The Impact of Religio-Cultural Beliefs and Superstitions in Shaping the Understanding of Mental Disorders and Mental Health Treatment among Arab Muslims

ABSTRACT

This study aimed to explore mental health and wellbeing perspectives among Arab Muslims and assess the impact of Arab-Islamic culture on their understanding of mental disorders and treatment options. Semi-structured interviews with 12 participants (six men; six women) were conducted online during the COVID−19 pandemic and analyzed thematically. The results identified six themes that demonstrated the significant influence of Arab-Islamic culture on participants’ comprehension of mental disorders and preferred treatment methods. The absence of mental disorder-related concepts within the formal mental health treatment framework led to hesitancy in seeking professional help, and relying on Arabic resources for mental health information further perpetuated misconceptions and stigma within the Arab Muslim community. The study concludes that Arab-Islamic culture plays a crucial role in shaping the understanding of mental disorders and treatment preferences among Arab Muslims, but the lack of formal mental health treatment concepts and reliance on Arabic resources may hinder professional help-seeking and exacerbate misconceptions and stigma in the community.

KEYWORDS:

• Religion
• Culture
• Mental health
• Mental disorder
• Beliefs
• Mental health treatment
• Cultural competence
• Superstitions

Mental disorders are serious public health concern that involves significant disturbances in cognition, thinking, emotion, and behavior (World Health Organization, 2022). According to WHO, mental disorders, along with broader mental health conditions such as psychosocial disabilities, constitute one of the major causes of disability worldwide (World Health Organization, 2022). Disability in this context refers to the negative impact that mental disorders have on a person’s ability to function and participate in daily life, including difficulties with cognition, thinking, emotion, and behavior, which can have a significant impact on a person’s overall quality of life. Approximately, one in seven or eight people globally experience mental disorders in a given year (Dattani, Ritchie, & Roser, 2021). Mental disorders such as anxiety, depression, and bipolar have become quite common globally (World Health Organization, 2022).

The Arab world is not immune to the high prevalence of mental disorders. However, a lack of information about mental health statistics in the region can present a barrier to mental health research (Ghanem, Gadallah, Meky, Mourad, & El Kholy, 2009). Despite this, there are few studies have shown that mental disorders are common in Saudi Arabia, Morocco, United Arab Emirates, and Egypt (Al-Khathami & Ogbeide, 2002; Almutairi, 2015; Okasha, Karam, & Okasha, 2012; Sulaiman, Hamdan, Tamim, Mahmood, & Young, 2010). Further, many Arabs who fled their native lands due to war, political conflicts, and sectarian violence live in refugee camps and are at risk of developing Post-Traumatic Stress Disorder (PTSD) (Kira, Amer, & Wrobel, 2014). Despite the high prevalence of mental disorders and the urgent need for mental health services in the Arab world, mental health literacy remains poor, leading to delays in seeking help and accessing mental health services (Tambling, D’Aniello, & Russell, 2021).

There are more than 400 million people in the world who call themselves Arabs (World Bank, 2020). It is a multi-ethnic and multi-religious community with a shared language and cultural values and beliefs. The Arab community is primarily concentrated in the Middle East (MENA) and North Africa region, where 22 countries are members of the Arab League (Mazbouh-Moussa & Ohtsuka, 2017). However, a significant number of Arabs also reside outside of the MENA region, with an estimated 17.5 to 20 million living in Western countries such as the United States, Australia, France, Canada, the United Kingdom, and Brazil (World Bank, 2020). The Arab Australian community, in particular, has been established through migration patterns similar to those of other Arab diaspora communities around the world (Mazbouh-Moussa & Ohtsuka, 2017).

Arab diaspora communities include refugees and displaced persons who had been exposed to trauma before settlement with increased mental health risks from Post Traumatic and Stress Disorders (PTSD). Further, Arab communities have faced significant racism, particularly in the form of Islamophobia, following the 9/11 terrorist attacks in 2001 (Mazbouh-Moussa & Ohtsuka, 2017; Poynting, 2006). It is crucial to acknowledge that racism thrives on ignorance and the erroneous assumption of uniformity within a group and to recognize the unique characteristics and experiences of each individual within the Arab diaspora.

However, the influence of culture and religion on the Arab Muslim community is significant and cannot be overlooked. Arabic cultural and traditional beliefs (e.g., the importance of family) are deeply ingrained in Islamic theology among Arab Muslim beliefs and values. Many people in the Arab Muslim community use their Islamic faith as a foundation for their culture, traditions, and customs. It’s hard to separate Arab culture from Islamic culture as they have been intertwined for centuries and have significantly influenced each other (Abu’-Rabi, 1989; Al-Omari, 2008). Further, Arab Muslims contend that Islamic teaching and beliefs are integral to the Arab culture (Al-Omari, 2008). Therefore, it is necessary to consider the influence of Islamic-Arabic culture and traditional beliefs on the understanding and treatment of mental disorders among Arab Muslims

Researchers have long studied the impact of culture and religion on mental health, mental disorders, and mental health services and their treatment. Cultural and religious traditions and perspectives have a significant impact on people’s conception and expression of mental disorders (Prinz, 2022). Culture can determine how people understand the mental disorder symptoms, coping strategies and their attitudes toward mental health treatment (Bass, Bolton, & Murray, 2007). Cultural differences may affect the way people experience and report symptoms of psychological problems. For instance, Ryder et al. (2008) indicate that the Chinese tend to emphasize physical symptoms of depression more than North Americans, which may lead to possible misdiagnosis or inadequate treatment approaches. Culture also plays a role in an individual’s perception of the severity of their mental health issues and their willingness to seek help from mental health professionals or traditional healers (Marsella & White, 2012). Additionally, cultural and religious beliefs can impact the level of support and resources available to an individual seeking treatment for mental health issues, including support from their family and community.. These cultural and religious factors should be considered in the assessment, diagnosis, and treatment of mental health issues.

