Psychiatry in the Kingdom of Saudi Arabia by nyl11041



                           Psychiatry                               in the Kingdom                                                of Saudi                          Arabia

                      T        he firsthand               account          in this issue by Steven                     Dubovsky             of his recent             experience              as
                               a psychiatric                  consultant              in Saudi            Arabia         is a thoughtful,                    well-written,                 and
                      comprehensive                    review        of a country                and a mental               health       system         in statu         nascendi.              It
                      provides           an interesting                   perspective               from        which         to view           the history               of Western
                      psychiatry           as well as an opportunity                               to consider           some ways in which                        our profession
                      can be involved                    in contributing                 to the development                      of a somewhat                   different           system
                      of psychiatric                 care.
                           In 1982            we were              appointed               by APA President                      H. Keith            H. Brodie,               M.D.,           as
                      consultants              to the Ministry                  of Health           of the Kingdom                  of Saudi         Arabia.           As a result            of
                      our November                       1982        visit,       we find ourselves                    in agreement                 with        Dr. Dubovsky’s
                      conclusion              that American                    psychiatrists              may have an important                            role to play in the
                      future      of psychiatry                  in Saudi          Arabia.          Here are some of the reasons                               we urge that this
                      international                cooperation                and involvement                    proceed.
                           Dr. Dubovsky                    makes        a very brief reference                     to the Shehar               Mental           Hospital            in Taif.
                      This 1,500-bed                    hospital,           located         in the rugged              mountains              of the western                 section          of
                      the peninsula,                   near       Mecca,            is the only              mental         hospital          serving           a population                  of
                      (guesses        vary) about                 6 million           Saudis.        Some        Yemenis          and other            non-Saudis               living on
                      the Arabian                  peninsula            are treated               here       as well.          Yet 25 years                 ago there             was no
                      psychiatric            hospital;            mentally            ill persons           were housed              in various            residences             without
                      organized             treatment               programs.               A remarkable                 transformation                    (roughly            from         the
                      eighteenth             to the mid-twentieth                            century)          was brought                about         largely         through             the
                      efforts     of Dr. Osama                     Al Radi,          who is an APA member.                           Coincident              with our visit, Dr.
                      Al Radi was appointed                             Adviser          on Mental              Health         to the new Minister                      of Health              in
                      Riyadh.         A new hospital                      director,           Dr. Othman               Tawil,        sought         our help and involve-
                      ment.      Dr. Tawil                is a young,             U.S.-educated                psychologist             with little administrative                            or
                      clinical      background                   upon         whom          considerable             responsibility               was thrust.              He quickly
                      recognized             the need to improve                          the quality           of care and, in particular,                           the quality              of
                      the medical                staff. He concurred                       with        our recommendation                        that he try to recruit                          a
                      cadre      of U.S.-trained                     psychiatrists               to consult            with       or join his psychiatric                          staff.       A
                      recruitment               effort       is now underway.                        Particularly            important            is the recruitment                      of a
                      child psychiatrist                   knowledgeable                 in pediatric           neurology.            U.S. psychiatrists                 could         play a
                      critical      role in improving                           the quality              of psychiatric              treatment              and       in developing
                      standards           for a modern                 hospital          environment,              outpatient           care, psychotherapy,                        biopsy-
                      chosocial          approaches,                and a mental                health       system        adapted         to Saudi culture.
                           Second,         there         is a large potential                   for improving                psychiatric           education             in the Saudi
                      medical        schools.              Although            there       are no formal               departments               of psychiatry,                consider-
                      able interest                has been           expressed              in training           Saudi         medical          students           in psychiatry.
                      While       there         is no doubt             that such training                    could       take place in U.S. programs,                                recent
                      experience              has demonstrated                        the importance                  of having            strong         psychiatric              depart-
                      ments       in the home                  medical           centers        to ease the return                 home        and provide                support            for
                      the recent            graduates.               Connections                 among          psychiatric            hospitals,             general         hospitals,
                      and medical                schools          need to be strong.                    Consultation-liaison                    psychiatry             awaits          birth;
                      psychodynamic                      thinking           is rare;        child psychiatry                 is rarer.
                           Psychiatric              research         is another            underdeveloped                  area in the kingdom.                       The psychiat-
                      nc aspects           of the role of women                          in this deeply             conservative             country           are intriguing,                 as
                      are the implications                          of sudden               great       wealth         and sudden                bits of modernity                        in a
                      somewhat              medieval              society.         One of the most                    fascinating            phenomena                 of Islam,            the
                      extraordinary                  annual         immigration                known          as hajj-the             religious         pilgrimage              in which
                      a country            of almost                6 million            people          receives        more        than       2 million             visitors          for I
                      month’s          time, some of them                          bringing           infections         and parasitic               disease,         malnutrition,
                      various        addictions,                and psychiatric                   disorders-provides                      exciting           research          possibili-
                      ties. The research                    unit at the Abdul                   Aziz Medical               School        in Jedda           has begun             to focus
                      on studying                the biomedical                   dimensions              of hajj; what              a fine opportunity                     for one or
                      more       U.S. researchers                    to take a sabbatical                      year or two to study                      the biopsychosocial

Am   J   Psychiatry         140:1       1, November                  1983                                                                                                                                     1493

                  Another       area for research,                teaching,          and creative          systems        planning        could     be that
             of psychiatry               and      the law.          What          are the implications                  for potential            abuse      of
             psychiatry         in the absence              of mental            health     law? Can ways               be found         to help in the
             development              of new legal guidelines                      in the context           of traditional          Islamic       law and
             custom?         What         are the effects           (e.g., on length            of stay or overmedication)                      of having
             family        and      then       psychiatrist           be financially            responsible           for a patient’s              harmful
             behavior?         These         are only a few of the important                         questions           that come         to mind       and
             strike     us as remarkably               pertinent         in these days ofJoint               Commission            on Accreditation
             of Hospitals             issues,      the right         to treatment,            the insanity           defense,      and the right            to
             refuse      treatment.
                  Clearly,     Dr. Dubovsky’s                article       is worth       a careful      reading       and a critical         review.      We
             hope       some     additional           psychiatrists             will consider,         as we do, being                involved        in the
             development             of such a burgeoning                    Third      World     mental       health      system      an opportunity
             and an adventure.

                                                                                                             ROBERT   0. PASNAU,                       M.D.
                                                                                                        LAWRENCE    HARTMANN,                          M.D.

                 Dr. Pasnau     is Professor      ofPsychiatry         and Director,    Adult   Psychiatry       Program, at
             the University       of California,         Los Angeles.       Dr. Hartmann       teaches     at the Harvard
             Medical    School.     Address      reprint      requests    to Dr. Pasnau,      UCLA       Neuropsychiatric
             Institute,   760 Westwood           Plaza,     Los Angeles,       CA 90024.

1494                                                                                                          Am     J   Psychiatry          140:11,        November   1983

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