Does mental health care consider diverse cultural experiences?


Does mental health care consider diverse cultural experiences?

At 16, I started to experience panic attacks and went to see a therapist for the first time. I had spent the first half of my life in my home country of Lebanon, and the other half in France, where I had emigrated with my family. After the first few sessions where I was distant and struggled to open up, I eventually started to get more comfortable, bit by bit. Hesitant and a bit puzzled, I talked, for the first time in my life, about my painful experience with immigration, the anxiety that I was going through and couldn’t explain, and most of all, my relationship with the intergenerational traumas and losses, all related to the Lebanese civil war. 

Delighted to see me finally opening up, the woman in front of me listened to everything with a reassuring but condescending smile. I confided about the constant fear for my parents, which was due to their own war traumas and background. I said it was hard for me to put those anxieties at a distance.

When I was done, she still had the same smile and the same mixture of reassurance and condescendence on her face. “But you know how Orientals are!” she exclaimed, laughing. “They like to make up things, to exaggerate things. And Oriental women are so theatrical. You shouldn’t take your family’s anxiety seriously. Arabs like to dramatize everything.”

Due to genetic hazards, I happen to be white-passing. This means that I am fortunate enough not to experience racism on a daily basis, based on my looks. As a result, the racism I face is pernicious and hidden, only arising and hitting me in the moments and places when I choose to embrace my Arab identity or talk about it. Therapy has been one of those places. 

It took me years, if not a decade, to understand what had happened in that therapist’s office, who, with that single sentence, was already drawing a firm line between an “us” and a “them.” While she was implicitly convincing me that I — like her — belonged to the former, she was also plainly encouraging me to look down on my family’s history or reactions. 

As time passed, and as tragedies continued in the region, I started to witness other friends around me seeking help and passing the door of a therapist’s office. As I listened to their stories, and analyzed and observed what was going on around me, I soon realized that my stories and experiences were far from unique. 

I realized that as Arab women, the space of therapy — a space that, we were assured, would help us to heal, and even, sometimes, was sold to us as the only way to heal — concentrated pernicious colonialist power dynamics. As we made ourselves vulnerable in the hope to heal, we were finding ourselves bluntly exposed to systemic racism.

These issues are rooted at the very core of therapy and trauma theory — back to how those spaces were built, how the narratives and theories are framed. Those are all matters that are discussed in “Third Culture Therapy,” a podcast where British-Syrian journalist Layla Maghribi explores how social identity and cultural heritage impact our mental health. 

In the first episode, she discusses trauma, memory and recovery in the Arab world with Layla Al-Amar, an academic and writer, and soon enough in the discussion emerges the idea that our understanding of trauma is “adopted from the West,” as Layla puts it. She gives the example of the Freudian definition of trauma — something that stands “out of the ordinary,” a kind of exceptional event. But what do you do when trauma is happening to your whole society, asks Layla. You, your neighbor, your parents, cousins — your whole country? Bombings have been constant during the Lebanese civil war, traumatizing a whole society. 

“There’s been an understanding of systemic trauma, chronic traumas, societal traumas — but those things don’t meet Freudian criteria,” explains Layla. “In situations where trauma is the norm, where is there to study?” 

To Layla, the therapeutic models that have been created in the West, and imported to the Levant, don’t work today because they haven’t been created to take our experiences into account. 

This echoes the experiences that me and my friends went through, trying to seek healing through therapy in the West. Our experiences were pointed out as abnormal when they were systemic. Untrained Western therapists tried to make us appear as deeply flawed individuals before trying to understand and apprehend our intergenerational traumas and identities.

As Arab women, the space of therapy, a space that we were assured would help us to heal concentrated pernicious colonialist power dynamics.

I remember a friend of mine, Sasha, went once to see a typical Parisian psychoanalyst — complete with a Freudian couch in his office. Very soon, she started to open up about issues with her parents, who had stayed back in Lebanon, and with whom she started having complicated relationships. Both had endured severe trauma due to the civil war and as Sasha was growing up and moving forward in her life, she was experiencing more and more communication issues with her parents, especially with her mother. 

