سندرم دی‌ماه؛ چارچوبی پیشنهادی برای ترومای جمعی — انگلیسی

Mr Peyman Bakhshayesh, MD, PhD, MBA

Original manuscript: 20 June 2026. Edited for web publication: 13 October 2026.

This edition preserves the original analytical horizon. Event reports and estimates refer to their stated source dates and should not be read as an update on conditions at the publication date.

Abstract

Background and objective: Following nationwide protests in Iran that began on 28 December 2025, credible human rights reports described a sudden escalation of lethal violence on 8 and 9 January 2026, corresponding to 18 and 19 Dey 1404, together with a widespread internet shutdown, the use of lethal weapons, an accumulation of bodies and pressure on victims' families. The pronounced divergence among official figures, name-based counts and media estimates, combined with the unresolved fate of many individuals, has created a complex psychological and social situation. This article aims to formulate, in a scientifically cautious manner, the proposed concept of "Dey Month Syndrome" to describe a cluster of individual and collective responses following extensive state violence.

Method: This article is an integrative narrative review that combines reports from the United Nations, human rights organisations and media outlets with explicit methodologies with scientific literature on collective trauma, post-traumatic stress disorder, prolonged and traumatic grief, ambiguous loss, moral injury, survivor guilt, secondary traumatic stress, continuous traumatic stress and media exposure to violence.

Conceptual findings: Dey Month Syndrome is not proposed as an independent diagnosis. It is defined instead as a context-specific framework comprising seven interwoven domains: re-experiencing and hypervigilance; insomnia and exhaustion; impaired concentration and rumination; traumatic grief and ambiguous loss; survivor guilt and moral injury; repeated digital exposure; and rupture of trust and collective identity. The intensity of this pattern may differ among direct survivors, bereaved families, injured people, clinicians and rescuers, activists, Iranians living abroad and children exposed to images and narratives. Evidence from Rwanda, Srebrenica, the attacks of 11 September 2001 and the Boston Marathon bombing indicates that the consequences of mass killing can persist for years and can spread through media exposure and collective memory even without direct physical exposure.

Conclusion: The term "Dey Month Syndrome" will have scientific value only if statistical exaggeration, collective diagnosis and the politicisation of clinical practice are avoided, and if the construct is validated through qualitative, longitudinal and psychometric research. Appropriate intervention should address safety, truth-seeking, the possibility of mourning, social connectedness, evidence-based treatment and the reduction of misplaced responsibility at the same time.

Keywords: collective trauma; Dey Month Syndrome; traumatic grief; ambiguous loss; moral injury; survivor guilt; continuous traumatic stress; Iran; Dey 1404.

1. Introduction and Research Question

Collective violence is not merely a collection of individual deaths and injuries. When large numbers of citizens are killed or injured within a short period, communications are cut, families are prevented from announcing names or holding mourning ceremonies, and society is left among fragmented images, rumours, hope and despair, an event can become a form of collective trauma. Collective trauma transforms not only individual mental health, but also a group's shared narrative, social trust, sense of safety, relationship to the homeland and image of the future [10].

For many Iranians, the events of 18 and 19 Dey 1404 had this quality. Some directly witnessed shootings, death, injury or arrest. Some lost loved ones or remained uncertain about their fate. Physicians, clinicians, activists and volunteers inside and outside Iran worked to assist injured people, transmit information and record names. Others repeatedly witnessed the event from a geographical distance through videos, interrupted telephone calls and uncertain lists. These differences show that a single term should not pathologise or homogenise everyone, but it may still be useful for studying a shared, context-specific pattern.

The principal research question is whether a scientific framework can be developed for the cluster of reactions following the killings of Dey 1404 without replacing formal diagnoses and without medicalising grief or political action. The subsidiary questions are: Which mechanisms constitute this framework? Which symptoms does it encompass? How does it overlap with recognised disorders or constructs? What lessons can be drawn from Rwanda and Srebrenica? How can the framework be tested in future studies?

2. Method

This is a conceptual article informed by an integrative narrative review, not a systematic review or meta-analysis. The original manuscript considered sources available up to 20 June 2026 in four areas: United Nations and human rights reports on the Iranian protests; the diagnostic literature of DSM-5-TR and ICD-11; research on collective trauma and related constructs; and empirical studies concerning Rwanda, Srebrenica, 11 September 2001 and the Boston Marathon bombing. Sources were selected for relevance to definition, mechanism, measurement or intervention. The approach does not establish exhaustive coverage or permit pooled estimates for Iran [1, 2, 3, 4, 8, 9].

