Mental health is a person’s Psychological and emotional well-being, it affects how we think, feel, and act. It included how we handle pressure, identify with others, and settle on decisions (Anne, 2014). We all experience fluctuations in our emotional state or mood but for many of us, at certain periods in our lives, this can be to such an extent that it a person suffering from these conditions can be diagnosed with mental illness (Claire, 2012; Fernando and Keating, 2008). The majority of us who experience mental health problems can get over them or learn to live with them, especially if we get help early on (Henderson et al, 2013).
Most mental illness symptoms have traditionally been divided into groups of either ‘neurotic’ or ‘psychotic’ symptoms (Anne, 2014; Mind.Org.UK, 2013). ‘Neurotic’ covers those symptoms which can be regarded as severe forms of normal emotional experiences, such as depression, anxiety, or panic (Claire,2012). These conditions are now more frequently referred to as ‘common mental health problems’ or ‘common mental illnesses’ (CMI). Less common are ‘psychotic’ symptoms, which interfere with a person’s perception of reality, and may include hallucinations such as seeing, hearing, smelling, or feeling things that no one else can (Anne,2014). These types of conditions are referred to as severe mental illness (SMI).
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Since the early 1980’s issues around race and culture in mental health services in the UK have been highlighted, mainly based on ethnic differences in admission to psychiatric institutes and compulsory detention under the mental health act (Fernando, 2010).
Many people who live with a mental health problem, or are developing one, try to keep their feelings hidden because they are afraid of other people’s reactions – stigma is still a reality for many (Sabry and Vohra, 2013).
Globally, 70% of young people and adults with mental illness do not receive any mental health treatment from healthcare staff (Mind.Org.UK, 2013).
According to Karasz (2005) comparing illness presentation between South Asians and White Americans, found that the South Asians interpreted the symptoms of depression in situational terms – as an emotional reaction as opposed to a pathogenic state – and were unable to label the illness. The aspect of concept of depression may be unique to Western cultures (Tsai & Chentsova-Dutton, 2002). However, other cultures do appear to differ in such expectations (Greenwood et al, 2014). Modern definitions of South Asian countries are Afghanistan, India, Pakistan, Sri Lanka, Nepal, Bhutan, Maldives, and Bangladesh (Bhui and Bhugra, 2002).
This assignment will look carefully at differences in the way mental illness is seen in the Bangladeshi Muslim (cultural) tradition that compromises British society.
The vast majority of the Bangladeshi community came from the rural area of Sylhet region, which lies in the northeastern part of Bangladesh. Sylheti is the main dialect spoken throughout Sylhet and has no written form. Around 90% of the population are Muslims (Kapasi, 2000).
Sylhetis are largely Sufi-influenced Sunni Muslims (but 10% are Hindu) who follow an Islamic path that is depicted by ‘purist’ (clerical, scripturalist) Islam as contaminated with Hinduism culture in its reverence for, if not actual worship of, saintly pirs (religious spiritual leader), a more thaumaturgical (magical or black magic) approach to the problems of social and religious life, and with local practices of oblations, music, and dancing (Hinduism) (Dein et al, 2008). While the earlier migrants originated from rural and non-literate backgrounds, some of the most recent Sylheti migrants derived from towns, and some have university degrees obtained before coming to the UK (Gardener, 2002). Bangladeshi families are characterized by a patrilineal kinship system, male authority over women, which includes restrictions on women when outside the household, and an emphasis on family honor (Hussain and Cochrane, 2004). This paper will demonstrate the attitudes toward mental illness in the Bangladeshi Muslim community and how their beliefs lead them to seek help from spiritual leaders before seeking medical help. Followed by an analysis of the findings, then a critical discussion and debate on the emerging themes and limitations of engaging the Bangladeshi community about mental health services, emphasizing the importance of cultural understanding and better treatment/s for individuals suffering from mental illness, following this, a conclusion will be drawn.
Literature review
Cultural beliefs often affect people’s attitudes toward mental illness and their help-seeking behavior ( ).
The aim of this paper is to:
- Explore the attitudes towards mental illness in the Bangladeshi Muslim community. Traditional methods used to treat mental illness and how it can be addressed by professionals, engaging them in Mental health services
The objective of this paper is to:
- What are the attitudes of Bangladeshi people towards mental illness?
