Sources of stress in the practice of psychiatry: perspective from the Arab world

The main challenges faced by psychiatrists in the Arab world are stigma, shortage of resources, role of the family and effects of conflicts and migration. Psychiatrists practising in this region have to adapt to these challenges and use creative methods to provide a good service to their patients. A woman in her mid-20s presented to a private psychiatric out-patient clinic with a longstanding obsessive–compulsive disorder of contamination. She had fled her home country with her family because of an ongoing armed conflict. They were under temporary ‘visitor’ visas and the possibility of their stay not being renewed created immense anxiety. The patient was prone to bouts of anger on a regular basis, causing her to shout at her mother and brother. Her mother was concerned that the neighbours might complain, which might get the family into trouble with the police. The family were eager to know if the patient's condition was likely to improve with medication. They also asked if she could be admitted to an in-patient unit for treatment. Unfortunately, the psychiatric in-patient unit was not suitable for her needs and she could not go back to her home country because of safety concerns. The cost of treatment at a private clinic was expensive for the family. She was not eligible for state-funded healthcare. The psychiatrist had to manage a complex situation created by stigma, effects of war and migration, lack of appropriate resources and the role of family. He maintained a trusting relationship with the patient and made sure no information was given to her family without her consent. Regular contact with the family was maintained to increase awareness about the nature of the patient's symptoms and to support the family in coping with the difficulties mentioned above.