No primary participant data were collected. The author's first-person account in Section 9 is used as a phenomenological and self-reflective illustration, not as epidemiological evidence or proof of prevalence. The article therefore cannot determine the frequency of the proposed syndrome, establish a causal relationship between political calls and psychological outcomes, or establish a final casualty figure.

3. Event Context and the Problem of Uncertainty

3.1. Documented Timeline

The protests began on 28 December 2025 following a severe fall in the value of the currency, inflation, and strikes and shop closures in Tehran's Grand Bazaar. They subsequently developed into widespread street protests. Amnesty International reported that internet access was extensively disrupted from 8 January 2026 and that the peak of the killings occurred mainly on 8 and 9 January. Human Rights Watch likewise described a coordinated intensification of repression after 8 January, the killing of thousands of protesters and bystanders, and severe restrictions on communications [1, 2].

The Independent International Fact-Finding Mission on the Islamic Republic of Iran reported that, on the night of 8 January, the presence of Basij forces, plain-clothes agents, special units of the Law Enforcement Command of the Islamic Republic of Iran and the Islamic Revolutionary Guard Corps increased at protest sites. According to credible information gathered by the Mission, women, older people and children were killed in at least nine provinces. Witnesses reported the use of shotguns with lethal ammunition, DShK heavy machine guns and military weapons. Gunshot wounds to victims' backs, faces, heads and chests were also documented [3].

At the political level, Donald Trump stated on 2 January that the United States would come to the aid of peaceful protesters if they were violently shot and killed. Reza Pahlavi also called on people to chant in coordination, either in the streets or from their homes, at 8 pm on 8 and 9 January. This context is relevant to understanding hope, feelings of abandonment, anger and guilt among some activists, but it does not by itself establish a simple causal relationship among the call, participation and the killings [5, 6].

3.2. Disagreement Over Casualty Figures

In the study of the psychological consequences of collective violence, statistical uncertainty is itself part of the harm. Not knowing who has been killed, disappeared, detained or injured obstructs the end of searching and the beginning of mourning. Pressure on families, the conditional release of bodies, restrictions on ceremonies and fear of retaliation further complicate the processes of naming and counting [1, 2, 3, 4].

Table 1. Range of reported casualty figures and the epistemic status of each figure as of 20 June 2026

Accordingly, this article uses the phrase "thousands killed" as a documented statement and presents higher figures only with their source and an explicit indication of uncertainty. The claim of participation by "millions" cannot be established in the absence of an independent count, although HRANA recorded protests in 203 cities across all 31 provinces [1, 4, 7].

4. Theoretical Foundations

4.1. Collective Trauma and Collective Memory

Collective trauma occurs when a violent event damages the identity and meaning structure of a group and its memory extends beyond the experiences of individual people. It can change the narrative of "who we are", the relationship between citizens and institutions, and expectations of the future. Remembrance, the naming of victims, anniversaries and mourning rituals all help transform an event into collective memory [10].

From this perspective, "Dey" is not merely a date. It can become a temporal and moral marker that evokes streets, hospitals, interrupted calls, incomplete lists of names and a prolonged sense of waiting. Naming can support meaning and preserve memory, but premature use can also reduce the complexity of diverse experiences to a single label.

4.2. Traumatic Grief, Ambiguous Loss and Disenfranchised Grief

Grief after a violent death is often accompanied by images of the death, anger, questions of justice and a sense that something remains unfinished. When the body is unavailable, the victim's identity is unconfirmed or a person's fate remains unknown, ambiguous loss may arise. In this condition, the boundary between presence and absence is unclear and the mind cannot bring the loss to psychological closure [17].

When a family cannot mourn freely, when the official account denies or distorts the death, or when society does not recognise the grief, mourning can become disenfranchised. Prohibition or restriction of ceremonies, pressure to repeat a government account and fear of publicly naming the dead can intensify this form of grief [2, 3, 18].

4.3. Survivor Guilt and Moral Injury

Survivor guilt includes thoughts such as "Why did I remain alive or safe?", "I should have done more" or "My action caused harm". Such thoughts are common after events in which others have been killed and may be associated with rumination, self-blame and post-traumatic stress symptoms [15, 16].

