Friday, January 9, 2015

Istanbul Psychiatry - Acil Psikiyatri

I am sitting in the cafeteria at the psychiatry complex. I’ve just toured the grounds.  Naturally I can’t tell staff from patients. It’s a thing we pride ourselves on as physicians of mental illness. I wanted to visit the Museum here but they don’t seem to be open. I’ve visited the building and looked in the windows. There’s something existential about that.  A Museum of Mental Illness that one can't get in to on the grounds of a psychiatric asylum where one might not be able to get out.
The statue in the centre of the complex is telling and true.
I’ve wandered all around the Saglik Campus,  which psychiatry is apart of.  Every specialty of medicine is represented.
This is the only place with that particular feeling of psychiatry. It's something akin to the feeling one gets in sacred places but not quite.  Distinctive.  Something like a library but not a library. Where life is on hold.  We used to say of the asylum that the bars on the window were to keep the outsiders out.  I’ve read of all the invaders Istanbul has known, first as Byzantium, then as Constantinople, then as Istanbul.  It has walls and more walls.  And when the war wasn’t being brought to Istanbul the people were revolting and burning the city from within.  That’s  a metaphor for mental health if ever there was one.
Schizophrenia is roughly 1% of the population and doesn’t respect race, religion or gender. A recent study said higher IQ protects from schizophrenia. At the same time we’ve long known that schizophrenia and genius run in families.
Depression is as high as 30% but religions generally protect. I’ve not seen a comparison of Islam versus other religions. I don’t believe there’ll be much difference. The more fanatic a religion the more it helps some psychiatric illness while at the same time it makes others much worse.  Moderate religions seem overall with prevention and cure. Yet moderate religion might well be an oxymoron. These studies ran parallel to the high expressed emotionality in family research.  The more guilt and shame the less beneficial for mental illness but the more cohesive a group  the more protective it is.
Alcoholism may not be a problem as such in Turkey. They’re doing a wonderful job of maintaining high prices to reduce availability. Vaillant in his research showed that the more available a substance of abuse the greater the percentage of the population will have problems with addiction.  Canada is experimenting with it’s population and increased availability of marijuana and other drugs. The future is not bright.  However, given I'm in the 'business', it's fairly certain I won't have to worry about unemployment anytime soon.   Alcoholism and tobacco addiction weren’t enough, now we're throwing in dope while the full extent of sex addiction hasn't been addressed and gambling is certainly steady.
Meanwhile Turkey in it's conservatism is developing more advanced polices in hope of prevention.  The Muslem religion is certainly on the side of public health in this regard.
I met a family physician and learned that he had 5000 patients he was responsible for.  He has a computerized program much like our system and was able to show me the total number and the percentage of children.  He is working in a government clinic and it doesn’t appear that onerous.  It’s set up like our clinics. If there's obstetrics or surgery or procedures necessary they're sent to hospital. He refers to specialists routinely including psychiatrists.
In Malaysia the Moslem doctors had  actually located the Methadone Clinic in the Mosques.  Iman’s were involved in a therapeutic community as part of the process. We’d do well to have more of this following the success of Salvation Army’s Harbour Light program in the Vancouver Downtown Eastside.
 I hope to meet addiction medicine specialists from Turkey at the next International Society of Addiction Medicine conference I attend. When I get back to Vancouver I’m hoping my new text book of International Addiction Medicine edited by Dr. Nady el Guebally and Dr. Marc Gallanter will have arrived.  
Now that I've been to Turkey I've a keen interest to know more about what they're doing in psychiatry and addiction medicine.  



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