It’s OK to ask for help

Saudis are break­ing the stigma of mental ther­apy by be­ing given a choice be­tween on­line and face-to-face coun­selling

Arab News - - Spotlight - Ameera Abid Jed­dah

It’s pretty typ­i­cal for so­ci­eties to brush off mental health problems as mi­nor is­sues caused by fluc­tu­a­tions of a per­son’s man­ner, some­times even blamed as a per­son­al­ity trait. But the un­der­ly­ing truth is that mental health aware­ness and the im­por­tance of seek­ing help when needed is still seen as a stigma or taboo. Keep­ing to one­self is seen as “safer” than ven­tur­ing out to find proper care. Not any more.

Hala Ab­dul­lah first real­ized she needed help when she ex­pe­ri­enced breath­ing problems for two weeks at a stretch. Ev­ery time she tried to sleep, she found her­self strug­gling. When Ab­dul­lah con­sulted a pul­mo­nolo­gist, he made her go through the whole gamut of tests, then gave her his di­ag­no­sis: Anx­i­ety dis­or­der, which had noth­ing to do with her lungs.

A sub­se­quent visit to a ther­a­pist con­firmed the doc­tor’s di­ag­no­sis. The 27-year-old Saudi is an ex­cep­tion, in the sense that she is one of the rare peo­ple who is not only will­ing to talk about mental ill­ness but also do it on so­cial me­dia, thus help­ing to shed light on a con­di­tion that is be­lieved to af­fect nearly one out of ev­ery two peo­ple in Saudi Ara­bia, ac­cord­ing to the Jour­nal of Clin­i­cal Psy­chi­a­try.

“I am a mar­ke­teer by pro­fes­sion and a poet by pas­sion,” Hala Ab­dul­lah told Arab News. “Rec­og­niz­ing that I needed help wasn’t easy. It took me a long time to re­al­ize that the phys­i­cal pain I was ex­pe­ri­enc­ing was a symp­tom of a big­ger prob­lem.”

Around the world, the re­al­iza­tion has been slow, too, that mental ill­ness is noth­ing to be ashamed of. Those who have read Harry Pot­ter and the Deathly Hal­lows will re­call Pro­fes­sor Al­bus Dum­ble­dore say­ing: “Of course it is hap­pen­ing in­side your head, but why on earth should that mean that it is not real?”

In­deed, mental ill­ness is a med­i­cal con­di­tion no dif­fer­ent from heart dis­ease or di­a­betes and is treat­able. Sci­en­tists are con­stantly ex­pand­ing the un­der­stand­ing of how the hu­man brain func­tions and have de­ter­mined that mental health is the foun­da­tion for emo­tions, think­ing, com­mu­ni­ca­tion, and self-es­teem. Treat­ments are avail­able to help peo­ple cope with a wide range of mental health dis­or­ders.

The Amer­i­can Psy­chi­atric As­so­ci­a­tion de­fines mental ill­nesses as “health con­di­tions in­volv­ing changes in emo­tion, think­ing or be­hav­ior or a com­bi­na­tion of these.” It says that “while mental ill­ness can oc­cur at any age, three quar­ters of all mental ill­ness be­gins by the age of 24.”

It is in­creas­ingly ac­cepted in Saudi Ara­bia that the best way to pro­mote mental health aware­ness and help the pub­lic’s un­der­stand­ing of the is­sue is to talk about it. Hala Ab­dul­lah said the ther­a­pist’s di­ag­no­sis was a dif­fi­cult con­ver­sa­tion to have with her par­ents, but she was sur­prised by the sup­port they of­fered.

“I wanted to breathe, or maybe just go an en­tire day with­out be­ing in some kind of pain,” she said. “The med­i­ca­tion helped. It took a cou­ple of weeks to re­ally set­tle in, but I was able to func­tion again on a day-to-day level. I was able to sleep. To fo­cus. To breathe.

“It is OK to ask for help when you need it. The peo­ple in our lives would rather we ask for help than suf­fer qui­etly. So, let them in.”

Al­though Saudi Ara­bia has seen much progress in re­cent years in ad­dress­ing mental ill­ness as a pub­lic-health is­sue, it was not al­ways like that. Up un­til the 1980s, the treat­ment of peo­ple with any kind of dis­or­der, specif­i­cally those with chronic psy­chotic dis­or­ders in ru­ral ar­eas, in­volved tra­di­tional and mal­treat­ment of chil­dren were con­sid­ered a pri­vate mat­ter, so was mental ill­ness, an at­ti­tude that to a large ex­tent con­tin­ues to this day be­cause of the ap­par­ent stigma at­tached to it. Rarely do Saudis get to hear of some­body seek­ing ther­apy even though many dis­or­ders are mild and in­ter­fere in lim­ited ways with daily life, and de­spite the fact that only those with se­vere con­di­tions re­quire care in a hos­pi­tal.

“The pre­oc­cu­pa­tion with avoid­ing stigma and the ad­verse so­cial and psy­cho­log­i­cal ef­fects as­so­ci­ated with it, such as em­bar­rass­ment or shame, may act as a de­ter­rent to seek­ing psy­cho­log­i­cal help,” said Dr. Manal Kayal, coun­selor and psy­chother­a­pist at IMC Hos­pi­tal in Jed­dah.

