Slides from a lecture Dr. Abbasi gave at the University of Michigan for the Investing in Ability series of events. Her topic is on the stigma associated with mental health.
7. U.S.-born Whites of Western European
descent, who may not present as a
"stereotypical" Muslim, but do in fact
follow Islam
Pew, 2007
Diversity
8. Spirituality and religion
•
The Qur’an, “the word of God,” serves as
“a guide and a healing to those who
believe”
Qur’an, 41:44
9. Spirituality and religion
• The Hadith (traditions and sayings of the
Prophet Mohammed) also provides
guidance for moral and ethical behavior.
• Following Islamic directives is believed to
promote a high quality of life and a
healthy mental state
Qur’an 2:177
10. The Qur’an considers a number of
psychosocial issues, such as care for
the ill, marital and family relationships,
child-rearing, honesty, justice and
modesty.
11. › Both men and women are expected to
dress in a way which is modest and
dignified; the traditions of female dress
found in some Muslim countries are
often the expression of local customs.'
13. Shrouded in silence
I needed words because unhappy families
are conspiracies of silence. The one who
breaks the silence is never forgiven. He or
she has to learn to forgive him or herself.
Jeanette Winterson
14. Stigma
“absence of evidence is not
evidence of absence”
n Muslim culture deems mental illness as
a weakness of the soul
• keeping silent in the face of suffering is
the norm and to persevere is pious.
15. Stigma
• stigma and shame of mental illness
worse than suffering.
• reluctance to seek professional help
• vague pain and somatic symptom
presentations
• frequent misdiagnosis
16. To Persevere?
n Illness is part of human suffering regarded
as a way of atoning for sins.
n Reward may be greater if suffering is
endured with patience and prayer.
17. • Illness believed to be a divine test of
level of piety, devotion and loyalty of the
faithful.
• 98% of survey respondents asked
about perceptions of mental illness
agreed that life stressors are a test of
one’s faith.
• 84% of respondents
believed in devil possession of mentally
ill persons.
Abu-Ras & Abu-Bader (in press)
18. Djinn/Evil eye
n
It is believed that when alternate beings,
such as Jinns, possess individuals,
hallucinations, delusional beliefs and
disorganized behavior may result.
n Other purported supernatural causes are
black magic and the evil eye.
19. • Some believe that envy (intentional or
not) can invoke negative
consequences and charms, markings,
jewelry, prayers or rituals are used to
distract jealousy and envy.
•
20. • Curiously, beliefs and practices
pertaining to demonic possession,
witchcraft, black magic, and the use of
exorcists, charms and magic potions
are not condoned or supported by the
Qur'an or the Hadith
21. Mental health
international epidemiologic data
demonstrate:
n rate of schizophrenia in Muslims is similar
to that of non-Muslims.
n Higher rates of depression in women
versus men (as seen in U.S
populations)
22. • Anxiety disorders as prevalent in
Muslims as in non-Muslims,
• High rates of PTSD in Muslim men and
women facing post-9/11-related trauma
and discrimination
(Abu-Ras & Abu-Bader, in press).
23. Disorders also seen
n Post traumatic stress disorder
n Major depressive disorder
n Generalized anxiety disorder
n Panic Disorder
25. Addiction
• The low rate of alcohol abuse in Muslim
countries also true for adherent Muslim
populations in the United States
Hanolt
• Muslims born in the U.S. are more likely to
drink than immigrant Muslims
Haddad, 1987
• Drinking alcohol is taboo, Muslims who do
drink are less likely to report their use out
of shame.
26. • South Asians chew areca nut (in the
leaves of betel nut plant) which, when
combined with smokeless tobacco,
raise cardiovascular disease risk
factors
Croucher, 2002 ,
Warnakulasuriya, 2002
27. • Use of tobacco and culture-specific
psychotropic substances is more
rampant and problematic
Zaman et al., 2004
• Ethiopian Muslims chew khat, a tea-
like plant used recreationally for its
release of amphetamine-like
substances
Alem et al, 1999
28. • Hookahs are becoming increasingly
popular among Muslims and the
broader American community
29. suicide
Suicide is strictly forbidden in Islam
because it supposedly curtails the
possibility of entrance into religious
Paradise. Generally low suicide rates are
seen across.
.
30. • Low rates of completed suicides are
reported in Muslim countries.
• Suicidal ideation and attempts are
relatively high, particularly in young
women experiencing
intergenerational conflict, domestic
violence
31. Family Unity and Elderly
• Extended and multi-generational
households are common for Muslim
Americans.
• The elderly typically live with their adult
children who provide care
• The Muslim family provides security and all
essential personal, emotional and material
support to its members
Al-Haj, 1989
Hassouneh &Kulwicki, 2007
Watson, 1995
32. • Community support, commitment,
and sharing of responsibilities and
obligations are valued
Abu-Ras, 2003
• Members of collectivist cultures
depend on each other as well as
institutions and organizations for
social support, security, safety, and
acceptance
Buda & Elsayed-Elkhouly, 1998
33. Without such customary support
systems, isolation and loneliness can set
in. This may impede adjustment to U.S.
society, and increase vulnerability to
stress or trauma
34. Women in Islam
n Islam sees a woman as an individual in
her own right, with the right to own and
dispose of her property and earnings.
n A marriage dowry is given by the groom to
the bride for her own personal use, and
she keeps her own family name rather
than taking her husband's.
