As a psychotherapist who has practiced for the better part of a decade, I’ve seen and worked with a wide variety of patients. Working in Southern California (especially around the LA area) has given me the opportunity to treat clientele from a plethora of diverse cultural, ethnic, and religious backgrounds — including people from my own community.
Coming from an Egyptian and Jordanian background, I can say I have a fairly unique position in being able to comprehend multiple dialects of Arabic and having a pretty solid understanding of the multifaceted cultural issues that arise for many patients with backgrounds from the Middle East and North Africa (MENA).
This, in turn, has inspired me to start a practice that specializes in serving this population, one of the first ever on the West Coast.
I recall having a conversation when I was in the early stages of opening my practice. I was explaining the concept to an acquaintance and I was asked an unexpected question: “Do you really think Middle Eastern people will actually come to therapy?” I initially dismissed the question but later thought about it for a while.
At this point in my career, I already had a few Middle Eastern clients who did benefit from the work we did. As a matter of fact, they all told me how happy they were to find a therapist that understood them and their problems without judgment. The clients were the reason I got into this field in the first place — but was I kidding myself to think I could actually build a practice based around helping this community?
I powered through the doubt and did it anyway. I learned quite a bit in a very short time, and I ended up delving into researching the barriers to treatment for patients from MENA regions. I was very surprised to learn that mental health is not as neglected in MENA countries as you would think.
Take Egypt for example: For a developing country, they have a comparably excellent mental health treatment system. Besides the classic hospital and inpatient services, they have an extensive network of outpatient mental health clinics, and most of the care is paid for by the government. Many other MENA countries also have treatment widely available to their people.
The issue in these regions is not lack of availability, but lack of utilization. Time and time again, I have found the reason is stigma. I’ve outlined below what I believe to be the major contributing factors:
1) Lack of information about mental illness and treatment — Just as in the United States, countries in the Middle East offer very little in the form of public education about mental illness. In the media, the mentally ill are portrayed as violent and unpredictable. Therapy is a foreign concept since all treatment is presumed to be based on medications (which are thought to be mind-numbing or mind-altering). Older generations may only remember a time when mental hospitals, where people dealing with psychosis were placed in locked-down facilities, were the only treatment option; they may not have any idea about being able to go to outpatient counseling. Many first-time MENA patients will ask me if I’m going to put them into an MRI machine or attach electrodes to their heads.
2) Lack of understanding of patient’s rights — A major barrier to treatment I’ve found is the fear MENA patients have about losing their privacy. They often express concern about who will have access to their health information, if their information gets reported to a government database, if they will be denied jobs if they participate in treatment, and if people in their community will know if they are being treated. I’ve had patients tell me they would be afraid to work with me if I were a female because of “gossip”. I’ve even had patients who were dealing with sexual orientation issues express fear that I would abandon them or refuse to work with them because of my own cultural background.
3) The concept of mental illness as spiritual weakness — This is a biggie. This concept is ingrained in the very language. The word majnun (مجنون), which is colloquially used to mean “crazy,” literally translates into “demon possessed.” This is a major reason that some MENA patients will not seek out treatment. They do not want to be seen by their families and communities as lacking faith that God or Allah will heal them — even if they are not necessarily religious.
4) “These problems don’t exist for us” — Possibly the main reason MENA patients (especially in the Western world) will avoid treatment is the idea that somehow Middle Eastern, Coptic, Muslim, etc. culture shields us from the problems that everyone else has. This is the collective denial that mental illness, addiction, sexual abuse, and family discord happen in our cultures. Unfortunately, even Middle Eastern clinicians can be guilty of this. We’re human too; deal with it.
Overcoming these barriers seems to be a daunting task. However, from my experience, I can attest to the fact that any person that really wants help and is willing to participate actively can benefit from therapy. I’ve seen it, and it is a privilege to be able to offer help to those in my community who might have otherwise not received it. It can be done and you can help.
If you have friends and family members that you see need help, you can be the voice of encouragement. Once you understand the stigma, you can challenge it. And if you are reading this and you’ve been struggling with depression, anxiety, or addiction, It’s OKAY to need help and it’s OKAY to get help.