Moral injury is broader. It refers to enduring distress that follows committing, failing to prevent, witnessing or feeling betrayed in relation to events that violate a person's deeply held moral beliefs. The concept was first developed in military settings, but in civilian populations it has also been associated with shame, guilt, depression, post-traumatic symptoms and self-harming behaviour [12, 13, 14].

4.4. Continuous Traumatic Stress

Classical models of post-traumatic stress usually assume that the principal danger belongs to the past. This assumption is insufficient when arrest, surveillance, threats to families, execution, communication blackouts and the possibility of renewed violence continue. The concept of continuous traumatic stress was proposed for life under real, ongoing and unpredictable danger [20, 21].

In such circumstances, hypervigilance is not always a perceptual error because part of the danger is real. The purpose of treatment cannot simply be to convince a person that they are safe. Intervention must distinguish adaptive vigilance from exhaustion caused by constant monitoring, and it must address practical safety alongside psychological regulation.

4.5. Media and Digital Trauma

Research following the Boston Marathon bombing found an association between repeated exposure to distressing media and acute stress; in that study, extensive media exposure was more strongly associated with acute stress than direct exposure. This observational finding does not establish that viewing images causes PTSD or that remote exposure is generally more harmful than direct exposure. Longitudinal research also suggests a reciprocal cycle in which distress predicts greater news consumption and further exposure predicts later distress [22, 23].

For some Iranians living abroad, mobile phones and social media can be both tools for assistance and channels of distressing exposure. Repeatedly reviewing videos, searching for names, waiting for internet connections to resume and feeling obliged to respond immediately may disrupt sleep, concentration and the boundary between personal life and national crisis. Studies following 11 September showed psychological distress beyond those physically present at the attack sites. Distress after media exposure should be taken seriously, but it does not by itself establish a PTSD diagnosis or satisfy every diagnostic exposure requirement [9, 24, 25].

5. Proposed Definition of "Dey Month Syndrome"

The word "syndrome" is used here to mean a co-occurring set of signs and processes, not an established disease category. This construct is not included in DSM-5-TR or ICD-11 and must not replace diagnoses such as acute stress disorder, post-traumatic stress disorder, complex post-traumatic stress disorder, prolonged grief disorder, depression, anxiety or adjustment disorder [8, 9].

The proposed distinguishing feature of the framework is its simultaneous connection of four layers: a political and collective event; loss and grief; moral conflict and perceived responsibility; and continuing threat and media exposure. None of these layers is unique to Dey, but their combination may be useful for research on this particular historical experience.

6. Symptom Domains and Manifestations

Table 2. Principal symptom domains in the proposed framework

6.1. Insomnia, Increased Activity and the Boundary With Mania

Insomnia, fatigue and restlessness are common after a severe collective event. Some people remain active for long periods to provide help, obtain information or document events. This form of crisis-driven overactivity may be an attempt to preserve control and meaning and does not necessarily indicate mania. However, a sustained reduced need for sleep without fatigue, markedly elevated or irritable mood, pressured speech, racing thoughts, grandiosity and risky behaviour require urgent clinical assessment. This distinction is especially important when a person has slept almost not at all for several consecutive nights.

6.2. Warning Signs Requiring Urgent Assessment

Suicidal thoughts, self-harm, or a belief that the person does not deserve to have survived.

Inability to sleep for several nights together with severe agitation, dangerous behaviour, or signs of mania or psychosis.

Repeated panic attacks, severe dissociation, inability to perform basic self-care, or escalating use of alcohol or other substances.

A real security threat, surveillance, detention, domestic violence, or risk to a child or vulnerable person.

7. Exposed Groups and Moderating Factors

Exposure to an event occurs in different forms. Symptom intensity is usually not determined by direct observation alone. It interacts with loss, emotional proximity, previous trauma, social support, current safety, the degree of uncertainty and media exposure. Research and services should distinguish among the following groups:

1) Direct survivors, injured people and witnesses to shootings or death.

2) Bereaved families, families of missing people, and those who have not received a body or reliable information.

3) Physicians, nurses, psychologists, rescuers, documenters and volunteers who have repeatedly encountered distressing accounts. This group is at risk of secondary traumatic stress and burnout [19].

4) Activists and public figures who encouraged participation, coordination or resistance and who developed perceived responsibility or moral injury after the killings.

