Conceptualization of mental illness within Arab cultures: Meeting challenges in cross-cultural settings

Posted by Justin | July 31, 2007 .

Keywords: Arab, interpreters, cross-cultural, conceptualization, mental illness.

For the families of Arab patients psychological treatment primarily entails pharmacotherapy.

Using the aid and expertise of a doctor practising psychological science is seen as a sign of weakness (El -Islam, 1998; Okasha, 2000) or a shameful event that might bring disgrace to the family and the tribe. This may be attributable to rigidity in perception, rather than to a distorted misattribution of what constitutes treatment. These elements, mainly existential in nature, are traditionally relegated to a more “specialized” individual who often employs nonmedical, nonpsychological, noncultural bound methods of healing (Lefley, 1994). The traditional healer or Sheikh or Matawaa, in the typical Arabic dual acceptance of the two seemingly contradictory ways of dealing with mental illness, is considered the one who would drive the “evil spirit” and “evil eye” away. Family members may assume the role of guardians so that the patient may not reveal family secrets in sessions, which accounts for the triad configuration in many psychotherapeutic encounters with Arab patients. This may present a challenge for therapists who employ psychodynamically informed techniques. Needless to say, in such a therapeutic configuration some factors would be present that are not related to the therapy process, and which lend themselves to attenuation of the transference/countertransference paradigm leading in turn to dilution of transference that would be antitherapeutic for those clinicians subscribing to psychodynamically informed therapy. It may, in some extreme cases, lead the person present in the therapy room to develop some psychological problems himself/herself, due to repeated exposure to the traumatic material presented in the therapy session, especially if the person accompanying the patient has certain vulnerabilities, and there is a total immersion in the patient’s affairs.

This transference psychosis according to Meissner (2001a) occurs when “failure of reality testing leads to loss of self-object differentiation and diffusion of self and boundaries….such mirroring may reflect an attempt to re-fuse with an omnipotent object as a defense against underlying fear of vulnerability and powerlessness” (p. 199).

THE USE OF INTERPRETERS AND TRANSLATORS IN PSYCHOTHERAPY OF ARAB PATIENTS

The following case study illustrates the difficulties one would encounter when Arab patients are treated in a psychodynamically informed milieu. In addition to difficulties outlined by Meissner, (2001a & 2001b) regarding issues of alliance and transference, a complication arises from using interpreters and translators in the therapy sessions.

The relationship between companion and patient can cause role confusion for the companion who also acts as an interpreter in an individual psychotherapy process. It can be confusing and awkward to both companion and patient if the companion is more like a therapist in one setting, and a friend in another. At times, however, the companion may feel pulled into the role of patient as his or her charge needs to discuss his/her relationship in psychotherapy. When using a companion as an interpreter, the therapist in the triad may have to work in an unfamiliar modality that has elements of individual therapy, marital therapy, group therapy, and cotherapy. The presence of a companion in psychodynamic psychotherapy adds complexity in other ways. These include two additional relationships (i.e., companion-patient and companion-therapist), companion as transference object, companion’s countertransference, and the therapist’s countertransference to the companion. The following case illustrates the phenomenon of having a companion in a psychodynamically informed psychotherapy process: