Sage Journals: Discover world-class research

Abstract

Research on the mental health needs of and services for Arab American women from a feminist lens has been limited. Through a review of the literature, this article briefly describes Arab American women, their mental health needs, and the mental health services available to them from a feminist viewpoint. The literature cited in this article covers a 20-year period and, in addition to feminism, draws on such disciplines as anthropology, ethnic studies, medicine, psychiatry, and religious studies. On the basis of the literature review, it is recommended that culturally competent mental health practice integrate a feminist lens with Arab American women clients.

Keywords

Arab American women cultural competence feminism mental health

There is a need for culturally competent mental health services for Arab American women (Krase, Nicoletti-Krase, & Krase, 2007). Gaining a better understanding of the culture, race, and ethnicity of Arab American women and how the women engage with mental health services from a feminist perspective may be a first step toward cultural competence. In this article, I examine the mental health needs of Arab American women through a review of the literature. The literature that I cite includes sources from Arab and non-Arab American and international authors and covers a 20-year period from 1989 to 2009, including books, academic and nonacademic journals, unpublished works, gray literature, and works by Arab not-for-profit organizations in the United States and U.S. government and nongovernmental agencies. The review draws on a variety of disciplines, including anthropology, ethnic studies, feminism, medicine, psychiatry, psychology, religious studies, social work, and sociology. Examples of topics that are covered include Arab American mental health after September 11, 2001; culturally competent mental health practice with Arab Americans; ethnocentrism; feminist practice and mental health; immigrant women and mental health treatment; Islam and feminism; and mental health services in Arab countries. Despite the need, the literature identifies a lack of culturally competent mental health services available to Arab American women. However, attempts to increase culturally competent mental health services for this population are growing.

Arab American Women

Arab American women may be described as women who are culturally, racially, or ethnically Arab; currently live in, but may not have been born in the United States; and may be of any religious background. Abudabbeh (2005) described women of Arab descent as those who may or may not speak Arabic; have a connection to the original peoples of Arabia, broadly divided today into the Middle East (Palestine, Jordan, Lebanon, Syria, and Iraq), the Gulf area (Saudi Arabia, Kuwait, Oman, Qatar, United Arab Emirates, and Yemen), North Africa (Morocco, Algeria, Tunisia, Libya, Egypt, and Sudan), and Bahrain, the Cosmoros Islands, Djubouti, Mauritania, and Somalia (see also Ahmad, 2004; American-Arab Anti-Discrimination Committee, n.d.; Erickson & Al-Timimi, 2001).

The 2000 U.S. Census Bureau reported approximately 1,190,000, or .42%, of people of Arab descent residing in the United States (Brittingham & de la Cruz, 2005; Krase et al., 2007). Of this number, roughly 512,000 were women (Brittingham & de la Cruz, 2005, p. 4). However, the Arab American Institute (2008), designated by the U.S. Census Bureau as the only Census Information Center dedicated to analyzing data on the Arab American community, estimated that at least 3.5 million people of Arab descent live in the United States. This discrepancy may be due, in part, to the reluctance of Arab Americans to identify themselves as Arab for fear of discrimination (Ahmad, 2004). Furthermore, the U.S. 2000 census did not provide a specific ethnic or racial category choice for Arab (Amri, n.d.; de la Cruz & Brittingham, 2003, p. 1; Cross Cultural Health Care Program Resource Center, 2004; Krase et al., 2007).

Arab immigrants came in distinct waves. The first wave of immigrants, who came from greater Syria and Lebanon between the late 1800s and World War I, consisted of Christian merchants and farmers who were searching for economic opportunities (Ahmad, 2004; Ammar, 2000; Erickson & Al-Timimi, 2001; Hooglund, 1998). The second wave arrived in 1948 after the creation of Israel and was comprised primarily of Muslim college-educated professionals and Palestinian refugees (Ahmad, 2004; Ammar, 2000; Erickson & Al-Timimi, 2001; Hooglund, 1998). The third wave, which is still occurring, began after the 1967 Arab–Israeli war, when Arabs from Lebanon and Iraq fled to the United States as refugees (Ahmad, 2004; Ammar, 2000; Erickson & Al-Timimi, 2001; Hooglund, 1998). Ultimately, the historical context and composition of these waves have resulted in a diverse population of Arabs living in the United States with regard to culture, language, politics, religion, values, class, and acculturation levels (Ahmad, 2004).

