RIYADH AL-BALDAWI, M.D., PH.D.
Director
Orient Medical and Rehabilitation Centre
Stockholm, Sweden

My pathway to cultural Psychiatry

Life includes a lot of memories. The memories are a part of us and it is not always easy to share them publicly. Some of them include happiness and others sadness, but altogether they form our life. When one of my mentors and friends, Ron Wintrob, asked me to share some of my memories, I thought they could be of interest to my colleagues in the field of cultural psychiatry and for those who intend to start a career within this field. I thought this task would be easy. But when I started the process of putting my memories on paper I discovered how difficult it is to write about oneself. I hope these memories will at least outline some of the reasons that made me find my way into this field. I have changed some of the details out of respect for some of the people I refer to in this essay who I am unable to contact to ask permission.

My home and family background

I was born in Baghdad, the capital city of Iraq. My family lived in a house in the heart of the old part of the city. My father worked as a senior administrator at the Iraqi ministry of justice for many years (I think more than 35 years). His profession gave him a high social position and respect not just from our extended family members and friends, but more generally in Baghdad. My parents were cousins. Following the traditions of that time, they got married when my father was 26 years old and my mother was just 14 years old. She gave birth to her first child at the age of 15. My mother's formal education was limited, as was generally true with the majority of women in Iraq in the early decades of the 20th century. She attended a religious school where she was taught to recite the Quran, but not how to write. She was a housewife throughout her life.

I was the fifth of six children in our family. Me and my brother one year younger than me, were the youngest children in the family. There is an age difference of over 17 years between us and the older children. All the members of our extended family were very surprised when my mother became pregnant after 16 years.

By the time I was born, my oldest brother had already finished his university education as a pharmacist, had started to work and was on his way to the USA to begin his PhD studies. He was diagnosed with cancer and passed away at the age of 27. This tragedy had a profound impact on my family, and particularly affected my mother throughout her life. My two sisters were well educated as well; one of them was a lawyer and the other one a teacher. My father was one of few Iraqi young people of his generation who got an education in English. An English school was opened in Iraq after the occupation by the English army, following the First World War. He led his life with respect towards English traditions such as tea time in the afternoons. Discipline and loyalty towards his job were very important to him. He was one of very few Iraqis who changed his clothes from the traditional Iraqi style to the English way of dressing. He was very liberal as a Muslim and enjoyed a good whisky, but preferred the traditional oriental drink (Araaq). Therefore, there was a big contrast in our home between my father's way of living and my mother's.

My mother was a very religious woman, but not conservative or intolerant. She tried to follow the traditional Islamic way of living but at the same time accepted her husband as he was and gave love and encouragement to all of us. Furthermore, she gave all her children the opportunity to develop their own way of living and accepted their decisions about following Islamic rules. She had a great impact on all of us and earned our respect and admiration.. She was the one who kept the family functional through her kindness and caring. She was very wise and understanding, which made her an important person not just for our nuclear family, but for all our relatives and friends as well.

When I was four years old my family moved from the old part of Baghdad to a new area in the suburbs of the city where many middle class families had built modern houses in the American or English style. The most interesting aspect of this new residential suburb of Baghdad was its multi-ethnic and multi- religious composition. Muslims, Christians and families with a Jewish background as well as Arab, Kurd, Turkmen and Mandai all lived in this area. Many embassies and their staff moved there as well. Consequently, I grew up in an atmosphere of multicultural tolerance and developed friendships with people regardless of their background. On our street, where thirty families lived, while the majority were Muslims from both Shia and Sunni background. There were also several Christian families and five Jewish families. Growing up, this was a very good environment to teach us how to live and develop tolerance and respect for each other. It enabled us children build friendships with each other regardless of our religions or ethnic backgrounds. In fact, we didn't have any idea about these differences. All the families on our street belonged to the middle class and most of the fathers were highly educated and worked for the government or had other high status jobs... We went to the same school and played football on the same teams. We celebrated each other's birthdays and enjoyed swimming together in theTigris river, close to our houses.

