An in-depth look into the stigma of mental illness and how it affects the lives of those struggling as well as those who have pursued a career in the field.
You wake up to a busy Cairo morning with a sore throat and a headache. What do you do? You take a Panadol. You convince yourself it's really not a big deal. Just a cold and maybe in a few days it’ll go away. You head to work hoping your boss doesn’t notice you really shouldn’t be there. You continue working, timing your coughs for when your boss is no longer in the room. God forbid you get anyone at the office sick. And finally, you head home only to be greeted by the incessant pain in your throat. Again. Maybe you should go see a doctor? Nope, it’s really not a big deal, you conclude, but eventually that sore throat turns into a fever and you find yourself in a hospital bed surrounded by relatives you didn’t even know you had.
Pain and sickness are no joke, you begin to realise. Or rather, physical illnesses are no joke. Most people do not have a hard time acknowledging them once they are diagnosed. However, the same cannot be said for mental illnesses. You could say that human beings are infamous for rejecting what they don’t understand. And what many people don’t understand is mental illness. They categorise it under “dala'a", “avwara", or if you have them convinced, “genan", further worsening the stigma of mental illness.
In Egypt, you could be abandoned as a child, not be eligible for marriage, and lose your job if you have a mental illness. And for those who do seek help, often times it is really difficult to transition back to everyday society. The World Health Organization reports that for every death, there are 20 suicides. And despite the fact that there are over 62 outpatient mental health facilities in Egypt, suicide is still on the rise with 1,160 suicides in 2005, 2,355 in 2006, and 5,000 in 2009, according to Al Ahram.
The stigma of mental illness continues to affect those struggling with it as well as those who pursue a career in mental health. I spoke to both patients and professionals to shed light on the stigma and how it has impacted each of their journeys. Here are their stories.
When you see a therapist, which is a privilege many do not have, you’re allowed to reveal the ugliest sides of yourself
I was diagnosed with Obsessive Compulsive Disorder (OCD) after some believed I had autism when really my reclusiveness was the result of my OCD. In the beginning, I didn’t think I had a problem but after reflecting, I realised I do. It's counter-productive for workplaces and schools to stereotype and neglect what your problems are really about. It usually doesn’t have disastrous consequences, but it worsens the problem itself. If your workplace itself doesn’t take your illness into consideration, it often leads to more severe cases of anxiety and depression. My mother’s side of the family is Palestinian and so they’re even more traditional than my Egyptian relatives. I tried convincing my grandfather I have an actual problem. He doesn’t believe me. Some people just don’t believe mental illnesses exist. Life is much simpler in some societies and way more concrete.
People from less privileged backgrounds have it even worse because the stigma affects them from getting help, and almost always they cannot accept that they have a problem. When you see a therapist, which is a privilege many do not have, you’re allowed to reveal the ugliest sides of yourself in those sessions. My therapist is the only one who’s seen the most disgusting parts of me. Of course, some things you hide from your parents and so coming to speak to my therapist helps me find the best solutions.
I saw two therapists and one of them was the best so far for me because she had experience working with trans people but in Egypt
My feelings of depression started in grade 10 or 9. When I realised I was only attracted to women, it obviously took a long time to accept myself and acknowledge that I'm different. So, I hid this about myself for three years in high school, not wanting to go to a therapist or seek help because of the stigma and I didn’t want to be one of “those people” who need professional help. I ended up deciding to go in my first year of university because it was free and very discreet. I kept being very secretive about it for like 2-3 years. But honestly, after I started seeing how I can feel better and leading to my transition, it broke the image for me and I tell people about therapists and all of that. I feel like people are now starting to open up to the idea and share that they go to therapists and stuff, at least in our circles.
When I was in the US, I saw two therapists and one of them was the best so far for me because she had experience working with trans people but in Egypt. They were good too. They’re so big on disclosing to you that they’re not allowed to share anything you say to them with anyone except if you’re considering suicide, so my experience with the 3-4 therapists I’ve seen here has been pretty good.
