Did you know that Fez hosts the first psychiatric hospital ever? Yes, the Maristan of Sidi Frij is located at the heart of the Old Medina, near “Souk El Henna” and “Souk El Attarin”. This Maristan was brought to light in 1993 when Professor Driss Moussaoui was Chairperson of the “Moroccan Association of History of Medicine”, and placed three descriptive marble plaques on its wall.
Doctor Moussaoui told Barlamantoday about his dissatisfaction with psychiatry in Morocco; however, he said that we are far from the Sidi Frij era.
The said facility was accepting patients until 1924, when all Maristans in Morocco were sites not only for patients with mental disorders but also for ophthalmology and internal medicine.
According to Dr. Moussaoui, the Maristans were filled with fountains and gardens; everything was free, and patients were given money and new clothes as a type of social security when they were leaving the hospital. This led Father Jofre to establish the first psychiatric hospitals in Valencia, as well as in important cities in Spain. This is an excellent example of “technology transfer” from the south to the north.
Back to our era, Dr. Moussaoui, one of Morocco’s first professors of psychiatry and the founder of the Department of Psychiatry at the Casablanca Faculty of Medicine and Pharmacy which he chaired from 1979 to 2013, accepted to be our guide in delving into the annals of psychiatry in Morocco.
When he started practicing, Dr. Moussaoui was the only psychiatrist in the public sector. A region including over 8 million people was to be served by only one resident. Morocco had less than ten psychiatrists at the time.
Pavilion 36, the ward where Dr. Moussaoui was working, had only 55 beds. He could only hospitalize 50 people every day. The seasoned psychiatrist stated that the sector was and still suffering from a lack of medication and deteriorating infrastructure.
Working conditions were described as “the inferno” by Dr. Moussaoui. Many nurses couldn’t manage the stress and departed their job. They were at risk every second of the day due to the violence of people suffering from mental disorders. These patients would assault the staff or other mentally-sick individuals, or even commit suicide.
Dr. Moussaoui highlighted that the situation started to improve with the establishment of the “League for Mental Health”, which purchased 100 additional beds for the center, paid by donors.
Currently, Morocco has around 415 psychiatrists, between 200 and 300 psychotherapists, and around 2200 beds. These figures are poor compared to France which has over 15,000 psychiatrists and more than 40,000 beds.
Psychiatrists report that 26.5% of Moroccans are depressed, and 22% of adolescents have some kind of suicidal ideation, Dr. Moussaoui regretted. “Half of the population of Morocco has some kind of mental disorder, this is almost equal to the USA, in which 52% of the population had, has, or will have a mental disorder.”
Morocco’s budget for mental health has grown significantly in recent years, though it is still insufficient. There are almost no public clinical psychologists. There is a significant demand, mostly for people who are delusional, hallucinating, excessively anxious, and may be aggressive. These individuals must be admitted but they are sent home due to infrastructure issues.
Psychotherapy is an essential component of treatment, said the psychiatrist who gave the example of the Friendship Bench in rural Zimbabwe, which is basically a listening session on a bench. “Studies showed that this is very beneficial.”
Professor Moussaoui discussed “coaching” as a new field and asserted that if the patient believes that this person (the coach) will help, the result will be positive. “Yes, everybody can help, if the person has the will, time, and psychological energy to listen to the difficulties of others, but we must admit that many of these coaches are not qualified enough and are driven solely by money.
Dr. Moussaoui distinguished between psychiatry, psychology, and neurology. Psychiatrists are medical professionals who can prescribe medications and order bloodwork and scans. Psychologists, on the other hand, cannot ask patients for tests or prescribe medications. They can only utilize psychotherapeutic approaches.
Neurology and psychiatry are inextricably linked. Many neurological illnesses result in psychiatric symptoms and vice versa. When psychotherapy is effective, anatomical changes in the brain occur.
The doctor illustrated how depression affects the brain by reducing the volume of the hippocampus (a part of the brain connected mostly with memory), which shrinks as a result of depression. If the patient is given antidepressants, this volume returns to normal. The same consequence happens if the patient is offered a psychotherapy session.
Psychiatrists must know neurology and neurologist must know psychiatry, according to him.
Psychiatry progressed tremendously by the end of the last century, and Professor Moussaoui played a big role in this progress as far as Morocco is concerned.
In 1992, the Professor started collaborating with World Health Organization (WHO) and became part of the research group in psychiatry, psychopharmacology, and health. He created the 1st WHO collaborating center in Africa.
The World Congress of Social Psychiatry held in Marrakech in 2010 elected Dr. Moussaoui as President of the International Association of Social Psychiatry from 2010 to 2013.
As for the evolution of the field in Morocco, the country hosted recently (Feb. 9-11) the 23rd edition of World Congress of Psychotherapy, organized by the international federation for psychotherapy. The culmination of the event was the Casablanca proclamation in Psychotherapy.
Referring to this proclamation, Dr. Moussaoui described it as a historic moment as it gathered many international associations. “The proclamation was signed by the international federation of psychotherapy, the president of the world psychiatric association, the president of the world association of social psychiatry, the secretary general of the world federation of mental health, and the secretary general of the world association of dynamic psychiatry. This has never happened in the history of psychiatry and psychotherapy.”
The proclamation can help decision-makers, especially the ministry of health and the ministry of education, he said.
To conclude, needs in psychotherapy and psychiatry are considerable. Demand exceeds offer in terms of human resources. It is high time that Morocco pays attention to mental health as well.