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By Mariyam Nashaz, B.A. (Psych.) Published on 03/10/2019

Why does Mental health stigma exist in the Maldives?

There are a lot of reasons for the stigma in our community from traditions that existed since before we were born to recent actions that surged in the society.
Mariyam Nashaz, B.A. (Psych.) Avatar
Mariyam Nashaz, B.A. (Psych.)

Published on: 03/10/2019

DhulhaHeyoSihhathu Mental Health Depression Anxiety Stigma
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Fatima, a mother of two does not feel like getting out of bed at all even to shower and eat. Her husband and in laws call her lazy and tells her that she needs to pray and recite Quran more to get better. 

Adam sees and hears things he knows he should not be seeing or hearing and his family has been consulting multiple black magicians. He is being exorcised without any success for the past six months. 

Haseena is devastated because her son with autism had a tantrum in the hospital and she requested to let her consult sooner. The hospital staff dismissed her request and she had to wait until her number came up all the while trying to ignore the annoyed stares at her son. 

Ahmed has to see his counselor every week and has to pay four hundred rufiyaa for every hourly session while paying rent and being the breadwinner of a family of four. Government does not give any aid or compensation for psychotherapy and counseling so he skips sessions due to financial hardship at the cost of his mental health. 

These incidences are fictional yet they are similar to what we witness in our society. Despite the many mental health awareness programs carried out by government, private organizations, NGOs and the like, we still see people criticizing, mocking, discriminating and publicizing sensitive issues and deviant behavior in households, workplaces, schools, social media and even within the health sector.  

Why is this society so insensitive towards those suffering from mental illnesses?

 

Misinterpreted religious beliefs

One reason could be misinterpreting the beliefs of our religion. We as Muslims have to believe in Qadr which is the will of our almighty God. Therefore, we have to believe that all hardships are trials to test us, to be patient and pray for it to pass. This was exactly the belief of women who were interviewed in Glasgow in a recent research and this belief made them neglect seeking help for mental health issues they were facing (1). 

Why does this belief only apply to mental health issues and not to physical health issues? 

It is obvious that people will not just pray and be patient for a heart or kidney condition to pass. The prime reason for this is because Muslims tend to attribute symptoms of mental illnesses to weakness of faith (1).

Perhaps someone with illness anxiety disorder maybe advised not to be so precautious because whatever Allah wills will happen. Of course it will and the person is also likely to hold that belief but when anxiety strikes, he will be unable to think anything rational because his emotion center overrides areas of the brain responsible for logical reasoning. 

Praying and recitation of Quran are the best remedy for a Muslim’s mind and soul and we should encourage each other to do acts that bring us close to our lord. Yet to expect it from someone who is unable to think clearly because of an illness is absolutely absurd. Even Islam does not obligate one who is not in their right mind to perform any act of worship.  

Furthermore, our faith as Muslims obligate us to believe in the presence of unseen beings that has the power to posses our minds. People with psychological disorders such as schizophrenia exhibit symptoms similar to those possessed by jinn. As per our belief it is necessary to work towards ruling out the spiritual possession possibility by doing the necessary.  

The problem arises when this belief has been too stubbornly ingrained in the minds of some Maldivians and they dismiss the possibility of psychosis. This makes people opt to differential diagnosis and treatments for mental illnesses such as Ruqya or black magic. In the process, people with actual mental illnesses lose time, money and hope before getting any medical or therapeutic treatment.  People could also be opting for these misdiagnoses in denial due to the belief that people with mental illnesses are weak. 

 

Belief that mental illnesses should have a known cause

She is rich, good looking and smart then why is she so depressed?

His family has always been so loving and supportive then why did he start using drugs? 

Many people tend to believe that mental illnesses are caused only due to past or present trauma or being psychosocially disadvantaged.

This area is ambiguous even in research and a lot of psychotherapists and counselors work towards unraveling suppressed thoughts or memories to explain deviant behavior.

The blaming of a person’s childhood and environment for their illness may cause harm to important relationships and may cause more damage than help.  

 

Belief that some mental illnesses are self-inflicted

Mental illnesses such as eating disorders and drug addiction are widely seen as self-inflicted. For example a drug abuser returning from the rehabilitative centre starts abusing drugs again by hanging out with the same group of friends. These decisions are seen as selfish choices rather than an unimaginable pull towards drugs to activate his pleasure system.

