Barriers to Mental Health in the Minority and Middle Eastern Experience

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, mental illness, and need for assistance.

Nicole Vowell, a 35-year-old Palestinian, Irish woman from Michigan grew up hearing similar words. She recalled being at an American Federation of Ramallah Convention in 2000 in Detroit, Michigan when she was only 14. She was walking next to her brother when her aunt called her back, yelling, “’you can’t walk next to any man because people will talk and look at you and think you’re a shlokah (slut) .’”

Vowell bogged down and found a group of women to spend her time with but is still working through the impact of her upbringing in therapy today.

My family wasn’t restricted by the same social rules. It wasn’t a problem if I was seen walking with my brother or male cousins in a public place.

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 preserved in women. Her reputation, and the reputation of the family, outweighs the wellbeing of its members.

It’s not difficult to understand why. For generations, a family’s “good” reputation was tied to their survival and social standing in their homelands. But as immigrants living thousands of miles away, although they are deeply rooted, they are no longer a necessity for survival. Too often, Middle Eastern family members suffer in silence, falling apart under pressure to exceed expectations in every part of their life; to keep up with an illusion.  

The mental health of an individual is hardly recognized, and mental struggles are tied to personal failure and shame.

Vowell was raised in a Christian-Palestinian family. They migrated to America as refugees in 1956 and settled in Michigan, where they live today. Vowell’s sido, grandfather, started a grocery store and her grandmother was a stay-at-home mom. Two of her three aunts and her uncle were born and raised in America. They lived humbly, she said, and helped run the store.

I was raised in a Muslim-Palestinian family who moved from Kuwait to Oklahoma under different circumstances. My uncles migrated to America for college but decided to start a family business near Dallas, Texas, instead. I was born and raised in Kuwait until I was almost seven. That’s when my mother, siblings, and I moved to Texas. My father followed shortly after.

Vowell and I were raised with issues unique to our family. But we were raised knowing the issues at home were private and not to be spoken about to anyone. If we were hit or beaten, it was because we misbehaved. If we were yelled at or belittled, it’s because we deserved it. We were not allowed to have boundaries, or space.

We were taught others simply wouldn’t understand the nuances that come with being a cultural minority. That it’s natural for our “normal” to differ with what is normal in American homes.

If we showed depression symptoms, we were called lazy and shamed. If we held boundaries or asserted our own needs, we were punished for being disrespectful.

We come from good families and no matter the abuse or mental struggles we experience, our parents love us, our family loves us, and one does not turn their back on their family, we were told. As children, we accepted it all and protected our reputation, covering any faults, mistakes, or vulnerabilities.

Although it has become a buzzword in social media culture, mental illness is a matter that remains shrouded in stigma and shame, especially when it’s something experienced by women in the Middle Eastern American community.

Mental health vs. mental illness

The American Psychiatric Association defines mental illnesses as health conditions involving changes in emotion, thinking, or behavior that cause distress and interfere in daily functions. Mental illnesses can be mild and manifest as phobias or so severe they require hospitalization, according to the APA.

Mental health, conversely, is the state of emotional, psychological, and social well-being, according to the Centers of Disease Control and Prevention. It helps people make decisions about how to handle stress and relate to others.

It is possible a person may have poor mental health but no mental illness, according to the CDC. It is also possible a person is mentally ill and feeling well.

Mental and physical health are vital components to overall health and influence the other. For instance, depression increases the risk for health problems like diabetes, heart disease, and stroke. Such chronic conditions, in turn, impact depression.

There is no single cause of mental illness, according to the CDC. When demands placed on a person exceed their resources and coping abilities, that could impact it. A number of factors, like trauma or a history of abuse, chronic medical conditions like cancer, chemical imbalances in the brain, loneliness, isolation, or the use of alcohol and drugs, contribute to developing it.  

One in five Americans experience a mental illness every year and one in 25 Americans live with one, according to the CDC. However, studies examining the mental illness in the Middle Eastern American population is absent.

According to estimates by the U.S. Census Bureau, about 3.7 million Americans claim Arab ancestry but data on Arab-Americans’ health 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 healthcare 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 United States.

In addition to this, mental illness is common and unreported in the Middle East. An individual suffering from abuse, toxic environments, or struggling mentally keeps it to themselves or seeks the counsel of their faith, family, or a physician.  

Because the wellbeing of the family outweighs the individual, people are hesitant to admit they are struggling with mental health. The extended family in Arab culture is at the core of social support, and they are called on to resolve abuse or domestic violence.

In fact, dependence on the family is so prevalent that members could even be ostracized for going to formal services to resolve such issues because it is seen as an attempt to circumvent the family structure.

Stigma surrounding mental health is born from people not understanding what it is.

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. To combat the stigma, people should be educated about what emotional health is and governments should increase medical and psychological help facilities abroad and in the U.S.

If this doesn’t happen, people will continue to suffer in silence and turn to unhealthy, sometimes deadly, coping mechanisms.

In 2018, a man in Irbid, Jordan burned himself alive in front of a gas station. On a Saturday evening in 2020, a 50-year-old grandfather in a populated neighborhood in Amman, Jordan’s capital, poured gasoline over his head and lit himself on fire after years of trying to pay off his family’s debt.

While these may be extreme examples of what mental illness may lead to, they are not uncommon. They also paint a picture of what people are driven to in places of desperation. Suicide, self-harm, and substance abuse create more trauma in the individual and the community.

The attitudes people are raised with in the Middle East are brought to the U.S. In my Palestinian family of origin, 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 the 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 has narcissistic tendencies and refuses to see a therapist to this day, Vowell said. 

Generational change

Vowell grew up to become an award-winning broadcast journalist and later, a communications director for public health. She also mentors women transitioning their career out of the TV news business and into 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 did exactly what I set out to do. I covered the Syrian Civil War, wrote about refugees and economic stakeholders in the Middle East. I dined with ambassadors, activists, Muslim apostates, and defected military officers. I 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 without direction  after moving.

I put myself back in therapy and was diagnosed with depression symptoms and anxiety.

Like Vowell and I, other Middle Eastern, millennial women and greater youth 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.

But, barriers are creating a challenge. Some can’t afford the services. Some don’t have the autonomy, living with their families or husbands, to see a therapist. And some 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 well enough, 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 said.

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, and Vowell explains the customs during sessions. Sometimes she records conversations with her family members to help her therapist understand.

But there are still too many women who are seeking the counsel of patriarchal elders with good intentions and the reputation of the family at heart. There are still too many women who endure physical and mental harm because they lack the necessary support for them or their children.

They become self-sacrificial and mostly suffer alone, in silence, developing unhealthy coping mechanisms along the way and hurting loved ones in the process.

Those who think they could be suffering from mental illness should seek advice from an experienced mental health professional.

If left untreated, mental illness can cause permanent damage through poor decision making and an inability to maintain relationships. If severe enough, it can lead to suicide or addiction, according to Mental Health America.

Living with a mental illness doesn’t mean one’s life has to change. At the same time, it will feel easier to manage.

It’s alright to be overwhelmed, confused, or discouraged. One should take time to understand their feelings. To resist the stigma, learn about what mental health is and how it has affected you and possibly your family history. Encourage others to do the same.

Author Information

Nada Atieh is a Report For America corps member and education reporter focusing on childhood trauma and the achievement gap for the Redding Record Searchlight in Northern California.

She previously worked as a reporter based in Amman, Jordan, where she covered the Syrian Civil War for Syria Direct, and the Middle Eastern economy for Venture magazine.


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