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On Power, Boundaries, And The Accountability Of Imams

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By Samaiya Mushtaq

Soon after I started residency in psychiatry, the movie Spotlight was released, about The Boston Globe’s investigation and groundbreaking story on sexual abuse within the Catholic Church. I remember thinking then how the seed of psychiatric illness for so many of my patients was planted the same: childhood and adolescent trauma. The parent who beat me. The uncle who molested me. The clergy who took advantage of me. Often, the ones who had the responsibility to protect also had the power to do the most harm. The second injury was that when young, those abused couldn’t really ever tell anyone, particularly when it was the person whom they would tell that was perpetrating the abuse. And that was the very worst part: that their ability to trust was left totally shattered.

Now as I end residency, the most rewarding part of my job as a psychiatrist is my role as a therapist, treating patients primarily using psychodynamic (insight-oriented) therapy. It is joyful work in which I can examine some of these old hurts with people in order to help them live a more meaningful and satisfying life. When I reflect on what makes my work safe for me and my patients, it boils down to these three key precepts:

  1. Acknowledgment of the inherent power dynamics. Over the years, I have become very aware of the one-sided intimacy of the therapeutic relationship. It demands a lot of vulnerability from my patients to entrust me with the most private aspects of their lives. Simply knowing that guides how I phrase my questions and the balance I strike between supporting and challenging my patients. Which leads to…
  2. Awareness of and respect for boundaries. In training to be a therapist, I was taught about the transference (the patient’s feelings towards the therapist) and countertransference (the therapist’s feelings towards the patient). Sometimes, the transference is erotic. Sometimes, the countertransference involves frustration. To be aware of that in real time is critical in maintaining a healthy therapeutic relationship. Clear boundaries are the kindest thing we can do to protect both our patients and ourselves as therapists while preserving a healthy clinical relationship. Boundaries around after-hours communication, meeting in a dedicated therapy space, holiday gifts, or physical touch when a patient wants a hug can all be discussed. Which is further protected by…
  3. Oversight and accountability to third parties. I spent several hundred dollars and months obtaining licensure from the Texas Medical Board, which tracks malpractice against healthcare providers. I am regularly evaluated by my peers and faculty at the medical center where I am employed. And for every hour of therapy, I conduct as a trainee, I have a half-hour of supervision with senior providers with whom I discuss my cases. All these pieces create both a regulatory climate and a rich learning environment for my own growth as a therapist. This can go on even after residency when psychiatrists participate in continuing education to maintain licensure and or seek the counsel of mentors.

I can’t imagine practicing therapy safely and effectively without these guidelines, and so for a long time, it has disturbed me that the realm of spiritual counseling does not share some of these safeguards. As it is now, imams are often the first point of contact for our community members (1) when congregants are in the throes of marital discord or divorce, suffering internal spiritual turmoil, and even when decompensating from psychiatric illness. Whether they elect to be or not, they are also in the position of acting as counselors during these experiences of their congregants’ with potentially no codified set of ethics to guide them.

To put imams in this position of responsibility untethered hurts everyone, including imams, many who work for little pay and often no benefits. Without clear professional guidelines when it comes to spiritual counseling, both our imams and community members are left vulnerable and face dire consequences. It’s no wonder then that you’ve got fertile ground for situations such as, according to a pending lawsuit in Irving, Texas, an imam completely traumatizing a congregant through exploiting his access as a spiritual counselor (2). The organization investigating this case reported that, in the wake of this nightmare, the mosque dealing with the fallout stopped providing counseling on their premises and began outsourcing counseling into the community through referrals and funds (3).

Imam As Counselors

That was one mosque in one city. As it stands now within our greater community, however, we have not yet refined the role of imams-as-counselors, and trying to get to the roots of the problems within that role is an uphill battle. There is still little acknowledgment of the inherent power dynamic of an imam’s privilege in our society. Mention of #MeToo in Muslim spaces or the real threats to women at the hands of powerful men is quickly met with anger and conspiracy theories about an all-powerful Western machine designed to brainwash Muslim women through a feminist-but-secretly-Islamophobic agenda.

Our celebrity shaykh culture has run away with us, to the point where individuals pay hundreds of dollars to get a selfie with scholars and communities and give them carte blanche to speak to anyone and everyone on anything and everything from fiqh to racial injustice; even when they are not fully learned in either. We place no boundaries on their scope. And finally, we have little oversight regulating our imams and few governing bodies that communicate internally. When we do have nascent organizations that try to provide accountability, we tear them down or question their funding and motives.

