The Mental Health Stigma in the Arab Community
I sit on the low, outstretched couches housed in Siti’s, my grandmother’s, seemingly dim-lit majlis, your typical sitting area in an Arab household. My legs hang atop vibrant, colorful fabric etched in floral patterns. I fiddle with my phone, glaring extensively at the new, bright LED spotlights my uncle had installed before he went overseas. They’d replaced a chandelier older than Siti’s first grandchild. I squint as my pupils enlarge, as I note the look of the lights, and as I realize that they look too modern for such a sitting. However, my chest tightens as I realize something more. These lights are somewhat paradoxical, almost metaphorical to the current situations that take place at Siti’s house.
You see, Siti is the caregiver to my four cousins whom witnessed their parents’ divorce right before their eyes. If you ask them, they still recall the day their mother left, the day they came back from school and were taken by hand, by Siti, to the local toy store in Ramallah, Palestine. It was innocent, a reward for completing another year of elementary school. They hadn’t known it would foreshadow the coming days.
The youngest, Mohammad, was always a happy, rowdy child. He’d been hurt the most.
He was still a toddler, just out of diapers, at the time. The separation had blown out his fire, extinguished the last of his legitimate smiles. The now Kindergartner sits next to me, the prayer mat Siti had neatly folded was now wrapped tightly around his torso, his head on my shoulder. He constantly taps my arm, pronouncing my name “Malaaak,”rolling the “a’s” with his lisp, making sure I’m still there. His older brother and sister sit on the oval dining table, stuffing their mouths with junk food even though lunch was just over. Food is their only comfort. The second youngest also sits on the couch, rocking back and forth, hands clasped shut, her eyes fixed at the wooden walls. No one says a word.
Siti stands in the corner of the kitchen, her tired eyes darting back and forth to her phone on the marble counter. She’s worried, I presume, as my uncle has yet to answer any of her seven phone calls. She’d told him to call once he’d arrived at the airport. That was yesterday night. I want to tell her that the plane was delayed and that the phone service is horrible in the basement. But I know she won’t listen. I know she won’t hear anything but her overthinking, won’t feel nothing but anxiety. I guess anxiety runs in the family.
And yet, she stays silent, preoccupied by her own thoughts, wooden spoon in hand, mixing the traditional Palestinian dish on the stove.
She’s also worried that it won’t be enough to feed the thirty or so of us.
Soon, more family arrives. Janah picks at her eyebrows, plucks her hair when she thinks no one notices. I notice. I make a Google search: trichotillomania. Cringing at the heading, “Behavioral Health,” I choose not to share my concern. Siti tells her to stop. She begins to cry. Her mother, my aunt, khaltoo doesn’t seem to mind. She tells her, “You’re fine, go play with the toys,” and Janah obliges. Her sister looks at herself in the bathroom mirror and frowns. Khaltoo gives her a look, a stern warning, and tells her to help clean up.
She comes to me for advice on school, on her transition through the adolescent years, which I try to give. She isn’t doing well in school and is hanging out with the wrong crowd. I know my advice isn’t any help. She asks me if I’ll forget about her once I graduate. I shake my head, but this time, actions don’t speak louder than words. She sighs. Siti urges me to give her lessons in religion, to take her with me to the masjid, the mosque, and get her involved in service projects. I nod but know that it won’t help. She needs acknowledgment. Everyone needs acknowledgement. And as I sit at the Arab family gathering, I observe, I wonder, and I deny. I deny that there is a problem but it’s only because I, too, have been infected by this stigma, the stigma of mental health in the Arab community.
These situations are not unique to Siti’s house, nor are they exotic, unusual occurrences, especially in the Arab community. However, we might not just yet grasp the idea that a stigma lingers in this specific community, my community, warping around the low-lit majlis, sitting next to us on the floral-patterned couches, staring back at us from the wooden walls and encircled in our empty plates. We might not understand that it hides away from the bright, LED spotlights.