Islamic culture is believed to significantly impact how Arab Muslims understand and approach mental health disorders and treatments. Numerous Arabic texts on mental disorders and treatment consider Islamic teachings to be a reliable source of information for mental health interventions and therapies. One notable example is Najati's (2001) work, “Introduction to Islamic Psychology,” which highlights the significant impact of Quranic teachings and the Prophet Mohammed’s guidance on people’s mental health. Najati (2001) posits that these teachings, as revelations from God, hold immense importance for the mental wellbeing of individuals.

Research has demonstrated that even Muslim psychiatrists have a religious and cultural context in which mental disorders are understood (Bulbulia & Laher, 2013). This emphasis and reverence toward theology, religious tradition, and cultural beliefs have often led many Arab Muslims to misunderstand mental disorders and their treatment (Fakhr El-Islam, 2008). Consequently, many may turn to informal sources such as traditional and religious healers for help.

Despite being traditionally and conservatively viewed by Western eyes, the Arab Muslim culture is rapidly evolving and changing. For example, the recent decision to allow women to drive in Saudi Arabia, implemented by Crown Prince Mohammed bin Salman, is a significant step toward modernization. Additionally, contact with other cultures through acculturation and education can also play a role in shaping attitudes toward mental health and treatment. For example, the increasing number of Arab Muslim students studying abroad, including in Australia, may impact their understanding and acceptance of mental health professionals and treatment options.

Arab Muslims often attribute mental disorder symptoms to supernatural causes, such as demonic possession, the evil eye, or magic (Al-Adawi et al., 2002). Al-Krenawi and Graham (2000) suggest that envy also has a role to play as an explanation of the symptoms of mental disorders among Arabs. These beliefs often lead to a preference for traditional healing methods and informal resources, rather than seeking professional mental health services (Amri & Bemak, 2013). Arab Muslim people tend to believe that mental disorders are caused by God, Allah as a test of faith or punishment. As a result, they believe that Allah tests or punishes people for something that they have done. Also, they believe that the test or punishment may be considered Allah’s mercy (Aloud & Rathur, 2009). These beliefs, thought to be supported by Quranic teachings and the Prophet Mohammed’s guidance (Weatherhead & Daiches, 2015), can act as barriers to seeking help and engaging in psychotherapy for mental health issues among Arab Muslims.

Previous research has investigated the impact of Arab Islamic culture on individuals’ understanding and perception of mental disorders (Abdel-Khalek, 2011; Darwish, 2016; Hamid & Furnham, 2013; Youssef & Deane, 2006). These studies have primarily focused on how Islamic and Arabic cultural beliefs and practices may exacerbate mental health problems among Muslims. However, there have also been attempts to examine how Arab individuals conceptualize and understand mental disorders (Alosaimi et al., 2014; Aloud & Rathur, 2009, Dalky, 2012; Hamid & Furnham, 2013). In particular, Aloud and Rathur (2009) and Hamid and Furnham (2013) specifically explored factors affecting help-seeking for mental health services among Arab individuals, suggesting that religious and cultural beliefs may act as barriers. However, these studies did not thoroughly investigate how Islamic and Arabic cultures specifically shape the understanding and treatment of mental disorders.

Research questions

This study aims to investigate the influence of cultural, religious, and traditional beliefs on Arab Muslims’ understanding of mental health, mental disorders, mental health treatment, and mental health professionals. The research questions are:

1. How do Arab Muslims conceptualize and understand mental health and mental disorders?

2. What sources do Arab Muslims rely on and trust for information about mental health, wellbeing, mental disorders, and treatment options?

3. To what extent do Arab Muslims believe in the effectiveness of psychotherapy and psychological interventions?

Research significance and contributions

This study provides a deeper insight into the impact of religion on the Arab-Muslim understanding of mental disorders. The findings from the current research can help improve mental health services by increasing understanding of how cultural perceptions and beliefs affect accessibility to healthcare. The research also investigated and analyzed the impact of these misconceptions on individuals with mental disorders. In addition, the findings from the research assist in identifying how perceptions and beliefs are practised and intertwined within the Arab-Muslim culture. The study also helps to identify the extent to which Arab-Muslim communities are aware of available treatments and facilities for mental disorders. Furthermore, the research contributes to the field of mental health by emphasizing the importance of understanding cultural contexts in order to provide more effective and culturally responsive services (Satcher, 2001).

Method

Participants

In this study, 12 Arab Muslim participants (6 men, 6 women) aged 28–53 from Egypt, Saudi Arabia, and Sudan, living in Melbourne, Australia, were interviewed using a semi-structured format via ZOOM conference program. The researcher recruited participants through social networks within Melbourne’s Muslim communities. Invitations, information forms, and informed consent forms were sent via e-mail and WhatsApp. Of the 15 who agreed to participate, three were excluded for not meeting the inclusion criteria. Pseudonyms were used to ensure anonymity, and most participants (10) were born and raised in their home countries before immigrating to Australia, except for Amal and Aleaa who grew up in Australia. For additional demographic details of the participants, please refer to Table 1.

Table 1. Demographics of interviewees: Age, Sex, Nationality, length of living in Australia, martial status, education, profession, and spoken languages (N = 12).

