Arab Americans and American Muslims Express Mental Health Needs

By Deborah Goodman

The Islamic Center of Long Island received a supportive community response after September 11 because of previous outreach efforts, according to spokesperson Dr. Faroque Khan.

"I have a friend who said, 'In the morning, instead of telling me Good Morning, my boss tells me Hi Terrorist.' And then I asked her, 'But why don't you call the police or call somebody who would be able to help you with this?'

"And she said, 'Adnan, I want you to know that if I call anybody, I will be fired. And I need this job.' "

This incident was related by Adnan Hammad, Ph.D., director of health and medical services at the Arab Community Center for Economic & Social Services in Dearborn, MI, at an Arab American and American Muslim listening session hosted by SAMHSA's Center for Mental Health Services (CMHS) in November, just 2 months after the September 11 terrorist attacks on America.

It is one example of the verbal harassment, vandalism of property, and physical assaults-some resulting in deaths-that many Arab Americans and American Muslims have experienced since the attacks. These events prompted SAMHSA to hold a listening session to examine the effects on the mental health of this community.

CMHS staff-Capt. John Tuskan, Jr., R.N., M.S.N, Teresa Chapa, Ph.D., and Zena F. Itani, M.P.H.-planned and coordinated the meeting, which focused on identifying unmet mental health needs and drafting recommendations to address them. The discussion was facilitated by CMHS National Advisory Council member Abdul Basit, Ph.D., a research associate in the Department of Psychiatry at the University of Chicago and president of the American Islamic Association of Mental Health Professionals.

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Problems & Needs

In the wake of September 11, many Arab Americans and American Muslims experienced both grief and fear: grief at the tragedy and loss of life, and fear of being blamed and stigmatized.

Zahid Bukhari, Ph.D., director of Project MAPS (Muslims in American Public Square) at the Center for Muslim-Christian Understanding, Georgetown University, described the variety of ways in which Muslims were affected by the incidents: some as victims or relatives of victims killed while working in the World Trade Center, some as targets of backlash discrimination, some serving as members of the American military, and some who have received positive expressions of support from other Americans in the wake of the tragedies.

Citing some examples of interfaith solidarity, Sayyid Syeed, Ph.D., secretary general of the Islamic Society of North America, said that when the Toledo, OH, Islamic Center was attacked after September 11, approximately 1,500 people of other faiths circled the Islamic Center and provided protection the next day.

The diversity of societal reactions has created an emotional "roller coaster for Muslims for the last 2 months," Dr. Bukhari observed.

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Identity Crisis

Perhaps the most universal experience following the attacks has been a profound self-questioning.

"The same question keeps coming up," said Salma Abugideiri, M.Ed., LPC, of the Center for Multicultural Human Services in Falls Church, VA. "How American am I? What does it mean to be Arab? Can I be Arab American? And what does it mean if I'm a Muslim in America who has, up till now, felt very comfortable, very safe, appreciating the religious freedom . . . and now being forced to answer some very difficult questions."

Listening session participants said that many Arab American and Muslim children born and raised in the United States are now fearful to attend school or go to the movies and have been asking difficult theological questions that their parents cannot answer.

Participants further noted that some first-generation Arab Americans immigrated as refugees fleeing repressive regimes or war-torn countries. The events have caused a retraumatization for them in a country they had considered a haven.

Many Christian Arab Americans also experience confusion and isolation, feeling as if they don't belong in either the Muslim Arab world or in American society at large.

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Lack of Appropriate Help

Responding to the mental health needs of this community is complicated.

"Seeking mental health treatment [is] taboo; it's not part of our culture," Ms. Abugideiri said.

As in many other cultures, stigma and a sense that problems should be resolved within the family often prevent individuals from seeking help.

For those receptive to mental health counseling, other problems arise, such as a lack of Arabic-speaking service providers for new immigrants, or a lack of culturally appropriate treatment.

Dr. Basit, who has published articles on this subject, spoke about the pitfalls of cross-cultural diagnosis and treatment.

In an article, "Religious and Ethical Factors in Psychiatric Practice," published in the Journal of the Islamic Medical Association, Dr. Basit wrote, "The underpinning of all research, leading to various schools of thought in the field of psychiatry, is without doubt a product of Western scholars, representing the religio-cultural traditions, historical symbols, and narratives of Western society. . . . Consequently, methods and techniques developed in the West may not be suitable for treating American Muslims, whose religious and sociocultural backgrounds are quite different."

In other published papers, he delineates some of the differences between Western and Islamic perspectives on counseling. In the West, he says, primacy is placed on individualism and personal fulfillment, whereas in American Muslim culture, personal goals are often subordinated to the collective goals of the family and community.

Western psychotherapy, he also observes, is secular, focuses on the development of new coping techniques, and often espouses a relativism in ethical issues. In contrast, he says, an Islamic approach is embedded in spiritual faith.

One participant described a cultural sensitivity training session she had given for American social workers in which one of the social workers suggested she remove her hajab (head scarf) to avoid discrimination.

"The mental health professionals really can do a great deal of damage, and it only takes one person like that," she said. "The word will spread throughout the community and then [people] won't send their kids to the school counselors for fear that all of the girls then are going to be encouraged to take off their scarves or change other cultural patterns or ways of doing things."

In the current climate, many Arab Americans and Muslims further distrust and avoid social service organizations for fear that if they express themselves openly, they could be detained for questioning or even deported.

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Recommendations

Community and Interfaith Outreach

Participants noted that in places where earlier efforts had been made to build bridges with the greater community and to establish interfaith activities before September 11, fewer problems arose.

Faroque Khan, M.B., M.A.C.P., a physician and the spokesperson for the Islamic Center of Long Island, said that his Center's previous outreach and educational activities over several years had resulted in a supportive community response after September 11.

Participants urged that mosques and Muslim community centers invite representatives from the police, fire, and public health departments, as well as churches, synagogues, and temples, to attend events and prayer services.

They also said that offering educational programs about Arabs and Muslims to schools could help foster understanding among children, teachers, and other school personnel.

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Culturally Sensitive Services

In addition to providing training in cultural sensitivity to mental health professionals, participants also recommended that mental health professionals work closely with Muslim religious leaders.

As one participant observed, "People in the Muslim community-and it's probably true in Christian and other communities when these crises occur-they will go to the religious leader in the community, and quite often the religious leaders are not trained to intervene properly."

Collaborating with imams and providing them with additional education about mental health would enable the mental health and religious communities to reach and assist people more effectively, participants said.

They called for funding more research on culturally grounded therapeutic approaches for Arab Americans and Muslims, for the development of manuals detailing best treatment practices, and for the compilation of a directory of Muslim resources and services in America.

Participants also expressed a desire to help Americans increase their understanding of Arabs and Muslims. They advocated for more work with the media and entertainment industries to combat negative stereotyping.

Despite their concerns and the enormity of their task, participants still generated a feeling of optimism.

As one observed, "We have come here today because we believe that things can change."

For more information, contact Capt. John Tuskan at SAMHSA's Center for Mental Health Services, Room 17C-05, 5600 Fishers Lane, Rockville, MD 20857. Telephone: (301) 443-1761. E-mail: jtuskan@samhsa.hhs.gov.

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