Past, Present and Future of the Maghrebian Psychiatry

Driss Moussaoui, M.D.

Maghrebian Psychiatry (Algeria, Libya, Morocco and Tunisia) has a multisecular history, like in other Arab-speaking countries. Medical doctors such as Ibn Rushd, Ibn Tofail and Maimonides in Morocco, as well as Ibn Al Jazzar and Ishak Ibn Omrane in Tunisia, were also philosophers in the wide concept of « Hakim ». Ishak Ibn Umrane wrote an Epistle on Melancholia in the Xth Century, probably the oldest book in Psychiatry, and Abou Marouane Ibn Zohr in Morocco wrote chapters on Neurology and Psychiatry. Institutions called “Maristans” in all big cities, played a role in treating mental patients during the Middle Ages, especially “Sidi Frej Maristan” built in Fez, Morocco during the 13^th Century.

Modern Psychiatry was introduced in the Maghrebian countries by the French colonization/Protectorate, and created a special school of Psychiatry in Algiers in the first half of the XXth Century with Antoine Porot and his team. Asylums were constructed in La Manouba (Tunis), Blida (Algiers) and Berrechid (Casablanca). The first Maghrebian psychiatrists graduated in the 1960s in Tunisia and Algeria and in the 1970s in Morocco. Lybia had psychiatrists later on, mainly trained in Eastern Germany. At present, there are about 3,000 psychiatrists in the 3 main Maghrebian countries.
The future is full of challenges : Child Psychiatry is just at its beginning, problems of stigma and discrimination are not yet addressed, Geriatric Psychiatry is non-existent, Addiction medicine, despite a few progress, is at its preface, and the huge problem of access to care in mental health is still an unclimbed mountain, including for victims of civil war in Algeria, migration crisis in Tunisia and consequences of disasters in Morocco and Libya. The private sector is also structuring itself.

These problems are, of course, universal but they hamper the social development of these countries. Still, there are a lot of opportunities for real progress from good teams in the whole region.