- How professionals working with service users can have a better understanding of different cultures and religions.
- How cultural and religious beliefs contribute to the treatment gap and assesses the evidence that public health approaches to different cultures and traditional beliefs can facilitate access to mental health care and the stigmatization attached to mental illness in the Bangladeshi community.
According to Sheikh and Furnham (2000) regardless of whether the individual has experienced mental illness or communicated in enthusiastic, emotional, or physical terms is probably going to be an impression of the social foundation of the person. Individuals from ethnic minorities, especially Bangladeshis, generally possibly use psychological well-being care services when they believe that their modified condition of working is identified with their physical well-being (Bhui & Bhugra, 2002).
Although the general health indicators for this population are not good (National Statistics 2004). Yet South Asians, including Bangladeshis in Britain are generally noted for having lower reported rates of psychiatric hospital admissions and minor psychological symptoms than most other ethnic groups (Littlewood, R. and Dein, S., 2016).
For Bangladeshi service users, the fear of being unwell played an important role in consolidating beliefs in religious and cultural explanations of illness (McClelland et al, 2014). Religion gave them a sense of structure and purpose and a framework within which to understand emerging symptoms (Dein et al, 2008).
Weatherhead and Daiches (2010) state there is a significant stigma in the Bangladeshi community around mental health. They go on to state that sometimes, Bangladeshi people who suffer from mental illness simply stay at home.
The popular image of Bangladeshi families is that they provide unquestioning care and support to elders (Gardner 2002). Dein et al (2008) claim the main carers for Bangladeshi patients were generally close family members and some reluctance was expressed when needing professional carers instead of them. Littlewood and Dein (2016) agree and state a strong sense of moral duty was expressed by spouses toward their husbands or wife when they became sick.
If their condition gets worse, they may be taken to Bangladesh for treatment, rather than being treated in the UK (Dein et al, 2008).
Hussain & Cochrane (2004) state, the South Asian people group appears to connect more prominent shame to psychological instability than that of their British White partners.
Dysfunctional behavior may likewise be seen as a test or discipline from God (Mental health stigma in the Muslim Community, 2012). For instance, illness may be seen as an opportunity to remedy disconnection from Allah or a lack of faith through regular prayer and a sense of self-responsibility. Imams (traditional spiritual leaders) are often seen as indirect agents of Allah’s will and facilitators of the healing process (McClelland, 2014). Imams may also play central roles in shaping family and community attitudes and responses to illness (Mental health stigma in the Muslim Community, 2012).
Cultural influences on the presentation of symptoms and mental health problems also need to be considered (Sheikh and Furnham, 2000). In addition, normative cultural beliefs in the existence of jinn (evil spirits) may be confused with delusions of possession and control and may prevent patients and family members from recognizing medical or psychiatric problems (Islam et al, 2015; Dein, 2008). Significant cultural differences with respect to gender may also put women at especially high risk of diagnosis (Hussain and Cochrane, 2004) and treatment of mental health problems in Muslim communities.
According to (Littlewood and Dein, 2016) it was additionally anticipated that Older British Bangladeshis will be progressively disposed to look for assistance from their family and to make utilization of 'lay referral frameworks' solidarity than British Whites (It is an illness referral system through which a person passes from the first recognition of an abnormality to an announcement to the family, to members of the community, to traditional or culturally recognized healers, and then to the regular medical system that includes nurses and physicians), furthermore, that British Bangladeshis will have more superstitious convictions about despondency than the British Whites (McClelland et al, 2014). Research shows Bangladeshis in the UK are hesitant to disclose mental issues to well-being experts (Dein et al, 2008). Religious and cultural beliefs in supernatural causes such as possessions by evil spirits and evil eyes often lead people to faith healers and religious advisors before seeking medical help (Islam et al, 2015; McClelland et al, 2014). Stigma and shame have been heavily implicated in poor help-seeking behavior (Mental health stigma in the Muslim community, 2012), and profoundly stigmatizing community attitudes about mental illness can determine religious rather than psychiatric help-seeking for such cases.
