Kinana Issa

Syrian refugee writer, artist and community researcher in Canada. She conducted and supervised community based researches in Syria, Lebanon and Canada, and currently she’s focusing on issues related to mental health. An honorary fellow of the International Writing Program in IOWA university.

Recently, Hussein Alshihabi tackled the social stigma around mental health in the Arab world on Henna Platform. He discussed the important linguistic issue that exists around the term. It references a concept that has been brewing in Western culture for years until coming to its present-day usage. Therefore, when we talk about mental health, we are referring to something culturally foreign which suggests the binary of either health or illness. I agree! We need linguistic revolutions from within the Arab-speaking cultural context. 

To do so, we must understand the barriers facing the development of such language, and also, examine its terms in a scientific light. This way we link each linguistic unit back to a single holistic concept. I also think it necessary to review these concepts in their historical contexts in order to properly restructure them in contemporary terms. Avicenna, an Islamic scholar and the father of modern medicine, put it best: “A word is a single pronounced unit that signifies a meaning and the era in which this meaning exists.” 

Being Possessed, Enlightenment, Colonialism, and Deterioration

In my first attempts at understanding cultural barriers and to push the linguistic revolution’s wheel forward, I would like to examine the history of the concept of social stigma as I see it, how it was changeable by shifts in the political, spiritual, and social powers. Then we can take a final stop in the present. 

Historically, both in the East and the West, there were attempts to deal with mental or psychological problems in a scientific manner. But the control of corrupt religious men stigmatized science and labeled it as blasphemy, mostly in order to give corrupt religious men the exclusive rights to salvation. Mental disturbances were the work of devils, only a priest or a sheik could exorcise them. In the Age of Enlightenment of the Arab world, things were different, even when religion was the official dominating power. For example, science and arts flourished under the rule of the Abbasid empire. 

The culture of the region introduced scientists who approached mental and psychological issues medically. Ishak Ibn Omran, Al Farabi, Avicenna, and Al Razi studied psychological, emotional, mental, and neurological symptoms. That included healing with music, diets, natural scents, and travel. These physicians gave special attention to understanding the role of one’s feelings, in disparate areas of medical recovery. From a religious perspective, before psychoanalysis, the human psyche was the realm of the spirit. The self and the soul get sick, and they can be soothed. The difference between an enlightened spiritual approach and a corrupt one is the first accepts the ailments of the psyche and seeks ways to heal them, the other stigmatizes it and labels those who suffered as evil or blasphemous. 

I find it hard to examine the historical context of the social stigma attached to mental health away from colonization in the Arab-speaking world, starting with the Ottoman Empire, concluding with the current day dictatorships and extreme political-religious forces. We also need to take into consideration the economic pressures that don’t allow much space for contemplating things other than daily bread. Seeking growth and prosperity is a luxury for many. This gives way to anti-progressive forces which impose their narrow visions on religion, politics, economy, and society. Finally, the recent trouble in the region, generating humanitarian crises, require victims to ignore their pain in order to survive and maintain their dignity. 

Yet, such social, economic, and political circumstances may be a better reason to admit the importance of mental health and start considering it as a serious collective and cultural cause. After the recent upheavals, it is hard to think there are many who survived without some form of mental distress. It is impossible to solve any political or social problems without involving a deep understanding of mental and psychological health. We need to understand the effects of this violence and how it reshapes the culture itself. The trauma of witnessing atrocities has resulted in counter-violence, social and religious radicalisation, domestic violence, so-called honour crimes, suicide, depression, learning difficulties, and social isolation. Social stigma, in this context, can be seen as a result of post-traumatic reaction, and a form of denial. 

Denial and the Five Stages of Grief

In the event of a trauma, the sensory input system can be overloaded, interrupting neuropsychological information processing. To avoid facing feelings of loss, this can often lead to a state of denial, either short-term or long-term. There are numerous scientific approaches to understand trauma, but to simplify the process, I am inclined to refer to the more popular and simplistic model of Elisabeth Kübler-Ross’ 5 stages of grief: denial, anger, bargaining, depression, and acceptance. They are not necessarily in that order, yet acceptance is always the final stage and the gateway to resolution. Because of the nature of the situation in the region and the justice-seeking needs for its children, I feel it may be meaningful to say that acceptance does not mean giving in to the dark reality. It only means accepting what there is, on an individual level, so we can start working to change it. 

In her research on collective freedom, Denisha Gingles says “Acceptance is active, not passive; it does not mean you need to resign, but rather engage. It is with acceptance one may empower themselves to evoke behaviors as a means to shift aversive oppressive contingencies.” 

The way I see it, stigma can be a form of denial. By stigmatizing those who admit their issues, a social structure gives itself permission to isolate and bully them. It can then live peacefully with its denial. But, denying a problem doesn’t make it disappear. When we stigmatize mentally distressed people and label them as lazy or weak instead of understanding their conditions, we negate our opportunity for positive engagement in the recovery process. 

Stigma occurs in a condition of ignorance. It is the act of judging what we fear and do not understand, so we do not have to deal with it. This enables older patterns of coping, even if they have proven faulty. 

We can adopt some new tools that would make things easier for us and the ones we love. Mental Health is not a Western construct. It is the result of interaction between civilizations. If we invest enough time researching our own cultures, we will find ourselves able to discuss it in rich detail. If we go online, we will find many resources derived from Western medicine. If we choose to, we can find approaches that marry the two. This needs extensive research and work. It may seem like an effort that needs big institutions to sponsor, yet the reality of the situation is, even if this is possible, it would require individual initiatives to get started. 

In this day and age, the internet makes it easier to turn individual initiatives into collective ones. I find self-reliance in seeking knowledge about mental health can alleviate the stigma, and give us a proactivity advantage in dealing with its distresses, be it on the individual or collective levels.