People are unaware that he loses control of his actions because he has not yet fully recovered from addiction which is a mental illness. While a large percentage of recovery occurs during therapy or rehabilitation, the remaining occurs in the society with support, love and acceptance from family, friends and the community. Believing that a person is choosing to be sick will discourage us to help him or her in their recovery. 

 

Ignoring is easier than trying

People with mental illnesses are considered stubborn and difficult to communicate with. We may sometimes have to be extra careful with what we say to be sensitive towards their insecurities or triggers.

They may continuously dismiss our well meant advice and support. This can be mentally and physically draining so a lot of people resort to ignore or distance from the person. In turn, the person with mental illness stops disclosure of their issues to loved ones and blames themselves causing self-stigma. Self stigma is the hardest impact of stigma to overcome and it could also hinder recovery (2). 

 

Ignorance of the biology behind mental illnesses

Most people do not understand mental illnesses as physical ailments of the brain because most symptoms manifest as magnified versions of everyday emotions everyone experience. For example we all don’t have chest pain all the time so we automatically believe that the person with chest pain must be having some physical problem.

In contrary, we all feel sad, anxious, tired and the like in our everyday lives and when we see someone experiencing these feelings at a higher level than we do, we tend to believe that the person is exaggerating. Or we believe that they can overcome it just like we do with a little bit of rest, prayers, and a good laugh.

What we fail to understand is that the brain can malfunction just like any other organ. Research has also shown that when people understand the neurobiology of mental illnesses, blaming the sufferers significantly decreased (3).

However, there is also a downside of understanding the psychopathology of mental illnesses. When people see it as a physiological illness of the brain, they tend to believe that those who suffer from mental illnesses are not in control of their symptoms thus, they are not encouraged to work towards getting better (3).

People also tend to believe that medical interventions would be most effective in overcoming the symptoms of mental issues similar to any other physiological problem (3) which is in reality used as a last resort. These beliefs are a result of ignorance about the amazing neuroplasticity of the brain and that psychotherapy and counseling could rewire the maladaptive neural pathways towards a better way of thinking and a better lifestyle.

 

Over-simplifying and popularizing mental illnesses

I had an argument with my husband I’m so depressed! 

She has her clothes color categorized so OCD! 

It has become so easy for us to use diagnostic terms casually to describe everyday hassles and emotions.  The over-simplifying of mental illnesses has lead people to undermine its effects. As a result, many people are self-diagnosing and popularizing surreal mental illnesses. This can make people with real mental illnesses hesitant to open up and they tend to doubt their own assessment of their mental state. 

The normalizing of mental illnesses could be one main reason why government’s health compensation scheme has not covered psychotherapy, assessment and counseling until now. Either it is not given priority because it seems harmless or because everyone seems to have a mental illness nowadays. 

On a positive note, the new government has ensured Aasandha services for mental illnesses. If it is implemented it will change lives of so many people who avoid treatment due to financial hardship.

This article was reviewed by Aishath Hazma, MSc Coaching Psychology.

 

Sources

(1) Gunson, D., Nuttall, L., Akhtar, S., Khan, A., Avian, G., Thomas, L (2019). UWS-Oxfam Partnership. Retrieved from: https://mwrc.org.uk/wp-content/uploads/2019/01/Spiritual-Beliefs-and-Mental-Health.pdf

(2) Huggett, C.,Brtel, M.D., Awenat, Y.F., Fleming, P., Wilkes, S., Williams, S., & Haddock, G. (2019). A qualitative study: experiences of stigma by people with mental health problems. Psychology and Psychotherapy, 91(3), 380-397. 

(3) Lebowitz, M.S. (2019). The Implications of Genetic and Other Biological Explanations for Thinking about Mental Disorders. Looking for the Psychosocial Impacts of Genomic Information, special report, Hastings Center. Report 49, 3, 82-87. DOI: 10.1002/hast.1020

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2 Comments
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Nuzu
03/10/2019 10:31
I am glad reading this article , which is great . excellent 👏
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Ahmed Zuhair
04/10/2019 11:37
excellent read .. very informative
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