“Eib!”: How a culture of shame keeps people in Jordan from accessing the help they need
Fear of stigma and honor systems in the country have left those experiencing domestic violence, mental illness, and addiction to suffer in silence.
by Samaa Khullar
I. DOMESTIC VIOLENCE
“What will people say?”
(* = Indicates name change for safety)
Farah* had always dreamed of a traditional Arab wedding. In her fantasy, her fiancé would knock on her parents’ door with a bouquet of black irises to ask for their daughter’s hand in marriage. She would gather with everyone she loved to partake in henna night, dance dabke, and stuff herself with enough kunafa and baklava to last a lifetime.
What Farah didn’t envision was that she would be forced into a marriage at age 19, and her future husband would try to burn their house down with her and her son inside of it.
Calling recently from a women’s program center in Irbid, Jordan, which is funded by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Farah says she doesn’t even feel safe discussing her past in her parents’ house. Three years after her divorce, she still feels scared of how the community might react if they find out she’s speaking about her abuse publicly.
Eib! they would say, telling her to have some shame. “I kept hearing the phrase that, ‘Tomorrow, he will be better. Tolerate it for your kids’ sake,’ and so on. But my life got so much worse.”
Domestic violence is a public health problem worldwide — no nation can escape its insidious effects. But women in Jordan, like other countries in the Arab world, are in an especially precarious situation. In 2017, researchers from the Directorate of Forensic Medicine in Al Karak, Jordan, found that people in the country see violence against children or women as an acceptable form of discipline.
Researchers Hasan Al-Hawari and Asmaa El-Banna say that domestic violence and abuse in the Arab world is “a hidden or masked epidemic” primarily due to a culture of shame and stigma. While shelters for those who have undergone domestic abuse exist in the country, notifying authorities about one’s abuse is described as Eib, or shameful, as matters concerning family are supposed to be handled privately.
“Things got bad on more than one front. He became a totally irresponsible person,” she says. Farah’s husband was abusing opiates, his behavior becoming erratic and his mood swings unpredictable. He would leave their house in the evening and not return until early morning. He sold the small convenience store that he owned, their only source of income, to fuel his drug habit and started asking everyone they knew for loans.
“When I found out he sold our shop, I tried to tell his family, but unfortunately no one took this issue seriously,” Farah says. “His mother told me ‘It’s none of your business, my son knows what he’s doing.’” Every time Farah opened her mouth, he would berate her with demeaning language. “I was a maid in my own house,” she says of the way she was treated.
She tolerated his emotional abuse and the neglect because her family reassured her that she would be okay. They told her that his behavior wasn’t so bad, and that every wife has to deal with her husband’s faults. His family also knew about his addiction, and his emotional volatility, but did nothing to protect her. “They spoke to him several times, but unfortunately, the back and forth lasted for eight years.”
“When I was sure he was taking drugs, I spoke to him, reminding him to look at our situation, that we didn’t even have enough money to bring milk for the kids.” He snapped: “Where do you want me to bring money from?! Should I just burn myself and the house down?!”
He then ran to another room, grabbed a bottle of what looked like kerosene, and poured it over himself before striking a match. “Alhamdulillah [Thank God] it didn’t catch fire.” Luckily, she says, it wasn’t kerosene, but Farah’s son witnessed the entire event. “My son got a hold of my neck out of fear and started screaming. To this day, he still wakes up from his sleep in a panic.” That night, Farah reached her breaking point—she grabbed her son and whatever necessities she could find, and went to her parents’ house to tell them she was leaving her husband.
“With time passing he will get better and Inshallah [God willing] he will change,” Farah’s father told her. Her mother also told her it was wrong to seek a divorce because of the stigma that would follow her. When Farah raised fears that he would become physically violent toward her if she stayed, her mother simply responded: “So what? Not everyone’s life is a breeze.”
Women in Jordan are in an especially vulnerable position, as there are significant consequences to reporting abuse—such as divorce, which could leave them in a dire economic situation.
Since women minimally participate in Jordan’s labor force, they depend upon their husbands for financial support: fear of losing their children and social stigma are among the biggest reasons why a woman might remain in a violent relationship. This could also explain why 69% of Jordanian women self-reported that they believe wife beating to be an acceptable practice.
“We live in a society that has no mercy toward a divorced woman. The fault is always on the woman,” Farah explains. “If I could go back in time, I would not have gotten married.” At the age of 29, after almost eight years of pleading with her parents, she was finally able to end her marriage. But that decision essentially left her stranded in society, as it’s rare for divorceés with children to get remarried in the country.
“A woman has no stability after she goes back to her family, especially if she has children,” she says. At first Farah’s husband refused to sign the divorce papers, throwing out insults and promising to ruin her life, and his parents were uninterested in seeking custody of their grandchildren. “He paid me for the first two months of child support, but hasn’t helped me since,” she says. “The government is still chasing him up to pay.”
Farah is now living with her two children in her parent’s house in Irbid. Her younger brother, who also lives in the house, tells Farah that she brought shame on the family by getting a divorce, and that she and her kids are not welcome and he wants them gone. “I truly don’t know why my brother treats my kids the way he does,” she says. “Even if I ask why, I get no answer.”
Farah says she will tolerate anything for her kids’ sake. “You forget yourself and your needs for their sake. Instead of living your life with love and happiness, you become someone who just wants the days to pass.”
