Mariam Salie

My first-year anthropology lecturer once said: “There are as many cultures as there are people in the world”. I am inclined to agree with him. My PhD study explores the explanatory models of mental health conditions amongst Muslims through a multi-stakeholder approach. My work and I are inspired by Arthur Kleinman, a medical anthropologist, who coined the term ‘explanatory models’. Explanatory models refer to people’s beliefs, attitudes, understanding, and symptom and treatment knowledge about any given condition. That was a mouthful but stay with me.

Kleinman believed that it was important to construct a cultural formulation of illness based on the information noted above. According to Kleinman, people’s beliefs and perceptions about their health conditions are important to consider as it can improve the patient-practitioner relationship. The improved relationship contributes positively to treatment adherence, thereby improving treatment outcomes. A win for all! There are many others, like me, who have started to engage seriously with conversations around cultural competency, cultural relevance, cultural sensitivity, or cultural humility – whichever term tickles your fancy. The bottom line is the intersection of culture and mental health is an important one!

For my PhD, four stakeholder groups will provide the data. These stakeholder groups are: 1) Muslims with lived experience, 2) general Muslim public, 3) psychologists who have treated Muslims, and 4) Muslim clerics. While I would love to share everything I have learnt, I will save that for the PhD publications. What I would like to draw attention to in this post is two things: 1) culture and religion are often conflated and this impacts the mental health experience, and 2) mental health is understood through a cultural lens perhaps more than we realise.

First, religion is often perceived to be a part of culture, and some cultural practices are embedded within religion. Teasing apart culture and religion is a challenging task, and more often than not, their boundaries blur in ways that make clear distinctions difficult. I have witnessed this conflation first-hand in my practice as a clinical psychologist, as well as in my research. These experiences have demonstrated how cultural practices are often perceived with religious significance which has implications for how mental health is experienced, as well as whether help is sought appropriately. Cultural practices also establish rigid rules by which the community must abide, and any deviation is seen as deviating from the religion. Pertaining to Islam, I have now learnt after engaging with Muslim clerics on the matter that many of these cultural practices and cultural constructions have, in fact, nothing to do with Islam. Islam promotes holistic health which acknowledges mental health as an important component of overall health and wellbeing. Interestingly, recent literature has highlighted historical Muslim scholars who wrote extensively about mental health, as we understand it today. See Dr. Rania Awaad’s work, amongst others.

This brings me to the second point – how mental health is understood through a cultural lens. I cannot speak for all cultures or religions, but my work in the Muslim community has highlighted how mental health has predominantly been understood through a cultural lens. These cultural constructions of mental health have largely influenced perceptions about mental health and have contributed to the continued stigmatisation of mental health conditions (MHC) in the Muslim community. There are several problematic perceptions about MHC. Firstly, and most notably, there is the perception that MHC are non-existent. Conversations on the topic are taboo, and the cultural norm is to endure any kind of hardship. Secondly, MHC are sometimes perceived to be an indicator of ‘madness’ and people who are treated for these conditions are often alienated, feared, and treated with disdain. An interesting experience for me was the feedback I received from many participants. They thought I was ‘quite brave’ to explore this topic in the Muslim community and regarded the study as important but were also quite cautious about participating openly. During the focus groups, participants opted to keep their cameras off and use pseudonyms.

My work as a clinical psychologist in the Muslim community gives me a different perspective so it was interesting to engage on this topic through a research lens for my PhD. It is apparent that while more Muslims are seeking formal mental healthcare, stigma is still very much alive and thriving in the broader community. And dare I say it; it is the cultural constructions associated with mental health that continue to feed the stigma. Why is this conversation important? South Africa is a diverse nation and if we are serious about decolonising our practices (in whichever discipline), we need to understand how South Africans make sense of their experiences and collaborate with them as experts on their own lives.