Afzal Javed, M.D. 
Pakistan

I graduated in medicine from the University of Punjab, where I studied at King Edward Medical College in Lahore, Pakistan, from 1971-1976. Despite having very limited exposure to mental health or psychiatry in medical school, I chose to do specialty training in psychiatry after completing my first degree in medicine. As in many other developing countries, teaching and training in mental health were not considered a priority and psychiatry was not a preferred specialty choice for many medical graduates in Pakistan at that time. There were many reasons for this "non popularity" of psychiatry among medical professionals, such as stigma related to mental illnesses, prejudice about their treatment, lack of awareness about the importance of the mind and its disorders, limited training facilities, and controversies about the scientific understanding and causes of many mental disorders. Isolation of mental health services in old asylums or mental hospitals was also a major factor in keeping psychiatry at a physical as well as emotional distance from other medical services and health professionals.

However, the scene in Pakistan was not that bad and there was a gradual shift in the practice of psychiatry that was bringing a new and more appealing face to this emerging specialty. Shifting trends from the old-fashioned mental hospitals to newly established departments of psychiatry in general teaching hospitals, and the introduction of psychiatry as an important discipline in the new list of medical specialties were also proving very encouraging for many young doctors, who were becoming excited to join this challenging and relatively undiscovered specialty.

My initial training proved very stimulating for me and this first exposure to clinical psychiatry gave me a better insight about different dimensions of mental health and its practice in a country where treatment services were limited and unevenly distributed.

I must pay tribute to my first teacher and mentor in psychiatry, the late Prof Rashid Chaudhry, who taught me the basics of psychiatry, its application and the meaning of the well-being of the mentally ill, based on the philosophy of humanity, respect, compassion and kindness. I owe him a lot and will never forget these principles of care. These ideas are going to stay as guiding principles for me throughout my professional career.

This was also the time when I started getting more interested in culture and its relevance to mental health. These views gained more strength for me when I realized that people faced with the dilemma of finding mental health care and striving even for basic health care, were relying mainly on traditional and religious methods for the management of their psychological problems. I was also fascinated by the success stories of my patients getting cured by going to religious sites, traditional healers and spiritual leaders, rather than psychiatric facilities and psychiatric staff.

After getting initial postgraduate training in psychiatry in Pakistan, I got a chance to go to the UK for my advanced postgraduate qualifications. While working in Edinburgh, I was actively involved in the activities of the Transcultural Society at the University Department of Psychiatry and acquired more awareness of the importance of cultural diversity and its role in understanding the broader dimensions of mental health. My thesis for the university degree again reflected my growing interest in this field. I investigated the mental health of overseas students at the University of Edinburgh and found out about impact of migration, issues about coming to a different culture, acculturation and adjustment in foreign countries. During the process of collecting data for my thesis, I was also involved in setting up some services for overseas students that again helped me in understanding the real issues in this area.

During my stay in UK, I also had a chance to spend some time at the Maudsley Hospital and the Institute of Psychiatry in London, and again my interest in culture and mental health remained a preferred area of interest for learning and training at this prestigious institution.

After spending three years and completing my advanced training in psychiatry in the UK, I returned to Pakistan and continued my university position in Lahore. In addition to the teaching responsibilities of my job, I also started taking keen interest in service development and planning teaching/training programs for general practitioners and other non-medical professionals in psychiatry. I was lucky to have the mentorship and the privilege of working with the late Prof Rashid Chaudhry, who, as the pioneer of psychiatry in Pakistan, had laid the foundations of modern psychiatry in this country. His vision about starting rehabilitation psychiatry in Pakistan also made him unique among the mental health professionals in Pakistan. It was an exciting experience for me to work with him and learn the fundamental realities of working in a developing country. It was troubling, that after working in the field, I realized that most of my UK training was only theoretical learning, and that I needed to develop new concepts for working in a non-western developing country like Pakistan. This was indeed a great experience and helped me a lot in my professional development. It was also another good opportunity for me to examine the cultural values and requirements for Pakistani patients in their rehabilitation and it impressed me with the results of incorporating such needs in the provision of local mental health services.

