Iraq must cope with an epidemic of mental illness

From The Washington Post:

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."

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.

"What have I seen in this world? And its wonders?" she recited.

"I try to give them positive reinforcement and the tools to rejoin society," Humaidi said.

As Humaidi walked through the barren wards with their dingy white walls, women cried out.

"I want to go home," a woman begged, tears streaming down her face.

"Sing me a song," he asked her. The tears dried, and she began to sing.

The pink curtains and plastic flowers don't mask the sadness of this place: the metal bars on every door, the television locked in a cage and the fluorescent lights that flicker above. The women stare out the windows waiting for something to change.

Dhia Hardan, 38, suffers from manic depression. He comes to the hospital for very short stays to play music for the patients and collect his medication. He hears the whispers in the streets about his illness. He sees the looks of passersby worried they could catch what he suffers from, as many people here believe.

Hardan was always prone to depression, but his music helped. When the sadness comes, the Shiite Muslim pulls out his ornately carved oud, a pear-shaped string instrument, and pours his grief into his songs. But after the U.S. invasion, the civil war and the militant sectarianism that followed, he stopped talking to people and he rarely left his home, the art teacher said.

The Mahdi Army, a Shiite militia that enforces a prohibition on music, controlled the streets of his poor Shiite neighborhood. Hardan worried he would be killed or reprimanded for his music, as so many others were. He put away the instrument, the only thing that understands him, he said.

To this day, despite the drop in violence, the only places he plays are at the hospital and in his living room with a fellow artist. "I feel the whole universe is shrouded in darkness, without hope, without life. I even hate to walk out the door," he said.

Hardan is philosophical about the violence of the past seven years. "Everything that is bad we threw on the occupation," he said. "But if we shook hands and were united, this wouldn't have happened to us. I hope our country can finally have some rest."

For Shaker's family, there is no rest. The first bombing in 2005 destroyed their home and their store and took her husband's leg. But it was the second bombing, which also struck the family home last year, after they had made repairs, that left Shaker mentally ill, family members say. No place was safe, she concluded, and she soon became inexplicably violent.

Two days after that attack, she walked into her son Muntathar's room and held a knife over him. Her husband, Raad Fadhil Ali, wrestled it from her arms. She threw the television into the wall. She ripped out an electrical socket before running into the streets. Her husband took her to the hospital the next day.

After two weeks of treatment, she came home calmer. Things would be okay now, her husband thought. Their home was near a Shiite mosque, which was frequently targeted, and he moved them to a new Baghdad neighborhood. They left behind the family store they had borrowed money twice to repair and resettled into a rented two-room shack.

About two weeks ago, a third bomb was planted, this one in a nearby coffee shop. As her husband and son recalled it, the glass in their house blew in, and as the dust settled, Shaker screamed.

"They followed us here?" she sobbed. "We're going to die."

Her husband sought help from faith healers across the country, then returned her to the hospital. At home, he takes care of Muntathar alone, hobbling on his remaining leg. Outside, he set up a small, street-side business selling cigarettes and drinks. Inside, in the stark living room, a picture of the couple during better times is propped near the family's only bed.