(Written in 1997 for the Bulletin of the International Association of Child and Adolescent Psychiatry and Allied Professions) 

More than one-third of Turkey’s sixty million people are children and adolescents. To many, Turkey may be known as a tourist destination or as a country entangled in escalating political and economic turmoil. But beyond these impressions, daily life for ordinary people has its own twists and turns. 

“It’s like a Turkish film,” an Israeli friend once told me—a phrase used in Israel when life feels like a never-ending sequence of coincidental and accidental suffering, followed by equally surprising recoveries. In those films, misfortune never seems to end for ordinary people; lovers remain separated, and resolution arrives only after prolonged chaos. And yet, most children and adults in Turkey manage to survive these “dramas” with a remarkable and often hard-to-imagine capacity for adaptation and resilience. Real life here often feels just like those films. 

Over the past 75 years, Turkey has undergone profound shifts in its social fabric. Following an accelerated Westernization process in the 1920s, rapid economic and social changes—particularly since the 1950s—triggered large-scale migration from rural to urban areas, dramatically reversing the urban/rural population ratio (now approximately 70/30). The health care system, historically split between government-run hospitals and private offices, failed to keep pace with societal needs and became increasingly inadequate. 

Despite sustained efforts since the 1960s to improve health care—especially for mothers and children—frequent policy shifts, alongside mounting social and economic issues, have undermined progress. By the 1980s, infant mortality had decreased to 63 per 1,000 live births (down from 154 in the 1970s), and immunization rates reached 90%. The number of medical schools grew (29 by 1994), and medical school graduates numbered around 5,000 annually. However, gains in health care delivery have not always matched these numerical increases, especially given the uneven distribution of national wealth. Mental health services, in particular, remain inconsistently provided across different social strata—and children’s mental health needs have been almost entirely absent from national health planning. 

As a result, child psychiatry has remained a low-priority field. The vast majority of children and adolescents in Turkey do not receive any mental health care. Is child psychiatry—and child mental health as a whole—unknown to policymakers? 

In fact, the concept of child psychiatry in Turkey dates back to the establishment of the first child protection agency in 1911. At that time, care for children with emotional and behavioral difficulties fell within the scope of neuropsychiatrists (the official title for physicians trained in both neurology and psychiatry). One notable figure from that era, Dr. E.K. Gökay, appears among the founding members of IACAPAP. 

Yet despite this early practical history, child psychiatry was not formally considered a psychiatric subspecialty or academic discipline until the 1960s. A few pioneering Turkish psychiatrists—such as Drs. M. Öztürk, A. Yörükoğlu, and R. Cebiroğlu—trained in the U.S. in the 1950s and went on to establish academic departments in Istanbul and Ankara. Their work, along with growing public interest in children’s emotional well-being, laid the groundwork for official recognition. One of the most influential figures, Dr. A. Yörükoğlu, became a household name in urban Turkey. His books sold hundreds of thousands of copies, and his regular TV appearances earned him the affectionate nickname “the behavior doctor” among children. 

Child psychiatrists in Turkey have almost exclusively worked in medical schools and training hospitals, within the public sector. Despite formal recognition of the field nearly three decades ago, the number of child psychiatry trainees has remained extremely low. As of January 1995, the Turkish Association of Child and Adolescent Mental Health reported only 35 members—including trainees. Currently, there are ten academic child psychiatry divisions in medical schools. However, these divisions often lack the personnel and financial resources they need. 

Until recently, child psychiatry residency programs only accepted candidates who had already completed four years of adult psychiatry training (which included a six-month rotation in child psychiatry). Due to changes in national regulations and academic requirements, programs have now begun selecting trainees directly from medical school graduates via the national residency matching exam. Under the new system, child psychiatry training includes 24 months of child and adolescent psychiatry, 18 months of general psychiatry, and 6 months of child neurology, followed by a certification exam. This reform is expected to reduce the total training time from six years to four, thereby increasing the appeal of the specialty. 

In recent years, psychiatry has gained popularity among medical graduates in Turkey. Psychodynamic concepts and social perspectives on mental illness have drawn considerable interest from younger psychiatrists. Many residents, disillusioned by the limited focus on psychodynamic approaches in their general psychiatry training, see child psychiatry as a field that preserves a more “balanced” view of mental disorders. For these reasons—whether by choice or by contrast—child psychiatry has become increasingly attractive. 

Still, these positive perceptions have not been enough to accelerate the field’s growth. Turkey faces several specific obstacles in expanding child mental health services: 

First, child psychiatrists often work alone. The number of trained clinical child psychologists, social workers, school psychologists, special education teachers, and child therapists is extremely low. 

Second, existing human resources and institutional potential are not fully utilized. Service systems are fragmented, and collaboration across disciplines is difficult to establish or sustain, often due to bureaucratic barriers. 

Third—and perhaps most crucially—child mental health remains absent from the immediate priorities of national health policy. 

As a result, child psychiatrists in Turkey are often expected to take on a wide range of responsibilities beyond traditional medical roles: they may serve as patient advocates, teachers, and community liaisons. They typically work in close partnership with families, though not always with the authority or resources to fully support them. Fortunately, family systems in Turkey—despite significant shifts in social structure—have remained relatively intact and continue to play a central role in children’s care. 

Looking ahead, the provision of mental health care for the majority of Turkey’s population will continue to depend heavily on public funding and governmental policy. Unfortunately, children’s mental health remains a low priority in those policies. In this context, child psychiatrists share the same marginalized position as the families they serve. 

And, much like the characters in Turkish films, child psychiatrists often find themselves relying on internal dynamics—spontaneous, sometimes miraculous shifts beyond one’s control—to carry their work forward. There is still a strong belief in human resilience and adaptability. The next step must be to move beyond merely surviving the system, toward building a new one—one that reflects what these children, families, and professionals truly need.