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Immigration, Islamophobia, and Psychiatry

Immigration, Islamophobia, and Psychiatry

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PSYCHIATRIC VIEWS ON THE NEWS

Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.

-Yoda, Star Wars: The Phantom Menace

When the Presidential edict to put a moratorium on immigration from 7 countries came out on Friday, January 27th, I was in the early stages of planning a presentation on social, clinical, and religious perspectives of Islamophobia for the upcoming annual APA meeting in May. Colleagues raised questions of whether the Presidential pronouncement related to Islamophobia. When I mentioned that I was to present on the topic at the meeting, they asked, “Why wait”? Why wait, indeed.

When the executive order was signed on International Holocaust Remembrance Day, the President did not even mention the millions of Jews who were killed on that day. Jews who wanted to immigrate to the US during the Holocaust were turned away, and history shows that when Jews are discriminated against, they are often not the first group.

Here are some of my initial ideas on the topic.

What is Islamophobia?

The term literally means an excessive fear of Islam. Phobia is also a psychiatric diagnostic term. Given that “specific phobias” are a diagnostic category in DSM-5, is it a diagnosable disorder?

Never did I have a patient where that diagnostic consideration came up. Nor have I heard of any colleague considering or making that diagnosis.

In DSM-5, a phobia is defined as “an anxiety disorder involving a persistent fear of an object, place, or situation disproportional to the threat or danger posed by the object of the fear.” Given that, couldn't Islamophobia qualify? Indeed, it seems like it could as you continue to read about it, that is, it seems so until you get to one of the specific criteria: “The person recognizes the fear is out of proportion.” It seems to me that the people who fear Islam feel it is reasonable. Just take Lt. General Michael Flynn, national security advisor to President Trump, who tweeted: “Fear of Muslims is RATIONAL...”1,2

The recommended treatments for a phobia include cognitive behavioral therapy (CBT) to down regulate the threat response, which may be abnormally hyperactive, or various varieties of exposure therapy to desensitize the patient. Meditation and medication are also used. Even if Islamophobia does not technically qualify for an individual DSM-5 diagnosis, would any of these treatments still be of use?

Social factors

The term Islamophobia predates any versions of DSM. Approximately a century old, Islamophobia came into prominent media usage after the 9/11 terrorist attack in the US, an attack linked to people who were Muslim, although these perpetrators did not come from any of the countries in the current moratorium. So, the term appears to refer to the ensuing social changes in the US after that terrorist trauma.

Millions of Muslims were already living peacefully in the US, from Southeast Asia, the Middle East, and converted Black Americans. Moreover, the public can assume that someone is Muslim, when they never were, or they had renounced their religious beliefs.

We do not—and never did—have a psychiatric classification of social disorders, though there have been some attempts to do so over the years, or at least to include social pathology into DSM, as in the case of racism. One limiting factor is where to draw the line, as implicit bias tests can suggest that most, if not all, of us have some degree of racism.

In addition to racism, other social pathologies to consider are based on an ism or phobia. Phobia probably assumes more fear, and includes homophobia and the broader xenophobia (fear of strangers and foreigners). After all, anti-Islamism could have been embraced instead of Islamophobia. Isms include racism, sexism, ageism, and the longstanding anti-Semitism. All are subject to prejudice and discrimination by the majority and dominant culture—but negative attitudes toward Muslims poll higher than any other group.3

From a psychoanalytic perspective, certain concepts may fit Islamophobia and other social phobias and isms. One is projection. In other words, we project psychological aspects of ourselves which we would rather disown. Therefore, in terms of Islamophobia, it may be our own aggressive impulses toward those who are different in a religious sense.

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