Rania Awaad – The Future of Muslim Mental Health Stanford Engineerings The Future of Everything podcast

			This is Stanford Engineering is the future of everything and I'm your host, Russ Altman. If you
enjoy the podcast, please follow or subscribe to it on your favorite podcast listening app. Today
Professor Rania Awad will tell us about how she is helping understand and serve the Muslim community
as they deal with mental health issues. It's the future of Muslim mental health. Before we jump into
this episode, a reminder to please rate and review the podcast. That helps us immensely with getting
the word out about the podcast and improving it. The last couple of decades have shown an important
D stigmatization of mental health for many years before that having depression, schizophrenia,
		

			bipolar disorder was something that was hidden. People were ashamed to admit that they had these
diseases. We've made great progress in helping people understand that these are diseases just like
diabetes, or lung cancer, and that you need to seek help. However, what about religious people? What
about folks with a deep faith Christians, Jews, Muslims, how does the faith interact with their
understanding of mental health? In particular for Muslim communities in the United States? This
hasn't been a big challenge. Very often, they're coming as recent immigrants from war torn areas,
they are experiencing lots of discrimination and misunderstanding from the pre existing population
		

			in the US. Others have been here for many generations and continue to have traumatic experiences.
What does this mean as they process both their mental health challenges, as well as their religious
faith? Well, Rania Awad is a Professor of Psychiatry and Behavioral Sciences at Stanford University.
She specializes in understanding the special challenges of treating mental health disorders in the
Muslim community. She has studied the texts of the Muslim faith, and she's a board certified
psychiatrist. And she brings us together to create innovative programs for treating her patients.
Not surprisingly, the lessons that she's learned are relevant to more than the Muslim community. And
		

			so she's also exporting these learnings to patients dealing with faithful Christians, Jews and other
religions. So Rania, your work focuses on the mental health of the Muslim community. What are the
special challenges in studying and serving that community? Yeah, definitely. This community here in
the United States, and in the West, in general, is a minority community. So one of the biggest kind
of challenges really, is how do we make sure that there is access to care, and also kind of bringing
down some of the stigma related to mental health? In this community, it's a very diverse community
is another kind of main challenge we have here. It's not homogenous in any way. And so there's lots
		

			of diversity ethnically, racially, social economically, even religiosity wise. So there's lots of
different factors to consider. And when you think about how do you get mental health care to all of
these different parts of the Muslim community, then you realize, Wow, this is kind of a big
undertaking. So those are some of the biggest challenges currently that I would say are happening
for this community, it's not hard to imagine that being a Muslim person in the United States can be
very challenging. I'm sure a fraction of them are new immigrants coming from places where there's
been terrible things happening. Some of them may be long term people whose have many been here for
		

			many generations. What are the issues that you see most commonly as as a, I believe, a practicing
psychiatrist? What what do you see in this community? And are there heightened rates of mental
health challenges compared to other populations? So that these are all great questions, honestly,
what we see in and here again, I'll use the word I prefer to use the word communities, because
really what we're talking about is multiple different communities. And you're absolutely right,
depending on whether this the person we're talking about is an immigrant, a new immigrant, are they
first generation second generation, a point five generation or 1.5 generation? There's all these new
		

			terminologies in terms of acculturation? How long has a person been here and kind of is there the
sense of like having a heart in two worlds, where they're very much still mind and heart is
somewhere else, actually not here in the US, maybe also family members and challenges that they're
constantly thinking about their versus, let's say children who may have been born and raised here
all their life, and now they're raising their own children here. And those issues might be very
different actually, than their parents who may have emigrated. Then you have, for example, the
African American community, which is actually the largest subgroup of the American Muslim community,
		

			and they have been here since the start of the United States. And so you're talking about, you know,
intergenerational trauma and interracial trauma for a very, very long time, all of which adds to
mental health concerns. So yes, I would say that there's, there's there's a lot of factors to think
about. And when you compare mental health rates to other communities, you actually don't feel
		

