INTERNATIONAL TRANSCULTURAL PSYCHIATRY CHARACTER
Prof. Ahmed Okasha
PROF. AHMED OKASHA,
MD, PhD, FRCP, FRCPsych, FACP(Hon.)
- Professor and Director of WHO Collaborating Center for Training and Research in
Mental Health, Institute of Psychiatry – Ain Shams University, Cairo.
- President Egyptian Psychiatric Association.
- Honorary President Arab Federation of Psychiatrists.
- President World Psychiatric Association (2002 – 2005)
- President of the Egyptian Society of Biological Psychiatry, of WFSBP.
- Chairperson of WPA Ethics & Review Committee.
- Editorial Advisory Board of 20 International Scientific Journals.
- Member of National Mental Health Council and Supreme Council of Culture.
- Published More than 276 Original Articles in National and International Journals.
- Editor and contributor of 47 national and International books in the field of psychiatry and
psychology in both the Arabic and English languages.
- Honorary fellow of American College of Psychiatrists, Royal College of Physicians
(Edinburgh), Royal College of Psychiatrists (London), World Psychiatric Association
- Presidential Commendation American Psychiatric Association,
- Honorary Doctorate and Fellowship of many Universities and Psychiatric Associations
- Awarded from the Egyptian Academy of science, The highest honors in Egypt; State Merit
Prize in creativity in Medicine (2000), State Merit award in Medical Sciences (2007), Nile
(Moubarak) Merit award in Medical Sciences (2010), Medal of Science and Arts of the first
degree (2013).

E-interview:
Q1
What is the relevance of Transcultural Psychiatry in your day to day clinical work?
Highly relevant, you can never treat patients unless you are aware of their culture. In traditional
Eastern cultures, social integration is emphasized more than autonomy; that is, the family, not the individual, is the unit of society. Dependence is more natural and infirmity is less alien in these cultures. In the same manner, physical illness and somatic manifestations of psychological distress become more understood and acceptable and evoke a caring response; in contrast, a vague complaint of psychological symptoms may be disregarded or be considered to indicate that the patient or possessed or lack of faith is “ soft” or, worse, “insane”,.
If the patient recovers it is God’s will, if not, it is the doctor’s mistake...!!!
Deference to God’s will or the influence of spirits dominate the picture. Transcultural psychiatry is the bread of clinical work in both developed and developing countries!!!!
Q2
You have a long experience in psychiatry. Has transcultural psychiatry got more relevant to your practice in the twenty first century compared to the last century?
It is getting more relevant with the disappointment of 40 years emphasis on neuroscience and drugs which has not improved the outcome of mental disorders. Focussing on a psychosocial model is pivotal in transcultural psychiatry.
Q3
What is the difference between practicing psychiatry in the developing compared to developed countries?
In developing countries, you should use all your skills with continuous innovation for the patient’s care because of lack of human resources in mental health, lack of essential drugs balanced by the family cohesion and social support. You don’t follow guidelines as most of drugs mentioned are unavailable. You should tailor your management according to your resources!!!.
Q4
Have you done any research about immigration? What is the most interesting finding in your view?
Immigrants are more vulnerable to mental disorders especially the first generation whether they are a special group, or the cultural and language variation or they belong to a minority group, it may need more studies. Immigration has an impact on the pathogenesis of psychosis and schizophrenia.
Q5
You have treated a lot of patients over the years, what was the most important learning experience you have had in one patient?
Treat the patient as a person and not as an organ. Respect his identity and always remember that there are some patients who are more intelligent and creative than their treating physicians!!!
Talking to violent patients, have sometimes better results that pharmacological jackets.
Q6
You live and practice in Egypt. Egypt is on the interface between the West and the East. It has got many ties to the west, geographically, historically and culturally. It has also its ties