It’s too afraid to be replaced, like Siti’s chandelier, for some new stigma, a positive one. It’s too afraid to enter the bright side. Because of this fear, it remains, like the mental health issues, unnoticed and unacknowledged. We don’t know it now, but this stigma might really be the underlying cause of other, “bigger,” more “worrisome” problems. At least from our perspectives. And it is not until we understand this idea, ultimately, that we could solve those other problems. But we can’t understand it until we notice it, acknowledge it, and accept it.
The Origin of Mental Health Awareness
We live in a tough world, where we all fight different battles to survive. Many of us, however, fight especially terrifying battles- tough enough to threaten our everyday lives and prevalent enough to ruin us until the point that we surrender. These battles are the fights against our own minds - the battles against our mental health. The World Health Organization (WHO) defines mental health as “a state of wellbeing, in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Mental health, in a sense, hasn’t always gotten the attention it deserves. In recent years, however, it seems that people are more aware of its existence. Why? We can credit social media, statistics and studies and even politics. Though I’ve only now lived through the beginning of the 21st century, I feel that somehow people are beginning to understand, detect, and further treat mental illnesses more than ever. Perhaps I’m wrong. Maybe mental health awareness has always been around. But, maybe today people are just not ashamed to talk about it, to let the world know that they are suffering. Maybe mental health is slowly, but surely becoming more socially acceptable. The mental health illnesses, though, have always been here. But have they always been acknowledged? Has everyone acknowledged them?
Mental illness doesn’t discriminate. People from all different walks of life are affected, regardless of race, age, gender, social status, or ethnicity. A study from the WHO found that one out of every four people in the world suffer from some type of mental illness. Unfortunately, within the realm of mental health exists dangerous, perpetual stigmas and misconceptions. Stigma is hence embedded in its social context. What may be considered acceptable in one society may be considered the opposite and subject to stigmatization in other societies. The most significant example of this stigmas lies in the Middle East.
Arabs and the Mental Health Stigma
With 25% of the world known to have some mental illness, the Middle East region, made up of majority Arab nations, has the highest rates of mental disorders than any other region. But why? Why are those affected by mental disorders in the Middle East afraid to speak up? The reason lurks behind the bitter truth: the strong social and cultural stigmas the Middle East carries against mental illness – stigmas that prevent discussions, education, and aid. When it comes to the Middle East, speaking about mental problems is unheard of, almost impossible.
The Arab Way of Thinking
Arabs have a shared set of beliefs, values, and traditions that are considerably different from those of Westerners. These all make up a common identity amongst the Arab population and the cultural norms that we live by dictate it. Those norms have shaped us into thinking that mental health is taboo, something that should never, under any circumstances, be discussed. It has made us internalize our mental issues out of fear of being labeled and ridiculed because it brings “shame” and “disgrace” to our families. This stigma is one of the most common reasons for not seeking any type of mental health care, which leads to negative health consequences and overall suffering for many. Furthermore, in most Arab nations, formal mental health resources are scant and people who suffer with mental illness experience the disadvantages of poverty and illness stigma. To date, not much is known about how mental illness stigma manifests within the Arab community, making it difficult to create and experiment measures that support Arab individuals with mental illness and their families in treatment seeking and fidelity. The lack of awareness has not only led to feeble stereotypes but also to a lack of funding for mental health programs. Mental health was never a priority in the Middle East region, and therefore trained psychiatrists and overall medical assistance remain dangerously scarce. To illuminate, six out of twenty Arab countries still remain without any mental health legislation. According to the WHO, while there are 1.2 psychiatrists per 10,000 people in the United States, there are only 0.5 in most Arab countries. The difference is staggering, disturbing, and just plain terrifying – all of it rooting from the social and cultural stigmas that have blurred people’s understanding towards such conditions in a very detrimental view.