I was exposed to the idea that antidepressants make you "numb" and you become dependent on them
I got my first panic attack in 2014 on a university bus while I was going home from a summer class. I've had anxiety ever since and was diagnosed very recently with anxiety and "mild” depression. The stigma of mental illness wasn't really a big deal for me except when it came to dealing with strangers, like my professors and bosses. For example, wanting to get out of having to take a final exam because I got a panic attack the night before and couldn't study because I was crying and puking. And then forcing myself to go and getting a bad grade because my professor wouldn't understand that I have anxiety.
When I started getting physical symptoms of anxiety like a fast heart rate, difficulty breathing, low blood pressure, numbing fingers, chest pain, my father took me to a doctor in the family who gave me a check up and when I told him I had anxiety, he told me to stop reading nonsense on the internet and that there's no such thing as anxiety or panic attacks. He suggested that I just need to gain weight and eat better and that this is “dala3”.
On the other hand, the only way I think the stigma affected me is when my doctor prescribed antidepressants and I was reluctant to take them because of the stigma around them. I was exposed to the idea that antidepressants make you "numb" and you become dependent on them and it was represented as a life-long commitment that's gonna mess with your brain. I was scared and reluctant to take the meds at first until I was very desperate and only then, I started taking them. I've been on medication for a year and a half now and they've honestly helped me a lot.
I realised the stigma around antidepressants comes from the stigma around mental health in general and people live on these meds and nothing happens to them. People get better on them and they do change people's lives for the better. What difference is it from, say diabetes meds or any meds that people take for chronic diseases?
he's just overreacting, look he doesn't even seem upset about it
When I went to my first therapist here in Egypt, it was because of an accident I had with sleeping pills. I had a shitty experience because the therapist would basically jump to so many conclusions in an annoying, all-knowing way. He wasn't understanding at all and didn't seem to put any effort into really grasping what it was I was going through. He took it more as "a young boy trying to get attention by pulling off a stunt" than a guy who was actually struggling. I kept seeing him for three months partly because I felt like it was the least I could do to reassure my parents and make them feel better after what they went through that day, but also because I still wanted to feel better and get help.
I never minded telling anyone I was seeing a therapist, mainly because I didn't really care what anyone would think. What I mean is: if you bring it up so lightly to people the way I did where I'd say "I have a therapist today, so let's try to go out another day", they're more likely to take it lightly the same way. But the problem with that is that if you don't make it seem like it's the end of the world, then Egyptians will think "he's just overreacting, look he doesn't even seem upset about it", you know? So, I guess in Egypt they either don't take you seriously at all or they treat you like you need special care all the time.
They see me as someone they can't talk to or fuck with
I was diagnosed with borderline personality disorder, insomnia, depression, and social anxiety. With social anxiety, people haven’t really accepted the concept. If a guy has social anxiety, he’s kind of a wuss. He doesn’t know how to talk to people and doesn’t know how to talk to girls. If a guy is shy, he’s a weirdo. If a guy has social anxiety, then he will get picked on.
When I first told my parents, they were kind of skeptical and were kind of in denial but after a while, I talked to my mother about my condition. And then they were pretty supportive. There were some things I couldn't say, otherwise I'd ruin the family. I didn’t really start talking to people about it until the depression and anxiety turned to anger. I had a bad temper and I used to fight everyone and everything. I got sick of people treating me the way they do. I sort of still have a temper problem. When I talk to people about it, they see me as a kid with temper problems instead of someone who’s going through something. They see me as someone they can't talk to or fuck with.
Alexandra Gazis, Assistant Director and Counselor at AUC
I think that social media like Facebook will actually help accommodate more people with mental illnesses
As psychiatrists and therapists, the most common thing you’ll hear as soon as you mention your profession is, “khaly balek a'ala nafsek tet'edy min el maganeen” (take care you don't catch the crazy from patients) and “te'dary te'ry fekry?” (can you read my mind?), essentially underestimating the real illness by poking fun at it.
