I tell my patients, on a daily basis, that you cannot fix something if you have not yet identified what it is that you need to fix. In a broader context, the recognition of mental health issues starts with acknowledging and accepting that mental illnesses are no different than any other health problems. Only then can these illnesses be treated successfully and those individuals affected obtain the appropriate and necessary care. The bottom line: Healthy individuals create healthy communities.
Recognition of this fact may have prompted the World Health Organization to travel to Iran in 2004 with the Assessment Instrument for Mental Health Systems (WHO-AIMS) and a goal of establishing a baseline with which to compare future change. The report (WHO-AIMS Report on Mental Health System in the Islamic Republic of Iran) was finally published and available to the public in 2006. While Iran was not completely without care for the mentally ill, the system left much to be desired, and major gaps were found, for example, in the areas of human rights’ protection for patients, and equity and access of care to all people (even in more rural communities). The assessment also uncovered inadequate resources for mental healthcare needs, in particular, for children and women. In addition to these findings, there is a lack of scientific research on mental illness in Iran and even on Iranians in the United States (where we have significantly fewer restrictions on what is studied and published). A literature search of academic publications in the past decade, on any mental illness topic, yielded a random conglomeration of articles studying small groups of people in specific settings. Findings cannot necessarily be generalized to an entire population when there are such limitations to research studies. (Note: These are publications that are available internationally through MEDLINE (PubMed and Ovid) database searches.) However, there is both good and bad news about mental illness research.
The good news: Although we have been slow to start, it appears as though the numbers of Iranian-American psychologists are increasing in the United States, which means more attention to mental health issues regarding Iranians living in this country. Most of these studies focus on immigration-related issues and acculturation, but there is at least one study each on women, children, and elderly.
The bad news: In the past decade, there have been only between one and three published studies on any mental illness topic in Iran annually (at least from those available online for public access). We have not been doing even that much research in the United States, with fewer than 15 studies total since 2002, most of which are dissertation abstracts.
This scarcity of research on the incidence of mental illness in Iran and on Iranians in the United States invites us to delve deeper to uncover what challenges might be driving this reality. The issue of stigma is not unique to Iran, but appears to be ubiquitous. Westernized countries have made significant progress towards to goal of destigmatizing mental illness, however, it is by no means destigmatized today in 2017. Perhaps if we were all reminded that the brain is simply an organ like any other, we might begin to feel less shame for illness related to chemical imbalances in the brain.
Where does this stigma originate? It derives often from a lack of knowledge and comprehension. When there is ignorance or fear about a topic, we (as human beings) tend to stereotype, generalize, and discriminate. If Iranians and Iranian Americans wish to progress as a country, a culture, and a cohesive group of people, it is paramount that mental health be addressed as would be any other healthcare issue. Currently there is an unspoken understanding among so many Iranians and immigrants that, as in past centuries, mental illnesses must be hidden away, never acknowledged, and certainly not discussed. There may be whispers about the tragic suicide of someone and the conclusion that he or she was “different” than the rest of us, minimizing the reality that many Iranians suffer from untreated and often undiagnosed anxiety and depression, which is only exacerbated by immigration and acculturation difficulties. It is so remote from what is socially acceptable, that a family may keep asking why their daughter has not yet found a “good husband” instead of accepting that she may be lesbian and may find the same or greater happiness in the company of another woman. Divorce causes us shame and is often considered disgraceful, and thus avoided even the cost of an individual’s own health. Despite observable marital strain, friends and acquaintances are reassured that “everything is okay.” Alcoholism and drug addiction may be enabled by the very people closest to those individuals who so desperately need help, because to set boundaries and intervene would lead to a disruption of the family unit. Families and community members may share a belief that if mental illness is not talked about, it does not exist.
The Iranian community, like most ethnic communities, is close-knit, collectivistic, and family-oriented. Nonetheless, Iranians and Iranian-Americans are not immune to the issues that plague the Western World. Ironically, those positive aspects of our culture may put us at increased risk for mental illness because avoidance and ignorance prevent accountability and ultimately treatment. Our community’s children are also vulnerable to abuse, molestation, and neglect. We have heterosexuality, homosexuality, and bisexuality and everything in between. We have chronic depression, anxiety disorders, and trauma too. Plain and simple, though the issue of destigmatizing mental illness is a complex one in family-oriented cultures, it is critical to the long-term success of the community.
In sum, it is the responsibility of every member of the community (any community!) to take an active role in destigmatizing mental illness. We can start by initiating a conversation with the people closest to us, so that we can begin to identify what exactly we need to fix. We can educate ourselves about mental illness and available treatments. We can open our hearts and listen without judgment or criticism. We can encourage our loved ones to seek professional help without the fear of negative evaluation. We can choose not to suffer alone or in silence any longer. Silence is not a solution and will not lead us towards a goal of better mental health and well-being.