Like Water on a Cabbage Leaf: Islam and Mental Health Stigma

An examination of mental health stigma as a necessary product of maintaining Muslim norms

Content note: physical abuse, imprisonment, interrogation, forced hospitalization, and overmedication. 

My analysis concerns mainstream conservative Muslim societies as described in the below culture and context and is not to be taken as universal to all forms of Islam or Muslim belief or temporally absolute.

There is no doubt in my mind that mental health stigma is one of the most serious cultural problems in various parts of the Middle East and other Muslim majority regions today, and that it ties in quite neatly to our conceptions of autonomy and human competence. I understand why this is the case.

When I say ‘understand’ here, this means I recognize why there is ideological impetus for mental health to be viewed in the way that it is. That is a curious sentence now that I read it back, but I have come to realize, after long years of struggling with my own mental illness to the obliviousness of those surrounding me, that our cultural language in my home culture is steeped in attitudes that are both necessary for the promulgation of a properly Muslim lifestyle and radically out of tune with what we know about human psychology.

First let me trace out the extent of the problem, before I tackle its roots. Here is an anecdote for you. The following had to happen before for my parents to finally cave and get me medical help for my mental illness:

I ran away from home. I was an adult, though barely (I left maybe 2 months after my 18th birthday). It’s a long  story, but I was essentially hunted down with help from a militant Muslim organization. They found me and held me until my father, who was overseas, could come claim me. He did. In the subsequent weeks, my parents began their interrogation process, because the explanation I gave for running away was unacceptable. After all, I lived in a society where leaving home is unthinkable for an unmarried Muslim girl. I told them I wanted my own life, that I wanted self-determination, that I was depressed living among them–none of this made any sense or was acceptable to them. Note that I was still Muslim at this point–none of it was about leaving Islam. But my actions were in such violation of what was permissible in their understanding of the faith that they did not even question the use of force, control, and extortion to try to get to the bottom of what was going on.

I won’t go into too much detail here, but in the subsequent weeks I was imprisoned and abused in attempts to extort ‘the truth’ about my motivations from me. My father asked if I was a prostitute, pregnant, etc. Those were the sorts of confessions they tried to wring out of me, because depravity was the only explanation in their minds for my actions. I was already depressed. I was already dealing with a myriad of other mental health issues and this interrogation process exacerbated them. Over the course of weeks and eventually months, I withdrew so much into myself that I even stopped physically reacting to external stimuli. It was at this point that something clicked in my father’s mind: Maybe I was not responding because I was incapable of doing so.

Up until that point, he thought I was just being stubborn, willful, cruel. That I was being a vicious, evil woman by not submitting to the interrogations. He quite literally could not conceive of another reason.

It took all of that, but he finally took me to a psychiatrist. I was put on medication right away. The physical abuse stopped and I was confined to my room for the next better part of a year. My mother resisted all of this at first, partially because ‘Western psychology is nonsense’ and also because she fully believed the myths surrounding mental health stigma in the Middle East: That psychiatric care was only for the raving mad, the broken, people-who-weren’t-people anymore. And she couldn’t or wouldn’t believe that her daughter could be those things.

In the following years, I tried to build a life and career surrounding my stigmatized mental health state. I grew to learn that my parent’s biases were only a reflection of the language of our culture, of the ways in which I’d be treated within larger society. The doctors were worse than laypeople. I found that with every doctor and psychiatrist I saw, patriarchal norms regarding the mentally ill superseded adherence to medical training. I was given no right to self-determination or privacy regarding my health and was excessively overmedicated, partially in attempts to subdue me. After I came to the States, I wrote an open letter detailing my abuses at the hands of one of the region’s premier psychiatry departments. You can find it here.

How does Islam tie into these cultural attitudes? I have said that our cultural language regarding minds in Lebanon is steeped with attitudes necessary for the promulgation of a properly Muslim lifestyle. In other words, in order for our most Islamic of cultural norms in Lebanon to be upheld, to make consistent sense, people must subscribe to a theory of human psychology that not only makes very little actual-world sense, but involve a series of unfortunate conflations and erasures regarding will, autonomy, and self-interest. And, I will argue, all of this is in service of preserving ironclad norms while being able to boast consistency.

