Barriers to Mental Health: The Middle Eastern Experience

“Once an Arab woman taints her reputation, she cannot be redeemed.”

Those are the words I came to understand intimately in my childhood. The demands of purity and a good reputation still influence countless Middle Eastern women to hide their pain and need for assistance.

The social rules governing Middle Eastern families may be as different as their migration stories, but the themes are the same: purity, honor, graciousness are all characteristics are paramount for women. The reputation of the family depends on it — and the needs of the family unit outweighs the well-being of its members.

For generations, a family’s “good” reputation was tied to their survival and social standing in their homelands. Although these cultural norms are deeply rooted, they are no longer a necessity for survival for immigrants living thousands of miles away. But too often, these norms prevail, and Middle Eastern family members suffer in silence.

Mental Health Struggles Are Tied to Personal Failure

Nicole Vowell, a 35-year-old Palestinian, Irish woman was raised in a Christian-Palestinian family. They migrated to America as refugees in 1956, and settled in Michigan, where they live today. I was raised in a Muslim-Palestinian family that moved from Kuwait to Texas when I was almost seven.

Vowell and I were raised with issues unique to our families. But we were both taught that these issues at home were private and not spoken of publicly. If we were yelled at or belittled, it’s because we deserved it. If we showed symptoms of depression, we were shamed and even called “lazy.” If we held boundaries or asserted our own needs, we were punished for being disrespectful.

We both come from good families, and regardless of the mental struggles we experienced, our families loved us — and “one does not turn their back on their family,” we were told. As children, we accepted this and protected our family reputations, covering any faults, mistakes or vulnerabilities.

Experiencing mental illness as a woman in the Middle Eastern American community is a matter that remains shrouded in stigma and shame.

There Aren’t Studies Examining Middle Eastern Americans’ Health

According to estimates by the U.S. Census Bureau, about 3.7 million Americans claim Arab ancestry, but data on Arab Americans’ health, including mental illness, is missing because they are not identified as an ethnic group. This has led to an inability to provide for their medical and psychological needs.

“Arab Americans are in an unusual position in the American health care system — they are a group that both exists in the public consciousness, but is also un-counted, and hence has not been a part of a national reckoning with its needs and particularities,” according to a literature review about the health of Arab Americans in the U.S.

Anecdotally, mental illness is common in the Middle East. But if an individual suffering from abuse, toxic environments or struggling with symptoms of mental illness, they are unlikely to report or seek help. This can be explained by the desire to protect family reputation and address issues privately. Indeed, the extended family in Arab culture is at the core of social support, and it is the extended family’s job to resolve abuse or domestic violence. In fact, family members could even be ostracized for seeking formal services — because seeking help publicly is interpreted as an attempt to circumvent the family structure.

A Lack of Mental Health Education

The concept of psychological health in Middle Eastern culture is constructed through misinformation, a reliance on stereotypes and exaggerated media reports, according to research published at the University of California, Davis. This stigma can only be addressed through comprehensive mental health education and the prioritization of culturally responsive medical and psychological facilities.

The attitudes and misinformation often migrate with families to the U.S. In my Palestinian family, an uncle with a history of family trauma died alone in an alley after overdosing one night. His siblings tried to get him help for drug abuse, but it was too late. They did not acknowledge the trauma and mental health issues that led him to use.

Vowell believes her mother is unstable because she suffered sexual trauma when she was growing up at the hands of someone in her extended family. No one truly knows the details of her abuse or speaks of it. Vowell’s mother refuses to see a therapist to this day.

Generational Change

Vowell grew up to become an award-winning broadcast journalist and later, a communications director. She also mentors women transitioning from careers in TV news to communications.

Behind the scenes, however, Vowell has also been working through PTSD, depression, anxiety and ADHD diagnoses, she said. She has been going to therapy since she was 13 years old and became consistent about her healing in the last two and a half years. 

I moved to Jordan in 2017 and created the independence I once thought to be impossible. My parents initially disowned me but later came to understand the damage that caused. After three years, I moved to California where I worked as a newspaper reporter covering education, the achievement gap and childhood trauma. However, I felt lost, restless and directionless. I returned to therapy and was diagnosed with anxiety and symptoms of depression.

Like Vowell and I, other Middle Eastern, millennial women “are paying attention to their psychological states,” said Yassmin Eldouh, a half Egyptian, half Pilipino PhD student at George Washington University studying counseling and human development. There has been a generational shift taking place. “More and more children of immigrants are turning to services every day,” she said.

Other Barriers to Care

Even when a Middle Eastern woman decides to break cultural norms and seek help, she may not be able to. Some can’t afford the services. Some don’t have the autonomy to seek out a therapist, as they live with their families. And others simply don’t speak enough English and struggle to find someone who can provide services in their language.

“Those who can access services often have a hard time finding a therapist who understands their culture,” Eldouh said. “There are religious institutions training their own counselors, but, outside of houses of worship, too few understand the complexities of Middle Eastern culture and religious tradition well enough to work through them to their clients’ satisfaction.”

Eldouh became a therapist after suffering through severe anxiety in her own youth. She struggled to find a counselor who understood her culture and family of origin’s dynamics, or even language.

Vowell also struggles: her therapist doesn’t understand Palestinian culture. Vowell explains the customs during sessions and sometimes she records conversations with her family members to help her therapist understand.

While this generation is making progress, there are still too many women who are seeking the counsel of patriarchal elders with only the reputation of the family at heart. There are still too many women who endure physical and mental harm and suffer in silence.

To combat the stigma, I encourage people to learn about mental health and examine how cultural norms have affected you and your family history.

A version of this article was published on The Recovery Team’s website. It has been edited and reprinted with permission.