The Illness of the Heart

Psychological illness among Muslims is regarded as a special problem. Many doctors do not know how to deal with the situation, while treatment concepts and patient-focused services are lacking in Germany. By Cigdem Akyol

A woman receiving light therapy for depression (photo: dpa)
Like the rest of the population, many Muslims suffer from depression, but they don't always get the treatment they should.

​​When his children phone and ask him, "How are you feeling?" he answers, "Fine." Nonetheless, his depression sits deep inside like a virus in his body and has become a chronic condition – it comes and goes, sometimes stronger, sometimes weaker, but it is always there.

Yilmaz A. is 60 years old and came with his wife to the Ruhr region of Germany from eastern Turkey some 36 years ago. Mr A., who's Kurdish, worked as a welder. The couple had three daughters, and lived quietly in the middle of the Ruhr – his only link to his home country being a satellite dish so that he could watch Turkish television.

His family isn't particularly religious. Neither his wife not his daughters wears a headscarf. Mr A. never goes to the mosque, preferring instead the tearoom. Ten years ago, he lost his job and did not look for a new one. He began to lose himself in thought and his psychological state became unbalanced.

Mr A. says that, for a long time, he didn't know what was wrong with him. Neither did his doctors. Only later did a psychiatrist recognize his symptoms as being those of clinical depression and, since then, he has been taking the anti-depressant drug Fluoxetin.

Lack of interest in the needs of the Muslims

Mr A. is just one of 15 million migrants living in Germany. Among them are some 3.5 million persons of Muslim faith, who have turned Islam into Germany's second largest religious community. For far too long, the majority society has not interested itself in the life led by "the foreigners" apart from their work in the coal mines and on the construction sites.

Talk has always been in terms of "us" and "them," while reservation and mistrust have characterized both sides. Yet, the migrants are also a part of this society, with all their strengths and also with their troubles and difficulties. It is only natural that mental illness afflicts members of this group as it does others.

Psychotherapy for Muslims, however, remains a side issue in the West. There are statistics for almost every detail of Muslim life, such as education levels and even Internet behaviour, but hardly anyone has shown concern for their mental well-being.

There are no statistical surveys on mentally ill Muslims. When German Health Minister Ulla Schmidt recently presented a report on mental illness in the country, Muslims were not mentioned. "This disregard also contributes to the rise in the number of clinically depressed Muslims," says Meryam Schouler-Ocak, director of the psychiatric outpatient clinic at the University Psychiatric Clinic of the Charité Hospital and head of the Berlin Alliance against Depression.

Problems of comprehension

There are studies showing that individuals with an immigrant background are rarely recommended psychotherapeutic treatment. Many attempt to deal with their suffering within the family for fear of not being properly understood. "This is why we have to make a greater effort with these patients," says Schouler-Ocak.

a pile of tablets (photo: DW)
Medication is not always the best answer for psychological problems, but it can help in some cases.

​​Of course, the hurdle is great for anyone to admit to a psychological problem and seek out help. But how is anyone going to agree to treatment by a doctor or therapist practically unable to understand them – either culturally or linguistically?

The Rüsselsheim-based therapist team, Ibrahim Rüschoff and Malika Laabdallaoui, have written a book called "Guide for Muslims," offering both specialists and patients information on dealing with such difficult situations. Some patients travel all the way to Rüsselsheim from other German states or even from abroad out of a sense of shame, reports Rüschoff, who works as Assistant Medical Director for Neurology, Psychiatry, and Psychotherapy and also runs a private practice together with his wife, who's a qualified psychologist,.

Cultural differences

In a cultural environment that stresses saving face and in which the concept of honour holds a high place, those suffering from psychological difficulties are willing to travel a long way in order not to encounter anyone they know.

The reasons for this secrecy lie not only with the culture, but also with the religion. The private sphere in Islam is greatly valued. Intimate details and family life are not topics of discussion with outsiders. Practicing Muslims fear that their problems are not taken seriously enough and that they therefore can't expect any help, explains Rüschoff.

This could simply be seen as a reflex to avoid therapy, but Rüschoff believes that the mistrust is not entirely groundless. "Therapists are themselves mirrors of society and also hold many prejudices against Islam," he says. Some doctors might regard the wearing of the headscarf as unnecessary or not take seriously other religious practices. The consequences are dire. "Patients fear that one of the aims of therapy is to eliminate their faith, and they therefore avoid treatment," states Rüschoff.

Lack of provision

Treatment concepts and patient-focused services are lacking in Germany – especially native language counselling. There are, of course, individual projects, such as the Turkish-speaking Psychotherapist Working Group and the German-Turkish Society for Psychiatry, Psychotherapy, and Psychosocial Health, which help to provide psychiatric and psychotherapeutic care to Turkish immigrants. But in no sense do comprehensive mental health services for immigrants exist in Germany. Those Muslims who are not Turks simply fall through the cracks in the system.

Clearly, good treatment does not depend on the religious affiliation of the therapist, yet a better understanding of the faith of the patient can help reduce the fear of contact. Rüschoff, however, rejects the view that Muslims are best treated by other Muslims. "Empathy alone is insufficient. It is easier for a good non-Muslim therapist to fill in the gaps in his knowledge than it is for a bad Muslim therapist to improve on his lack of expert skills."

In order to better understand the progression of an illness, a religious case history can prove helpful, as the Islamic understanding of illness differs from that in the West. The Koran, for example, refers to the "illness of the heart," meaning an imbalance of the soul. According to the Islamic perspective, a person is healed when the balance between spiritual, bodily, and social spheres is re-established.

Religion can play a role

The Koran is not a medical text. Yet, it does contain accounts of the relation between treatment, curative effects, and God, as well as instructions on required prayer in the case of illness. This all leaves its mark on the Muslim understanding of illness. As faith can also play a role in recovery, many doctors in the USA refer to the religious biography of the patient in treatment.

It is likewise conceivable that religion and involvement in a community can, in addition to psychotherapy or prescribed pharmaceuticals, provide vital support for a mentally ill believer. The problem is that many mosques lack an understanding of psychological counselling and therapies. Many Islamic cultures are still characterized by a belief in genies and spirits. Supernatural powers and the "evil eye" (Nazar in Turkish) are often held responsible for symptoms such as hallucinations and hearing voices.

Due to this widespread superstition, many Muslims with psychological problems will first seek advice from a trusted imam or hodja. As opposed to an imam, who preaches and leads the faithful in prayer, hodjas rarely have any theological training. Instead, they merely sell herbs that are supposed to have a curative effect.

Such treatment does not convince Mr A. His depression has gotten worse, and, as a result, he has been open to various treatments in recent years, from new psychopharmaceuticals to treatment in hospital. He frequently loses himself in a mental fog caused by his medication, whether diazepam or atosil. Up to now, no one has been able to help him. "I don't understand them," says Mr A. "and they don't understand me either."

Cigdem Akyol

© Tageszeitung / Qantara.de 2009

Qantara.de

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