2. Mental illness in Islamic and Muslim tradition
3. Mental health stressors
4. Muslims in the US
4.1. Statistics and demographics
4.2. Coping strategies and health care seeking behaviour
5. Muslims in the UK
5.1. Statistics and demographics
5.2. Coping strategies and health care seeking behaviour
For the past decade, the Islamic faith, especially when represented by minority communities living in Western countries, has repeatedly been the subject of heated debate in the political and the public sphere. Its followers are consequently confronted with the predicament of living in accordance to the prescriptions of their faith and being compelled to justify it. In this regard, Islamic adherence could very well be assessed as quite a burden. However, religion and spirituality have long since been recognised as beneficial to the coping process in times of emotional and psychological distress, albeit predominantly in the Christian context. Acknowledging the special situation of Muslims in Western countries, this paper aims to provide an analysis of the situation of Muslims with mental health issues living in a non-Islamic society, namely the multicultural, secular societies of the UK and the USA. It furthermore seeks to establish in what ways the Islamic religion influences the patients‘ outlook on themselves and their choices of treatment. It presumes that anti-Muslim bias, unfortunately widespread in the West, has its impact on its victims‘ psychological well-being. Not merely belonging to a minority group, but one that is continuously hated against, might prove to be a factor that negatively affects the psychological health of Muslims.
Numerous questions are inherently connected with this approach: How does affiliation to Islam influence adherence to treatment regimes? Do Muslims in the West generally oppose biomedicine? Or are biomedical and traditional treatment complementary in the minds of the sick? Does Islam promote behaviour beneficial to mental health or does it rather constitute a risk factor? Does the simple fact of following Islam present Muslims living in the West with conditions harmful to their mental health?
Academic literature has brought forward an array of research with regard to the situation of Muslim mental health in Western countries, the majority of which has focused on the US and the UK. Scholars such as Haque, Abu-Ras and Abu-Bader have paid special attention to the mental health situation of Muslims in the US, viewing the American context as uniquely challenging. Outstanding among the comparably smaller body of work dealing with British Muslims is Hussain’s article that offers a comprehensive introduction. Cinnirella and Loewenthal stand a the beginning of a diversified series of studies investigating the perception of illness and the corresponding health care seeking behavioural patterns of ethnic minorities, particularly Muslim communities in the US and the UK, while the works of academics like Utz, Amri and Bemak provide, among other things, a useful overview of recent research pertaining to the conceptualisations of health and treatment decisions of Muslims in relation to Islam. Padela and Curlin have undertaken a more general approach with their consideration of the impact Islam has on the health and treatment decisions of American Muslims and thus put the question of mental health in a more comprehensive framework.
The Islamic and Muslim concepts of health in general and mental health in particular as well as an analysis of the mindsets possibly associated to them constitute a useful starting point as they allow an insight into the religious background of attitudes, perceptions and practices later discussed in detail. Afterwards, mental health stressors considered specific to the life as a Muslim in a Western society shall be discussed, albeit speculatively in places. A first impression of the difficulties posed by a hostile environment as encountered by Muslims is attempted. Finally, the situations of American and British Muslims will be outlined consecutively and in detail. After an initial look at the demographic situation, thereby especially regarding the ethnic composition of the respective Muslim population, its levels of religiousness and acculturation, if statistically available, and the prevalence of mental illness, a review of studies aims to throw light on the mental health care seeking behaviour, referring back to the above-discussed in the process.
2. Mental illness in Islamic and Muslim tradition
Muslims living in Western countries are ethnically and culturally diverse. In religious matters, though, hardly any major deviation is discernible seeing as the Qur’an and the Sunnah generally constitute the basis for practice and belief. Because of its comprehensive nature, providing codes of conduct, rules and guidance, Islam represents much more than just a belief system and is thus considered a way of life.
Islam views man as consisting of the physical, mortal body on the one hand and the metaphysical, immortal soul on the other. Due to the body’s function as the mere container of the soul, priority in terms of health and care is placed upon the latter. Only by obeying God’s commands and following the Prophet’s traditions as prescribed in the Qur’an and the Hadith can the soul be kept pure and thus healthy; where man goes astray by ensuing vices rather than virtues, his soul and thus his mind will be infested with illness as a consequence. It is inherently implied that only “bad“ Muslims would fall victim to psychological disturbances, a belief that stands at the root of societal stigma. Consequently, suffering from a psychological condition would be judged as the result of detachment from God, a situation considered shameful and thus often hidden from the public, lest the societal stigmatisation not only of the person concerned, but his or her family as well be avoided. Yet there exists another connotation to illness as well, that of God hereby expressing his mercy by providing opportunity for spiritual growth and purification that secures a place and raises one’s status in Paradise. Aside from this, mental illnesses and diseases in general embody God’s will, to punish, to test and to restore purity after sinful acts: “No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that.“ Afflictions, be they physical or psychological, are thus thought to be ultimately caused by God; “devoted Muslims must therefore accept their fate with strong faith, courage and great patience.“ This reliance upon God’s will and workings is a double-edged sword, though, as it could possibly both encourage optimism and a positive view on difficult life events and discourage any moves towards seeking help. Furthermore, the work of jinns and their human accomplices by way of possession, black magic, whispering and the “evil eye“ may lead to mental health problems as well, affecting those whose faith in God has waned in favour of worldly interests. How these specific afflictions are to be treated is described in the Qur’an and the Sunnah. Although “such beliefs and practices are found in other religions as well and are often reflective of cultures rather than religion“, it can be assumed that most Muslims would be familiar with them by way of Qur’anic tradition.
