Linda Sakr on psychotherapy in Arab countries

The word “psychology” in the Arab world has always been equated with taboo. It was not customary to talk about mental health, except behind closed doors and in whispers. However, life does not stand still, the world is rapidly changing, and the inhabitants of traditional Arab countries are undoubtedly adapting to the changes that have come from the West.

Psychologist Linda Sakr was born in Dubai, UAE to a Lebanese father and an Iraqi mother. She received her psychology degree from the University of Richmond in London, after which she went on to study for a master’s degree at the University of London. After working for some time at an intercultural therapy center in London, Linda returned to Dubai in 2005, where she currently works as a psychotherapist. In her interview, Linda talks about why psychological counseling is more and more “accepted” by Arab society.  

I first got acquainted with psychology when I was in the 11th grade and then I became very interested in it. I have always been interested in the human mind, why people behave in certain ways in different situations. My mother was absolutely against my decision, she constantly said that this was a “Western concept”. Fortunately, my father supported me on the way to fulfill my dream. To be honest, I wasn’t too worried about job offers. I thought that if I couldn’t find a job, I would open my office.

Psychology in Dubai in 1993 was still perceived as taboo, there were literally a few psychologists practicing at that time. However, by my return to the UAE, the situation had improved significantly, and today I see that the demand for psychologists has begun to exceed supply.

First, Arab traditions recognize a doctor, a religious figure, or a family member as a help for stress and illness. Most of my Arab clients met with a mosque official before coming to my office. Western methods of counseling and psychotherapy involve self-disclosure of the client, who shares with the therapist his inner state, life circumstances, interpersonal relationships and emotions. This approach is based on the Western democratic principle that self-expression is a fundamental human right and is present in daily life. However, within the Arab culture, such openness to a stranger is not welcome. The honor and reputation of the family is of paramount importance. The Arabs have always avoided “washing dirty linen in public”, thereby trying to save face. Spreading the topic of family conflicts can be seen as a form of betrayal.

Secondly, there is a widespread misconception among Arabs that if a person visits a psychotherapist, then he is crazy or mentally ill. No one needs such a “stigma”.

Times change. Families no longer have as much time for each other as they used to. Life has become more stressful, people face depression, irritability and fears. When the crisis hit Dubai in 2008, people also realized the need for professional help because they could no longer live the way they used to.

I would say that 75% of my clientele are Arabs. The rest are Europeans, Asians, North Americans, Australians, New Zealanders and South Africans. Some Arabs prefer to consult with an Arab therapist because they feel more comfortable and more confident. On the other hand, many people avoid meeting with a psychotherapist of their own bloodline for reasons of confidentiality.

Most are interested in this issue and, depending on the degree of their religiosity, decide to make an appointment with me. This happens in the Emirates, where the entire population is Muslim. Note that I am an Arab Christian.

 The Arabic word junoon (madness, insanity) means an evil spirit. It is believed that junoon happens to a person when a spirit enters into him. Arabs in principle attribute psychopathology to various external factors: nerves, germs, food, poisoning, or supernatural forces such as the evil eye. Most of my Muslim clients came to the imam before they came to me in order to get rid of the evil eye. The rite usually consists of the reading of a prayer and is more readily accepted by society.

The Islamic influence on Arab psychology is manifested in the idea that all life, including the future, is “in the hands of Allah.” In an authoritarian lifestyle, almost everything is determined by external power, which leaves little room for responsibility for one’s own destiny. When people indulge in unacceptable behavior from a psychopathological point of view, they are considered to lose their temper and attribute this to external factors. In this case, they are no longer considered responsible, respected. Such a shameful stigma receives a mentally ill Arab.

In order to avoid stigma, a person who has an emotional or neurotic disorder tries to avoid verbal or behavioral manifestations. Instead, the symptoms go to the physical level, over which the person is supposed to have no control. This is one of the factors that contributes to the high frequency of physical symptoms of depression and anxiety among Arabs.

Emotional symptoms are rarely enough to get a person in Arab society to come to therapy. The decisive factor is the behavioral factor. Sometimes even hallucinations are explained from a religious point of view: members of the family of the Prophet Muhammad come to give instructions or recommendations.

It seems to me that the Arabs have a slightly different concept of borders. For example, a client may willingly invite me to his daughter’s wedding or offer to have a session in a cafe. In addition, since Dubai is a relatively small city, chances are high that you will accidentally meet a customer in a supermarket or mall, which can become very inconvenient for them, while others will be delighted to meet them. Another point is the relationship to time. Some Arabs confirm their visit a day in advance and may arrive very late because they “forgot” or “did not sleep well” or did not show up at all.

I think yes. The heterogeneity of nationalities contributes to tolerance, awareness and openness to new diverse ideas. A person tends to develop a cosmopolitan outlook, being in a society of people of different religions, traditions, languages, and so on.

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