This was also the time (late 1980s and early 1990s) when I became a member of the TP Section and got a chance to set up a Transcultural Psychiatry interest group in Pakistan. We started having seminars and academic meetings, highlighting the importance of cultural issues and their relevance in the provision of mental health services in our country. I encouraged other colleagues to explore further developments in this area.

I was also lucky enough to attend some of the regional and international meetings of the TP Section and other congresses addressing cultural issues. This certainly helped me a lot in shaping my views, concepts and practice in cultural psychiatry. In 1994, with the support and patronage of the late Prof Chaudhry, I was able to organize the first joint TP Section meeting in Pakistan (Lahore) and India (Chandigarah). Prof Varma, a senior colleague and active member of TP Section, was the organizer in India for this meeting. This was the first time that an academic meeting was arranged jointly by these two rival countries. This was also the first time, after a gap of many years, that the professionals of both these countries got a chance to get together and start talking about future collaborations in different areas of mental health. This interest continued and later on I was able to play an active role in the functioning of TP Section by organizing similar meetings (Lahore, Pakistan in 2004 and Delhi, India in 2005) and initiating various other projects related to cultural psychiatry in these two countries.

I came back to the UK in 1996 and started my work in NHS and with the University of Warwick. I made use of this opportunity to get more involved in the development of the Transcultural Psychiatry services at regional and national levels in this country. I set up a group in the West Midlands and we started having formal meetings and academic activities highlighting the need to understand culture and cultural differences in managing mental health problems. Under this platform, in 2002, I organized the TP Section meeting in Coventry that proved very successful and paved the foundations of our Section's future activities in the UK. The success of this meeting also helped me to continue organizing several seminars on Transcultural Psychiatry in recent years. In 2003, under the leaderships of Prof Goffredo Bartocci and Dr Ronald Wintrob, the TP Section organized the first joint meeting of our Section with World Islamic Association for Mental Health in Narni, Italy. As an active member of both the organizations, I was able to help the TP Section with coordination of this historic initiative. This was a unique opportunity for all the participants of this meeting, that helped them to understand different cultural issues from the perspective of different religious beliefs and faiths. Subsequently, this collaboration helped us to participate in a similar meeting held in Cairo in 2003.

I have continued my interest in the field of cultural psychiatry and practiced different innovations in my clinical and academic positions. I also organized TP Section meetings in Lahore (Pakistan) in 2004 and in Delhi (India) in 2005. These meetings were well attended by a number of Section members and other mental health professionals.

I am currently working as a Consultant Psychiatrist & Honorary Associate Clinical Professor at Warwick Medical School, University of Warwick, UK. My academic experience has been invaluable in my publishing more than 80 scientific papers and being the author of six books/monographs. Having a special interest in psychiatric research, I have been involved in planning, preparing and undertaking a number of research projects in several aspects of mental health, including transcultural psychiatry.

It has been a privilege for me to work with the Royal College of Psychiatrists, UK in different roles over the past many years. As Deputy Registrar of the College, I took a lead role for the Affiliates special committee and have also been involved with the Patients and Carers special committee. This has helped me in raising the profile of these groups at different national and international platforms. I have represented the College at many international meetings and have promoted the College policies; especially the importance of ethnic minority patients and carers' involvement in mental health programs. Being chairman of the College's Midlands Division, where a large number of ethnic populations live, I have been able to initiate a number of programs for these communities in public education, mental health awareness campaigns and other related areas.

On the international scene, I am currently working with a number of professional organizations; as Secretary of the WPA Section on Psychiatry in Developing Countries, Co-chair of the WPA Task Force on Brain Drain, as a Member of the WPA Nomination Committee, Member of the WPA Task Force on Disaster Management, Secretary General of the World Association for Psychosocial Rehabilitation (WAPR) and chairman of an international charity, Richmond Fellowship Foundation International. I was also a member of the Council on Global Psychiatry of the American Psychiatric Association (APA) and as founder and Secretary General of South Asian Forum on Mental Health and Psychiatry (SAF).

December 5, 2007