My first cross-cultural experience

One of my friends who lived in the same street and went to the same school was Dawood. We were the same age. Dawood was one of the cleverest boys at our school, especially in mathematics. I was very interested in football and played, at that time, on our school's top team. One day Dawood asked me to teach him how to play football and I invited him to watch one of our games. We agreed that I would teach him how to play football and in return he would help me with mathematics. We became very close friends. He would visit and spend time together at each others' home. He was very fond of my mother's cooking and I enjoyed his mother's tasty cookies.

After the 'six day war' between the Arab countries and Israel, Dawood told me that he and his family had to leave Iraq. I was very surprised and upset by this news. I asked him why, and where they would go. He told me that it had become difficult for them to stay in Iraq as a Jewish family after this war. His family had lived in Iraq for many generations and his father didn't want to leave but was forced to. He told me that he was leaving for their original home Israel. When I asked him if Iraq wasn't his home he started to cry and so did I. He just looked at me and said: I don't know who I am.

Dawood and his family left Iraq within two weeks. My whole family was very sad about their leaving Iraq. My mother liked Dawood just as much as I did, and when he came to say goodbye she didn't know what she could give him as a memory. She found a small Quran and she asked him to take this with him as she usually did when somebody decided to travel far away. She told him that she knew that he was Jewish but that she was sure that the Quran would keep him safe, In sha Allah (If it was God's will). He took the Quran, thanked her and asked her to remember him. We never forgot about Dawood and his family and the memories have stayed with us. I haven't had contact with him since the day he left. This was my first experience of painful separations and the meaning of cultural identity.

My migration to Europe and my pathway to becoming a cultural psychiatrist

When I finished school I wanted to study medicine, which had been my dream since I was child. I was given the chance to pursue my studies in the former Soviet Union, as an exchange student. In the beginning of the 1970s, the Soviet government invited students from a number of developing countries to study there on exchange programmes.

This was an opportunity for me to escape the expected way of living and the political turmoil in Iraq which had started at the time of the Baath regime takeover of power in Iraq. I wanted to move outside Iraq to be able to discover new cultures and traditions. My father, who had the dream for me and my younger brother to study in the west (and preferably in England, which he considered to be the ideal place for education), was not happy at all when I informed him about the opportunity I had to study in Moscow. He become very sad, but realized that this opportunity for me to study in Moscow would be a first step to expanding my life prospects.

The years I spent in Moscow were very enjoyable for me. Even though the people, were poor they were very hospitable. Life was sometimes very difficult in Moscow due to the rigid political system and controlling. However, as exchange students our lives were less subject to political control, and we were allowed to travel outside the Soviet Union, whereas most Russian people weren't. This atmosphere taught us to be very diplomatic and find different ways to cope with the rigidity of the Soviet system. Campus life in Moscow at that time was characterized by a highly international atmosphere, with a lot of students from different cultural and ethnic backgrounds. Studying in such a rich and complex atmosphere greatly influenced my way of thinking.

My father passed away during the second year of my studies in Moscow. I was very sad that he hadn't been able to see me graduate as a doctor, which was his life's dream. And I could not go back to Iraq at that time because of the tense political situation. There was substantial risk that they could stop me from coming back to the Soviet Union to finish my studies. So I asked my brother to bring my mother to Moscow. After five years by myself in Moscow, it was a wonderful reunion with my mother and brother. This was her first trip to Europe.

Moscow, with its more than thirty theatres and concert halls, opened my eyes to the world of classical music. You could attend an opera or a ballet performance almost every day. The city's many museums, with paintings from some of the most famous artists in the world, from different eastern and western schools of art, also gave me an opportunity to learn about art.

All this formed me into the person I am today and altered my view of life. I embraced new experiences from other cultures and mixed them with Arabic traditions and beliefs. This approach made me think about the world differently and provided me with a wider perspective on cultural identity. My new identity brought with it more respect and tolerance towards others, regardless their cultural, ethnic or religious background.

After completing my medical degree in Moscow, I went to England to pursue fellowship training for the Royal College of Surgery. I lived in London and started to take a special course in English. I had started working at a hospital in London when war broke out between Iraq and Iran in 1980. The regime in Iraq asked all Iraqi medical doctors to return to the country and participate in the war effort. I, and many others, refused and return, or participate in the war. The regime punished us by refusing to renew our passports.

