Monday, 12 November 2012

Sisters take on stigma of mental health in Kuwait, Awareness, education seen as crucial

Sisters take on stigma of mental health in Kuwait,  Awareness and education seen as crucial
SOUND mental health is essential to an individual’s total well-being and thus vital to society at large. Sisters Alaa and Dalal AlHomaizi, who have championed the cause and addressed issues of mental health through their organisation Standing for Psychological Education and Awareness in Kuwait (SPEAK) shed some much needed light on the topic of mental health while disclosing the perceptions and attitudes of people towards mental illness and the barriers to treatment. Believing that awareness and education in this regard is crucial to society’s welfare, they elaborate on the activities of SPEAK and what they hope to achieve.

Question: Can you enlighten us on your background and why you both decided to pursue studies in Psychology?

Dalal: When Alaa was in the 9th grade, she saw a documentary on Obsessive-Compulsive Disorders (OCD) that included stories about the lives of the brave people living with it and the treatment of OCD. She became very interested in the field of psychology and went back to her high school counselor and asked her all about it. She loved it instantly!

Alaa: Dalal, at that time, wanted to pursue medical school. However, by the end of high school, Dalal realized she wasn’t really interested in the field of medicine and found herself interested in the field of psychology as well. After high school, we first entered Kuwait University and then transferred to Northeastern University in Boston in the US to study psychology.

Dalal: We are currently both studying to attain a Bachelor of Science in Psychology, are part of the Honors program, and are research assistants at Massachusetts General Hospital/Harvard Medical School.

Q: Your decision to study Psychology garnered a negative response from people. Can you elaborate on that experience?

Alaa: Ever since we told people we wanted to pursue the field of psychology, we have received quite a lot of negative reactions. Some have told us that we should not waste our “smarts” on psychology and should instead pursue medicine or that we would be dealing with “crazy” people. Of course, this was ridiculous to us and we just assumed these people didn’t understand the true nature of mental illness.

Dalal: Negative responses didn’t just come from people, it even came from officials. With near perfect grades, we were easily eligible for a scholarship from the Ministry of Higher Education. However, our selection of the major of psychology lost us that scholarship. When we went to apply for a scholarship, our father was asked by a prominent official at the Ministry for Higher Education why he would allow his daughters to deal with ‘crazy’ people and if he, or any Kuwaiti for that matter, would ever seek a psychologist.

Alaa: Despite our father jumping to our aid by stating that he thinks there is no shame in seeing a psychologist if needed, we never got the scholarship. Not only did the Ministry of Higher Education not support our choice and disrespect people with mental illnesses, who should never be called ‘crazy’, they were biased against the field of psychology in general by claiming it is not needed in Kuwait! You can only imagine how prejudiced our society is towards people with mental disorders, if they are this prejudiced towards people working in the field of psychology. Regardless, we are extremely lucky to have a very supportive family.

Dalal: Our parents, family and friends have been our greatest supporters. Our SPEAK supporters have also been amazing! We also have wonderful support from Northeastern University, Massachusetts General Hospital/Harvard Medical School, and many inspiring professionals from Kuwait. So we are extremely grateful to have so many people support our career as well as our work with SPEAK.

Q: How did SPEAK come about?

Alaa: Due to the negative response that we got from people when we decided to pursue psychology, we wanted to show the people the truth about what psychology does and whom it can help.

Dalal: But it wasn’t until we took the class “Deviant Behavior and Social Control”, at Northeastern University, that we realized how pervasive the problem of stigma is in our society. In this class, we learned about all types of people that society unfoundedly deems are deviants or “different”. We were shocked to learn about the cruel and inhumane way people with mental illness are treated in almost all societies of the world at almost every point in our human history. The fact that we are in the 21st century and some people in society still disrespect, dehumanize, institutionalize, and look down upon people with mental illness is disgraceful. It is unfair, unfounded, and we decided we needed to do something about it.

Alaa: Northeastern University offers something called a “Directed Study” where you get a faculty member to cover a subject that you are interested in and supervise your research in that topic. So we created a class where we could study mental illness in the Middle East, stigma in the Middle East, and how to develop a program to reduce the stigma of mental health in a Muslim, Arab population. We spent an entire semester researching it. We also went around Kuwait and asked psychologists, psychiatrists, and regular people about their views on mental illness and mental health treatment as well as their take on the issue of stigma in Kuwait. The final project of the class was to create an evidence-based culturally competent campaign, which we called Standing for Psychological Education and Awareness in Kuwait or SPEAK.

Q: What is the scope of SPEAK? How have you involved yourself in the community?

Dalal: Our work with SPEAK includes giving anti-stigma presentations for the public and/or professionals and providing mental health and anti-stigma information through newspapers, magazines, TV, radio, blogs, etc. Also, social media outlets such as twitter (@speakuwait), facebook (, and ( are our primary sources of spreading awareness and information about mental health and stigma. Social media outlets and the press have been a blessing and has enabled us to reach a wide audience even while we are still studying and working in the US During our breaks, in the winter and summer, we conduct live presentations.

