Dare to Seek Help

Dispelling Misconceptions on Mental Health in the Arab World
Young Muslim woman at a counselling session. (Getty)

Following the news 24/7 in the recent decades could be enough for some people in the Arab world to accumulate negative emotions which, if not well-handled, may affect their everyday life. Other people may find career challenges and everyday competition getting on their nerves and ultimately leading to a burnout. Some people may suffer due to family problems and unresolved conflicts with partners. More examples can be added to make a long list of people who have hard times with resulting psychological problems.

However, many of them dare not seek help or reach out to the professionals who are best qualified to assist them to lead better lives.

Many psycho-education projects were launched in the last few years across social media platforms by Arab and Egyptian professionals to raise awareness of psychological disorders and the various means of diagnosis and treatment in order to encourage people to take a step and seek help.

Nevertheless, these efforts have fallen short of completely breaking the taboo and eliminating the stigma of visiting a psychotherapist.

In an attempt to remove part of the stigma associated with mental illness and seeking therapy, Majalla spoke to two experts of psychiatry who dispelled many misconceptions surrounding their specialization and drew our attention to major problems facing people who are in dire need of a specialized help.

“Although still not enough, awareness has been getting better recently, particularly in the younger generations and even teenagers due to their access to information on social media platforms such as YouTube videos,” Ahmed Abdelkarim, MD, PhD, Lecturer in Psychiatry at Alexandria University, told Majalla, adding that at least more people are visiting specialists for assessment and to see if they have any problems.

Agreeing that more awareness campaigns are still required, Dr. Hala Elsaid Sayyah told Majalla, “There is huge misinformation about mental and psychological illness. Most people still think that any person with a neurotic disorder (whether anxiety, OCD, panic or depression) is suffering because he is weak. Patients who suffer psychotic disorders are falsely considered bewitched or affected by bad envy. Some people even push patients to seek help from perilous sources.”

Dr. Sayyah argued that schools and universities do not focus on the importance of mental health and the development of resilience in face of life challenges and difficulties. She lists problem-solving, social interactions, crisis management, and interrelationship management as essential life skills to be taught to new generations to address mental health problems at their root.

ROLE OF MASS MEDIA

Just the mere examples of a mentally suffering person in a media production confronted with “Sit down on the lounger and tell me your life story” or “Take this sedative and you’ll be ok” – These are examples of the stereotypical therapy session as seen in the media which experts believe is one of the main hindrances to people seeking help, in addition to the shame surrounding the character represented on the screen. For example, patients in the media are often stigmatized as losers and as sources of family shame.

“We may spend years of hard work to build awareness of mental illness and therapy, but a single media production, a movie or a TV series that lacks correct information can ruin all our efforts by making fun of people with a mental disorder,” Dr. Sayyah said.

To counter widespread misconceptions, Dr. Abdelkarim explains the different kinds of mental problems and therapies engaged in the process, “Origins of mental illness can be explained according to a biopsychosocial model which means that three factors can play a role in developing the disorder: biological (neurotransmitters); psychological (upbringing, environment, relationships); and, sociological (present conditions).”

As for treatment, he reveals that there are two types of treatment – medicinal and non-medicinal. Non-medicinal types include talk therapy, play, dance or reading therapy, etc.

“Medicinal therapy is also misrepresented as being only sedatives, which is only one category of medication and is not always prescribed. There are other categories such as antidepressants, mood stabilizers and antipsychotics, and these are non-addictive,” he confirmed.

FINANCIAL BURDENS

In addition to the stigma, another problem may prevent people from seeking professional help in the Arab world, namely, the expensive fees required for follow up sessions which some people might see as overrated or unjustified.

Dr. Abdelkarim explains, “It is related to the health system as a whole, not just psychiatry. Private medical services are not subsidized and not included in the health care system. A psychotherapy session which extends from 45 to 50 minutes is expensive because it lasts for a longer time than ordinary visits to doctors in other specializations.”

Dr. Abdelkarim thinks that another reason is that the psychotherapy training required for doctors in order to be accredited by foreign entities is also expensive.

He suggests that some answers to this problem already exist though other solutions are still incomplete. “In addition to public and university hospitals whose professionals are well-qualified and provide treatment for affordable fees, some organizations and agencies are assisting people who cannot afford therapy. Also, some private clinics provide discounts for people-in-need after conducting an intake interview and assessment.”

However, he stresses that “this does not apply only to the Arab world as psychotherapy is also expensive all over the world compared to other specializations because the number of professionals providing such kind of help is much less than the number of the clients demanding it.”

A still from the Egyptian film “Aasef ala el-iz'ag” or Sorry to Distrub (2008) starring Dalal Abdel-Aziz (L) and Ahmed Helmi (R), in which Hassan, an aviation engineer, struggles with loneliness and depression while trying to design his exceptional project.

BEFORE SEEKING HELP

Another major misconception in the Arab world surrounding the first step of therapy is the question of whom should we ask for help? Many confusing titles and specializations are crossing our paths to the therapy session, all with promises to help better people’s lives regardless of the type of their problems.

“Many professionals introduce themselves as capable of helping people with mental problems, but remarkably they are not psychiatrists or psychologists, some are life coaches,  or human development specialists,” said Dr. Sayyah.

She explains that a psychiatrist is the only professional who is capable of diagnosing, treating and prescribing medication for a mental disorder, as well as setting a therapy plan. Some psychiatrists complete therapy training such as dynamic, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), assertive community treatment (ACT), after which they are qualified to hold specialized therapy sessions for their clients along with prescribing medication. She confirms, “Importantly, such trained psychiatrists are peer-supervised to ensure they achieve progress in treating their clients."

In a similar way, a clinical psychologist is another professional who is trained in all or some of the previously mentioned modalities of therapy and is also supervised by their peers. Psychologists just cannot prescribe medication for the clients.

In Sayyah’s view “the problem is that patients go to the wrong professional. Some might go to a life coach in part to escape the stigma of mental illness. Consequently, they spend more money on useless sessions because the root causes have not been addressed.” Instead, she believes clients of a life coach are not supposed to be mentally ill, otherwise the coaching will not be fruitful.

Asked when a person needs to think of visiting a therapist, Dr. Sayyah replied, “Consider a visit when you face a psychological stress, or have low appetite, low energy or excess energy, inability to sleep or excess sleeping, fluctuating mood, remarkable difficulty in dealing with people, a decline in job or learning performance, and a preference for isolation, all with no diagnosis of any physical disorder.”

PITFALLS OF ONLINE SUPPORT GROUPS

As people spend more time online at social media platforms, there seems to be a rising tendency to open up their feelings and seek help at a time of vulnerability. Hence many support groups appeared across various platforms, gathering people who are not necessarily specialists.

“I have a deep reservation about support groups on social media platforms,” says Dr. Abdelkarim as he sees “a big issue of privacy, because we don’t know who is on the other side talking to us.”

Nevertheless, he sees no harm in groups and initiatives posting information, general knowledge and awareness. But he still believes that people who post their life problems in the open cyberspace asking for advice or complaining about their problems with no guaranteed privacy are at risk for major problems.

“Definitely, these are not alternatives for a professional and real life support,” Dr. Abdelkarim concluded.