In a survey it was found that 98% of Muslims questioned shared the opinion that adverse life conditions were in fact God’s way to test the faithful’s devotion, while 84% perceived mental illness as a consequence of devil possession. With 95% nearly all respondents believe that recovery could be attained by reciting the corresponding suras. In addition to Qur’anic reading, prayer, fasting and repentance serve as Islamic healing methods. An international study applying the Psychological Measure of Islamic Religiousness (PMIR) confirms the notion of Islam’s crucial influence on health by finding that Islam is indeed essential to the well-being of its adherents.
Despite its emphasis on supernatural and spiritual causes of mental illness, Islamic tradition does not disallow purely biological and environmental explanations: "There is no disease that Allah has sent down except that He also has sent down its treatment“ is a Hadith that implies the existence of natural causes of disease and furthermore urges the people to seek cures and treatment on their own authority for “it is upon human beings to discover the cure and apply it to the appropriate cases“.
Traditional ways of healing do not always root in Islamic texts, or are even condemned in them, despite being common in some Muslim communities; as a result, they are not considered Islamic at all and thus rejected by other communities, rendering them cultural rather than religious modes of healing. Depending on their country of origin, it is reasonable to assume that Muslims would engage in a range of traditional healing methods in their Western host countries as well, both Islamic ones and those commonly believed to be Islamic. For Islamic teachings indeed encourage to take care of one’s own health and well-being “by seeking advice and receiving treatment as health is considered a gift from God, which should be cherished.“ When cited as a primary motivation to adhere to health risk reducing behaviour, Islam also directly benefits Muslims‘ health; both by placing great importance on the prevention of illness through moderation and prohibition and by promoting certain ways of conduct. Such is the case with breast-feeding which is both prescribed in one of the Hadith and known to protect the mother from postnatal depression.
3. Mental health stressors
The following section is in points highly speculative. By simply observing religious practices such as regular praying and wearing distinctive clothing, Muslims already become an easy target for anti-Islam discrimination the Western world. An example: Especially the female dress code gives rise to discussions and conflicts. Since the hijab or headscarf reflects the Muslim identity of its wearer and is generally acknowledged as a main indicator of adherence to Islam, they provide an obvious point of attack and tend to irritate nationals. In recent times there have been debates about the right to wear the hijab or other face-veiling garments, for many an obvious sign of female oppression, in public institutions like schools or even in the streets. The denial to wear facial coverings by public and political coercion has already proven to cause great distress among those who wish to wear them. Furthermore, Muslim eschewal of certain foods and customs offers space for misinterpretation on the part of the natives who might view it as “a type of social rejection and a refusal to accept the country’s norms“, thus being conducive to the development of resentment which, in turn, occasionally expresses itself in open discrimination. In a climate of non-acceptance and cultural alienation, people feel marginalised, strange and much more easily fall prey to depression and other mental illnesses. Moreover, if a Muslim feels unable to fully integrate into mainstream society due to his religious beliefs, a sense of distance inevitably develops, rendering him a stranger in his own country. Isolation from the host community may act as protection from negative experiences outside the family environment, though. The finding that the susceptibility to psychological problems of Pakistanis grows the longer the time they have lived in Britain implies that “interaction with and experiences in the host culture made them more vulnerable to mental illness.“
Recent opinion polls capturing the European public’s attitude towards their fellow Muslim citizens indeed reveal a generally mixed view. The traumatic events relating to the New York City attacks on September 11, 2001 have attracted global notice to the supposed Muslim threat to democracy and Western lifestyle, triggering a general suspicion, fear and hatred against Muslims, thereby causing the “issues arising from this event [to] very well exacerbate the already existing mental health concerns of these people.“ The younger generations seemingly struggle even more than their parents with this kind of prejudice seeing as identity issues that especially children and adolescents are confronted with in the first place are further aggravated by anti-Muslim attitudes. Ever since Islam has become more and more associated with terrorism after 9/11 and ensuing wars in Iraq and Afghanistan, there has been an increased government, media and public scrutiny of Muslims, especially in the US; so much so in fact that female college students have reported fear of openly identifying with their faith by wearing the hijab. Here, the inner conflict becomes most apparent; the desire to fit in on the one hand and fear of betraying one’s faith, family and tradition on the other. Abu-Ras and Abu-Bader’s studies empirically prove that 9/11 has significantly impacted upon the lives of Muslims in the US. By feeling discriminated against because of their religion, which represents, as clarified, much more than belief practices and religious customs but a whole way of life, the transition into the host society and culture is very much complicated for immigrant Muslim communities. Various studies suggest that “since September 11, 2001, Islam-directed discrimination and social marginalization has led to adverse health outcomes for those who are socially identifiable as Muslims in America“, including psychological difficulties above all that sometimes result in physical ailments as well.