Alaa: SPEAK has been covered in many national and international media outlets and our anti-stigma research has been presented at the Northeastern University’s Honor’s Evening and will be featured at the National Collegiate Honors Conference in November 2012. We’ve given anti-stigma presentations at the Mortaqa Leadership Training for Girls in Kuwait, Women’s Cultural and Social Society in Kuwait, and the Almajles Alkhaleejee student association in Boston. Our most recent and largest event was on World Mental Health Day on Oct 10-11 in Kuwait. SPEAK in association with the Ministry of Health hosted a conference featuring leading psychiatrists from Harvard Medical School and Massachusetts General Hospital, the number 1 hospital in the USA. The two-day event included large public presentations in the evening and seminars for doctors and health professionals in the morning.

Q: Looking at Kuwait, can you shed some light on the prevalence and/or severity of mental health diseases?

Dalal: According to the World Health Organization (WHO), mental disorders affect an estimated 450 million people worldwide. One in four people are likely to face a mental health problem at some period in their life. Five out of the ten leading causes of health disability are mental disorders, and by 2020, depression will be the second most disabling health condition in the world! This puts it ahead of heart disease, road traffic accidents, and chronic obstructive pulmonary disease. Mental disorders which include common disorders like depression and anxiety - affects people of all genders, religions, nationalities, and income levels. Mental illness can definitely be treated and/or managed. People with mental illness can lead full, productive lives. And as with every illness, mental illnesses are better treated earlier. Sadly, due to the stigma attached, people are ashamed of seeking treatment and delay or refuse treatment. This is extremely wrong because the later you go to seek treatment, the more difficult it will be.

Dalal: Unfortunately, we do not have any prevalence rates on specific disorders in Kuwait. We need extensive research on this and for a very long time mental health took a back seat in research. Hopefully in the future Kuwait will invest more in mental health research because without research, we can never know the extent or nature of mental health problems prevalent here.

Q: What are generally the most common ailments and who is most at risk?

Alaa: We don’t have any local statistics. But globally, the most common mental disorder is depression. Other common mental illnesses are bipolar disorders and anxiety disorders (for example: obsessive-compulsive Disorder, phobias, post-traumatic stress disorders, generalized anxiety disorder etc.). The least common mental illness is schizophrenia, which occurs to about 1% of the population. All mental disorders, from depression to schizophrenia, can be treated with therapy, medication, or a combination of both.

Dalal: With regards to mental illness being found in certain demographics, actually all mental illness including depression, anxiety, bipolar, etc. can occur to people of all ages, even children. Of course, they don’t look the same. For example, depressed children seem to be more irritable than sad.

Alaa: The rates of mental illness differ per demographic. For example, women are twice as likely as men to suffer depression. Also, Attention Deficit/Hyperactivity Disorder and learning disorders are common in children.

Dalal: We don’t really know who exactly is at risk for mental illnesses. Just like with all illnesses there are several factors to consider and even if someone has all these factors they may still never develop a mental illness in their life. The factors that may affect why a person has a mental illness are genetics, their environment, life events, etc. Some factors may put a person at risk for a mental illness, such as extreme trauma, but then again, it’s not necessarily going to cause a mental illness.

Q: How are mental illnesses diagnosed? What are the preferred treatments?

Alaa: Whether you do have a mental illness or not is not something you can determine by just reading about its symptoms on the Internet or from a book. The diagnosis of a mental illness can only given by a licensed Psychologist or Psychiatrist who usually uses specifically designed interviews and assessments and looks at symptoms, duration, and relevant medical history.

Dalal: As a result of the stigma attached to mental illness, many people refuse to be diagnosed with a mental illness. However, receiving a diagnosis is an essential part of finding an effective treatment plan. A diagnosis is not about applying a label to a problem. It is about understanding the reason behind the difficulties a person is facing and discovering solutions and treatments to manage them. More importantly, a diagnosis allows the person to access the treatment he/she needs.

Q: What are the commons barriers to treatment?

Dalal: People with a mental illness deserve to access treatment. However, the stigma of mental health usually causes people to fear seeking treating because they are worried how society might react to them. Unfortunately, society usually discriminates and excludes people with a mental illnesses. Even worse, sometimes an individual with a mental illnesses may face this treatment at home and from their own family. Many families will pressure the person with a mental illness into hiding his/her symptoms as long as possible. This usually results in patients seeking treatment when they have reached the more advanced stages of their mental illness which usually causes them more suffering.

Alaa: What families and even friends of people with mental illnesses don’t know is that one if the best predictors of the success of treatment is their support. When a person with a mental illness knows the people in his/her life are there for him/her, he/she are more likely to seek help and do well in treatment.

