Ahmed Hankir, MD

FIRST MAN: We should defend ourselves. An eye for an eye, a tooth for a tooth.

TEVYE: Very good. And that way, the whole world will be blind and toothless.

- From 1970 script of the play “Fiddler on the Roof” and often attributed to Mohandas Gandhi

“The three ingredients for healing relational wounds are safety, truth, and reconciliation, and in that order.” - Alisha Moreland-Capuia, MD

Achieving peace in the Middle East is a monumental task that seems to be ever evasive, daunting, and out of reach. A cease fire is welcome, but a far cry from what we want to achieve—lasting Middle East peace. The violence is also spilling over into increased conflict between groups in the United States. Muslims and Jews are subject to worrisome degrees of Islamophobia and Anti-Semitism. The Palestinian-Israeli conflict is an extremely complex tangle of issues to resolve, but a solution is possible, and imperative.

Both sides and their supporters need to abandon ultimately futile and self-defeating acts of violence and retaliation. Instead, they must embrace a more comprehensive and humble vision that takes into consideration the historical, geographic, religious, and cultural context of two cousin tribes that have wounded each other over generations. It is like a longstanding family conflict in which family members stop talking to one another and replace talking with hatred, necessitating therapeutic family interventions. Despite the reservations that some psychiatrists have on entering the social conflict sphere, these are, in fact, areas of psychiatric expertise.

As psychiatrists we know group dynamics. We know our tendency to scapegoat “the other”. We know how the powerful can divide and conquer less powerful groups. We know how to analyze leaders. We know the temporary but necessary pain of revealing and processing the truth. We know from Abraham Maslow, PhD’s pyramid of psychological needs that safety and security must be fulfilled before higher levels needs can be completed. We know that often deeper levels of traumatic causation need to be processed and dealt with before healing can meaningfully occur.

This is not a naive proposal by any means, though it may seem so to some. Inevitably, many will disagree with any Middle East analysis. Rather, it is a plea for change because doing the same thing over and over again, expecting different results, is the very definition of insanity. Constantly suspecting each other’s motives has not moved this protracted struggle even an inch out of square zero. As good as prior endeavors were—that is, things could have gotten even worse—they have not been nearly enough.

There are many intricate political and psychosocial dynamics that come into play to make this mission look impossible; however, fighting parties in other parts of the world have managed, for the sake of their children, to reach some kind of compromise that benefits all involved. Children in the blessed land should not continue to pay the price of our ignorance, false pride, and generational bigotry.

As Muslim, Jewish, Christian, Hindu, and Sikh psychiatrists, in a bio-psycho-social-spiritual model we sense this is a moral and spiritual crisis. We support peace among nations, safe and secure homelands, and opportunities for all. This is not at its essence a fight between Muslims and Jews, or between Arabs and Israelis. This is an ideological and practical war that often intentionally feeds cultish misinformation, especially via the internet, which artificially arouses emotions, leading to relieving emotional tension by ever-increasing violence. Peace-loving civilians lose their lives, while extremist groups and fear mongers run rampant.

Unfortunately, the media usually chooses to focus on the negative events occurring in the Palestinian-Israeli conflict, and ignores equally dispiriting, yet equally important, inter-ethnic tragedies taking place in places like Kashmir, Myanmar, China, Syria, Yemen, Iraq, and elsewhere around the globe. This disproportionate attention to one particular locale in the Middle East only enflames matters more. It leads the public to believe that this is a unique situation, when it is a tendency of human nature that needs to be overcome everywhere. Despite our paradoxically doing so in this paper, we include other examples and intend to address them more in the future.

Perhaps we can learn and apply a few lessons from countries like South Africa, Rwanda, and Bosnia, where warring tribes have seemingly learned to live together. The Truth and Reconciliation Commission was especially effective in helping to bring South Africa out of apartheid without a bloodbath. 

Big problems get resolved only when broken down into small pieces. The use of dialogue can—and should—start in our households, small intra- and inter-faith circles, and cultural communities. A group of international and interfaith psychiatric caregivers have come together to create a community of care and have produced two requested, well-reviewed books that can be used as tools towards healing: 

From these sources, here are some ideal prescriptions to start with:

- Dignity for all, established by working together respectfully for a common end

- Humiliation for none, which means hearing each other out

- Apologies by all, as saying “I’m sorry” and meaning it begins the healing of many wounds

- Gifts to the others, such as sharing assets and promoting each other’s strengths

- Neutral peace-maker(s), or the calling in of trusted third parties, which may ideally need to include mental health experts

- Teaching tolerance to children, both by parents and educators

- Addressing intergenerational trauma, which includes that affecting political decision-makers

Also, as psychiatrists, we know very well that an illness cannot be cured unless we address its root causes, and similarly we have the moral obligation to call for the immediate dismantling of bigoted and violent ideologies, dictatorships, and all structures and systems that support them. They are so damaging to the body, mind, heart, soul, and spirit of so many of the people.

These are simple, though not simplistic, aspirational goals. They are meant as an antidote to the common lament about how complex these situations are, so often leading to excuses about what cannot be done and what cannot be tried. Prayer and mourning must be supplemented with action.

We need a few small steps in addition to this manifesto. Some that could be taken by SPIRIT and like-minded groups include: joint business projects, a student exchange, common textbooks (especially in the early grades), shared vacation spots, media consultation, and joint research. We must look towards innovative and out-of-the-box solutions.

Members of SPIRIT are available for consultation and discussion. We welcome other like- hearted psychiatrists of any religious background, as well as those who are agnostic or atheist, to join our SPIRIT.

is practicing psychiatrist in Providence Healthcare System, Portland, OR. He has provided psychiatric and humanistic care to trauma survivors around the world.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

is Clinical Professor and Chair of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences.

is an associate professor of psychiatry at Harvard Medical School and a Fellowship Site Director for Brigham and Women's Hospital.

is Professor Emerita, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

is a Professor of Psychiatry at Cooper Medical School of Rowan University. He is active in several national and regional organizations and published and presented on International Medical graduates, culture, religion, family psychiatry, gender issues, etc.

serves as Assistant Dean of Clinical Education at Charles R. Drew University and Chief Medical Officer of Kedren Health Systems Inc.

is Medical Director of Child and Adolescent Psychiatry Clinic and Multidisciplinary Autism Program at ChristianaCare, Delaware.

is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai, New York, NY.

is a psychiatrist, the author of more than 300 peer reviewed papers, founder of Critica, and board member of the Social venture Fund for Arab Jewish Equality in Israel.

is Professor Emeritus in Psychiatry at the University of California at San Diego, as well as the author of more than 100 professional articles and 6 books.

interested in exploring the intersection between childhood political trauma with immigration stress. She has been recently offered a full-time research appointment as a Visiting Researcher at Harvard University, in Cambridge, Boston.

is a doctor working in frontline psychiatry for the National Health Service at South London and Maudsley NHS Foundation Trust in the UK.

is a Clinical Associate Professor of psychiatry at the Stanford University School of Medicine where she is the Director of the Stanford Muslim Mental Health & Islamic Psychology Lab, and the Director of its community organization: Maristan.org. She also serves as the Associate Division Chief for Public Mental Health and Population Sciences as well as the Section Chief of Diversity and Cultural Mental Health in the Department of Psychiatry and Stanford.

1. Moffic HS, Peteet J, Hankir A, Awaad R. 

Islamophobia and Psychiatry: Recognition, Prevention, and Treatment

https://www.springer.com/gp/book/9783030005115

2. Moffic HS, Peteet J, Hankir A, Seeman, M. 

Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions

https://www.springer.com/gp/book/9783030377441

Articles

A cease fire is welcome, but a far cry from what we want to achieve—lasting Middle East peace.

An Interfaith Psychiatrist Prescription for Middle East Peace

Ahmed Hankir, MD, shares experiences and offers advice on these difficult times of the pandemic. He shared more of his thoughts in his article, 

is Academic Clinical Fellow in General Adult Psychiatry at South London and Maudsley NHS Foundation Trust, London, UK. He is also a Senior Research Fellow with the Centre for Mental Health Research in association with the University of Cambridge. Twitter:

Videos

Some words of advice on coronavirus: "God grant me the serenity to accept what I cannot change, the courage to change what I can, and the wisdom to tell the difference between the 2..."

Salvaging Serenity

I’m feeling the heat. Not the high temperature associated with an infection but the hot flush that is a psychosomatic symptom of 

, the epicenter of the coronavirus outbreak in the UK, working at the frontline of the 

. A patient on the acute adult mental health ward who tested positive for COVID-19 is deteriorating so I’ve donned some personal protective equipment (PPE) to examine him.

The British government has come under intense pressure not only because of the shortage of PPE but also because of reports from care providers that the quality of the equipment they are donning is poor and not fit for purpose. Personally, I’m anxious because I’m not feeling at all protected in the thin apron, flimsy face mask and gloves that I’ve been given, and I fear that I will contract the virus. However, notwithstanding my apprehension, the overriding feeling is my commitment to providing care to our patients with mental illness so I “go in” regardless of the increased risk that I’m exposing myself to. It’s important to note that never for a moment did I feel pressured by my employers to examine patients who tested positive for COVID-19. On the contrary, my managers have been incredibly supportive and understanding (they, themselves have had to take time off work because they succumbed to the virus). What compelled me was my sense of duty, not the undue influence that is so often associated with being placed under duress.

