http://www.paiwand.com/
Culture, Religion and Traditions of
Afghan Refugees in the UK and their relevance for
mental health practitioners
December 2014
Acknowledgments
This booklet and event is the result of a collaborative work
between organisations and individual experts in the field of
Afghan culture, health and migration. The organisers Brent
Mind (WEB) and Afghan Association PAIWAND want to thank
the following experts for their guidance and input.



Dr. Ihsanullah Wardak, MD, MRCGP, Chairperson of
Association of Afghan Healthcare Professionals-UK
Dr. Patricia Omidian, PhD in Medical Anthropology,
Fulbright Special Projects Awardee. Co-Founder and Codirector of Focusing International. Specialist consultant for
international agencies such as UNICEF, the World Food
Program, UN Women, UNAIDS, Save the Children and
International Rescue Committee
Dr. Wahab Ghani, MD, MRCGP, GP Trainer, Member of
Management Committee of Association of Afghan
Healthcare Professionals-UK (AAHP-UK) and ExChairperson of AAHP-UK
1
Table of Contents
Acknowledgments........................................................... 1
Introduction .................................................................... 4
Socio-Cultural Context .................................................... 5
Impact of long lasting conflict .................................... 5
Core Socio- Cultural Values ........................................ 8
Family Structure in Afghanistan ........................... 10
Family Honour and Privacy................................... 12
Family Hierarchy................................................... 13
Family Authority and Gender ............................... 14
Communication .................................................... 14
Greeting and Socialising ....................................... 16
Taboo and Shame ..................................................... 17
Culturally Specific Idioms of Distress ........................ 18
Practical implications ................................................ 19
Religion ......................................................................... 21
Islam and mental Health........................................... 21
Practical Implications................................................ 22
Tradition Beliefs ............................................................ 24
Jinns and mental health............................................ 24
Evil eye ...................................................................... 25
Saya........................................................................... 25
Traditional Healers ................................................... 26
Practical Implications................................................ 26
Glossary of Terms.......................................................... 28
2
Einstein Poster- UNHCR collaboration with Nicosia Bus
Company. 2009
……It is only one aspect of the story….
Apart from their knowledge and expertise, refugees also
bring with them many other elements, including their
culture, tradition and religious beliefs which do not only
enrich the diversity of the host countries, but also impact
their own integration process.
3
Introduction
The effect of long lasting conflict, experiences of torture
in their country of origin and lengthy journeys affect
refugees. In addition, issues related to the integration
process in the host country - including shattered identity
in the context of common behaviour patterns, traditional
practices, cultural and religious beliefs - are important
determinants to be considered when dealing with
refugees in general and with their health and mental
health in particular.
Although it is not possible for healthcare professionals to
change or have significant
Nawruz Celebration in the UK
Nawruz Celebration in Afghanistan
influence
on
the
contextual issues, it
might be advisable to consider them when assessing the
patient-client and designing suitable preventive and
coping strategies. At the same time it is also possible to
encourage the clients to take agency by themselves,
starting a process of self-empowerment.
This document is part of materials for a workshop for
medical and healthcare professionals who may have the
opportunity to work with Afghan refugees and
immigrants in the UK. It has been developed with the
aim to further enhance understanding of Afghan cultural,
4
traditional and religious beliefs & practices impacting on
the mental health and wellbeing of refugee communities
and to promote culturally & traditionally appropriate and
religiously sensitive approaches when dealing with the
mental health of Afghan clients.
In addition, this article aims to enhance our knowledge
and practice in dealing with different minority groups. In
considering the aspects that make specific patient/client
different from others, we can enhance the outcome of
our work, and contribute to improving to clients’
wellbeing.
Socio-Cultural Context
Impact of long lasting conflict
Long lasting conflict and subsequent massive
displacement, ongoing violence, loss of property and/or
family members, torture, experiences of terror and
difficult life conditions in a conservative and traditional
society, have victimised millions of Afghans in recent
decades. In addition, through forced migration, Afghans
have been exposed to different value systems which
changed their expectations and attitudes.
Such experiences can create confusion and conflict for
immigrants adapting to new social norms and values and
later on readapting to their previous norms when
returning back to their homeland.
Anxiety, post-traumatic stress disorder (PTSD) and
depression are common particularly among Afghan
women. A population survey (Mental Health, Social
5
Functioning, and Disability in Post-war Afghanistan)
carried out by Centre for Diseases Control and
Prevention-CDC (Table-1) in 2002 revealed1
-
Multiple trauma events during the previous 10
years in over 60% respondents
High prevalence of depression (even higher in
those with disabilities).
High prevalence of anxiety.
PTSD in respondents was over 40%
Feelings of hatred about what happened to them
and their families were very high.
Coping mechanisms included religious and
spiritual practices; focusing on basic needs, such
as higher income, better housing, and more
food; and seeking medical assistance.
Table-1: Data from Mental Health, Social Functioning,
and Disability in Post-war Afghanistan survey-2002
1
Mental Health, Social Functioning, and Disability in Post-war
Afghanistan, JAMA. 2004; 292(5):575-584
(doi:10.1001/jama.292.5.575), Barbara Lopes Cardozo; Oleg
O. Bilukha; Carol A. Gotway Crawford; et al.
6
The survey also revealed women had significantly poorer
mental health status than men (please see table-2).
Although both men and women in Afghanistan went
through the same challenging experiences restrictive
social norms for women resulted in high affect amongst
the female population who can struggle to access
support as easily.
Table-2: Gender Difference of Mental Health
Outcomes (Non-disabled respondent)- Data from
Mental Health, Social Functioning, and Disability In
Post-war Afghanistan survey-2002
7
According to a recent announcement by Afghanistan’s
Ministry of Public Health (MoPH), over 60% of Afghans
suffer from stress and mental illness2 but despite mental
health disorders being one of the leading causes of
morbidity, they has not been sufficiently addressed over
the last decades and little is known about disease
patterns in Afghan society at present. At the same time
due to competing priorities and ignorance, the country
lacks minimal resources in term of human capita and
infra-structure.
These shocking statistics mean that a considerable
number of Afghans who became refugees in other
countries had already suffered from mental health
problems in their native Afghanistan and most probably
never had contact with professional mental health
services in the past.
Core Socio- Cultural Values
The core socio-cultural values which affect the way
Afghans live, formulate their feelings and thoughts,
determine the way they express themselves and
perceive reality have deep historical linked to tradition
and religious beliefs. Despite ethnic and geographic
variations, the core values accepted and followed by the
majority of Afghans (and supported by socio-cultural
institutions and forums) are as follows:
1. Belief in God and the Qur’an: promotes a sense
of moral and social responsibility and the
2
Speech of Dr S. Dalil minister of Public Health Afghanistan
on occasion of World Mental Health Day-2014.
8
2.
3.
4.
5.
obligation to support others (especially the poor
and those in need). Guided by a strict moral
code, it is a source of hope, formulates the
definition & purpose of life for Afghan Muslims
and encourages modesty and bravery.
Honour and respect, for self: promotes the idea
of having large families where members support
each other and everybody contributes.
Respect for others: This value promotes
respecting elders, teachers, parents and guests.
Family privacy: This is a value strictly respected,
particularly in rural Afghanistan, even by Afghan
refugee communities settled in western
countries. It aims at protecting the family from
shame, strengthening ownership of homes and
assets and promoting care for women and
children. It is this value that may prevent Afghan
refugees from sharing sensitive problems with
others or reporting issues such as domestic
violence, rape etc.
Hospitality: Guests must be honoured and
provided with everything they need. Anger or
negative feelings should not be expressed in
front of others. It is not allowed to ask a guest to
leave the house or not to come. Even an enemy
has the right to be safeguarded if he/she asks for
it.
9
During recent decades, many Afghans fled the country
and were exposed to new value systems. Most of them
chose to keep their own values but they also learnt about
and practised the values of their host countries (in
particular younger generations). Such dual exposure and
practices have become source of conflict between the
way of thinking and behaving of the old and new
generations.
Some of the norms and social behaviours which could
have practical implications when dealing with Afghan
refugees are explained in the following pages.
Family Structure in Afghanistan
(What is my life like in Afghanistan? We have a very large
family. I live with my parents, second mother, three
brothers, two half-sisters, two half-brothers, and my
uncle's family and his six kids and a wife. My
grandmother lives with us, too. So, we have 18 people in
our home. And sometimes we have cousins come visit
from other villages. It is nice having so many people
around. There is always someone to play with or have
10
help with the work. Sometimes my mom doesn't get
along with my grandmother, but they always make up
quickly. My father is in charge and he doesn't like anyone
to fight. The only problem is that our house is very small.