Q: Can early intervention help patients? Are there any preventative measures?

Dalal: Early intervention is vital in the treatment of every single illness, including mental illness. The later you treat a mental illness, the higher the chances are of the mental illness becoming chronic, more difficult to treat, and/or the slower the path is to recovery. Therefore, if you think you or someone you love has a mental illness, then seek treatment. People will almost always be better off after treatment. You can only get better with accurate and good treatment.

Alaa: There are preventative measures in mental health. This is an extremely large area of mental health around the world and so we can only shallowly get into here. According to the World Health Organization (WHO), preventative measures in mental health include two main things: mental health promotion and prevention of mental health disorders. Basically, with mental health promotion the goal is to increase positive mental health, psychological well-being and to promote supportive environments that foster mental health. As for mental health prevention the goal is to increase the protective factors that defend against mental disorders, such as social support, and to decrease risk factors for mental disorders, such as trauma and abuse.

Q: How can you persuade someone to seek help?

Choosing to seek treatment should be the choice of the individual with the mental health problem because the first step to getting help and feeling better is for them to acknowledge that they have a problem and need help. Acknowledging that they need treatment and having the desire to get better can help make the path to recovery easier and faster. However, family and friends of these individuals can also be there for them by supporting them in this brave battle. This type of support is known as social support and social support from family and friends is one of the strongest predictors of recovery and a better quality of life for an individual with a mental illness.

Q: Can you elaborate on the social stigma that accompanies mental illness?

Dalal: The stigma of mental illness is universal and is not only found in Kuwait, it occurs in all countries in varying degrees. It is a result of widespread negative stereotypes that have been portrayed in the media, the lack of knowledge about psychology as a discipline and the experience of mental illness, and the inhumane practice of past psychological asylums. Unfortunately, the media has played an active role in portraying people with a mental illness as “weirdos” and ‘freaks’ or even sadly, ‘criminals’. And that is in NO way accurate, because people with a mental illness are no more violent than the rest of the population and “violence” was never and will never be listed a “symptom” of a mental illness. Unfortunately the media and word of mouth are the common sources of information about mental illness to the public, thus people are at a big risk of hearing exaggerated or untrue stories of the horrors of mental illness. However if you hear the stories from people who have experienced it first hand or have a family member with a mental illness, the stories are very different. Finally, due to the invalid and inhumane practices of the “crazy hospitals” in the past where people were tied up and treated like infants, people automatically think that people with a mental illness should be isolated from society. What they don’t realize is this is not the treatment for mental illness; this is a violation of the most basic human right, freedom, and the right to receive appropriate treatment.

Alaa: What is important to remember is that people with mental illnesses are just like us. They are parents, daughters, brothers, husbands, doctors, engineers, and businessmen. They are no different; we choose to see them as different. If you had an illness such as the flu or a chronic illness such as diabetes, would you want the people to kick you out of their communities or would you want them to hold your hand and help you in this healing process? Therefore, people with mental illnesses suffer the burden of stigma in addition to their psychiatric symptoms, which makes their experience particularly difficult.

Q: Is the Kuwaiti environment/society conducive to good mental health?

Dalal: Most people with mental illness in Kuwait risk social rejection, prejudice, and discrimination from society. This stigma forces the person with a mental illness into hiding their illness from fear of being mocked or judged by society. People in every society, including Kuwait, are not very understanding and accepting to people with mental illness.

Alaa: One of the worse outcomes of the stigma that people with mental illness face in our society is delaying treatment. They are afraid of being labeled “mentally ill” and being ridiculed by people so they refuse or delay getting. This is very wrong because when they finally seek treatment, the treatment will be more difficult and the recovery will take longer, all this because of people’s perception of mental illness.

Dalal: Of course, by presenting people with education and the accurate information about the nature, treatment or manageability, and experience of having a mental illness, many people become less stigmatizing and less prejudiced. This is what we do with SPEAK and countless Kuwaitis are changing their perceptions and becoming more accepting and less judgmental regarding the field of mental health and people living with mental illness in Kuwait.

Alaa: There is an aspect of society that is considered quite conducive to mental health. Kuwait is characterized as a society with strong family relations which means great “social support”. Social support is when your family or friends are there for you when you are going through a difficult time in your life or when you are seeking treatment for an illness, like a mental illness. This is extremely important for many reasons. First and foremost, when a person goes through problems or trauma, if they have social support, they are less likely to develop a mental illness or have mental health problems. Second, if a person living with mental illness is going through treatment and has social support, their chances of recovering from a mental illness increase a lot. Finally, social support is very important in the journey to recovery or manageability of a mental illness. Most psychologists/psychiatrist offer psycho-education to the family members of people living with a mental illness. Psycho-education is when the doctor explains to the family about the illness of their family member. This allows the family to understand and empathize with what their family with a mental illness is going through. This understanding makes the experience of having a mental illness not only easier and smoother on the patient, but also on those that love him/her.