But she has dreams of a better life for her daughter. “I will make her finish her education and then let her make her own life decisions without pressuring her,” Farah promised. “My daughter seems to be able to understand life better than me. She’s very strong and demands her rights from everyone. I discovered I was the one that was naive and stupid for getting married at 19 to a man my parents forced me to be with.”
Three years after her divorce, the only place that Farah feels any sense of independence is at the UNRWA women’s shelter, where she’s able to spend a few hours away from family to learn skills like sewing. The semi-abandoned center, with random workout equipment dumped on a vacant floor and a “computer lab” filled with defunct electronics, is a protected place where women in Irbid feel comfortable talking amongst each other about the abuse they’ve suffered, away from the ears of authorities. The kitchen’s small dining table is a meeting point for women all across the small city. Freshly brewed sage tea and warm, gooey cheese manakeesh are a welcome sight to anyone who walks in.
Jordan has historically been described as a haven for Arab refugees, mainly because during the Ottoman period the entire levant region (comprising modern-day Jordan, Lebanon, Palestine and Syria) was unified as “Al-Sham.” It was only after European imperialism and the rise of Arab nationalism that the four nations were created, and thus, populations are still very much mixed in the country.
As the only Arab state to grant full citizenship to Palestinians in 1948 (the Kingdom once ruled over Jerusalem), Palestinian-Jordanians now constitute around half of the country’s population of 11 million people.
According to the UN, Jordan also hosts more than two million registered Palestinian refugees from various Arab-Israeli wars, 67,000 refugees from Iraq following the 2003 US invasion, and 655,000 Syrian refugees since the start of their 2011 civil war. (Some estimates put the number of Syrian refugees as high as 1.3 million; there is no official census data).
Citizenship in Jordan is complicated, but to simplify: if you were a Palestinian who arrived before 1950, chances are you’re now a Jordanian national. If you came from anywhere after that point, you’re likely a registered refugee with the UN with the internationally recognized right to return to your home country.
When Reem*, another survivor of domestic violence, arrives at the UNRWA women’s shelter in early January, her three children trail closely behind her. She tears a piece of manakeesh for each of them and then follows me into another room. Finally seated, a cup of tea laid out in front of her, she takes a deep breath and tells her story.
Reem came to Jordan from Syria, fleeing Bashar al-Assad’s regime in 2014, with the belief that the neighboring country would be a safe home for her family as it has been described for decades. She and her husband, Hassan*, were smuggled across the border, joining hundreds of thousands of people in Zaatari, the world’s largest refugee camp for Syrians.
Reem and Hassan had always had small disagreements, but life at Zaatari exacerbated them. Hassan started an affair with another woman at the camp and he soon began to direct all of his negative emotions towards Reem. He would come home and beat her after meeting with the other woman. “Why did he hurt me?” Reem says with tears in her eyes.
“He once beat me and cut my head open,” Reem says, choking back tears. “Seven stitches. All because people told him I was learning a skill.”
Though she was scared, Reem went into a family protection unit funded by the United Nations High Commissioner for Refugees’ (UNHCR), and told them about the abuse she had suffered. “Then the order came to move [my husband] to Azraq Camp,” Reem reflects. “They sent him there to sort him out.”
The problem was, Reem didn’t have any income, and Hassan began making threats that she would lose everything if she didn’t accompany him to the new camp. “I was forced to tell [the authorities] that I was willingly going with him,” Reem says. “Where else would I go?”
It’s at this point during our conversation that Reem admits she needs a tissue. Telling this story is not easy, and she already fears what might happen if she speaks, even under the condition of anonymity. Her children are in the next room, and she worries for their safety too.
“Azraq camp… What shall I tell you…” Reem sighed. “Zaatari is heaven compared to Azraq.”
Reem is not alone in her description of the secluded desert camp. Azraq has been described more like a storage depot than a home for those fleeing violence, with strict police surveillance, limited rations of water and daily power blackouts. A 2018 study by anthropologist Melissa Gatteron for Forced Migration Review paints a particularly bleak picture of Azraq: “Some refugees have likened the camp to an outdoor prison, while humanitarian observers have described it as a dystopian nightmare.”
Though Reem hoped that Hassan would learn from the consequences he faced at Zaatari, the abuse only worsened when they moved into smaller living quarters and he lost his job. The beatings stopped for a month or two, but then he went straight back to his old ways. “He would tell me ‘I’ll beat you. I’ll crack your head,’” Reem recalls. He wouldn’t let her go to the doctor, accusing her of faking an illness as a guise to report the abuse to another UN official.
In addition to the physical and emotional abuse, Reem was also suffering financially. Hassan was not interested in finding a new job. She decided to take the initiative and host small activities for women and children within the refugee camp to earn some extra income for her family. But someone told Hassan, and, as Reem recalls, “it set him on fire.”
Hassan was furious that his wife had ventured outside what he believed to be her only role: dutiful wife and mother. “What about the people who see you going out every day?” Hassan would yell at her. “What are they going to say?”
Some cultural anthropologists have divided humanity into shame-based cultures and guilt-based cultures. In their 2007 article “Cultural Models of Shame and Guilt,” from the Handbook of Self-Conscious Emotions, anthropologists Ying Wong and Jeanne Tsai explain that both guilt and shame can arise when a transgression takes place.
Shame-based cultures, usually Eastern nations with collectivist thinking, use exterior influences to deter people from an action. The Arabic phrase that Hassan used, “Aysh al-nas badha tahki?” or “what will people say?” is one of the most common sayings in a shame-based culture.
By contrast, guilt-based cultures, usually Western nations with individualist ideologies, use one’s own conscience to deter from an action, causing people to feel remorse, pity, or indeed, guilt. Living in a shame-based society, Arab children are taught from a young age that they should be more concerned about how people perceive them rather than how they see themselves.
To this day, Reem remains with her husband, despite her fear of him and the restrictions on her life. After violent beatings, she tries her best to cover up evidence, and only seeks help when she absolutely has to. “I went to the doctor and he told me, ‘I will not stitch your cut on the head. I want you to bring the one who beat you up like this,’” Reem recalls.
She told the doctor that her husband beat her up, but that under no circumstances did she want to file a complaint against him. She shook her head and described the feeling of being branded with the word Eib. “For us, it is shameful if the woman complains against the man. They look at us like…” Reem takes a deep breath, “I need to tolerate his faults.”
“Official establishments like family protection agencies or domestic violence shelters don’t fit our way of life,” Farah concurred. “If I sought refuge from an agency, they might have taken my children away from me because I didn’t have money and my husband’s family refused to take responsibility for them. I would have lost my home and my kids.”
Domestic violence has intergenerational consequences, with children repeating the violent behavior they either witnessed or endured, or both. Children who have experienced domestic abuse often display increased fear, depression, aggression, and antisocial behavior, which can follow them into adulthood. Reem is beginning to see this in her own children, and fears for what might happen as they grow older.
Reem says that, after witnessing how his father treats the women in his life, her eldest son started copying his every move. “He started bullying his sisters. He says, ‘Since you are a girl, get up and work. Bring me water to drink.’”
During our hour-long conversation, Reem’s husband has already called her three times, demanding to know where she is. “Will this interview cause me harm?” she asks, her hands shaking. Even though she had an “alibi” for the day, telling Hassan she took their children out for games and activities, she still fears someone may start a rumor about her whereabouts. She fidgets with anything she can touch, and after telling her story, it’s almost as if she feels the need to look over her shoulder.
II. MENTAL HEALTH
“They’ll say I lost my mind”
One of the first conversations I had about the term Eib was with Sarah Aziza, a Palestinian American journalist who has reported on mental health in Jordan. In 2014, she visited one of only two mental health hospitals in the country at the time.
“It was pretty much a fancy hotel for people who had relatives that they wanted out of sight,” she said. “It was mostly for people who had disabilities that were seen as shameful.” Her observations reminded me of a passing comment my mother made years ago when I asked if anyone in her family struggled with a mental illness.
“We don’t talk about those things to other people,” she said. “Those are private issues that stay in the household.”
She then told me a story about one of her distant relatives that I had never met. This woman was my grandmother’s cousin, but my family never talked about her, not even when my mother was a child.
I later learned that this was because the woman suffered from postpartum depression. But the story gets hazy from there. Some say she experienced a psychotic break after the birth of her child. Others say she entered a depressive episode that lasted years. One story within her neighborhood even suggests that she “lost her mind” after being scared by a cat in her window.
All we know for sure is that after experiencing some mental health-related issue, she was locked away within her own house. Her parents moved their grown daughter onto a separate floor, and forbade her siblings from seeing or speaking to her. Her children moved in with their father and his new wife. There seemed to be an unspoken rule that no one in the extended family was to ask about her.
Their expectation was that people should act as though she no longer existed: She was not dead, but she may as well have been.
To this day, her ex-husband refuses to talk about what happened. He says he stays silent out of respect for her, but the rumors surrounding her exit from society are fueled by stereotypes and misconceptions about mental illness. That stigma has spread to the rest of her family. Questions about the stability of her siblings and children still float around. She exists as more of a stain on the family than a member of it.
I know if I ask my grandmother about her today, I still won’t get a straight answer about why they all chose to hide her away instead of getting her the help she deserved, especially because her own siblings don’t even know.
“It was a different time,” my mother said. “They didn’t know then what we know now.”
But if that was true, the culture of shame and silence would have ceased. Unfortunately, it is still alive and well, especially within minority populations.
“People are going to point fingers,” or “people will talk about me” are two of the most common phrases heard by Haneen Abdulhamid, a psychotherapist at Maria Den Braven Center in Amman, Jordan, one of the nation’s leading private mental health clinics.
Depression, schizophrenia and anxiety are the most prevalent forms of mental illness in Jordan, according to the World Health Organization. Fear of shame keeps many from seeking treatment, despite the fact that there are several public and private mental health clinics throughout the country now.
“It’s because of the stigma, actually, that they wouldn’t go see a therapist,” Abdulhamid explains about the hesitance to seek help. While some people in the country simply cannot afford to see a mental health professional, she says that in her experience, even some who are financially comfortable avoid her center like the plague. Mostly, Abdulhamid is tasked with helping patients dealing with suicidal ideation who have reached their breaking point, or whose family have forced them to see her.