The greatest merit Islam had to me in my teen years was its internal consistency. The meme of the atheist who points fingers and mocks silly religious beliefs was actually quite recognizable to me when I first encountered it, because it brought Muslims I’d known to mind. You will routinely find Muslims who bear an almost-mocking stance towards what they view to be the inconsistent vagaries of a Christianity that divides an allegedly omnipotent, omniscient God into three entities. The Qur’an says quite plainly that it is only disbelievers who conceive of God as the third of three, and to a large extent, Islam has been able to frame itself as a re-constitution of Christianity in attempt to rid it of the confusing inconsistencies that come with an ideology that places a grand transcendent sacrifice at its core in service of ridding people of some innate sickness of Original Sin.

Islam has none of that, and has waved away the Original Sin myth altogether in favor of a less counter-intuitive understanding of human souls as fundamentally good if also fundamentally prone to corruption, whose salvation must be earned via a life of virtue. To Muslims, it makes absolutely no sense that some god-person-ghost-idk-what’s bodily sacrifice would absolve you of sin…no, you must earn your own salvation yourself through action and sincere belief, and work quite hard for it. There is quite a bit of pride taken in this worldview–it is presented as reasonable, consistent, and self-evidently right.

The nit-picky nature of Islamic edicts surrounding ‘Matters of Living’ also extends from this worldview. These are matters concerning what you wear, eat, where you go, how you manage your business, who you interact with and how and when, how you marry, inherit, and so on. All of these rules and restrictions are placed in favor of preserving the virtue of your spirit. They are extensive and quite detailed, which is often a source of puzzlement to outsiders, I’ve found, despite prevalent acknowledgement that bodily, mental, and cultural health are very much byproducts of the manners in which we interact, eat, and live. Islamic norms, however, are puzzling in that they seem quite arbitrary. The detailed justifications that are given do explain how/why each rule is necessary for the preservation of some essential human virtue, such as modesty. These justifications unfortunately don’t map onto reality. Along with requiring shoddy scientific understanding in general, the norms in question more particularly require a quite unrealistic view of human psychology in order to be maintained. Consider the following:

The moral rightness of my home society’s cultural norms is definitely their most overt quality in our language surrounding them. To take an example that might seem less obvious than the hijab or daily prayer: Muslims are ordained to only eat meat slaughtered in a specific way. To an outsider this seems highly arbitrary, but the consumption of what is halal is spoken of culturally as a moral good in pretty straightforward ways. Halal meat is considered good for your mind and for your body (that is, for various reasons that are not supported by science, it is considered more humane and healthy). It is also an exclusive good. There is overt cultural language that literally presents the consumption of non-halal as so harmful that it will harden your heart and weaken your moral character. As will not praying, not fasting, and so on.

But leading a properly Muslim lifestyle in adherence to these strict rules is patently unrealistic, both because mental health problems are common and maladaptive and because Islamic rulings are framed as moral imperatives and brook coercion through social pressure and sanction among other methods, which itself may lead to psychological harm. This is a manifestation of how environmental circumstances can contribute to mental illness symptoms. While this might seem to pose a problem to any stringent sort of lifestyle, the particularly normative nature of Islamic doctrine leads to some unsavory conclusions: The idea that seemingly sane, competent, well-adjusted adults might fail to do what is morally incumbent due to involuntary stress, anxiety, phobia, or depression undermines the normativity of those customs. The idea that these very customs themselves might contribute to the deterioration of one’s mental wellness undermines them even more. These are customs that are spoken of as God-ordained, as good-for-man, as never an imposition, difficulty, or strain, as perfectly minimal in terms of requirements, as merciful, kind, and right.

