Affective disorders in Iraq.

Abstract

A retrospective study of clinical features of 98 Iraqi patients suffering from affective disorders of various degrees was presented. The incidence of various symptoms and signs was rated on a two-point scale. Certain demographic data were also collected. Ideally, to draw valid conclusions from these data they should be compared to data derived from an identical sample of patients in a western society; however, as such a study with a control western population is not known to the author, the conclusions that are made here are based solely on clinical judgement. Essentially, there are a few select areas where affective disorders in Iraq seem to differ from the same group in England. There appears to be a lesser incidence of ideas of unworthiness even in the more severely depressed patients. The same can be said about suicidal thoughts and attempts. The affect does not seem to follow the classical western descriptions of this illness. In depression, patients do not feel nor show the sadness of western depressed patients, and in mania they lack the infective joyous mood. Depression is conspicuously coloured by physical symptomatology and hysterical behaviour. Paranoid thinking and projection of responsibility in depression are not uncommon. Mania, on the other hand, is more often characterized by aggression and anti-social behaviour than in the West. These differences, in the author's opinion, can only be explained by recourse to the differences in personality structure as moulded by cultural influences and child rearing. The disorder in affective illness is seen as a manifestation of a defence mechanism that has gone too far. It is an emotional equivalent to the instincts of fight or flight in the animal kingdom, but complicated and exalted by the presence of such faculties as the mind, the affect and the other higher acquisitions of man in his evolution.