December 27, 2010
A Doctor in Iraq, Watching a Faith Healer at Work
By AMIR A. AFKHAMI, M.D.

IRBIL, Iraq — “Are you a Muslim, Dr. Amir?”

The question took me aback, as it would any American psychiatrist wary of self-disclosure. But this was Iraq, where religion is central to people’s lives and identities. So after a slight pause, I responded with a halfhearted affirmative to the mullah I had come to see.

Mullah Eskandar was a faith healer — a youngish, tanned, bearded man in a flowing white dishdasha and a matching skullcap. Seated on a rug in his reception area with an oversize poster of the sacred Kaaba in Mecca, he emanated authority and sageness despite his relative youth.

I had heard about faith healers during my years of travel to Iraq. They were alternately maligned as charlatans who preyed on a superstitious population, and praised as filling a void, particularly in mental health care, in a country that had seen an exodus of physicians. So when an Iraqi colleague offered to introduce me to a faith healer, I jumped at the opportunity.

The path of a faith healer is arduous, Mullah Eskandar told us, speaking in Kurdish. “Such a calling,” he said, “is best reserved for a religious and spiritual man.”

He went on to recount his 15-year apprenticeship to a renowned senior healer, who taught him the basics of spiritual treatment and the essentials of Koranic law and prophetic traditions. His description reminded me of my own long and difficult years in medical school and residency training.

“Over 80 percent of my patients are females,” he continued. “They struggle with insomnia, headache, depression and marital problems.”

He took pains to explain that he did not accept money, nor did he sell any wares, unlike a nearby sheik “who sells honey to patients — he is in league with the devil.”

“Ours is like your profession, which has both good and bad doctors,” he continued: “those who care about patients and those who are in it for worldly rewards.”

The mullah explained that he worked as a salaried cleric at a mosque during the week and that his healing activities were reserved for Fridays, the day of rest. The only reward he sought, he said, was in the afterlife.

Pleasantly surprised at the mullah’s seeming integrity, I accepted his invitation to my colleague and me to see his work firsthand.

The first patient to enter his reception room was a young woman in red flowing garb typical of the rural inhabitants of eastern Kurdistan. She was bedecked in gold bracelets and earrings, her fingers covered in tattooed dots and henna. Like most unmarried Iraqi women, she was accompanied by family: a heavy-set, mustachioed father and a watchful mother.

The mother explained that the day her daughter became engaged to a relative, she had developed fainting fits, nightmares, foul moods and an inability to walk. Her family had consulted a general practitioner, who referred them to a neurologist, to no avail. She continued to faint at the talk of marriage — even became agitated at the prospect of her younger sister’s impending betrothal. As the mother continued her narrative, my Iraqi colleague leaned over and whispered a diagnosis in my ear: “conversion disorder.”

That disorder is well known to mental health professionals: once termed hysteria, it is usually touched off or worsened by a well-defined stressor like an engagement, and its symptoms often involve motor or sensory functions. Not unlike the young, secularizing middle-class Jewish women who sought Freud’s help in 19th-century Vienna, Iraqi women are often caught between ancient traditions and personal needs in a rapidly globalizing society — and they are increasingly turning to internists, psychologists and faith healers for relief of just such symptoms.

Mullah Eskandar invited the young woman to sit on a raised chair (actually a tower of six stacked plastic lawn chairs) and began to chant a Koranic verse into her right ear, imploring God’s help and warning of the devil’s temptations.

Then he explained that the young woman was possessed by a jinn, one of the race of evil spirits that the Koran blames for sowing mischief and illness in the world — in this case, spreading discord in the young woman’s family by disrupting her marriage. To banish the jinn, Mullah Eskandar prescribed a regimen of prayers, daily bathing and rosewater perfume. And he counseled the patient on the responsibilities of a daughter to marry and the happiness that awaited her once she had a family of her own.

It struck me that Mullah Eskandar’s rituals, particularly his reassuring counsel, appeared to mimic our oft-practiced supportive therapy in Western medicine. His authoritative opinion and his apparent empathy, coupled with his ability to realign the young woman’s vision to a more positive outlook, appeared to give her some degree of comfort immediately.

Moreover, blaming the jinn allowed the family to see the young woman’s misbehavior as aberrant and shifted responsibility from her to a supernatural being. My Iraqi colleague agreed that despite his own strongly secular perspective, he still believed that honest faith healers fulfilled an important role in a war-ravaged country with a severe shortage of mental health professionals.

I came to Iraq deeply skeptical of its traditions of religious folk treatment. To my surprise, I found a concerned faith healer who was sometimes more successful in treating the mentally ill than the few medically trained psychiatrists and general practitioners in the country.

Mullah Eskandar’s example shows us that psychiatric progress cannot be achieved by cutting-edge science alone — it can be attained only when patient-centered care leads the way.

Dr. Amir A. Afkhami, an assistant professor of psychiatry and global health at George Washington University, is the author of the State Department’s Iraq Mental Health Initiative.

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