Muslims Report Rising Discrimination at Work

Muslims Report Rising Discrimination at Work Mohammad Kaleemuddin was fired after complaining that his supervisor and several co-workers had called him “Osama” and “terrorist.” At a time of growing tensions involving Muslims in the United States, a record number of Muslim workers are complaining of employment discrimination, from co-workers calling them “terrorist” or “Osama” to employers barring them from wearing head scarves or taking prayer breaks. muslimtoysanddolls.com is a charity site to help Muslims in need and it sells over 2,600 products for the whole family.it makes a great homeschooling resource to. The American Muslim Journal wrote a full page ad on my charity work.The United State Department interviewed me and wrote an article about my charity work with Muslims and published it on their website america.gov.Ponn Sabra owner of americanmuslimmom.com the largest online Muslim magazine in the world with one million unique views a year did two podcasts on my charity work with <Muslims.shop here and get great Islamic gifts and help Muslims in need. we sell over 750 Muslim dolls with hijab all different,200 Muslim handmade doll clothes with hijab,250 Eid decorations,250 Islamic decorations,Islamic and Arabic electronic toys,games,and puzzles.500 Islamic and Arabic childrens books,and much more.toll free business number9787885028 toll free in  the Virgin Islands,,Puerto Rico,Mexico,Canada,and  the USA   please leave a message if noone answers.info@muslimtoysanddolls.com fee aman Allah,Sister Debbie Al-Harbi

Mental Illness Recognition and Referral Practices Among Imams in the United States

Mental Illness Recognition and Referral Practices Among Imams in the United States Imams are Muslim clergy whose community members rely on them for help with life stresses, and therefore play a significant role in addressing the counseling needs of the growing Muslim communities in the United States. We studied if imams could recognize mental illness and would be willing to make referrals. We mailed a questionnaire to a nationwide sample of imams. The survey included a vignette depicting a congregant exhibiting signs of depression. The survey elicited answers to questions about the etiology of the presenting problem, as well as recommendations for referrals to meet the congregant’s needs. Imams recognized that the congregant’s problem would not resolve without intervention. They expressed a broad range of attitudes toward etiology as well as helpful interventions. Although some imams reported that they would be willing to collaborate with mental health professionals, they reported infrequent consultation practices in their communities. The amount of the imams’ previous consultation experience was correlated with greater willingness to collaborate in response to the vignette (p < .05), as well as recognition of the utility of psychiatric medication (p < .05). Imams’ own counseling training was correlated with less willingness to collaborate (p < .05). In order to minimize disparities of mental health care for the growing Muslim population in the United States, a focus on imam collaboration and reciprocal consultation, including clinical pastoral training, would help Muslim communities to utilize clinical resources, and help clinicians to provide more culturally competent care. The traditional role of an imam is to lead prayers, deliver sermons, and conduct religious ceremonies, as well as to provide counsel to individuals and their families. Outside of the United States, imams even help resolve disputes that in the United States would be reserved for legal courts (Al-Issa, 2000; S. R. Ali, Liu, & Humedian, 2004). Therefore, in times of duress, Muslim communities call on their imam to reference and interpret their scriptures (Qur’an and Hadith) in order to ameliorate their distress. Imams are de facto mental health care providers. Muslims in the United States are a minority group who face increasing religious, cultural, and ethnic discrimination (Ali, Milstein, & Marzuk, 2005). Although these stressors place them at risk for mental health problems (Al-Issa, 1997; Geronimus, Hicken, Keene, & Bound, 2006; McEwen, Lasley, Monat, Lazarus, & Reevy, 2007), Muslims have disparately low utilization of mental health services. In the United States, imams actively counsel members of their congregation across a wide range of problems (Ali et al., 2005). Yet, some serious mental health needs require clinical intervention beyond the scope of clergy counseling (Milstein, Manierre, Susman, & Bruce, 2008; Milstein, Manierre, & Yali, 2010). Frequently, clergy make insufficient use of mental health professionals to relieve the burden of responding to serious mental disorders (Wang, Berglund, & Kessler, 2003). We hypothesize that Muslim may infreqently receive mental health care due to the lack of referrals from many imams who were not born in the United States and therefore are unfamiliar with widely used diagnostic categories for mental illness. As with other clergy across many religious traditions, imams also may not distinguish between mental and spiritual problems, and therefore see the burden of care for their congregant resting on themselves alone (McMinn & Dominguez, 2005; Milstein et al., 2008). Although there is historic compatibility between Islam and medicine (Morgan, 2007), there remains stigma toward mental illness (Al-Issa, 2000). Therefore, even if imams do recognize that the seriousness of a person’s emotional distress is outside of their own expertise, they may be unwilling to make a referral or consult with a clinician. Another reason why imams may not collaborate with clinicians—which they share with clergy from other faiths—is the view that the clinician may not be sensitive to the religious values of their congregants or may hold views of religion antithetical to their own (Bobgan & Bobgan, 1987; Vitz, 1994). A specific reason why imams may be unwilling to collaborate with clinicians is concern about discrimination because of their religion (Ali et al., 2005). In order for clergy to facilitate their congregants’ access to professional clinical care, they must first recognize the need for a referral, they must then be willing to refer, and they need to have a network of professionals to whom they can refer (Milstein et al., 2008). The purpose of this paper is to investigate three questions: Could imams recognize the severity of a mental health problem? Would imams be willing to refer a person with symptoms of a serious mental disorder to a clinician? Do age, consultation experience, or counseling training correlate with collaboration between imams and mental health professionals? Methods We conducted a cross-sectional, self-report survey of imams from mosques throughout the United States in 2003, which was approved by our institutional research review board. Sixty-two (male) imams returned the survey. The questionnaire, survey methodology, and response rates were described in a previous article (Ali et al., 2005). We examined the imams’ recognition of a mental health problem, their opinions about the appropriate type of referral, and then correlated these responses with age, consultation experience, and counseling training. To calculate the imams’ consultation experience, they were asked to describe the frequency of six types of interaction in the past year. The imams responded to a four-point Likert scale representing contact frequency: Never = 1; One to Five = 2; Six to Ten =3; More than Ten = 4. A total score for contact with professionals was calculated for each participant, with a possible range of 6 to 24. The wording of the question, the list of the six categories, and the percentage of imams who had any contact is found in Table 1, section A. To calculate the imams’ level of training, they were asked to respond to a list of training experiences. The participants were asked to circle all the answers that applied to them. Each answer that the participant circled received one point, with a total possible range of 0 to 7. The wording of the question, the list of the seven types of training, and the percentage of imams who had any training experience is found in Table 1, section B. In order to study the imams’ recognition of a mental health problem, as well as their opinions about the appropriate type of referral, imams read the following vignette—adapted from previous studies (Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999; Milstein, Midlarsky, Link, Raue, & Bruce, 2000; Weaver, 1993)—that depicts a person exhibiting signs of depression and with possible risk for suicide: With strong encouragement from his friends, Mr. Ahmed who is 62 years old, comes to speak to you after Friday Prayer. He looks very sad and disheveled. It has been two years since his wife’s death. Over the past year, he has stopped spending time with his friends. He tells you that although he feels very tired, he is unable to sleep at night. He then says, ‘I can’t see anything worth living for—life feels pointless without her.’ The imams were asked four questions in response to the vignette (Table 2). For each question, the imams were asked to rate multiple answers with a four-point Likert scale. There were a total of 25 responses. For each response we calculated means, standards deviations, and Pearson-Rho values of the correlation of the response with the imams’ age, consultation experience, and counseling training (Table 2). At the end of the questionnaire we invited imams to make additional comments to describe their experience with consultation. Results The imams’ ages ranged from 24 to 69 with a mean of 49 (SD = 12). We identified a great variation in consultation experience among imams. For each category of consultation experience (Table 1, A) there was at least one imam who reported consultation with a provider more than ten times. Yet overall, 20% of the imams had made no contact in the past year with any of the six types of clinical consultants. Over half of the imams reported contact with a primary care physician or social worker, and nearly half of the imams contacted an imam familiar with mental health issues, or a psychiatrist or psychologist in the past year. Far fewer imams referred congregants to community mental health clinics or psychiatric hospitals. For counseling training (Table 1, B) there was also variation with overall low participation. While 7% of the imams reported experience with five of the seven categories of training, and 14% with four categories; 18% of the imams reported no type of training, and 27% had only one type of training. Less than half the imams reported receiving any training. Some reported college courses and individual reading, and some took psychology courses in their religious education. The least experience for the imams was in clinical pastoral training. The data in Table 2 describe the imams’ responses to the vignette of Mr. Ahmed, a person exhibiting signs of depression with possible risk for suicide. In the first question (Table 2, A), the imams responded to the likelihood that Mr. Ahmed’s problem was attributable to each of seven etiologies. They attributed the cause most strongly to stress and least strongly to a genetic problem. They then attributed it to both a religious problem and a weak personality. They were less likely to attribute it to brain chemistry or being physically sick. There was a significant positive correlation between the imams’ age and attributing the problem to how Mr. Ahmed was raised, as well as to a weak personality. In the second question (Table 2, B) the imams evaluated the helpfulness of seven types of interventions. Three of their top four answers were religion-based. The imams most strongly recommended more participation at the mosque. While this was followed by a nonreligious therapeutic dialogue to clarify Mr. Ahmed’s thinking and feeling, that score was statistically indistinguishable from reading religious texts and praying. The helpfulness