			I mean, necessarily that there are much higher depression, anxiety, so on, where you do find some
major differences have to do with adjustment rates. So adjusting to the current climate that we're
in, or the sometimes the social political climate keeps changing, right, the last few years have
been different than the year either, you know, the years prior to that. And so, we've really been,
it's, it's a bit of a roller coaster, I would say, and those of us who are mental professionals in
the field have felt this to, actually, so one of the things that always comes up and I know you've
studied this is the relationship of the faith itself, the religious faith, to perceptions of mental
		

			health, openness to treatment, I know that all all faiths, have traditions, some of them are easier,
some of them are less easy to kind of resolve with mental health problems and challenges. So I'm
wondering if you could tell me how did how, what is the situation with respect to the Islamic faith
and the ways in which it helps or hinders people in recognizing their need for treatment, and then
doing the treatments themselves? This is probably one of my favorite questions, I would say, and
hear it because for me, it's kind of preface this by saying, for me, it's been a really long and
personal journey, actually to try to answer this exact question. Growing up, I would say I never
		

			heard of a connection between Islam and mental health, I didn't even realize that there was one. In
fact, when I personally entered into the field, there were a lot of naysayers around me saying,
who's even going to come to you for help? Like, no, this is not something we do. And it turned out a
lot of that sentiment was really much more cultural taboos kind of like we don't air our dirty
laundry to strangers, kind of, you know, sentiment, which actually is shared by many communities,
not unique to the Muslim community. And then I said, set up on this journey of figuring out what is
the connection between Islam itself and mental health. And that's where a lot of the research, I've
		

			pulled up and published now on myself with my entire lab on historical understandings of mental
illness, and treatments actually discovering amazing things like that talk therapy was used in
historic Muslim communities. And most people don't even realize that, you know, don't realize that
there's origins to that historically, within Muslim communities. I'm very interested in your comment
about the cultural root versus the root in the in the faith and the tradition of the faith, because
I think many of us don't, many people, including perhaps me, don't always think carefully about
what's coming from the cultural background versus the faith tradition. And so can you talk a little
		

			bit more about that, because I'm imagining that people have trouble separating that because you grow
up, and then both of them are intermingled, you know, that the holidays are both a family and civic
event as well as a faith event? So how do you and I'm sure that these principles apply to all
faiths, where there's a resistance, especially since mental health has come with stigma? And over
the years? How do you start to untangle these very tight connections? Yeah, that's it. That's, I
think that is the question of the day. So often, I find myself saying, Oh, is that cultural? Or is
that something that's coming from the faith itself? And part of that is for me, it's actually been
		

			going back to the literature, the primary sources, the primary texts, the scriptures, of course,
that has been very useful to be able to set you know, basically sets apart what is culture and what
is religion. And it's been very eye opening, I think what I've been able to discover in this journey
is that actually, the Islamic faith as a faith is very much in line with the concept of holistic
health and healing. And so mental health is part of holistic health. It's, it's, you can't really
even be physically well if you're not mentally well, and so and and I would add to that spiritually,
well, so all of these are intertwined, Mind, Body Soul, I mean, that is really the essence of
		

			Islamic teaching. And so coming to that realization, had me then realized, wait a second. So what
did what did the early scholars say about this? And that's where I was doing a lot of the reading of
primary texts spend many years actually digging through those manuscripts, found amazing things like
the discovery on the talk therapy and other forms of you know, OCD was discovered in the ninth
century for example, in those papers phobia was discovered. And are these just just sorry to
interrupt but are these actually discussed and described in the in the scriptures and in the, in the
read in the
		

			original texts of the faith? So there so what happens is with a lot of the early Muslim scholars,
what they're doing is referencing the Scripture. So their works as they're writing about and really
contemplating and also classifying and diagnosing what is this illness they're seeing in front of
them, they refer back to Scripture. And, and it's really interesting because they'll say things
like, there is a prophetic saying, and a hadith Prophetic narration of the Prophet Muhammad peace be
upon him that literally says, If God sends down an illness, there will also be sent down a cure, a
treatment, and then says in a different statement you need
		

			to go seek out treatment if you're ill. So that really inspired so they can impetus that really
inspires them to figure out how do you treat every every type of illness we see around us, including
mental illness. So and I'm guessing that your knowledge of this isn't is one of many tools you have
when when when interacting with a patient who might be hesitant. I also want to on this cultural
distinction, I want to ask, are people willing to make that distinction, because I could imagine
that some people, the cultural background is just as important as the faith, you know, they self
identify. So I don't think it's not obvious to me that you could say to a to a patient, oh, by the
		

			way, this is very consistent with the readings of our faith. Because they might say, well, I also
have cultural concerns. So I guess I'm asking how if a new patient comes to you, and I guess it's a
big step to even come to you, right? Because that means they've already acknowledged, what does that
conversation look like if one of the kinds of tools that you have to establish an alliance with that
patient and like, make progress in their treatment? So let me share this with you earlier this
month, I was at the American Psychological Association Annual Convention. And this is the first time
in their entire history 130 Some years of their history to ever have on their mainstage a topic on
		