Participant pseudonym	Age	Place of berth/Nationality	Sex	Length of living in Australia (in years)	Marital status	Education	Profession	Language
Ahmed	35	Egypt	M	7	Married	bachelor’s in science.	working as an Arabic teacher	Speaks Arabic and English
Bader	32	Egypt	M	5	Single	bachelor’s in HR	working as an Executive Secretary	Speaks Arabic and English
Najwa	32	Egypt	F	4	Married	bachelor’s in science	working as a bank clerk	Speaks Arabic and English
Shema	40	Egypt	F	10	Married	high school	Homemaker	She stated that she is limited in English and speaks only Arabic
Salem	32	Saudi Arabia	M	2	Married	master’s in engineering	PhD Student	Speaks Arabic and English
Dbean	30	Saudi Arabia	M	4	Married	Master’s in management.	Business consultant	Speaks Arabic and English
Najd	28	Saudi Arabia	F	2	Single	master’s in management	PhD student	Speaks Arabic and English
Asma	29	Saudi Arabia	F	5	Single	master’s in chemistry	Not working as she just finished her master	Speaks Arabic and English
Essa	28	Sudan	M	12	Single	bachelor’s in engineering	working as an engineer	Speaks Arabic and English
Fahmy	53	Sudan	M	23	Divorced	Master’s in social work.	working as an interpreter. He has worked with psychologists and psychiatrists.	Speaks Arabic and English
Amal	23	Sudan	F	18	Single	bachelor’s in English literature	Not working	Speaks Arabic and English
Aleaa	22	Sudan	F	20	Single	studying bachelor’s in IT	Student	She could speak Arabic but not as fluent as her English.

Procedure

This study, approved by the Victoria University Human Research Ethics Committee (Application HRE20–124), used qualitative semi-structured interviews to explore participants’ views on mental disorders and treatment across three distinct Arab cultures. Interviews were conducted in Arabic via Zoom, in accordance with COVID−19 restrictions. The first author transcribed and translated audio recordings into English. Participants were offered alternative telecommunication options if uncomfortable with Zoom. Informed consent was obtained, and pseudonyms were used in reporting. Interviews, lasting about an hour, involved open-ended questions on participants’ knowledge, attitudes, and behaviors related to mental disorders.

Data analysis

The semi-structured interviews were transcribed, translated from Arabic to English, and analyzed using thematic analysis, a flexible method commonly used in psychology research (Braun & Clarke, 2006). The analysis focused on interviewees’ subjective experiences of mental disorders. Transcripts were read multiple times to identify common beliefs and perceptions, which were coded and grouped into key themes. Six themes were generated to answer the research question. These themes were reviewed to determine consistency with existing literature on mental disorders among Arab Muslims or if they were new and unexpected. Themes were then revised for a more detailed understanding of participants’ views on mental disorders.

Findings

Overview of the participants’ religiosity

Participants were initially asked about their religious practices. Ten participants expressed a desire to be more religious but felt they were not, despite praying five times a day (salah) and engaging with the Quran. One participant considered herself “somewhat” religious (Najd, 28 years old, Female, Saudi Arabia), while another male participant claimed he was not religious and only prayed on Fridays (Fahmy, 53 years old, Male, Sudan).

Six Themes Generated from the Twelve Semi-Structured Interviews

Most of the interviews traversed a wide range of topics, and in this section, the researchers focused only on those aspects relevant to the study’s aims. The following 6 themes emerged from the findings.

Good mental health

The majority of participants (11 out of 12) concurred that the absence of mental disorders and life issues signifies good mental health. However, the influence of religious culture was apparent, as several participants expressed the belief that maintaining a strong relationship with God and having faith contribute to mental health and wellbeing. Seven participants emphasized that religion consistently supported them during challenging times in their lives.

In fact, I have never encountered anyone with a strong relationship with God who is unhappy. Even in my own experience, when I feel depressed, I pray or read the Quran, and it brings me a sense of calm and happiness. (Najd, 28 years old, F, Saudi Arabia)

Essa (28 years old, M, Sudan) suggested that all other religions could help their believers have good mental health status; however, Islam is more effective than other religions because it came from the creator (Allah).

I believe that other religions like Christianity and Judaism could help their believers to have good mental health, but Islam is more effective because it came from Allah. (Essa, 28 years old man, M, Sudan)

A participant claimed that there is scientific evidence that Islam helps maintain good mental health.

Numerous studies have suggested that Muslims tend to be happier and less prone to depression than others, which implies that there may be unique aspects of Islam that contribute to better mental health. (Najd, 28 years old, F, Saudi Arabia)

Aetiology of mental disorders: Natural and supernatural causes

The participants suggested several factors as causes of mental disorders. All participants mentioned that external events may play a role in causing mental disorders. Two participants (Asma, 29 years old F, Saudi Arabia) and (Ahmed, 35 years old, M, Egypt) suggested genetic factor has a role to play in causing mental disorders. When the participants were asked if they believe that mental disorders can be caused by factors that are beyond or above the natural, all participants except one (11 out of 12) said they believe that supernatural factors can also cause mental disorders. They suggested magic could be a common supernatural cause of mental disorders.

Everyone believes that magic can cause physical and mental harm. Surely, you have seen people affected by it. If you search on YouTube, you’ll find numerous videos of individuals who have died, lost their sanity, or become disabled due to the effects of magic. (Ahmed, 35 years old, M, Egypt)

Six participants also claimed that they have seen some people who have mental disorders caused by black magic.

The impact of magic cannot be denied. I’ve seen instances where individuals lost their lives or their sanity due to black magic. It can also alter one’s emotions, causing them to harbor negative feelings toward their spouse or children. Magic has the power to change how we feel about our loved ones. (Shema, 40 years old, F, Egypt)

Moreover, all except Fahmy (53 years old, M, Sudan) believed that the demon “Jinn” could possess a person’s body and control his actions. They claimed that demonic possession could cause some symptoms such as irrational thoughts, disorganized behavior, aggression, and self-harm.