Culture, Race, Ethnicity, and Arab People

Cooper and Denner (1998) defined culture as a complex web of core societal values, contexts, castes, capital, universally adaptive tools, intergroup relations, and dynamic psychological constructs. More recently, McGoldrick, Giordano, and Garcia-Preto (2005) defined culture as a complex set of values passed down from one generation to the next. They defined race as a social construct and an external, political issue put in place to privilege a certain group of people at the expense of another while imposing a form of judgment (negative or positive) that is strongly based on skin color and/or other physical characteristics. In addition, they defined ethnicity as a social group with a shared history, sense of identity, and geographic and cultural roots that occur despite racial differences.

A complete description of Arab people is beyond the scope of this article because of the complexity of culture, race, and ethnicity. Furthermore, defining Arab populations without stereotyping is challenging because of the vast diversity among and within them. Nonetheless, several researchers have outlined a few cultural characteristics that may be common to Arab populations. For example, some Arab cultures are collectivistic, rather than individualistic, and rely on the family as the main source of physical, emotional, and mental support (Abou-Hatab, 1997; Amri, n.d.; Dwairy, 2008). In addition, the concept of family goes beyond the nuclear unit to include extended relatives and tribal relations (Abou-Hatab, 1997; Amri, n.d.; Dwairy, 2008). Other cultural characteristics cited by researchers include family honor, dependence over individuation, and physical discipline (Abou-Hatab, 1997; Amri, n.d.; Dwairy, 2008).

Feminism and the U.S. Environment

Feminism is a political discourse that strives to obtain equal rights and legal protection for women. It entails a plethora of movements, theories, and philosophies that are concerned with issues of gender difference that advocate equality for women and campaigns for women’s rights and interests. Feminism may also be a reaction to the oppression of colonization, specifically in terms of racial, class, and ethnic differences that have marginalized women. According to Mojab (2001), one view of this oppression is patriarchy—a system that promotes male power in the state, religion, class, law, culture, language, the media, and other social sectors as the dominant method of organizing human society. Other facets of feminism that expose oppression include intersectionality, transnationalism, power struggles, economic struggles, self-determination, critical theory, historicizing, and contextualizing. In this article, I focus on the oppressive context that Arab American women may encounter with Western mental health services.

In the United States, an oppressive ideology dominates and defines the social relationships of Arab American women as passive and voiceless victims. Even Western feminist projects, designed and carried out by feminists, have been indicted for their “rescue” agenda. Abu-Lughod (2002) found that one popular view of Arab American women is that they escaped a life in which they could not go to school, listen to music, or feel the sun on their hair. Both Arab and non-Arab experts on feminism have determined that Arab American women need to be “saved” from their oppressive, inferior lives by Western culture (Abu-Lughod, 2002; Ali, Mahmood, Moel, Hudson, & Leathers, 2008; Chowdhury, 2009). Researchers have also agreed that “saving” Arab American women from their oppression reinforces Western ideology as superior (Abu-Lughod, 2002; Afary, 1995; Weisberg, 1993).

In contrast, Arab American women live within what Benhabib (2006) would call a binary of oppression and empowerment. Other researchers have agreed with Benhabib and have stated that from the viewpoint of oppression, Arab women may be subservient, veiled, helpless, and oppressed (Ahmed, 1992; Ammar, 2000). Mojab (2001) took the view of oppression further and distinguished a “private” and “public” arena for women and men, respectively, noting that Arab women are restricted to the “private,” including the home and family, while Arab men have access to the “public,” including the government and civil society. Weisberg (1993) stated that this division of “private” and “public” has allowed men to continue to subordinate women. In agreement, Ali (2005) found that in some instances, Arab men have used the public sector of religion to oppress women for political and economic reasons. Researchers have further determined that although Arab women may be granted social or political rights, or access to certain parts of the public sector, these rights are defined and limited by their status as mothers and therefore are part of the private sector (Afary, 1995; Mojab, 2001).

In contrast to the oppressive view, Erickson and Al-Timimi (2001) found that an empowerment view reveals that Arab women exert self-determination in indirect, private ways. For example, an Arab American housewife did not prepare dinner and left her home at dinnertime because a family member complained that the previous meal was “overcooked.” When her family went without dinner that day, they realized their lack of appreciation and respect for her contributions to the family and corrected their mistake, thereby reinforcing her place in the family.