This isn’t where we have to be, though. This is an opportunity for us to collectively examine the necessary role of imams in our lives and what we expect it to look like. We have to honestly ask ourselves how much more we are willing to risk putting imams and congregants in unsafe situations when we know this risk can be mitigated. Can we decide that now is the time when: men can acknowledge their privilege over women? When spiritual leaders acknowledge their power over their congregants? When the older generation can acknowledge their influence over young people? When a central body requires an imam to have the training to counsel people? When mosques are willing to enforce this? When mental health professionals provide supervision for imams to discuss their challenging cases? When imams can be taught about transference/countertransference and learn how to navigate those complexities? When mosques enforce boundaries during counseling on how you meet people, where you meet people, how often you meet people, to the exclusion of any kind of relationship outside of the counseling one? When imams are accountable to God as well as His creation?

The most egregious wrong is the inaction of our society in situations that call for anything but. As we turn the corner in providing resources for and destigmatizing mental health care, I hope we can combat willful ignorance within the domain of spiritual counseling, because, with free reign, no boundaries, and zero accountability, this isn’t the last time “counseling” will be trauma in disguise.

References:

  1. A study conducted by this writer found that almost 70% of individuals in Nashville, Tennessee’s Muslim community would seek mental health care from imams. http://www.medicineandreligion.com/bringing-psychiatry-into-the-mosque-analysis-of-a-community-psycho-education-intervention.html
  2. https://drive.google.com/file/d/1c6g3-pf4MiG2WLq4ICYz9VqIebj1xpof/view?fbclid=IwAR0pimydsGLJf5qe_XaY6xAfLixk6OhgX543n12MrqEJz0NcMohPn25CsWQ
  3. https://facetogether.org/zia-ul-haq-sheikh-irving-texas/

Samaiya Mushtaq, MD is a resident psychiatrist based in Dallas, Texas. She teaches workshops on wellness and conducts research on help-seeking populations.

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3 Comments

3 Comments

  1. Avatar

    Kathryn

    November 15, 2018 at 8:56 PM

    Masha Allah, as the wife of an Imam I agree with the premise wholeheartedly, I would only point out that sharia makes clear that men have power over women and vice versa, and has this established very clear boundaries in this area which, if followed, would be very protective for both imam and congregants. For example: my husband refuses to meet with female congregants alone, and will only take phone calls from them if I’m in the vicinity and the call is on speaker. He does not casually text or e mail, and there is zero physical contact. This is all per boundaries laid out clearly in Quran and sunnah.

  2. Avatar

    AbdulAleem

    November 15, 2018 at 11:55 PM

    A timely and well written piece. It is a fault of our community that we require Imams to act as mental health professionals on top of their traditional responsibilities.

    We would never tell an Imam to remove a cancerous tumor (in most cases), but somehow it’s completely normal to expect them to address psychological issues. When this the state and value we give to mental health, is it any surprise that corruption occurs?

    Therapy/counseling is a very sensitive exchange for both the seeker and giver. When professionals who dedicate themselves to this practice full-time face charges of criminal and ethical violations, what happens to an inadequately trained part-time practioner?

    Part of the problem is that we do not have enough Muslim psychologists/psychiatrists. Another part is that some of the ones we do have are (unfortunately) lacking in Islamic knowledge causing the average Muslim to relegate therapy as unislamic hocus pocus.

    May this fitna be a cause of positive change in our Ummah.

  3. Avatar

    Megaman

    May 17, 2019 at 4:04 AM

    Remember moses and Pharaoh, authority sometimes God see them as an abuse, the point is to trust only in God

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How Grandparents Can Be Of Invaluable Help In A Volatile ‘Me First’ Age

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I grew up in a small rural village of a developing country during the 1950s and 1960s within a wider ‘extended’ family environment amidst many village aunties and uncles. I had a wonderfully happy childhood with enormous freedom but traditional boundaries. Fast forward 30 years, my wife and I raised our four children on our own in cosmopolitan London in the 1980s and 1990s. Although not always easy, we had a wonderful experience to see them grow as adults. Many years and life experiences later, as grandparents, we see how parenting has changed in the current age of confusion and technology domination.

While raising children is ever joyous for parents, external factors such as rapidly changing lifestyles, a breath-taking breakdown of values in modern life, decline of parental authority and the impacts of social media have huge impacts on modern parenting.