“Jinn” can make someone speaks irrationally and they can control them and make them aggressive, and they might hurt or kill others. (Essa, 28 years old, M, Sudan)

“Jinn” can change your personality; it can make you a thief or a murderer. When you see someone who is very aggressive, he might be demonically possessed not always mentally ill. (Asma, 29 years old, F, Saudi Arabia)

Some also claimed that they have seen a number of people who were demonically possessed. Three participants explained more that mental health professionals sometimes cannot understand demonic possession and they think their patients are mentally ill.

I’ve witnessed cases where individuals were believed to be possessed by demons, and psychologists were unable to diagnose or treat them. However, when these people received Quranic therapy from “Sheikhs” (Islamic priests) their condition improved. Mental health professionals often seem to overlook the spiritual aspects. (Salem, 32 years old, M, Saudi Arabia)

In addition, ten participants suggested evil eye has a role to play in causing mental disorders. Evil eye (العين) “Al 'Ayn” is an Arab belief that the overt display of wealth, beauty and happiness would attract the envy and jealousy of others which would bring misfortune or disease.

I think “Ayn” (العين) (evil eye) can affect people’s health physically and mentally. As we know the evil eye can make you sad, anxious, or even crazy. (Salem, 30 years old, M, Saudi Arabia)

Shema claimed that she got affected by the evil eye and envy or “Hasad” (الحسد). And that made her depressed and change her emotions toward her husband.

After two years of marriage, I started to be depressed and began to hate my husband for no reason. Until someone told me that one of my distant relatives envied us and “gave us an evil eye.” Later, I had a chance to get a cup of water that had been drunk by that person. I put the cup in a pot and poured water on that pot. Then, I took the water and poured it over me. After that, I started to feel much better and my relationship with my husband became stronger than ever. (Shema, 40 years old, F, Egyptian)

Sources that provide knowledge about mental health

The participants were asked about the sources that they use to learn about mental health and its treatment. Most of the participants said the internet, and some specified a website (this website is a popular Islamic- Arabic website, the authors prefer not to reveal its name) that they use if they want information related to mental health. Shema said there are many sections on that website that concern marriage counselling, kids’ counselling, and mental health. She added that a person can ask any question related to mental health on that website and would get an answer within 24 hours.

I sometimes use this website when I want to ask questions related to marriage conflicts or depression and anxiety. There are many sections on the website concerned about everything related to mental health such as marriage counselling or kids counselling. When you ask them a question, they normally get back to you within 24 hours. (Shema 40 years old, F, Egypt)

All the participants (except Fahmy) mentioned the Quran and other Islamic books and teachings (hadiths) as sources of learning about mental health.

I studied in a mosque when I was a kid, and the “sheikh” was constantly teaching us how to be always satisfied and avoid sadness and grief by reading Quran. (Dbean, 30 years old, M, Saudi Arabia)

Salem emphasized that the Quran is the first and best source of learning for everything and not just mental health. However, he mentioned some other books that he used for learning about mental health conditions and mental disorders.

All of us know that Quran has an answer for everything, not just the mental health aspect. I think the Quran is the best source to know more about your feelings. I have also read some books more about the psychology field such as “Alroah” (the soul) and “Islam and psychology.” I know these books were written by Muslim scholars, but they are really helpful. There is a psychologist in Saudi Arabia who I often watch on YouTube; his YouTube videos sometimes help me learn more about psychological problems. (Salem, 32 years old, M, Saudi Arabia)

The idea of mental disorders can be God’s punishment was believed by all participants. When we asked the participants why they believe in God’s punishment they stated that it is mentioned in Quran.

Allah Says in Quran “whosever not worship me properly and not listen to my orders, I will make him depressed, and I will make his life hard.” So, it is obvious that sometimes people get depressed because Allah is mad at them. (Ahmed, 35 years old, M, Egypt)

Two participants validated the idea of the impact of magic on mental health by a hadith that the prophet Mohamed got affected by black magic.

You know even the prophet Mohamed got affected by magic and he saw Jinn and Shaytan (devil) so they are real, and they can affect your thinking and emotions. (Najd, 28 years old, F, Saudi Arabia)

Dbean indicated that he read some neuro-linguistic programming books, and they helped him change his negative thoughts and deal with life stressors. Moreover, Dbean reported that there are many Arabic videos on the Internet about mental health and mental disorders. When he was asked to suggest some psychological videos, all the videos he suggested were by Muslim scholars. When he was asked why his psychological video suggestions were made by Muslim scholars, he explained that there is no one who can talk about mental health issues in the Arab region as effectively as they can.

Have you heard about Neuro-linguistic programming? I think it really helps; I have read some Neuro-linguistic programming books and they helped me change my negative thoughts and deal with life stressors. There are some videos on the Internet that can really help. I know these videos were done by “Sheikhs” but you know when I search mental health issues on the Internet mostly I find Sheikhs talk about them. (Dbean, 30 years old, M, Saudi Arabia)

Fahmy said that working with psychologists and psychiatrists as an interpreter for many years shaped his understanding of mental health. He also stated that when he was an adolescent his understanding of mental health was affected by Islamic teachings.

My understanding of mental health when I was a teenager was affected by Islamic teachings. For example, I thought a person with hallucinations and delusions is demonically possessed. But, when I get older and learn more about mental diseases, I became aware of the causes and symptoms of mental disorders. Now, I do not listen to religious priests when they talk about mental health because they are not mental health professionals. (Fahmy, 53 years old, M, Sudanese)

Except Fahmy, all the participants talked about the Islamic ideas of mental health when they were asked about their opinions of mental health and mental disorders. Five participants mentioned some verses of the Quran when they tried to explain mental issues. Ahmed, Salem, and Essa believed Islam was the first port of call to try and explain mental health and mental disorders to people.

