Introduction to Dr. Sherif Darwish by Richard Hill

I first met Dr. Sherif Darwish at a conference in Switzerland, in 2010. We spoke about a difficult case and have continued our connection to this day. Dr. Darwish is based in Alexandria, Egypt. He is a champion for those troubled by addiction. When he found that recovered addicts, after discharge from the hospital, had nowhere to find ongoing help, he opened the Recovery Center. This centre has become a fundamental element in the battle against addiction in Egypt.

Before Dr. Darwish tells his story, I want to share what I consider one of the most uplifting and insightful stories from the Recovery Center. During the political upheaval of the Egyptian Spring, Sherif told me that the police disappeared, leaving only the military who were not concerned with general law and order, and local neighbourhoods organised their own checkpoints to help protect their local communities. Unfortunately, the loss of law enforcement was an open door to drug merchants. Sherif could see that they were setting up near to the neighbourhood checkpoints, and the whole situation seemed to spell a recipe for disaster. To his surprise, none of the recovered addicts from the Recovery Center relapsed. When he finally asked them what this was all about, the universal answer could be summarised as, “We did not relapse because what we were doing to protect our families and community was too important.”

I invite you to contemplate that sentiment as you read about this wonderful doctor.

NPT: What was the path that brought you to psychiatry? And where did you begin your residency?

SD: My first target as a specialty was cardiology. In a very strange incident of fate, all my papers were lost in the Ministry of Health and I had to apply for another job. At that point I decided to shift to psychiatry.

An important motivation was the hospital where I would be training. Mamoura Hospital for Psychiatry and Addiction is the largest Ministry of Health hospital in northern Egypt. There are about 1,000 psychiatry and addiction inpatient beds and an outpatient clinic that covers some 400 patients per day. I still remember my first day when I stood in the middle of the very long corridor of the wards and how intimidating it was. Yet, in less than a year, I was playing football with the patients and having friendly conversations with them. This taught me much more than any textbook.

My passion for psychiatry grew day after day. I could see it clearly. Every person is different, and managing each case is like taking a journey in human experiences and lives. It is not only challenging on the professional level but also very nourishing on the personal level.

NPT: Why did you start the Recovery Center? What is your experience working with addicts and recovered addicts?

SD: Unfortunately, our country has a very big problem with drug addiction. When I first chose to work with addicts, treatment was ineffective, the relapse rate was very high, Narcotics Anonymous (NA) meetings were not popular, and unethical practices were everywhere.

In 2003, when I first decided to work on addiction treatment as a subspecialty, I felt that the stigma of addiction was a problem and addiction treatments were largely ineffective.

Working closely with addicts and listening to their stories and experiences made me believe that people, when they are given a true second chance and treatment, can really change.

I believe it is our responsibility as therapists to provide patients with good therapy and really believe they can change. This empowers them and helps them achieve abstinence. Using, or not using, drugs is just a symptom of the bigger problem of dependency. Working with people to stop their drug-taking without them also changing their way of thinking and their own lives will always result in relapses.

Although this makes our job much harder, it also makes it much more rewarding. The community we have built grows day by day, and this allows us to support more people and promote the idea of recovery and true change. Many of our patients have their own families now, and they consider us very much a part of these families.

NPT: In your experience has an understanding of neurobiology helped you in your practice/ research?

SD: The understanding of neurobiology and linking it to the practice of psychotherapy and rehabilitation has been very helpful. It helps us make more sense of what is happening in the patient, and also helps us to see ahead. This allows us to explain to the patients what to expect next, how they are going to feel, and explain their behaviour in a scientific way. One of the most enjoyable groups is when I share a simplified explanation of a neurobiological theory. The participants usually reflect on the theory and explain their own behaviours and feelings, and this process helps me to develop a very deep understanding of the neurobiology.

From a medical perspective, neurobiology raises questions that need to be answered. Can we track the progress of the patients by functional imaging? Can we do brain stimulation that can potentiate the executive functions? Is there a neurobiological abnormality that hinders the learning capabilities of these patients? These are some of the questions that I would like to find answers to through neurobiological studies.

NPT: Can you tell us about theories and philosophies that have most impacted your work?

SD: I come from a cognitive background. Five years ago I stated training and understanding object relation therapy. My dynamic therapy supervisor always tells me that one needs to have a general theory about the origin of mental illnesses. Hers is that mental illness manifests when one loses faith in the good quality of human relationships. This understanding has added a lot to my practice, and I now have my own philosophy towards mental illness. I believe that people start to suffer when they cannot accept their personal limitations and weaknesses. This pushes them to blame themselves as in depression, or blame the world as in paranoid schizophrenia, or use drugs to cover their limitations, and so on. Through therapy I always try to make people accept their limitations and embrace them. The work of Brené Brown on vulnerability has had an important impact on my understanding of how we suffer a lot.

NPT: What are you working in currently?

SD: Currently I am working on several different projects. We are opening our new branch of the Recovery Center, and this is taking a lot of my effort. Secondly, I am leading a small team to make Arabic infographics for psychoeducation for the public. Thirdly, we are in the middle of a year-long addiction treatment course in Alexandria, Egypt. And lastly, I am trying to write a book about some of the insights and understanding I have gained about the process of change in relation to addictive behaviour and patterns of interpersonal relationships.

NPT: If there was one thing you would like to impart to a new psychiatrist or psychotherapist, what would it be?

SD: I think the first thing is a great saying from one of my mentors: “Therapy is the therapist.” Understanding and mastering the techniques of therapy is a great thing, but the core of therapeutic power comes from you as a therapist. You impact your patient more than any technique. It is your soul that heals theirs. Your attention, your presence, your moves, your attitude, your readings and culture, and even your stories, are your real power. Your relationship with your client is the bridge that he or she will cross to regain faith in their relationships with the world.

This means that healing ourselves is a non-negotiable condition before you can effectively heal others. You always need a clear mirror in order to be empathic and reflect your patient’s thoughts and emotions.

Psychotherapy is a very powerful and strong tool, yet it can also be a very dangerous one. When you are skilled enough, you can really change people lives, sometimes with a sentence, so we must be careful where we are going and where we are taking our patients.

Finally, always see God in your practice. Nothing comes by chance. Slips of the tongue and other small things that happen in the patient’s life can give meaning to things. Observe these things carefully and link them to both the therapy and the neurobiology. This will give you a deeper understanding towards your practice and your clients, and even to the world.

NPT: What’s ahead for the next 12 months?

SD: I have a dream that 2018 will be my year for international experience. I am looking forward to two main goals. The first is to obtain work experience in the United Kingdom or in Australia for a period of time. I feel I need to learn more and to explore more about practices outside of Egypt. I would like to propose some kind of a roundtable discussion on practice dilemmas around the world and share our experiences and stories of treatment. My other goal for this year is to establish partnerships between the Recovery Center, which is an Egyptian, Middle Eastern treatment centre that comes from an Arabic, Egyptian, Islamic culture, and other western treatment centres that have different cultural perspectives.

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