LUMINARIES IN SOCIAL PSYCHIATRY
Year : 2021 | Volume
: 3 | Issue : 2 | Page : 57--59
An Interview with Driss Moussaoui
Oxford Health NHS Trust, Didcot, United Kingdom
Dr. John Simmons
Oxford Health NHS Trust, Ridgeway Centre, 99 Wantage Road, Didcot, OX 11 0AF
|How to cite this article:|
Simmons J. An Interview with Driss Moussaoui.World Soc Psychiatry 2021;3:57-59
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Simmons J. An Interview with Driss Moussaoui. World Soc Psychiatry [serial online] 2021 [cited 2021 Dec 5 ];3:57-59
Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/2/57/324986
Driss Moussaoui is a preeminent Moroccan psychiatrist with global reach and influence. He was among the first psychiatrist in Morocco and founded the Ibn Rushd University Psychiatric Centre at the University of Casablanca. He has worked with many different multinational groups in a clinical and academic career spanning five decades. Although retired from his position at the university, he is still engaged in multiple different projects both within Morocco and internationally.
John Simmons is a junior doctor currently working in Oxford.
What Attracted You to Specializing in Psychiatry?
”When I started my internship in Rabat, Morocco, I chose a ward of internal medicine with an orientation toward neurology and my second choice afterward was psychiatry. One day, I woke up from a nap with this certainty: “I will be a psychiatrist”– And, I really thought I chose this profession. In fact, it is not exactly the case – the choice was there much earlier. A lady who was a cousin of mine came to see me in 1979 when I came back from Paris, Sainte Anne Hospital, where I graduated as a psychiatrist – and she said, “I am glad you have joined this profession. Remember when we were 11/12 years old, we would see each other during the holidays, and 1 day you said, “Close your eyes, I will try to guess what are your thoughts, we will play psychology.” I did not remember that episode! My conclusion is that, when we think we choose in life, most probably, we are chosen; because of our history and personality, we go one way instead of another – freedom of choice is a little bit of an illusion.”
In Your Words, How Would You Describe What Social Psychiatry Is, and What Made You Become Interested in This Area?
”Biological aspects of psychiatry were studied since 1822 with general paralysis, syphilitic encephalopathy, by the French psychiatrist Antoine Laurent Bayle. Psychological issues were tackled at the end of the 19th century by Charcot, Freud, Ribot, and others. The third component of mental health and psychiatry is made of its social aspects. At the beginning of the 20th Century, very few people addressed social aspects of Mental Health and Psychiatry, with the notable exception of the work of Emile Durkheim on suicide in 1897, despite the fact that he was neither a medical doctor nor an “alienist” as psychiatrists were called at that time. Concerning psychoanalysis, Carl Gustav Jung disagreed with Sigmund Freud, saying that the founder of psychoanalysis insisted too much on sexuality and gave not enough importance to religion, myths, and culture. I have admiration for Jung because he kept the balance between psychological/psychodynamic and social aspects in an inclusive way; Freud did not agree and they separated.
When social psychiatry started in the UK, Italy, and elsewhere, the concept at the beginning was that institutional psychiatry was a terrible place to be, which was the case. The World Association of Social Psychiatry (WASP) was created in 1964 in London, and at that time, a number of psychiatrists called them antipsychiatrists and hence badly received them. In fact, they just wanted more social and cultural sensitivity in psychiatry and to involve families, patients, and society. They were not in the real sense antipsychiatrists; they had a more humanistic approach. On this aspect, for example, Ronald Laing said in an interview to the newspaper Le Monde in 1981 the following: “if I am in a manic episode, throwing money of my children out of the window – please hospitalize me in a psychiatric institution.” I remember that another “antipsychiatrist” from the UK, Dr. Cooper came to Sainte Anne Hospital, Paris, in the mid-seventies asking to be hospitalized. Social psychiatry in this respect, among other things, brought a new concept: We do not need big psychiatric hospitals but to integrate people in their families and society. One of the best works in this field was done by Julian Leff in the UK. Medical anthropology is another important aspect of Social Psychiatry, including cross-culturality, religions and spirituality, migration, stigma,…. Another aspect is a more democratic relationship between carers and users. The story of Britney Spears that makes the headlines in media in the world is part of this evolution of Social Psychiatry.
You Have Worked with Many Different Multi-National Groups Throughout Your Career – What Have You Learned from Working with Psychiatrists from Many Different Countries and Backgrounds and How Has This Affected Your Practice?
”What I learned is that cultural similarities throughout the world are more important than differences. I published a paper in 1983 on an anthropological classification of depression. Depending on the kind of society and culture, depressive symptoms are interpreted differently by depressed patients, leading to four main clinical pictures (possession, persecutory, guilt, and biological interpretations). I already witnessed the remarkable changes that happened in Moroccan Society since 1973 when I presented my MD thesis on “Impact of Moroccan Traditional Education on Psychiatry.” Cultural differences in Psychiatry exist not only from one country to another but also from one historical moment to another. If you go back to descriptions of melancholia in Europe, possession depression was the main clinical picture during centuries; then, persecutory depression became the dominant type of depression in the second half of the 19th Century. After that, guilt depression became progressively dominant at the beginning of the 20th century till the 1950s. Then, with the psychopharmacology era, serotonin and the brain became the main interpretation. This means that there are differences between societies and cultures, but in the same society and culture, one can see changes throughout time, depending on its evolution and perception.
When You Began Practicing, There Were Not Many Psychiatrists in Morocco – Can You Talk about Your Experience of Working as a Clinician This Point in Your Career? How Are Things Different Now?
