Omar Reda, MD

Our national attention has turned to Afghanistan, as the media shares disturbing pictures as news unfolds. Meanwhile, we in psychiatry hear related testimony from patients and colleagues, and are concerned that the withdrawal of US troops may lead to escalating mental health problems locally as well as internationally.

A recent encounter with an Afghan patient embodied the concern and brought the issue to the forefront of consciousness. The patient, who came to America years ago on a special visa based on his work with the US Army, presented with severe symptoms of posttraumatic stress disorder (PTSD). The PTSD was reactivated because of the unfortunate developments in Afghanistan.

I joined the war to act like a buffer. I wanted to protect my people, and also to serve America, the country I love and now call home. That backfired. Despite my best efforts, many people died because of wrong intelligence. Information I gave was ignored or misused. I am now left with the memories, the flashbacks, and the nightmares. How can I undo the damage I caused? I wanted to build schools, so the Afghan children might have a better future. But would God forgive me for taking part in killing?

The patient, wrestling with existential issues and navigating through many layers of shame, guilt, and taboo, was comforted by having a Muslim psychiatrist who shared his religion and aspects of culture. In turn, the cultural and religious understanding helped to create a safe therapeutic space and a sounding board for this patient in his search of meaning and healing.

We have also heard from a Jewish psychiatrist colleague, who entered the US Army as a psychiatrist in 1975, just as the Vietnam war was ending. He saw soldiers who developed unexpected symptoms after serving in Vietnam. Although PTSD as a formal diagnosis was relatively unknown at the time, Vietnam was an impetus to its deeper understanding. Upon arriving at his base in Alabama, a General told him and his physician colleagues that they needed to learn about soldiers because there would be another war in our lifetime.

Nobody could have known that the war in Afghanistan would be the longest war in American history, or that we would again abandon our allies when we left the country. However, despite all the comparisons being made with Vietnam, there is at least 1 big difference: The public has seemed relatively unconcerned with this war compared with the Vietnam war. Nevertheless, this clinician predicted a disaster when a specific Afghanistan withdrawal date was made public, (since it gave the Taliban a clear timetable to prepare for) and now is troubled by the escalating deaths, trauma, and losses, especially among families, women, and children.

Another colleague is a Muslim psychiatrist who wears a hijab. She took care of military veterans during her psychiatric residency training. Almost all of the veterans were being treated for PTSD stemming from the trauma they witnessed in the Iraq and Afghanistan wars(Operation Iraqi Freedom (OIF) and Operations Enduring Freedom (OEF)). [Often her presence, even as a care provider, was a trigger for them. Frequently the veterans would refuse to see her at the outset of their hospitalization because, as one patient put it, “24 hours before I came back home, I killed a woman who looks like you . . . how am I expected to flip the switch and work with you?”

In time, these reactions changed. In fact, over the course of the treatment program, many veterans reported that being treated by someone who looked like the individuals they were trained to fear and distrust was an important part of their healing. There were even some who, by the end of the treatment program, refused to work with anyone but her, reporting that it changed their views of Muslim and Middle Eastern individuals.

This experience reflects many layers of complexity. Veterans following orders experienced trauma and came home with severe PTSD, making it very difficult to return to a multicultural society. Clinicians have an ethical duty to do no harm, yet many Muslim clinicians understandably feel complex emotions when treating those who took the lives of their brethren. Most importantly, the moderate Muslims may be battling for their safety on 2 fronts: there may be forces from within as well as forces thrust upon them, both ultimately contributing to their ongoing intergenerational trauma.

The current trauma can only add to the intergenerational trauma in Afghanistan. Whether or not pulling the armed forces from Afghanistan is the right decision, it seems like better plans could have been made to protect those at risk. It is reminiscent of our ethical principle of not abandoning patients. If a transfer is needed, we cannot drop a patient until a new psychiatrist is involved. Moreover, when we terminate our therapeutic alliance with a patient, we try to do that slowly, reassessing how well that is going along the way. It would be flaunting medical ethics to arbitrarily pick a date just around the corner and abruptly leave.

Psychiatrists must decide whether or not to stand up and speak out against injustice. It may be a professional obligation, in line with the ethical principles of the American Medical Association, American Psychiatric Association, and World Psychiatric Association. These principles put patient needs first, but also include the ethical needs of society.

“A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health,” the APA’s adaptation adds “Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness.”

This annotation covers our potential obligations to those at risk in Afghanistan. What can we say or, more importantly, what can we do to help them? As far as patient care goes, our troops will need special attention. How those who served feel about the sudden withdrawal may be crucial for how they process the trauma they encountered, especially from a moral injury point of view. Will they feel that their time and participation was wasted? Likewise, will this withdrawal be a trigger for troops who served in Vietnam and were traumatized and criticized for their participation?

In addition, potential patients are likely to come from those in Afghanistan who worked with the United States. If they stay alive and stay there, or become refugees, they are at risk for the repercussions of trauma, betrayal, and loss. Women and children seem to be a target of potential repression and abuse.

The World Psychiatric Association approved their first Code of Ethics for Psychiatry in October 2020, after 10 years of deliberation. That must reflect how difficult it is to come to a consensus on health and mental health values and virtues of various countries and cultures. Yet it has principles that seems relevant to Afghanistan

Psychiatrists advocate in particular for support for mental health programs, especially in but not limited to developing countries and in areas where care for persons with psychiatric disorders is non-existent or rudimentary…

Psychiatrists are aware of the deleterious consequences of family violence, emotional and sexual abuse on mental health and well-being, especially for women and children . . .

There is also another relevant professional ethical set of principles for physicians, those of bioethics, which focus on 4 main principles in individual patient care: beneficence, nonmaleficence, justice, and autonomy. However, when we speak of population health, we must insert 

 before beneficence, nonmaleficence, and justice. Social justice is population health. Social justice movements may come from outside the traditional lines of institutional power, such as Dorothy Day and the Catholic Worker Movement. Thus, although psychiatrists have their own institutional ethics, they must attend to outsiders’ voices, which may offer special guidance.

We must look inward. Have we, as the United States, had an arrogant attitude in our dealings with the rest of the world? Have we acted like we had the power to bend anyone, anywhere to our will? America is not alone in its hubris. Other nations such as the United Kingdom, for instance, played a significant role in military operations in Afghanistan and must accept some responsibility for the chaos that is rapidly unfolding.

This is not a new issue for our country and, therefore, not a specific criticism of any political administration. Instead, perhaps it is a reflection of a deeper psychological problem. This episode is reminiscent both of our withdrawal from Vietnam and our disengagement from Iraq in 2011. It is as if after we are humiliated by not winning a war, we have something to prove, and so we end up doing the same thing again.

This is very similar to a strategy that traumatized individuals often use: recreating the same traumatizing situation over and over in order to master it. Just as a traumatized individual might tend to do, sometimes impulsively and sometimes intentionally, the United States has jumped into situations we did not fully understand, leading to armed civil conflicts around the globe. Although we continue to be a world power, trust in us and our reputation may be deteriorating. Of course, in Afghanistan, we also cannot ignore that continuous wars, conflicts, and humanitarian crises have been ongoing since the Soviet invasion in 1979.

Some could argue that our intentions have always been good, that we intended to help the oppressed, to prevent bloodshed, and to democratize the world. But much of the world does not want to be democratized. Starting with Vietnam and ending with Iraq and Afghanistan (not to mention the many countries left in shambles in the aftermath of the Arab Spring and similar movements), we seem to leave behind wreckage and chaos, lots of civilian casualties, unfinished business, and collateral damage.

Reflecting on the speed with which Afghanistan has fallen, we feel overwhelmed by unfathomable human suffering and the amount of hurt we inflict on each other. Yet we can also choose to be part of the solution through healing activities. Just as our country is trying to reckon with the meaning of the death of George Floyd, we must search for actionable social justice in the midst of this tragedy.

What can be done? Individual mental health professionals can write to politicians and the public. They can raise awareness about the far-reaching effects of trauma and inform the public about the gravity of the situation in Afghanistan, which seems to be heading toward a humanitarian and refugee crisis. They can advocate for as many urgent evacuations of Americans, Coalition Forces, Afghan allies, and vulnerable women and children, as is practically possible. We can also collectively act in ways that engage, rather than shy away from, the silent pandemic of human cruelty. Perhaps the World Psychiatric Association can develop a rapid response team, a United Psychiatrists like the United Nations, to employ when international mental health is at risk. Similarly, perhaps a whole-world approach can bring in NATO and other countries, including China, Russia, and other Muslim countries.

Those who work in the military and the VA should be prepared for the troops’ reactions and be ready to provide education and care. We might anticipate and prepare for a rise in Islamophobia as the country goes through a restless stage of uncertainty and searches for someone to blame. All of these measures would be enhanced by harnessing the power of storytelling and social media to raise awareness about how important psychiatric care really is.

Besides these opportunities, the United States needs some longer-term psychological soul-searching, perhaps via a special Task Force called Operation Mental Freedom (OMF), to break the cycle of these failed invasions. Psychiatrists knowledgeable about intergenerational trauma and cross-cultural relationships are available to help.

Although the US government decides to withdraw from an issue by simply pulling our forces out of a country, it is not an easy task for mental health care professionals to withdraw emotionally and ethically. We are healers, and human suffering touches our very deep core. Thus, we must act accordingly.

–SPIRIT (Social Psychiatrists Interested in Recovery from International Trauma)

The multicultural group SPIRIT was assembled in May 2021 to publish the article “

An Interfaith Psychiatrist Prescription for Middle East Peace

. SPIRIT’s first piece was inspired by the collective concern about the escalating Palestinian-Israeli conflict.

is a practicing psychiatrist for Providence Healthcare System, Portland, Oregon. 

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of 

is Professor Emeritus in Psychiatry at the University of California at San Diego, as well as the author of more than 100 professional articles and 6 books. 

is Professor Emerita, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

 serves as Kathleen & John Bricker Chair, Department of Psychiatry, LSUHSC. He also is Chairman of the Board of Trustees of the Cobb Research Institute and is the 113th Present of the National Medical Association. 

is Medical Director of Child and Adolescent Psychiatry Clinic and Multidisciplinary Autism Program at ChristianaCare, Delaware. 

is Assistant Professor of Clinical Psychiatry, Columbia University; and Research Psychiatrist, New York State Psychiatric Institute, New York, NY. 

is a Clinical Associate Professor of psychiatry at the Stanford University School of Medicine where she is the Director of the Stanford Muslim Mental Health & Islamic Psychology Lab, and the Director of its community organization: Maristan.org. She also serves as the Associate Division Chief for Public Mental Health and Population Sciences as well as the Section Chief of Diversity and Cultural Mental Health in the Department of Psychiatry and Stanford. 

is Clinical Professor and Chair of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences. 

is a Professor of Psychiatry at Cooper Medical School of Rowan University. He is active in several national and regional organizations and published and presented on International Medical graduates, culture, religion, family psychiatry, gender issues, etc.

is an associate professor of psychiatry at Harvard Medical School and a Fellowship Site Director for Brigham and Women's Hospital. 

is a doctor working in frontline psychiatry for the National Health Service at South London and Maudsley NHS Foundation Trust in the UK.

The Principles of Medical Ethics, With Annotations Especially Applicable to Psychiatry. 

American Psychiatric Association. The American Psychiatric Association Press; 2013.

2. Code of ethics for psychiatry. World Psychiatric Association. October 2020. Accessed August 17, 2021. 

Articles

What can psychiatrists do to help veterans, Muslims, immigrants, refugees, and all those affected by the US withdrawal?

Psychiatrists Concerned With the Afghanistan Situation: Ethical and Practical Issues

6 Lessons From a Tragedy

Slideshows

There are beautiful things that you can only see in the dark.

For the most part, the field of psychiatry has looked at organized religions with suspicion, however, a majority of sacred texts have paid particular attention to emotional wellness and holistic health.

I have used my religion and my Muslim background as a grounding and healing tool for myself, my family, my small community, and for clients who requested to use God’s words (the Noble Quran) and the authentic teachings and traditions of Prophet Muhammad (peace be upon him) as part of our therapeutic relationship.

It is usually much easier to introduce religious themes with terminology like spirituality and tending to the soul. Youth in particular seem to have a difficult time reconciling the religious aspect of their personality with societal expectations. I have queried Muslim youth and their caregivers, but my understanding from Jewish and Christian friends and colleagues is that there are similar themes in all 3 monotheistic religions. However, most of the Muslim community’s negative feelings around 

 organizations and places of worship comes from a heavy legacy of trauma, caused mainly by the culture of the leadership and from the out-of-context quoting and misinterpretation of a sacred text.

Psychiatrists can bridge gaps between the community and religious leaders through 

 education that targets stigma, which in turn helps with opening channels of communication and building bridges of trust.

For instance, look at some of the most widely criticized areas of Islamic centers:

1. A lack of trust between the community and its leaders.

2. A lack of demographic diversity and representation, especially in positions of leadership.

3 .Systemic exclusion of certain sects of the community.

4. A lack of attractive alternatives to the mainstream culture, especially for the youth.

5. Gross violations of the rights of some worshippers, like those with mental disabilities.

6. A lack of transparency and a culture of secrecy.

8. A culture of competition, rather than collaboration.

9. Poor interfaith and outreach to the larger non-Muslim community.

10. A lack of flexibility of policies and procedures.

11. Harsh approaches in providing and receiving advice and feedback.

12. An underestimation of the role of women.

13. Not taking advantage of the talents, skills, and expertise of most worshippers.

14.Poor sustainability of programs and resources.

15. Reactive, rather than proactive, response to issues.

16. Spreading a punitive message of despair, rather than advocating for hope and beauty.

17. Weak societal impact, possibly stemming from the attitude of “going back home one day.”

18. Rigid adherence to a certain style or school of thought.

19. Rare access to new blood and young leaders who speak the cultural language.

20. Poor understanding of the American cultural norms, laws, and systems.

22. Misusing religion to justify dysfunctions like domestic violence and child abuse.

23. Double standards when treating men and women, and boys and girls.

24. Minimal representation of Muslims in the media and in politics.

I have been blessed to earn the trust of both the Imams and the Muslim community in Portland, Oregon, and it is now common to hear discussions inside the house of God about family dynamics, self-care, emotional intelligence, trauma healing, suicide prevention, and many other psychosocial topics that were otherwise censored.

In Islam, the relationship between the Creator and His creation is a personal and intimate one; the face of God can be seen not only in the mosque, but in every beautiful act of kindness toward others. Ultimately, the best way to worship is to serve humanity.

is a practicing psychiatrist for Providence Healthcare System, Portland, Oregon.

Psychiatry and spirituality have many things in common, including family dynamics, self-care, emotional intelligence, trauma healing, and suicide prevention. 

Reflecting on Psychiatry’s Role in Religion

FIRST MAN: We should defend ourselves. An eye for an eye, a tooth for a tooth.

TEVYE: Very good. And that way, the whole world will be blind and toothless.

- From 1970 script of the play “Fiddler on the Roof” and often attributed to Mohandas Gandhi

“The three ingredients for healing relational wounds are safety, truth, and reconciliation, and in that order.” - Alisha Moreland-Capuia, MD

Achieving peace in the Middle East is a monumental task that seems to be ever evasive, daunting, and out of reach. A cease fire is welcome, but a far cry from what we want to achieve—lasting Middle East peace. The violence is also spilling over into increased conflict between groups in the United States. Muslims and Jews are subject to worrisome degrees of Islamophobia and Anti-Semitism. The Palestinian-Israeli conflict is an extremely complex tangle of issues to resolve, but a solution is possible, and imperative.

Both sides and their supporters need to abandon ultimately futile and self-defeating acts of violence and retaliation. Instead, they must embrace a more comprehensive and humble vision that takes into consideration the historical, geographic, religious, and cultural context of two cousin tribes that have wounded each other over generations. It is like a longstanding family conflict in which family members stop talking to one another and replace talking with hatred, necessitating therapeutic family interventions. Despite the reservations that some psychiatrists have on entering the social conflict sphere, these are, in fact, areas of psychiatric expertise.

As psychiatrists we know group dynamics. We know our tendency to scapegoat “the other”. We know how the powerful can divide and conquer less powerful groups. We know how to analyze leaders. We know the temporary but necessary pain of revealing and processing the truth. We know from Abraham Maslow, PhD’s pyramid of psychological needs that safety and security must be fulfilled before higher levels needs can be completed. We know that often deeper levels of traumatic causation need to be processed and dealt with before healing can meaningfully occur.

This is not a naive proposal by any means, though it may seem so to some. Inevitably, many will disagree with any Middle East analysis. Rather, it is a plea for change because doing the same thing over and over again, expecting different results, is the very definition of insanity. Constantly suspecting each other’s motives has not moved this protracted struggle even an inch out of square zero. As good as prior endeavors were—that is, things could have gotten even worse—they have not been nearly enough.

There are many intricate political and psychosocial dynamics that come into play to make this mission look impossible; however, fighting parties in other parts of the world have managed, for the sake of their children, to reach some kind of compromise that benefits all involved. Children in the blessed land should not continue to pay the price of our ignorance, false pride, and generational bigotry.

As Muslim, Jewish, Christian, Hindu, and Sikh psychiatrists, in a bio-psycho-social-spiritual model we sense this is a moral and spiritual crisis. We support peace among nations, safe and secure homelands, and opportunities for all. This is not at its essence a fight between Muslims and Jews, or between Arabs and Israelis. This is an ideological and practical war that often intentionally feeds cultish misinformation, especially via the internet, which artificially arouses emotions, leading to relieving emotional tension by ever-increasing violence. Peace-loving civilians lose their lives, while extremist groups and fear mongers run rampant.

Unfortunately, the media usually chooses to focus on the negative events occurring in the Palestinian-Israeli conflict, and ignores equally dispiriting, yet equally important, inter-ethnic tragedies taking place in places like Kashmir, Myanmar, China, Syria, Yemen, Iraq, and elsewhere around the globe. This disproportionate attention to one particular locale in the Middle East only enflames matters more. It leads the public to believe that this is a unique situation, when it is a tendency of human nature that needs to be overcome everywhere. Despite our paradoxically doing so in this paper, we include other examples and intend to address them more in the future.

Perhaps we can learn and apply a few lessons from countries like South Africa, Rwanda, and Bosnia, where warring tribes have seemingly learned to live together. The Truth and Reconciliation Commission was especially effective in helping to bring South Africa out of apartheid without a bloodbath. 

Big problems get resolved only when broken down into small pieces. The use of dialogue can—and should—start in our households, small intra- and inter-faith circles, and cultural communities. A group of international and interfaith psychiatric caregivers have come together to create a community of care and have produced two requested, well-reviewed books that can be used as tools towards healing: 

From these sources, here are some ideal prescriptions to start with:

- Dignity for all, established by working together respectfully for a common end

- Humiliation for none, which means hearing each other out

- Apologies by all, as saying “I’m sorry” and meaning it begins the healing of many wounds

- Gifts to the others, such as sharing assets and promoting each other’s strengths

- Neutral peace-maker(s), or the calling in of trusted third parties, which may ideally need to include mental health experts

- Teaching tolerance to children, both by parents and educators

- Addressing intergenerational trauma, which includes that affecting political decision-makers

Also, as psychiatrists, we know very well that an illness cannot be cured unless we address its root causes, and similarly we have the moral obligation to call for the immediate dismantling of bigoted and violent ideologies, dictatorships, and all structures and systems that support them. They are so damaging to the body, mind, heart, soul, and spirit of so many of the people.

These are simple, though not simplistic, aspirational goals. They are meant as an antidote to the common lament about how complex these situations are, so often leading to excuses about what cannot be done and what cannot be tried. Prayer and mourning must be supplemented with action.

We need a few small steps in addition to this manifesto. Some that could be taken by SPIRIT and like-minded groups include: joint business projects, a student exchange, common textbooks (especially in the early grades), shared vacation spots, media consultation, and joint research. We must look towards innovative and out-of-the-box solutions.

Members of SPIRIT are available for consultation and discussion. We welcome other like- hearted psychiatrists of any religious background, as well as those who are agnostic or atheist, to join our SPIRIT.

is practicing psychiatrist in Providence Healthcare System, Portland, OR. He has provided psychiatric and humanistic care to trauma survivors around the world.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

is Clinical Professor and Chair of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences.

is an associate professor of psychiatry at Harvard Medical School and a Fellowship Site Director for Brigham and Women's Hospital.

serves as Assistant Dean of Clinical Education at Charles R. Drew University and Chief Medical Officer of Kedren Health Systems Inc.

is Medical Director of Child and Adolescent Psychiatry Clinic and Multidisciplinary Autism Program at ChristianaCare, Delaware.

is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai, New York, NY.

is a psychiatrist, the author of more than 300 peer reviewed papers, founder of Critica, and board member of the Social venture Fund for Arab Jewish Equality in Israel.

is Professor Emeritus in Psychiatry at the University of California at San Diego, as well as the author of more than 100 professional articles and 6 books.

interested in exploring the intersection between childhood political trauma with immigration stress. She has been recently offered a full-time research appointment as a Visiting Researcher at Harvard University, in Cambridge, Boston.

is a Clinical Associate Professor of psychiatry at the Stanford University School of Medicine where she is the Director of the Stanford Muslim Mental Health & Islamic Psychology Lab, and the Director of its community organization: Maristan.org. She also serves as the Associate Division Chief for Public Mental Health and Population Sciences as well as the Section Chief of Diversity and Cultural Mental Health in the Department of Psychiatry and Stanford.

1. Moffic HS, Peteet J, Hankir A, Awaad R. 

Islamophobia and Psychiatry: Recognition, Prevention, and Treatment

https://www.springer.com/gp/book/9783030005115

2. Moffic HS, Peteet J, Hankir A, Seeman, M. 

Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions

https://www.springer.com/gp/book/9783030377441

A cease fire is welcome, but a far cry from what we want to achieve—lasting Middle East peace.

Perhaps you have heard the saying, “even your shadow leaves you in the dark.” There are many ways this metaphor can be understood. Some individuals might encourage you not to depend on others, because even your own shadow will leave you when you lose your light. Others might assure you that you are never really alone when things get dark, and that at least your shadow will certainly be there when the light is turned on.

I would like to take this further and ask you to befriend your shadows. Your literal shadow will likely leave you in the dark, but this is when your metaphorical shadows come out, the memories of traumas that are always with you, though sometimes unseen.

Walking alone on a dark path is scary and heartbreaking, yet it is a common experience for many survivors of trauma. When they try to listen for the sound of comfort, it is only the voices of uncertainty and self-doubt that they hear. When they try to look for a source of light, it is only the shadows of trauma that they see.

The shadows of trauma can keep us in a chronic state of hypervigilance even when it is no longer dark. It is important therefore to befriend our trauma stories.

How can you befriend something as ugly and as frightening as trauma? You do that when you practice self-compassion. Edward Smink, PhD, in his impressive book, 

The Soul of Caregiving: A Caregiver's Guide to Healing and Transformation

, referred to our reactions to trauma as 

 As caregivers, when we are depleted, he invites us to notice our shadows and embrace them with compassion. We should know that we will meet our shadows both in times of distress, and also when things feel relatively safe. Sometimes we encounter a moment of deep insight through a painful psychodynamic interpretation in a therapy session, and sometimes that light is illuminated by our support or faith system.

Without self-love through self-care, these shadows can cast darkness on the way we interact with our clients and our loved ones. As a healer, I urge you to pay attention, be attuned to what is stirring within, focus on the current moment, observe difficult feelings with curiosity, and welcome your shadows as brief guests.

That is not at all an easy task. Bruce Perry, MD, PhD, in his new book,

 What Happened To You?: Conversations on Trauma, Resilience, and Healing

, eloquently wrote, “trauma leaves you shipwrecked. Part of the rebuilding is to sit through the wreckage, looking for what remains, seeking your broken pieces.”

 Michael Hollifield, MD, asked that at the end of that search, “celebrate the pieces you find and mourn the rest.”