But We Can’t Blame Them
Why do you think our rates of mental illness are the highest in the world? We judge the most. Judgment, I believe, coexists with mental illness and that remains entirely accurate in the Arab world. And that is why it undoubtedly makes sense that we will continue to suffer if this attitude remains. This is the problem: there is no change. I don’t see people moving away from constantly judging others, but rather adapting it as a way of life and mimicking “traditional” ways. It’s a cycle and we’re trapped in it. The most ironic part of it all is that we are so judgmental, yet we worry about others judging us. We are taught from a young age to look at what others have and compare to what we don’t. We were taught to always think of ourselves as better. We were fed with competition and clothed with ego. We are stricken with the idea that we can’t do things unless they are approved by our families, that our wants have to be accepted by some nonexistent council, by a sacred doctrine that dictates the roles we have as individuals raised in the Arab culture.
Among them, the infamous idea that we have to be lawyers, doctors, engineers, or hold a profession that gives us a title, a label that our parents too should hold. “Oh, that’s im aldactor, the mother of the doctor.” Or the idea that we have to get married, that we have to further our education. Think about this: we stress all these ideas yet each one is so specific and has its own requirements. We are looked down upon if we marry a person of a different race, a different religion than our own, yet we still are a race that accepts the unacceptable. We accept the marriage of children. We accept slavery, whether that may be our translation of the African American race, abid, meaning slave, and not blacks, or the idea that women are slaves to men, and must do as they say. We accept oppression and persecution. And still, we don’t accept mental health issues. Do you not see the problem here? Do you not see how much pressure these “expectations” put on an individual, how much they affect their mental health? Do we not see the mental scars on children married off at 12? Do you not see the pale face, the tired eyes of the college student who yearns to major in the arts and not the STEM field? They, our parents and grandparents blame it on the fact that they never had the opportunities that we do now. But they didn’t live in time like ours. They lived in a different time where mental health wasn’t as prevalent as it is now, where the struggle was in day-to-day survival. They lived in a more difficult time than we did. And ultimately, they didn’t have time to worry, to overthink, or to really question their purpose in life. That’s why we can’t blame them. We can’t blame our parents. We can’t blame our grandparents. We can’t even blame our ancestors. We can’t blame anyone but ourselves. Because we let this happen. We let this problem continue to go unnoticed.
Putting it All Together
The traditional mindset Arabs still have has resulted in ubiquitous ignorance. It has never been hatred towards mentally ill people, but rather, a lack of awareness and education in our communities. We never thought that mental health issues should be treated and addressed like physical illnesses. It was never made common knowledge to us. A physically ill person gains sympathy and support from people who become assets in their healing process, understanding, and empathetic. However, when the illness is in the mind, it is considered taboo, discarded, and looked down upon. Society attaches labels to the ill, stereotyping them as “weird, “aggressive,” and “delusional,” and associating their illness with negative connotations. Consequently, we avoid voicing our issues in fear of how people will think about us, in fear of being excluded and different. There is still limited knowledge about mental health in the Middle East. Who knows how many people are experiencing constant hallucinations and delusions? Who knows how many people are being confronted with suicidal thoughts? God knows how many have surrendered as we speak?
The Call to Action
The fight to raise awareness in the Arab community is interminable. For so long, this silent suffering has plagued the Middle East and we’ve all been susceptible to its incurable symptoms. Taboo has become a barrier to progress and growth and has scarred the mentally pained, terrified them from speaking about their struggles. As a community, we need to do better. We need to break the stigma by doing our research. We need to understand mental illness, debunk misconceptions, encourage awareness, and reshape our old cultural beliefs and norms. Our society needs to accept that mental health issues do not define people or bring any shame, and those suffering from mental issues need proper medical treatment and support. We can’t allow old misconceptions and beliefs hold us back from making a change. Because no one, and I mean no one, should suffer in silence anymore.
“Mental Health: a State of Well-Being.” World Health Organization, World Health Organization, 15 Aug. 2014, www.who.int/features/factfiles/mental_health/en/.
Opposite page: Jonathan Roach “Lilies” 2D design. Instructor: Mariam Ezzat