It only has four rooms. Before the war there were two
houses. We want to rebuild the second house so we have
more room)3.
Atman, 8 years, Burka, Baghlan Province .
Even with variations on ethnicity and local traditions, the
family remains the most important institution in Afghan
society. Afghan society and families bear one or of the
following characteristics:4




Endogamous: with parallel and cross-cousin
marriages encouraged.
Patriarchal: authority vested in male elders.
Patrilineal: inheritance through the male line.
Patrilocal: girl moves to husband's place of
residence on marriage.
3
SCHOLASTIC, Read every day, lead a better life ;
http://teacher.scholastic.com/
4
Society and Norms.
http://uwf.edu/atcdev/afghanistan/society/Lesson1Family2.h
tml
11

Polygyny: multiple wives are permitted,
although no longer widely practiced.
Although the situation is changing rapidly, the extended
family is still the most common family structure
especially in rural Afghanistan. Factors that support the
extended family system are economic, security and
safety (mainly in tribal societies) or religious beliefs.
Some UK Afghan refugee communities still try to keep
the traditional extended family structure and even
though new generations prefer nuclear families, they are
still expected to obey the authority of the elders.
While the extended family system may have its benefits,
conflict can arise among family members, especially
when the elders (accustomed to be the decision makers)
demand the new generation to follow their path.
The extended family structure prevents the younger
generation from independent living and keeps them in
the position to be told “what to do or not to do” and
report on “what they have done or not done”.
Breakdown or changes in family structures can cause
stress to family members.
Family Honour and Privacy
Family honour is still a holy matter for Afghans, even for
those living in western countries.
Traditionally Afghan families with religious background
or affluent families have higher positions and bear more
respect. Although extensive migration, increase in
education and social awareness and rise of warlords have
12
to some extend changed this, family bonds still play an
important role in the social status of a person.
Afghans keep family matters extremely private. Bringing
shame upon an Afghan Family is nearly always followed
by some form of retaliation or revenge. When a female
member of family is shamed, the retaliation may literally
be a matter of life and death.
Family Hierarchy
Age demands respect within the family and in wider
Afghan society. Grandfathers, fathers and even older
brothers are the decision makers. Traditionally, younger
members of the family are expected to follow the orders
and instructions of the elders even against their wishes.
Younger family members are expected to follow the
family rules and need permission from their elders to
engage in social activities. Challenge to family hierarchy
causes conflict, unrest and ill feelings among Afghan
13
refugee families in the UK and even in Afghan urban
settings.
Family Authority and Gender
Women are responsible for household management,
caring for their husbands and raising of the children.
Remarkable changes took place after 1959 when
opportunities were extended for women to enroll in
education and higher education institutions, work
outside their homes and to some women in urban
settings, to participate in social activities. However,
women are still expected to socialise only within the
family, not with work colleagues.
The traditional belief in male superiority provides the
basis for the acceptance of male control over families Life
crises, decisions about education, careers and marriage
are, therefore, made by male family members.
Afghan women -especially in western countries- who
have had access to higher education and employment
seek to act independently but older women and male
members of the family tend to expect them to act as
“traditional housewives”. These differing views can
cause conflict, domestic violence and breakdown of
families.
A considerable number of refugee women still follow the
traditional norms of a male dominated system and keep
busy with housekeeping affairs, avoid socialising and
even need permission to attend medical appointments.
Communication
Afghanistan has two national languages: Dari and Pashto.
Although there are other minority languages,
14
bilingualism (that includes at least one national
language) is common5. Afghans tend to speak in stories
rich in context, rather than providing brief answers to
specific questions. There are gender differences: women
discuss their problems with friends, including nonAfghans when they feel sad (to receive sympathy or
empathy from others); in contrast, men are reluctant to
express their feelings and thoughts, bottling up feelings
and tension. Incidents of domestic violence may be a
reflection of strong emotional distress experienced by
men outside the family.