Mental Health Needs of Immigrant Women

Various researchers have cited a wide range of common issues that may lead to mental health concerns for immigrant women. These issues include language barriers; discrimination and exclusion because of cultural differences; the lack of social networks and support; a change in income, educational, and/or family status; and discrimination against spiritual beliefs and practices (Amri, n.d.; Baker, 2000; Crocco, Pervez, & Katz, 2009; O’Mahony & Donnelly, 2007; Sechzer, 2004). According to Baker (2000), further mental health concerns may be related to the conditions under which immigrant women came to the United States, such as whether the move was planned or not or if they came as refugees and/or whether or not the move was by choice. More recent research revealed additional sociocultural factors, such as a possible change in immigrant women’s role in the family and/or the possible stress of leaving extended family members, which may affect the need for mental health services (Amri, n.d.; Crocco et al., 2009; Sechzer, 2004). Guruge and Collins (2008) found that characteristics like age, race, class, and political background may also have an impact on immigrant women’s mental health. These issues and concerns are examples of what may be common to all immigrant women, including Arab American women.

According to some researchers, an event that may have increased the need for mental health services for Arab American women was the attack of September 11, 2001. Since then, Arab American women have experienced increased negative stereotyping, open prejudice, hate crimes, civil rights violations, deportation, and incarceration (Abu-Ras, 2007; Ahmad, 2004; Amer, 2005; Amri, n.d.; Barry, Elliott, & Evans, 2000). Goodman (2002) noted that the mental health needs of Arab Americans were never addressed until after September 11. Further research by both Arab and non-Arab academics and counselors following September 11 found that Arab populations living in the United States have had an increased risk of anxiety and depression as a result of perceived discrimination and anger toward their communities (Abu-Ras, 2007; Amer, 2005; Amri, n.d.; Winerman, 2006). Furthermore, Arab immigrant women may be refugees from war-stricken countries and may have experienced a reenactment of trauma since the events of September 11 (Goodman, 2002).

To date, there have been few recommendations for culturally competent mental health practice specifically for Arab American women living in the United States. In 2000, Al-Krenawi and Graham published “Culturally Competent Social Work Practice with Arab Clients in Mental Health Settings.” However, the information in that article should be updated and expanded to address the mental health needs of Arab people living in the United States today, including more information that is specific to Arab American women.

The lack of culturally competent mental health services for Arab American women has led to inappropriate interventions; distrust by clients; and, in some cases, clients’ avoidance of mental health services. According to Goodman (2002) and Tobin (2000), much of the present culturally competent training for diagnosis and treatment has originated from Western scholars, which may not be appropriate for treating Arab American women. Various studies, conducted from 1989 to 2007, agreed that many Arab American women who suffer from mental illness may seek traditional healers or religion for treatment first (Ahmed & Reddy, 2007; Al-Krenawi, 2005a, 2005b; Al-Sabaie, 1989; Amri, n.d.; Dwairy, 1998; Hamdan, 2007; Okasha, 2001; Youssef & Deane, 2006). Unfortunately, Western therapists may not include traditional healing support or religion in their treatment plans.

Further research found that the Western perspective may lead to greater cultural insensitivity by mental health practitioners toward Arab American women (Abu-Ras, 2007; Ahmad, 2004; Arredondo, 1999; Nobles & Sciarra, 2000). For example, an American social worker suggested that an Arab American woman remove her hajab (head scarf) to avoid discrimination (Goodman, 2002). Ibrahim (2006) cited further examples of inappropriate interventions, such as an incident detailing an American psychiatrist who insisted that his female Arab American client remove her hajab during treatment. In response, the client requested a new therapist and ultimately ended treatment early. In another case cited by Ibrahim (2006), a married female Arab American client who was receiving treatment from an American therapist nearly terminated treatment because the therapist taught her assertive and anger expression techniques; among some Arab cultures, a woman’s outward expression of anger toward her husband is taboo. Another example provided by Ibrahim (2006) illustrates a mismatch of the client’s and therapist’s treatment goals. The client sought mental health treatment for anxiety, low self-esteem, weight gain, and boredom, but the therapist focused on the client’s relationship with her husband. According to Ibrahim (2006, p. 173), the client described the experience as “uncomfortable and irrelevant to solving her problems.” Thus, mismatched treatment goals between Arab American women and Western mental health professionals may lead to further distrust and avoidance of professional mental health services (Goodman, 2002).

A number of researchers have found that some behaviors that are accepted in some Arab cultures may appear dysfunctional and maladaptive from a Western perspective (Budman, Lipson, & Meleis, 1992; Dwairy, 1998; Ibrahim, 2006; Nobles & Sciarra, 2000). For example, various studies found that it may be acceptable in many Arab cultures to express mental illness somatically (Ahmed & Reddy, 2007; Al-Krenawi, 2005a, 2005b; Amri, n.d.; Hamdan, 2007; Youssef & Deane, 2006). According to Ibrahim (2006), although expressing mental illness somatically may be culturally appropriate for Arab American women, Western mental health treatment models may label it dysfunctional. Ibrahim (2006) also noted that feelings, such as guilt and shyness, may be viewed by Western therapists as maladaptive, but in some Arab cultures, they are virtuous traits.

These examples illustrate an oppressive approach that Western therapists may or may not knowingly apply when providing mental health services to Arab American women. According to the research, the Western therapist may be perceived as the dominant paternal “expert” who is dictating to the Arab American woman what she needs rather than engaging her individual thoughts, feelings, and values. Both Arab and non-Arab researchers have stressed that only by acknowledging the oppressive factors in play and taking action to correct biases and prejudices can Western therapists be successful in providing mental health services for Arab American women.

Culturally Competent Practice

James (2008) defined cultural competence as an awareness of potential and actual cultural factors that may affect the relationship between a practitioner and a client. She noted that cultural competence is the practitioner’s ability to engage clients from different cultural and/or ethnic backgrounds successfully. According to James, the components of cultural competence include practitioners’ ability to understand the language, culture, and behavior of their clients from different backgrounds; make appropriate recommendations; and be critically self-aware of their own culture. A culturally competent practitioner strives to make programs, materials, and recommendations that are culturally relevant and specific. Under this definition, culturally competent mental health practice may increase utilization rates and the success of outcomes.

Okasha (2001) suggested that culture determines not only the outward expression of mental or emotional distress but also beliefs about whether treatment is sought and, if so, by whom and under what circumstances. Further research found that culturally competent practice is more likely to meet the mental health needs of a specific population and result in more effective and satisfying outcomes (Downs, Bernstein, & Marchese, 1997), thereby reducing early termination of treatment services, increasing the use of services, and resulting in higher functioning evaluation scores at the end of treatment (Yeh, Takeuchi, & Stanley, 1994). As Yeh et al. (1994, p. 5) noted, in comparing the practices of culturally competent and mainstream mental health outpatient service centers with regard to Asian American clients,

participants who received services at ethnic-specific [or culturally competent] centers were less likely to drop out after the first session, utilized more services, and had higher functioning scores at discharge than those who attended mainstream centers. This was true even when variables including socio-economic class and functioning scores at admission were controlled.

A report by the U.S. Surgeon General (n.d., p. 1) noted that research and clinical practice strive to provide “linguistically and culturally competent services” to improve the usage and success rate of treatment for different ethnic and racial groups living in the United States. “Without culturally competent services, the failure to serve racial and ethnic minority groups adequately is expected to worsen, given the huge demographic growth in these populations predicted over the next decades” (U.S. Surgeon General, n.d., p. 2). In addition, several researchers determined that practitioners’ critical awareness of their own culture and the culture of another is a key factor in providing successful mental health services (Al-Krenawi, 2005b; Dwairy & Van Sickle, 1996; Ibrahim, 2006). For example, an awareness of cultural behavior may inform the practitioner of how treatment is progressing (Ibrahim, 2006).

For Arab American women who are seeking mental health treatment, cultural competence is not enough. Researchers have found that mental health treatment exists within Western culture and affects Arab American women at various levels and degrees of oppression (Rossiter et al., 1998). Further research determined that mental health practitioners must be aware of and acknowledge how this oppression affects Arab American women, both in negative and in positive ways (Amri, n.d.; Nassar-McMillan & Hakim-Larson, 2003). Abu-Lughod (2002) emphasized that given the Western society in which Arab American women reside, mental health practitioners must recognize, respect, and accept that the Western way of life may not be the life that Arab American women want. However, because of the oppressive nature of some Arab cultures, some Arab American women may embrace Western culture and ideology and thrive. Abu-Lughod noted that Arab American women may have opportunities in the United States that they did not have in their native countries, such as opportunities for higher educational attainment, for career advancement, and for participation in government and civil sectors. Thus, an awareness and respect of ideological differences with Arab American women is necessary to provide culturally competent mental health services (Abu-Lughod, 2002).