Before the psychological scientists, Islam was talking about mental health and prophet Muhammed was the first one who taught his followers how to deal properly with depression, anxiety, and negative thoughts. (Ahmed, 35 years old, M, Egyptian)

When five participants were asked why they believed in supernatural causes, they answered that these supernatural causes were mentioned in the Quran. Salem, in particular, emphasized that it is imperative for every Muslim to accept the existence of demons and their influence on human behavior and cognition. This belief is rooted in the Surah Al-Jinn (سورة الجن), a whole chapter in the Quran that refers to the “Jinn” demons' acknowledgment of the Quran and Allah (Quran, 72:1–6).

Actually, there is a whole chapter in the Quran that talks about “Jinn” and their effects on people’s actions. Every Muslim must believe in “Jinn” it is not our choice. (Salem, 32 years old, M, Saudi Arabia)

On the other hand, Fahmy no longer believes in the Islamic interpretation of mental health after he worked as an interpreter for psychologists and therapists in Australia. However, he acknowledges the early influence of Islam on his acceptance of possible supernatural forces.

In fact, I do not believe that demons can cause mental disorders, however, sometimes I find myself believing that there are some supernatural forces that may affect individuals. I think I still somewhat believe in some irrational beliefs. I attribute these beliefs to the impact of Islamic culture in my early life. (Fahmy, 53 years old, M, Sudanese)

Misconceptions and misunderstandings of common mental disorders and conditions

Before the participants were asked about common mental disorders, they were asked if they had heard about psychotic and neurotic disorders. All the participants reported that they had no knowledge of psychosis and neurosis. All the participants were then asked about what mental disorders they knew. They stated that they were familiar with mental health conditions such as depression and anxiety. Nine participants mentioned that they also knew dissociative identity disorder (DID), commonly referred to as “Infosam” among Arabs. Four of the participants explained that they knew about DID because Arab media and movies often depict this disorder. Additionally, Salem stated that in Saudi colloquial language, people who display contradictory behavior are referred to as having “Infosam” or multiple personalities.

Besides depression and anxiety, I also know about “infosam.” The Arabic media often talks about this disorder. Additionally, in Saudi Arabia, when a person has double standards or tells different things to different people, we usually say this person has multiple identities. (Salem, 32 years old, M, Saudi Arabia)

I know that “Infosam” is a captivating disorder that caught my attention, as it involves a person having two distinct personalities. Sometimes, I wonder if some people I know may have this disorder, especially when their actions contradict their words. (Najwa, 32 years old, F, Egypt)

When asked if they were familiar with schizophrenia, referred to as “fosam” in Arabic, all participants claimed to know about it. However, when prompted to provide a definition for schizophrenia, it was surprising to find that they were unable to distinguish between schizophrenia “fosam” and Dissociative Identity Disorder (DID) “infosam.” The participants described schizophrenia as a condition where an individual has two or more distinct identities or personality states.

Schizophrenia when a person has two or more different identities or personalities like sometimes, he has a kid identity and sometimes he has a woman identity. (Bader, 32 years old, M, Egypt)

 

Because of the confusion between schizophrenia and DID, the researcher explained the symptoms of schizophrenia to the participants. In this case, some participants explained that the confusion occurred because the Arabic words for schizophrenia (“fosam”) and DID (“infosam”) are startlingly close in pronunciation. However, they reported that they often heard about “infosam,” but they never heard about “fosam.”

I thought you asked me about “infosam” because it is hard to recognize the differences between these two words. Indeed, I have heard about “infosam” DID, but I have not heard about “fosam” schizophrenia.” (Fahmy, 53 years old, M, Sudanese)

Is “fosam” different from “infosam”? Because, to me, they seem alike. Once I heard the word “fosam” it came to my mind that it is a word that describes a person with two personalities. (Najwa, 32 years old, F, Egypt)

Even after explaining the schizophrenia symptoms to the participants, nine participants did not exclude the possibility of demonic possession when a person has schizophrenic symptoms.

The symptoms you just explained to me are similar to the symptoms of demonic possession. As I told you I believe in mental disorders but some mental disorder symptoms such as “fosma” may not be really a mental disorder, I think it may be demonic possession. (Amal, 23 years old, F, Sudan)

These symptoms sound like demonic possession. When a person has disorganized speech or claims that he sees something that does not exist in reality, then that may mean he is demonically possessed. (Asma, 29 years old, F, Saudi Arabia)

Eight participants reported that they have seen people with some schizophrenic symptoms, but they thought whether they were demonically possessed or crazy. Further, Dbean believed people with these symptoms must be seen by religious priests first.

Actually, I know someone with these symptoms, but I thought he was demonically possessed. His family also believed that he was demonically possessed. I believe that people with these symptoms must be seen by “Sheikh” first. If a person starts shouting once he listens to Quran that means he is possessed. (Dbean, 30 years old, M, Saudi Arabia)

Amal believed that not everyone with these symptoms is schizophrenic but might be demonically possessed. She believed that the symptoms of schizophrenia and demonic possession were rather similar.

These symptoms are pretty close to demonic possession. So, I do not think everyone with these symptoms is schizophrenic, but they may be demonically possessed. (Amal, 23 years old, F, Sudan)

In contrast, however, Fahmy said,

Before you (the researcher) explained to me the schizophrenia disorder, I would have considered anyone with schizophrenic symptoms as a crazy person. (Fahmy, 53 years old, M, Sudan)

When asked if the participants are familiar with depression, all indicated that they understood well. They answered that depression is a mental health disorder characterized by feeling of sorrow, anger, loss of interest in life, and disruptions of sleep. All participants had the similar notion regarding the symptoms of depression.

