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دکتر جلیل گل عنبر



Illness, both mental and physical , though based on universal physiological factors, is in its expression highly culturally patterned .
One becomes "sick" or "crazy" in a well defined culturally delimited way. Concepts of health and illness are based on a value system and they are culture-bound .
Every culture has a theory or theories of mental illness. Various forms of therapy are developed by every culture as well. These standards of behavior reflect the values of the group.
However, major categories of mental disorders may be universal. Schizophrenia, for instance , is now believed by many to be caused by some kind of biochemical imbalance.
Some Asian, Middle East and Near East societies provide therapy within a complex of what has been described by Westerners as magic or ritual. Such is the case of the Iranian culture which traces its lineage through 2500 years of Persian history to the most ancient Aryan peoples .
Psychotherapy and religious healing are very closely allied in Iran. More specifically, in the province of Kurdistan, there is a form of psychotherapy practiced by the native people that are directly related to the Islamic teachings .
Background of the Problem
The people who live in Kurdistan and other provinces in Iran depend on native "healers " for treatment of physical and mental disorders, as well as for spiritual guidance and counseling. There is at least one healer, accompanied by his helpers (morids), in every town or village.
The healer is usually at least forty years of age and must possess an adequate knowledge of herbal medicine, human anatomy and physiology, and knowledge of the spirit or "psyche," as it has been called. This knowledge is based for the most part on classical books and ancient religious and scientific writings. Unlike the majority of specialists in Western countries, these healers have a holistic approach in their treatment of disorders .
Every Thursday night the people of a particular town or village gather at the mosque, or a room adjoining to it, to perform what they call Zekr (remembering God). This is no doubt a religious ceremony, but it is never­ the less their most common form of psychotherapy. The room where they sit is simply decorated with a few carpets to sit on. The participants sit in a circle and repeat phrases such as "La illaha illa'ala," (There is no God, but Allah) under the direction of the healer.
This chanting is supposed to increase their spiritual awareness and heighten their consciousness, which in turn helps them to worship Allah and reflect more deeply upon themselves and their lives. This meeting ends with a prayer and the people go home. But the healeri function doesn't end here .
The healers help people with their per­sonal and family problems on a daily basis. For instance, a man may come to him claiming that he feels guilty for despising the poor. In response, the healer might advise him to actually play the role of a beggar for a short time so that he can learn to sympathize with poor people instead of disliking them. Or, a woman who is being abused by her husband might seek the healer's counsel. He would most likely try to help her and her spouse to improve their marital relationship, and if necessary include the intercession of relatives and/or friends .
The healer's helpers aide him for the most part by helping victims of disaster or misfortune in a material way. For instance , they may assist an orphan in finding a home, or provide temporary shelter to the poor or persons who have lost their homes by fire, flood or earthquake. It is the healer himself who takes care of their more specific emotional and behavioral problems. Together, this team of persons provides assistance to the people of their community .
The types of problems Iranians face who live in the larger cities and towns of Iran do not differ drastically from the problems that are common to the people living in the smaller towns and villages of Kurdistan. However, people living in larger communities may experience more problems due to the faster pace of life and other conditions associated with living in an urban industrial setting. In particular, they may encounter an increased number of  family related problems that occur as family members spend less time at home and fall victim to outside influences. For example, a young man or woman: may get involved with drugs, underground politics or sexual experimentation and, thus , become social outcasts .
The healers of Kurdistan typically see a number of people suffering from stress and anxiety, including children, who live within a very competitive and restrictive social structure . Any deviation from cultural norms may promote guilt or anxiety in them. The loss of virginity, for instance, may contribute to hysterical reac­tions or obsessive-compulsive symptoms in some girls .

Very few of the people who live in the larger cities are familiar with the healers or the therapy they provide. However, it is the opinion of the author that they too could be helped by use of techniques similar to those used by the healers. In order to successfully treat his patients, the therapist with a practice in Iran might try to combine the new techniques and skills he has acquired with those the healers implement .