35. Honor killing
n An honor killing is the homicide of a member
of a family or social group by other members,
due to the belief of the perpetrators that the
victim has brought dishonor or shame upon the
family or community.
n It is a traditional practice that occurs in various
cultures
38. MUSLIM MAN AGAINST DOMESTIC
VIOLENCE
n "Imams Speak Out: Domestic Violence
Will Not Be Tolerated in Our
Communities," asking all imams and
religious leaders to discuss domestic
violence in their weekly sermon or their
Friday prayer services.[
39. Youth
n Muslim youth may be at higher risk for
anxiety and depression (Al-Hinai 2006),
religiosity appears to be a protective factor
Vasegh&Mohammadi2007
• Studies conclude that religiosity is an
important positive factor in negotiating the
stress of acculturation
Amer & Hovey, 2007
40. • religiosity and spirituality are positively
associated with adolescent peer group
status, academic achievement,
emotion regulation, pro-social
behavior, and self-esteem, as well as
educed antisocial/problem behavior
and internalizing behavior
French 2008
41. Religious beliefs and cultural identity
among Muslim youth and adolescents
may impact the way they address
issues of substance use, immigration,
and the need for peer affiliation.
Marsiglia et al.,2005 , Timimi, 1995, Bhuiet al 2005 , Newman 2006
42. n While
religiosity
is
a
protective
factor
for
mental
disturbance,
perceived
religious
discrimination
has
been
shown
to
in9luence
sub-‐clinical
paranoia
in
Muslim
American
youth
n
Rippy
&
et
al
43. Why so serious?
n A Yale University Study demonstrated that
50% of all Arab Americans surveyed had
clinical signs of depression.
Amer 2006
44. In interviews with three hundred thousand US
households, “anger, stresses, and worry are
more likely to be reported by some groups of
Muslim Americans than by their racial
counterparts and other faiths”
Gallup Center for Muslim Studies "Muslim Americans:
A National Portrait."
45. • Muslim Americans were the least likely
religious group to be thriving,
especially when compared with Jewish
Americans and Mormons.
• Muslim youth age 18 to 28 were the
least happy and most angry compared
to the youth of other faith groups.
46. Beyond 9/11
in structured interviews of New York
Arab Americans regarding the 911 attacks
participants identified several common areas
of concern including:
n fear of hate crimes
n anxiety about the future
n threats to their safety
n loss of community
n isolation
n stigmatization.
Wahiba
Abu
Raas
47. Fight, Fright, Flight
n Immigration, legal, illegal or as a refugee
is a traumatic and stressful experience,
fraught with hardships, fear of the
unknown and social disruption.
48. Refugees additionally have to deal with
the consequences of exposure to
violence and political oppression with
severe and lasting impacts on mental
well being.
49. Cultural Bereavment
n Loss of familiar sights, sounds and smells.
n Language barriers.
n Norms, values and cultural beliefs, stark
contrasts to host country.
50. • collectivistic to Individualistic focus.
• interdependent to Independent
thinking.
• change of economic and social
status.
• lack of social support.
• racial discrimination.
51. “ It’s All In Your Mind”
“Minority status, experiences of prejudice
social and economic disadvantages and
communication barriers become a
lamentable part of daily life adversely
affecting the immigrant’s mental state
Saeed
Islam
52. Given cultural and ethnic mismatches
between caregivers and patients,
mental disorders, especially
depression, often are not recognized in
immigrant populations.
53. Objectives
n Improving awareness of the frequency
and importance of mental health issues
n Training Imam’s/chaplains to better
understand behavioral disorders, handle
mental health crises and to be able to
refer to mental health services.
54. • decreasing the sense of isolation by
teaching cultural competencies to the
non-Muslim providers
• education about Islamophobia as a
form of racism
• creating more understanding around
spiritualism /religious practices.
55. n
provide health related information in
various languages and improving access
to interpreters.
n Train cultural consultants and advocates
to help navigate complicated health care
systems
56. • dealing with acculturation issues to
improve integration in the host society
by improving language skills, cultural
understanding, community support and
vocational skills.
57. Proposal
• We propose a Community Engagement
Project for the Muslim Community to
address stigma and thus improve access
to and the acceptance of mental health
care in these communities.
59. Hierarchy of Help-Seeking
Alternative Medicine Practitioner Community Elder Religious/Spiritual Leader
Primary Care Provider
Mental Health Services
Family - Immediate or Exended
64. Role of the Islamic centers
n This growing population relies heavily on
Islamic Centers to support their social,
religious and spiritual needs.
65. › The Islamic center of Lansing is
continuously expanding to keep up with
this growing demand. During a recent
Friday congregation 700-1000 people
attended, including children and
women
66. MUSLIM MENTAL HEALTH
CONFERENCES
n First conference in 2009-Islam and Mental
health
n Sixth conference –April 24-26 2013 in Dearborn
n “Barriers to Access to mental health care”
n Average attendance-100-200
n Targeted audience-students ,residents, mental
health providers
n Muslim community, Islamic centers and Imams.
67. Impact Factor
n Awareness of Islamophobia.
n Cultural competency trainings
n Trained cultural aides MSU
n Collaborated with SAMHSA, Minority
fellowship-American Psychiatric
Association, Psychiatry Department
Michigan State University College of
Osteopathic medical school.
68. Impact factor
n Increased awareness in Muslim community
regarding mental health issues
n More willingness to access mental health
treatment
n More than 300 Imams and community leaders
trained as First Aid Mental health providers over
the years.
n Successful collaboration with local Islamic
center.
69. References
Muslim Mental Health inc.
with Nathan Kline Institute:
Muslim Mental Health Guidelines.
70. Osman Ali
Clinical Assistant Professor
Bellvue Hospital
Wahiba Abu Ras PhD
Assistant Professor, Adelph University
Hamada Hamid DO MPH
Fellow, Neurology, Yale University