			mental health and religion. And so, yes, exactly. So it it's, I mean, it's it's kind of a new area
within this field, but it's a growing area. And I found myself on that stage saying, the exact same
sentiment of you need to all the providers clinicians in the room, you need to figure out actually,
is this person self identifying more with their culture? Or more with their religion? Are they
seeing themselves as a Muslim, American? Who is of Arab origin? Or are they an Arab who's living in
America who happens to be Muslim, like, depending on the order that they put this in, these things
definitely will play a bigger role in the conversation and the rapport that you build with them in
		

			therapy. So I'm guessing I'm not very familiar familiar with Muslim faith, but I'm familiar with
other faiths. And I know that people sometimes say, I'm not going to a doctor, because this is a
test from the Lord. And I'm, it's my duty to battle this, these demons. And to get help, too,
especially to take a pill is really undermining the whole process of how I'm supposed to live my
life. And I'm suspecting you've heard this. Tell plenty. Yeah, tell me how, how do we then address
that issue, being respectful of the context, but also trying to push your agenda of a holistic
treatment? Exactly, that, you know, the fancy term in our field would be to call this spiritual
		

			bypassing, where you essentially, you know, give this kind of almost like a rosy tinted glasses of
like, that use a lot of religious kind of framework to explain what's happening, trials and
tribulations was all by the way, maybe very well, the kite, the conceptual, the mental
conceptualization that person has of their illness, that may be accurate to them. And that's very
important, and not to minimize that in any way. Here, you know, rest, this is where my dual training
has served me well, because I'm also trained formally in Islamic law and theology. And so it's
really been helpful, actually, for patients that are on the more religious end of the spectrum, to
		

			say that say like, No, this is really a test from God, this is not something I need medications for.
And we'll talk through that and being able to actually give insight, direct scripture and passages
as they're reciting back, you know, kind of a friendly tussle a little bit sometimes. But often, I
find that patients are
		

			kind of relieved, actually, to know that it's okay to take to seek out treatment to get help that
they need. And that's actually encouraged by the religion. And so that's often more often what I
find is the response. Very good. Very. So that's, that's good to know, though, of course, the
question that comes up then is you have this spectacular training and preparation for this with your
dual credentials, as you just described, we can't have all of the doctors with that dual training.
So how do you evangelize? There's a loaded word? How do you evangelize these learnings that you
have? I know you were on the podium at the meeting. That's great. But are there other ways in which
		

			you can transfer to practitioners some of these practices without them having to become Islamic
Muslim scholars? Yes. Yes. Perfect. Perfect question. Yeah, this is actually after, after having my
lab for, you know, the Stanford love the most Men's Health and Islamic psychology lab for we're
about to celebrate the 10th year, we're like simulation. Thank you. And after some sort of, you
know, a period of time I realized, you know, we really need something that's actually more community
facing because they're going to be all these physicians, psychiatrists are gonna come forward, who
won't be able to be dual trained. I mean, that's going to be the rarity. So what do you do? And we
		

			decided, actually, I helped co found a nonprofit that is attached to my lab that's called Mara Stan,
which is import
		

			into and maybe I'll come to that what does this word even mean? Because it has historical meaning to
it. But this nonprofit, one of the main things it does is actually take on the trainings you're
referring to, it does a lot of the train the trainer's essentially model, where you're training
people who are already in the field, but just are missing this extra portion. We've also written a
book on traditionally Islamically integrated psychotherapy. So the tip model, which basically takes
Islamic concepts, and integrates it into clinical psychotherapy. And so that is a four level
training that people can attend, clinicians can attend, and actually learn how do you integrate
		

			Islamic concepts into the clinical training that you already have received from your masters or PhD
programs, or MD programs. So this, this is great. And so now, just to dive a little bit more into
that, so I have training as a general internist, and I know that I see lots of mental health
		

			issues in my patients. And in fact, as you well know,
		

			probably general internist, and primary care physicians see a huge number of patients. Is there a
way to? I guess the two questions are, is there a way to also package it up not for your fellow
psychiatrists, but also for the busy primary care physician? A and then B, I am asking two
questions, I guess, are the principles for devout Muslims significantly different from the way you
might approach a devout Christian or a devout Jew? Do we need to learn about these different faiths?
And the different approaches? Or are there common threads that we can kind of lean on instead? Okay,
a lot of questions. No, no, they're great questions. And I definitely been thinking about this quite
		

			a bit. And so I'll answer the second question first. Yes, there are definitely common threads
between especially the Abrahamic faiths, there's just such a connection between all three of them.
There's an a commonality that actually makes sense, including the concept of religious bypass, the
spiritual bypassing, a lot of that happens, actually, all three faiths are developed, observant, you
know, members of that community, those communities. And so what I'm finding actually is I'm finding
myself actually doing trainings, it's really interesting, being a hijab wearing Muslim woman doing
trainings in church, you know, for pastors and priests and so on, because there's such a level of
		

			commonality, actually.
		