Statement of the Problem
Psychotherapy, the treatment of problems of mental health, can be defined as a series of contacts between a socially sanctioned healer and a patient who seeks relief, It is the treatment of personality disturbances by psychological means. Many different techniques of therapy are found scattered around the world; it is also true that they are not distributed evenly. Certain techniques occur much more often than others, and each culture appears to have its own preferences.
The reason is that techniques of therapy are intimately related to culture. They are related to the theories of causation of illness, the personality types valued, and the goals of therapy in the culture. The last is a reflection of more general cultural values .
The goals of therapy are also culture bound and are related to the basic ideals of the society. In the United States, for instance, personality characteristics held in high regard are achievement, independence, responsibility and rational thinking. Therefore, goals of therapy which are usually considered appropriate for a patient in this country include: improved insight, improved personal efficiency , and improved social efficiency, and the techni­ques of therapy which best achieve these goals are psychoanalysis, insight-oriented therapy, behavior therapy, drug therapy and occupational therapy.
In other cultures the values, goals and techniques are often different. An example of this is seen in Kurdistan (Iran), whose unique form of psychotherapy is the focus of this study .
In order to present an adequate description of psychotherapy as it is practiced in Kurdistan, the author has found it necessary to include a discussion of several aspects of psychotherapy found in Kurdistan and in Western cultures such as; the meaning of psychotherapy, the function of the psychotherapist, therapy techniques and the theories behind them .
Purpose of the Study
The intent of this study was to present the importance of the psychotherapeutic techniques used in Kurdistan within a coherent scientific framework .
Specifically, the purpose of the study was as follows:
1. To describe and characterize the healers of psychotherapy in Kurdistan .
2. To fully document and describe the theories and techniques of psychotherapy as practiced by healers in Kurdistan .
3. To determine whether the theories and techniques of psychotherapy as practiced in Kurdistan are bound by pre-Western scientific concepts .
4. To determine whether the theories of psychotherapy as practiced in Kurdistan bear any resemblance to those used in Western cultures .
5. To determine whether the techniques of psychotherapy as practiced in Kurdistan bear any resemblance to those in Western cultures .
Importance of the Study
The form of therapy that can be applied to all psychogenic disorders and is best suited to accommodate the people of Iran must be broad enough to sa­tisfy the needs of people who live both in cities and in rural areas. The counselor/therapist must utilize all possible sources -- new and old; traditional and progressive that could aide in the treatment of a variety of clients .
This would render flexibility and a basic commitment to help all people as essential characteristics of the professional with a practice in Iran .
It is relatively easy to familiarize oneself with Western psychotherapists and their theories and techniques. But there is a general lack of information and knowledge about psychotherapists and the practices in other cultures. This study is important because it introduces the "healers " of Kurdistan and their therapy and techniques as a valuable resource to Iranians and to people living in other countries as well. In addition, it is important because it provides a case study of cross-cultural comparison that can help to find out more about similarities and differences as human beings living in different societies .
Scope of the Study
This study was concerned with the description of the therapeutic techniques used by the indigenous healers in Kurdistan, and whether or not their practices were similar to those used in the West. The investigator   made no attempt to evaluate the effectiveness of these techniques, however, because of problems such as setting the criteria to be used in judging effectiveness, and the difficulties associated with trying to set up a control group or observe participants over long periods of time .
The study was limited to :
1. The discussion of mental disorders and their treatment which are thought to be psychogenic in nature; such as anxiety-reactions, conver­sion reactions, phobic reactions or obsessive compulsive reactions .
2. Including only data that were felt to be relevant .
3. Observations made by the researcher; that is , the observations of others were not used .
4. The fact that the researcher was not able to observe the healers consistently, or their clients except when they were being treated. There is a need for a longitudinal study in this regard .
The study was conducted under the following assumptions:
1. The healers in Kurdistan provide valuable therapy for their clients .
2. The therapy which the healers provide has some bases in Islamic religion .
3. There are both similarities and differences exist between the psychotherapy used in Kurdistan and Western cultures .
4. The researcher was able to record data as the events occurred naturally.