I emerged from the clinical encounter unscathed; however, it transpires that my anxieties were not unfounded. Approximately 2 weeks later after working on the new 

 ward in our hospital I had a high temperature, fatigue, generalized aches and pains, and malaise. So here I am in my room in South London on day 6 of self-isolation composing this article waiting for the COVID-19 self-testing kit to be posted to my address by Amazon courtesy of her Majesty’s Government.

Self-isolation compels you to engage in contemplation. I’m actually feeling extremely fortunate; my symptoms have almost completely resolved after plenty of rest, fluids, and paracetamol. I’ve convalesced and I’m very much looking forward to returning to work to provide care to patients with mental illness during the pandemic. I miss interacting with patients and the camaraderie that I experienced with my colleagues. I think about the people who have tragically died (as of April 25, 2020 over 20,000 deaths related to COVID-19 have been recorded in the UK, the fifth nation to surpass that grim figure), their loved ones, those with more severe symptoms, and the patients on ventilators who are fighting for their lives. I think about the health care professionals who made the ultimate sacrifice and died while treating patients with COVID-19.

These wonderful and inspirational human beings are our heroes and we must honor their legacies. (We will be setting up a fund to provide financial support to medical students from black and ethnic minority backgrounds because there is an overrepresentation of deaths related to COVID-19 from health care professionals in these groups.)

Coronavirus has truly brought out the best and worst from us. I am heartened by the outpouring of support I received from the public. I’m grateful for technology that has allowed me to maintain social connectedness (and therefore salvage my sanity!) with my family and friends through WhatsApp and other digital platforms. There is also an online community on Twitter that has been absolutely amazing and has helped to bolster my morale.

So, I will not despair but rather I will see COVID-19 as an opportunity to serve our society and to instill 

 in all of the people I am so very fortunate to make face to face and virtual contact with.

 is Academic Clinical Fellow in General Adult Psychiatry at South London and Maudsley NHS Foundation Trust, London, UK. Twitter: 

I’m feeling the heat. Not the high temperature associated with an infection but the hot flush that is a psychosomatic symptom of anxiety.

From London With Love . . . 

The expression on his face was that of disgust. Of course, I knew this look only too well; I am an expert by lived experience after all, and I had been the victim of mental health related stigma and discrimination for many years. But seeing this person’s reaction somehow surprised me.

I received an invitation to deliver my Wounded Healer program at an Ivy League college in the US as a Grand Rounds presentation. A Professor of anesthesiology approached me after I delivered a talk titled 

 at the 2014 International Symposium of Poetry and Medicine in London. He emphatically exclaimed, “We’ve gotta bring this over to the US!” After the presentation, my hosts arranged for me to meet with the head of the department of psychiatry and it was this person who had the perceived expression of revulsion on his face during my meeting with him.

Throughout the meeting, this expert at caring for people with mental health problems appeared guarded, and he made very little eye contact with me. He seldom spoke; however, he did disclose that he had met a renowned British scholar who I revered immensely. I displayed excitement and exuberance at this revelation. It was at this point that his face contorted, and he suddenly recoiled his body as if I were about to contaminate him with some ghastly disease. Was it because he had seen this elation in many of the patients whose mania he treated in his illustrious career? It felt as though he reflexively “pathologized” my overture as if it were symptomatic of my illness and not an expression of human emotion.

In my Wounded Healer program, I openly disclose that I am a practicing Muslim and that my faith protected me against suicidal behavior. Given that Islamophobia is rife in the US (and this was what inspired me to co-edit a textbook, 

, with H. Steven Moffic, MD, and colleagues (Springer; 2019).

 I suspect that this may be a factor that also contributed to the professor’s reaction towards me. In hindsight, I felt that he stigmatized me because I am an adherent of the Islamic faith and because of my experience with mental illness (the so-called “double stigma” and intersectionality that Muslims with mental illness are often subjected to).

After I left his office, we walked in opposite directions in the corridor and I recall smiling at him. What ensued was astonishing. Instead of reciprocating, not only did he seemingly shun me, but it felt like he also wanted me to both see and 

 this act. His manner came across as hostile and aggressive, and it was only at that moment that I was galvanized into realizing that I was being reduced 

 of mental illness and being an adherent of the Islamic faith. Indeed, his disgust was intense enough to induce a visceral sensation of pain in my chest…

Was I simply misreading him? If I was, clearly I was not the only person to because his medical secretary, who was also in the corridor, appeared visibly perturbed by him and the expression on her face betrayed this. He attempted to dissolve the tension by smiling, but all the while he refused to look at me and acknowledge my existence.

