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<\/b><\/p>\n<\/b><\/p>\n
I. DOMESTIC VIOLENCE<\/b><\/p>\n
\u201cWhat will people say?\u201d<\/i><\/b><\/p>\n
(* = Indicates name change for safety)<\/p>\n
Farah* had always dreamed of a traditional Arab wedding. In her fantasy, her fianc\u00e9 would knock on her parents\u2019 door with a bouquet of black irises to ask for their daughter\u2019s 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.<\/p>\n
What Farah didn\u2019t 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.<\/p>\n
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\u2019t even feel safe discussing her past in her parents\u2019 house. Three years after her divorce, she still feels scared of how the community might react if they find out she\u2019s speaking about her abuse publicly.<\/p>\n
Eib<\/i>! they would say, telling her to have some shame. \u201cI kept hearing the phrase that, \u2018Tomorrow, he will be better. Tolerate it for your kids’ sake,\u2019 and so on. But my life got so much worse.\u201d<\/p>\n
Domestic violence is a public health problem worldwide \u2014 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<\/a> that people in the country see violence against children or women as an acceptable form of discipline.<\/p>\n Researchers Hasan Al-Hawari and Asmaa El-Banna say that domestic violence and abuse in the Arab world is \u201ca hidden or masked epidemic\u201d 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\u2019s abuse is described as Eib<\/i>, or shameful, as matters concerning family are supposed to be handled privately.<\/p>\n \u201cThings got bad on more than one front. He became a totally irresponsible person,\u201d she says. Farah\u2019s 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.<\/p>\n \u201cWhen I found out he sold our shop, I tried to tell his family, but unfortunately no one took this issue seriously,\u201d Farah says. \u201cHis mother told me \u2018It\u2019s none of your business, my son knows what he\u2019s doing.\u2019\u201d Every time Farah opened her mouth, he would berate her with demeaning language. \u201cI was a maid in my own house,\u201d she says of the way she was treated.<\/p>\n 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\u2019t so<\/i> bad, and that every wife has to deal with her husband\u2019s faults. His family also knew about his addiction, and his emotional volatility, but did nothing to protect her. \u201cThey spoke to him several times, but unfortunately, the back and forth lasted for eight years.\u201d<\/p>\n \u201cWhen I was sure he was taking drugs, I spoke to him, reminding him to look at our situation, that we didn\u2019t even have enough money to bring milk for the kids.\u201d He snapped: \u201cWhere do you want me to bring money from?! Should I just burn myself and the house down?!\u201d<\/p>\n He then ran to another room, grabbed a bottle of what looked like kerosene, and poured it over himself before striking a match. \u201cAlhamdulillah [Thank God] it didn\u2019t catch fire.\u201d Luckily, she says, it wasn\u2019t kerosene, but Farah\u2019s son witnessed the entire event. \u201cMy 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.\u201d That night, Farah reached her breaking point\u2014she grabbed her son and whatever necessities she could find, and went to her parents\u2019 house to tell them she was leaving her husband.<\/p>\n \u201cWith time passing he will get better and Inshallah [God willing] he will change,\u201d Farah\u2019s 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: \u201cSo what? Not everyone\u2019s life is a breeze.\u201d<\/p>\n Women in Jordan are in an especially vulnerable position, as there are significant consequences to reporting abuse\u2014such as divorce, which could leave them in a dire economic situation.<\/p>\n Since women minimally participate<\/a> in Jordan\u2019s 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%<\/a> of Jordanian women self-reported that they believe wife beating to be an acceptable practice.<\/p>\n \u201cWe live in a society that has no mercy toward a divorced woman. The fault is always<\/i> on the woman,\u201d Farah explains. \u201cIf I could go back in time, I would not have gotten married.\u201d 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\u2019s rare for divorce\u00e9s with children to get remarried in the country.<\/p>\n \u201cA woman has no stability after she goes back to her family, especially if she has children,\u201d she says. At first Farah\u2019s 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. \u201cHe paid me for the first two months of child support, but hasn\u2019t helped me since,\u201d she says. \u201cThe government is still chasing him up to pay.\u201d<\/p>\n Farah is now living with her two children in her parent\u2019s 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. \u201cI truly don\u2019t know why my brother treats my kids the way he does,\u201d she says. \u201cEven if I ask why, I get no answer.\u201d<\/p>\n Farah says she will tolerate anything for her kids\u2019 sake. \u201cYou 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.