Recently, my wife and I decided to undertake the arduous task of looking after our three young grandchildren – a 5½-year old girl and her 2-year old sibling brother from our daughter, plus a 1½-year old girl from our eldest son – while their parents enjoyed a thoroughly deserved week-long holiday abroad. My wife, who works in a nursery, was expertly leading this trial. I made myself fully available to support her. Rather than going through our daily experiences with them for a week, I highlight here a few areas vis a vis raising children in this day and age and the role of grandparents. The weeklong experience of being full time carers brought home with new impetus some universal needs in parenting. I must mention that handling three young grandchildren for a week is not a big deal; it was indeed a sheer joy to be with these boisterous, occasionally mischievous, little kids so dear to us!

  1. Establish a daily routine and be consistent: Both parents are busy now-a-days earning a livelihood and maintaining their family life, especially in this time of austerity. As children grow, and they grow fast, they naturally get used to the daily parental routine, if it is consistent. This is vital for parents’ health as they need respite in their daily grind. For various practical reasons the routine may sometimes be broken, but this should be an exception rather than a norm. After a long working day parents both need their own time and rest before going to sleep. Post-natal depression amongst mums is very common in situations where there is no one to help them or if the relationship between the spouses is facing difficulty and family condition uninspiring.

In our trial case, we had some struggles in putting the kids to sleep in the first couple of nights. We also faced difficulties in the first few mornings when our grandson would wake up at 5.00am and would not go back to sleep, expecting one of us to play with him! His noise was waking up his younger cousin in another room. We divided our tasks and somehow managed this until we got used to a routine towards the end of the week.

  1. Keep children away from screens: Grandparents are generally known for their urge to spoil their grandchildren; they are more relaxed about discipline, preferring to leave that job to the parents. We tried to follow the parents’ existing rules and disciplinary measures as much as possible and build on them. Their parents only allow the children to use screens such as iPads or smartphones as and when deemed necessary. We decided not to allow the kids any exposure to these addictive gadgets at all in the whole week. So, it fell on us to find various ways to keep them busy and engaged – playing, reading, spending time in the garden, going to parks or playgrounds. The basic rule is if parents want their kids to keep away from certain habits they themselves should set an example by not doing them, especially in front of the kids.
  2. Building a loving and trusting relationship: From even before they are born, children need nurture, love, care and a safe environment for their survival and healthy growth. Parenting becomes enjoying and fulfilling when both parents are available and they complement each other’s duties in raising the kids. Mums’ relationship with their children during the traditional weaning period is vital, both for mums and babies. During our trial week we were keenly observing how each of the kids behaved with us. We also observed the evolution of interesting dynamics amongst the three; but that is a different matter. In spite of occasional hiccups with the kids, we felt our relationship was further blossoming with each of them. We made a habit of discussing and evaluating our whole day’s work at night, in order to learn things and plan for a better next day.

A grandparent, however experienced she or he may be, can be there only to lend an extra, and probably the best, pair of hands to the parents in raising good human beings and better citizens of a country. With proper understanding between parents and grandparents and their roles defined, the latter can be real assets in a family – whether they live under the same roof or nearby. Children need attention, appreciation and validation through engagement; grandparents need company and many do crave to be with their own grandchildren. Young grandchildren, with their innate innocence, do even spiritually uplift grandparents in their old age.

Through this mutual need grandparents can transfer life skills and human values by reading with them, or telling them stories or just spending time with the younger ones. On the other hand, in our age of real loneliness amidst illusory social media friends, they get love, respect and even tender support from their grandchildren. No wonder the attachment between grandparents and grandchildren is often so strong!

In modern society, swamped by individualism and other social ills, raising children in an urban setting is indeed overwhelming. We can no longer recreate ‘community parenting’ in the traditional village environment with the maxim “It needs a village to raise a child’, but we can easily create a productive and innovative role for grandparents to bring about similar benefits.

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Our Struggles – Mental Health And Muslim Communities | The Family and Youth Institute

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By Elham Saif, Sarrah AbuLughod and Wahida Abaza

Fariha just started her freshman year at university. Overnight, she was separated from her support system of family and friends and thrust into a foreign environment. She was facing many new challenges, including a heavier workload, new friends, student clubs and organizational responsibilities. She was drowning in endless assignments, exams, and meetings.

Fariha never thought much about mental health issues beyond the few “mindfulness” posts that she’d scroll through on her Instagram feed, but recently she was starting to feel out of sorts. She started to feel anxious as a hijab-wearing woman on campus especially after hearing about anti-Muslim incidents on the news. All of the possibilities of what could go wrong played over and over again in her head–and kept her up at night. Everything was beginning to feel overwhelming. She started having trouble getting out of bed in the morning and was losing motivation to complete her assignments. She felt confused and at times, even afraid. 