Likewise, an unwillingness to submit to other Islamic  norms that would strip a person of autonomy (eg: limited mobility for women except with explicit permission) or objectify them (all the hijab things basically) is hashed in terms of vice and stubbornness. The very concept that what is morally incumbent in Islam might be psychologically weighty to the not absolutely-broken human mind is absolutely untenable. No, for these norms to be upheld, a consistent lack of adherence to them must be hashed in terms of the sins of sloth, laziness, lack of self-control. Otherwise, they make no sense. Otherwise, God is not just.

One might think that a conclusion that leads you to question the justice of God might call for a re-examination of your theology, but such a questioning is so unapproachable that it is preferable to deny real-world facts in favor of preserving the idea of a just God. Right now I’m recalling attempts to convince a relative that gay people are born that way, or at least have some innate propensity influencing their sexual orientation–but no, she says, that would mean God is condemning them for something that they cannot help, and God would never do that. Instead of questioning God, she finds it more reasonable to deny the ‘born-this-way’ theory rather than revising her conception of divine justice. Which, despite being unreasonable, is a form of rationality built on false premises: If your goal is uphold moral religions norms, attributing absolute stringency to them above and beyond human knowledge is one of the most powerful ways to do this. This is radically consistent with Muslim denial of data that could serve to undermine norms. For instance, data does not indicate negative correlation between modest dress and sexual harassment rates, or evidence that halal slaughter is not in fact humane. 

This means that these beliefs regarding human psychology aren’t specialized, don’t only come out in specific reference to mental illness and Islam. Common understandings of duties and roles in Islam (gender and otherwise) are steeped in linguistic reference to attitudes of the human mind as impermeable to damage. Not all damage, but specifically damage considered not-valid-as-damage under Islamic code. That is, it is inconceivable that a requirement of Islam might pervasively be too taxing*. When the Qur’an ordains that women might be beaten in certain circumstances, that slaves might be owned, that women inherit half, their testimony is worth half of men’s, that they must suppress their voices, bodies, movements etc etc etc…this entails an understanding of human psychology as resistant to emotional abuse, to objectification, to repression, to lack of autonomy, to suppression, to oppression.

Like water rolling off a cabbage leaf, whatever difficulties that come with following Islamic norms are just part-and-parcel of their virtues and nothing actually beyond the bounds of the reasonable. Children who are beaten when they sin are being brought up properly, because beating is viewed as corrective, and because sin is the greatest self-harm possible so there is a utilitarian calculation to beating children in attempt to save them from the far greater pain of hellfire. When women attempt to object to the hijab as repressive, as objectifying, as restrictive and dehumanizing, their arguments are waved away as nonsense…to the religious, only a desire to be a sinful hussy can properly explain why a woman would reject this hijab ordained to her. Ironically, the deleterious mental health effects of using such dehumanizing labels is lost on those who use them, doubly-reinforcing cultural obliviousness towards what mental illness is and what contributes to it.

I believe this understanding can be extended both upwards and downwards. Upwards to the most extreme: physical judicial punishments such as whipping are quite notorious in Islam, and the fact that they are viewed as corrective–as doing good to the mind after the body has healed–rather than potentially psychologically damaging is quite telling. This is a more complex belief than thinking physical trial is not psychologically damaging. No, provisions for healing and grief in times of war within Islam acknowledge fully that human bodies and minds sustain damage and can’t be expected to bounce back from anything and everything. Muslim focus on illness, poverty, and foreign invasion as incredible human tragedy are also evidence of this.

No-the philosophy isn’t that humans are especially malleable and cannot be run-down–it is that human beings cannot and should not–unless there is something so wrong with them that they can no longer be considered human–be adversely affected by morally proper norms, including the requirements of Islam–because to be human is precisely to have affinity to what is God-given as morally right. This is why when we extend this understanding downwards to more every-day problems that are not particular to Islamic norms but consistent with them, we find similar sentiments: Attempts to explain to a strict Muslim father that his son’s bad grades are due to executive dysfunction and motivational issues that arise from ADHD rather than laziness can go nowhere quite fast.

