Iraq ill-equipped to cope with an epidemic of mental illness

Dhia Hardan, 38, who deals with manic depression, plays the oud, a pear-shaped string instrument. He says music helps him purge his sadness, but when militants took over the streets following the U.S. invasion and during Iraq's sectarian war he worried he'd be killed for playing. Now he only plays at the mental health hospital and in his home.
By Leila Fadel
Friday, June 18, 2010

Asmaa Shaker sits on a leopard-print blanket in a Baghdad psychiatric hospital, her eyes heavy. The drugs have kicked in now, the fear has subsided, and she can sleep.

Without medication, she rarely sleeps. Three times in five years, her home was damaged in bombings, the most recent just two weeks ago. Her husband's leg was ripped from his body, her 12-year-old son turns yellow and shakes at the thought of leaving the house, the family is thousands of dollars in debt, and she lives with a constant fear.

"The pressure is too great," she said at Ibn Rushd, a central Baghdad psychiatric hospital. "I found my neighbors on the ground, children dead on the ground. I'm scared. I'm very scared."

Even as a pullback of American troops marks a winding down of the war, more and more Iraqis are seeking medical treatment for trauma-induced mental illnesses, and the medical community is unable to keep up.

Across Iraq, 100 psychiatrists are available to serve a population of about 30 million people, Iraq's psychiatric association says. Many people self-medicate, and prescription drug abuse is now the number one substance abuse problem in Iraq. The most abused drug is called Artane, known generically as trihexyphenidyl but referred to in Iraq as the "pill of courage," with a marked sedative effect.

At the country's largest and only long-term mental health institution, Al-Rashad, this year has seen a 10 percent increase in patients, and doctors say they've had to turn people away from the government-funded facility because of crowding.

For Shaker and for scores of other Iraqis, every street is a reminder of what was, what is and what could be again: Reminders of people gingerly stepping over the bodies thrown in the streets in tit-for-tat killings between sects during the sectarian war. Reminders of the U.S. military raids, Iraqi military raids, militia interrogations, assassinations and insurgent bombings. Now the violence has subsided to a lower but still frightening level, and many Iraqis struggle to deal with the trauma of their past and the uncertainty of their future.

Last year, Iraq's health ministry began to incorporate psychiatric treatment into primary-care hospitals to keep up with the trauma people have suffered, said Naama Humaidi, the general secretary of the psychiatric association. "The violence, aggression and turmoil in Iraq is directly connected to the increase in mental problems," he said. "There is an exceptional, threatening situation that cannot be understood by any other society. It made a thumbprint on each person in our country."

Poetry and psychiatry

On a recent Monday, Humaidi sat inside the rehabilitation center at Al-Rashad hospital, the walls decked with patients' paintings. The gloomy institution is more than 50 years old and rises on the horizon in a deserted area outside the poor and sometimes dangerous slum of Sadr City. It stands away from other buildings, forgotten and neglected. About 80 percent of families abandon their relatives once they commit them here, doctors said. When patients are ready to rejoin society, they often have nowhere to go.

At a long work table, Humaidi gathered the men and women to sing and to recite poetry. The songs often circled back to grief, abandonment and fear.

Some wept as they sipped on pink soda, painted portraits and ate sweet cakes. Some who have been here for decades have lost a sense of time and place, while others came after the trauma of Iraq's latest war. Eight doctors, including Humaidi, care for about 1,300 patients. There is no bed space for more, and the facility needs more than a dozen additional psychiatrists to function properly, he said.

A young girl named Fatma, petite and sad, screamed the words of an 11th-century Iraqi poet. Her family, exhausted by her mental illness, dropped her here recently when her father died.

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