(1991) I was an adult psychiatry resident at the time of this writing, about 25 years ago. Later on, I moved to the US where I finished my fellowship in child and adolescent psychiatry along with a research training. I was fortunate to work with pioneers in the field who could bring together both ends of the field, neuroscience and developmental psychoanalytic thinking (namely, Donald Cohen, James Leckman among many others)
Until recent years, whenever a resident or a candidate for a residency program in Turkey pronounced the word “psychotherapy”, all but few members of the senior staff have considered them as unaware of the huge changes in neuroscience which, they thought, made “such fanciful thinking” unfashionable. However, even before the time of neurobiological revolution and its impact on the on the practice of psychiatry, psychotherapies were not accounted as an essential part of the psychiatric therapeutics, with the exception of minor problems believed not deserving the attention of a medical expert. This negligence or ignorance about psychotherapy may be seen as a part of the predominating ideology in this era. The leading figures of Turkish psychiatry, including Mazhar Osman, a close associate of Emil Kraepelin, had been trained in a so-called “organic” and descriptive approach, and the continental European influence has been felt during the development of Turkish psychiatry, throughout the first half of the twentieth century.
Besides this “ideological” predetermination, there is a common belief that Turkish people are fond of the medical approach, which seems the mode of professional concern with the easiest access. Despite the validations of this belief throughout the average medical practice, it often becomes an alibi for neglecting the vacuum due to the absence of a therapeutic approach. Some of the psychiatrists, trained in the clinics which have tutors with psychodynamic orientation on their staff, do not share this belief depending on their experience in the rural parts of Turkey at various times. They claim that they have been able to maintain even private practice in towns where, “therapy” or “talking” treatment” have not ever been heard of, but talking about the problems was an essential part of their treatments. They frequently emphasize the naïve and non-defensive expressiveness of the rural people, which is claimed to be of help in facilitating the therapeutic processes.
Now, the time has changed and people know the name of the talking treatment and they demand it. A demented patient asks a better way to cope with the losses she had to face. Another patient says, “I, myself, want to do something for this,” while he shakes just after a terrifying panic attack. Demented or panicky, depressed or remitted schizophrenic, hypertensive or Parkinsonian, many people with a variety of problems that make them miserable, are in search of a tool or technique that includes their participation. The time has changed and shrunk since the old days, and even the patient from the most rural part is hurrying. The traditional search for a remedy facilitates this impatience, an “intermittent” characteristic of the majority living in Turkey, which appears in traffic, in bed, and in the doctor’s office.
This made the way for cognitive and behavioral techniques, which in fact, seemed familiar and logical to a number of psychiatrists. Perhaps, the concreteness of these techniques and their links with the “common sense” enhanced this sympathy. However, one cannot take himself from thinking that a considerable number of psychiatrists assume themselves as the representative of common sense, and thus become external common sense for the patients (which the patients, indeed, may need at times). A professor with the so-called “organic” approach, claims frankly at a meeting that they have already been doing cognitive-behavioral therapy without being aware of it, and adds, “so, what is new about all this stuff?” it is certain that “something psychodynamic” should have taken place between him and his patients, but he still was not aware of it.
A professor of psychiatry from Kentucky had told me that the psychodynamic psychiatry and psychotherapy courses and seminars in most of the departments (in US) were not very popular among the residents any longer. And at this point, I believe, the difference beyond the similarities between Turkey and USA shows up. Both countries seem under the same sort of time and financial pressure for prescription of short-term, practical remedies.
The similarities between the USA and Turkey are in appearance and not well-rooted. In USA, there is a “used to” period inherent to the common pasts of the biological, cognitive or behavioral psychiatrists. This period, “the age of psychotherapy”, is absent in the professional past of most of the psychiatrists in Turkey.
Now, in Turkey, a greater number of residents and junior psychiatrists are chasing this age of psychotherapy (let me call it “the lost age”) in a hurry. The few senior psychiatrists with psychodynamic orientation, most of whom have received their training in the eminent North American centers of 1950s and 1960s, are under great pressure for spreading their knowledge and experience. The recent national congresses of psychiatry have turned out to be forums for a better training in psychiatry, with a particular emphasis on psychotherapy. The voices get louder as the “chasers” long for the lost age and accuse the tutors for keeping them away, while the tutors (who indeed might have kept away) nod their heads and you can hear them saying “it was not the proper time”.
Now, at a period of increased democratization in the Turkish political system, for vocalization of inner thoughts and feelings with absolute freedom, it seems the time. Patients want to talk and to be listened to while the treating doctors appear to be not properly prepared or trained for this service. Indeed, the polyphonization in the atmosphere of Turkish public life seems to take the form of a “confession epidemic” in the lives of patients among other members of the community. One may notice the liberal character of the Turkish chaser for the lost psychotherapy age, which I believe to contain profound links with the new democratization wave throughout the country. The chaser aims to possess the necessary equipment of psychodynamics, in order to build up his own (biological, cognitive or whatever) way resonating with the needs of the society and the individuals, and his enthusiasms and ambitions. As T.B. Karasu cited from Robert Burton, in the monograph on the psychotherapy of depression, the psychiatrist “will have to be a Magician, a Chemist, a Philosopher, an Astrologer”. This may be why the chaser is a chaser…