Further research revealed that the mental health needs of Arab American women are frequently misunderstood or misinterpreted in Western mental health practice (Abu-Ras, 2007; Erickson & Al-Timimi, 2001). Improving mental health services for Arab American women begins with changing negative attitudes, shame, and stigma by engaging in culturally competent practice and acknowledging the oppressive factors that influence both the practitioner and the client. A significant number of researchers have found that for treatment to be successful, Western mental health practitioners need to be aware of their stereotypes and oppressive views of Arab American women; seek education on Arab culture, including the sociopolitical impacts on Arab American women; and identify culturally competent mental health interventions for Arab American women (Al-Krenawi, 2005a, 2005b; Amri, n.d.; Dwairy, 1998; Erickson & Al-Timimi, 2001; Nassar-McMillan & Hakim-Larson, 2003). In addition, considerable research has shown that the more knowledge a practitioner has of the cultural and religious backgrounds of Arab American women from a nonoppressive perspective, whether Arab American women are Muslim, Christian, or of another faith, the more effective the treatment will be (Abu-Ras, 2007; Al-Krenawi, 2005a, 2005b; Al-Krenawi & Graham, 1999; Amri, n.d.; Erickson & Al-Timimi, 2001; Nassar-McMillan & Hakim-Larson, 2003; Schbley & Kaufman, 2006). Thus, providing culturally competent mental health services with an awareness of the oppressive ideology of Western culture is ideal. Furthermore, combining cultural competence and a feminist perspective with Arab American women is predicted to meet the mental health needs of this specific population better and yield more successful mental health treatment outcomes.

Positive Endeavors

Regardless of the lack of culturally competent mental health services and acknowledgment of Western oppression, resources for mental health practitioners are becoming available. The American Psychology Association held a symposium in 2006 entitled, “When Multicultural Worlds Collide: Working with Arab and Muslim Americans,” informing practitioners of evidence-based culturally competent mental health practices (American Psychology Association [APA] Practice Directorate, 2006, p. 66). In 2009, a conference on the issues of Arab American women, including mental health issues, was held at Kansas State University (Sinn, 2009).

In terms of outreach, Winerman (2006) recommended that practitioners give presentations at community center health fairs, avoid jargon, and present topics like family conflict resolution and parenting skills when attempting to engage Arab American women in mental health services. She identified some best practices for providing mental health services for Arab American women, including offering Arabic-speaking interpreters and telling the client the name of the translator prior to the session (in smaller communities, clients may want to ensure their privacy by making sure they do not know the translator socially); offering to provide mental health services in the client’s home; providing the option of a practitioner who is the same gender; using appropriate terminology (such as listing Middle Eastern or Arab as an ethnic category on intake forms); addressing topics, such as sex or alcohol, after a firm, trusting therapeutic relationship is established; increasing the number of staff who are Arab in the mental health agency; and asking the client for permission to consult with someone outside the therapeutic relationship.

The eastern states of the United States have made progress toward meeting the mental health needs of Arab American women. For example, agencies in New York State have paid special attention to Arab American women. Tamkeen: The Center for Arab American Empowerment, the Arab American Family Support Center, the Yemeni American Association of New York, and the Arab American Association of New York provide social services specifically to Arab American women (Krase et al., 2007). In New Jersey, a focus group revealed the need for professional mental health services and Arabic-speaking therapists (R. Salloum, personal communication, June 10, 2008). As a result, funding was awarded to Tanweer, a mental health service agency in Passaic County, New Jersey, to make mental health services available to the Arab community and Arab American women. Tanweer employs two professional mental health clinicians that serve clients of Arab descent (R. Salloum, personal communication, June 10, 2008). The Arab Community Center for Economic and Social Services (ACCESS), located in Michigan since 1971, led an initiative to develop a national network of agencies serving major Arab American communities (in Cleveland, Ohio, and New York City, for example; Arab Community Center for Economic and Social Services [ACCESS], 2007; S. C. Nassar-McMillan, personal communication, June 3, 2008). ACCESS (2006, p. 16) has a mental health division that provides professional mental health services to the Arab population, including Arab American women. As its annual report stated, 66% of the women they serve are Arab American (ACCESS, 2006, p. 5).

Limitations

The literature review presented in this article was not comprehensive. It may have excluded sources that could provide valuable insights into the mental health needs of and services for Arab American women because only references written in the English language were included. Future reviews should explore sources in a variety of languages, such as Arabic and French. In addition, the majority of the literature citied in this article was academic and peer reviewed. Although such sources as books and gray literature were included, they were limited in number. A wider range of types of sources would have also strengthened the review. Furthermore, the majority of the literature that was cited was from social science disciplines, such as ethnic studies, psychology, and sociology. Expanding the search to include literature from a larger scope of disciplines, such as the humanities and applied sciences, would have strengthened the review. By including a broader range of disciplines, researchers may expand the topics covered and ultimately provide a more in-depth picture. Finally, although the review covered a 20-year time frame, a broader time span may provide a more diverse range of sources and topics.

Conclusion

There is a need for culturally competent mental health services integrated with an awareness of the oppressive ideology that affects Arab American women. Although agencies like Tanweer and ACCESS have begun to address the mental health needs of this population, much research and training are still needed. I recommend that a manual detailing the best practices for culturally competent feminist mental health services for Arab American women be developed, funding for more research on feminist culturally competent treatment be made available, and a directory of resources and services be compiled and disseminated. The manual should address issues in the assessment, diagnosis, and treatment of Arab American women and provide treatment models that are culturally competent and evidence based from a feminist perspective. Research has determined that the willingness of the practitioner to take risks and ask cultural questions will begin to help educate the practitioner and ultimately lead to successful treatment outcomes for Arab American women (Budman et al., 1992; Dwairy, 1998). Mental health practitioners have much to learn about the mental health needs and treatment of Arab American women. It is hopeful that future opportunities to examine the experiences of Arab American women with mental health issues and services will arise and include a feminist perspective.

Footnotes

Acknowledgments

The author thanks Jene Moio, PhD, for her invaluable comments, editing, and encouragement with regard to this article.

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author received no financial support for the research, authorship, and/or publication of this article.

References

Abou-Hatab

F. A. L. H.

(1997). Psychology from Egyptian, Arab, and Islamic perspectives: Unfulfilled hopes and hopeful fulfillment. European Psychologist, 2, 356–365.

Abudabbeh

(2005). Chapter 31: Arab families an overview. In McGoldrick

Giordano

Garcia-Preto

(Eds.), Ethnicity and family therapy (pp. 423–436). New York, NY: Guilford Press.

Abu-Lughod

(2002). Do Muslim women really need saving? Anthropological reflections on cultural relativism and its other. American Anthropologist, 104, 783–790.

Abu-Ras

(2007). Cultural beliefs and service utilization by battered Arab immigrant women. Violence Against Women, 13, 1002–1028.

Afary

(1995). The Iranian constitutional revolution, 1901-1911: Grassroots democracy, social democracy, and the origins of feminism. New York, NY: Columbia University Press.

Ahmad

N. M

. (2004). Arab-American culture and health care. Retrieved from http://www.cwru.edu/med/epidbio/mphp439/Arab-Americans.htm

Ahmed

(1992). Western ethnocentricisim and perceptions of the harem. Feminist Studies, 8, 521–534.

Ahmed

Reddy

L. A

. (2007). Understanding the mental health needs of American Muslims: Recommendations and considerations for practice. Journal of Multicultural Counseling and Development, 25, 207–218. Retrieved from http://www.accesscommunity.org/site/PageServer?pagename=ACCESS_History2

Ali

S. R.

(2005). Global feminist connections: Muslim feminist: An oxymoron? WomanView, 13–15.

10.

Ali

S. R.

Mahmood

Moel

Hudson

Leathers

(2008). A qualitative investigation of Muslim and Christian women’s views of religion and feminism in their lives. Cultural Diversity and Ethnic Minority Psychology, 14, 38–46.

11.

Al-Krenawi

(2005a). Mental health practice in Arab countries. Current Opinion in Psychiatry, 18, 560–564.

12.

Al-Krenawi

(2005b). Socio-political aspects of mental health practice with Arabs in the Israeli context. Israeli Journal of Psychiatry and Related Sciences, 42, 126–136.

13.

Al-Krenawi

Graham

J. R.

(1999). Social work and Koranic mental health healers. International Social Work, 42, 53–65.

14.

Al-Krenawi

Graham

J. R.

(2000). Culturally competent social work practice with Arab clients in mental health settings. Health and Social Work, 25, 9–22.

15.

Al-Sabaie

(1989). Psychiatry in Saudi Arabia: Cultural perspectives. Transcultural Psychiatry, 26, 245–262.

16.

Amer

M. M.

(2005). Arab American mental health in the post September 11 Era: Acculturation, stress, and coping (Unpublished doctoral dissertation). University of Toledo, Toledo, OH.

17.

American-Arab Anti-Discrimination Committee. (n.d.). Facts about Arabs and the Arab world. Retrieved from http://www.adc.org/index.php?id=248

18.

American Psychology Association Practice Directorate. (2006). Tools for practitioners: Learn the latest in practice programming on record-keeping and evidence-based, culturally competent treatment. Monitor on Psychology, 37, 66.