One study conducted in 2017 found that many Jordanian families of people with schizophrenia felt they “only have themselves to blame” and that taking them to a clinic is useless because they “would not improve if given treatment.”
“We have a culture of stigma,” said UNICEF’s Zubaida Ali, a case worker with children and teenagers across the country. “They are aware internally that they need these services. But there remains apprehension, like, ‘If people come to know that I’m seeing a psychiatrist, they’ll say I am crazy or that I lost my mind’ and things like that,” she explains.
Ali says that she once worked with three brothers who were related to one another, but none knew the other was seeing her. They would never discuss such delicate matters, even with their own blood.
“They keep it hidden. They know they need help, but they still fear society. That if they say, my daughter has depression, she might not get a chance to get married. Maybe her sister will not get married either,” she explains.
And unfortunately, these fears are valid, according to Ali. “There are families who, if they know that a particular girl sees a psychologist, won’t approach any girl in her family at all, or get married to anyone in that family at all,” she says, as though mental illness were contagious. Nine percent of all divorce cases at Sharia Court are a result of one of the parties finding out the other takes psychiatric medication, she adds. (There are no official statistics available to verify Ali’s statement, but she works with the courts on a daily basis.)
Even when resources are available for free in remote areas, such as refugee camps, people stay clear of them. “There are clinics, but because everyone knows each other, you feel shy going to them. Because outside, it is written ‘Mental Support,’ and everybody knows each other,” Reem recalled of her time at Zaatari. “If I see a therapist, my kids will think it means they have a problem, as well! They fear mental illness being passed on to them.”
“I see stigma everywhere,” says Abdulhamid. “I see it within adolescents too ashamed of their mental health or too ashamed of me telling their parents something about their mental health. And I also see it within the older population.”
Noor*, another Syrian refugee mother who lives in Irbid, says that fear of pity from the community is what keeps her son from asking for help. Noor’s husband passed away a few years ago, and since then, she has struggled to raise her four children, as they deal with the trauma of displacement and the loss of a loved one.
She has tried to get her eldest teenage son, who has been traumatized by the death of his father, to visit some of the non-profit organizations that offer PTSD and grief counseling in the area, but he refuses. “He tells me ‘Mama, tomorrow they will say that you are begging. We don’t want anyone to know we are orphans so that they give us things out of pity. If God wants to give to us, he will. If he doesn’t, it’s okay,’” Noor says, with tears in her eyes.
Once, when Noor’s daughter told her friend of all the mental pressures she was dealing with, her brother chastised her. “Why did you talk?” he asked his sister angrily. “It is an internal issue within our house. We don’t want to give people a reason to gloat over us!”
Depending on others for help, or even just emotional support, is seen as shameful for young men in the country, as they are supposed to become providers for their families. As Ali explains, young men have difficulty being expressive. “The man in our society is raised to be a tough person who can’t be defeated,” she explains. “The one who is not permitted to say ‘I got weak’ or ‘I suffer from an issue.’ The man is raised to be strong and courageous, so, of course, he will have trouble expressing that he has a problem. Even between him and his friends.”
Ali remembers when a young boy came to her for counseling, and was bullied almost immediately after walking out of her office. It’s no surprise that Noor’s son would stay far away from those trying to help him.
“The picture … They keep looking at their dead father’s picture on the phone,” Noor laments. “They say ‘Baba, if you were with us, we would not have needed anyone.’”
People believe that young men who talk about their problems are not being “manly enough,” says Haya, a young Palestinian-Jordanian woman living in Irbid. “If you are a man and you speak out… you’re judged like, ‘You’re gay.’”
Within the country’s older population, Abdulhamid says, there is still the notion that therapy is a purely Western concept — a “made-up,” selfish practice that is a waste of time and money. Palestinian-American comic Mo Amer mocked this attitude in his recent Netflix series: “I don’t believe in therapy. It’s a scam. You pay some Ph.D. $200 an hour, when you can talk to God for free any time.”
While Amer was being facetious, his sentiment rings true with many in Jordan. Reem recalls passing by a mental health care clinic once, and seeing people point and laugh. “I heard them saying, ‘This is all lies.’”
Yasmine*, a young Jordanian woman living in Irbid, says that when she was struggling with depression as a teenager, her mother refused to let her see a therapist, not believing that it was a real mental health issue. “You’re just lazy,” her mother would say. “If you went to bed earlier, you could get up in the morning.”
So Yasmine started secretly seeing a therapist that her friend recommended. When her mother found out years later, she was furious. “My mom took the blame on herself. And she started guilt-tripping me, like ‘Why are you doing this to me?’”
Yasmine says she is no longer upset about her mother’s invalidating words because her parents were a product of a shame-based environment. “I think now I understand my mom. I think when you’re a parent, it’s just hard for you to believe that your kid is suffering because somehow you’re going to blame yourself. That’s how they were raised. We can’t really blame them.”
“There is a percentage of people who are still not convinced, or who say it is better to get treated through religious means,” Ali explains. “They have awareness that mental health care is important, but they prefer seeking help from the faith rather than from a specialist.”
For example, when Noor’s son was struggling with the death of his father, they started treating him by reading him verses from the Qur’an, the Islamic holy book. Even now, when she finds herself depressed or anxious, she says, “I don’t visit anyone. I stay alone. I turn on Surat Al Baqarah [a recording of a section of the Qur’an] and keep myself at home.”