Dalal: We are extremely fortunate to have a protective mechanism, social support, built into our societal structure. As long as we increase social support and decrease stigma in the Kuwaiti culture, people with mental illness or without a mental illness in Kuwait will be blessed an environment truly conducive to good mental health!

Q: How would you rate the level of awareness concerning mental health in Kuwait?

Dalal: To accurately know the level of awareness, we need to measure with empirical, scientific research. Currently, no such project is underway, yet. However, we can judge the awareness level of mental health by different indicators. First, in general compared to other fields of health, there is a general lack of awareness and interest in the field of mental health in Kuwait. Many people still regard the field of mental health, which is one of the three pillars of health (i.e. physical, mental, and social health), as unimportant.

Alaa: Previously, the field of mental health took a back seat in the government and was not given the same priorities as other fields of medicine. However, this is slowly and quite greatly changing. For example, the Ministry of Health has taken a great interest in the field of mental health and psychiatry. The Ministry has opened about 5-10 mental health clinics in our primary care centers, which previously only included medical services.

Dalal: Also, the Ministry has established a new psychiatry residency in Kuwait, to train medical students in psychiatry. One of the ways we measure awareness is through institutional support or the support of authorities or governments and as you can see this is increasing. Of course, this is just the beginning. To truly increase awareness and importance of mental health, we need policies to improve the care and rights of people living with mental illness, to keep improving the mental health services in the public and private clinics, to increase mental health research, to provide scholarships to study psychology abroad, and many more.

Q: What are the biggest misconceptions about mental health diseases that you have come across?

Dalal: We have come across a lot of misconceptions regarding the field of mental health, mental illnesses, and the treatment of mental illnesses. There is a misconception that people with a mental illness are violent and dangerous but in reality they are no more violent or dangerous than the general population. But in reality, the majority of them are not violent and are more likely to be victims and targets of violence.

Alaa: Another commonly held belief is that treatment doesn’t work and that once a person is affected with a mental illness, they will never recover. But this is false; most mental illnesses are highly treatable. There are many diverse treatment and medication options. And with every passing day research is going into increasing the success rate of treatment, which is already very high. People with mental illness can and do lead full and productive lives.

Another myth we’ve come across it that mental illness is the result of people’s imagination and is not as real as a physical illness. Mental illnesses are very real. Their symptoms are not imagined and cause a person great suffering and impairment if untreated; they have biological and genetic causes like physical illness, but also have psychological and environmental causes as well.

Alaa: People have also believed the falsehood that mental illnesses are contagious. Mental illnesses are NOT contagious. Once a person is diagnosed with bipolar or depression, they will not infect others. Mental illnesses are illness of the brain, they are usually caused by a combination of biological, psychological, and environmental factors not viruses and bacteria. Thus they cannot be transmitted from one person to another.

Dalal: It is also untrue that people with a mental illness cannot hold down a job. We have an overwhelming examples of people with mental illnesses who have flourished in their careers — Nobel Prize winner for Economics John Nash who suffered with schizophrenia, Former US President Abraham Lincoln who was ailed with severe clinical depression, Former UK Prime Minister Winston Churchill who contended with bipolar disorder and dyslexia.


Dalal AlHomaizi and Alaa AlHomaizi are the founders of Standing for Psychological Education and Awareness (SPEAK) campaign, the first campaign of its kind in Kuwait. The SPEAK campaign works to reduce the stigma of mental health, to be a source of mental health information and to promote excellence in psychology and psychiatry in Kuwait.

Dalal and Alaa work as full-time student research assistants in The Chester M. Pierce, MD Division of Global Psychiatry in the Department of Psychiatry at Massachusetts General Hospital, the largest and oldest teaching hospital of Harvard Medical School. They provide critical support to Harvard faculty and MGH staff on global research, policy, and development projects that span the spectrum of adult and child mental health related areas. They also work as part-time research assistants in the Clinical Neuroscience and Development Neuropsychology Lab at Massachusetts General Hospital/Harvard Medical School where they assist in research projects using functional Magnetic Resonance Imaging (fMRI) with adolescent populations.

Dalal and Alaa currently study psychology at Northeastern University, where they are in the Undergraduate Honors Program and on the Dean’s List. They have received the prestigious Northeastern University International Scholars Award and Scholarship, and are members of the Psi Chi International Honors Society, American Psychological Association, and the National Alliance on Mental Illness.

Dalal and Alaa plan to pursue a Clinical Psychology Doctorates (PhDs). Alaa’s interests are in mental health policy, child and adolescent mental health and development, and cross-cultural psychology. Dalal’s interests are mood disorders, spirituality, and cross-cultural psychology.

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