Afghan women tend to be affectionate and in public
settings they speak loudly; in private settings, the
mother’s voice commands power and control of the
children at home. Men speak in soft tones in private or
public settings, this denotes being in control of the
situation; showing aggression or speaking loudly
indicates loss of control and is seen as disrespectful6.
There are also ethnic differences: Pashto speaking
people may sound like they are arguing when they talk
but this is just their style of communication and does not
reflect emotional content; Dari speakers speak softly and
use polite tones and words, even if they feel strongly
about something.
Physical contact: touching the other on the hand,
shoulder, back and even legs is common among Afghans
to draw attention to the listener, to give advice, to show
appreciation or even as a sign of superiority. In some
5
CIA World Fact Book, 2006
Giger, J. & Davidhizar, R.-2007, Afghans and Afghan
Americans
6
15
contexts, particularly when one wants to convey respect,
silence may mean disagreement7.
Gender segregation is evident in communication: men
and women who are not related never touch each other
and do not socialise. This is common practice especially
among people from rural Afghanistan and most of
Afghan refugees in the UK follow these norms. Afghans
keep family matters secret and do not talk about them
even with healthcare professionals.
Communication is linked to the way Afghans
demonstrate their respect for others and it translates in
different behaviours: listening without interrupting,
standing up when an elder enters the room, greeting
elders first or walking behind them. Afghans generally
call elderly people or women by respectful terms rather
than addressing them by their names (Kaka= uncle,
Khala= auntie, Padar= Father, khahar, hamshira, Bibi=
Mother). “Respect others in order to be respected
yourself” is a saying among Afghans which stems from
the value of respecting others.
Greeting and Socialising
Common greetings among Afghans are: to bend the head
forward, putting one/both hands on the chest or shaking
hands. Men who are close friends or meet after a long
time may shake hands and kiss each other on cheeks (23 kisses), and hug.
Women usually great each other with kisses on cheek 3
or more times. Women do not tend to shake hands with
males (even members of the family).
In certain rural areas such as Eastern and South-Eastern
Afghanistan, shaking hands is an accepted practice
7
Giger, J. & Davidhizar, R.-2007, Afghans and Afghan
Americans
16
among family members and relatives, but women prefer
to cover their hands while shaking hands.
Men may accompany a verbal greeting or farewell with
placing the right hand over their heart as a sign of
respect. This is common practice when men greet
women who are not immediate family members. As a
general rule a man should wait for a woman to take
initiative and extend her hand first.
Taboo and Shame
Most taboos in Afghan society are linked to religious
beliefs and socio-cultural values and are mainly focused
on sex: the loss of virginity before marriage, sex outside
marriage, rape, incest, and homosexuality are cause of
shame and are kept secret even from family members.
Mental ill health is also cause of shame; a member of the
family suffering from mental health problems is cause of
shame and social exclusion for the whole family.
Apart from taboos, shame for Afghans may occur when
they deviate from religion, fall into poverty, are
disrespected (within or outside the family), are caught in
criminal acts, loss of control (e.g. in a traumatic event, in
prison, under torture), or are unable to fulfil their duties
towards wife, children and parents.
Not having a baby is also a matter of shame and concern
and in most cases it is the wife who is blamed for this as
husbands are reluctant to undergo medical tests. This
becomes a matter of great concern and emotional
hardship for women.
Taboos and shame are cause of stress and can engender
violence such as beatings, forced marriages, child
marriages, exchanging women and honour killings, acts
that are carried out with the intention to keep the
“family honour”.
17
Culturally Specific Idioms of Distress
It is important to keep in mind that most of the time
Afghan women present themselves with non-specific
somatic symptomes such as pain, fatigue or headache
when in reality, the underlying issue may be mental
distress. This somatisation of emotional issues is partly
because of stigma and partly due to a lack of
undrestanding of nature of mental and emotional
hardship. In addition there are culturaly specific idioms
of distress to be aware of while assessing mental health
of Afghans such as:8:




Jigar Khun: a form of sadness that includes grief
following personal loss but that may also be a
reaction to any deeply disappointing or painful
experience.
Jigar
khun,
rather
than
ghamgeen(sadness), was the term normally
used to describe the emotional reaction of
people who had lost family members during the
war.