To show insight into my own reaction, I am a sensitive soul. His reaction may very well have influenced my feelings, thoughts, and emotions. Maybe I was overreacting? Notwithstanding this caveat, there is a loud and wise voice in my mind that declares this was a flagrant act of arrogance. Of course, I could be wrong. But then again, I could be right.

In short, I felt violated by the experience; I expected this eminent psychiatrist to know better than anyone that stigma can be devastating (many report that mental health stigma is worse than the mental illness itself) and that my being so honest and open about my lived experience was an act of candor and courage.

I wish I could say my evaluation of the encounter was wrong, but the fact remains there are people in this world who are cruel toward those with mental illness, including psychiatrists. Indeed, the 2008 Stigma Shout Survey conducted in the UK on 4000 people using mental health services and carers revealed that psychiatrists are a common source of stigma reported by people with mental illness.

Although the wound remains indelibly carved in my consciousness, I am grateful for learning a precious lesson-and that is never to make someone feel the way I felt, It is, however, crucial to note that many people I met at the college welcomed me. In fact, I received a standing ovation, and some people literally embraced me afterwards. A perceived isolated incident of discrimination must not tarnish what was otherwise a beautiful experience.

In 2006 when I was a medical student at Manchester University in the UK, I woke up to discover that my hometown in Lebanon was bombed and that hundreds of people were killed overnight. I feared that my family were among the dead and I reacted; I developed an episode of psychological distress. I was forced to interrupt my studies and mental illness rendered me impoverished and homeless. I was stigmatized and ostracised and whilst sleeping on the cold and hard streets of Manchester I would contemplate suicide by watching the oncoming traffic and thinking about which vehicle I would thrust myself under.

My psychiatric issues had far reaching implications on my family, especially my mother. When she first saw me, the degree of my distress was such that she barely recognized me. I will never forget the pain in her eyes when she saw what had become of me. She tried her best to encourage me to see a psychiatrist, but the stigma was (and is) so powerful that I refused to acknowledge psychopathology in myself. This only prolonged my suffering and that of my family.

I eventually decided to seek help and I was started on a course of treatment by my psychiatrist. I subsequently made a full recovery. I resumed my medical training with a renewed sense of determination and resilience and qualified as a doctor in 2011.

I decided to specialize in psychiatry, and I was passionate about challenging mental health related stigma. In 2013 I collaborated with Dr Rashid Zaman FRCPsych at Cambridge University, and together we pioneered 

 program, an innovative method of pedagogy that blends the performing arts with psychiatry. The argument we make is, “How can you educate an audience if you can’t engage them?!” I named my presentation after Carl Jung’s archetype, “The Wounded Healer.” Jung used the term as a model to describe a dynamic that may take place in the relationship between analyst and analysand. Jung described 

in relation to himself; for Jung, “. . . it is your own hurt which gives you a measure of your power to heal . . .”

Since its inception in 2013, I have been fortunate to deliver the program to over 65,000 people in 14 countries in five continents worldwide (including a lecture circuit in the US during which I delivered 

 as a Grand Rounds at the college described above).

I try my best to instill hope in people with mental health difficulties whenever I can that not only can you recover, but you can also achieve excellence in what you do. Indeed, from homeless man with mental illness in 2006, twelve years later the Royal College of Psychiatrists conferred upon me the 2018 Core Psychiatric Trainee (Resident) of the Year Award, which marks the highest level of achievement in psychiatry in the UK. My testimony is further evidence that if I can recover and realize my dreams, other people with psychiatric illness can also recover and realize theirs.

All views represented in this article are my own and do not represent those of Psychiatric Times, my employer, or the Royal College of Psychiatrists. 

Dr Hankir is Academic Clinical Fellow in Psychiatry at South London and Maudsley NHS Foundation Trust, London, UK. Twitter: 

Islamophobia and Psychiatry: Recognition, Prevention, and Treatment.

2. Ciftci A, Jones N, Corrigan PW. Mental health stigma in the Muslim community. J Muslim Ment Health. 2012;7.  DOI: 

http://dx.doi.org/10.3998/jmmh.10381607.0007.102

Notes on the Management of Spoiled Identity.

4. Time to Change. Let's End Mental Health Discrimination. 2008. 

5. Hankir A, Zaman R. Jung's archetype, 'The Wounded Healer', mental illness in the medical profession and the role of the health humanities in psychiatry. 

From homeless man with mental illness to the Royal College of Psychiatrists-the journey was not easy, but few things worthwhile are.

Ahmed Hankir, MD

Articles

An Interfaith Psychiatrist Prescription for Middle East Peace

Salvaging Serenity

From London With Love . . .

Portrait of a Wounded Psychiatrist