It is in many cultures very shameful to admit to mental symptoms because people perceive it as a sign of weakness. The taboo and stigma towards seeking professional help is unmistakable, and I have come across it repeatedly during many field missions. The absurdity of acknowledging having a problem, but not seeking help for it, is a recurrent issue.

by AHLAM CHEMLALI

DURING many of my travels I have crossed paths with people who have moved, touched and inspired me. Faces, stories, smells and places have stuck with me long after I am gone. The ruined and unstable towns of Libya, the dense and overcrowded streets of Cairo, and the miserably despairing refugee camps in the occupied Palestinian territories.

The people I meet are all different, each with their own story, to live and tell; their own light, their own pain. Nevertheless, no matter how different, almost all stories include Love and Loss. I remember the heartbroken women waiting for their men to be released from Israeli imprisonment. Female relatives of prisoners suffer greatly when their husbands and brothers are taken away. Not knowing about their whereabouts, nor whether their loved ones are dead or alive, is unspeakably distressing. Will I ever see him again? Will our daughters know their father? Is he still alive? Then there are the lonely and sleepless Mothers of Martyrs, who impatiently look out their windows, jumping at any sound in the hope that their sons will return from the frontlines. Sadly, this rarely happens. Loss and grief are the only certainties in such times of darkness.

Thinking of these women, I recall the words of Khalil Gibran, “And ever has it been known that love knows not its own depth until the hour of separation.”

AH_Column_xxWhen travelling and working in the Middle East and North Africa, working in the field of torture and mental health, one cannot avoid getting familiar with the concepts of Maktub and Sabr.

Sabr is the Islamic virtue of “patience” or “endurance”. It teaches to remain spiritually steadfast. Patience in the face of a calamity, at the moment of grief. Still, Sabr is more than patience. More than endurance. Sabr is the strength of your soul and mind. It is accepting hardship as a pathway to peace. It teaches you not to break when you have been bent.

Maktub is an alchemist term which literally means “It Is Written. From mystical point of view, it points to the fact that whatever happens is already known to the One. It signifies that Destiny exists. Everything is already known to God.

These concepts are usually how victims of torture and violence, or people who have lost loved ones in conflict and war, explain their suffering to me. They are their coping mechanism.

To understand this logic one has to understand the fundamentals of Islam; to submit to the Will of God. The faith is a form of refuge that offers consolation and comfort. Moreover, Muslims believe that God will avenge an injustice that befalls the faithful. Hence, the matter is left to God and trauma or distress is accepted as divine will.

It is in many cultures very shameful to admit to mental symptoms because people perceive it as a sign of weakness. The taboo and stigma towards seeking professional help is unmistakable, and I have come across it repeatedly during many field missions. The absurdity of acknowledging having a problem, but not seeking help for it, is a recurrent issue.

This causes further problems. Many countries across the Middle East and Africa have a custom of not seeking support for psychological pain, with few trained psychologists and psychiatrists having experience of treating trauma. As a consequence of this low prioritisation, severe social stigma exists regarding those affected by mental illness. Mental illness is often considered a demonic possession and psychiatric symptoms are attributed to supernatural sources, such as the evil eye, magic or sorcery. The most common form of seeking help is to solicit traditional healers, witchdoctors or Sheikhs who communicate with evil spirits known as Jinns. In Morocco and Libya going to Al-Hijama is preferred. Hijama in Arabic is derived from hajm which means “sucking”. Blood Cupping (Hijama) is the process of applying cups to various points on the body by removing the air inside the cups to form a vacuum, in order to suck “bad” blood out. The procedure is also widely used across Asia in alternative medical practices.

Treatment and psychiatric hospitals are also saturated in deep stigma and taboo. Psychiatric hospitals are believed to be “frightening” places only for “crazy” people with severe mental disorders. In an Arabic context, women receiving care at a psychiatric hospital are marked as “crazy” and her chances for marriage are greatly diminished, leaving her likely to be perceived as a burden to her family for the rest of her life. Fewer females compared to males are inpatients in psychiatric hospitals, potentially due to the aforementioned stigma. In order to protect the family, sometimes individuals are sent to other countries for care, like a family I met in Egypt who sent their daughter for treatment in Tunisia, because of the perceived shame and dishonour to the family.

So do we change this culture? Is the Western way of thinking the most appropriate? Or is pathologising the problem — the real problem?

If, as a society, we do not bear witness to grief, the burden of loss is placed entirely upon the bereaved while the rest of us avert our eyes and wait for those in mourning to stop being sad, to let go, to move on, to cheer up. If they don’t — if they have loved too deeply, if they wake each morning thinking that they cannot continue to live — then we pathologise their pain; we call their suffering a disease. We do not help them. We tell them that they need to get help.

They say that time heals all wounds but that presumes the source of the grief is finite. I disagree. The wounds remain. The body will be seared in scars. In time, the mind covers these wounds with scar tissue in an effort to protect its sanity, and the pain lessens. But it is never truly gone.

The reality is that you will grieve forever. You will not get over the loss of a loved one. You will have to learn to live with it. You will heal and you will rebuild yourself around the loss you suffered. Yet you will never be the same again. Nor should you be the same. Nor should you want to.

Ahlam Chemlali is a programme coordinator at DIGNITY – Danish Institute Against Torture in Copenhagen, Denmark. She holds a BSc. degree in Medical Science with specialization in Forensic Pathology and a MSc. degree in Health Science with specialization in Torture and Trauma. Her dissertation was on victims of violence and torture in post-conflict Libya with field work in Benghazi. She is a part of multiple international research programmes and has subsequently conducted research activities and field mission in several low-income countries and post-conflict settings, across Sub-Saharan Africa, the MENA region and South Asia.