Yasmine says this line of thinking extends to a few mental health professionals too, referencing one she knew from Irbid. “She literally used to force her patients to pray. And she would blame them,” she recalls. “Imagine, you’re struggling and depressed and she’s just blaming you because you’re not religious enough. She would actually say it to their faces, like, ‘you’re too needy.’”
Abdulhamid makes it clear that the stigma isn’t born out of Islam specifically, but is part of the broader shame-based culture. The two are intertwined of course, but not every Jordanian who feels shame is religious. “I don’t think it’s religion — I feel like it’s more cultural,” Abdulhamid says. Ali agrees, and Yasmine believes people are too quick to blame Islam for what’s wrong in their community.
“It’s not just a Muslim thing — even Christians have Eib,” she says. Jordanian Christians are among the oldest Christian communities in the world and make up 8% of the nation’s current population. “I have a Christian friend who is struggling with her mental health. I remember her mom forcing her every Sunday to go to church with her and praying because she believed that she was not close enough to Jesus,” she recalled.
Abdulhamid says she often hears non-Arab or non-Asian therapists tell their clients to set boundaries, and leave the family or community if it makes it easier for them to seek help. But she says this approach isn’t always feasible for them. “Collectivist cultures come with a lot of shame. And the last thing you want is the client making a decision that’s going to make them feel more ashamed,” she says.
To tell a Jordanian daughter “just stop talking to your family until they can respect your needs” is wholly unrealistic, she explains. “This is something that I always have in the back of my mind. Like, you don’t want to create more mess within the family.”
Aziza says well-meaning Western therapists both in and out of the country often overlook the complexities of Jordanian culture (like how most families live in multi-generational households and depend upon each other for help) and apply a Eurocentric approach to healing. “If the first responders of this mental health crisis are Westerners, are they intervening in a way that’s actually helpful to people who aren’t from that culture?” she asks.
When Aziza reported on the topic of mental health in Jordan almost a decade ago, she found that European protocols were widely respected, but it was the local adaptations — ones that highlighted collectivist thinking and religious elements — that gained the most trust in the community.
With all of the different forms of stigma that exist in Jordan, people struggling with mental health issues often feel like they have to exhaust every possible option before seeking help from a professional. Dr. Baydar Issa, a psychiatrist at the Ministry of Health in Amman, the largest public hospital in the country, recalled a specific case that proves just how bad things can get when families are unwilling to admit someone may need help.
A few years ago, a patient had come to see Issa with her father and sister by her side. As soon as they all sat down in a private office, the patient began to tell Issa that the country’s monarch, King Abdullah, was in love with her, and that they had been secretly texting for months. After that, she said, she started an affair with Lucifer.
“She said the shayateen (demons) were singing and chanting while I was interviewing her,” Issa recalled of her visual and auditory hallucinations. He tried to figure out when these delusions began.
“Her original story was that she was in Turkey, and she slept with a Moroccan guy, and after the third time they slept together, she looked into his eyes and they were on fire,” he recounted her story. “That’s when she said she realized that he was Lucifer and she was Lilleth, and they had many black kittens as children.”
The family who brought her in said seeing a psychiatrist was their last resort. They didn’t want anyone to know of her possible schizophrenia, but they no longer knew how to deal with her.
“According to her sister, she tried to sacrifice her two nieces to the devil as tributes,” Issa says. That was the family’s breaking point. They knew they could no longer keep her in hiding.
“Most of the people who come to us at the hospital, they try a million things before they end up here,” Issa explains. “Usually they go to sheikhs (religious leaders), because they think it’s some sort of ghost or spirit or jinn [genie]. We see a lot of religious-based delusions like, ‘Someone put a spell on me,’ or ‘God is talking to me.’” Some people tell Issa there are specific verses in the Qur’an or Bible that prove God is talking to them directly. Others say they are the next prophet.
Most religious Jordanians would hear these kinds of statements as blasphemy and a warning sign to families that that person needs professional help.
The hardest part of Issa’s job, he says, is trying to help people who are unwilling to acknowledge they have a problem. “You see a lot of people who have promising futures. But just for the simple fact they’re not aware that they’re sick, or they refuse to admit that they’re sick, they won’t take their medications. So it’s going to go downhill from there,” he says.
“The thing about our culture that you need to understand is that people don’t come here [to therapy] when they first start feeling down. People come to therapy when, khalas (enough), they’re done,” says Abdulhamid. “When they go to four or five sheikhs with no results, then they come to us,” Issa agreed.
Both Issa and Abdulhamid say patients are so afraid of people finding out they talk to a mental health professional that they try to remain anonymous, even to the therapists. Issa has had patients call him on the phone to say they don’t want to come to the hospital in person, but they want a consultation. “We tell them, no, in this case, we should meet and evaluate you. But they end up not coming because they don’t want other people to say, ‘Oh, he’s seeing a psychiatrist.’”
Abdulhamid has had clients who wait several sessions before disclosing to her that they made up a fake name to come see her. She also knows people who take therapy sessions in their car to avoid someone seeing them walk into a clinic.