Yeah, I think depression is when you feel sad, you feel that life is worthless and you always want to be alone. (Ahmed, 35 years old male, Egypt)

However, the participants have different ideas about the causes of depression. All of them focused on environmental factors such as trauma, sad events, childhood violence, and the loss of loved ones. When they were asked if they believe that supernational factors could play a role in causing depression, all participants except Fahmy suggested that evil eye and envy have roles to play in causing depression.

I think the evil eye can cause depression and can harm people physically because the prophet Muhammed said, “The evil eye is real, and if anything were to overtake the divine decree it would be the evil eye. (Dbean, 30 years old, M, Saudi Arabia)

As I told you I have been depressed because of the evil eye. My depression was cured when I drank a glass of water used by the person who caused me the evil eye. (Shema, 40 years old female, F, Egypt)

Moreover, eleven participants suggested depression could be God’s punishment for those who do not believe in Allah or do not pray to him. Three participants mentioned that there is a verse in the Quran that explicitly indicates that in the 124th verse of chapter 20 (sūrat ṭā hā) “people who turn away from God’s remembrance will have a miserable life.”

Yes, I think God can cause depression and other disorders as a punishment. I can see that when I miss a prayer for any reason, I feel sadness, fear, and anxiety. (Bader, 32 years old, M, Egypt)

Asma used the ratio of depression prevalence worldwide to justify her belief that depression could be God’s punishment.

You can see non-Muslim countries have the highest rates of depression and suicide mortality which may consider as God’s punishment. I also think that confirms the impact of being Muslim on mental health. (Asma, 29 years old, F, Saudi Arabia)

Moreover, the participants were asked if they have heard about post-traumatic stress disorder (PTSD). All participants reported that they never heard about the name of the mental disorder PTSD. Therefore, the researcher listed PTSD symptoms to investigate if the participants heard about these symptoms. Seven participants said they saw some people who had similar symptoms to those described.

I had a relative who experienced a terrifying event at sunset, then, he got some of the PTSD symptoms such as nightmares, depressed mood, and anger. His family thought their son was demonically possessed. Actually, I also thought he had been demonically possessed; especially because when someone began reciting Quranic verses, he started screaming for no reason. (Amal, 23 years old, F, Sudan)

Dbean also talked about the risk of witnessing a terrifying event around the time of sunset.

Prophet Muhammad cautioned all Muslims to avoid leaving their homes during sunset, as that is when demons are believed to be most active. (Dbean, 30 years old, M, Saudi Arabia)

Moreover, after explaining the PTSD symptoms to Salem (32 years old, M, Saudi Arabia) and Najd (28 years old, F, Saudi Arabia), they suggested a traditional name for PTSD which is panic (Roaah). Salem suggested “Esfar” (Safflower is a plant native to the Middle East and Central Asia) as a potential medication for PTSD.

Okay, you know in our culture, when someone has such symptoms, that means they have panic (“Roaah”) or they are panicked, and he must be treated by “Esfar”. (Salem, 32 years old, M, Saudi Arabia)

Mental health treatment and traditional treatment

All participants reported that they had no prior experience in psychotherapy. However, three participants reported that they had been treated by Muslim priests once in their life for different reasons. All the participants stated they had never been in psychotherapy because they did not need it. Four participants stated that they would seek help if they encountered only severe mental health problems.

I’ve never sought mental health treatment because I don’t believe I need it. In my view, such treatment is intended for those who struggle with interpersonal interactions, have irrational thoughts, or exhibit aggressive behaviours. (Essa, 28 years old, M, Sudan)

The participants were asked to explain the psychotherapy process; 6 participants failed to explain them properly and five of them stated that they could not provide an explanation because they had never been in psychotherapy before.

To be honest, I have never been in mental health therapy before, but I have seen psychiatrists in movies, they talk with their patients and give them pieces of advice. (Aleaa, 22 years old, F, Sudan)

Only one participant provided a proper explanation and definition.

Psychotherapy, in my understanding, involves a client lying on a couch while a psychologist sits behind, taking notes during the conversation. I’ve participated in psychotherapy, not as a client, but as an interpreter for refugees. I’m aware that therapists aim to assist clients with their issues by implementing a treatment plan. (Fahmy, 53 years old, M, Sudan)

Further, all the participants were asked to name the types of treatments of mental disorders they know. Five participants could not name any type of psychotherapeutic treatment. Fahmy stated that he has heard about psychoanalytic therapy.

I actually have heard about psychoanalytic therapy I think it was created by Sigmond Freud, but I did not know how it works (Fahmy, 53 years old male, Sudan)

Furthermore, the participants were asked about their views on the proper treatment for mental disorders. Ten participants identified psychotherapy as their preferred treatment option for most mental disorders, with a focus on severe cases. Additionally, eight participants suggested Quranic healing as an alternative option if psychotherapy is not effective.

If psychotherapy does not work, then, you can have someone recite the Quran to heal the sick who were suffering from mental disorders. (Aleaa, 22 years old, F, Sudan)

For the treatment of mental health conditions, such as depression and stress, a number of participants suggested that it would be better to start reading or listening to the Quran first. If that does not help alleviate symptoms, they could seek help form mental health professionals.

It depends on the case if you do not have a severe mental illness, and you are just depressed or something like that you can start reading Quran and mostly that works and make you feel better. If not, you can ask for help from psychologists. (Areej, 29 years old, F, Saudi Arabia)

Nine participants talked about the effectiveness of “ruqia,” which is invoking the names of God and reading the Quran to people who have mental disorders or demonic possessions. Furthermore, some suggested the Quran best treatment for depression because it often helps them have a sense of relaxation and be happy.

You know the “ruqia” is a really good choice for those who are suffering from mental disorders and demonic possession. It is also good for those who are depressed. Sometimes I use the “ruqia” when I feel depressed, it really helps. (Najwa, 32 years old, F, Egypt)

In addition, three participants believed that performing “ruqia” over themselves could be more effective with depression and anxiety than other mental treatment options.

