Releasing the jinn

A group of pioneering religious leaders from Israel’s Arab community is paving the way in tackling the stigma of mental illness.

December 2, 2010 00:37
Arab Religious Leaders

arab religious leaders 311. (photo credit: Ruth Eglash)

Imam Jamal Eloubra is troubled.

For 15 years he has provided religious and spiritual guidance for his community at the mosque he manages in the Beduin city of Rahat.

Just over a month ago, however, he embarked on a course aimed at tackling the stigma attached to mental health disabilities in Arab society and providing Muslim religious leaders with the tools to raise awareness and offer practical medical advice to their communities.

“I’ll be honest, in 15 years of being an imam, I have no idea if I ever dealt with a mentally ill person,” admits Eloubra, a trained engineer who dons traditional Beduin garb and a wide smile. “It’s a subject that is just not talked about in my community. But now, after being part of this course, I’m going over in my mind all the people that came to me for help in the past and wondering if they were really sick and needed medical attention.”

We are in the Othman Ben Affan mosque in Kafr Bara (not far from Rosh Ha’ayin) and Eloubra is among 25 Muslim religious leaders taking part in this six week course, run by the American-Jewish Joint Distribution Committee’s Masira (journey) program, with support from the Interior Ministry’s Department for Religious Communities, the Health Ministry and the Tauber Foundation.

“After hearing some of this information, I’m beginning to think that almost everyone in my town is mentally ill,” jokes Eloubra, quickly turning serious again. “Our job as an imam is not only to stand before our people in the mosque, but it is also for us to know how to help all our community.”

This topic is especially acute, points out Eloubra, “because most people in the Arab community are too ashamed to deal with it at all. They are afraid to come forward and ask for help.”

Indeed, the course, which was proceeded by a similar one focusing on people with physical disabilities and is part of Masira’s general outreach to people with disabilities in Arab society here, is still being met with measured resistance from community members who believe it’s just too complicated an issue to deal with.

“It’s a very taboo subject,” explains Soud Diab, of the Division for Disability and Rehabilitation at JDCIsrael, who oversees the course. “We are really going far in challenging attitudes and trying to change people’s beliefs.

“When we ran the last course on physical disabilities, it was much easier to get people interested in making a change, because we talked about the charitable side of working with the disabled. With mental illness it’s different, it’s not easy for people to accept; they have their ideology and it this is really breaking their myths.

“Even today I’m still getting people who are telling me not to deal with this subject,” says Diab, who claims she is spurred to continue with the project because “I’ve met so many individuals who suffer from this disability and there are almost no materials in Arabic, no services in Arab villages and no help for the individuals or their families. It’s really tough for them.”

Luckily, for Diab and the other JDC organizers, their struggle for recognition has been encouraged by the support of Dr. Ziad Abu Moch, the Interior Ministry’s director of Muslim affairs, who describes this program as revolutionary in the Islamic community here and in the Arab world in general.

“Arab society is afraid to deal with mental illness; it is something that is hidden and there is a real lack of awareness and confusion about this topic,” says Abu Moch, who is responsible for some 320 statesalaried imams that head mosques across the country.

“After our success with the previous program for people with physical disabilities, we felt that we had a responsibility to run a similar course about mental health disabilities. At first we debated whether we should do it because we know this is a very deep issue, but we realized that we do not have the right to neglect one whole group of people.”

He says that the main barrier to understanding mental illness is the Islamic belief in jinni – spirits from another world who can sometimes be good, but most often are bad and are likely to wreak havoc if left unchallenged.

“There is a lot of confusion on this issue,” Abu Moch explains. “In Islam we believe in jinni; they are written about in the Koran, and often people see mental illness as being caused by a jinn but it is a scientific or medical condition that can be dealt with by medicine.”

In this case, he theorizes, the Koran dictates that if a person suffering from a medical disorder – this includes mental illnesses such as schizophrenia, bipolar disorder or depression – he “must” seek medication.

“Mental health disabilities are a disorder in the brain and therefore people suffering from them must be treated by a doctor,” he says, adding quickly, “it is fine for an imam to read sections of the Koran to help the sick person spiritually, but this has to be done in conjunction with providing medication too.”