Asabi: nervous agitation
Fishar: an internal state of emotional pressure
and agitation (fishar-e-bala- High pressure) or
low energy and motivation (fisha-e- payin-Low
pressure). Although they reflect different
internal states, Afghans often talk generically as
fishar.
Self harm: Hitting oneself in the head, face or
elsewhere on the body as an expression of
intense distress.
8
The Afghan symptom checklist, American Journal of
Orthopsychiatry
18
Practical implications
• Male members of the family are the decision
makers. Their involvement in the process of
managing the health and welbeing of Afghan
women and children is crucial. While they may
not react or express their disagreement in front
of healthcare professionals they might -later onput pressure on women and prevent them from
following the prescribed advice.
• Even though Afghan women like to express
themselves when they are stressed, they will not
do so in initial meetings. They will only talk when
the healthcare professional gains their trust,
showing sympathy and empathy towards them.
• Afghan women are eager to show their abilities
and potential but need to be listened to,
encouraged and acknowledged. Such approach
promotes positive thinking and behaviour and
help healthcare professionals to build on positive
experiences of such clients and promote selfconfidence.
• Afghan men more likely internalised to stigma.
They “tough-up” and “deal” with strugles with
depression and and anexiety. Most of the time
they approach the professionals for help late. If
Afghan man cry during the psychotherapy
session, it is an indication of high level of pressure
and stress. On the other hand Afghan women are
more open to seek support but it is not the case
with unmarried girls because of fear of social
labeling and it’s consequences.
• Afghans keep family matters including domestic
violence within the family, they need reassurance
that sharing such information will not hamper
their family relations and reputation before
addressing this with healthcare professionals.
19
• Matters considered taboo and shame are cause
of stress and mental health unrest but Afghans including refugee communities- rarely express
them to the healthcare professionals. Again,
gaining trust of the clients is paramount.
• Although Afghans may need an interpreter, the
presence of the interpreter may prevents them
from sharing their problems due to taboo or
shame. In addition, Afghans may doubt that
interpreters and even healthcare professionals
will remain impartial and confidential. The
Afghan women tend to prefer women
interpreters.
• Although most Afghans are able to speak Dari, it
is advisable to translate information documents
in Pashto as well. Farsi is not a common language.
Considering the low literacy rate, especially
among Afghan women, it is necessary to check if
clients can read, write and fill the forms by
themselves or if they need additional help.
• Involving Afghan refugee women in outdoor
activities to provide them with an opportunity for
self empowerment and get out of their homes
and socialise can have positive impact on their
mental health and wellbeing, however without
involvement of the men (discussions,
encouragement and follow-up) it is unlikely to
happen and be sustainable..
• It is important to clarify the meaning of culturaly
specific idioms (idioms of expressing distress) as
they need proper translation and the interpreter
must be careful about them. Fisher simply means
pressure but it does not necessarily mean
hypertension. It need to be considered as an
idiom and translated appropriately.
20
Religion
Islam and mental Health
The concept of spirituality is inclusive and affects
everybody. Belief in God and in the afterlife defines and
gives purpose to the life of most Afghans. This also acts
as a source of hope, comfort and tolerance. It has been
found that9:
•
Religious beliefs may allow people to reframe or
reinterpret experiences and events in a way that
makes them less stressful.
•
Religious and spiritual support are a valuable
source of self-esteem, companionship and
practical help that enable people to cope with
stress and negative life events.
Activities which help Muslims cope with mental health
problems are:
• Praying and expressing gratitude or repentance
to Allah, Munajat etc.
• Charitable activities: Zakat, Fitr etc.
• Expressing optimism and faith
• Using written verses of the Qur’an e.g. Tawiz.
• Asking other Muslims for support
• Retreat and meditation Muraqaba or Naht
khiwani
9
Role of Islam in the management of psychiatric disorders,
Walaa M. Sabry and Adarsh Vohra, Indian J Psychiatry. Jan
2013; 55(Suppl 2): S205–S214.
21
Misinterpretation of Islamic rules or replacing them with
traditional beliefs is common in many parts of
Afghanistan and can result in negative impacts on
people’s health in general and mental health in
particular. An example of this is the use of shrines as
“mental health hospitals” which are used even now and
preferred to hospitals and health facilities even though
they offer very little or no treatment at all to patients.
People with severe mental health disorders are still
taken to shrines in different parts of the country, chained
and kept there without food or care.