She confessed feeling tired and hurt by the constant power dynamics that she felt, as a woman in a patriarchal world, and as an Arab in a Western society. That is when the therapist started reacting for the first time: “You are being paranoid. You should stop seeing evil everywhere and focus more on yourself and on your own issues.”  For that man, the power dynamics that Sasha was pointing out and suffering from clearly did not exist but were mere symptoms of her own paranoia.

This is how our experience of systemic and intergenerational trauma is often neglected. Instead of trying to understand our wounds, our culture, and our identities, they try to reduce us to Freudian textbook cases, bringing everything back to sexuality and death drives instead of facing their own ignorance and lack of curiosity. 

In that regard, Layla Al-Amar points out the need to “decolonize trauma studies,” in order to understand how other cultures cope with extreme events. “We shouldn’t think that the Western model of the talking cure is always the best model to go by. It is our detriment that we don’t have our own terms to these things,” explains Layla. 

The fact that our understanding of mental health is today “adopted” from the West, as Layla coins it, is to her a problem linked to the weight of the Western influence in the Arab world — especially since the Nahda, the cultural movement that flourished by the end of the 19th Century and early 20th century, in the Arab countries dominated by the Ottoman Empire. “perpetuation of the Nahda problem,” She relates how Arab psychologists went to get training at the Sorbonne in the 19th Century and then came back to Damascus, Cairo or Beirut to put those Western ideas into practice. But this did not always work, was criticized, and sometimes felt alienating.  

“Regardless of whether the therapist is an Arab or not, they’re ill-equipped to deal with the issues you bring them, because of their training.”

After her first experience with the Parisian psychoanalyst, Sasha decided to see a Lebanese female therapist, “who was adorable and very understanding.” But something was off. 

“She was from my parents’ generation and had the same ideas. It was hard to feel totally safe, even though it wasn’t her fault at all.” Sasha told me that she might have been projecting, but that she was not totally comfortable talking to her about her new sexual orientation as a lesbian and how she would come out to her parents. “Maybe I was wrong, but I felt like she felt sorry for my parents, maybe thinking that it would be difficult news for them to digest. I was not comfortable with that.” Plus, her therapeutic approach, the Cognitive Behaviour Therapy, didn’t fully correspond with her. 

Our experience of systemic and intergenerational trauma is often neglected. Instead of trying to understand our wounds, our culture, and our identities, they try to reduce us to Freudian textbook cases

For Sasha, what helped was to go and see a therapist who specialized in intercultural trauma issues. “She was recommended by a Franco-Syrian friend, who had experienced these issues with her father,” Sasha told me. The therapist she’s seeing now has been “incredibly helpful.” “She’s not Lebanese, but she has an Arab name, so that’s probably what I mean when I talk about migrations and identity. When I talk about Lebanon, I have to explain some little things to her, but I can see that she gets it very quickly.” 

With a non-judgemental approach, her current therapist taught her to put, very gently, a salvatory distance between her own views of life and her parent’s vision of the world, shaped by the war they outlived. 

I do believe that there are places of in-between, of understanding, where we can find peace and healing like Sasha did. Even if there’s maybe a whole new system to rebuild — one that would be more inclusive, and that would take minorities’ experiences more into account. That wouldn’t limit itself to a Freudian, Western theory, but more interdisciplinary, considering a historical, geopolitical, and cultural perspective as well. One that would come from a place of genuine curiosity and empathy for the “Other’s” experience, and not from a place of condescendance and whitesplaining.

I think a key step is understanding the power dynamics that we can still find, and that could destroy instead of heal, when they are labeled as healing. I wish I knew, 10 years ago. But bit by bit, we learn. Observing the web around us, how it works, how it can crush us, we become more aware. We open up conversations. Connect things together. Share our experiences. Voice what we feel. And we get stronger. We build our own safe spaces, together. 

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