Additionally, they mock the ways you practice therapy. They’ll say “Di bete'od tekalemhom wi takhaod felooshom wi khalas” (she just sits and talks to them and just takes their money). As someone working in mental health, you're also not as popular as other professionals because most people are embarrassed to say that they’re seeing a therapist because of the stigma. However, this has changed and has been changing. There are four or five groups for mental health awareness and well-being only. Marriage therapy and adolescent behavior and modification have also become very popular. I think that social media like Facebook will actually help accommodate more people with mental illnesses and essentially help in eliminating the stigma. After the revolution, the stigma of mental illness decreased and more people are seeking help for themselves as well as for their family members.
I think one of the main factors of this stigma is that the media doesn’t depict mentally ill people accurately
If you’re a psychologist or other professional, you often get asked, “how can you understand the patients if you’re not crazy as well?”. You don’t have to be “crazy” to understand them. They speak the same language as we do. Also, some people perceive us as mind-readers and people have come up to me at social gatherings asking if I can “read them”. No human being is 100 percent transparent and we do not, as professionals, analyse personalities.
Before I was a working professional, I visited the Abassia hospital (the psychiatric hospital in Cairo). I remember when we were renovating a ward, I was painting window shutters and a guy came up to me and told me I was doing it wrong. He explained to me how to do it right. I thought he was a member of the staff when really he was a patient that used to be a painter. He didn’t show any signs of how the media portrays those struggling with mental illness and I think one of the main factors of this stigma is that the media doesn’t depict mentally ill people accurately. How can we eliminate the stigma? There are evidence-based studies that suggest that the best way to eliminate stigma is to have contact with the patient. We need to be more inclusive of mentally ill people.
The last person I spoke to is both a patient and a therapist. Her story sheds light on how the stigma exists even within the field of mental health.
As Egyptians in general, we feel like we’re above everyone, especially the doctors who have a God complex
Recently, I realised that my generalised anxiety disorder affected every part of my life, my friendships, my relationship with my parents, as well as maintaining a relationship romantically. What made it worse was the stigma and how people deal with that kind of behavior. You get called names and you get treated as an alien. As a child, that really shapes your personality and affects you in a way there's no coming back from.
I work with special needs kids and other speech and language therapists. Most of the kids have parents that have challenged themselves and society and came to put their children in therapy. However, there are also pro-bono cases, which are a different story. One child I’m working with was abandoned in the streets by his parents.
In my profession as a therapist, I get stigmatised, “di magnoona ba'a” (she's crazy), “tab hazby teganeny” (be careful you don't turn crazy). To me, it comes from ignorance. Working at a special needs place, all the kids we get are in therapy. When I told my boss I couldn’t come to work on Sunday because I had therapy, he said, “Leh betroohy therapy enty kwayesa aho” (Why would you go to therapy? You're fine).
Psychiatrists go to medical school and don’t receive any training in counseling. You can be stigmatised against by your own therapist. Some will say, “Da shwayet panic bas ehdy shwaya, khody bo'a maya” (It's just a little panic, calm down, have a sip of water). I feel like a huge part of this is the internalised Egyptian persona. As Egyptians in general, we feel like we’re above everyone, especially the doctors who have a God complex. unless you’re bleeding on the floor gasping, to them, you’re not sick.
Writing this has been an eye-opening experience for me. I have known a number of the patients in this article my whole life and have not been aware of their stories until recently. Denying the existence of cases like these will not make them go away. Rejecting them will only feed your ignorance. The stigma of mental illness is very much real and alive in our culture and around the world. So, if you have the tiniest inkling that your mental health is not what it should be, get help. Your illness is real and valid.
*Names of the patients have been changed to protect their privacy.