Case Study 8

The following case study describes the barriers for South Asian Muslim families to engagement with CAMHS. In South Asian communities mental illness is closely associated with madness and therefore highly stigmatised. Parents are concerned about associated gossip which would broadcast the stigma. Stigma arises from the heritability of madness, with the mother’s standing in her husband’s family as a potential carrier of madness and children’s marriage prospects jeopardised. Gossip about madness is a strong disincentive to any help-seeking beyond very close, trusted family. The case study provides a question for viewers to consider and reflect on.

Case Study 8: Psychosis (Muslim)

(Adapted from Bradby et al., 2007).

Rifat was 13 when first admitted to hospital hearing voices. At that time she ‘did not want any help’ and felt that ‘everybody was against me’, worrying that the hospital was ‘going to keep me over there for ever.’ During the first couple of years Rifat felt very suspicious of her medication, and, particularly when she felt well, she would stop taking it and subsequently symptoms would recur. Rifat says in the past she ‘went hyper’, got very withdrawn or ‘could not think’. She attempted suicide on at least two occasions, and was admitted to hospital as an emergency twice, once against her will, (under section) when legal powers were invoked to impose treatment. Rifat’s mother points out that Rifat is not mad, but does have an illness. Since the family had not met this type of illness before, they were extremely worried and sought help from the Molvi (holy man) at the mosque. Stories of possession by ghosts or djinns (which they now regard as foolish) frightened the family and they put prayers written on fragments of paper (taveez) around Rifat’s neck.

Now aged 16 and attending college, Rifat says she understands the importance of her medicine. Her clinicians describe her condition as stable and appropriately medicated. Rifat’s mother says her daughter is ‘fully recovered now’. Rifat’s mother makes no criticism of medical staff and their understanding of Rifat’s medical needs, but insists that hospital arrangements were deeply unsuitable for her daughter: Rifat was in a mixed psychiatric ward sleeping next to a young man. No special provision was made for her halal food requirements, toilet and hygiene habits or her prayer routine, which as an observant Muslim were important elements of daily life.