In my opinion, performing “ruqia” on oneself is more effective for those struggling with depression and anxiety than other treatments, as I’ve personally experienced a sense of satisfaction from it. (Bader, 32 years old, M, Egypt)

On the other hand, Fahmy did not believe religious treatment for mental disorders would work; however, he thought that reading the Quran might help in treating depression.

Actually, I don’t believe in religious treatment for mental disorders, but I have seen many people use reciting the Quran as a cure for depression; so, I think the Quran may help some people. (Fahmy, 53 years old male, Sudan)

Stigma toward mental disorders and seeking help for treatment

All participants were asked about their feeling when they meet someone with severe mental health problems. Four of the participants stated they feel compassion for people with mental disorders.

When I encounter individuals with mental disorders, I feel empathetic and wish I could offer assistance. (Najd, 28 years old, F, Saudi Arabia)

However, most participants stated that they feel threatened when they encounter people with mental disorders.

When encountering people with mental disorders, I feel uneasy as they may exhibit aggressive behaviour and not be accountable for their actions, potentially causing harm to others at any moment. (Aleaa, 22 years old, F, Sudan)

Essa stated that if he had a mental disorder, he would not tell anyone about it, because in his culture, a person with a mental disorder is often perceived as “crazy.” He indicated that in Arabic culture if one of the family members had a mental disorder, it is better for the family to isolate the mentally ill member to protect the family’s reputation.

If I had a mental disorder, I would not tell anyone about it because you know they may think I am crazy and not responsible. Also, that would affect my family too. (Essa, 28 years old, M, Sudan)

The participants were asked what would prevent them from seeking help for mental disorders. Nine participants indicated that the only reason that might prevent them from seeking help for mental disorders is the stigma. Some of the participants explained that in their culture, people who are seen by mental health professionals are often labeled “crazy” which may affect their careers and reputations.

The primary reason that might deter me from seeking help for mental disorders is the fear of being labelled as “crazy” in our culture, where those who attend psychotherapy are often perceived as such. (Amal, 23 years old, F, Sudan)

Therefore, some participants said they prefer to seek help from religious healers instead, so, people do not place shame on them.

I would prefer to seek help from “sheikhs,” as doing so would not lead to any stigma being associated with me. (Bader, 32 years old, M, Egypt)

Discussion

Before discussing the impact of Islamic Arabic culture on mental health understanding, it is important to explain the finding that no prior studies have illustrated, which is why most of the participants did not consider themselves religious despite reporting they often prayed and read the Quran. A probable explanation for this is that in Islamic Arab culture, considering oneself a religious person is a kind of self-praise that is greatly disliked by Allah. Self-praise has always been criticized in the Quran, for example, the Quran says, “do not flaunt your piety: He (Allah) knows best those who are Godwary” (Quran 53:32). Consequently, it may not be advisable to inquire about religiosity directly from Muslim individuals, as they might refrain from identifying as religious to avoid the appearance of self-praise.

In the present study, participants demonstrated a limited comprehension of mental health and available treatment options. Many were unfamiliar with specific mental disorders, such as schizophrenia and bipolar disorder, as well as the treatments associated with these conditions. Furthermore, the majority of participants had not encountered the terms “psychosis” or “neurosis” nor could they differentiate between the two. While three participants mentioned receiving treatment from Muslim priests, none reported seeking psychotherapy. This reluctance may be attributed to the sensitivity surrounding mental health discussions within the Arabic culture (Zolezzi, Alamri, Shaar, & Rainkie, 2018), and a prevailing belief among participants that psychotherapy is reserved for individuals experiencing severe mental health challenges. These attitudes toward seeking assistance for mental health concerns may contribute to the low utilization of mental health services within this population.

In addition to their limited understanding of mental health, the participants have a clear misunderstanding of mental disorders as well as psychotherapy. This misunderstanding appears to be influenced by Islamic Arabic culture, which shapes participants’ beliefs about the causes of mental disorders and appropriate treatment options. For instance, the participants often attributed the causes of mental disorders to supernatural forces, such as the belief that mental health is tied to a good relationship with God, or that mental disorders are the result of God’s punishment or supernatural entities like magic, evil eyes, and demons. Additionally, the participants suggested the use of traditional practices like reading the Quran or traditional medicines such as “Esfar” for the treatment of specific mental health conditions like depression and PTSD. These findings highlight the need to consider cultural factors in understanding and addressing mental health issues within Arabic communities.

The participants’ belief in supernatural forces may give an explanation for Amri and Bemak (2013) found that Muslims are less likely to seek mental health assistance from mental health professionals than other cultural groups and findings from Al-Krenawi and Graham (2011); Assad et al. (2015) that Arab- Muslims tend to use informal mental health treatments. This belief in supernatural causes can create barriers to seeking help for mental health issues and accepting the psychotherapy as a treatment option. Instead, these individuals may turn to religious healers for treatment, but this approach may not be effective, particularly for more severe mental disorders such as schizophrenia and severe mood disorders. Additionally, traditional healers in the Arab region have been known to abuse their patients physically, financially, and sexually (Darwish, 2016), further highlighting the need for caution in seeking help from these sources.

Our research found that participants who attributed mental disorders to supernatural causes were more likely to suggest informal or religious therapies, such as Quranic therapy, as an effective treatment for depression. While some studies have suggested that reciting the Quran can have psychological benefits for Muslims, such as reducing depression and anxiety (Mashitah, 2020; Nayef & Wahab, 2018), it is important to note that these findings may be misused by Muslims to reinforce the belief that the Quran is beneficial in all aspects of life (Yilmaz, 2021). This is evident in the present study, where some participants misused scientific findings to support this belief. It is important to consider the potential for such misunderstandings and the need for education about the appropriate use of religious practices as mental health treatments.