\u201d<\/p>\n But she has dreams of a better life for her daughter. \u201cI will make her finish her education and then let her make her own life decisions without pressuring her,\u201d Farah promised. \u201cMy daughter seems to be able to understand life better than me. She\u2019s 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.\u201d<\/p>\n Three years after her divorce, the only place that Farah feels any sense of independence is at the UNRWA women\u2019s shelter, where she\u2019s 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 \u201ccomputer lab\u201d filled with defunct electronics, is a protected place where women in Irbid feel comfortable talking amongst each other about the abuse they\u2019ve suffered, away from the ears of authorities. The kitchen\u2019s 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.<\/p>\n 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 \u201cAl-Sham.\u201d 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.<\/p>\n 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.<\/p>\n According to the UN, Jordan also hosts more than two million registered Palestinian refugees<\/a> from various Arab-Israeli wars, 67,000 refugees from Iraq<\/a> following the 2003 US invasion, and 655,000 Syrian refugees<\/a> since the start of their 2011 civil war. (Some estimates put the number of Syrian refugees as high as 1.3 million<\/a>; there is no official census data).<\/p>\n Citizenship in Jordan is complicated, but to simplify: if you were a Palestinian who arrived before 1950, chances are you\u2019re now a Jordanian national. If you came from anywhere after that point, you\u2019re likely a registered refugee with the UN with the internationally recognized right to return to your home country.<\/p>\n <\/p>\n When Reem*, another survivor of domestic violence, arrives at the UNRWA women\u2019s 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.<\/p>\n Reem came to Jordan from Syria, fleeing Bashar al-Assad\u2019s 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\u2019s largest refugee camp for Syrians.<\/p>\n 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. \u201cWhy did he hurt me<\/i>?\u201d Reem says with tears in her eyes.<\/p>\n \u201cHe once beat me and cut my head open,\u201d Reem says, choking back tears. \u201cSeven stitches. All because people told him I was learning a skill.\u201d<\/p>\n Though she was scared, Reem went into a family protection unit funded by the United Nations High Commissioner for Refugees\u2019 (UNHCR), and told them about the abuse she had suffered. \u201cThen the order came to move [my husband] to Azraq Camp,\u201d Reem reflects. \u201cThey sent him there to sort him out.\u201d<\/p>\n The problem was, Reem didn\u2019t have any income, and Hassan began making threats that she would lose everything if she didn\u2019t accompany him to the new camp. \u201cI was forced to tell [the authorities] that I was willingly going with him,\u201d Reem says. \u201cWhere else would I go?\u201d<\/p>\n It\u2019s 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.<\/p>\n \u201cAzraq camp\u2026 What shall I tell you\u2026\u201d Reem sighed. \u201cZaatari is heaven compared to Azraq.\u201d<\/p>\n 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<\/a> by anthropologist Melissa Gatteron for Forced Migration Review paints a particularly bleak picture of Azraq: \u201cSome refugees have likened the camp to an outdoor prison, while humanitarian observers have described it as a dystopian nightmare.\u201d<\/p>\n 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. \u201cHe would tell me \u2018I\u2019ll beat you. I\u2019ll crack your head,\u2019\u201d Reem recalls. He wouldn\u2019t let her go to the doctor, accusing her of faking an illness as a guise to report the abuse to another UN official.<\/p>\n 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, \u201cit set him on fire.\u201d<\/p>\n Hassan was furious that his wife had ventured outside what he believed to be her only role: dutiful wife and mother. \u201cWhat about the people who see you going out every day?\u201d Hassan would yell at her. \u201cWhat are they going to say?\u201d<\/p>\n Some cultural anthropologists<\/a> have divided humanity into shame-based cultures and guilt-based cultures. In their 2007 article \u201cCultural Models of Shame and Guilt,\u201d 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.<\/p>\n Shame-based cultures, usually Eastern nations with collectivist thinking, use exterior influences to deter people from an action. The Arabic phrase that Hassan used, \u201cAysh al-nas badha tahki?\u201d or \u201cwhat will people say?\u201d is one of the most common sayings in a shame-based culture.<\/p>\n By contrast, guilt-based cultures, usually Western nations with individualist ideologies, use one\u2019s 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.<\/p>\n 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. \u201cI went to the doctor and he told me, \u2018I will not stitch your cut on the head. I want you to bring the one who beat you up like this,\u2019\u201d Reem recalls.