Un­sur­pris­ingly, peo­ple of­ten with­hold sen­si­tive in­for­ma­tion about them­selves al­though, in re­al­ity, they can be sure that psy­cho­log­i­cal ser­vices pro­vide a safe and trust­ing at­mos­phere with­out fear about con­fi­den­tial­ity.

“Main­tain­ing con­fi­den­tial­ity is an ex­pected el­e­ment in psy­cho­log­i­cal ser­vices,” Dr. Kayal said. “More­over, psy­cho­log­i­cal ser­vices are not meant for ‘sick’ or ‘ in­sane’ peo­ple, but aimed at as­sist­ing peo­ple who con­front a mul­ti­tude of con­cerns rang­ing from aca­demic dif­fi­cul­ties and ca­reer de­vel­op­ment strug­gles to more se­vere psy­cho­log­i­cal problems.”

The good news is that events are be­ing or­ga­nized with in­creas­ing reg­u­lar­ity on the is­sue of mental ill­ness to make sure that ther­a­peu­tic help is avail­able to those in need. For in­stance, the ACT Adult & Child Ther­apy Cen­ter in Jed­dah has held sev­eral ses­sions and work­shops both for peo­ple suf­fer­ing from dis­or­ders and for their fam­i­lies. The cen­ter des­ig­nated Oc­to­ber as the Mental Health Aware­ness Month.

An in­creas­ingly pop­u­lar tech­nique of mak­ing treat­ment ac­ces­si­ble to the pub­lic is on­line psy­chother­apy, which takes the chore out of reg­u­lar vis­its to a hos­pi­tal. For Saudis, one of the many web­sites of­fer­ing this type of dis­tance ther­apy is YouPos­i­tive, which was founded in Jed­dah. The ser­vices it pro­vides are suit­able for peo­ple from age 18 to 50 and in­clude both off­line and on­line life coach­ing and psy­cho­log­i­cal coun­sel­ing by cer­ti­fied and li­censed pro­fes­sion­als.

Speak­ing to Arab News, Dr. Hawazan Bin­zaqr, a YouPos­i­tive coun­selor, said the peo­ple she in­ter­acted with typ­i­cally showed symp­toms of mild, mod­er­ate or se­vere anx­i­ety dis­or­ders, de­pres­sion and other mental ill­nesses.

The ob­vi­ous ad­van­tages of on­line coun­sel­ing over face-to­face ses­sions be­tween a psy­chother­a­pist and a pa­tient in a clinic, begs the ques­tion as to whether the for­mer method can make a real dif­fer­ence to a pa­tient’s con­di­tion. “On­line ther­apy is a bless­ing for peo­ple who can­not visit a cen­ter be­cause they might be in an­other city or coun­try,” Dr. Bin­zaqr told Arab News. “Treat­ment from the com­fort of the home is more con­ve­nient for them be­cause they might find un­pleas­ant the idea of reg­u­larly vis­it­ing a cen­ter for coun­sel­ing in per­son, as well as its im­pact on their so­cial stand­ing or pro­fes­sional rep­u­ta­tion.”

Ex­plain­ing the steps of the ther­apy, Dr. Bin­zaqr said that to as­sure peo­ple that there is noth­ing to be hes­i­tant about, “the ther­a­pist lis­tens to the client over sev­eral ses­sions, ac­cepts the client un­con­di­tion­ally mak­ing no judg­ment what­so­ever, and all the in­for­ma­tion is kept com­pletely con­fi­den­tial.

“The most im­por­tant step is to build a re­la­tion­ship be­tween the client and the ther­a­pist. Typ­i­cally, the client ex­presses their feel­ings through the ses­sions while the ther­a­pist en­cour­ages, em­pow­ers, teaches and guides the client through the com­pli­ca­tions of life.”

Ac­cord­ing to Dr. Bin­zaqr, ideally “one should share the names of their ther­a­pists with­out em­bar­rass­ment, talk about the treat­ment at home and at work, and even post in­for­ma­tion on so­cial me­dia, blogs, and mag­a­zines. These steps are nec­es­sary to en­sure sound mental health of a fam­ily.”

Mental health is not an in­ap­pro­pri­ate topic that should not be dis­cussed in hushed tones and locked away in jour­nals, say doc­tors. Rather, it should be talked about, an­a­lyzed and treated as a nor­mal part of life. Since mental health is key to a per­son’s re­la­tion­ships and per­sonal and emo­tional well-be­ing, psy­chi­a­trists and coun­selors say those who share their ex­pe­ri­ences would be sur­prised to learn how many peo­ple around them could use that in­for­ma­tion.

Of­fers the hu­man touch, a per­sonal con­nec­tion.Ther­a­pist can ob­serve body lan­guage, which can be help­ful.As the tra­di­tional means of re­ceiv­ing ther­apy, it helps the client feel more con­fi­dent or open about the is­sue.Ex­pen­sive, al­most dou­ble the price of on­line ther­apy.If you miss an ap­point­ment you have to wait un­til the next ses­sion.Long-dis­tance travel to ap­point­ments can be an is­sue.Cheaper than in-of­fice ther­apy.Al­lows ther­a­pists and clients to chat mul­ti­ple times a day.Ther­a­pists and clients can talk across con­ti­nents.May not be able to re­spond in times of cri­sis.May not be ap­pro­pri­ate for those with se­ri­ous psy­chi­atric con­di­tions.If ther­a­pist and client be­long to dif­fer­ent cul­tures, it can be harder to un­der­stand con­text.

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