These are dark and difficult times we live in. Look for light and beauty within the individuals you serve and those you love, but mainly look for that within yourself. The world can be a dangerous place, full of shadows. Befriending them might bring us a little closer to our light source, or at least get more comfortable with the darkness.

Your shadows might be the light source you are looking for. Rumi elegantly reminds us that “only in the dark cave can we find the light. At the end, pain is what leads to love. There are beautiful things that you can only see in the dark.”

What Happened to You?: Conversations on Trauma, Resilience, and Healing

3. War Survivors Institute. Our Team. Accessed May 7, 2021. 

4. Schimmel A. Rumi: Sufi mystic and poet. 

https://www.britannica.com/biography/Rumi 

The Wounded Healer: The Pain and Joy of Caregiving

Walking a dark path alone is a common experience for survivors of trauma. 

Befriend Your Shadows

The Muslim community in Texas was shaken to its core by the news of a murder-suicide of a whole family on April 5, 2021.

Apparently, 2 young Muslim boys decided to kill their parents, their sister, and their grandmother, before killing themselves. One of the brothers left a chilling and troubling note listing some of his reasoning for committing such a horrifying act. He mentioned feeling empty, that life had no meaning; he talked about depression as a lonely and alienating experience, that having a supportive family can be a protective factor, but only to an extent. He even briefly described gun control in America as a joke—getting access to lethal weapons was not that difficult for him.

Religious leaders and mental health professionals have been quite vocal about showing moral and material support for the local community, especially the youth. They are also using this incident as both a learning curve and a teaching tool for the larger Muslim community, with the hope that lessons learned might help the future design and delivery of culturally appropriate services and resources, an approach that might help prevent or at least reduce the odds of having similar incidents in the future. This is an emergency that the Muslim community needs to urgently and immediately address.

Spirituality can be a protective factor against suicide. Like any other religion, Islam is practiced on a spectrum. With a population of more than 1 billion Muslims, there are diverse reactions and responses to challenges within the Muslim community. Some of the research I came across showed that the overall rates of suicide were lower among Muslims than non-Muslims, but there are many factors that come into play here, like cultural cohesion, familial bonds, and social support, which are highly valued components of the Islamic faith. Talking about religion needs to be tactful when approaching the topic of depression and suicide. Those with mental illnesses should not be judged as having weak faith or a poor relation with God; rather, we need to extrapolate using examples from the Quran and the life of Prophet Muhammad that focus on self-care, the reward of mending broken hearts, and bringing healing to injured souls.

Imam Yasir Qadhi, PhD, a prominent scholar in Dallas, Texas, gave a heartfelt talk to help shatter taboos about mental health and emotional wellness, and to address misconceptions that are quite prevalent in the Muslim culture, despite having nothing to do with the authentic teachings of the religion that encourage stress management, emotional-expression, and speaking up. Here are some of the points that sheikh Qadhi covered in his 

1. As written in the suicide note “who knows, some good might come” out of this tragedy. Hopefully there will be more education and awareness about the prevalence and magnitude of the issue of depression in Muslim teens.

2. We need to show sensitivity and respect to the family. We are in no position to pass judgment, as the “fate of those involved will be determined in the divine court.”

3. In some form or another, everyone who died was a victim. This is not to justify the homicidal or the suicidal act, but rather to try to understand the bigger picture from a trauma-informed perspective.

4. Humans tend to try to process and make meaning out of suffering. Sometimes it is difficult to comprehend the reason or “the divine wisdom” behind such traumatic events.

5. These community discussions can feel awkward, but they are essential and overdue.

6. We need to aggressively advocate through educating community members that mental disorders are as tangible as physical ones. When afflicted with cancer, broken bones, or bleeding wounds, patients are rushed to the emergency room; emotional injuries should not be treated any different.

7. Desperate people do desperate things. When they reach a point where life becomes meaningless, they might become unreachable. Hopelessness and loneliness are awful feelings. Try to be a light source, mend broken hearts, show up for others, tell those around you that “maybe I do not understand your pain, but teach me, I am here for you.” A simple act of kindness like a smile or eye contact might brighten someone’s day—or even save their life.