5) Iranians living abroad who were physically safer but psychologically present in the crisis through family, professional networks and media.

6) Children and adolescents exposed to images, parental fear, family bereavement or loss of communication with relatives.

7) People with a history of trauma, depression, anxiety, sleep disorder, physical illness or limited social support.

Conversely, social connectedness, the possibility of effective but bounded action, mourning rituals, a coherent narrative, a sense of safety, access to treatment and realistic hope may be protective. Research on resilience indicates that many people do not follow a trajectory of chronic illness after trauma. The Dey framework should therefore not automatically classify natural reactions, resistance or the reconstruction of meaning as disorder [11, 33].

8. Differentiation From Existing Diagnoses and Constructs

Table 3. Relationship of "Dey Month Syndrome" to adjacent clinical and research concepts

9. The Author's Self-Reflective Account

During the first days after the killings, I experienced insomnia and prolonged wakefulness. I wrote letters, made contacts, coordinated work, helped form specialist groups to assist injured people in Iran and continuously followed the news. Alongside this activity came a heavy sense of guilt: because people inside Iran had been encouraged to act together, I felt that their deaths were somehow connected to those of us who had supported the calls, or that they had been killed “because of us” in the struggle for our country’s freedom. This records a feeling I experienced, not a finding about causation or legal responsibility.

One possible interpretation of this experience involves overestimated responsibility and counterfactual thinking. After catastrophe, the mind returns to imagined alternatives: if no call had been made, if external support had arrived, or if another warning had been given, would people have survived? Such questions deserve honest political reflection, but definitive answers may be unavailable. Support should respect political commitment while distinguishing actual influence, perceived responsibility and the responsibility of those who ordered or carried out unlawful violence. This distinction neither supplies a retrospective diagnosis of the author nor substitutes for independent investigation [12, 15, 16].

Creating aid groups and pursuing treatment for injured people can be a meaningful and reparative response because it transforms helplessness into action. However, when helping becomes an internal compulsion, eliminates sleep, disregards personal health or becomes a form of self-punishment, the risk of burnout and secondary traumatic stress increases. Sustainable action requires rest, shared responsibility and acceptance of the limits of individual capacity.

10. International Comparative Examples

Historical comparison should not produce moral or numerical equivalence among events. Its purpose is to identify shared psychological patterns following concentrated killing, extensive loss, difficulty with burial and mourning, media circulation of violence and collective reconstruction.

Table 4. Comparative evidence and its implications for the study of Dey

10.1. Rwanda

The United Nations describes the Rwandan genocide as organised killing over a period of close to 100 days. Studies conducted years later showed that the intensity of exposure to violence was associated with PTSD symptoms and attitudes toward justice and reconciliation. In the survey by Pham and colleagues, 24.8 percent of the sample met symptom criteria for PTSD. A meta-analysis estimated pooled PTSD prevalence in the Rwandan population after the genocide at approximately 25 percent, although differences in methods and samples produced a wide range of results [26, 27, 44].

Studies of widowed and orphaned survivors found substantial trauma-spectrum and prolonged grief difficulties. Psychological effects were not confined to the original generation, and differing psychological symptoms and social conditions were reported in survivors' families [28, 29, 30]. These findings indicate that justice, memorialisation, economic support and psychological treatment are not separate components.

10.2. Srebrenica

In July 1995, more than 8,000 Bosnian men and boys were systematically killed in Srebrenica. Subsequent research indicated that childhood exposure could be associated with more severe PTSD symptoms during adolescence. A qualitative study of burial at Potocari also showed that the place of burial and memorialisation shapes the connection among home, identity, grief and reconstruction [31, 32, 45].

For Iran, this experience underlines the importance of securely recording names, identifying bodies, protecting each family's right to choose the place and form of burial, preserving evidence and creating memorials trusted by families. Obstruction of mourning is not only a civil restriction. It can also prolong psychological suffering.

10.3. 11 September and Boston

After 11 September, psychological symptoms were reported among people who had not necessarily been at the immediate site of the attack. After Boston, extensive media exposure was associated with acute stress. These studies support the concept of the "digital witness", a person who encounters violence through media and may experience genuine and disabling symptoms [22, 23, 24, 25].

