries vary considerably in their socio-economic development. At one end
of the spectrum are the politically stable and rich countries with a steady
well co-ordinated socio-economic development; in the middle of the spectrum
are stable but less rich countries that have been able to sustain reasonable
socio-economic advancement; and at the other end there are poorly - endowed
and less stable countries. The state of medical education including psychiatric education in the
Arab world is inseparable from the state of health care, socio-economic
development and political stability. Moreover the future of health care and
medical education in the Arab region will depend on how it meets a number of
challenges which center around the gap that is rapidly becoming a gulf
between the socio-economic situation of the richest and poorest countries in
the region. More specifically there are challenges of population explosion,
poverty, the environment, unemployment, debt and arms imports. In relation to
health care there is the important matter of investing in public health which
entails re- allocation of public resources, the provision of essential health
services, the finance of health between the public and private sectors and
the provision of health education to all. Finally and most relevant are the
forces of change in medical education: the new biology, emphasis on
preventive medicine, community orientation of medical education, medical
education that is relevant to the needs of the population, the application of
information technology and the drive for excellence in medical education in
terms of admission policy, curricula, learning materials, laboratory
facilities and direct learning and training in community - based medicine (1).
A landmark development in medical education was the AI-Ain Conference
on the Partnership of Health Care Delivery and Medical Education: a Blueprint
for Change (Medical Education Supplement 1, vol. 29, 1995). The conference
was guided by the Edinburgh Declaration principles identified at the 1988
World Conference of the World Federation for Medical Education. The
Conference made recommendations to the Eastern Mediterranean office of the
WHO, to countries and faculties of medicine on funding and ensuring essential
resources; on reorientation of teachers; specialist training and continuing
education of health care professionals; and on medical research. All these
recommendations are particularly relevant to psychiatric education in the
Arab region with its poorly resourced and planned psychiatric service,
variability of its standards for undergraduate and postgraduate medical
education and the virtual lack of continuing medical education and
development. The more specific landmark development however, is the establishment
of a 'Core Curriculum' in psychiatry for medical students produced by the
partnership - of the World Psychiatric Association and the World Federation
for Medical Education. The Core Curriculum sets a universal gold standard for
undergraduate psychiatry education and will be instrumental in bridging the
gap between psychiatry and the rest of medicine and will place it in its
rightful place at the heart of medicine contributing to the re-design of the
new physician for the third millennium. Underpinning this Core Curriculum is
the agreement that psychiatry should occupy a major part of the medical
curriculum in view of its generalized approach which stresses the unity of
body and mind, the particular utility of its skills to ail medical practitioners
and the common occurrence of its problems among patients seen by doctors
working 'in ail branches of medicine. This chapter starts with the historical background of Arab-Islamic
medicine and education and includes the results of a survey of psychiatric
education in the Arab Region and its implication and refer to important
aspects such as the Arabisation of medicine and concludes with elements of an
Arab Strategy for psychiatric education. q
Chapter 22 §
Mental Health Research In
The Arab Speaking Countries / Elie Karam, Maalouf Wadih DISCUSSION and CONCLUSION: There
are several interesting points of importance that emerge from this study: First, it is clear that the Arab speaking countries have produced much
more than one is led to believe. The search in the electronic databases docs
not claim to bc complete due to the fact that many of the published Arab
research might not have been traced by the above stated method. In an effort
to make the search as exhaustive as possible, an effort was made to
contact some of the prominent Arab Researchers in the field of Mental Health
to provide us with a list and abstracts of their publications: many,
especially those printed in locally printed journals, had not reached the
electronic databases. This is a- clear indicator that there is still a wealth
of research done by Arab researchers that needs to bc unveiled and indexed
properly. Hence a serious attempt must bc made in order to encourage these
journals to reach international electronic servers. Second, the subjects covered are quite varied and the wealth of
information becomes apparent upon reviewing the CD-ROM that I.D.R.A.C. has
produced. A further point is that individual researchers have been making the
difference in these countries, which speaks for the determination and drive
of these "pioneers". It is
hoped that these efforts are coupled with the establishment of research
institutions with the funds and the know-how that could benefit from the
momentum of these pioneers. It would be interesting to compare, at some time,
the productivity of the Arab speaking countries to other countries keeping in
mind the following parameter-most, if not all, researchers in the Arab world
are primarily clinicians-that is they need to see patients at a rate
comparable to psychiatrists in private psychiatry in the Industrialized
countries. Judging by the amount of funds allocated to research by the
respective Arab governments, it is practically a miracle to see any research
at all. On the other hand, the pharmaceutical industry is still relatively
shy in involvement in this area of the world although this seems to have been
changing. |
|||
|
Document Code PB.0096 |
ترميز المستند PB.0096 |
||
|
Copyright ©2003 WebPsySoft ArabCompany,
www.arabpsynet.com (All Rights
Reserved) |