<\/p>\n 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<\/i>. \u201cFor us, it is shameful if the woman complains against the man. They look at us like\u2026\u201d Reem takes a deep breath, \u201cI need to tolerate his faults.\u201d<\/p>\n \u201cOfficial establishments like family protection agencies or domestic violence shelters don\u2019t fit our way of life,\u201d Farah concurred. \u201cIf I sought refuge from an agency, they might have taken my children away from me because I didn\u2019t have money and my husband\u2019s family refused to take responsibility for them. I would have lost my home and<\/i> my kids.\u201d<\/p>\n Domestic violence has intergenerational consequences<\/a>, 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.<\/p>\n Reem says that, after witnessing how his father treats the women in his life, her eldest son started copying his every move. \u201cHe started bullying his sisters. He says, \u2018Since you are a girl, get up and work. Bring me water to drink.\u2019\u201d<\/p>\n During our hour-long conversation, Reem\u2019s husband has already called her three times, demanding to know where she is. \u201cWill this interview cause me harm?\u201d she asks, her hands shaking. Even though she had an \u201calibi\u201d 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\u2019s almost as if she feels the need to look over her shoulder.<\/p>\n II. MENTAL HEALTH<\/strong><\/p>\n \u201cThey\u2019ll say I lost my mind\u201d<\/i><\/b><\/p>\n One of the first conversations I had about the term Eib<\/i> 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.<\/p>\n \u201cIt was pretty much a fancy hotel for people who had relatives that they wanted out of sight,\u201d she said. \u201cIt was mostly for people who had disabilities that were seen as shameful.\u201d 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.<\/p>\n \u201cWe don\u2019t talk about those things to other people,\u201d she said. \u201cThose are private issues that stay in the household.\u201d<\/p>\n She then told me a story about one of her distant relatives that I had never met. This woman was my grandmother\u2019s cousin, but my family never talked about her, not even when my mother was a child.<\/p>\n 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 \u201clost her mind\u201d after being scared by a cat in her window.<\/p>\n 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.<\/p>\n Their expectation was that people should act as though she no longer existed: She was not dead, but she may as well have been.<\/p>\n 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.<\/p>\n I know if I ask my grandmother about her today, I still won\u2019t 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\u2019t even know.<\/p>\n \u201cIt was a different time,\u201d my mother said. \u201cThey didn\u2019t know then what we know now.\u201d<\/p>\n 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.<\/p>\n \u201cPeople are going to point fingers,\u201d or \u201cpeople will talk about me\u201d 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\u2019s leading private mental health clinics.<\/p>\n Depression, schizophrenia and anxiety are the most prevalent forms of mental illness in Jordan, according to the World Health Organization<\/a>. 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.<\/p>\n \u201cIt’s because of the stigma, actually, that they wouldn’t go see a therapist,\u201d 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.<\/p>\n One study<\/a> conducted in 2017 found that many Jordanian families of people with schizophrenia felt they \u201conly have themselves to blame\u201d and that taking them to a clinic is useless because they \u201cwould not improve if given treatment.\u201d<\/p>\n \u201cWe have a culture of stigma,\u201d said UNICEF\u2019s Zubaida Ali, a case worker with children and teenagers across the country. \u201cThey are aware internally that they need these services. But there remains apprehension, like, \u2018If people come to know that I\u2019m seeing a psychiatrist, they\u2019ll say I am crazy or that I lost my mind\u2019 and things like that,\u201d she explains.<\/p>\n 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.<\/p>\n \u201cThey 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,\u201d she explains.<\/p>\n And unfortunately, these fears are valid, according to Ali. \u201cThere are families who, if they know that a particular girl sees a psychologist, won\u2019t approach any girl in her family at all, or get married to anyone in that family at all,\u201d 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\u2019s statement, but she works with the courts on a daily basis.)<\/p>\n Even when resources are available for free in remote areas, such as refugee camps, people stay clear of them. \u201cThere are clinics, but because everyone knows each other, you feel shy going to them. Because outside, it is written \u2018Mental Support,\u2019 and everybody knows each other,\u201d Reem recalled of her time at Zaatari. \u201cIf 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.\u201d<\/p>\n \u201cI see stigma everywhere,\u201d says Abdulhamid. \u201cI 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.