The DSM and Muslim mental health

In this article, Saadia Tayyaba appraises the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental health problems among Muslims living in minority contexts.

Saadia is a Non-clinical Lecturer and Psychometrician at the School of Medicine, Cardiff University.

The DSM is based on what are considered to be universal norms for mental health in the field of mainstream (or Western) Psychology. In the DSM, mental health problems are defined as unique patterns of behaviour that occur because of psychological dysfunction which become evident because an individual is unable to function as normal and/or because they are distressed (DSM IV, APA, 2000, pp.xx1-xxii).

The DSM definition of mental health problems has, however, been debated and criticised for not taking into account different understandings and explanations for mental health problems from non-Western contexts. People from other cultural backgrounds may understand and describe the symptoms of their mental health problems in ways that are not recognised within the DSM (Salman, 2020).

The DSM classification does not consider the full range of ways in which mental health problems are described and experienced in a multicultural and religiously diverse society like Britain. Insufficient attention to culturally or religiously informed expressions and understandings of mental health problems can lead to incorrect diagnoses, inappropriate mental health support, or no support at all. Adjustment of DSM criteria to identify the causes of mental health problems for Muslim communities is essential.

For example, within some Muslim communities, mental health problems are attributed to spiritual beliefs around spirit possession. Therefore, spirit possession can be seen as a religiously specific way of displaying mental health problems. The association of mental health problems with spirit possession is not the norm in Western cultures and so, this presents a major diagnostic challenge because the DSM classification does not sufficiently consider the religious and spiritual beliefs that underlie such understandings of mental health problems. If the DSM criteria for mental health problems included additional criteria for accepted religiously informed spiritual beliefs among Muslims, this would help mental health practitioners to distinguish between these religious beliefs and actual psychological symptoms.

Mental health practitioners would benefit from a greater awareness of religiously informed understandings of mental health problems among Muslims. This might be achieved through engaging with Muslim communities using collaborative methods to gain meaningful understandings. These nuanced understandings might then feed into the development of appropriate and sensitive approaches to mental health service delivery for these communities. In particular, a familiarity with the language Muslims use to describe experiences and symptoms of mental health problems would be helpful.

For example, commonly used terms to explain the symptoms of depression in some Arabic and Urdu speaking Muslim communities include khunaq or afsordegi, which can be translated to low mood and sadness (Good et al. 1985). In Shi’ite Islam, for example, grief is a religious experience, associated with a recognition of the tragic consequences of living justly in an unjust world (Good et al. 1985). Thus, Shi’ite people may not consider that they have depression, instead, they might see prolonged periods of sadness and grief as a natural reaction to various external causes such as accidents, unfavourable socio-economic living conditions, or physical illness.