Without a doubt, though, it is not solely external reaction towards Islam that affects the psychological well-being of Muslims in the West, but Islam itself or rather living according to its prescriptions as well, although both possibly go hand in hand at times. E.g., being surrounded by a mentality that accepts homosexuality while living in a community that strongly stigmatises and condemns this orientation might aggravate identity conflicts and feelings of inadequacy. Also, certain Muslim-specific yet not necessarily Qur’an-derived customs and traditions harbour the potential to negatively affect the mental health, such as female genital mutilation.
 The special situation of refugees and converts, though insightful in a different academic scope, needs to be left out of this paper.
 Due to a scarcity of academic literature and surveys regarding the mental health situation and behaviour of French and German Muslims, these large populations that surpass in size that of the UK unfortunately have to be left out of this analysis.
 Seeing as there appear to be significant differences in the perception and treatment of mental illness in the Muslim world, “Islamic“ and “Muslim“ should be treated as non-interchangeable terms, even more so considering the fact that many common customs among Muslims pre-date Islam.
 The Qur’an and the Sunna constitute the two single most important foundational texts of Islam.
 Haque, 2004, p. 47.
 Hamdan, 2008, p. 103.
 Traditions and sayings of the Prophet Muhammad.
 Al-Krenawi & Graham, 1999, p. 55.
 Cf. Amri & Bemak, 2013, p. 50.
 Utz, 2012, pp. 23f.
 Sahih al-Bukhari, no. 5641, 5642, as cited in Utz, 2012, p. 23; for further Islamic evidence cf. ibid., pp. 17-24.
 Al-Krenawi & Graham, 1999, p. 55.
 Next to angels and humans, jinns constitute the third creation of beings of God. Relevant in this context are those of malevolent, demonic nature who aim to harm human beings. Interestingly, the term “jinn“ shares its etymology with Arabic “junun“ which means “madness“.
 The “evil eye“ is a curse cast by an envious glance and believed to cause any kind of damage to those befallen by it.
 Haque, 2004, pp. 48ff.
 Ibid., p. 50.
 Cf. NKI Center of Excellence in Culturally Competent Mental Health, 2009.
 Described as a “reliable“ measure to assess “Islamic identification, beliefs, ethics, religious duty, coping, and other domains of Islam relevant to physical and mental health“ (Pasic et al., 2010, p. 39), the PMIR “provides a scientifically based, multidimensional understanding of Islam needed to advance the nearly nonexistent psychological theory, practice, and research focused on Muslims“ (cf. abstract Abu Raiya et al., 2008).
 Cf. Pasic et al., 2010, p. 39.
 Utz, 2012, pp. 17f.
 Sahih al-Bukhari, no. 5678 as cited in Utz, 2012, p. 17.
 Utz, 2012, p. 17.
 Sabry & Vohra, 2013.
 Utz, 2012, p. 25.
 The author judges on the basis of her personal observation in Germany, acknowledging that the situation in other European countries might differ even significantly in some places, yet presuming similarities.
 An opinion poll conducted in 2011 revealed that two-thirds of the British public agree that the Burqa (often used as a representative term for all face-covering Muslim female clothing) should be banned in the public sphere, cf. Thompson, 2011.
 Al-Issa, 2000, p. 257.
 Ibid., p. 263.
 Ibid., p. 264.
 Pew Research Center, 2014.
 Haque, 2004, p. 46.
 Haque, 2004, p. 52.
 Ciftci et al., 2013, p. 26.
 Abu-Ras & Abu-Bader, 2008, 2009.
 Amri & Bemak, 2013, p. 45: “[...] acculturation also depends on factors such as country of origin, sociopolitical history, reason for immigration, length of time in the U.S., socioeconomic status in the U.S., level of education and English language proficiency, level of social support, pre-migration experiences such as trauma, and post-migration experiences of trauma and racial/ethnic discrimination.“ The country of origin plays a vital role, too, particularly when it is at war with or a political enemy of the US. Political matters possibly even eclipse the religious ones.
 Cf. Padela & Curlin, 2013, p. 1339. It needs to be added, though, that all Arab Americans indiscriminately fall under general suspicion and endure discrimination, despite 77% of them adhering to the Christian faith (cf. Abu-Ras & Abu-Bader, 2008, p. 219).