Belief in superstitious causes of mental illness can lead to seeking help from non-medical practitioners, which might hinder treatment. Lack of education and information has also been considered to be an attributing factor in such explanations of mental illness in the United Kingdom and in developing countries (Islam et al, 2015; Greenwood et al, 2014). According to Greenwood et al (2014), voluntary and community organization representatives stated that the stigma about mental illness was a factor for South Asian communities not attending local mental health awareness-related events. people who needed the support of services were failing to reach services until the crisis.
Furthermore, Bangladeshi carers may be less likely to seek out information about services, which may then result in them being less likely to be aware of services (McClelland et al, 2014). Reasons for not seeking out services include: a perception that care for kin is the family's responsibility, the information may not be provided in a culturally appropriate way or, because of the stigma associated with illness and disability or asking for help for themselves, they avoid admitting needing it (Mental health stigma in the Muslim community, 2012).
Methodology
This research is a desk-based research that involves an analytical review of existing research. The research subject is Mental illness and the group of people that this research is based on are the adults in the Bangladeshi Muslim community. This study will focus on and explore the attitudes toward mental illness in the Bangladeshi community and engage the Bangladeshi community about mental health services. The research will be obtained from journals, books, and electronic databases. Searches were also made in the A-Z database in the library catalog. The database used was CINHAL, google scholar, and SocIndex. Books on mental illness in the Bangladeshi community were difficult to find. However, books on mental illness and ethnic minorities were plenty. Four books from the University library were used for my research and study. When searching in the A-Z database, the SocIndex database was used. The word search used was ‘Mental illness and stigmatization’ 335 journal articles were found. However, when the search word was changed to ‘Mental illness in the Bangladeshi community, only two journal articles were found. When the search was made in google scholar, the search word used was ‘Attitudes towards mental illness in the Bangladeshi community’, but only three journal articles were found. I later typed the search word ‘Mental illness in the Muslim community’, as 90% of Bangladeshis were Muslims and they followed the Islamic religious tradition as well as their cultural tradition. I found plenty of information and journal articles on mental illness and Islam. So, a decision was made to use these journals and websites for my study. Instead of just writing about Bangladeshi culture, it was decided to go for religion also, as that has a big impact on ones thinking. Therefore, this paper is about the Bangladeshi Muslim community. All journals and researches are in full text, from the UK, and in the English language, and ethical principles such as consent, privacy, and confidentiality were followed in all the research used. Analysis was based on the principles of thematic analysis. Research from outside the United Kingdom and languages other than English were excluded. Only the most recent and relevant data for my subject were collated. Key search terms used for my study are:
- Mental health problems
- Mental illness
- South Asians and mental illness
- Bangladeshis and mental illness
- Muslims and mental health
- Mental illness and culture
- Mental illness stigma
- Care and mental illness
- Attitudes toward mental illness
- Multiculturalism.
Findings
The Bangladeshi population in the UK has grown rapidly, from 6,000 in 1961 to 162,835 in 1991 (Eade and Garbin, 2002), and is now estimated to be over double that figure. According to the 2001 Census, there were 275,395 Bangladeshis living in England of which 254,704 reported their religion as Muslim, 17 percent of England’s Muslim population (Gardner, 2002). The Bangladeshi Muslim community is the most concentrated and ethnically segregated Muslim community in England with 24 percent of the absolute Bangladeshi Muslim populace living in the London Borough of Tower Hamlets and a further 19 percent of the total population living in surrounding boroughs (Gardner, 2002).
Despite the growing size of the Islamic community in Western countries, most Western practitioners appear not to have been very well exposed to Islamic values and teachings during their educational careers (Sabry and Vohra, 2013). Researchers found that many Bangladeshi Muslims are hesitant to seek help from mental health professionals in Western countries due to the differences in their beliefs and lack of understating of the helping professionals about Islamic values in their treatment modalities (Mental health stigma in the Muslim community, 2012). Consequently, Muslims might feel uncomfortable in seeking psychiatric help to avoid being in conflict with their religious beliefs (Sabry and Vohra, 2013).
As indicated by the Mental Health Survey (2013), a network study found that there was an under-portrayal of British Asians in mental measurements, especially for full of feeling issues, for example, depression. Research demonstrated that there were lower rates of depression among South Asians (Karasz, 2005), including British Bangladeshis, compared to their British White partners (McClelland et al, 2014).
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