\u201d<\/p>\n 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\u2019s 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.<\/p>\n 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. \u201cHe tells me \u2018Mama, tomorrow they will say that you are begging. We don\u2019t 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\u2019t, it\u2019s okay,\u2019\u201d Noor says, with tears in her eyes.<\/p>\n Once, when Noor\u2019s daughter told her friend of all the mental pressures she was dealing with, her brother chastised her. \u201cWhy did you talk?\u201d he asked his sister angrily. \u201cIt is an internal issue within our house. We don\u2019t want to give people a reason to gloat over us!\u201d<\/p>\n 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. \u201cThe man in our society is raised to be a tough person who can\u2019t be defeated,\u201d she explains. \u201cThe one who is not permitted to say \u2018I got weak\u2019 or \u2018I suffer from an issue.\u2019 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.\u201d<\/p>\n Ali remembers when a young boy came to her for counseling, and was bullied almost immediately after walking out of her office. It\u2019s no surprise that Noor\u2019s son would stay far away from those trying to help him.<\/p>\n \u201cThe picture \u2026 They keep looking at their dead father\u2019s picture on the phone,\u201d Noor laments. \u201cThey say \u2018Baba, if you were with us, we would not have needed anyone.\u2019\u201d<\/p>\n People believe that young men who talk about their problems are not being \u201cmanly enough,\u201d says Haya, a young Palestinian-Jordanian woman living in Irbid. \u201cIf you are a man and you speak out\u2026 you\u2019re judged like, \u2018You’re gay.\u2019\u201d<\/p>\n Within the country\u2019s older population, Abdulhamid says, there is still the notion that therapy is a purely Western concept \u2014 a \u201cmade-up,\u201d selfish practice that is a waste of time and money. Palestinian-American comic Mo Amer mocked<\/a> this attitude in his recent Netflix series: \u201cI 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.\u201d<\/p>\n 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. \u201cI heard them saying, \u2018This is all lies.\u2019\u201d<\/p>\n 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. \u201cYou’re just lazy,\u201d her mother would say. \u201cIf you went to bed earlier, you could get up in the morning.\u201d<\/p>\n So Yasmine started secretly seeing a therapist that her friend recommended. When her mother found out years later, she was furious. \u201cMy mom took the blame on herself. And she started guilt-tripping me, like \u2018Why are you doing this to me?\u2019\u201d<\/p>\n Yasmine says she is no longer upset about her mother\u2019s invalidating words because her parents were a product of a shame-based environment. \u201cI 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\u2019s how they were raised. We can\u2019t really blame them.\u201d<\/p>\n \u201cThere is a percentage of people who are still not convinced, or who say it is better to get treated through religious means,\u201d Ali explains. \u201cThey have awareness that mental health care is important, but they prefer seeking help from the faith rather than from a specialist.\u201d<\/p>\n For example, when Noor\u2019s son was struggling with the death of his father, they started treating him by reading him verses from the Qur\u2019an, the Islamic holy book. Even now, when she finds herself depressed or anxious, she says, \u201cI don\u2019t visit anyone. I stay alone. I turn on Surat Al Baqarah<\/em> [a recording of a section of the Qur\u2019an] and keep myself at home.\u201d<\/p>\n Yasmine says this line of thinking extends to a few mental health professionals too, referencing one she knew from Irbid. \u201cShe literally used to force her patients to pray. And she would blame them,\u201d she recalls. \u201cImagine, you’re struggling and depressed and she’s just blaming you because you\u2019re not religious enough. She would actually say it to their faces, like, \u2018you’re too needy.\u2019\u201d<\/p>\n Abdulhamid makes it clear that the stigma isn\u2019t 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. \u201cI don’t think it’s religion \u2014 I feel like it’s more cultural,\u201d Abdulhamid says. Ali agrees, and Yasmine believes people are too quick to blame Islam for what\u2019s wrong in their community.<\/p>\n \u201cIt’s not just a Muslim thing \u2014 even Christians have Eib<\/i>,\u201d she says. Jordanian Christians are among the oldest Christian communities in the world and make up 8% of the nation\u2019s current population. \u201cI 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,\u201d she recalled.<\/p>\n 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\u2019t always feasible for them. \u201cCollectivist 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,\u201d she says.<\/p>\n To tell a Jordanian daughter \u201cjust stop talking to your family until they can respect your needs\u201d is wholly unrealistic, she explains. \u201cThis is something that I always have in the back of my mind. Like, you don’t want to create more mess within the family.