Mental illness is a serious concern for many Muslims living in the United States. In post-9/11 America, Muslims are faced with a complexity of risk factors for developing mental illness. Trauma from migrant country, immigration trauma, and culture shock, all put Muslim Americans mental health in jeopardy. In addition, the backlash of Islamophobia, with a lack of social support, challenges Muslim’s coping abilities. The rise of hate crimes towards Muslim Americans produces fear and anxiety, especially for those without a social network to rely on. Gallup (2009), reported that out of all minority groups in the United States, Muslim Americans are least likely to have positive experiences in life, and have the greatest amount of negative emotions, especially anger and stress (p. 30). Depression and anxiety are the two most common diagnosed mental disorders among Muslim Americans (Herzig & McGrath, 2014). Muslim women are especially susceptible to mental illness. Sexual reproduction and higher rates of sexual assault put females at a greater risk for postpartum depression and post-traumatic stress disorder. Additionally, criticism towards the Muslim woman narrative influences internalized inferiority, resulting in greater amounts of major depressive disorder, eating disorders and suicide (Douki, Ben Zineb, Nacef, & Halbreich, 2007). Further, mental illness in the Muslim world has been stigmatized and shamed, creating huge barriers for Muslim women to receive care.
Initially, this research project sought out to answer to question: how do Muslim women at Michigan State University navigate through the United States health care system? With this, the research aimed at discovering ways in which the United States health care system is lacking culturally competent care, and therefore creating a barrier to care for Muslim American women. Through interviews, participant observation and in-depth research, I found the most pressing issue for Muslim women is the barriers to care for issues regarding mental health. Therefore, this essay will focus on stigma and misconceptions, inside and outside the religion, that account for the drastic underuse of mental health services within the American Muslim population. In addition, the changing narrative of Muslim mental health will be examined.
My research relies on interviews with three young women at MSU: Hauwa, Aymen and Hiba. Hauwa, a senior studying advertising with a focus in political campaigning, provided me with an observant Muslim perspective. She shared interesting concepts relating mental illness to Islamic faith. Hiba, a sophomore studying interdisciplinary studies in social science, and Aymen, a junior in anthropology, both shared perspectives from South Asain culture. The varying levels of religiousity in these women gave me multiple perspectives on Muslim mental health. Futher, the bulk of obersravations and fieldnotes is contributed to my experience volunteering at the Ninth Annual Muslim Mental Health Conference.
No Health Without Mental Health
Imam Sohail Chaudhry, of East Lansing Islamic Center, led Friday prayer during the Ninth Annual Muslim Mental Health Conference. During the sermon, he shared, “Islam came for the benefit of humanity. In Islam, health is included in the five things to take care of before all other things. It is important to recognize Allah wants you to take care of your health”. With this, the group formed a diagonal line and shifted their bodies towards Mecca. Prayer began as participants engaged in a series of four movements: standing up, bending down, kneeling to the floor, and sitting upright. Repeated five times a day, Islamic prayer appears to be an excellent mix of light exercise with the psychological benefits of meditation. In addition to prayer, further positive health behaviors are intertwined into Islamic faith. For instance, Islamic dietary restrictions enforce careful thought about what, and how much of something, goes into one’s body. Research shows that fasting during Ramadan provides physical and psychological benefits (Qureshi & Bhat, 2013). One of most beneficial obligations is the restriction of alcohol and smoking, which discourages issues with addition. Hauwa shares the health promoting aspects of Islam in this audio clip,
Muslims are further encouraged to take care of their health through the importance of personal hygiene. Before afternoon prayer, women gathered in the bathroom of the conference and slowly took off their shoes to begin the cleansing process. Towels were laid out on the bathroom floor for women to wash their exposed body parts, which is repeated before every prayer time. This practice encourages healthy behaviors, as Ali (2014) shares, “hygiene is the study of health and involves practices that promote mental, emotional, and physical health as well as the social well-being of the individuals (Ali, 2014, p. 35). Islam is not only promoting physical health with this practice, but positive mental health benefits as well.
The message to, “take care of your health before you fall sick”, mentioned by Imam Chaudhry during his sermon, includes taking care of all aspects of one’s health, not just physical health. Dr. Farha Abbasi, physiatrist and founder of the Muslim Mental Health Conference, stresses the statement, “There is no health without mental health”. This statement encompasses the understanding that psychological processes are in direct interaction with physical health. This often goes unlooked, as invisible mental disorders are hard for many to understand. However, the young Muslim women I interviewed all mentioned the importance of one’s mental state while sharing their definitions of health. Hiba provides her definition of health in this clip,
These Muslim women understand the influence of psychological processes on the physical body, but this is not always the norm, especially in Muslim populations. Therefore, while many Islamic practices are encouraged for prosperous physical, mental, and spiritual health, the undermining of mental health causes confusion when Muslims fall sick to mental illness.