Some of these fears are well founded. In late 2022, Yasmine says, a university student in Irbid was struggling with depression and filled out a mental health form to get help. “Then one of the professors literally just went into the lecture he was in and screamed ‘Where’s the psycho?! If you don’t show yourself, I will expose your name in front of your friends.’ And this was a professor! It’s made a huge public impact. Everyone talked about it.”
Yasmine is not the only person who referenced this story. Several students in Irbid whispered about the story of the “psycho” weeks after it happened, and claimed the university was trying to cover it up.
It’s not just at school that people are afraid of their private conversations being exposed: sometimes even a therapist’s office isn’t safe. “There’s no privacy here. They’ll tell your parents what you say,” Yasmine says.
“With the culture here, sometimes parents feel like they are entitled to know everything that’s happening in the session, even though the kid is not a teenager, they’re over 18. They’re adults,” Abdulhamid further explains. “But because this person lives within their household or within the family household, and maybe they’re also paying for the therapy, they feel entitled to that information.”
Abdulhamid says that all patients are entitled to confidentiality in the country, but not all professionals stick to their promise. “That’s the sort of struggle that a lot of therapists fall into, like, if I don’t tell the mom what she wants to know, that person might stop going to therapy,” she says. “There are doctors who have many lawsuits against them as well because they broke the confidentiality clause,” Issa confirmed.
“A culture of denial”
The worst week of Yasmine’s life came at the age of 16, when her dealer could no longer send her the opiates she had been abusing for over a year. She was forced to go into withdrawal in her childhood bedroom, in secret. As the daughter of an Imam, a Muslim religious leader, and a member of an upper-middle class Jordanian family, she could not risk damage to her reputation in her community by going to a rehabilitation center.
The only reason she got out of bed that week was to run to the bathroom to throw up. Her muscles seized up, and she felt like her body was on fire. Then came the panic attacks. How much longer could her parents believe that she was just “under the weather?”
“That’s how people in Jordan cut drugs off,” she says. “They just have to go through withdrawal on their own.”
Four years later, in a friend’s house in Irbid, Yasmine reflected on that time in her life with a great sense of sadness. “I would put myself in situations that I knew would end up with me dead.” She didn’t plan on living past the age of 18, and says if you told her she would be in college today, she would have laughed in your face.
What Yasmine didn’t know back then was that, in addition to an eating disorder, she had undiagnosed borderline personality disorder and depression. She would experience mood swings so unpredictable and intense that she was sure the anger and sadness would never leave. Unfamiliar with mental health language, and unaware of why she couldn’t just “feel better,” she decided that alcohol and drugs would be the best coping mechanism. She eventually tried to take her own life.
“I drifted away so much because I was trying to find something, anything to take the pain away,” she reflected. “Anything. I didn’t care if it was good or bad.”
While Yasmine’s parents are strict Muslims, they didn’t seem to notice that their daughter was drunk for most of the day, even at school. “My mom was just caught up in her own stuff. My dad was never there. My brothers were just… everyone was just trying to just survive.”
She says, as a young person struggling in Jordan, if you make one wrong move, you’re doomed. “When you’re struggling and you can’t really afford therapy and your parents are not really supportive, drugs are going to take your brain away. It’s gonna numb your feelings. And that’s exactly what someone who’s struggling wants: to numb their feelings. Just end it all.”
Her addictions to alcohol and opiates were a big part of her life, but to this day, her parents know nothing about it. “I was just mixing and doing more stuff. I was just putting myself at risk. I was high at home. I was drunk at home. But they were too busy to notice,” she says.
While she feared what would happen if they did find out, she was also afraid of the stigma she might face if she spoke to anyone other than her friends about her problems. But now, at age 20, she says that she wishes someone in her family knew. “I want them to know that I really struggled. You guys weren’t there,” she says, with a lump in her throat. “I made it out on my own. No one helped me with the withdrawals, the drug issue, the alcohol issue, the people I was surrounded with. As someone who was like 16 years old, that’s pretty messed up.”
There is a specific type of stigma associated with addiction in the Arab-Muslim world that makes it particularly hard for people like Yasmine to get the help they need. To understand just how isolated people with substance abuse disorder (SUD) feel, it’s important to look at the root of all religious knowledge in the country, and the touchstone for much of the culture: The Qur’an.
The Qur’an explicitly forbids the use of khamr, the Arabic word for wine/intoxication. There is no debate among Islamic scholars that alcohol is haram, or forbidden — there are three specific verses in the book that relate to the prohibition of alcohol. However, there is still discussion within the Muslim community about whether other intoxicants are halal, lawful/permitted, or haram.
Many religious Muslim Jordanians smoke cigarettes and allow their teenage children to smoke them as well, despite nicotine’s addictive nature. But a substance like hashish (a strain of marijuana found in the region) is expressly forbidden in most religious households because of its hallucinatory properties that many compare to the effects of alcohol. Therefore, certain Islamic scholars, like the famous Egyptian translator Abdel Haleem, use the word khamr to describe all forms of intoxicants, despite the fact that its literal meaning only applies to alcohol.
There is a principle in Islam regarding the importance of shame: A “good” Muslim must show shame (haya’) and humility toward God, and if one forgets this aspect of the religion, the fellow Muslim is encouraged to act as a mirror to help strengthen the community. While this has positive effects in some aspects of the religion, it can also be counterproductive, keeping people in hiding rather than seeking the help they need. In the case of addiction, conservative Islamic societies, like that in Jordan, see a person suffering from SUD as not only an individual failing, but “the failing of society as a whole.”