with the East through history, language and religion. How different are you from other psychiatrists living in the East like Iraq, Pakistan or Malaysia?
Egypt has a unique cultural matrix. The Egyptian was exposed to different cultures for 6000 years, Pharaonic, Greek, Roman, Coptic, Islamic, Byzantine cultures, apart from the fact that it is
African (Hemite) and Asian (Semite), Mediterranean, Middle East and Arab. Gene expression and the epigenetic role have influenced the character of tolerance, moderate religiosity and pride
(The Egyptian was the first, before heavenly religions, to believe in one god and the afterworld!!!).
Q7
You trained in Egypt and had your postgraduate studies in England. What is the difference between your practice before and after you trained in the West?
The exposure to different cultures is an enrichment of the neural circuits of the brain and has a favorable effect on neurogenesis leading to better creativity and assimilation of science and culture. In Egypt, education is still focusing on dependence while in England it is on independence which has a detrimental effect on the personality. In Egypt everything is attributed to God’s will, success, achievement , health and disease…..etc. while in England it depends on your dedication, hard work, and yourself not failing to have your faith. The practice and assessment in Egypt depends on knowledge while in England on skills and attitude.
Q8
What is the most interesting paper you have read about Transcultural psychiatry?
The late professors Lamboo from Nigeria and Tigani AL Mahdi from Sudan were the first to speak about transcultural psychiatry and traditional healing e.g. in some places in Africa Mental
Illness is attributed to the wealth of the dead ancestors and reburying them with dignified ceremony can cure them……Surprisingly…..some did recover!!!!
The transcultural study of schizophrenia of WHO by Jabensky and Sartorius and the international pilot study of schizophrenia: Five years follow up findings by Leff et al showed the different systematic and functional outcome between developed and developing countries. The
WPA section on transcultural psychiatry has its journal and its impact on the development of transcultural psychiatry research is evident.
Q9
What area of transcultural psychiatry you advice psychiatrists to investigate?
The pharmacogenetics of our psychopharmacological therapy and liver enzymes and metabolism differ in various cultural, ethnic and racial groups. It is important to study the differences as we do not have evidence based guidelines to the best pharmacotherapy to different cultural groups.
Longitudinal studies for the best psychotherapeutic approach in different cultures as e.g. psychoanalysis may be rejected in some societies and cognitive therapy may be useless in illiterate or low average intelligence. The role of spiritual and religious psychotherapy is practiced in many societies in the world. I have edited a book on “Ethics, Culture and
Psychiatry” by American Psychiatric Press ; Okasha, Sartorius and Arboleda Florez (2000) in which we have 8 cultures namely Chinese, Japanese, Indian, Arabic, Latin American,
Scandinavian, European and American cultures and in spite of major differences in culture and symptom presentation yet the ethics were similar.
Q10
Psychiatric Trainees in Europe come from different backgrounds. What is your advice to trainees who move to work in the West from the transcultural psychiatry point of view?

Try to assimilate the skills, attitude and knowledge in the West in your own cultural heritage. Do not try to impose the western cultures on your own; however, you may modify the balance between science and culture. Try to absorb the culture and science of the west and modify it to be applicable to your culture. Be confident that with your limited resources and sometimes that you are alone yet, you produce a state of the art scientific and epidemiological and transcultural work that can be respected and published in the best journals.
Q11
You served as the president of the World Psychiatric Association for four years. How relevant was Transcultural Psychiatry to that experience? And what is the most interesting experience during those four years?
During my presidency of WPA (2002-2005) my presidential educational program was on global child mental health, an area of neglect where I gathered 70 scientists of child mental health from all over the globe to study awareness, early detection and services for child mental health. Field studies were done in Egypt, Brazil and Russia. The products are in WPA website as a book published on this topic. I remember dissolving the conflict of the Falung Gong in China and establishing an educational program in China to differentiate between cultural beliefs and delusional systems. Being involved with 137 member societies worldwide representing 117 countries and 67 scientific sections representing all aspects of mental health from various disorders to Religion, Spirituality and Mental Health and Philosophy and Humanities in
Psychiatry to Psychological Consequences of Torture and Discrimination and being introduced to pioneers of world psychiatry gave me the privilege to cultivate my horizon of knowledge and to try to understand the aspirations of more than 200000 psychiatrists worldwide!!!!
Acknowledgement:
The Transcultural Psychiatry SIG is very grateful for Prof.Okasha’s kind continued support for the group and for the development of psychiatry all over the world.