Introduction
According to the World Health Organization, mental health is “a state of well-being in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and can make a contribution to his or her community. Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life” (Mental Health: Strengthening our Response, 2014, para. 3). One of the factors jeopardizing mental health, along with mood disorders, eating disorders and substance-related disorders, is social anxiety or phobia. In Saudi Arabia, the specifics of treatment (or lack thereof) of social anxiety disorder are conditional upon various religious restrictions and customs, Islam is the state religion. Unlike it is with the USA, where about 6.2 % of Americans (15 million American adults) suffer from social anxiety disorder according to the Anxiety and Depression Association of America (Social Anxiety Disorder, 2015, para. 3), “there are no projections on the burden of mental disorders specific to the Arab world” (Okasha, Karam, & Okasha, 2012), which indicates certain unawareness of the problem. Moreover, Saudi Arabia has yet to implement the Mental Health Legislation, which is a mandatory attribute for civilized countries, as its goals include facilitation of mental health awareness, promotion of mental health, and making the mental health services accessible, affordable and available (Trivedi & Tripathi, 2014). Against the backdrop of inadequate attention to addressing mental disorders, there is also a problem of insufficient treatment of certain social categories, including females, children, and domestic workers. This paper shall focus on social anxiety in Saudi women.
Main body
Social anxiety disorder is one of the most common and frequent disorders among mental disorders. The anxiety inherent in social phobia is a special psychological and physiological state, which includes the following components: physical (somatic), emotional, cognitive, and behavioral. In addition to the social factors, the causes of anxiety and phobic disorders include heredity (genetic profile), the individual characteristics of the nervous system (temperament), and the presence of congenital abnormalities. It is necessary to define that occasional disturbance is a normal reaction to stressors as it helps the human body to cope with them. However, if the worriment starts to prevail over the rest of emotions, increases in intensity and becomes constant, one may talk about anxiety and phobic disorders. The anxiety that arises in patients with social phobia is perceived as an uncontrolled, non-specific, dissipated, free-floating, or inevitable situation. It is characterized by “an intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life” (Myers & DeWall, 2014). Social anxiety disorder consists of two components: the fear of human society in general, and the fear of action, related to a possible assessment from the side. People suffering from social phobia experience excessive anxiety in a variety of everyday situations; they are afraid to be judged by other people, especially strangers, are worried that their behavior can be interpreted as inappropriate, fear that others will notice their nervousness. Anxiety is strong emotional stress, and since the stressors constantly affect the suffering individual, anxiety greatly interferes with daily activities, career development, training, and interpersonal relationships. Apropos, one of the arguments against Saudi women receiving proper treatment from psychiatrists, is their secluded lifestyle: “for a stay-at-home female, who perhaps rarely socializes outside of her extended family, even high levels of social anxiety are unlikely to be experienced as problematic (Thomas, 2013).” It is particularly alarming in view of the fact that, according to the Anxiety and Depression Association of America, “it’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa” (Depression, 2015, para. 3). Whereas the untreated social disorder may be tolerated, it is better to avoid untreated depression and its implications. And here, Saudi society is faced with another problem, the ambiguous perception of mental illnesses and their treatment within the context of the country’s state religion, Islam. According to Gielen, Fish & Draguns (2014), some Muslim psychologists and psychiatrists even reject psychoanalyses, which is the primary means of social anxiety disorder treatment, “not only because of its unscientific stance but also because of its negative view of human nature, which is against Islam” (p. 311). It also applies to many other concepts used in modern psychiatry and psychology. Muslim psychiatry is based on the ideology of Islam and the fact that an individual, its mind and a variety of mental characteristics were created by Allah, and the individual was endowed with a soul, which together with the brain plays a crucial role in absolutely all psychophysical processes. In the Muslim society, mental disorders are usually considered as the result of God’s will and punishment for sin; therefore, religious practices are used for the treatment, with patients seeking salvation in the Koran. It often develops into the concealment of one’s mental problems in the fear of being stigmatized by the society. According to Rassool, “the literature distinguishes two types of stigma: label avoidance and public stigma” (p. 65). Label avoidance refers to instances in which individuals choose not to seek help for mental health problems to avoid negative labels (Ben-Zeev, Young & Corrigan, 2010). Public stigma is “the prejudice and discrimination that occurs when members of the community endorse stereotypes about mental health problems” (Rassool, 2014). In the case of Saudi Arabia, it is mainly the label avoidance that prevents people from addressing their health issues. Provided that stigma is “the situation of the individual who is disqualified from full social acceptance” (Goffman, 2009), it is fair to suggest the presence of a certain vicious circle, where the suppressed individuals (mainly women) further immerse into their anxiety.
Since the basis of mental health is a social environment, which ensures respect and protection of basic civil, political, socio-economic and cultural rights, the status of a woman in the Arab world per se is fertile soil for the development of various anxieties. According to the patriarchal Sharia law, woman’s rights in the Saudi Arabia imply a set of restrictions. Women are prohibited from taking part in elections and engaging in politics. Saudi Arabia is the only country in the world where women are forbidden to drive. As of 2009, the country ranked 130 out of 134 countries on the infringement of women’s rights. It is also the only country that received a zero score on the political and social rights granted to women. “All women, regardless of age, are required to have a male guardian. Saudi Arabia has been the only country in the world to prohibit women from car driving” (Women’s Rights in Saudi Arabia, n.d.). Women are not allowed to study, work, or travel abroad unless permitted by the husband or male relative. Saudi girls are given in marriage at any age, so they often leave school without acquiring secondary education. The Saudi government has a strong psychological pressure on women and their role in the country. In particular, a 2006 survey showed that more than 80% of women did not consider it necessary to have the right to drive a car and work with men.
According to the laws of Saudi Arabia, all women must be accompanied by a mahram, a male relative or husband. The guardian plays an important role in virtually all aspects of a woman’s life. Formally, the system is designed to protect women in accordance with Islamic rules. However, since various officials and institutions, including hospitals, police stations, banks and so on, may require the presence of a male guardian, it may be a hindrance to visiting a psychiatrist. Therefore, Muslim women often “avoid sharing personal distress and seeking help counselors due to fear of negative consequences with respect to marital prospects or their current marriages” (Ciftci, Jones & Corrigan, 2012).
Further obstacles to the mental well-being of women in Saudi Arabia include gender segregation and the low level of employment, which results from the lack of education. Gender segregation affects all women, whom mahrams aim to isolate from the surrounding society to maintain their “feminine purity.” As a rule, festive events are held with the separation of men and women, and mixed parties are extremely rare. In Saudi Arabia, the open world is the prerogative of men, who seek to isolate their women, condoned by the religion. The traditional house projects also provide separate rooms for women, with high walls and small windows with curtains, so that they feel safe while fenced from the outside world. Undoubtedly, it leads to the development of anxieties and depression. When it comes to employment, Sharia allows women to work on the condition that they do not neglect their family duties, although ever since early childhood, girls are taught that their main role is to maintain the family hearth, to bear and raise children. Saudi women are only allowed to work with the explicit consent of their guardians. Needless to say, the “psychological consequences of unemployment include impaired psychological well-being, anxiety, depression, reduced self-confidence, social isolation and reduced level of activity” (McLaughlin, 2002).
Conclusion
Although the detriment of untreated social phobia is undeniable, there are not many ways to cope with the problem, since it stems from the fundamental and imperishable aspects of Islam, the cornerstone of Saudi Arabia society. Abdul Malik Mujahid has suggested four ways of addressing the problem: a) the Muslim community in general and Muslim psychiatrists, psychologists and social service providers in particular, must urgently begin a mental health awareness campaign; b) Imams must present Khutbas (the Friday sermon) on the topic of Muslim mental health, with a special focus on breaking down the taboo nature of this issue; c) masjids (mosques) must be the first institution Muslims can turn to in times of crisis; and d) Muslim schools (full time and weekend) must urgently hire professional counselors and establish mentorship programs for Muslim children, which will offer students a way to share their stress or concerns with qualified personnel who can help them (State of Muslim mental health, 2010).
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