Amir Afkhami, vice chair for clinical affairs and the director of medical student education at George Washington University’s Department of Psychiatry and Behavioral Studies, spoke to an April 28 Middle East Forum Podcast (video). The following summarizes his comments:
Psychiatric disorders in Islamic societies are reflected in “the unique societal, cultural, and religious contexts that influence mental health.” Increasing rates of stress-related disorders, such as anxiety, depression, and post-traumatic stress disorder (PTSD), are correlated with the prevalence of “political unrest” in the Middle East and North African (MENA) region. The “psychological distress” due to loss and trauma occurring in conflict zones often manifests in physical as well as mental symptoms.
Many seek aid from “imams or sheikhs instead of psychiatrists or psychologists”—an approach inadequate in addressing the biological causes of mental illness.
Many affected individuals suffer from lack of treatment due to the stigma that mental illness often carries in these societies. In rural and the more conservative areas, mental illness is often seen as a spiritual weakness rather than a biological or psychological malady. Women, in particular, exhibit higher rates of depression and anxiety in Islamic societies compared to men. Societal restrictions affect women’s access to treatment. Their psychological distress can stem from “societal expectations” regarding “family responsibility, limited economic independence, and exposure to domestic violence.”
Behavioral health disorders among children and adolescents are also rising as globalization, social media, bullying, and family and academic pressures increase. In conflict zones, such as in Syria, Iraq, and Afghanistan, trauma experienced by these groups manifests itself in “high rates of mental disorders, including post-traumatic stress disorder, deep depression, and anxiety.” Displacement of children due to war and witnessing violence are shown to have long-term psychological effects.
Socioeconomic conditions of poverty and unemployment in the MENA region, where there are “fewer social safety nets” and a lack of “access to mental health services,” contribute to higher rates of mental health conditions. Compounding the lack of access to care is the destabilizing effect of migration. The loss of “social networks” exacerbates the stress experienced by migrants acclimating to a new culture. Many seek aid from “imams or sheikhs instead of psychiatrists or psychologists”—an approach inadequate in addressing the biological causes of mental illness.
There is a growing awareness among the younger population in urban centers that medication, as well as a blend of “faith and evidence-based treatment,” is a culturally sensitive way to apply “Islamically-integrated psychotherapy.” Imams can play a healing role in the treatment process by destigmatizing mental illness through “mosque-based mental health education.” Partnering with clinicians, faith leaders can advocate for their communities when it is “time to refer an individual to a higher-level of treatment.”
In Iran, the problem grew since it was recognized that classifying substance abuse as a “social/moral ill,” and resorting to “beat[ing] it out of individuals,” only spread the problem.
The issue of radicalization and mental health is more complex. “Radicalization is a multifactorial process” rather than the result of “mental illness, poverty, or even ideology alone.” While a “religiously radicalized individual” can exhibit untreated symptoms of depression and PTSD, others are radicalized due to a “loss of meaning and humiliation or isolation.” Marginalized communities of young people seeking a sense of belonging are vulnerable to ideological narratives offering a binary world view.
While the emotional void among at-risk individuals drawn to radicalism “can be due to broken familial connections or social connections,” protective factors against radicalization require a “multivariate response.” In addition to psychotherapy and psychiatry, “I believe strong family connections and communal ties” are barriers to religious violence and extremism.
When those ties are “ruptured,” a critical step in protecting susceptible individuals is by engaging with clerics who emphasize “a more moderate perspective” in Islam and who stress compassion and ethics. Developing critical thinking skills also serves as a way to detract individuals from being drawn to extremist groups. Critical thinking offers alternative “anchors” through civic engagement and education.
Substance abuse is a large problem in the region. In Iran, the problem grew since it was recognized that classifying substance abuse as a “social/moral ill,” and resorting to “beat[ing] it out of individuals,” only spread the problem. Treatment specialists, even in the Islamic Republic of Iran, recognized the need to address the issue with a biologic approach. “What gives me hope” is a “growing awareness and acknowledgement” across the Middle East that the basis for mental illness is biological. “The trend is positive, but unfortunately, as far as I’m concerned, not growing fast enough.”