Contrasting interpretation of how Islam responds to illness are especially prevalent when deal with mental illness. My participants focused on the obligations towards seeking professional health-care treatment. Hauwa shares a common saying in Islam,
In this clip, Hauwa introduces the obligations placed on Muslims to have agency towards their health care. The message of “putting your trust in God while also tying your camel” encourages Muslim’s not take a backset in their health care, including mental health care. Further, the use of medical treatment is encouraged in the report by Usama bin Shareek,
“I was with Prophet Mohammad (PBUH) and some Arabs came to him asking, ‘O messenger of Allah, do we take medicine for any disease.’ He said, ‘Yes O you servants of Allah take medicine as Allah has not created a disease without creating a cure except for one. They asked which one, he replied old age” (Qureshi & Bhat, 2013)
Allah as the source of both health and medicine is shared in this report. Individual’s utilization of God’s creations is a necessity in Islam, which includes the use of mental health treatment. Hauwa mentions that Muslims are expected to follow the rules of the land that they reside on, meaning she accepts Western medicine as it is delivered to her. Despite misconceptions, Islam encourages the strengthening of mental health through prayer and the use of professional resources outside of the religion.
As stated above, the Islam practiced by my participants promoted health and help-seeking behaviors. However, my participants and fieldwork also exposed challenges that make Muslims reluctant to care. Stigma, due to religious misconceptions, was repeatedly shared as the most pressing issue at hand. In contrast to my participants, many Muslims find themselves having a fatalistic approach to their health. Fatalism, the belief that one’s health is beyond their own control, contributes to poor health-seeking behaviors. Padela & Curlin (2013), use the term, “God-centered Islamic framework”, to describe those who see illness as a punishment from God, and something that they must endure. Another way to describe this framework is the term “Alhamdulillah syndrome”, presented by Dr. Aneesah Nadir during her workshop at the Ninth Annual Muslim Mental Health Conference. She translates this saying to, “praise God, all praises to God”. The conference participants must know this saying well, as the crowd bursts into laughter after hours of serious faces. Dr. Nadir explaining the concept in this clip,
Those who possess “Alhamdulillah syndrome” are in direct contrast to the Islamic obligations that encourage seeking health care, as shared above. The fatalistic approach to health is not bounded to Islam. Aymen gives an example of this, “I have an aunt whose son is epileptic and she does not want him to go to doctors to take medicine, because she believes that it is God’s will and that’s just how he has to live. And a lot of orthodox people think that way too, not just Muslims”. Correlation between levels of education and those who possess “Alhamdulillah syndrome” can be drawn, as Aymen notes how her highly-education father completely disagrees with her aunt. The “Alhamdulillah syndrome” denounces mental illness as a simple weakness of faith, which creates challenges to care for those who have symptoms of mental illness. Hauwa speaks about religious stigma towards mental illness in this clip,
Hauwa recognizes how many Muslims view mental illness as a weakness of faith. In addition, she touches on how this belief goes against Islamic faith, because the religions encouragement of help-seeking behaviors for one’s health care.
Stigma is perceived through different lenses, based on the various identities that Muslim women hold. Social stigma towards mental illness is greater for those who hold a multitude of identities. Both Hiba and Aymen speak about issues happening within the South Asian community throughout their interviews. Hiba shares her understanding of stigma towards mental illness,
She credits South Asian communities as the source of that stigma surrounding mental health, as this is the identity she holds closest to. Rather than being weak in faith, she states that her community believes those with mental illness are just being lazy. In contrast, Hauwa does not speak much about her Nigerian ancestry, and focuses more on her role as an American Muslim woman. Because of this, she recognizes stigma towards mental illness as subjective to religious misinterpretation. Further, Muslim woman, specifically, must navigate through their multiple identities, and the various stigmas associated with them. The universal narrative of women being overly sensitive restricts individuals from taking their mental health issues seriously. Muslim women are faced with this stigma, in addition to the religious and social shame tied to mental illness. The complexity of identities and social stigmas associated with mental illness create a diverse set of barriers for American Muslim women seeking mental health care.
The negative reputation surrounding mental illness interferes with Muslims wanting a career as a mental health professional. There is a lack of Muslim mental health professionals in the United States because of stigma and fear of being associated with mental illness. Dearborn, Michigan is the second-largest Muslim community in the United States, however, according The Institute of Muslim Mental Health directory, only six Muslim mental health professionals are available in the area. This greatly reduces the help-seeking behaviors of Female Muslim Americans, who tend to rely on social networks to receive health care. A family-based health care system was included in all my participants’ preference of care. Social networks essentially guide Aymen to her health care professionals, she shares, “we don’t necessarily research who is the best and go to them. We look at who do we know and who do they know”. The tendency to choose care that is in the community, combined with the lack of Muslim mental health professionals, contributes to poor help-seeking behaviors and establishes culturally incompetent care.