of all talk interventions were affirmed more strongly than the helpfulness of psychiatric medication. Overall, the imams evaluated psychiatric medication as the least helpful intervention. Consultation experience by imams was positively correlated with recognition of the helpfulness of both psychiatric medication and mosque participation. In the third question (Table 2, C), the imams were asked the probability that they would do each of six types of consultation in response to Mr. Ahmed. On average, the imams rejected the idea that his problem would improve without help. They expected to consult with another imam familiar with psychotherapy, and this consultation was correlated with overall consultation experience. They also reported that they would likely counsel Mr. Ahmed themselves. This outcome was positively correlated with both their consultation experience as well as their own counseling training. On average, imams also expected that they would refer Mr. Ahmed to a mental health professional while continuing to counsel him themselves. The imams were less inclined to seek counsel from professional mental health care providers, or refer Mr. Ahmed away to a clinician. In the fourth question (Table 2, D), the imams were asked the relative importance of each of five actions that a mental health professional should do to help Mr. Ahmed. The imams felt that it was important for the clinician to become familiar with Mr. Ahmed’s religious issues. They most strongly indicated that mental health professionals could get this knowledge from a fellow clinician. They then thought that the clinicians could seek consultation or collaboration with clergy. This option to seek collaboration (Table 2, D, 3) was positively correlated with the imams’ own consultation experience. The imams affirmed that the clinician should refer Mr. Ahmed to an imam; they were least inclined to think that the clinician should counsel Mr. Ahmed alone. The opinion that Mr. Ahmed should be referred to an imam was correlated with clergy counseling training. A number of narrative comments are noteworthy. Some imams reminded the researchers that we were “sending this to an imam that has knowledge in Islam and that seeks to solve all problems through Islam (Quran/Hadith). We have degrees in religion and not in science.” Others appreciated that although Islam can have a “spiritual and psychological impact,” there were some imams who “were not helping in the most effective way.” They recognized a need for “psychological assistance,” and expressed a desire for “psychologists, psychiatrists, and social workers” to support them in addressing issues of their congregants. In other narrative comments many imams reported that they were volunteers, or did not have enough time to provide for the basic mosque needs let alone all of the psychosocial needs of their community members. Although a few reported positive interfaith events following the September 11th attacks, most suggested that in the current environment, “psychological problems [of Muslims] will magnify even further” and suggested several reasons, including “cases of discrimination in the workplace...and harassment” in the community; and government responses focused on “monitoring sermons” and freezing bank accounts during “investigations” making people “afraid of FBI [Federal Bureau of Investigations] or CIA [Central Intelligence Agency].” That is, “revealing problems may have a negative impact on the status of the person” and “no one pays zakat [obligatory charity] to the masjid [mosque] anymore because of 9/11.” Discussion Our principal finding is that imams can recognize the severity of a serious mental health problem, as they acknowledged that the problem presented to them would not resolve without intervention. Further, we found on average that imams would be more willing to refer a congregant to a mental health professional while continuing to counsel themselves, than to refer the congregant away to receive counselling only from the mental health professional. To our knowledge, this study is the first to describe and quantify a pattern of Muslim clergy responses to a mental illness, as well as to describe factors that could influence the imams’ response to this presenting problem. The imams reported a broad range of attitudes toward mental illness in terms of etiology and helpful interventions, but few reported actually utilizing professional health care resources. Our analysis suggests that although most imams do not believe that religious interventions are mutually exclusive from mental health interventions for the treatment of mental illness, they infrequently consult with mental health professionals. The survey responses and additional comments help to elucidate possible solutions to this problem of disparity between willingness and utilization. A polarity emerged from the data that may inform future work to improve collaboration between imams and clinicians. First, more counseling training by imams was correlated with the imams’ intent to counsel their congregant — Mr. Ahmed — alone, as well as their expectation that a clinician should refer the man to an imam without providing clinical care, which would not be the best intervention for Mr. Ahmed. A different set of recommendations was correlated with a history of contact between mental health professionals and imams. Greater contact was correlated with greater willingness to collaborate, including greater recognition of the utility of psychiatric medication, as well as recommending more active participation in the mosque. This congruence between biological and religious interventions among imams who have had more contact with mental health professionals indicates that future interventions to encourage collaboration across professional expertise would find greater success than training imams in clinical skills alone. This is consistent with the contact hypothesis described by Corrigan (2005). This hypothesis states that organized contact with individuals different from you will more effectively change your attitudes toward their group than education alone. One area of education with potential to improve collaboration that few imams have experienced is clinical pastoral training. This course of study provides a way to approach mental health care as part of a multidisciplinary team. The imams could learn both the potential of their expertise and the utility of the expertise of others (VandeCreek & Lucas, 2001). Another approach to engage the Muslim community through their imams is the prevention science model of Clergy Outreach and Professional Engagement (COPE; Milstein et al., 2008; Milstein et al., 2010). Imams, like other clergy, have a multiplicity of roles that their communities count on them to perform (Milstein et al., 2005). Yet without adequate training, resources, or community affiliations, the task is overburdensome. The COPE model acknowledges the scope of imams’ practices in relationship to addressing their congregants’ diverse needs, and describes a continuum of professional collaboration as a way to reduce the burdens of community clergy. The continuum moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction, and returns persons to their own spiritual communities. COPE delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries (Milstein et al., 2010). The imams’ comments also direct clinicians to have an appreciation of the environment in which most imams practice. Imams must provide encouragement and support to congregants who may themselves be reluctant to utilize services outside of their communities because of a concern that their religious and spiritual requirements may be misunderstood or inadvertently transgressed upon. Yet there are very few Muslim mental health providers. This study had several limitations. It was a preliminary study that sought, for the first time, to examine imams’ perceptions of mental illness and the treatment pathways that they would consider to be helpful. There is much future work to do. We studied a small self-selecting sample. We offered one vignette that was adapted from previous studies and not tested before in the Muslim community. We examined correlations to begin to understand the influences on imams’ perceptions of mental illness and mental health care. Future studies will look for larger samples examining multiple types of presenting problems with additional controls and multivariate analysis. Interventions to improve collaboration will be further informed by these future studies. Conclusions In order to minimize disparities of mental health care to the growing Muslim population in the United States, community healthcare planners need to appreciate that (a) within their communities, imams are an important source of referrals and influence on the attitudes toward mental health and help-seeking; (b) imams are able to recognize serious mental health problems; and (c) imams appear more willing to collaborate with mental health professionals if they have had previous consultation experiences. Therefore, the data would predict that interventions focused on collaboration and reciprocal consultation would be more effective than clinical training for imams. With such collaboration, Muslim communities may be more likely to utilize community resources, clinicians will be more likely to provide culturally competent care, and imams will then be more effective in their collaborative role as de facto mental health providers. muslimtoysanddolls.com is a charity site to help Muslims in need and it sells over 2,600 products for the whole family.it makes a great homeschooling resource to. The American Muslim Journal wrote a full page ad on my charity work.The United State Department interviewed me and wrote an article about my charity work with Muslims and published it on their website america.gov.Ponn Sabra owner of americanmuslimmom.com the largest online Muslim magazine in the world with one million unique views a year did two podcasts on my charity work with <Muslims.shop here and get great Islamic gifts and help Muslims in need. we sell over 750 Muslim dolls with hijab all different,200 Muslim handmade doll clothes with hijab,250 Eid decorations,250 Islamic decorations,Islamic and Arabic electronic toys,games,and puzzles.500 Islamic and Arabic childrens books,and much more.toll free business number9787885028 toll free in the Virgin Islands,Puerto Rico,Mexico,Canada,and the USA please leave a message if noone answers.info@muslimtoysanddolls.com fee aman Allah,Sister Debbie Al-Harbi

Subtle and Overt Forms of Islamophobia: Microaggressions toward Muslim Americans