The Qur’an describes intoxication as the “handiwork of Satan,” and therefore, many in the community see substance dependency as a person succumbing to “satanic impulses.” Thus, while reporting domestic violence or seeking out mental healthcare may be described as Eib, addiction can prompt the label ‘Aar, the most severe form of the word “disgrace.” A person that has brought ‘Aar to their family has effectively shunned them from society. The significance of this word cannot be understated, as it is still used in many tribal areas in the country to describe an act so reprehensible that it can “only be washed away with blood” — in other words, an act deservant of an “honor” killing.
According to an analysis by Dr. Muhammad Mansur Ali, a professor of Islamic Studies at Cardiff University, these thought processes align with the “moral model” of addiction—a very unpopular model in medical circles because of its judgemental nature. The “disease model” argues that addiction is a disease with biological, neurological, genetic, and environmental sources of origin. However, the focal point of the moral model is that people become addicts out of their own volition, and thus, it is entirely their responsibility to rehabilitate themselves.
Yasmine says that the society’s “moral model” approach is one of the biggest reasons why she did not seek help for so long. Before she got clean, one of her friends told her a story of his encounter with a therapist that left a sour taste in his mouth. “When he told her that he was struggling with drug abuse, she started blaming him, saying he was not religious enough,” Yasmine recalls. Oftentimes, she says, improperly trained therapists resort to forced prayer as a treatment plan. “She started forcing him to pray more, and said ‘That’s how you’re going to be healed.’ So there’s a lot of unprofessionalism. A lot of it.”
“Christian Arabs drink, so why don’t we judge them when they do it?” Yasmine asks, tensing her eyebrows. “But when you see a Muslim drink, you immediately judge them like they left their religion.”
Even if members in the community are willing to care for addicts, or invite them into their homes like a mutual friend of Yasmine’s and mine did for this interview, the empathy often stops when they close the door. People will often say, “Don’t get too close to that girl” or “She’s nice, but you don’t want to be seen with her,” when speaking about Yasmine. The stigma surrounding addiction therefore becomes associative. Anyone seen mixing with a current or former addict is looked at with suspicion. Then come the rumors. There is a lack of trust and level of sensationalism within the community that leads to people like Yasmine never truly finding a safe space to talk about their struggles.
The moral model approach is especially concerning considering Jordan is in the midst of a drug epidemic as the result of the amphetamine trade in the region. The Kingdom has long been an important transit route for smugglers of illicit drugs. Heroin from Turkey is hidden in transport lorries and trafficked via official border crossing points in Jordan before reaching Israel and Saudi Arabia, and hashish produced in Lebanon is transported to Egypt through Jordan and Syria.
But most concerning for officials is the presence of Captagon throughout the country. Captagon is an amphetamine that was first introduced for its beneficial effects on hyperactivity, depression and narcolepsy, but doctors quickly realized its addictive and hallucinogenic features made it unsafe for the general public.
The drug no longer has any accepted medical use and has been banned globally, but counterfeit Captagon tablets are still popular in the Middle East. They are now illegally produced in the region, and are combined with amphetamines, and stimulants like caffeine and ephedrine, causing unpredictable complications.
While Captagon was mostly used by university students in Jordan to cope with stress, many of them did not know the long term consequences of taking an amphetamine, and have grown addicted to the substance, withdrawing from their social lives because of the stigma and legal consequences, a 2021 study found.
Another major concern about the drug is its use among soldiers in Syria and other neighboring countries as a combat stimulant, or “chemical courage” (it has also been described by Vox News as ISIS’ favorite amphetamine). The counterfeit drug was previously mass produced in Syria, but the unstable situation has moved production to Jordan, Libya, the UAE, Saudi Arabia, and Sudan.
The most recent official figures show that drug-related crimes in Jordan rose from 2,041 in 2005 to 20,055 in 2020. Drug offenses are now the most common type of crime committed in the country, a recent study by Jordan’s justice ministry found. The Anti-Narcotics Department (AND) is responsible for drugs seized at the border, and investigating domestic use. They work closely with Amman’s Royal Badia forces, the Army, and the air wing of the Public Security Directorate. Thus, the fear of legal consequences for self-reporting one’s addiction is certainly exacerbated by the country’s crackdown on illicit drugs.
Whenever asked about her alcohol dependency, Yasmine was more than willing to talk about where and when she would drink, but questions about what opiates were most common on the street she grew up on, or who introduced them to her in the first place, were met with hostility. Yasmine was clear that was the one question she would not answer.
While the Jordanian government is willing to acknowledge the drug problem they are facing today, it wasn’t always like that. According to a 2002 study by Philip Robins, an Oxford University professor of Middle East Politics, despite the growing drug trade in the 1980s and 90s, officials were unwilling to discuss the problem publicly. “As is the classic experience, Jordan’s first response to the growing illegal drugs problem was one of denial,” he wrote.
The most common statements Robins heard at the time were that “only a few consumers of drugs do exist in Jordan” and that “drugs do not pose a serious threat to the [sic] Jordanian society.” When Ghaleb Zoubi, the director of the AND in 1989, was asked about the citizens that were clearly suffering from addiction, he asserted that “most of [them] have acquired the habit while living abroad.” Officials also attributed drug usage in the country, especially hashish, as a habit brought from foreign workers.