			And, in addition, I would say, for the clinicians now, who are outside of the field of psychiatry.
So recently, Stanford hosted their CME continued medical education program kind of hosted a training
that I did that was really open to all clinicians. And it's this it was called, and it was a quick
and kind of quick and dirty kind of like, hour and a half, two hours of the nuances like the unique
aspects of what do you what happens when you work with a Muslim patient, and it was called pol
centered, you know, holistic care for Muslim patients, right? And that, those are the kinds of
things that I'm very passionate about doing because I want to make sure this message gets across the
		

			APA, the American Psychiatric Association actually is hosting on their website, a three hour
training that's free now they're actually making it free. Usually, CME trainings, as you know, are
not true or not free. But this is free. And I've recorded with my you know, my voiceover basically
on this training about three and a half hours of how do you work with this population. So that's
really the hope here. This is the future of everything with Russ Altman. More with Rania Awad next.
		

			Welcome back to the future of everything. I'm Russ Altman, and I'm speaking with Professor Rania
Awad from Stanford University. In the last segment, Rania told us about some of the special
challenges of ministering to the mental health diseases faced by the Muslim community in the context
of those with deep faith. In this segment, she'll tell us about her nonprofit, Mara, Stan, and how
there are lessons there that can help all patients from all faiths. I wanted to start out in the
second segment asking about COVID-19, and what it was like for you and for that community, it was
hard for everybody, and I'm guessing there were some special challenges, you know, definitely
		

			COVID-19 was such a difficult time. And, you know, two months into that lockdown was the month of
Ramadan. And that particular month is the month of fasting for Muslims. It's also a very communal
month, a congregational month where people get together, they break fast together, they eat
together, they pray together. And it's there's such an emphasis on family and community.
		

			And all of that changed. And so, you know, we thought, myself, as you know, clinician and
researcher, kind of really thought, I wonder how the community is going to do with all of this. And
a group of us actually came together and did a study, and I want to share a little bit about that
study. Yes. And it's, it was a global study was really interesting. You know, we kind of surveyed
Muslims in the US, but also actually across the world. And it had about something like 10,000 people
within the study, so a pretty big number of folks, and ask them things like, how are you doing kind
of conceptualizing COVID? Like what was this a test from God? Is this kind of like a reminder of
		

			some sort as a punishment of some sort? What is their spiritual understanding?
		

			And then how does that correlate with their mental health? How are they doing because we saw the
rates of depression and anxiety, even suicidality, go up everything sort of really mental health
wise really go up in the pandemic. And it was so interesting the findings, Muslims that are
observant, pray five times a day. And those prayers, I think what they did for so many people in the
study, what they explained is they were anchor points. So even when people are on lockdown, and not
going out and about and doing their typical daily kind of process, they still had an ability to kind
of have no one night was and one day it was because of these kind of rich rituals that were in place
		

			this routine that was in place. And even though the congregation changed, or the month of fasting
kind of changed without having community, there were all these alternative ways people were doing
their breaking fast over zoom with their friends and FaceTiming with their family and things of that
nature. But the mental health part was probably the most interesting to me. Because what we found is
those who conceptualize COVID-19 is sort of more like a reminder from God, or a test and a
tribulation, which is more aligned to the Islamic teachings versus like a punishment of some sort,
actually had a much better outcome mental health wise, in fact, so much so that actually, I don't
		

			have anything, as a psychiatrist, I can give to a patient where I can say, there will be a 60%
difference. And this was a 60% difference of those who reported that if they had this more positive
outlook, they did not actually have the depressive symptoms or anxiety symptoms we were seeing with
others. So I thought that was really fascinating. Does that give you anything actionable as a
practitioner? Because it's it's hard to affect how people are going to interpret right? So the ones
who were I don't I don't want to? I'm not sure I should use the word lucky. But the ones who had
this positive attitude towards the, towards the pandemic seem to have done well? Do you think
		

			there's an opportunity to kind of for those who were thinking of it, perhaps as a punishment, and as
something that was very negative? Is there an opportunity to move them? Yes. And I think this is
where I was really inspired, in fact that the nonprofit I was referring to was born during the
pandemic, because it occurred to me, while we have all this research, academic work, clinical work,
but it's not really reaching the community that the the average everyday person. And so this, the
goal here was, well, let's try to actually integrate aspects of spirituality and faith, as long as
the person wants that, right. We kind of integrate that in with their clinical and their mental
		