Psychotherapy in Western Culture
There are more than a hundred specific psychotherapies practiced in Western cultures, each unique in some ways but each expressing one of the three general orientations:
1) Psychoanalysis and other directive approaches;
2) Phenomenological approaches; including client-centered therapy, role therapy and Gestalt therapy and.
3) Behavior therapy, or approaches emphasizing behavior modification such as operant conditioning or systematic desensitization.
In addition to these therapies there are also group therapy and family therapy .
"'the basic function of psychotherapy is to provide a situation in which learning can take place. The patient comes to the therapist with a set of behavior that is ineffective and inadequate in dealing with his environment. The job of the therapist is to do something about it " (Lundin:399).
In determining the specific goals of therapy, theorists typically have indicated a range of attitudes, values and behaviors which they see as deviant and needing to be modified or eliminated. In some instances (as in the case of the above quotation) the definition of the goals of psychotherapy is very simple; in others highly elaborate and descriptive .
One topic that has been widely debated among Western psychiatrists is whether or not the personality characteristics of the psychotherapist are necessa­rily important. At one end of the spectrum are those in the client-centered school who believe that the personality characteristics of the therapist constitute the most important components of the therapeutic relationship. At the other end are behavior therapists and psychoanalysts who maintain that therapy is primarily the application of techniques, and that the personality characteristics of the therapist are secondary or unimportant altogether .
However, studies seem to indicate that, since the therapist-patient relationship is by definition a personal one, the personality characteristics of the therapist are an important factor contributing to the successful treatment of the client or patient. In a study of vocational counseling, Seeman concluded that methods are not as important in accounting for differing client reactions as are the characteristics of "warmth, interest and understanding.”
Friedler compared three differently oriented groups of therapists with three groups of relatively inexperienced therapists. He found that, among the experienced therapists, personality and experience, rather than different methods, accounted for differences in therapeutic outcomes. This view is also supported by Brammer and Shostrom who wrote that, "the counselor must be free to move naturally, quickly and easily in his thinking and feeling in order to adapt to the subtle nuances of client behavior ."
In most cases, emotional disturbances are temporary, surface phenomena that require no more than the help and care of family and/or friends . However, if such disturbances occur repeatedly or are of a severe and more complex nature then expert help is called for. According to Hilgard, therapist is an expert whose resources of know­lege and experience are superior to that of the client. Typically then, the client relates his life's history and problems to the therapist so that the therapist can make appropriate recommenda­tions. In this way, the therapists role may somewhat resemble that of an educator; he interpretes facts and imparts information to the client that can help him in an indirect or direct fashion .
Disturbed persons need the help of someone who understands the psychodynamics underlying maladjustment and one of the three specialists in personality disorders should be consulted; a psychiatrist, psychoanalyst or clinical psychologist .
Psychiatrists are physicians who specialize in the diagnosis and treatment of mental illness. They have been trained to differentiate between the organic and psychological causes of personality disorders. Psychiatrists recognize the fact that an illness that manifests itself primarily in physical symptoms, such as headache or fatigue , may be caused or aggravated by emotional stress . Or, on the other hand, a patient who is emotionally disturbed may appear to be so due to an organic cause such as brain damage or chemical imbalance . Psychiatrists who specialize in the function of the nervous system are called nueropsychiatrists , and those that have been specially trained to perform operations involving the central nervous system are called neurosurgeons. A psychoanalyst is also a psychiatrist; however, he has had more extensive training in psychoanalysis and/or other special methods of treating personality disorders .
The clinical psychologist currently practicing in America must have earned a Ph.D. in clinical psychology from an accredited university and completed at least one year internship in a mental hospital or clinic .

"Efforts are now being made in many states to obtain licensing for qualified clinical psychologists in order to guard against quacks infiltrating the proffession . . .  In recent years an increasing number of clinics have been set up that maintain teams of prof1essionally trained people. The minimum staff of such a team consists of a clinical psychologist, psychiatrist , and a psychiatric social worker" (Lehner and Kube).






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