How to Get Rid of The Boogie Man?
Hsain Al-Shihabi, educator and mental health advocate. He is Palestinian Syrian, and an immigrant settler living in Toronto. Studied Neuroscience at University of Guelph and currently completing a Masters degree in Child Study and Education at University of Toronto..
It was one of those warm nights that inspired that sense of serenity only summer nights can offer. I was at a music show at one of the bars in Kensington with a group of friends. I stepped out with two of my friends to get some air. One mentioned how glad he was to see that so many of us were out and that everyone was joyful. At some point in the conversation we were contrasting the momentary joy of tonight with the struggles of daily life. That same friend added that a significant part of these struggles, and especially in our social circles, is learning to live with mental health challenges such as trauma.
The response from my other friend? “What trauma?” He rushed to warn us about the harmful inflation of “these concepts” and about overstating the prevalence of trauma. He declared himself and his perfect mental health smoking gun proof to his theory. And that served as a perfect cap to this poor conversation that had barely begun to see the day of light.
Rather than hastily condemning mental health stigma in the Arabic-speaking world, it is worthwhile to pause here and contextualize it historically in order to appreciate the roots of the problem. Both the scientific and cultural histories are relevant for the topic of mental health. We can simultaneously consider both these histories by discussing them through the lens of language we use to discuss mental health and its evolution. It is well-known that the phrase “mental health” in Arabic is a translation from English, the language in which the concept was developed. Here, we can take to the history of mental health in the West, and its evolution through the 20th century, and highlight the role Canada had in the process. Before the phrase ‘mental health’ became the standard, its predecessor was ‘mental hygiene’ and it held negative connotations that reflected the public consciousness about mental health before World War II. The propositions put forth by mental hygiene generated a movement for further institutionalized isolation of those living with mental illnesses. Many of those institutions, often more like prisons, operated with therapeutic nihilism-driven experimental treatment in the nascent scientific fields of mental health and neuroscience.
In Canada, this institutionalized isolation also intersected with the eugenics movement that began to take hold in the early 20th century where many people living with mental illness were sterilized across the country. Later, the aftermath of World War II led to a substantial change in the public consciousness in the West toward mental health. Namely the change was connected to how the mental health issues of trauma in veterans challenged the collective understanding of mental health, both scientifically and culturally. The return of veterans coincided with developments in the field of psychiatry which led to a change in the treatment of the symptoms of trauma: from prescribing rest to medical treatment involving prescribing medications and preparation of treatment plans.
This marked the beginning of a shift in the public consciousness in the West toward mental health. The long standing binary view of people being either “healthy” or “crazy” was changing. Because veterans could neither be isolated nor ignored, they challenged the existing medical model of mental health which drew a line across society. On one side were the “crazy” people with severe mental illnesses, and they were treated by isolation. On the other side was everyone else, who is either “healthy” or just needs “some rest” or needs to “get it together.”
After that, mental health language and vocabulary continued to evolve alongside the evolution of the field, and they continue to coevolve today. Canadian Mental Health Association (CMHA) illustrated this with concrete examples of language changes that shift thinking. Today, the conversation on mental health in Canada is much more nuanced than it was in the 20th century, both in public discourse and privately. However, stigma is still alive and well here, evident by anti-stigma campaigns such as Bell’s “Let’s Talk” and CMHA’s “Ride Don’t Hide.”
Here again, the progress to destigmatize mental health finds itself at another language bottleneck. An example that demonstrates this language limitation is in how mental health is often contrasted with mental illness. In reality, mental health is a multidimensional spectrum that includes mental wellbeing and mental illness. An individual’s mental health is dynamic and can fluctuate along the spectrum throughout their day, week, years, or their lifetime. It can help to conceptualize mental health in the same way we conceptualized physical health. We can draw on an analogy comparing diabetes and anxiety to illustrate this. A person can develop both diabetes or anxiety as a child, adult, or elder. Severity of both diabetes and anxiety can be determined by, and fluctuate according to, both genetic and environmental factors. It is possible to be diagnosed with diabetes or be prediabetic and it is possible to be diagnosed with an anxiety disorder or have anxiety that is just under the threshold that meets the diagnosis criteria. Diabetes is treated with medication, or change of lifestyle, or both; anxiety is treated with medication, or change of lifestyle, or both.
Is it possible that my friend would have reacted differently if the language we were using was different? Perhaps if there was an alternative language, better suited to our cultural reality, would the conversation have moved along a little further than it did?
The reason culture is relevant here is that the private and public discourse on mental health in the Arabic-speaking world has only recently begun. This beginning represents a popularization of Western knowledge systems in the Arab World either through colonization or deliberate importation. So, it is important to delineate that the nascent discourse on mental health in the Arabic-speaking world is specifically referring to the Western discourse. Therefore, the language we are currently using is our best shot at translating concepts of mental health developed in the West. Bearing in mind that (a) this language developed as a result of a natural, 100 years long coevolution of culture and science of mental health and (b) despite this evolution, the language of dichotomy is the slope where the uphill battle against stigma is happening.
As a result, in our use of mental health language that is translated from the West we are (a) fitting a square peg in a round hole and (b) our square peg does not ‘peg’ very well. Perhaps, then, my friend’s sharp aversion to the conversation makes sense. We were using a language that was painfully out of tune with his cultural context and squeezed him into a paradigm that one can be only one of two things: healthy or mentally ill.
In search of answers for language, it seems appropriate to ask: prior to colonization, was there no private or public discourse on “mental health”? If there was, and there must have been, what was it called? Is it possible that the relative comfort with gray zones in cultures of Arabic-speaking communities can offer a language that accommodates fluid reality of mental health?
To be sure, I am not advocating that we completely abandon all language related to mental health coming from the West. Culture clashes of this kind are not new and finding ways to operate with the “best of both worlds” takes work, but it is possible. There are examples here in Canada where Indigenous communities led the development of ways to integrate the Indigenous Sciences and Western Science. The Mi’kmaw word Etuaptmumk traslates to “Two-Eyed Seeing,” which is a guiding principle for seeing the world through the strengths of both perspectives.
Western science and English language’s taxonomic obsession have offered the world a lot for understanding mental health. My hope is to start a conversation on the language we are using about mental health in Arabic and discuss its limitations and strengths. Then, we can explore how we can take the best parts of Western understanding of mental health and integrate the strength of our own language and culture to see a fuller picture. Maybe then, the conversation with our friends and everyone else we care about can go a bit further than it did on that beautiful summer night in Kensington.