\u201d<\/p>\n 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. \u201cIf 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?\u201d she asks.<\/p>\n 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 \u2014 ones that highlighted collectivist thinking and religious elements \u2014 that gained the most trust in the community.<\/p>\n 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.<\/p>\n 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\u2019s 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.<\/p>\n \u201cShe said the shayateen<\/i> (demons) were singing and chanting while I was interviewing her,\u201d Issa recalled of her visual and auditory hallucinations. He tried to figure out when these delusions began.<\/p>\n \u201cHer 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,\u201d he recounted her story. \u201cThat\u2019s when she said she realized that he was Lucifer and she was Lilleth, and they had many black kittens as children.\u201d<\/p>\n The family who brought her in said seeing a psychiatrist was their last resort. They didn\u2019t want anyone to know of her possible schizophrenia, but they no longer knew how to deal with her.<\/p>\n \u201cAccording to her sister, she tried to sacrifice her two nieces to the devil as tributes,\u201d Issa says. That was the family\u2019s breaking point. They knew they could no longer keep her in hiding.<\/p>\n \u201cMost of the people who come to us at the hospital, they try a million things before they end up here,\u201d Issa explains. \u201cUsually they go to sheikhs<\/i> (religious leaders), because they think it’s some sort of ghost or spirit or jinn<\/i> [genie]. We see a lot of religious-based delusions like, \u2018Someone put a spell on me,\u2019 or \u2018God is talking to me.\u2019\u201d Some people tell Issa there are specific verses in the Qur\u2019an or Bible that prove God is talking to them directly. Others say they are the next prophet.<\/p>\n Most religious Jordanians would hear these kinds of statements as blasphemy and a warning sign to families that that person needs professional help.<\/p>\n The hardest part of Issa\u2019s job, he says, is trying to help people who are unwilling to acknowledge they have a problem. \u201cYou 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,\u201d he says.<\/p>\n \u201cThe 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<\/i> (enough), they’re done,\u201d says Abdulhamid. \u201cWhen they go to four or five sheikhs with no results, then they come to us,\u201d Issa agreed.<\/p>\n 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\u2019t want to come to the hospital in person, but they want a consultation. \u201cWe 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, \u2018Oh, he’s seeing a psychiatrist.\u2019\u201d<\/p>\n 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.<\/p>\n 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. \u201cThen one of the professors literally just went into the lecture he was in and screamed \u2018Where’s the psycho?! If you don’t show yourself, I will expose your name in front of your friends.\u2019 And this was a professor! It’s made a huge public impact. Everyone talked about it.\u201d<\/p>\n Yasmine is not the only person who referenced this story. Several students in Irbid whispered about the story of the \u201cpsycho\u201d weeks after it happened, and claimed the university was trying to cover it up.<\/p>\n It\u2019s not just at school that people are afraid of their private conversations being exposed: sometimes even a therapist’s office isn\u2019t safe. \u201cThere’s no privacy here. They’ll tell your parents what you say,\u201d Yasmine says.<\/p>\n \u201cWith 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,\u201d Abdulhamid further explains. \u201cBut 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.\u201d<\/p>\n Abdulhamid says that all patients are entitled to confidentiality in the country, but not all professionals stick to their promise. \u201cThat’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,\u201d she says. \u201cThere are doctors who have many lawsuits against them as well because they broke the confidentiality clause,\u201d Issa confirmed.<\/p>\n III. ADDICTION<\/b><\/p>\n \u201cA culture of denial\u201d<\/i><\/b><\/p>\n The worst week of Yasmine\u2019s 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.<\/p>\n 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 \u201cunder the weather?\u201d<\/p>\n \u201cThat’s how people in Jordan cut drugs off,\u201d she says. \u201cThey just have to go through withdrawal on their own.\u201d<\/p>\n Four years later, in a friend\u2019s house in Irbid, Yasmine reflected on that time in her life with a great sense of sadness. \u201cI would put myself in situations that I knew would end up with me dead.\u201d She didn\u2019t 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.<\/p>\n What Yasmine didn\u2019t 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\u2019t just \u201cfeel better,\u201d she decided that alcohol and drugs would be the best coping mechanism. She eventually tried to take her own life.