			health kind of outcomes. And it actually turned out to work very well for this community. That's
wonderful. That's great news. That's great. And so now let's go to the to the nonprofit use, you
said that the name was Morriston, and it said that the word itself has some significance. So please
tell us more about the word and about the roots of this nonprofit that you set up. Yeah, thank you
this. So marriage standard is the Latin is a term that comes from the original Farsi or Persian
term, B, Marsden and B Mar as the first half of that word, and it means illness or someone who's
sick, a patient, and Stan like the all the countries that end with the word Stan is a location. So
		

			it's basically where a sick person goes as into, say, a hospital. And the Arabic term is daughter,
she thought, which also roughly translates into a little bit closer to the meaning a place of
healing and abode of healing. So they were more than just hospitals, they were actually healing
centers. And well, so fascinating to me, this is in the research that I was telling you about going
through the early primary texts and so on. I came then to realize after I, you know, bumped into and
read a lot of these scholars works, I thought to myself, well, it wasn't all just theory, they were
writing about mental health, or they actually put it into practice. And that's when I discovered the
		

			Mara stands that everywhere, Islam sort of spread. Yes, they built mosques everywhere they went and
schools and so on. But mera stands were also a trademark, they were built in every society in which
there was a Muslim majority presence. And this healing center was so unique, because unlike other
hospitals parallel and prior to them and other civilizations, we don't see proof that there was
psychiatric medicalized psychiatric care within those hospitals. And that was really neat. So psych
wards literally are in these medicines, and that I was fascinated. And now we're really talking
about rewriting the history of psychology because you can't find this in any of your psych 101 books
		

			at all. So just out of curiosity, is that the word that's currently used in any of the languages for
hospital? Or is that was that a word that fell out of use? So it's continued to use in certain
places. So even till now, people will, depending on the language they speak, they might still use
that actual term be Morrison or medicine or medicine, or data sheet that there's other terms that
have replaced it in modern languages. But yes, it's still a recognizable term. I'm also struck by
your use of the phrase healing center because as you know very well, there's a concern, even among
those of us in modern medicine, that hospitals and clinics have become very technical and
		

			medicalized and have lost the idea of the patient as a whole person who needs whole person healing.
That's pretty obvious, actually, to most other people who are not medical professionals. I
		

			And so it's I'm guessing that there's a model here that it's extremely attractive for our modern day
to kind of bring the human holistic part of healing back. We see sometimes we see this, especially
like in cancer treatment where, you know, we know in many cases, we're not going to be able to cure
the patient. But there's still many, many things we can do to give them quality of life and quality
of mental health. So I guess my question is, are there learnings there that we're going to be able
to take and bring to our modern, highly technical medicalized
		

			health system? Well, the book that I'm currently writing
		

			is actually called something to the effect of marriage stands as a model for modern healthcare and
treatment. I mean, that's kind of the goal. My goal here, my goal is, I mean, it's a bit of a pie in
the sky goal, but in a, you know, let's say tenure kind of goal, I would really hope, especially
especially to psychiatric care, yes, they really all medical care, is to really bring that holistic
healing concept back. And that means that you're really looking at all five senses. The Mind Body
Soul is part of the conversation, and you're really making sure that it's not just, you know, pills
that are taken or even just talk therapy in psychiatry, but really, everything all of the senses are
		

			healed. Yes. And I know that the patients want this and and it's not hard for them to see that that
is often missing so Okay, so in the final minute, this Mara Stan idea. And what you've now told me
is these are among the first recorded psychiatric units. What were they like? Because we have many,
many images of very bad treatment of our mentally ill, you know, in asylums, basically, prisons, did
the marathon give us please say yes, a better model for how this might go? These are not prisons at
all. If anything, this is this is what I spent my sabbatical doing is actually going and visiting
many of the the ones that are still standing today in Turkey, Cairo, other places, they're beautiful
		

			Islamic.
		

			The basically what do you think about construction? Islamic architecture is very beautiful to begin
with. And so we're talking about water fountains, we're talking about greenery, we're talking about
really kind of even the acoustics to make sure sound therapy and music therapy was used in addition
to the talk therapy, and of course, the medications. So just even you walk into this place and you
feel healed just by walking in beautiful places. They're beautiful, beautiful places. Okay, that is
wonderful. Thanks to Ron your wad. That was the future of Muslim mental health. You've been
listening to the future of everything with Russ Altman. If you enjoy the podcast, please subscribe
		

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