“There are symbolic places that awaken memories whether you mean to or not.”
-Dalil Boubakeur, head, Grande Mosquee of Paris
As loud as has been the discussion about Muslims in America and the Middle East ever since 9/11/01, as quiet has been the discussion about Muslims and mental healthcare. Most recently, of course, the controversy about building a Muslim community center near “ground zero” in Manhattan has reached shouting levels. Reminders of legal rights versus cries of cultural insensitivity abound. In other parts of the country, related controversies have erupted.
Over the same time, discussion of mental healthcare of American Muslims has been quite sparse in the psychiatric literature, especially in comparison to other prominent ethnic and religious cultural groups. I wonder why. Has that been because they received good care? Or, was their religious and/or ethnic background not known or even ignored? Or, did they come less to mainstream psychiatric facilities? Or, is the issue felt, consciously or unconsciously, to be “too hot to handle”?
I have long specialized in cultural aspects of psychiatry and received numerous grants for refugees. Muslims I have treated have included refugees from Somalia, immigrants from the Middle East, and Black American religious converts. We have tried to provide competent care for them and other groups that tended to be underserved or mis-served, using information on their cultural values supplemented by the unique perspective of each patient.
Other anecdotal experiences of colleagues, sparse as it seems to be, imply some special cultural considerations for American Muslims (or, Muslim Americans, depending on what one prefers in terms of terminology). Most note that trust is a large hurdle. In countries outside of the USA, privacy was rare, with the common anticipation that confidentiality would also be violated here. For similar reasons, the patient may prefer a clinician who is not Muslim and/or does not speak Arabic. Distrust can also be more intense if a Muslim clinician is from a different tribe or denomination than the patient.
On the other hand, the modesty of more traditional Muslim women will require them to not be alone in the office of a male clinician. If a patient believes in the Jinn spirits, a non-Muslim clinician may not understand what that may mean.
Yet, having all that knowledge and experience, and knowing better, here I am, beginning to wonder if the quality of my care of American Muslim patients was deteriorating recently. I became more irritable when patients asked for medication adjustments for Ramadan. Why didn’t I more readily prescribe a stimulant skin patch instead of oral medication? Countertransference mistrust? But why didn’t they ask me earlier? Transference mistrust? Though we rarely talked about our religious differences, there were clues in my office as to my background. Whatever the reasons, I wasn’t living up to the “I-Thou” ideal I recommended in my last blog. I must apologize when I see them next.
The first rule of cross-cultural psychiatry is cultural sensitivity. Maybe I was becoming as insensitive as those who planned a building so close to an emotionally provocative area. If built, there would invariably be triggers to the 9/11 trauma for those significantly affected, yet Muslims could take the controversy as a rejection, locally, nationally, and internationally, thereby escalating anger in the more radical.