<\/p>\n \u201cI drifted away so much because I was trying to find something, anything to take the pain away,\u201d she reflected. \u201cAnything. I didn\u2019t care if it was good or bad.\u201d<\/p>\n While Yasmine\u2019s parents are strict Muslims, they didn\u2019t seem to notice that their daughter was drunk for most of the day, even at school. \u201cMy mom was just caught up in her own stuff. My dad was never there. My brothers were just\u2026 everyone was just trying to just survive.\u201d<\/p>\n She says, as a young person struggling in Jordan, if you make one wrong move, you\u2019re doomed. \u201cWhen 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.\u201d<\/p>\n Her addictions to alcohol and opiates were a big part of her life, but to this day, her parents know nothing about it. \u201cI 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,\u201d she says.<\/p>\n 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. \u201cI want them to know that I really struggled. You guys weren’t there,\u201d she says, with a lump in her throat. \u201cI 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.\u201d<\/p>\n 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\u2019s important to look at the root of all religious knowledge in the country, and the touchstone for much of the culture: The Qur\u2019an.<\/p>\n The Qur\u2019an explicitly forbids the use of khamr<\/em>, the Arabic word for wine\/intoxication. There is no debate among Islamic scholars that alcohol is haram<\/em>, or forbidden \u2014 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<\/em>, lawful\/permitted, or haram.<\/p>\n Many religious Muslim Jordanians smoke cigarettes and allow their teenage children to smoke them as well, despite nicotine\u2019s 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<\/em> to describe all forms of intoxicants, despite the fact that its literal meaning only applies to alcohol.<\/p>\n There is a principle in Islam regarding the importance of shame: A \u201cgood\u201d Muslim must show shame (haya\u2019<\/i>) 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 \u201cthe failing of society as a whole<\/a>.\u201d<\/p>\n The Qur\u2019an describes intoxication as the \u201chandiwork of Satan<\/a>,\u201d and therefore, many in the community see substance dependency as a person succumbing to \u201csatanic impulses.\u201d Thus, while reporting domestic violence or seeking out mental healthcare may be described as Eib<\/i>, addiction can prompt the label \u2018Aar<\/i>, the most severe form of the word \u201cdisgrace.\u201d A person that has brought \u2018Aar<\/i> 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 \u201conly be washed away with blood\u201d \u2014 in other words, an act deservant of an \u201chonor\u201d killing.<\/p>\n According to an analysis<\/a> by Dr. Muhammad Mansur Ali, a professor of Islamic Studies at Cardiff University, these thought processes align with the \u201cmoral model\u201d of addiction\u2014a very unpopular model in medical circles because of its judgemental nature. The \u201cdisease model\u201d 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.<\/p>\n Yasmine says that the society\u2019s \u201cmoral model\u201d 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. \u201cWhen he told her that he was struggling with drug abuse, she started blaming him, saying he was not religious enough,\u201d Yasmine recalls. Oftentimes, she says, improperly trained therapists resort to forced prayer as a treatment plan. \u201cShe started forcing him to pray more, and said \u2018That’s how you’re going to be healed.\u2019 So there’s a lot of unprofessionalism. A lot of it.\u201d<\/p>\n \u201cChristian Arabs drink, so why don’t we judge them when they do it?\u201d Yasmine asks, tensing her eyebrows. \u201cBut when you see a Muslim drink, you immediately judge them like they left their religion.\u201d<\/p>\n Even if members in the community are willing to care for addicts, or invite them into their homes like a mutual friend of Yasmine\u2019s and mine did for this interview, the empathy often stops when they close the door. People will often say, \u201cDon\u2019t get too close to that girl” or “She\u2019s nice, but you don\u2019t 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.<\/p>\n 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<\/a> before reaching Israel and Saudi Arabia, and hashish produced in Lebanon is transported to Egypt through Jordan and Syria.<\/p>\n But most concerning for officials is the presence of Captagon throughout the country. Captagon is an amphetamine that was first introduced<\/a> 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.<\/p>\n 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.<\/p>\n 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<\/a> found.<\/p>\n Another major concern about the drug is its use among soldiers in Syria and other neighboring countries as a combat stimulant, or \u201cchemical courage\u201d (it has also been described by Vox News<\/a> as ISIS\u2019 favorite amphetamine). The counterfeit drug was previously mass produced in Syria, but the unstable situation has moved production<\/a> to Jordan, Libya, the UAE, Saudi Arabia, and Sudan.