It was only when King Hussein, the former king of Jordan, openly discussed the issue of illegal drugs in a public meeting in 1994, that the subject was brought out into the open. Law enforcement finally acknowledged the existence of drugs in the country, but their first priority was to keep individual cases private. “People are our family after all, and it is our job [as policemen] to keep people’s secrets and to protect their honor,” said Lt. General Abdul Rahman al-Udwan, six months after King Hussein publicly addressed the problem.
“This instinctive tendency to play down the problem was partly prompted by the fact that Jordan is a relatively small and conservative society, where notions of honor and shame are strongly held,” Robins noted in 2002. “The actions of the individual are deemed to reflect upon the reputation of the many.”
“Psychiatrists here are just really weird…” says Yasmine, who has also lived in several European countries, before explaining that people with SUD are treated differently even in clinical settings. “He never listened and I think he did judge me, because I had a drug abuse problem,” she says of the first psychiatrist she saw after getting rehabilitated. “He did not prescribe me the medication I needed because he did not trust that I was healed from [the addiction]. I recovered and I was clean for, I think, six months at the time. I was like, I’m clean, you can check!” She describes how difficult it was to be marked with shame everywhere she went, even with a person who is supposed to be highly educated on her issue.
Yasmine sought out a new psychiatrist, someone who would actually trust her enough to prescribe what she needed to treat her depression and borderline personality disorder symptoms. But the next person she saw was on the other extreme of the spectrum. “He never listened to my problems. The only thing he did was just prescribe stuff.”
“I struggled with insomnia. I never slept. So every session I was like, the pills that you gave me to sleep are not helping. I’m not sleeping.” Instead of listening to Yasmine’s concerns, her psychiatrist kept increasing the dose of the medication she was on. “He was like ‘Instead of 200 mg, take 500 mg. Instead of one pill, take two pills.’ I was like, it’s not helping!” She was also worried that the amount of medication she was taking every day might be unhealthy. When Yasmine sought help from her therapist, she dismissed the issue. “Psychiatrists are not supposed to listen,” her therapist said. “They’re just supposed to prescribe.”
Paradoxically, overprescription of psychiatric drugs is becoming a problem in the country. Dr. Issa explains that while the curriculum in psychiatric medical residencies is improving, many doctors across the country are uninterested in following protocol or taking the time to get to know each of their patients.
“Some doctors are actually… They’re not fit enough, let’s say, to do this,” Issa says with caution. “They don’t want to bother with actually talking with the patient. These sessions take a long time and they need work from both ends, from the patient and from the doctor. But sadly, some doctors only give people medication because for them, it’s like having a customer.”
“Certainly doctors here just go straight to over-prescribing medication,” Issa reiterates. He says there have been no studies conducted on psychiatric overprescription specifically, but there is evidence of doctors in the country overprescribing antibiotics, and other medical items especially among elderly populations, a pattern that seems to be spreading to other fields like psychiatry.
Issa says Yasmine’s home-withdrawal experience is common, but warns that going “cold turkey” is not a safe or recommended practice. He says cutting off drugs the way Yasmine did is extremely dangerous, but understands that not everyone feels safe walking into a hospital and saying they need help for SUD.
Issa has worked all across the country, from the smallest refugee camps to the largest public hospitals. “We deal a lot with drug-induced psychosis cases,” he says of his work in the capital. These days, he sees a lot more young people addicted to benzodiazepines (benzos) who are scared to admit themselves into rehabilitation treatment. But Issa wants them to know that efforts are being made to change the way Jordanian doctors, and the population as a whole, view addiction.
According to a World Health Organization report from 2010, medications for long term treatment for SUDs were not utilized in Jordan at the time. But now, Issa says, the National Centre for the Rehabilitation of Addicts (NCRA) in Amman, a public rehabilitation facility run by AND, utilizes both pharmacotherapy and psychological treatment for substance abuse.
Under Jordanian law, a person will not be prosecuted for drug usage if they willingly admit themselves into a rehabilitation program, and Issa encourages people to take advantage of this caveat. “We’re pretty straightforward that if they come in there they won’t get into any legal trouble.
“We look at it like this patient is someone who has a problem and he’s aware of it and he wants to get rid of it,” Issa says of the hospital’s policy. “He wants to be better. He wants to lose this, to solve this problem. So, of course, we’re not going to get him into legal trouble.”
Issa has also been very straightforward with the young people who fear they may be “trapped” in rehab. While the NCRA, one of Jordan’s two public rehabilitation centers, encourages patients to stay in the program for up to 60 days, Issa says it’s not mandatory. “If someone wants to leave and there are no lawsuits against him, we can’t force him to stay,” he says. Treatment is also free of charge and patients’ names are kept completely confidential, Yazan Barmawi, the center’s director, confirmed to Middle East Eye.
SUDs cannot be “cured” by treating the patient alone, Issa says. The larger community must be willing to accept that there is a problem that cannot be fixed with shame. While doctors on the ground are still concerned, the government’s recent acknowledgement of the situation, and the opening of rehabilitation centers in the capital, show promise.
Special thanks to Hakima Daoud for her contribution in translating all interviews conducted in Arabic.