11. Proposed Conceptual Model

Conceptual Figure 1. Possible pathways in the development and maintenance of Dey Month Syndrome

This model assumes that symptoms do not arise from a single cause. Insomnia, for example, may result from hypervigilance, night-time aid work or media consumption, while also intensifying guilt. Grief and anger may lead to civic action and social connectedness in some people and to isolation or exhaustion in others. Research should therefore examine multiple pathways.

12. Testable Hypotheses

1) Greater direct exposure, close bereavement and witnessing death will be positively associated with intrusion, arousal and sleep disturbance.

2) Perceived responsibility and moral betrayal will predict guilt, shame and functional impairment even after the intensity of exposure is controlled.

3) Repeated and unrestricted media exposure will strengthen the relationship between informational uncertainty and insomnia or anxiety.

4) Real and continuing danger inside Iran will make a continuous traumatic stress pattern more prominent than a purely post-traumatic pattern.

5) The possibility of mourning, credible registration of names, social support, bounded meaningful action and collective efficacy will be associated with better outcomes.

6) The factor structure of the framework will not be identical inside Iran and in the diaspora, and measurement invariance should be tested before comparing groups.

13. Research Programme and Operationalisation

13.1. Proposed Design

A multi-stage programme is proposed to validate the concept. The first stage should include secure, in-depth qualitative interviews with groups experiencing different forms of exposure, so that local language, lived experience and possible domains can be identified without imposing a predetermined framework. The second stage should include development of an item bank, assessment of content validity by specialists and people with lived experience, and cognitive testing of translations. The third stage should examine exploratory and confirmatory factor analysis, reliability, convergent and discriminant validity, and sensitivity to change.

A longitudinal study with follow-up at one, three, six, twelve and twenty-four months after enrolment could identify recovery, persistence or recurrence around anniversaries. The interval from the original exposure must also be recorded. Sampling should include direct survivors, families, injured people, clinicians and rescuers, activists, the diaspora and an appropriate comparison group. Any new study would require independent ethical review, a credible security plan and referral arrangements. Identifying information should be minimised, consent must be genuinely informed, and participants must be free to stop without disadvantage. No claim of complete digital safety should be made.

13.2. Proposed Measurement Instruments

The proposed framework should not begin with a raw total score and a premature diagnostic cut-off. Initially, its domains should be assessed alongside validated instruments: the PCL-5 for PTSD symptoms, the ITQ for ICD-11 PTSD and complex PTSD, the Insomnia Severity Index, the PG-13-R for prolonged grief, the PHQ-9 for depression and the GAD-7 for anxiety [38, 39, 40, 41, 42, 43]. Validated scales or carefully developed and validated items should also address moral injury, trauma-related guilt, media exposure, present safety and social functioning.

The proposed "Dey Experience Research Form" should initially be modular and assess the following domains separately: type and intensity of exposure; communication disruption and uncertainty; grief and unresolved status; perceived responsibility; moral injury; media exposure; ongoing danger; sleep and trauma symptoms; aid or political activity; social support; and functional impairment. Only after the structure has been replicated in independent samples should investigators judge whether a unified construct exists.

14. Clinical and Public Health Implications

14.1. Principles for Immediate and Medium-Term Intervention

Consensus on intervention after mass trauma emphasises five principles: strengthening a sense of safety, calming, individual and collective efficacy, social connectedness and hope. Psychological first aid should be humane, practical, non-coercive and culturally appropriate. This means listening without forcing people to recount events, addressing immediate needs, connecting people with support and protecting them from further harm [11, 34, 35].

Safety and truth: Reduce danger, provide access to credible information, register and trace missing people, and provide legal support for families.

Sleep and regulation: Create shift systems for volunteers, reduce news consumption at night, obtain medical care for severe insomnia, and maintain nutrition and movement.

Grief and memorialisation: Enable safe mourning, naming, culturally meaningful rituals and memorials trusted by families.

Support concerning moral responsibility: Examine the person's contribution realistically, distinguish capacity from control, and challenge self-punishment without invalidating political and moral values.

Stepped care: Provide general support for all, targeted intervention for symptomatic people, and specialist treatment for persistent disorder or high risk.

Support for helpers: Provide professional supervision, distribute responsibility, require rest, establish peer support and ensure confidential access to treatment.