19.

Ammar

N. H.

(2000). Simplistic stereotyping and complex reality of Arab-American immigrant identity: Consequences and future strategies in policing wife battery. Islam and Christian-Muslim Relations, 11, 51–70.

20.

Amri

. (n.d.). Counseling the Arab and Middle Eastern population: Perspectives from an Arab-American counselor [PowerPoint slides]. Retrieved from http://www.counseling.org/handouts/2010/596.pdf

21.

Arab American Institute. (2008). AAI foundation census information center. Retrieved from http://www.aaiusa.org/foundation/34/census-information-center

22.

Arab Community Center for Economics and Social Services. (2006). ACCESS annual report. Retrieved from http://www.accesscommunity.org/site/DocServer/Final.Edited.06AnnualReport.pdf?docID=1361

23.

Arab Community Center for Economics and Social Services. (2007). ACCESS history. Retrieved from http://www.accesscommunity.org/site/PageServer?pagenmae=ACCESS_History2

24.

Arredondo

(1999). Multicultural counseling competencies as tools to address oppression and racism. Journal of Counseling and Development, 77, 102–108.

25.

Baker

F. M

. (2000). Immigrant women’s health: Problems and solutions. [Review of the book Immigrant women’s health]. Psychiatric Services, 51, 1461. Retrieved from http://psychservices.psychiatryonline.org/cgi/content/full/51/11/1461

26.

Barry

Elliott

Evans

M. E.

(2000). Foreigners in a strange land: Self-construal and ethnic identity in male Arabic immigrants. Journal of Immigrant Health, 2, 133–144.

27.

Benhabib

(2006). The “claims” of culture properly interpreted. Response to Nikolas Kompridis. Political Theory, 34, 383–388.

28.

Brittingham

de la Cruz

G. P

. (2005). We the people of Arab ancestry in the United States: Census 2000 special reports. Retrieved from http://www.census.gov/prod/2005pubs/censr-21.pdf

29.

Budman

C. L.

Lipson

J. G.

Meleis

A. I.

(1992). The cultural consultant in mental health care: The case of an Arab adolescent. American Journal of Orthopsychiatry, 62, 359–370.

30.

Chowdhury

E. H.

(2009). Locating global feminisms elsewhere: Braiding US women of color and transnational feminisms. Cultural Dynamics, 21, 51–78.

31.

Cooper

C. R.

Denner

(1998). Theories linking culture and psychology: Universal and community-specific processes. Annual Review of Psychology, 49, 559–584.

32.

Crocco

M. S.

Pervez

Katz

(2009). At the crossroads of the world: Women of the Middle East. Social Studies, 100, 107–115.

33.

Cross Cultural Health Care Program Resource Center. (2004). Arab American communities and Arabic health resources. Retrieved from www.xculture.org/files/CCRH052004.pdf

34.

de la Cruz

G. P.

Brittingham

. (2003). The Arab population: 2000. Census 2000 brief. U.S. Department of Commerce Economics and Statistics Administration, U.S. Census Bureau. Retrieved from http://www.censU.S.gov/prod/2003pubs/c2kbr-23.pdf

35.

Downs

Bernstein

Marchese

(1997). Providing culturally competent primary care for immigrant and refugee women: A Cambodian case study. Journal of Nurse-Midwifery, 42, 499–508.

36.

Dwairy

(1998). Mental health in Arab society. In Bellack

A. S.

Hersen

(Eds.), Comprehensive clinical psychology (pp. 313–324). Oxford, England: Pergamon Press.

37.

Dwairy

(2008). Culture analysis and metaphor psychotherapy with Arab-Muslim clients. Journal of Clinical Psychology, 65, 199–209.

38.

Dwairy

Van Sickle

(1996). Western psychotherapy in traditional Arabic society. Clinical Psychology Review, 16, 231–249.

39.

Erickson

C. D.

Al-Timimi

N. R.

(2001). Providing mental health services to Arab Americans: Recommendations and considerations. Cultural Diversity & Ethnic Minority Psychology, 7, 308–327.

40.

Goodman

. (2002). Arab Americans and American Muslims express mental health needs. Substance Abuse and Mental Health Services Administration (SAMHSA) News, 10, Retrieved from http://www.samhsa.gov/SAMHSA_News/VolumeX_1/article1.htm

41.

Guruge

Collins

(2008). Theoretical perspectives and conceptual frameworks. In Guruge

Collins

(Eds.), Working with immigrant women: Issues and strategies for mental health professionals (pp.19–38). Toronto, ON: Centre for Addition and Mental Health.