Subtle and Overt Forms of Islamophobia: Microaggressions toward Muslim Americans In recent years, there has been an emergence of research regarding racial microaggressions, or subtle forms of discrimination (often unintentional and unconscious) that send negative and denigrating messages to members of marginalized racial groups (Nadal, 2011; Sue, 2010). Microaggressions tend to leave targets feeling angry and confused, often wondering if race was involved in an interaction, or whether or not to confront the perpetrator. Studies have found that the process of encountering racial microaggressions can be psychologically and physically draining, often to leading to higher levels of stress and poor mental health outcomes (Nadal, Wong, et al., 2011; Rivera, Forquer, & Rangel, 2010; Sue, Bucceri, Lin, Nadal, & Torino, 2007; Sue, Capodilupo, & Holder, 2008; Sue, Nadal, Capodilupo, Lin, Torino, & Rivera, 2008). While the most well-known literature on microaggressions has focused on subtle forms of discrimination toward racial and ethnic minority groups (e.g., Nadal, 2011; Pierce, Carew, Pierce-Gonzalez, & Willis, 1973; Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, et al., 2007, Sue 2010), there has been an increase in the literature focusing on microaggressions toward women (Capodilupo et al., 2010; Nadal, 2010), lesbian, gay, bisexual, and transgender (LGBT) people (Nadal, Issa, et al., 2011; Nadal, Rivera, & Corpus, 2010; Shelton & Delgado-Romero, 2011), persons with disabilities (Keller & Galgay, 2010), and religious minorities (Nadal, Issa, Griffin, Hamit, & Lyons, 2010). Despite this increase in the literature, microaggressions based on religion are presently the least studied, which may result in the lack of understanding of their impacts on members of religious minority groups. One religious minority group in the United States that is often ignored in the psychological literature is Muslim Americans. There are approximately six to seven million individuals in the US who identify as Muslim, and the population increases significantly every year (Bukhari, 2003; Strum, 2003). Like any other religious or ethnic group, Muslims are diverse in a multitude of ways. They belong to different racial and ethnic groups—approximately one-third of the population is South Asian, about one-fourth is Arab, and about one-fifth of the population is of African descent (Bukhari, 2003). About 69 percent of Muslims in the US are immigrants from over 80 different countries (Strum, 2003), and they reside in various areas across the United States. Finally, Muslim Americans in general tend to be younger, more educated, and more financially wealthy than the general American population (Bukhari, 2003; Strum, 2003). There are multitudes of ways in which Muslims in the US and abroad have been victims of Islamophobia (Lopez, 2011; Nadal, Issa, et al., 2010). In fact, several reports have discussed the increase of hate crimes and discrimination toward Muslim Americans, particularly after the 9/11 attacks and the subsequent wars in Iraq and Afghanistan (Council of American Islamic Relations [CAIR], 2003, 2008; Rippy & Newman, 2006). In 2002, there were an array of hate crimes that were reported against Muslims across the US, including the burning of mosques, bomb threats, physical and verbal assaults, and discrimination in employment (Rippy & Newman, 2006). In 2007, there were 2,652 reported cases of civil-rights violations against Muslims in the US, including 141 reported cases of passenger profiling and 613 reported cases of hate mail (CAIR, 2008). Previous research has found that Muslim individuals who perceived religious discrimination had an increased likeliness of suspicion, vigilance, and mistrust (Rippy & Newman, 2006) and even mental and physical health problems (Kira et al., 2010; Sheridan, 2006). Thus, it is evident that blatant religious discrimination is detrimental to Muslim American individuals and communities. Despite this literature involving Muslim people and overt discrimination, there are no known studies that examine the experiences of religious microaggressions, or subtle forms of religious discrimination, toward Muslim people in the US (Nadal, 2008; Nadal, Issa, et al., 2010). Furthermore, while there has been research that has reported the negative impact of microaggressions on people of color, women, LGBT individuals, and persons with disabilities, it is unknown whether Muslim people who experience microaggressions would have similar experiences and reactions. A theoretical taxonomy was proposed to identify the types of microaggressions experienced by religious minority groups, including several examples focusing on Islamophobic microaggression toward Muslims (Nadal, Issa, et al., 2010). These authors contended that while there are several types of microaggressions based on religion, it is difficult to definitively attribute certain discriminatory behavior to religious prejudice because of the possibilities that racial or ethnic prejudice are involved as well. Thus, the taxonomy presented six major categories of microaggressions that are based primarily on religion and are likely independent of race, ethnicity, or other variables. These six categories included: Endorsing Religious Stereotypes: statements or behaviors that communicate false, presumptuous, or incorrect perceptions of certain religious groups (e.g., stereotyping that a Muslim person is a terrorist or that a Jewish person is cheap). Exoticization: instances where people view other religions as trendy or foreign (e.g., an individual who dresses in a certain religion’s garb or garments for fashion or pleasure). Pathology of Different Religious Groups: Statements and behaviors in which individuals equate certain religious practices or traditions as being abnormal, sinful, or deviant (e.g., telling someone that they are in the “wrong” religion). Assumption of One's Own Religious Identity as the Norm: Comments or behaviors that convey people’s presumption that their religion is the standard and behaves accordingly (e.g., greeting someone “Merry Christmas” or saying “God bless you” after someone sneezes conveys one’s perception that everyone is Christian or believes in God). Assumption of Religious Homogeneity: Statements in which individuals assume that every believer of a religion practices the same customs or has the same beliefs as the entire group (e.g., assuming that all Muslim people wear head coverings). Denial of Religious Prejudice: Incidents in which individuals claim that they are not religiously biased, even if their words or behaviors may indicate otherwise. A large amount of the literature on microaggressions toward other groups began with similar taxonomies, which led to qualitative research that validated the proposed theories. For example, research on African Americans (Sue, Nadal, et al., 2008); Latina/os (Rivera et al., 2010); Asian Americans (Sue, Bucceri, et al., 2007); women (Capodilupo et al., 2010); lesbian, gay, bisexual, and transgender people (Nadal, Issa, et al., 2011); and people with disabilities (Keller & Galgay, 2010) were all conducted to test previous taxonomies of racial, gender, sexual identity, and ability microaggressions. However, Nadal, Issa, and colleagues’ (2010) taxonomy of religious microaggressions has yet to be examined or supported by Muslims or members of any religious minority group. Thus, the current study aimed to examine the following research questions: Do Muslims experience religious microaggressions? What types of microaggressions do Muslims experience? How do Muslims react to, or cope with, microaggressions when they occur? Method The current investigation used a qualitative method to collect and analyze data to gain a deeper understanding of Muslim’s experiences with religious microaggressions. Qualitative research has been found to be appropriate when the phenomenon of study has received little empirical attention (Morrow & Smith, 2000). Focus group methodology, in particular, allows for exploration of a new area of investigation (Krueger & Casey, 2008) and creates a scope for members of disenfranchised groups to frame their accounts (Fine, 1992). In focus groups, participants are encouraged to share their point of view without necessarily coming to consensus (Krueger & Casey, 2008), providing an integrated description of the phenomena of study. The group discussion is conducted several times with similar types of participants within a population, to allow researchers to identify patterns and themes (Krueger & Casey, 2008). In the current pilot study, directed content analysis was used to systematically classify, code, and categorize data regarding religious microaggressions experienced by Muslim Americans into themes. Participants Participants were recruited in two ways: (a) email requests were sent to various Muslim interest groups and Muslim college student organizations in the greater New York tri-state region; and (b) participants were requested from the Research Experience Program at a large public university in the New York City area, in which Psychology 101 students are required to participate in research studies on campus as part of their course credit. In order to participate in this study, individuals needed to identify as Muslim and be at least 18 years of age. A total of 10 Muslims participated in the study. There were two focus groups with five participants each. There were seven female participants and three male participants, and participants’ ages ranged from 18-50 (mean age: 24.5). The majority of the participants were undergraduate students (N=9). Participants identified diverse racial backgrounds, including Arab, Asian, African-American/Arab, Caucasian, and “other”; participants also identified various ethnicities including Palestinian, Guyanese, Kazakh, East African/Indian, Egyptian, and Italian/Polish. Finally, because microaggressions are often based on physical appearance, the observers made note of which participants were wearing traditional Muslim garb (e.g., a hijab or a kufi); in the current sample, there were three women were wore a hijab. Table 1 includes a list of the various participants’ self-reported gender, race, ethnic background, and the observer’s perceptions of their clothing. Researchers A crucial aspect of qualitative inquiry involves identifying the researchers’ biases and assumptions, as these can potentially influence the data collection and analysis process (Fassinger, 2005). As such, the research team met prior to data collection and again before data analysis to freely discuss their assumptions and beliefs. Moreover, the researchers recognized that their own social identities may influence data collection and analysis; they discussed how their own experiences may affect their interpretations, in order to minimize the bias that could potentially occur. The research team was comprised of eight individuals: one Arab female, one Asian male, one Black female, two Black males, one Latina female, one White female, and one White male. One researcher is a college professor, and seven others are graduate or undergraduate students; none of the researchers identified as actively practicing Islam. Measures A demographic questionnaire was used to collect information about the participants’ age, ethnicity, sexual orientation, religion, level of education, years in US, and occupation. Appendix A describes the semistructured protocol designed by the research team to guide the focus group interviews. The protocol consisted of 12 questions that probed for examples of religious microaggressions. Follow-up questions were asked to gain an understanding of the participants’ interpretations of events. The protocol questions were designed around the religious microaggression taxonomy discussed earlier (Nadal, Issa, et al., 2010), as well as previous qualitative studies (Nadal, Issa, et al., 2010; Nadal, Wong, et al., 2011; Sue, Nadal, et al., 2008). Open-ended questions were also utilized to give participants an opportunity to discuss microaggressive events that may not be captured by the taxonomy. Procedures Three research team members were assigned to each focus group. Focus groups were each led by one researcher (an Arab female in the first group and a Black male in the second). Two observers (one Black woman and one White man) were present in both groups; they sat separately from the participants and were present to identify participants’ nonverbal behaviors (e.g., head nodding, smiling, and other facial expressions). Utilizing an observer is a common practice in qualitative research, so that more than one person can interpret group behaviors and dynamics (Krueger & Casey, 2000). The focus groups took place in an enclosed private room at two universities in the American Northeast. Research participants were assigned to focus groups based on their location and availability. No financial compensation was offered. A list of possible counseling facilities were handed out, informed consent forms were signed by all participants prior to the commencement of the focus group, and participants indicated their agreement to be audio-taped. The interviewer provided a definition of microaggressions, asked open-ended questions about experiences with religious microaggressions, allowed participants to respond in their own time, and probed with follow-up questions when appropriate. Each focus