Being mindful and respectful is the basis of culturally competent care. Further, providing culturally competent care requires the ability to draw upon cultural and religious beliefs of the patient, to provide them with appropriate care (Ahmed & Reddy, 2007). Speaking about the necessity of culturally competency in mental health care, “you cannot talk about a person’s wellbeing while taking out a part of their identity” (Keshavarzi, 2017). Knowledge about an individual’s various identities plays a vital role in communication and care in the health field. However, misunderstandings about Islamic practices, combined with a lack of Muslim mental health professionals, produces a system of mental health care in the United States that is not appropriate for comprehensive care. Misdiagnosis of mental disorders in Muslim patients is a consequence of culturally incompetent care. Hooman Keshavarzi shares a story about a Muslim woman being misdiagnosed with obsessive-compulsive disorder (OCD). The psychologist did not understand the importance Islam places on personal hygiene, and misread her hand-washing rituals as a symptom of OCD. After observing the washing ritual for the first time at the conference, I can understand the source of confusion for an uninformed psychologist. However, the goal of culturally competent care is to avoid these huge mistakes, and in return, have a system of care that is more accessible to Muslim culture.
Changing Narrative of Muslim Mental Health
The Muslim Mental Health Conference was first created in 2008 by Dr. Farah Abbasi. In a recent interview, Dr. Abbasi shares why she felt the conference needed to be created, “what I was realizing was that many were not acknowledging, accepting or accessing it (mental health care). I was seeing the same issues happening within the community but there was the deep shame, silence, and stigma and people were just suffering and not wanting to do anything, or not even sure what to do about it” (Stateside Staff, 2017). Since the creation, the conference is held annually and features a new theme of mental health issues facing Muslim communities each year. This year’s theme focused on substance abuse issues in Muslim populations. This extremely controversial subject displays the expanding field of Muslim mental health care. Slowly, Dr. Abbasi has seen a change in the narrative of Muslim mental health, and states that the psychiatric community has finally began to accept that faith plays an integral role in an individual’s resiliency (Stateside Staff, 2017).
Participants at the Ninth Annual Muslim Mental Health Conference (Photo by Author)
Flyer for Faith and Community Leader Training at the Muslim Mental Health Conference. Participants worked together to create ways to improve on culturally competent care for Muslim communities.
The acceptance of Muslim mental health is greatly contributed to the agency of first-generation American Muslim women. The cultural identity of Muslims living in the United States continues to shift as more Muslims are being born into the United States. With the changing identities, comes generational differences in religious and cultural beliefs. Aymen experienced first-hand generational differences and ideas about mental illness,
“That’s a really big struggle that a lot of my friends have to go through because, um, it’s just like something culturally known, that mental health isn’t really a big deal (in Muslim and South Asian communities). So, it’s a culture that’s emerging throughout the second generation, or actually the first American generation, that there is a strong emphasis on mental health, Um, but like, the older generations don’t’ grasp that”
Aymen believes her role as a first-generation American woman is to encourage other Muslim women’s agency towards mental health care. Acceptance towards Muslim mental health is strongly driven by these first-generation American Muslim women. Demographics of this year’s Muslim Mental Health Conference was composed of 96% female attendees. Additionally, five of the six Muslim mental health professionals in Dearborn, Michigan are women. These numbers display the agency of Muslim women to change the narrative of Muslim mental health.
Outsiders perceptions of Islam are especially important to Muslim women, who feel the most pressure from Orientalist views. As a result, they seem to have a greater sense of agency to create change within the religion. One young woman shared her frustration with the way Islam is being practiced today,
“We want to protect Islam. Islam doesn’t need our protection. If we would hold up to our Islamic values, we would not be in this situation. And so, we need to differentiate between this image that we don’t want to portray as bad Muslims. We are not following it to the true essence of what Allah has asked us. Women have, we got our right 14,000 years ago. That tells me that I have a right to an education, I have a right to inheritance, I have a right to money, I have a right to ask for marriage, I have a right to a divorce, if I make my money I have a right to keep it, if I give it to my husband it’s out of charity. So, at the end of the day we have our rights. The issue is that we are not exercising these rights. We are not exercising these rights and we are not changing policies”
To generate change within the religion, this participant encourages Muslim women to re-educate themselves on Islamic beliefs. Going back to the “roots” of Islam will also help remove negative connotations towards Muslim mental health. To do this, speaking about mental illness through education with open conversations is key.
The improvement of culturally competent care is another way to combat stigma and promote change. Filling the gap between faith leaders and mental health professionals can help with the changing narrative of Muslim mental health. Sister Um Ibrahim shares “Allah provides Muslims with great (invisible) weapons to fight all these diseases. Many Muslims, however, do not even know these weapons exist. And those who do, don’t put their best effort to use these weapons” (Ali, 212). The Qur’an provides beneficial tools to help Muslims deal with mental health challenges. Because of this, Muslims often go to their Imams for mental health care. However, Imams must provide ways to encourage professional mental health care, while also using religious stories as a way of coping with their illness. A story-telling strategy for the Imam’s role in mental health care was provided by a young woman at the conference,
She noted her ability to create a depression diagnosis for prophet Jacob, who was “so sad over Yusuf Surah that he went blind”. The use of stories within Islam can be extremely beneficial for Imam’s to encourage Muslims to seek professional mental health care. Collaborative mental health care can be established with the use of these stories.
Collaborative care is a term used often throughout the conference. Relationships between Imam’s and mental health care professionals are vital for culturally competent care. During the conference, one speaker looked around the room and noted, “It is nice seeing physicians in the crowd because often those two are seen separately. Imams need to reach out to professionals instead of relying on themselves to help with mental health issues”. As Imams are becoming more aware about the seriousness of mental illness, they starting to encourage more outside care. An Imam at the conference shared that when Muslims come to him with mental health issues he shares a list of mental health professionals that he is confident will provide culturally competent care. This strategy is excellent for promoting the use of professional mental health care. Another evolving role of the Imam is educating mental health providers on culturally specific values, which requires a great collaborative effort on both parts. Interactions between Imams, Muslim health professionals, and non-Muslim professionals during the Muslim Mental Health Conference gives optimism to the changing narrative of Muslim mental health.
Through my research, Islam was exposed as an excellent guide for healthy life-style choices. If followed as intended, Islam promotes healthy practices and positive health-seeking behaviors. However, issues occur when religious obligations are misinterpreted. Specifically, shame towards mental illness is produced through various outlets within the Muslim world, and through outsider’s misconceptions of Islam. Mutiple barriers to care are established in Muslim communities including: stigmatization of mental illness, a lack of Muslim mental health care professionals, and culturally incompetent care, just to name a few. As a result, mental health issues are often undermined and go untreated, resulting in a distraught community of Muslim American women.
However, my research found that agency in Muslim women in the United States is shifting the narrative of Muslim mental health. Through my interviews and participation at the Ninth Annual Muslim Mental Health Conference, I found that first-generation Muslim American females are currently working towards removing the barriers to mental health care in the Muslim world. This was by far the most significant finding in my research, as a fair amount of research has displayed the barriers to care, but not measured the ways in which care is actually being improved. This research provides interesting suggestions, created by participants of the conference, that aid in the development of collaborative care. Rather than separating religion and mental health, these young women all suggested increasing intergration between the two subjects. This will not only create culturally competent care, but will make Muslim American patients more understanding and comfertable with the field of Muslim mental health.
Knowledge, agency and identiy are all themes I found throught my research. Knoweldge about Islamic practices and obligations, that actually encourage healthy practices and help-seeking behaviors, was an important concept that my participants wanted to share. Specifically, Hauwa encouraged the idea of being knowledgabele about your religion in order to have agency to fight against the misconceptions. Agency was a theme found within all my participants, and shared often throughout the conference. Using agency to combat stigma towards mental health, instead of avoding uncomfortable situations, was emphasized as a way to improve cultural competenet care. Lastly, identity played a huge role in all pariticpants views of mental health and barriers to mental health care. The various identies held seemed to push Muslim American women to become somewhat defencive towards their values and understanding of Muslim mental heath. This has aided the changing narrative of Muslim mental health, which is countinuly growing as a important subject in the field of mental health care and in Muslim communities.
Overall, this experience as an ethnographic resaearcher enabled me to step out of my comfort zone and get involved in the Muslim community at Michigan State Unviersity. This fulfilling experience provided me with an overwhelming amount of information. I expect to continue research within this subject so I can further develop my understanding of Muslim mental health. Lastly, my work in this field has provided me with the confiendence to attend other scholarly conferences. My time spent volunteering at the Muslim Mental Health Conference was not only helpful for my research, but also for the development of my future career. I found myself becoming increasily interesting in the field of social work. I look forward to using the interview and obersvation skills gained throughout this process as I gradute from Michigan State University, and move on to higher education and jobs.