”When I was in Paris from 1973 till the end of 1978, Sainte Anne Hospital was the psychiatric hospital in France – discovery of chlorpromazine was done thereby Delay and Deniker in 1952, creation of the World Psychiatric Association (WPA) happened there in 1950 among other things. Hence, I went from a relatively rich place with many residents, professors, research studies, congresses, and libraries to Casablanca where the situation was a true disaster: 55 beds, and I was the only psychiatrist in the public and academic sector for four cities and 5 million inhabitants; only one intern worked with me, and we were on duty 24 h a day! In the whole of Morocco in 1979 (18 million population at that time), the number of Moroccan psychiatrists was less than 10.
Sometimes, I had to see 72 patients in one afternoon and often with many clerks around to try to teach them something. It was crazy. The only thing I could do was one word here, one word there, and replace the prescription; if not, they would relapse in an agitated form and we had only 55 beds. If we had to hospitalize all those in need, we would have had to hospitalize 50 patients a day. The setting was also very much depredated: Doors did not close and many patients ran away and were brought back 10 days after in the same state of agitation and danger for themselves and for the others. Everything was destroyed – not a single unbroken window! It took me a lot of time to improve the physical situation of the wards and to find people who are secure enough to start psychiatry – nobody wanted to come! A male nurse who was twice my size brought his gown to me and said, “I am quitting, I would like to stay alive for my children.” When, for the first time, after 2 years of hard work, exhausted, I entered the locked ward for males at 2:00 am and I heard silence – people sleeping – I said “Thanks God, this is the beginning of improvement. When I retired in 2013, we were 8 professors, 52 residents for only one city of about 5 million inhabitants and 104 inpatient beds, almost all of them built by an NGO I created in 1979.”
A lot more capacity by the end of your career then
The whole thing was to organize outpatient clinics, about 20 of them now in Casablanca; in 1979, we had only one. In 2000, I helped the creation of an association of families of mental patients as well as an association of users in Psychiatry. We worked hand in hand with them to improve things. The more we improved the situation, the less anxiety in families, patients, and staff, the less agitation and the less problems we had.
What Do You See As the Biggest Challenge Facing Psychiatry as a Profession in the Coming Years?
”The future of psychiatry must be based on the biopsychosocial model!! If we do not know the biological basis of psychiatry and neuropsychopharmacology, if we do not know how psychological aspects work in human beings at large and in people with mental health problems in particular, if we do not know how important are culture and social links – we are lost. Moreover, the most important is to take into account the constant interactions between these three components. Further, it is not just about knowledge; it is how we use it, ethically, serving the patient and the family, and also working with the community for prevention and for promotion of mental health. If we do not have these three things: knowledge, good medical practice, and opening up to the outside world; then, we are in trouble. Moreover, unfortunately, I do not know many in our profession who are good at the three aspects at the same time. They are excellent in one, sometimes two of the three and that's it. The metaphor I would give here is a tripod: one leg taken off, and we are in a less easy situation – you cannot sit on a tripod with only two legs or one only, for some time, but it will be unstable and you may fall eventually.”
In Your Career, What Are You Most Proud of Achieving?
”As a medical doctor, I received a golden medal because I donated my blood, all my life long – I am proud of that. The two other medals I received are a beautiful watch from the staff of my department in 2013 when I retired. When I wear it, it gives me great joy. The third one is a beautiful pen given to me by the association of users of psychiatry in Morocco – I am very proud of it as well. What it meant is that my team was happy with my work and the users were happy too. I am also proud of something else: I think I am the only psychiatrist who worked on the executive committees of the WPA, the WASP, the World Federation of Biological Psychiatry, and the International Federation for Psychotherapy – In all of them, I fought for inclusiveness, and at the end, for the biopsychosocial model.”
You Have Said That You Have Retired in 2013, But I Know That You Are Still Involved in a few Different Areas. Do You Have Any Projects That You Are Currently Working on or Have Planned for The Future?
”I have a good friend of mine in Egypt who used to say, “Retired but not tired.” I still work a lot with civil society in Morocco, I still work from time to time with the WHO, the WPA, and the WASP. There are two books coming out soon, one on Migration, Mental Health, and Illness (with Dinesh Bhugra, Rachel Tribe, and Antonio Ventriglio, editors), the other that will be published by Oxford University Press with Dinesh Bhugra and Tom Craig (editors). My main work for the time being is as President of the International Federation for Psychotherapy that made significant progress recently, with the help of its Board and Council Members.
Outside of Work, How Do You Enjoy Your Time?
Spending time with family, doing sport, seeing one movie per day. I am a fan of old and good movies. I have always been interested in history, science, and science fiction. Hence, I read whenever I can. Learning new things is one of my addictions.
What Do You Dislike About Being a Psychiatrist?
Stigma. It makes me angry when I see it. But, I have to control that and explain. It is tiring, but it is my duty and I do it.
Stigma from the public or other professionals?
Stigma from everyone! From the public, from professionals, sometimes from psychiatrists!”
If You Could Go Back to the Start of your Career, Is There Anything That You Would Have Done Differently?
”At that time I did not know, it was almost impossible to do so I just did it. There are a number of impossible things that are possible; it is just our minds holding us back.”
What Advice Would You Give to a Young Doctor Interested in Pursuing a Career in Psychiatry?
”Ask yourself if you enjoy your profession. Ask yourself if you like your patients; and, if you are a teacher, ask yourself if you like your students. If not, change, go away, do something else. Never forget to take care of yourself. You are the highest priority: You cannot help others if you are not well. Take also care of your beloved ones. If they feel bad, you will have hard time and will not be able to do a good work in your daily life.”
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Conflicts of interest
There are no conflicts of interest.