“Psychoanalysis is often whitewashed”: To Serve Philadelphia’s SWANA Communities, Mental Health Services May Need An Overhaul

Razan Idris

In the United States, mental illness amongst young adults is a key social issue. The National Institute of Mental Health states that nearly one in five adults in the U.S. — or about 57.8 million — live with one and immigrant communities are not exempt. But just as first-generation immigrants struggle to access mental health services in the Philadelphia area, second-generation children of immigrants grapple with their own unique set of challenges

Because they are not included on the United States census, specific data regarding the mental health of Southwest Asian and North African communities is hard to find. But in 2018, one study found that Arab Americans in Michigan reported “high levels of depression and anxiety symptoms”, while another study of older Iranian Americans in California reported that “60.0% met the criteria for PTSD”.

For Yusra Aziz, a local Iraqi-Moroccan therapist, growing up facing racist hostilities and informal segregation in the Philadelphia area had significant impacts on their mental health. Aziz tells Al-Bustan, “When I was growing up in Philadelphia, the SWAMA community was quite small. I went to predominantly white schools and it was very alienating.”

Outside of the city, Sarah Moussa, a Syrian-American therapist, had very similar experiences growing up. She tells Al-Bustan, “At home, we had a traditional Syrian mentality. But at school, I was expected to be ‘all American’. And I often work on similar identity clashes with my clients from SWANA backgrounds.”

“‘There’s a lot of shame, fear of judgment, and difficulty with accountability that we’re working through as a community in our collective healing process…’”

Many immigrants come from collectivist backgrounds and rely heavily on communal support in diaspora, and therefore heavily fear the social results of being stigmatized as "crazy". As a result,  second-generation teenagers often struggle to convince their families to allow them to go to therapy. Moussa, who shared that she had a mental breakdown in high school, recalls, “My mother kept my therapist a secret from my dad, and when he found out, he said to tell no one because of the shame.” 

“There’s a lot of shame, fear of judgment, and difficulty with accountability that we’re working through as a community in our collective healing process,” Aziz says. “And so people often resort to traditional ideas about the evil eye, black magic, and jinn possession to explain away all mental health challenges.”

For second-generation immigrant children, learning how to face their own mental health challenges while naming the challenges and traumas faced by their own parents is critical. But for Aziz, this has presented a unique opportunity to foster cross-generational conversations regarding intergenerational trauma. Aziz says,  ”I had no curriculum for this work but I’m doing my best to navigate these conversations, and I think I’m doing a pretty okay job!” Similarly, Moussa shares that she’s had these discussions with her own parents, telling Al-Bustan, “I’m hoping more people of our background can find healing together.” 

“Mental health practitioners in the U.S. often endorse institutionalized racism and Islamophobia by working with programs like Countering Violent Extremism…”

But even as second-generation immigrants try to access therapy, mental healthcare services themselves are far from perfect. Mental health practitioners in the U.S. often endorse institutionalized racism and Islamophobia by working with programs like Countering Violent Extremism, which can lead to “preemptive prosecution” of young SWANA second-gen immigrants by therapists who see their clients as racially, culturally, and/or religiously violent. And this holds true in Philadelphia, where researcher Hajer al-Faham found that FBI surveillance socially affected her minority interlocutors’ trust of social workers.

Just in 2015, the American Middle Eastern/North African Psychological Network wrote an open letter condemning the American Psychological Association’s collaboration with the U.S. government to justify torturing war prisoners throughout the War on Terror. For example, the letter noted that the APA “maintained conditions that have made it possible for psychologists to participate in abusive interrogation practices”, and critiqued that “what has been noticeably omitted in official APA discourse is acknowledgement of those who have been harmed by the events - namely marginalized ethnic/racial and religious groups”. 

“Psychoanalysis is often whitewashed,” points out Aziz, “And even social work has a racial history of white women doing ‘welfare’ for other communities.” In Philadelphia, this whitewashed history of therapy and social work is visible in how few therapists of minority backgrounds enter these fields, and how critical those few are of the structural issues within them.

“I started a consultation group for BIPOC therapists and we meet weekly - we’re able to talk about different ways of meeting our clients that aren’t Eurocentric,” Aziz continues. “It’s time for us to bring our own insights to the table rather than just being talked about.”

Razan Idris is a Sudanese-American PhD candidate in History at the University of Pennsylvania and the curator of the #SudanSyllabus, working on a project tentatively titled The Colors of the Earth: Blackness in 1930s Egypt.