According to the National Institute of Mental Health, close to 50 million Americans suffered from mental health issues in 2017. One in 5 adults in America is living with a mental health illness at this very moment. American Muslims are not an exception to these statistics. According to different studies, like Fariha, 15-25% of American Muslims report suffering from anxiety disorders and 9-30% report mood disorders. Many of these mental health issues in the Muslim population go unaddressed and unresolved because of lack of knowledge, stigma and shame experienced in many Muslim households and communities. 

When these issues go unaddressed, people report that the pain and suffering they experience rises and that overall their problems tend to get worse. Sadly, their struggles can snowball into additional illnesses that were not present before, such as self-harm or addiction. According to the research, mental illnesses such as depression, anxiety, and bipolar disorder are sometimes not considered to be “real” illnesses. Community members often see mental illness as a sign of weakness, a mark of poor faith, or something that doesn’t affect Muslims. They may also see it either as a “test from God” or sometimes as possession by evil spirits. Even when there is an awareness, many of these illnesses and issues are culturally stigmatized as shameful and kept hidden within the person or family. People may be concerned about the reputation of their family or their marital prospects should a psychiatric diagnosis be disclosed. 

The irony is that Islam ought to be more of a protective factor given how intertwined Islamic history is with the fields of psychiatry and psychology. The contribution of Islamic scholarship to the field of psychology is documented in our history and legacy from health promotion in the Quran and Sunnah, to early scholarly diagnosis, treatment, and intervention. Alaa Mohammad, FYI researcher and co-author of the chapter “Mental Health in the Islamic Golden Era: The Historical Roots of Modern Psychiatry” in Islamophobia and Psychiatry points out that,

“there was a lot of focus on concepts like ‘sanity’ and the significance of mental capacity as well as the general mental/emotional state in many of the early Islamic texts especially in regards to Islamic rules and law.”

Early Islamic scholars described the “cognitive components of depression and sadness, anxiety and fear, obsessions, and anger in detail and suggested a variety of therapies and treatments.” Learning more about this rich history and pulling from these stories in the Prophet’s (SAW) seerah is a key step towards opening the way for people to get the help they need and learning how to support one another. 

Fariha knows that she needs help. She was considering seeing one of the mental health workers on campus, but she’s afraid of what her parents would say if they found out she shared so much with a stranger, especially one that is not a Muslim.Click To Tweet

What can parents do?

Research has found that in the face of rising Islamophobia, supportive parenting serves as a protective factor and helps strengthen young Muslims’ sense of identity while unsupportive parents who don’t help their children navigate their experiences end up weakening their identity, which then increases their chances of participating in more risky behavior. 

When Fariha finally shared her fears and anxieties with her parents, she was surprised and relieved to hear that they took her seriously. They listened to her and she didn’t feel like they were ashamed of her, only concerned for her well being. They were eager to find her the help she needed to feel like herself again. 

As Muslims, we need to shift our mindset around mental illness and the effects of Islamophobia. Like Fariha’s parents, it is imperative that we listen carefully and look more deeply at the issues facing our youth. It is through this openness that we can reduce the stigma and encourage more people to seek help. 

The Family and Youth Institute recently released an infographic that talks about some of the struggles facing our American Muslim communities. They teamed up with Islamic Relief USA to get this infographic printed as a poster and will be sending them to over 500 masajid/community centers around the United States in the coming months. 

What can you do to help?

  • Reduce the stigma by sharing this article and infographic and starting a conversation with your friends and family members. The more we talk about it, the more we normalize and destigmatize mental illness and move towards mental health. 
  • Organize a community conversation around the issue of mental health. Invite a mental health specialist to come speak to your mosque youth group or parent group. 
  • Seek therapy when needed. Connect with SEEMA and the Institute of Muslim Mental Health for a list of Muslim therapists. If you are seeing a clinician who is not Muslim, share this book Counseling Muslims: Handbook of Mental Health Issues and Interventions with them to give them a better sense of the specific religious and cultural needs of their Muslim clients. 
  • Educate yourself – There is a plethora of information out there about mental wellness and wellbeing. For help navigating through it all, sign up for The FYI’s daily article share to receive vetted infographics, articles and videos on this topic. Mental health affects our whole life. Whether you are struggling with bullying, helping a loved one with depression, living with and caring for an elder or wanting to build the best environment for your new baby, we have a resource for you! 
These steps are just small ways we can begin to shift the conversation away from shame and stigma and towards help and healing.Click To Tweet

These steps are just small ways we can begin to shift the conversation away from shame and stigma and towards help and healing. Mental illness and mental health issues can be scary, but they do not need to be faced alone and in isolation. As the Prophet Muhammad ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him)said, “The parable of the believers in their affection, mercy, and compassion for each other is that of a body. When any limb aches, the whole body reacts with sleeplessness and fever.” Together, we can fight the existing stigma and misconceptions, provide support, educate the community and advocate for our brothers and sisters suffering with mental illness and their families. 

