Before her first cigarette is even extinguished, Sahar grabs another. In her small home in Beirut, the 30-year-old woman has finally found a sense of tranquility. She had moved there from the Lebanese mountainside a few years ago to find work.
Sahar recalls her first visit to her psychiatrist's clinic very well. She got out of the taxi and circled the building three times before she actually entered. Sahar did not tell her family or friends for a long time about the reasons behind her disappearance for a couple of hours every week, nor about the additional expenses spent on the sessions, which demanded that she cut down on the many pleasures afforded by the coastal city.
Sahar's situation is no different than that of a large number of women and men in the Arab world. Amid the myriad socioeconomic challenges posed by contemporary life, the Arab middle class is all-too-often afraid to ask itself the crucial question: “Are we okay?”
South of the Mediterranean, namely in Cairo, Yasmine finds no consolation from what she calls "the injustice of society, and its prejudice” regarding mental health.
Although many consider mental health to be an umbrella term including a broad range of issues, one simple way of verifying one’s mental well-being is by asking oneself the question: How am I today?
Yet, in the Arab world, as in many other locations, individuals scurry in fear of open self-interrogation, instead choosing to launch the first attack against their interlocutors. To evade any rumors that might malign them, they shoot first, and then repeatedly, through a million different iterations of the same question: “How are you?”
According to the World Health Organization (WHO), Arab countries are world leaders in terms of the rates of depression, in light of the spiralling levels of violence, the lack of stability, and the rapidly increasing urbanization.
Yet, on the flipside of the coin, the region has witnessed an increasing prevalence of awareness campaigns, in particular in light of May being Mental Health Awareness Month.
Mental Health Awareness Month
May was declared Mental Health Awareness Month in the US 1949, with the purpose of raising awareness on the importance of mental health.
In recent years, Arab interest has piqued in the topic of mental health, as activists and civil society organizations have organized Mental Health Days or Mental Health Weeks, before expanding to include awareness activities for the entire month .
According to the initiative Mental Health In the Middle East & North Africa, psychological disorders affect more than 10% of the population around the world, and most people suffering from these disorders are unable to seek treatment, due to either lack of funding or fear of stigma.
Egypt constitutes a key example of the growing popularity of psychological healthcare, according to psychological counsellor and researcher Nermeen Abdel Hadi. In contrast with previous tendencies in Egyptian society, those who suffer from psychological disturbances do not immediately resort to psychiatric help and medication, as was the case recently.
"Not only has the degree of interest in psychological treatment increased; people have also become more aware and capable of discerning between the different psychological setbacks that may cross their paths,” Abdel Hadi says.
Today, in addition to psychiatrists, there is a growing trend of qualified psychologists in Egypt, equipped with modern methods to address mental health issues without resorting to medication.
Arab countries are among the world leaders in terms of rates of depression.
In most Arab countries, mental healthcare is a luxury afforded to a select few.
Yet, as is the case in many countries in the region, the high cost of therapy, coupled with the low average purchasing power of the citizens, makes psychological healthcare an inaccessible luxury for the vast majority of the population.
Aisha, a young woman from Tunisia, recalls a point in her life during which she was struggling and felt the need to speak to someone as a disinterested, objective outsider. However, in order to do so, she was forced to work two jobs with two consecutive shifts to cover the costs of her visits to a psychologist’s clinic, because her university did not provide access to an on-campus specialist.
On the other end of the equation, psychiatric specialists around the Arab world, particularly in countries like Egypt, have a tendency to be all too generous with their drug prescriptions. This liberal approach, where some specialists will prescribe drugs from the first session, has come with its own series of adverse consequences, not least of which have been the more problematic side-effects of prescription pills, as well as the high risk of addiction.
Stereotypes and Social Condemnation
Ayman is considered one of the more fortunate young Moroccans, due to his ability to express himself comfortably through writing and poetry—an advantage not afforded to many of his peers, he says. Moreover, a large number of those seeking help do not differentiate between psychiatrists and psychologists.
This issue is prevalent in a number of Arab countries, and is very dangerous, according to Ayman, who points out that society continues to stigmatize those who seek psychiatric healthcare.
Mental health in the Arab world has long been considered a taboo topic that few dare to broach openly. A small minority resorts to psychotherapy, oftentimes ensuring that this is undertaken in complete privacy and discretion.
In order to avoid social stigmatization, initiatives that provide psychotherapy services have emerged in complete secrecy, including the Shezlong project in Egypt, a website that provides online psychological counselling services to those who wish for complete privacy.
Conflict Areas Particularly Vulnerable
The shortage of doctors and psychologists in Iraq has become particularly noticeable in the aftermath of the emergence of Islamic State, and the escalating violent war against it. According to Médecins Sans Frontières (MSF), this shortage has had a clear impact, with many Iraqis suffering from trauma due to having to coexist with Islamic State.
MSF is one of a few organizations that provide psychosocial support to war-afflicted people in conflict areas—a pressing need in several Arab countries, most notably Iraq, Yemen, and Syria.
Recent reports by MSF refer to them providing medical care and counseling to patients with severe depression, anxiety, or post-traumatic stress disorder (PTSD). Those with conditions affecting their ability to undertake their daily activities are referred to other organizations providing primary care or psychological support in refugee camps.
Small Victories in Lebanon
Like other Arab countries, those who seek psychological help in Lebanon suffer from the high costs of therapy, as well as the community's reservations in terms of recognizing the importance of psychological awareness.
Yet, amid a recent trend toward a more open approach to the topic, the efforts of a group named The Legal Agenda stand out in particular, most notably its ongoing efforts to review the draft law on the treatment of people with mental health issues since 2014. In this context, it has proposed a number of amendments to the draft law, in line with international recommendations.
A new version of the draft law was approved by the National Mental Health Program at the Lebanese Ministry of Public Health, incorporating the suggested amendments made by The Legal Agenda.
The draft law is currently being studied in the Lebanese parliament, potentially paving the way for the Lebanese Ministry of Health to provide subsidized mental healthcare—a major victory in both the country and the region.
The Role of Regional Crises
In a report issued in March 2017, the WHO stated that: “Emergencies, in spite of their tragic nature and adverse effects on mental health, are also opportunities to build better mental health systems for all people in need.”
According to the WHO, access to mental health care in public health facilities is better in many areas of Syria in 2017, for example, compared to the situation before the war.
The report further highlights that mental healthcare was only available in large cities before the war, but in its aftermath, more than 5,000 primary health care workers were trained for response in Syria.
Thus, there is evidence that, in spite of the overall dire effects of the various crises that have struck the region, certain benefits can be reaped in terms of both awareness-building and providing better mental healthcare.