"We are all psychiatrists": Oncology and Palliative Care in Iraq

By Mac Skelton
Submitted to Session P4750 (Psychiatry in the Middle East: Hospitals, Science and Care, 2017 Annual Meeting
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In Iraq's Hiwa Cancer Hospital, the first with a full service palliative care unit, idioms of psychiatry permeate the discourses of both oncologists and their patients. Oncologists increasingly understand their profession as intertwined with psychiatry. "We are all psychiatrists" is a common refrain in their professional meetings. Meanwhile, patients formulate etiological models that relate war-related fear and the resulting 'psychiatric disorders' to the onset of cancer, and they cite psychological well-being as the key mechanism of healing. I analyze these idioms as part of two historical processes: First, beginning with the first cancer pain management unit in Mosul during the 1980s, I track a gradual shift from the language of 'pain management' to that of 'palliative care' in Iraqi oncology professional discourses. This shift has broadened notions of cancer pain from the physical to the social and psychological among oncologists. Second, I analyze the widespread discourse of generalized war-related psychological distress, which has increasingly become central to cancer patients' explanatory models of illness. This discourse of war-related psychological distress among patients has not, however, figured prominently in the increasingly psycho-social notion of cancer pain among oncologists. Building on the longstanding engagement of anthropology with psychiatry and medicine generally, I ask how oncologists' and patients' divergent usages of the language of psychiatry shed light on the emerging notion of the palliative and, more broadly, the experience of illness and dying in contemporary Iraq.