42.

Hamdan

(2007). A case study of a Muslim client: Incorporating religious beliefs and practices. Journal of Multicultural Counseling and Development, 35, 92–100.

43.

Hooglund

(1998). Arab women in America [Review of the book Bint Arab: Arab and Arab-American Women in the United States]. Journal of Palestine Studies, 27, 113–114.

44.

Ibrahim

A. S.

(2006). Cultural perspectives on mental health practice in Arab countries. Arabpsychnet E-Journal, 12, 170–174.

45.

James

D. C. S

. (2008). Cultural competence. Retrieved from http://www.faqs.org/nutrition/Ca-De/Cultural-Competence.html

46.

Krase

Nicoletti-Krase

Krase

. (2007). Community needs assessment, New York city’s Arab American community: Draft and outline of final report. Retrieved from http://brooklyn-cuny.academia.edu/JeromeKrase/Papers/316560/_Community_Needs_Assessment_New_York_Citys_Arab_American_Community

47.

McGoldrick

Giordano

Garcia-Preto

(2005). Chapter 1: Overview: Ethnicity and Family Therapy. In McGoldrick

Giordano

Garcia-Preto

(Eds.), Ethnicity and family therapy (pp. 1–40). New York, NY: Guilford Press.

48.

Mojab

(2001). Theorizing the politics of “Islamic feminism.” Feminist Review, 69, 124–146.

49.

Nassar-McMillan

Hakim-Larson

(2003). Counseling considerations among Arab Americans. Journal of Counseling and Development, 81, 150–159.

50.

Nobles

A. Y.

Sciarra

D. T.

(2000). Cultural determinants in the treatment of Arab Americans: A primer for mainstream therapists. American Journal of Orthopsychiatry, 70, 182–191.

51.

Okasha

(2001). Mental health services in the Arab world. In Okasha

Maj

(Eds.), Images in psychiatry: An Arab perspective (pp. 1–20). Cairo, Egypt: World Psychiatric Association.

52.

O’Mahony

J. M.

Donnelly

T. T.

(2007). The influence of culture on immigrant women’s mental health care experiences from the perspectives of health care providers. Issues in Mental Health Nursing, 28, 453–471.

53.

Rossiter

de Boer

Narayan

Razack

Scollary

Willette

(1998). Toward an alternative account of feminist practice ethics in mental health. Affilia, 13, 9–30.

54.

Schbley

Kaufman

(2006). Social work practice with Arab Muslim women living in Western societies. Journal of Practice Teaching in Health and Social Work, 7, 25–38.

55.

Sechzer

J. A.

(2004). Islam and women: Where tradition meets modernity: History and interpretations of Islamic women’s status. Sex Roles, 51, 263–272.

56.

Sinn

. (2009). Conference on issues of Arab-American women being offered at K-state. Retrieved from http://www.k-state.edu/media/newsreleases/feb09/arabwomen21309.html

57.

Tobin

(2000). Developing mental health rehabilitation services in a culturally appropriate context: An action research project involving Arabic-speaking clients. Australian Health Review, 23, 177–184.

58.

U.S. Surgeon General. (n.d.). Overview of cultural diversity and mental health services. Mental health: A report of the surgeon general. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec8.html

59.

Weisberg

D. K.

(1993). The elements of feminist legal theory: Introduction. In Weisberg

D. K.

(Ed.), Feminist legal theory: Foundations (pp. 3–8). Philadelphia, PA: Temple University Press.

60.

Winerman

. (2006). Reaching out to Muslim and Arab Americans. Monitor on Psychology, 37, 54. Retrieved from http://www.apa.org/monitor/oct06/reaching.html.

61.

Yeh

Takeuchi

D. T.

Stanley

(1994). Asian-American children treated in the mental health system: A comparison of parallel and mainstream outpatient service centers. Journal of Clinical Psychology, 23, 5–12.

62.

Youssef

Deane

F. P.

(2006). Factors influencing mental health help-seeking in Arabic-speaking communities in Sydney, Australia. Mental Health, Religion & Culture, 9, 43–66.

Arab American Women,Mental Health,and Feminism

Abstract

Keywords

Arab American Women

Culture, Race, Ethnicity, and Arab People

Feminism and the U.S. Environment

Mental Health Needs of Immigrant Women

Culturally Competent Practice

Positive Endeavors

Limitations

Conclusion

Footnotes

Acknowledgments

References