8. People cannot just snap out of depression. The mental box is different than the spiritual one, and both boxes need to be filled. Prayers are wonderful, but they are one tool of many.

9. Adults should not shut down or dismiss pleas for help. Many parents do not know how to talk to their teenage children. Although there is a lot of silence in Muslim household, this is not a Muslim-only phenomenon—youth depression and suicide are invisible global pandemics.

10. Tragedies such as this one should serve as a wakeup call and motivate the community to act. Mental health staff and religious leaders need to come together to address short- and long-term solutions, as well as action steps. Bottled up emotions should not be the norm. Our children are our top priority. Muslim homes and houses of worship should be seen as a refuge, not a prison, and should always feel like places of safety.

The 13th century Persian poet Rumi eloquently wrote that “there are beautiful things that you can only see in the dark.” There is always some good that comes out of trauma—the Muslim community is forced now to have difficult, but honest and healing conversations.

There are culturally humble and responsive services and resources that are made available for the community. Here are few examples:

is a practicing psychiatrist, Providence Healthcare System, Portland, Oregon.

A tragedy has rocked the Muslim community. How can psychiatry try to help prevent further tragedies from occurring? 

More Than a Murder-Suicide

For the most part, the field of psychiatry has looked on organized religions with suspicion, even though majority of sacred texts have paid special attention to emotional wellness and holistic health.

Coming from a Muslim background, I have used my religion as a grounding and healing tool for myself, my family, my small community, and for clients who requested to use God’s words (the Noble Quran) and the authentic teachings and traditions of Prophet Muhammad (peace be upon him) as part of our therapeutic relationship.

It is usually much easier to introduce religious themes with terminology like “spirituality” and “tending to the soul.” The youth in particular seem to have a difficult time reconciling the religious aspect of their personality with societal expectations. I have asked questions to Muslim youth and their caregivers, but my understanding from Jewish and Christian friends and colleagues is that there are similar themes in all 3 monotheistic religions. However, most of the Muslim community’s negative feelings around Islamic organizations and places of worship comes from a heavy legacy of trauma, caused mainly by the culture of the leadership and from the out-of-context quoting and misinterpretation of a sacred text.

Here are 25 of the most criticized attitudes and practices when it comes to Islamic centers:

1. Lack of trust between the community and its leaders

2. Lack of demographic diversity and representation, especially in positions of leadership

3. Systemic exclusion of certain sects of the community

4. Lack of attractive alternatives to the mainstream culture, especially for the youth

5. Gross violations of the rights of some worshippers, like those with mental disabilities

6. Lack of transparency and culture of secrecy

7. Double standards when treating Muslims and non-Muslims

9. Culture of competition, rather than collaboration

10. Poor interfaith and outreach to the larger non-Muslim community

11. Lack of flexibility of policies and procedures

12. Harsh approach to giving and receiving advice and feedback

14. Not taking advantage of the talents, skills, and expertise of most worshippers

15. Poor sustainability of programs and resources

16. Reactive, rather than proactive, response to issues

17. Spreading a punitive message of despair, rather than advocating for hope and beauty

18. Weak societal impact, possibly stemming from the attitude of “going back home one day”

19. Rigid adherence to a certain style or school of thought

20. Rare access to new blood and young leaders who speak the cultural language

21. Poor understanding of the American cultural norms, laws, and systems

23. Misusing religion to justify dysfunctions like domestic violence and child abuse

24. Double standards when treating men and women, and boys and girls

25. Minimal representation of Muslims in the media and in politics

Psychiatrists can bridge gaps between the community and religious leaders through psychosocial education that targets stigma, that in turn helps with opening channels of communication and building bridges of trust. I have been blessed to earn the trust of both the Imams and the Muslim community in Portland, Oregon, and it is now common to hear discussions inside the house of God about family dynamics, self-care, emotional intelligence, trauma healing, suicide prevention, and many other psychosocial topics that were otherwise censored.

In Islam, the relationship between the Creator and His creation is a personal and intimate one, you can see the face of God not only in the mosque but in every beautiful act of kindness towards others, the best way to worship the Lord is to serve humanity.

One doctor shares his experiences with religion’s role in the practice. 

Omar Reda, MD

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