During the 40-hour course, which has included a lecture from a Muslim psychiatrist on how mental illness fits with Islamic philosophy and a session on understanding the country’s mental health disability laws, state benefits and rights, the imams are encouraged to research Islamic texts, including the Koran and the Hadith to find references to mental illness and come up with practical solutions to problems such as what is the definition of a mentally ill person, can people with mental health disabilities get married or how to deal with post-partum depression in new mothers.

“An imam is the key person in Muslim society,” explains Abu Moch. “He is a person who has won a place to be influential in his community and the people around him see the imam as a very important person; he is both a religious and social leader... he is the person that will be able to raise awareness to this issue and bring a better understanding of this subject, which almost no one talks about.”

WHILE IT is still too early to assess how influential this course will be, it is clear that after only a few sessions the religious leaders who gather here each week are talking about mental illness and taking it very seriously.

Even with this measured success, however, both Diab and Abu Moch are bitterly aware that the challenges lie far beyond religion. The two point out that almost no statistics exist to suggest how many Arabs suffer from mental illness and both say that services to help those who are so clearly hidden are even scarcer.

According to Avital Sandler-Loeff, area head of the Division for Disability and Rehabilitation at JDC-Israel, who runs the entire Masira project, even though the Law for Mental Health Rehabilitation was passed a decade ago and provides some “very advanced” services, only very few Arabs come forward to claim their rights.

They are put off by religious concerns and cultural fears that doing so will bring shame to their family’s honor. They prefer to keep quiet about relatives with mental health disabilities, she says.

Sandler-Loeff’s observations are backed up by a study on adults with disabilities carried out last year by the Myers-JDC-Brookdale Institute.

Among its findings were that onethird of those receiving disability allowances from the National Insurance Institute suffer from mental illnesses, but very few of those claiming benefits are from Arab towns or neighborhoods.

In addition, while 66 percent of those hospitalized in psychiatric wards each year were from Jewish neighborhoods, only 8% were Arabs and of those receiving outpatient treatment, 70% were Jews and only 2% were Arabs.

The report also revealed that of those receiving treatment in government- run mental health clinics 7% were Arabs while 67% were Jews.

Sandler-Loeff is quick to comment that lack of mental health services in Arab neighborhoods, towns and villages, as well as limited accessibility to information in Arabic plays a part explaining these figures, but mostly she says it’s due to lack of awareness.

She says that if there is more demand, the services will be created according to the law. Masira’s next project is to create a center in Tira that will provide the population with mental health services and treatments.

ON THE day I visit the course, the imams are receiving a lecture from Dr. Khaled Abu Asbah, director of the Masar Institute for Research Planning and Social Consulting. He is working with them on how to put what they have learned so far into practical use and encouraging them to create projects that will reach out to those suffering from mental health disabilities.

He is also giving advice on how to find appropriate government services for those with disabilities.

Abu Asbah, who recently completed a book on attitudes toward mental health issues in the Arab world, says that “in general there is very little recognition of mental illness, even though the richer states in the Gulf are starting to take an interest. Poorer countries such as Egypt, Jordan, Morocco and in the Arab community here are not aware of the problems at all.

“My role here is to give [the imams] the tools so they can help those in their communities who suffer from mental illness. They need to know what the rights are for the disabled, especially to let the families know they will not lose any of their social welfare benefits. I will also help the imams understand how Shari’a law, the Hadith and the Koran all fit in with this topic.”

Lod Imam Adel Elfar, however, is not convinced. “I still have no idea how to identify mental illness,” exclaims the 44-year-old father of seven, who is dressed more like a businessman. “I’m just not sure exactly what it is and I certainly don’t feel ready to tackle it in my community.”

Elfar says that Lod, which has made headlines recently for a spate of socalled honor killings and other violent crimes, lacks the services to properly treat people with mental illnesses, even if there were those brave enough to come forward and ask for help.

“There is a lot of violence in our community and I know that people are traumatized,” he says. “I want to help them but I just don’t know how.

I’m still lacking the proper tools and right now I can only provide them support in a religious way.

“I am starting to think, however, about all those people who have come to me in the past or those that society has labeled as ‘crazy’ and wondering if they were really suffering from mental health disabilities. I know this course has been helpful, but now I feel I like I have more questions than answers... I will just have to spend more time reading and learning about this new issue.”

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