In addition to shaping participants’ understanding of mental health, Islamic Arabic culture also promotes mental health stigma among those who suffer from mental disorders and those who seek treatment. This was evident in the interviews, where many participants cited stigma as a potential barrier to seeking help for mental health issues, citing the belief that being seen by mental health professionals can lead to being labeled as “crazy” and damaging one’s career and reputation. Additionally, some participants stated that if they or a family member had a mental disorder, they would not disclose it due to the negative perception of mental disorders in Arab culture and the potential impact on their own and the family’s reputation. This highlights the need to address mental health stigma within Arabic communities in order to facilitate the utilization of mental health services.

There has been a number of previous studies that have discussed similar results to what we have found in our study, which is that Arabs tend to believe that mental disorders are caused by supernatural forces (Islam & Campbell, 2014), to seek treatment from informal mental health services (Al-Krenawi & Graham, 2011; Assad et al., 2015), to misunderstand psychotherapy and hold negative attitudes toward mental health services (Al-Krenawi, 2005), and to stigmatize mental health (Ciftci, Jones, & Corrigan, 2013). However, the extent to which Arabs adhere to these beliefs, the origins of these beliefs, and strategies for addressing them have not been explored in depth. Our study contributes to a better understanding of these issues, thereby providing valuable insights for initiatives aimed at improving comprehension and acceptance of mental health treatment within Arabic communities.

The results of our study suggest that some Arab Muslims place a strong emphasis on the idea of supernatural effects on mental health, using Quranic or Hadithic quotations as evidence for such causes of mental disorders. These quotations are perceived as undeniable proof by some participants. This may be due to the central role that supernatural beings and concepts play in the Islamic faith, as described in the Quran. In Arab-Islamic culture, the teachings of the Quran are considered fundamental, and any individual who disregards even one verse may be considered an infidel. These findings highlight the influence of Islamic sources on Arab Muslims’ interpretations of mental health.

In this study, participants identified numerous sources that contributed to their comprehension of mental disorders. A significant portion of them referenced traditional Islamic texts or narratives when discussing psychological phenomena and frequently cited Quranic verses to elucidate specific mental disorders, especially depression. Additionally, some participants acknowledged the influence of well-known Arab psychologists who incorporate Islamic principles with a scientific approach to mental health. This blending of Islamic and scientific viewpoints on mental wellbeing among mental health practitioners aligns with Bulbulia and Laher (2013) findings, which suggest that the conceptualization of mental disorders by Muslim psychiatrists is molded by their religious and cultural backgrounds.

The present study found that the participants relied on a diverse range of sources to educate themselves about mental health, including websites, with some being Islamic in focus. However, none of the participants mentioned using a reliable mental health website as a source of information. These results highlight the difficulties that Arab Muslims may encounter in obtaining evidence-based mental health information.

Overall, the participants in this study exhibited a consistent understanding of mental disorders and psychotherapy. However, it is important to acknowledge that one participant, Fahmy, demonstrated a different perspective compared to the others. This unique understanding might be attributed to Fahmy’s professional experience as an interpreter, which provided opportunities to work closely with psychologists and psychiatrists. Consequently, it is challenging to generalize conclusions about the comprehension of mental disorders and psychotherapy among the entire Sudanese participant group based solely on this single deviation.

Limitations and recommendations

Limitations and recommendations for future research

Naturally, this study has several limitations, including a small sample size that may reduce the generalizability of the findings to the broader Arab-Muslim population. The use of semi-structured interviews could introduce bias due to the researcher’s perceptions and interpretations, and the single study location may not represent the experiences of Arab Muslims elsewhere. To address these limitations, future research should aim to include larger sample size and employ multiple data collection methods, such as focus groups or surveys, to triangulate findings and increase validity. Examining the topic in more depth and diverse contexts will enable a more nuanced understanding of the challenges and opportunities faced by Arab Muslims concerning mental health and disorders.

Recommendations for mental health professionals

Although the findings of this study cannot be generalized to the entire Arab-Muslim population, they offer valuable insights for mental health professionals. The study highlights that Arab-Muslim clients often perceive mental health within the context of Islamic theology, affecting their understanding of mental disorders and treatments. Mental health professionals should inquire about any informal treatments sought by Arab clients, encourage them to refer to formal sources of mental health knowledge, and be aware that some Arabic-language websites may not provide reliable information. Additionally, professionals must ensure that Arab clients feel comfortable discussing mental health concerns openly, as the fear of stigma may prevent them from seeking treatment. This approach can optimize treatment outcomes and raise awareness about mental health and its treatments in the Arab-Muslim community.

Conclusion

The research conducted reveals that Arabic Islamic culture has a significant impact on the conception of mental health among Arab Muslims. This can lead to misunderstandings about the symptoms and causes of mental disorders, and a tendency to seek help from informal healers rather than mental health professionals. The findings of this study indicate that it is important to consider culture and religion when working with Arab Muslim clients, as these factors can either facilitate or hinder the effectiveness of therapy. Moreover, a key factor to consider when working with these clients is the resources they use to learn about mental health, as many of these resources are misleading and unreliable. Understanding the role of Islamic-Arabic culture in shaping Arab Muslims’ understanding of mental disorders and psychotherapy will increase the effectiveness of intervention strategies with these clients. Ultimately, it is clear that cultural competence is crucial when working with Arab Muslim clients in order to provide the most effective and appropriate mental health care.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was approved by the Victoria University Human Research Ethics Committee (Application HRE20-124) and supported by Victoria University Institute for Health and Sport Graduate Student Research Fund.