And more directly, the concepts of  mental illness in Islam–and they do exist–are quite geared towards an understanding that only the inhuman can understandably flout Islamic norms. There are provisions made exempting the insane from religious duties like fasting and praying, with the argument being that they are as children who cannot process or understand these requirements, and thus are exempt from responsibility for them. As you can imagine, this leads to perfectly accepted practices where mentally ill people are stripped of rights to autonomy and self-determination–and if the only overtly linguistic reference to the mentally ill strips them of competence and moral compass, it is unsurprising such mistreatment exists.

Ironically, this view of mental-illness-as-incompetence is closer to being a biconditional than a conditional. Inability or unwillingess to understand or recognize the tenets of Islam as good is often equated with a mental health problem, because Islam is considered to be self-evident to those sufficiently acculturated into it, in a manner that fundamentally speaks to the presence of human reason. And of course, this uncovers a reductive, binary view of human psychology: That either we as humans are perfectly sane and capable, or else we lack any capacity whatsoever to be agents or moral agents, the latter being tied directly to an acknowledgement of Islam as true. There is no middle ground where a moral, competent, autonomous human being might nonetheless struggle with maladaptive symptoms due to mental illness. There is a conflation between mental health and moral capacity. And because humanity is tied to moral capacity in Islam, the mistreatment of the mentally ill is often no moral object.**

This linking of competence and moral compass to mental health, and thus mental health to Islam, extends beyond common cultural sentiments such us ‘You’re crazy if you don’t believe in God’…no, people have been institutionalized and forced to undergo ECT and take medication because they have flouted religious norms. See Reem Abdelrazek’s heart-rending account of being hospitalized for her non-belief. Others are exposed to the Muslim equivalent of exorcism, stemming from the conviction that the sin of denying your Creator’s existence must be the result of possession by a Jinn, so self-evident is that claim.*** My own traumas under Lebanese mental health care also stem directly from a perception of my illness, character, and actions being conflated… my immodest actions as a loose runaway woman served to account for my illness, my immoral actions, and excuse treating me like a child with no personal autonomy.****

But I don’t believe this is a sufficient explanation. Yes, the stringency of unapproachable norms definitely contributes to the maintenance of mental health stigma. But I believe that meager allowances, an important mirror image to unapproachable norms, is the second powerful force upholding these practices and attitudes as culturally accepted norms. It took a while for me to put my finger on it, but I have realized that the cultural language surrounding the self-evidence of Islam points to the rights, allowances, and privileges under Islam just as often as it points to the rules and regulations. More particularly, I noticed that Islamic allowances aren’t presented in terms of basic elements of human well-being, but are often magnified so as to seem like incredible bounties. Some Kant comes to mind. This is from ‘Religion Within the Boundaries of Mere Reason’. Kant writes:

For, however virtuous someone is, all the good that he can ever perform still is merely duty; to do one’s duty, however, is no more than to do what lies in the common moral order and is not, therefore, deserving of wonder. This admiration is, on the contrary, a dulling of our feeling for duty, as if to give obedience to it were something extraordinary and meritorious.

Duty has something in common with rights–they are what we take to be required. When Kant says that admiration towards doing duty dulls our feelings for duty, I think of the rights that are treated like special privileges back home. I think of how it is considered an especial marker of progressiveness and pride if women are educated–rather than a basic minimal requirement. I think of how husbands and fathers are gatekeepers to a woman’s access to the public sphere, where mobility is viewed as a special privilege rather than a right. I think of how not only are rights viewed as privileges, but oppressions are hashed in terms of right (the right for a woman to not work, for instance). And I’m not surprised, when our cultural language regarding what people need and deserve sounds something like this:

One of the Prophet’s companions once asked him, “Messenger of Allah, what is the right the wife of one of us has on him?” he said, “To feed her whenever you feed yourself and to clothe her whenever you clothe yourself; do not slap her across the face, revile her or separate yourself from her except in the house.” (Sunan Abu Daawood: 2142)’

and when we represent women’s rights and ideal relationships like THAT– with not only endorsement and approval, but with wonder at the great generosity of spirit and humbleness the Prophet had, when this is one of the POSITIVE ahadith. That is, we view it as especially meritorious that a woman should deserve food, clothing, and safety from being slapped in her own home. The phenomenon Kant describes is one that I have seen become an entire cultural attitude. By hashing our access to basic rights in terms of extraordinary merit, and building our religious ideology and thus cultural fabric surrounding that, we give credence to the claim that Islam is a self-evident truth, a matter of moral rightness. We dull our sense of outrage to violation. We think we can handle more, deserve less, and are weak, flawed, inhuman if we have all of these wonders Islam gives to us–as our culture tells us time and time again–and somehow aren’t happy, whole, satisfied. It’s not a wonder that the sinful are spoken to as if they lack gratitude, awareness, acknowledgement–when violations are treated as rights, and the most basic of rights are treated as great merits, this is only to be expected.

These attitudes are also unfortunately crucial for conservative Muslim norms to remain internally consistent. That is, for Islamic theology to survive in its present form, an obliviousness to the truths and relevance of human psychology is not only required, but must be encoded into common cultural language.

And if we happen struggle to live under these norms with the add-ons of rudely maladaptive mental illnesses–well, there is no heaven to help us.

-Hiba

*It’s worth noting that physical illness is treated with more compassion. But even when there are special provisions exempting eg: the physically ill from fasting, it is worth noting that all such provisions tend to follow very strict restrictions (eg, a flu or a job that requires great physical activity such as professional athetics are insufficient to excuse you from fasting–you must suck it up). They are also presented explicitly as exceptions, as rare and exclusive cases, or else common only among the chronically ill, the old, or the very young–outliers among the general population who have something “wrong” with them, instead of acknowledging illness as a normal part of the human condition.

**This is not to say that this is exclusive to Islam. Mental health stigma is a problem in the West too,  of course, and there are cultural misconceptions here that conflate insanity with a lack of rationality as well, and to define humanity in terms of rationality too. I have no doubt that at least in some areas in the US, mistreatment of the mentally ill stems from a conception of us as subhuman in one way or another. I’m sure even those of us who try to fight our biases can’t help but view the mentally ill with greater scrutiny. I’m sure that in some way or another my credibility is somewhat undermined by what you have just learned about my mental health. What I find to be crucially particular to the Muslim situation is how inextricable cultural attitudes towards human psychology seem to be from maintaining Islamic norms. This makes the problem more confounded, more difficult.

***A note here on the strange conundrum that is apostasy in Islam. On the one hand, apostasy is such a severe crime of conscience that ‘our blood is halal’, to use the Arabic expression, as heathens in many places–we can be killed with impunity. At the same time, there is a resistance to acknowledging the mere possibility that a person can choose to leave Islam because Islam is a self-evident truth–an analytic a posteriori truth, if you will. Those who have been Muslim, who have learned its truth, cannot be anything but. So which is it? If it never happens, then why is there such severe punishment for it? I think the resolution to this contradiction lies in the concept that those who voluntarily leave Islam are broken, inhuman in a way. They have been corrupted by their desires to sin, to lead lives of vice and indulgence. This still discounts the possibility that a person may leave Islam out of sincere ideological and moral lack of conviction while justifying inhumane treatment of those who do.

****That’s right; the explanations my doctors and family had for my mental health troubles weren’t genetic, environmental, or referencing a the life of abuse and suppression–no, it was because of my immoral actions and beliefs. To this day I don’t believe my father acknowledges that it his constant violence that has led us all into misery. Five years after the incidents I related above, my father (who had installed key-stroke-recording software on my laptop while I slept) uncovered a chat I had with a friend where I began to talk about the trauma of it all for the first time. He confronted me demanding to know why I wasn’t over it, and saying ‘did it ever occur to you that you caused everything that happened, that you deserved it because of your actions?’ So there’s that…