Sources:

Aftab A., & Khandai, C. (2018). Mental Health Facts for Muslim Americans. APA Division of Diversity and Health Equity, Washington, DC. 

Basit A, & Hamid M. (2006). Mental health issues of Muslim Americans. The Journal of Islamic Medical Association of North America, 42(3), 106-110.

Ciftci A., Jones N., & Corrigan, P.W. (2013) Mental health stigma in the Muslim community. Journal of Muslim Mental Health, 7(1), 17-32.

Hodge, D.R., Zidan, T. & Husain, A. (2016). Depression among Muslims in the United States: Examining the role of discrimination and spirituality as risk and protective factors. Social Work, 61(1), 45-52.

Zong, X., Balkaya, M., Tahseen, M., & Cheah, C.S.L. (2018). Muslim-American Adolescents’ Identities Mediate the Association between Islamophobia and Adjustment: The Moderating Role of Religious Socialization. Poster session presented at the biennial meeting of the International Society for the Study of Behavioural Development, Queensland, Australia. 

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Raising a Child between Ages 7-12

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From a cognitive-development standpoint, this is called a concrete operational period, according to Jean Piaget.

(N.B: Some adults never progress beyond this phase, while 15% of kids may reach the following formal-operational phase at age 9!)

The child now (7-12) may factor in two dimensions of an object simultaneously. So, the longer cup may have less water because it is thinner. However, this is still hard for him/her to perform in the abstract realm, so, they are still uni-dimensional in that respect. Concepts and behaviors are still black and white. It is also hard for the kids in this stage to imagine and solve the structure of a mathematical problem. They cannot think contrary to facts. In other words, you can’t get them to use as a basis for an argument a question like what if the sky rains sugar instead of water?

Socially, Erikson felt that in this period kids develop industry or inferiority. According to his theory, from age six to puberty, children begin to develop a sense of pride in their accomplishments. If encouraged, they feel industrious and confident in their ability to achieve goals.

Based on these observations, we may recommend:

1- Using a lot of hands-on teaching, since they still have limited ability with conceptualization and abstract reasoning.

2- Continue the focus on memorization. If you want them to finish the Quran in 1-2 years, 12 and/or 13 seem to be the prime years for that. This suits some children and some families, not all. If you like a more gradual approach, you should have them start serious memorization at 7, accelerate at 10, and finish by 15-17. Not all kids are meant to memorize the whole Quran though; they can still be educated and pious. Invest in their strengths, not your dreams.

3- Use concrete props and visual aids, especially when dealing with sophisticated material. Use story problems in mathematics.

4- Use open-ended questions that will stimulate thinking and help the child reach the following stage faster. Example: “What do you think about the relationship between the brain and the mind?”; “What do you think about the relationship between prayful-ness and piety?” Make sure you know the right answers!

5- More explanations will be needed, but keep them simple, and even though they should be more detailed than the last stage, they still need to be uni-dimensional. Examples: we obey God because he created us; if we disobey Him, we get punished, and if we obey Him, we get rewarded in this life and in the hereafter. Too early to teach him that “the brokenness of the disobedient is better than the haughtiness of the obedient.” Break it down. Humbleness and obedience are good, while haughtiness and disobedience are bad.

6- Encourage and praise their accomplishments, while making them aware that there is always room for improvement. Continue to encourage initiative-taking and leadership qualities, yet you may also set limits, and make them aware that they will have to always report to someone. Even if there are no people above them, Allah always is. They have to adapt to being leaders and followers at the same time, because that is the reality of all people.

7- This is still a stage of belonging and affiliation to the group, and the child will develop more or less attachment to Islam through his or her experience at the masjid and with the community.

Parenting: Raising a Child from Age 0 to 2 | Dr. Hatem Al Haj

Raising A Child Between Ages 2-7 | Dr Hatem Al Haj

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