14.2. Specialist Treatments

For people who meet criteria for recognised disorders, care should follow individual assessment, preferences and the relevant evidence. Trauma-focused cognitive behavioural therapies and eye movement desensitisation and reprocessing are recommended options for appropriate patients with PTSD. Grief-specific care, treatment for depression or anxiety and approaches that address guilt or moral injury may also be indicated. Age, timing, impairment, risk, current threat and the feasibility of safe contact matter. The proposed Dey framework is not a treatment protocol [8, 9, 36, 46].

People should not be compelled to recount traumatic events or undergo a psychologically focused debriefing intended to prevent PTSD. The Cochrane review found no preventive benefit from routine single-session debriefing and identified potential harm; NICE also recommends against psychologically focused debriefing for prevention or treatment. This is different from voluntary practical support, psychological first aid or an appropriately indicated course of therapy [37, 46].

14.3. Brief Guidance for Activists and the Diaspora

1) Convert responsibility into specific, bounded tasks that can be delegated. An unlimited duty leads to exhaustion.

2) Set defined periods for checking news and avoid highly disturbing images before sleep.

3) Assign at least one person to monitor team welfare, sleep, food and stopping work. Care for the helper is part of the mission.

4) Distinguish between "I wish the outcome had been different" and "I caused the killings".

5) Seek urgent professional assessment for suicidal thoughts, severe insomnia, signs of mania, psychosis or hazardous substance use.

15. Ethical, Political and Conceptual Considerations

First, naming a syndrome must not reduce the legal and political responsibility for killing to medical language. Treatment of symptoms is not a substitute for truth-seeking, accountability, reparation and preservation of evidence. Second, grief, anger, protest and remembrance are not necessarily signs of illness. Medicalising resistance can silence legitimate civic experience.

Third, the term "Dey Month Syndrome" should be used inclusively and without political exclusivity. Victims' experiences may differ by ethnicity, gender, city, political orientation, age and form of exposure. No single political narrative should be a condition for recognising suffering. Fourth, use of a victim's name, image, medical record or family account without consent and risk assessment may cause further harm.

Fifth, this framework cannot establish a casualty total. The psychological effects of uncertainty can be studied, but a reliable count requires independent documentation, forensic work and access to records. Unattributed public estimates, including figures of 40,000 to 50,000, are not adopted as evidence in this article. They must not be treated as equivalent to named-case documentation or presented as confirmed findings.

16. Limitations

The first limitation is that the crisis is continuing and the data remain incomplete. Internet shutdowns, security pressure, selection bias in testimony, difficulty accessing medical records and differences among counting methods prevent a definitive estimate. The second limitation is the absence of direct psychometric data from the population under discussion. The proposed domains are therefore derived from theoretical synthesis and comparative examples and do not yet have empirical validity.

The third limitation is broad overlap with existing constructs. Future research may show that the combination of PTSD, prolonged grief, moral injury and continuous traumatic stress adequately explains the experience and that a new title adds no value. The fourth limitation is the author's political position and personal experience, which may influence the selection and interpretation of concepts. Explicitly stating this position is part of methodological transparency.

17. Conclusion

For people affected by Dey 1404, the violence could represent a rupture in safety, trust, mourning and the imagined future. Insomnia, exhaustion, distractibility, anxiety, anger, guilt, relentless aid activity, continuous news consumption and social disconnection may be understandable reactions. Some people recover while continuing to act and find solidarity; others develop persistent, disabling difficulties. This article has no population data from which to estimate how common any trajectory is.

At best, "Dey Month Syndrome" is a provisional name for asking a scientific and ethical question: How does a society live after concentrated killing, statistical uncertainty, obstruction of mourning and a sense of collective responsibility? The value of the concept lies not in adding a disease label, but in connecting mental health with truth, justice, memory, safety and realistic responsibility. Whether the concept is established or discarded should be determined by data, survivor participation and scientific review.

Article Declarations

Ethics and study status: No primary participant study or new research dataset is reported. The proposed future studies would require their own ethical and security review.

Consent for publication: The first-person account concerns the author and has been included by his own decision.

Competing interests: The author reports no financial competing interests. The author's political position and intellectual involvement are disclosed in the text as potential influences on interpretation.

Funding: This article was prepared without dedicated financial support.

Data availability: No research dataset was generated. All sources used are identified in the reference list.

Authorship: The concepts, political position and personal account are those of Mr Peyman Bakhshayesh, MD, PhD, MBA. This website edition has been edited for clarity, source attribution and the distinction between a research proposal and a clinical diagnosis.

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