The British government, as well as many other governments in the west, supported Saddam Hussein's regime and insisted that all Iraqi students without valid passports leave the country. This was a tragic part of my life. I was very sad and alone, my family couldn't send me any financial support because of the war and I couldn't find a job in England or continue my studies without support. This was a difficult time for me and formed my future interest in migration and acculturative stress among migrants.

I was in such a dilemma about how I could continue my medical studies and career that I finally decided to call my department head at the University in Moscow. I started to explain the situation I found myself in and before I had had the time to finish, he asked me a question which I found rather strange initially. He said; "Riyadh, aren't you still our PhD student at the department"? I didn't understand what he was getting at, so I replied; "What do you mean"? He reiterated his question and told me not to worry. By the next week, I was given a visa that enabled me to return to Moscow and continue my studies as a PhD student. I finished my PhD studies in 1985.

What I learned from this experience is that the world is full of kind people and what we have to learn to do is to help others as much as we can in their times of crisis.

My recent life in Sweden

I came to Sweden at the beginning of 1986 as an asylum seeker. I found a country that gave me security and stability. I built my family and have seen my children grow up here. Since 1991, I have had Swedish citizenship, which I am proud of. I am trying to integrate the culture I was raised in with the new and different ones that I have experienced during 35 years of immigration.

I still have the dream that Iraq will one day become stabile and secure enough that I can take my children back to visit Baghdad and show them where I lived and grew up, and maybe we can swim together in the Tigris.

I have tried to help people in need ever since I came to Sweden. I have been involved in developing transcultural psychiatric service models within the public health and social services, as well as in the school system. I hope that make it easer for these systems to understand immigrants' traditional cultural and religious backgrounds, which will positively affect the services provided for those who need help and support. My involvement in this subject has given me an opportunity to bridge differences and make it possible for the immigrants to understand the indigenous Swedes and their way of thinking, which will help them in their adaptation process to a new culture and social system. I have tried, and am still trying, to understand and help people in crises and especially those who have been forced to leave their home countries. I am increasingly interested in the migration process and its effects on individuals and families.

I changed my specialty from surgery to psychiatry mainly because I find that psychiatry could help me to work very closely with those people who experience deep crises and particularly with immigrants. My mother passed away here in Sweden six years ago and is buried here in Stockholm. She wanted to be buried in Iraq close to here son and husband. However, the situation didn't allow it. After we finished the ceremony of burying my mother I told my children and other family members that from this day on we put our roots deep in this land.

I find now that we are more world citizens than citizens of one country. We need places to relate to, but we need to remember that the world with its people is our true home. Friendship and sympathy don't belong to a certain place but can be found all over the world.

This has influenced my choice of cultural psychiatry as a part of my professional identity. I have found humanity, tolerance and the acceptance of others with extensive professional and research competence as the most important part of this clinical subject.

The world is changing every day; the globalization process has made people closer to each other. However, at the same time the world is increasingly characterised by more serious confrontations and conflicts related to religious and ethnic differences. That is why we are in great need of cross-cultural perspectives in our work as clinicians and researchers. Cultural psychiatrists could play an important role in the future organization of the world based on understanding and acceptance of others, with tolerance for their differences.

Professional Activities in Cultural Psychiatry in Sweden

I become a consultant psychiatrist in 1994. In 1990, I inaugurated the first Swedish immigrant organization against drug abuse, and in 1995 initiated the first intercultural and multiethnic clinical centre in Stockholm for clinical evaluation and rehabilitation of individuals and families from different ethnic and cultural backgrounds. It was named the Orient Medical and Rehabilitation Centre. I have been the director of the Centre since 2003.

In 1999, I helped inaugurate and became the first director of the Transcultural Centre in the Stockholm region, under the auspices of the regional government. It is an education and consultation centre for medical staff who work in the public health service in Stockholm.

I have offered intensive education programs and clinical consultation for medical and social service personnel throughout Sweden who provide health, mental health and social services for immigrants and refugees. I collaborate with staff of several Swedish universities and colleges on similar courses related to immigrant and refugee issues.

I am continuing my research on migration, acculturative stress and adaptation among immigrants to Sweden.

In 2005, I helped inaugurate and have been a member of the executive committee of the International Iraqi Medical Association. The Association is dedicated to enhancing contact, communication and collaboration between Iraqi doctors within and outside Iraq.

December 5, 2007