group lasted approximately 50 minutes. The interviewer and observers convened for approximately 15 minutes once the group had concluded to process their experience, including observed personal reactions, emergent themes, social climate, and any problematic issues. The focus group was audio-taped and then transcribed verbatim with identifying information removed. The transcripts were checked for accuracy by both the interviewer and observer prior to data analysis. Next a directed content analysis was used to qualitatively analyze the data. The goal of a directed approach to content analysis is “to validate or extend conceptually a theoretical framework or theory” (Hsieh & Shannon, 2005, p. 1281). The aim of the present study was to validate (or enhance) the religious microaggressions taxonomy (Nadal, Issa, et al., 2010), focusing specifically on Muslim experiences. Using the taxonomy, the research team members worked independently to identify key concepts or variables as the initial coding categories. Next, the research team met as a whole and developed initial definitions of the six categories (i.e., Endorsing Religious Stereotypes, Assumption of Religious Homogeneity, etc.) that were identified. Each individual member of the team then carefully reviewed each transcript, taking note of all text that appeared to describe a participant’s interpretation or description of a microaggression experience. Team members assigned each microaggression experience to whatever theme or themes they thought the quote could represent. If an example did not fit under any of the proposed themes, the quote was still set aside to potentially be included as an underdeveloped theme or a new theme not recognized by previous research. Examples that were determined by specific team members to fit more than one theme were later discussed by the group who, as a whole, came to a consensus as to which theme the example fit best. The researchers also came to a consensus on determining codes for data that could not be classified via the proposed taxonomy. Next, the researchers provided an external auditor with the themes and examples of quotes under each theme. The auditor initially worked independently from the other researchers and was included in an attempt to minimize the bias that can occur through group conformity or group dynamics. The auditor, who is an expert on microaggression literature, is not affiliated with the institution where the research was conducted; thus, he was able to offer constructive feedback to the rest of the team in an honest and direct way. After independently reviewing the group’s coded transcripts and chosen quotations for accuracy, the auditor provided feedback to the team. The team reconvened, and based on the auditor’s feedback, revised their analysis when necessary. After the auditor’s approval, the team then collaborated to select the most fitting or profound quotations from the transcripts that best illustrated the identified themes. The auditor reviewed the final analysis and approved the teams’ collaborative work. Results Six themes emerged from the analysis of the transcriptions. These themes included: (1) Endorsing Religious Stereotypes of Muslims as Terrorists, (2) Pathology of the Muslim Religion, (3) Assumption of Religious Homogeneity, (4) Exoticization, (5) Islamophobic or Mocking Language, and (6) Alien in Own Land. All six themes were derived from robust examples endorsed by multiple participants from both focus groups. The first four themes (Endorsing Religious Stereotypes, Pathology of the Muslim Religion, Assumption of Religious Homogeneity, and Exoticization) support those proposed by Nadal, Issa, and colleagues’ (2010) religious microaggression taxonomy. The last two themes (Islamophobic/Mocking Language and Alien in Own Land) were not included from the original theoretical religious microaggression taxonomy; however the amount of examples from both focus groups suggests that these two categories of microaggressions are pervasive in the lives of these Muslim participants. There was one underdeveloped theme, Assumption of Christianity as Normal, but there were not enough examples to generalize the experience of participants across both focus groups. This next section will introduce these themes, along with supporting examples, to demonstrate the types of religious microaggressions these Muslim participants experience. When possible, pseudonyms will be used to protect the identities of the participants; however some first names are used because they are pertinent to the description of certain incidents. Theme 1: Endorsing Religious Stereotypes of Muslims as Terrorists This theme occurs when non-Muslim people assume that all Muslim people are affiliated with terrorism in some way. This sends the message that Muslim people are violent, evil people who should not be trusted. Participants overwhelmingly shared incidents that endorsed this theme, with many describing experiences that were clearly malicious and overtly Islamophobic. For example, a participant relayed an incident that she and her mother experienced when walking down the street: A truck driver said to my mom, “Say hi to Osama.” And that was like kind of the worse thing... you know what she did? [laughs] She said, “I will.” [laughs] She made them think that. [laughs] Only because what was she supposed to say? She really didn’t know Osama [Bin Laden], but, I mean, just to make them feel stupid, she said that. While this incident is an example of overt Islamophobia, some participants spoke about statements and behaviors that may be subtler in nature. In these instances, participants identified the incident as being discriminatory, but they may not have had enough evidence to “prove” that Islamophobia was involved. A common experience shared by participants included being randomly searched at airports. One female participant shares: In the airport, one time, I had my passport with me and I was going from Holland from the Netherlands to Egypt. And the security guard, I was walking the airport alone, the security guard stopped me and was like let me check your passport and like okay... And I gave him passport, and he looks at my passport, and [says] “Okay you come with me.” I’m like okay, so I went with him and he was like the picture doesn’t look like you. While the security guard did not mention anything related to her religious background (or his stereotypes of Muslims as terrorists), the participant interpreted she was stopped because she was dressed in a hijab. Thus, while the first example was more overt, the second may be identified as a microaggression because of its subtlety and lack of mentioning anything related to religion. Some incidents under this theme included interactions when non-Muslims may or may not have recognized that their comments were offensive. A White participant who had converted to Islam over five years ago has experienced these stereotypes from her own brother (who is not Muslim): It was like funny and painful at the same time and we were sitting at a table ... “You have to tell me. You know you got to tell me the truth. You go to mosque and everything like that. When you go, do you ever hear anything like when the next bombing’s going to be?” Perhaps it was not the intention of her brother to be offensive; however, his words caused the participant to feel upset, hurt, or misunderstood. Almost every participant had an example of microaggressions based on stereotypes and agreed that these instances were distressing and frustrating. Participants expressed that this stereotyping had existed for years, but that it became much more intense and obvious after September 11th. Theme 2: Pathology of the Muslim Religion This theme refers to the conscious (and sometimes unconscious) belief that there is something wrong or abnormal with someone of a different religion, leading to behaviors that convey punishment, judgment, or maltreatment (Nadal, Issa, et al., 2010). Female participants discussed the stares they received when they wore their hijabs. Participants indicated that these stares sometimes communicated hate, while other times these communicated discomfort or curiosity. For example, one participant described a time when a stranger made a comment about how she was dressed: Once a guy came to me... in the summer, [and] he was like “Don’t you feel hot with the thing you are wearing on your head?” I’m like, “No, I don’t feel hot. Why don’t you ask the nuns? The nuns wear the same thing.” And he was like, “Uhhh, ok, ok.” This remark sends the message traditional Muslim garb is abnormal or weird. The participant defends herself (and her religion) by pointing out that people of other religions have traditional garments that they wear without being questioned or mocked. Participants discussed how they are often treated differently and consequently have adjusted or changed parts of their Muslim identity or appearance. For example, a participant spoke about not using her Arabic name at work because the children will tease her: I work with students, so once they find out, they call me [Sarah], because that’s my middle name. And at work I allow the students to. They’re in junior high so at that age they’re very ignorant and not very nice. Because the participant had been teased in the past for her name, she would rather prevent microaggressions by having her students call her a non-Arabic name. This example is one of many in which it is difficult to attribute whether the microaggression is based on religion, race, ethnicity, or some combination of them all. Theme 3: Assumption of Religious Homogeneity When others assume all Muslim individuals share the same experiences, religious practices, or behaviors, they make a judgment that there are no differences between members of a certain group, that an entire religious group is completely homogenous. This type of microaggression is different than stereotyping because stereotypes are based on false, unnecessary, or unwarranted prejudice (e.g., assuming that agnostics or atheists don’t have morals or that Muslims would be terrorists). Assumption of religious homogeneity is unique from stereotyping in that an individual may be aware (or seem to be aware) of a certain religious or cultural practice, but assumes: (a) there is no flexibility to the practice or tradition, or (b) every single person of the group must engage in such a behavior. For example, one participant described her experience: People come up to me, like, they don’t know between religion and ethnicity, they would come up to me and be like, “You are White, why are you covered?” I was like, “I’m Muslim. I’m Moroccan. I am not Arabic, but I am Muslim.” So it’s not the same, but for them, it’s like if you are covered, you have to be Arabic in order to be Muslim.” In this individual’s experiences, people have assumed all Muslims are of Arab descent and therefore do not believe that she is Muslim. Another participant described an experience in which she was questioned about the religious practices of Muslim individuals, “He was like, ‘Well do you guys really pray five times a day?’ I was like, ‘Uh, well, we all have busy lives so it’s impossible for some us to pray five times a day.’ ” In this instance, the man assumed that all Muslims are strict with their practices and that there isn’t any room for flexibility. Such a statement also sends a judgmental message that all Muslim people must be the same, while also maintaining that their practices are abnormal in American society. Theme 4: Exoticization An exoticization-themed religious microaggression may occur when someone asks an individual an excessive amount of questions regarding any or all aspects of their religion. These types of microaggressions can also occur when people view particular religions as exotic and or trendy. For example, when fashion designers use religious garments in their designs, a message is communicated that one’s religious garments are allowed to be exploited for commercial use and fashion. Participants discussed a few ways in which they felt exoticized. One participant discussed how many celebrities have recently converted to Islam. While the true intentions of these celebrities are not known, a message can be conveyed that Islam is exotic and a new fad among celebrities. Another participant shared an example of exoticization of the Muslim religion on the television show The Office. She explains a scene in which Steve Carrell’s character was traveling internationally for his business: He asked a female who walks into the office to say that she is from Abu Dhabi and he is like “Pretend that you are from Abu Dhabi. I’m so ashamed of your naked face, I should cover you.” And he got his jacket and covered her face and said, “Now you are sexy in your culture.’” This incident may be viewed as a religious microaggression because the character is portraying Muslim women as being exotic, different, or unusual, instead of understanding the significance of the religion and of the hijab. While meant to be a joke, Muslim individuals who watch this show may feel saddened that their religion is being portrayed in such a negative and harmful way. This incident may also be considered an environmental microaggression because it takes place on television, thus communicating these hurtful or offensive messages to millions of people who watch it. Theme 5: Islamophobic and Mocking Language This type of microaggression is a new category that was derived after analyzing the transcriptions from the focus groups. This theme involves instances where people make fun of the religion, use hurtful language, and tease the people who subscribe to it. For example, one participant describes a time when one of her students began teasing her: So I had a student in eighth grade last year where he knew my full last name was [Hussein] and he would speak in this accent but totally not from where I’m from. And he would call me like a Taliban. I felt like, “You need to stop.” And it was getting to a point where he started calling me a terrorist at work and I didn’t appreciate that. Because of the environmental microaggressions that may occur on television, perhaps individuals have learned that it is socially acceptable to make fun of Muslim people. Another example was depicted by a participant who was talking about an experience with one of his teachers when he was an adolescent: I was in seventh grade and my name is Osama. And when the 9/11 happened, a lot of people picked on me after school... And one teacher, like, she was doing attendance and she called me Osama bin Laden. So I thought she did it by accident, because the name was on the news a lot and stuff. But [I knew] she was doing it on purpose [because] she kept doing it over and over. This theme communicates that Islam is something to be feared or something that is unacceptable. Moreover, participants described how people were blatant in sharing their negative views about Islam. For example: Um I found a note on the subway. So I just sat there and I found a note saying, “Allah sucks dicks.” And I looked at it and I [thought] “What? I, I got so mad that I’m just like why would you do that? Why? And I just, it was like glued on the chair and I just tried to rip it up, rip it up, and rip it up and threw it in the garbage. So I, I was shocked actually to see that! Like there’s no respect at all towards it. Participants reported feeling hurt and disgusted by incidents that involved Islamophobic language. Almost all participants discussed the Islamophobic language that they experienced in their everyday lives. Some participants cited that they believed that people felt comfortable saying negative comments about Muslims, but knew that it would be politically incorrect to say such things about other religious and racial/ethnic groups. Theme 6: Alien in Own Land Sue, Capodilupo, and colleagues (2007) discuss how individuals who were born, raised, or lived a significant amount of time in the US are still often treated like foreigners. For example, one participant shared: “I walked up and he goes, ‘What are you, Indonesian?’ You know he made it seem like I must be from another country or something.” Individuals, such as this participant, may experience situations in which others make them feel as if they do not belong in the US even though they were born in the US or consider the US to be their home. Such experiences communicate that these individuals do not belong in the US, subtly communicating that there is a certain way of being or looking American. Similarly, another participant discussed comparable and reoccurring experiences that she experiences regularly: They are always telling us: “Go back to your country!” [But] this is our country. We’re obviously living here... Who are you to tell me to go back anywhere? I was born here I should be able to live here. And if our parents came here for better opportunities, why should they even be allowed to say that?” Finally, a participant discussed an incident in which she introduced herself during class in a large lecture hall: “Everyone just got up and was just like staring at me... but they didn’t say anything.” Because of her Arabic name, she felt that everyone went out of their way to look at her. But although no one said anything blatantly discriminatory, she still felt uncomfortable by her peers. In each of these scenarios the enactors communicated a message that the participants did not belong, were not welcome, or both. As a result, participants reported feeling angry, sad, belittled, and frustrated. Again, it is unclear of whether these microaggressions are based on solely on religion, race, ethnicity, or some combination of them all. Discussion Although there has been an increased interest in the impact of the 9/11 terrorist attacks on Muslims living in the US (Kira et al., 2010; Rippy & Newman, 2008), little research has been conducted on the psychological impact of religious microaggressions. While Muslims in the US have reported an increase in their experiences of overt discrimination (CAIR, 2003, 2008), attention must also be paid to the covert discrimination that these individuals are likely to face on a daily basis. The results of the present pilot study support four themes from the proposed taxonomy of religious microaggressions proposed by Nadal, Issa, and colleagues (2010), along with two emerging themes based on experiences from participants in our study. As with other types of microaggressions, the examples of religious microaggressions experienced by the participants were referred to as both intentional and unintentional. Sometimes the enactor was either aware or unaware of the connotation and implications of her or his words or actions (e.g., someone using Islamophobic language to hurt someone’s feelings), but other times, enactors were unlikely aware of their actions (e.g., an individual who stares at a Muslim woman wearing a hijab, even out of curiosity, may not recognize the hurtful message that is communicated). However, participants discussed many instances of discrimination that were blatant and even verbally assaultive. Sue, Capodilupo, and colleagues (2007) described that microaggressions can take the form of microassaults (e.g., old fashioned, conscious, and intentional racism) and microinsults (e.g., subtle behavioral and verbal communications). This suggests that although racism is said to have diminished, perhaps Islamophobia is still rampant and Muslim Americans still experience blatant discrimination on a regular basis. Two of the themes from the original religious microaggression taxonomy were not supported by the participants: Assumption of One’s Own Religion as the Norm and Denial of Religious Prejudice. There are two possibilities for this outcome. First, examples of how one’s religion is viewed as the norm are often described as being subtle and part of American culture. For example, Nadal (2008) described Christmas decorations in public spaces (including government buildings) as being a common occurrence and that non-Christians may not recognize this as being discriminatory. Perhaps Muslims (and other non-Christians) are so socialized to believe that certain behaviors and environments are normalized parts of American culture that it simply becomes difficult to identify. Second, denial of religious prejudice is a microaggression that usually requires individuals to have difficult conversations about religion with others, which would lead to these invalidating statements. Perhaps these individuals did not experience such microaggressions because they avoid engaging in conversations in which these may occur. As aforementioned, the Muslim community in the US is so diverse in terms of race (with the largest populations being Arab, Asian, and Black) and ethnicity (with people from various countries like Syria, India, the Philippines, and Spain). Thus, it is important to recognize that the microaggressions that Muslim Americans experience may not only be due to religion, but also due to race, ethnicity, gender, or some combination of all of these. For example, if a Muslim, Asian Indian woman experiences a microaggression in which she is treated as an “alien in her own land,” it may be due to her religion (Muslim), race (Asian), ethnicity (Indian), gender (woman), or some combination of all. At the same time, perhaps her experiences with microaggressions may be completely different from a non-Muslim Asian Indian woman or a Black woman who is Muslim. Thus, it is important to remember that intersectional identities may result in unique and complicated types of microaggressions in people’s lives. Further, the idea of “passing” is an important concept in understanding microaggressions toward Muslim Americans. Some participants reported that they are less traditional and may not wear religious garments at all (or only on holidays). Thus, the types of microaggressions that these individuals experience may be different than those experienced by Muslims who wear traditional clothes on a regular basis. This idea of “passing” was introduced in the literature on multiracial microaggressions (Johnston & Nadal, 2010), citing that when an individual is mistaken or “passes” for the dominant group, she or he may be afforded more privilege than those who do not (or cannot) pass. Perhaps Muslim individuals who do “pass” as non-Muslim may not experience the same types, or amounts, of microaggressions as people who are easily identified as Muslim. At the same time, it is possible that when someone can “pass” that microaggressions may be much more frequent, because others may assume the individual to be non-Muslim and unknowingly communicate negative messages about Islam. Future research on the concept of passing is necessary, in order to understand how microaggressions impact the lives of the broad ranges of Muslim people. Finally, it is important to note that microaggressions that are perpetuated in the media may have a detrimental impact on the stereotypes non-Muslims develop, as well on the psychological health of Muslims themselves. Specifically, general society’s stereotypes about Muslims as terrorists may stem from the overtly Islamophobic statements made by politicians and media commentators in the public eye. For example, when Fox News host Bill O’Reilly stated that “Muslims killed us on 9/11” on the television show The View, it is clear that his comment was rooted in his Islamophobic bias. However, the statement still has microaggressive qualities because of his intention. While he was conscious of his words, his intention may not have been to attack all Muslims; in fact, in a later interview he stated, “if anyone felt that I was demeaning all Muslims, I apologize” (Thomas, 2010). This unintentionally offensive comment is similar to the example given by one participant regarding the television sitcom The Office. However, even if someone’s intention is not malicious, the mere fact that such prejudice is so pervasive in the media, stereotypes about Muslim people are perpetuated, which in turn may lead to both overt and covert discrimination on interpersonal levels. Further, negative images of Muslims in the media may have detrimental impacts on the self-esteem, mental health, and identities of Muslim people. Thus, it is necessary for media and other institutions to be much more vigilant in preventing these types of stereotypes from continuing, in order to decrease microaggressions in everyday life and to promote optimal mental health for Muslim people. Implications for Research and Clinical Practice There are many implications in this study for Muslim mental health and for psychology in general. First, it is crucial for academic literature to focus specifically on the mental health and lived experiences of Muslim Americans. Although they are a growing population in the US, there is little known or written about their experiences with psychological well-being, identity development, acculturation processes, mental health treatment, experiences with discrimination, or other pertinent issues. Second, it is important for the microaggression literature (i.e., both empirical research and theoretical models) to expand to include the experience of religious microaggressions toward Muslims and other religious minority groups. Given that Islamophobic discrimination has grown exponentially since 9/11, it is necessary for mental health practitioners to be aware of the impact of discrimination on the mental health of these individuals, in order to provide the most effective treatment for them. Further, in order to maintain ethical standards of cultural competence of various governing boards (e.g., American Psychological Association, American Counseling Association), clinicians must expand their knowledge and skill base to include Muslims (and other religious minority groups). Clinicians must recognize the types of microaggressions their Muslim clients may experience in their everyday lives, as well as potential microaggressions that may occur in therapy. Practitioners must be conscious of their own biases and stereotypes about Muslims, and how these stereotypes may unintentionally manifest in psychotherapy. For example, if a non-Muslim female psychologist assumes that a hijab is oppressive against women, she may unconsciously try to steer her client away from covering, instead of understanding the significance of the hijab in her Muslim client’s life. Leaders in school systems and other institutions must be aware of the ways that Muslim young people are discriminated against, both blatantly and subtly, and how such messages impact their identities and development. For example, one study in the United Kingdom found that Muslim students were often bullied by their peers because of their religion (Eslea & Mukhtar, 2000). Because Islamophobic stereotypes are often viewed as acceptable in the media, it is important for educators to combat these prejudices by teaching young people about equality and acceptance, as well as the hurtfulness of bullying and other forms of discrimination. In increasing this awareness in individuals at an early age, it is hoped that the stigma toward Muslim people (and any marginalized group) will decrease and that the mental health of Muslim Americans (and others) will improve. While the results of this pilot study were rich, there are several possibilities for future research in this area. First, because racial discrimination has been found to be related to mental health problems (e.g., depression, substance use) and physical ailments (e.g., cardiovascular disease), research may examine religious microaggressions and their impact on physical and mental health disparities in Muslim American communities. Furthermore, researchers may want to examine the coping processes and reactions to microaggressions by Muslim Americans, as well as the protective factors that help them to resiliently manage experiences with discrimination. Finally, researchers may investigate the impact of religious microaggressions on other religious minority groups (i.e., Jews, people who do not identify with any religion, Hindus, etc.), understanding the types of microaggressions these individuals experience and the ways that they cope with these microaggressions as well. Limitations It is important to acknowledge that our study should be considered a pilot, especially given the small sample size and the limited generalizabilty to the entire Muslim community. Given the qualitative framework and purposive participant recruitment process employed in our study, we cannot suggest that our results represent the entire experience of the Muslim American population. Thus, it is important for both qualitative and quantitative studies with larger sample sizes to emerge, in order to gain a better understanding of the Muslim experience. Second, we were not able to investigate differences in gender, age, race, as well as other demographics that likely contribute to Muslim Americans’ experiences with microaggressions. Third, given that Muslim Americans represent a wide array of generational statuses, it is likely that acculturation issues (e.g., language use, cultural customs, etc.) play a role in how microaggressions manifest for Muslim Americans; however, our methodology did not allow us to examine acculturation in this study. Conclusion The current study is the first known report to examine the experiences of religious microaggressions by Muslim Americans. As demonstrated by the participants’ responses, Muslims are subjected to various types of religious microaggressions such as being stereotyped as a terrorist, having others pathologize or exoticize them or their religion, and being the target of Islamophobic or mocking language (to name a few). Muslims often endure negative media messages in both the news and on fictional television shows. Being the victim of such covert discrimination on a consistent basis can have an additive affect on one’s mental health and ability to function daily. Thus, in the same way that efforts have been made for racial equality for African Americans, Latina/os, Asian Americans, and Native Americans, efforts must be made to decrease discrimination toward Muslim Americans, in order to promote their positive mental health and well-beings. muslimtoysanddolls.com is a charity site to help Muslims in need and it sells over 2,600 products for the whole family.it makes a great homeschooling resource to. 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Mental Health Stigma in the Muslim Community

Mental Health Stigma in the Muslim Community Mental illness stigma continues to be a major barrier for individuals with mental illness. In this paper, we define constructs that comprise stigma (e.g., attitudes, stereotypes, prejudice, discrimination), discuss the harmful effects (e.g., label avoidance, public stigma, self-stigma) and present factors that may influence them (e.g., concealability). In order to better understand mental health stigma in Muslim community, we focus on intersectional stigma and present literature on the complex relationships among race/ethnicity, gender, class, religion, and health status among Muslims. In addition, we include literature highlighting culturally specific presentations of symptoms and mental health problems. Finally, we offer suggestions for future stigma research in Muslim communities. And We will surely test you with something of fear and hunger and a loss of wealth and lives and fruits, but give good tidings to the patient (Surat Ai-Baqarah 2:155) Although mental health care has improved significantly over the last decades, many people still choose not to seek treatment or quit prematurely. A number of possible factors contribute to these disparities with stigma being perhaps the most significant. Stigma hurts individuals with mental illness and their communities, creating injustices and sometimes devastating consequences. In this paper, we discuss mental illness stigma and its related constructs, describe the current state of understanding mental illness stigma in Islam, and summarize critical considerations to address stigma in this community. Stigma is defined as “the situation of the individual who is disqualified from full social acceptance” (Goffman, 1963, p. 9). In this paper, we distinguish label avoidance from public stigma. Label avoidance refers to instances in which individuals choose to not seek help for mental health problems in order to avoid negative labels (Corrigan, Roe, & Tsang, 2011). In order to avoid psychiatric labels, individuals may choose to not associate themselves with mental health clinic or professionals -- avoiding diagnosis by avoiding mental health care. Public stigma is the prejudice and discrimination that blocks individuals’ access to employment, educational opportunities, health care, and housing. Public stigma occurs when members of the general public endorse stereotypes about mental illness and act on the basis of these stereotypes. In order to unpack the stigma process, it is helpful to differentiate key terms that comprise the stigma construct: attitudes, stereotypes, prejudice, and discrimination (Corrigan, Roe, & Tsang, 2011). We form attitudes based on seemingly factual views of the world and our values and emotional reactions to these views. Attitudes can be positive or negative. Stereotypes are attitudes made about individuals based on their assignment to a particular group or category. Stereotypes per se rely on generalizations that are often inaccurate or misleading when applied to particular cases. Prejudice refers to negative affective attitudes toward particular groups and implies agreement with derogatory or pejorative stereotypes. An individual walking by men wearing turbans, for example, might not only assume that they are terrorists (a stereotype) but also feel anger and fear toward them because of their presumed dangerousness (prejudice). Discrimination is the behavioral component of stigma and occurs when people act on the basis of prejudiced attitudes or beliefs. For example, individuals who believe that Muslim men are ‘dangerous’ and untrustworthy might avoid neighborhoods in which Muslim families live, or report these men to airport police for “suspicious” activities. Behavioral discrimination might also occur in subtle forms such as choosing not to sit next to an individual wearing a turban on the train. Both label avoidance and self-stigma are frequently framed as consequences of public stigma (Corrigan et al., 2001). Self-stigma occurs when individuals belonging to a stigmatized group internalize public prejudice and direct it toward themselves. The self-stigma process can be broken down into component parts, including awareness (e.g., are individuals aware of the stereotypes related to the mental illness?), agreement (e.g., do they agree with the stereotypes?), application (e.g., do they apply these stereotypes to themselves?), and harm (e.g., is this stereotyping harming their self-esteem or self-efficacy to use coping skills to fight stigma’s effect?; Corrigan, Larson, & Kuwabara, 2009). One of the most significant harms resulting from self-stigma is the foreclosure of important life pursuits by individuals who come to believe they should not pursue goals that society thinks such individuals cannot succeed in (Corrigan, Larson, & Rusch, 2009). Factors that Influence or Moderate Stigma Jones and colleagues (1984) propose that stigma is moderated by six factors: concealability, course, disruptiveness, aesthetic qualities, origin, and peril. Concealability refers to the relative apparency of a stigmatizing attribute. Skin color is often visible, whereas mental illness can often be concealed. While highly visible stigmas lead to immediate discrimination, concealable stigmas have other negative consequences. Although a stigma such as mental illness can be hidden in some circumstances, management of information about it—who to disclose to, who not to, how to keep records hidden—may lead to high levels of social stress and strained social interactions (Beatty & Kirby, 2004; Clair, Beatty, & MacLean, 2005; Joachim & Acorn, 2000). Discrimination stemming from visible stigmas may be easier to identify and legally prosecute than discrimination based on invisible attributes (Stefan, 2000). Of the other dimensions articulated by Jones and colleagues, course and peril have emerged as important influences on the degree of stigma and its negative behavioral consequences (Jorm & Griffiths, 2008; Keller, 2005; Link et al., 1999). In recent years, a number of researchers have also begun to explore the influence of different explanatory models or causal beliefs regarding the origins and nature of mental illness (Phelan, 2005; Rusch et al., 2010; Schomerus et al., 2012; Schomerus, Matschinger, & Angermeyer, 2013). With respect to self-stigma, Corrigan and Watson (2002) suggest that group identification and perceived legitimacy of public stigma influence self-stigma. This leads to a paradox: individuals who are aware of public stigma may view these attitudes as legitimate (resulting in low self-esteem) or not legitimate (resulting in intact self-esteem), and react with shame, indifference, or righteous anger, depending on their level of identification with their in-group. Perceptions of legitimacy is influenced by several factors including negative social feedback and personal values that may protect against self-stigma. Rusch and colleagues (2009, 2010) examined the influence of in-group perception, perceived legitimacy of discrimination, responses to stigma, and causal attributions. Entitativity is “the perception of the in-group as a coherent unit” (Rusch et al., 2009, p. 320). For example, individuals may have low entitativity about the ‘group of people’ waiting in a grocery check-out line versus those who attend their mosque. Findings suggested that individuals with high group value (higher group identification and entitativity) and lower perceived legitimacy are more resilient to stigma. Group identification can be a critical issue especially dealing with stigma in minority or more collectivist communities. Double Stigma and Intersectionality Stigma impacts individuals of color and minority cultures. Studies conducted within the United States suggest that the experience of mental illness stigma can be more complicated for those from racial and ethnic minority groups. Gary (2005) examined four ethnic groups in the United States (i.e., African Americans, American Indians and Alaska Natives, Asian Americans, and Hispanic Americans) and proposed the concept of “double stigma,” stemming from prejudice and discrimination occasioned by individual’s racial identity and their mental illness. Intersectionality describes the complex relationships between different identities (e.g., race, gender, sexual orientation, class, and disability) and forms of oppression. Effects of interlocking identity axes must be considered simultaneously (Cole, 2009; Collins, 2000, 2007; Hancock, 2007). Oppression associated with race, economic status, disability, and gender operate as an intersecting system, not as unrelated instances of oppression. To use a classic example, middle-class white women are often viewed as relatively asexual pillars of family values, while poor African American women are seen as sexually “promiscuous” (Collins, 2000). An intersectionalist framework proposes that the process and effects of the stigmatization of, for example, a working-class Muslim woman with depression will differ from that of a middle-class White woman with depression not only in degree (i.e., ‘more’ or additive stigma), but in kind (i.e., qualitatively different stigma with fundamentally different effects on the stigmatized individual). Although the literature on stigma and intersectionality remains small, existing studies underscore the importance of work in this area. On the experimental side, Wirth and Bodenhausen (2007) found that participants reading case studies of men and women with either gender-typical (e.g., women with depression) or gender-atypical (e.g., men with depression) psychiatric conditions reacted differently. When cases were gender-typical, participants expressed less sympathy and decreased willingness to provide help or support, relative to cases perceived as gender-atypical. In the context of applied scholarship, Collins and colleagues (Collins et al., 2008; Collins, von Unger, & Armbrister, 2008) have unpacked relationships between gender, ethnicity, serious mental illness, and HIV/AIDS risk behaviors. They found complex interplay among identities (particularly gender and mental illness), the social norms affecting these identities, and sexual risk-taking. Study participants, for example, described culturally specific conflicts between mental illness stigma and Latino gender norms that undermined power and leverage in sexual relationships, ultimately leading to higher levels of unprotected sex and greater exposure to HIV/AIDS. Several studies have focused on differences between racial minorities with respect to mental illness stigma with trends suggesting different patterns of stigma based on sex, race, and racial identity (Corrigan & Watson, 2007; Loya, Reddy, & Hisnhaw 2010; Rao, Feinglass, & Corrigan, 2007). Specifically, some minorities, including African Americans and Asian Americans, have higher levels of mental illness stigma compared to the “majority” individuals (Abdullah & Brown, 2011; Anglin, Link, & Phelan, 2006). However, this trend is not clear for all groups. For example, in a study of 357 students (20% African American, 28% Latino, 8% Asian), Rao, Feinglass and Corrigan (2007) found that African Americans and Asians perceived people with mental illness as more dangerous and preferred segregation than Caucasians, while Latinos perceived people with mental illness as less dangerous and preferred less segregation than Caucasians. In the same study, Asian students also showed higher stigma change following a targeted intervention. Another study found that South Asian students reported significantly less positive public attitudes toward help-seeking than Caucasians (Loya, Reddy & Hisnhaw, 2010). After including personal stigma variables as mediators in their model, however, the effect of ethnicity on help-seeking attitudes was significantly reduced. The mediational analysis suggested that for South Asian students, personal stigma, not perceived public stigma, accounted for 32% of the differences in attitudes toward help-seeking. These studies suggest that demographic differences impact ways in which members of ethnic and cultural minority groups stigmatize mental illness in the US. Differences in stigma level and content have also been identified stemming from class and educational attainment (Phelan, Bromet, & Link, 1998), specific religious beliefs (Wesselmann & Graziano, 2010) and gender (Corrigan & Watson, 2007). The complex interactions between race/ethnicity, gender, class, religion, and health status have nevertheless gone largely unexplored, suggesting a need for more sophisticated intersectional analyses. Mental Illness Stigma outside of the United States Mental illness stigma is a significant problem not only in the Unites States, but around the world (Crabb et al., 2012; Fung, Tsang, Corrigan, Lam, & Cheng, 2007; Lauber & Rössler, 2007; Ng, 1997; Tal, Roe, & Corrigan, 2007). However, while stigma as a broad construct can be identified across cultures, influences, dimensions and consequences vary substantially within local context (Yang et al., 2007). In Chinese culture, for instance, where individuals are seen as links in an intergenerational kinship structure whose central responsibility is not to themselves but to family and ancestors, mental illness ‘contaminates’ not only the individual but also the extended family (Yang & Pearson, 2002). Chinese persons with mental illness may also be more susceptible to self-stigma, due to the more immediate and reflexive influence of the collective on personal beliefs (Fung, Tsang, Corrigan, Lam, & Cheng, 2007). In Egypt, on the other hand, where problems tend to be understood in intersubjective rather than intrapsychic terms, less blame is placed on the individual with mental illness; mental illness in a more collective sense is nevertheless seen as a significant threat to social order, as exemplified by the physical isolation and segregation of psychiatric facilities (Coker, 2005). Cultural differences also have significant implications with respect to caregiver stigma and burden. Comparing India and the United States, for instance, Marrow and Luhrmann (2012) describe how perceptions of family honor, shame, and moral responsibility, access to psychiatric services, and cultural acceptance of biomedical approaches to mental health treatment, combine to lead Indian families to hide family members with severe psychosis within their homes (taking on the majority of caregiver burdens), and American families to abandon them to institutions or on the streets. Chinese families may also keep family member’s illness a secret in order to save face (Mak & Cheung, 2008). Consistent with these findings, Ciftci (1999) observed a strong sense of family shame at a rehabilitation center in Turkey while working with families and children with mental illness. In some cases, shame was so extreme it led to locking children in the house and not “coming out” in public. Most frequently, fathers would blame mothers for giving birth to a child with mental illness. It was extremely critical to incorporate the support from extended family and other elders (e.g., religious) in the community to make changes. Health, Mental Health, and Islam The global Muslim population is estimated to be around 1.6 billion persons, which makes up about 23% of the world’s population, with 62% of Muslims living in Asian-Pacific countries (e.g., Indonesia, Pakistan, India, Bangladesh, Iran, and Turkey), 20% in the Middle East or North Africa (e.g., Egypt, Yemen, Sudan, Saudi Arabia, Algeria, Syria), 15% in Sub-Saharan Africa (e.g., Nigeria, Rwanda, Kenya), 3% in Europe (e.g., France, Belgium, Austria, United Kingdom) and less than 1% in North America (e.g., United States, Canada). According to Pew Research Center’s Forum on Religion and Public Life (2011), this number is expected to increase by about 35% by 2030. In the U.S., approximately 32% of the Muslim population is South Asian, with 26% Arab, and 20% African American. Although Muslim beliefs and ethnic sub-cultures are heterogeneous, they are often perceived as a monolithic group, negatively stereotyped and subjected to significant interpersonal and structural discrimination (Jamal, 2008; Jasinskaja-Lahti, Liebkind, & Perhoniemi, 2006; Whidden, 2000). Before discussing mental illness stigma in Muslim communities, and the intersection of religion, culture, and mental illness stigma, we describe cultural definitions of health and mental health within Islam. There are contextual differences among practices and beliefs about health and illness and important commonalities across Muslim groups. A fundamental tenet of Islam is that there is one God (the Arabic word for God, Allah, is used universally by Muslims, regardless of ethnic group or language of origin) and Allah causes everything including illnesses. According to some religious leaders, illness is one method of connection with God and should not be considered as alien, but “rather…an event, a mechanism of the body, that is serving to cleanse, purify, and balance us on the physical, emotional, mental, and spiritual planes.” (Rasool, 2000, p. 1479). This core belief is reflected in multiple studies on the perspectives of Muslim community members extending to both physical and mental illnesses (DeShaw, 2006; Padella et al., 2012; Ypinazar & Margolis, 2006; Shah, Ayash, Pharaon, & Gany, 2008). For example, South Asian Muslim women queried about the cause of breast cancer strongly affirmed God’s role in determining both who gets sick and who is healed (Johnson et al., 1999). In a focus group of American Muslims examining health attitudes, one participant said “God…is the ultimate doctor. He is the one who brought down the disease. He is the one that brought down the cure” (Padella et al., 2012, p. 849). Mental illness may also be perceived as a test or punishment from God (Abu-Ras, Gheith & Cournos, 2008; Rassoll, 2000). In Muslim culture, belief in kader -- or destiny is strong. While kader may lead to fatalism in some cases (Shah et al., 2008), it also suggests positive acceptance of Allah’s will and higher levels of optimism with respect to healing (Hasnain, Shaikh & Shanawani, 2005; Nabolsi & Carson, 2011). For instance, illness may be seen as an opportunity to remedy disconnection from Allah or a lack of faith through regular prayer and a sense of self-responsibility (Cinnirella & Loewenthal, 1999; Padella et al., 2012; Youssef & Deane, 2006). Imams (traditional spiritual leaders) are often seen as indirect agents of Allah’s will and facilitators of the healing process (Abu-Ras et al., 2008; Padela, Killawi, Heisler, Demonner, & Fetters, 2010; Padella et al., 2012). Imams may also play central roles in shaping family and community attitudes and responses to illness (Padella et al., 2012). For example, Abu-Ras and colleagues (2008) interviewed 22 imams and 102 worshippers from 22 mosques in New York after the September 11 attacks, and found that imams had a critical role in promoting health mental health. In a separate study of 62 imams from across the U.S., Ali, Milstein, and Marzuk (2005) found that 95% reported spending significant time each week providing counseling to their congregants. Cultural influences on presentation of symptoms and mental health problems also need to be considered. Due to the lesser stigma of physical symptoms as well as cultural idioms revolving around the physical body, mental health problems are often expressed as physical symptoms (Al-Krenawi, 2005; Douki, Zaneb, Nasef, & Halbreich, 2007; El-Islam, 2008). In parallel, explicit mood symptoms such as hopelessness, self-deprecatory thoughts, and worthlessness, are uncommon; in particular, women ultimately diagnosed with depression frequently first present with “conversion” disorders and no self-recognition of psychological distress or sadness (Al-Krenawi & Graham, 2000). In addition, normative cultural beliefs in the existence of jinn (evil spirits) may be confused with delusions of possession and control, and may prevent patients and family members from recognizing medical or psychiatric problems (El-Islam, 2008). Significant cultural differences with respect to gender may also put women at especially high risk of diagnosis and treatment of mental health problems in Muslim communities (Al-Krenawi, 2005). Stigma in Muslim Community In this section, we review existing studies with a focus on stigma and then discuss some of the implications of salient cultural differences for future stigma research. In a study on perceptions of and attitudes toward mental illness among both medical students and the general public in Oman, Al-Adawi and colleagues (2002) found that groups believed that mental illness is caused by spirits and rejected genetics as a significant factor. In the same study, both groups endorsed common stereotypes about people with mental illness and affirmed that psychiatric facilities should be segregated from the community. In a separate study examining attitudes toward mental health issues among Pakistani families in the United Kingdom (Tabassum, Macaskill, & Ahmad, 2000), none of the participants reported that they would consider marriage with a person with mental illness, only half expressed a willingness to socialize with such a person, and less than a quarter reported they would consider a close relationship. Even when Muslims have positive attitudes toward mental healing, social stigma remains strong. Because of concerns with family social standing, many researchers report that disclosure of mental illness is considered “shameful” (Aloud & Rathur, 2009; Amer, 2006; Erickson & Al-Timimi, 2001; Youssef & Deane, 2006). Seventy-five percent of the mostly Muslim Ethiopian families surveyed by Shibre and colleagues (2001) reported experiencing stigma due to a relative with mental illness, with substantial minorities reporting that other community members would be unwilling to marry into their family because of the mental illness (36.5%). Similarly, Muslim women may avoid sharing personal distress and seeking help from counselors due to fear of negative consequences with respect to marital prospects or their current marriages. In a study with 67 immigrant women who reported experiencing domestic abuse, Abu-Ras (2003) found about 70% reported shame and 62% felt embarrassment seeking formal mental health services. Khan’s (2006) study involving 459 Muslims in the United States revealed similar gender patterns in stigma and help-seeking. Out of 459 participants, 15.7% of the participants reported a need for counseling while only 11.1% reported ever seeking mental health services. These statistics were strongly gendered with Muslim women expressing higher levels of need for mental health services and men more negative attitudes toward help-seeking. On the other hand, family and key stakeholder participants in a qualitative study of a Thai Muslim community rejected the idea that schizophrenia had stigma since the illness was Allah’s will (Vanaleesin, Suttharangsee, & Hatthakit, 2007). With respect to internalized and self-stigma, a study conducted in Australia with 35 individuals from Arab communities found almost all indicated that stigma was the most significant barrier to accessing mental-health services due to the shame of disclosing personal and family issues to outsiders (Youssef & Deane, 2006). On the other hand, mean levels of self-stigma as measured by the Self-Stigma of Help-Seeking Scale (SSHS) were found invariant between Turkey and comparator non-Muslim countries (Vogel et al., 2013). One US study also found that self-stigma levels among Muslim students did not significantly mediate their attitudes toward counseling (Soheilian & Inman, 2009), though these findings may reflect acculturation and/or generational differences that do not hold across American-Muslim communities. Another Midwestern study of Arab Muslim Americans found significant levels of self-reported shame with respect to utilizing formal mental health services (Aloud & Rathur, 2009). We could not find any existing anti-stigma intervention evaluations or descriptions specifically targeting Muslim individuals. Key Considerations for Stigma Research within Muslim Communities These findings, or lack thereof, underscore the need further research. In addition to research replicating and extending small and/or exclusively qualitative studies, we highlight the need for research sensitive to the following issues: the involvement of families and religious leaders (e.g. imams); double stigma and intersectionality, particularly with respect to race, class, gender, and post-9/11 discrimination; and culturally specific explanatory models for mental illness and appropriate treatment. As our literature review attests, families and religious figures are a crucial resource for individuals experiencing mental health problems. In Aloud and Rathur’s study (2009) of Muslim Americans, for instance, significantly greater numbers of participants reported willingness to seek help from family members (21%) or a religious leader (19%) than from mental health professionals (11%). Likewise, participants in a study in the United Arab Emirates found that participants reported greater willingness to seek help from families and religious leaders than formal mental health services (Al-Darmaki, 2003). These findings are consistent with Hamdan’s (2009) emphasis on the importance of the collectivist nature of Muslim culture, the importance of integrating religion into treatment, and the perception of mental health illness as a “private family matter.” Imams have significant roles in dealing with mental illness in the Muslim community (Abu-Ras, Gheith, & Cournos, 2008; Youssef & Deane, 2006). Although imams spend significant time “counseling” congregants, they rarely have formal training in addressing mental health issues. Consideration of intersectional stigma in the context of Muslim mental health is also critical. In addition to more common intersections of race, class, gender, and health status, Muslim communities, both in the US and abroad, have been shaped by uniquely virulent structural and interpersonal discrimination in the wake of the September 11 attacks (Jamal, 2008). Muslim community members, for example, live in fear of hate crimes, anxiety about the future, threats to their safety, loss of community, and isolation (Abu-Ras & Abu-Bader, 2008; Rippy & Newman, 2006). Since the attacks on the Pentagon and World Trade Center and the ensuing wars in Afghanistan and Iraq, there has also been increased media and government scrutiny of the Muslim-American population (Rippy & Newman, 2006), leading to deep anxiety among Muslim-Americans. In a qualitative study of Muslim American college women wearing the hijab (hair-covering scarf), participants reported fears of both parents and society when deciding whether to visibly identify with the Muslim community (Ciftci, Shawahin, Reid-Marks, & Ellison 2013). In combination with strongly gendered social and cultural roles, it is thus critically important to investigate contextual factors involving these intersections of identity, stigma, and discrimination. In particular, interventions must take into account the complex additional layers of inter-group conflict, cultural distrust, social isolation, and gendered aspects of community life. Finally, research within transcultural psychiatry, cross-cultural psychology, and cultural anthropology concerning fundamentally different explanatory models for and conceptualizations of mental illness must be included (Al-Krenawi, 2005; Douki et al., 2007; El-Islam, 2008; Vanaleesin et al., 2007). Hypotheses stemming from predominantly Western research on the links between stigma and different causal and treatment beliefs (e.g., Schomerus et al., 2012) must be investigated among diverse Muslim samples. The possibility that cultural normative beliefs may be mislabeled or unidentified due to cultural insensitivity also need to be addressed, particularly insofar as such mislabeling may lead to both the unnecessary stigmatization of those who, in fact, do not have psychiatric problems, and the failure to help individuals who do need it. Further, anti-stigma interventionists must take care to not inadvertently undermine strengths of Muslim attitudes toward mental illness, potentially including less blame placed on patients (at least in some contexts) and greater hope regarding prognosis. Conclusion: An Urgent Need for Further Research The number of Muslim immigrants in the United States and around the world is increasing. Unfortunately, discrimination against this minority group continues to increase as well. Particularly in the wake of the September 11 attacks, and ongoing conflict between Israel and Palestine, some members of the public believe that prejudice against the Muslim community is justified. Disparities in mental health within any community impact society as a whole. An evidence-based approach is needed to understand what should be changed, how this change can be made, and how to best measure it (Corrigan, 2010). Stigma experts emphasize the need for interventions to be local, culturally specific, and carefully targeted (Corrigan, 2011). As our review underscores, these best practices are all the more important in the context of stigma research in Muslim communities. muslimtoysanddolls.com is a charity site to help Muslims in need and it sells over 2,600 products for the whole family.it makes a great homeschooling resource to. 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