<\/p>\n The most recent official figures<\/a> 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<\/a> by Jordan\u2019s 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\u2019s 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\u2019s crackdown on illicit drugs.<\/p>\n 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.<\/p>\n While the Jordanian government is willing to acknowledge the drug problem they are facing today, it wasn\u2019t always like that. According to a 2002 study<\/a> 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. \u201cAs is the classic experience, Jordan\u2019s first response to the growing illegal drugs problem was one of denial,\u201d he wrote.<\/p>\n The most common statements Robins heard at the time were that \u201conly a few consumers of drugs do exist in Jordan\u201d and that \u201cdrugs do not pose a serious threat to the [sic] Jordanian society.\u201d When Ghaleb Zoubi, the director of the AND in 1989, was asked about the citizens that were clearly suffering from addiction, he asserted that \u201cmost of [them] have acquired the habit while living abroad.\u201d Officials also attributed drug usage in the country, especially hashish, as a habit brought from foreign workers.<\/p>\n 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. \u201cPeople are our family after all, and it is our job [as policemen] to keep people\u2019s secrets and to protect their honor,\u201d said Lt. General Abdul Rahman al-Udwan, six months after King Hussein publicly addressed the problem.<\/p>\n \u201cThis 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,\u201d Robins noted in 2002. \u201cThe actions of the individual are deemed to reflect upon the reputation of the many.\u201d<\/p>\n \u201cPsychiatrists here are just really weird\u2026\u201d says Yasmine, who has also lived in several European countries, before explaining that people with SUD are treated differently even in clinical settings. \u201cHe never listened and I think he did judge me, because I had a drug abuse problem,\u201d she says of the first psychiatrist she saw after getting rehabilitated. \u201cHe 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!\u201d 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.<\/p>\n 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. \u201cHe never listened to my problems. The only thing he did was just prescribe stuff.\u201d<\/p>\n \u201cI 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.\u201d Instead of listening to Yasmine\u2019s concerns, her psychiatrist kept increasing the dose of the medication she was on. \u201cHe was like \u2018Instead of 200 mg, take 500 mg. Instead of one pill, take two pills.\u2019 I was like, it’s not helping!\u201d 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. \u201cPsychiatrists are not supposed to listen,\u201d her therapist said. \u201cThey’re just supposed to prescribe.\u201d<\/p>\n 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.<\/p>\n \u201cSome doctors are actually\u2026 They’re not fit enough, let’s say, to do this,\u201d Issa says with caution. \u201cThey 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.\u201d<\/p>\n \u201cCertainly doctors here just go straight to over-prescribing medication,\u201d 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<\/a>, and other medical items<\/a> especially among elderly populations<\/a>, a pattern that seems to be spreading to other fields like psychiatry.<\/p>\n Issa says Yasmine\u2019s home-withdrawal experience is common, but warns that going \u201ccold turkey\u201d 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.<\/p>\n Issa has worked all across the country, from the smallest refugee camps to the largest public hospitals. \u201cWe deal a lot with drug-induced psychosis cases,\u201d 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.<\/p>\n 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.<\/p>\n 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. \u201cWe’re pretty straightforward that if they come in there they won’t get into any legal trouble.<\/p>\n \u201cWe 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,\u201d Issa says of the hospital\u2019s policy. \u201cHe 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.\u201d<\/p>\nWhile violence is under-documented and underreported in the region, experts believe<\/a> that sexual abuse is twice as common as physical abuse, with neglect a distant third. Most women are abused with blunt instruments, causing abrasions and bruises (70%), but intentional burning is also common (25%).<\/div>\n![\"\"](\"https:\/\/shoeleathermagazine.com\/2023\/wp-content\/uploads\/2023\/04\/shoe_section_break.png\")
<\/div>\n\u201cIn the beginning it was a normal marriage like any other,\u201d Farah says. Her husband and his family were kind to her, and for the most part, they were happy. It wasn\u2019t until she gave birth to her first child that things turned sour.<\/div>\n![\"The](\"https:\/\/shoeleathermagazine.com\/2023\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-02-at-12.07.52-PM-1.png\")
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