This is a clear indication of the fact that mental health
disorders are still misunderstood (linking disorders with
the divine and
evils) and also
there is lack of
resources
for
mental health care
and promotion. It is
therefore common
that Afghans fear a
mental
health
diagnosis and will
avoid seeking professional support for emotional and
mental health issues.
Practical Implications
•
Muslims believe that life, death, joy and
happiness are derived from God. Such belief
creates a level of tolerance (Saber) and acts as a
source of motivation to overcome suffering.
Drawing attention of the clients to his/her such
beliefs may be a source of peace.
22
•
Islam forbids suicide: according to Islam, God is
the author of life and only He can take it away;
therefore it may be effective to draw attention
of Muslim Afghan clients with suicidal thoughts
to their holy teachings.
•
Strengthen the support network: taking into
account the fact that Muslims tend to approach
Imams for counseling and support, establishing
working relations with a local imam could be a
good tool to increase awareness, overcome
stigma.
•
Group therapy: most Afghan Muslims do not
easily accept participation in group therapy
sessions especially mixed groups (men and
women). This is also because of the socialcultural values of privacy which compel people
towards keeping family and personal matters
secret. However, experience shows that Afghan
women love to attend such groups after a trust
building process.
•
Ramadan: during Muslim fasting month, it may
be good practice to adjust the dosage interval of
the prescribed medications according to timing
of iftar (eating time) and suhoor (fasting time). If
the patient suffers from a severe physical or
mental condition or there is need for frequent
dosing, it is possible to advise the patients not to
23
fast as Islam exempts them from fasting in such
conditions. “And whosoever of you is sick or on a
journey, let him fast the same number of other
days. Allah desired for you ease; He desired not
hardship for you”. (Qur’an 2:185).
•
Pork, pork products and alcohol are forbidden in
Islam. Muslim patients will stop taking
medication which contains products such as
gelatine, stearic acid or Alcohol. This is an
important consideration when prescribing
medicines that might be rejected by patients.
Tradition Beliefs
Like everywhere else, some beliefs and behaviours have
been transformed and adopted from generation to
generation. These traditions have significant impact on
Afghan social, family and personal life. It is important to
understand that sometimes these traditions, beliefs and
practices are considered Islamic rules while in reality
they are not. Some traditional beliefs influencing mental
health of Afghans are explained below.
Jinns and mental health
Most Afghans believe that Jinns can cause mental and
physical illness. Conditions linked to Jinns’ intervention
are: strokes, paralysis, persistent crying or discomfort,
behavioural changes, fear, forgetfulness, lack of energy,
psychosis, hysteria, mania, Tourette syndrome, epilepsy
or fits, schizophrenia or dissociative identity disorder,
vaginal bleeding and miscarriages.
24
In line with this Afghans believe that manifestations of
signs and symptoms related to mental illness are caused
by Jinns and therefore refer these cases to faith and
traditional healers who manage the case by using
religious interventions such as reciting verses from
Qur’an and Tawiz.
Evil eye
Most Afghans believe that the gaze of some people can
be harmful, even unwittingly. To protect those at risk,
Afghans hang amulets with holy names on them around
the neck of babies and children as protective measures
and in addition they recite verses from the holy Qu’ran.
A very common method to protect/treat the evil eye is
burning of “Aspand or Esphand10”.
Saya
The word “Saya” means shadow. In the Afghan
traditional context it refers to the invisible impact of
10
Peganum harmala
25
someone (alive or dead). There are two types of Saya; the
clean one (with good impact and attributed to someone
with good conduct) and the dirty or impure Saya (with
negative impact and attributed to people with low moral
conduct). Many Afghans believe that a dead body has
influence on the living (especially children and pregnant
women) with their Saya which can have negative
consequences.
Traditional Healers
Afghans have strong beliefs in traditional healers. In the
context of mental health, traditional healers are the
Mullah, Shaykh, Pir, Tawiznewis, Malang and institutions
such as shrine, khanaqa etc.
This engrained belief in the power of healers means that
Afghan refugees living in western countries use their
mobile phones and other means of communication to
consult with said traditional healers in Afghanistan about
their problems; The traditional healers are then asked to
apply healing methods on behalf of them or send the
Tawiz, Shoyest and other materials to be used in healing
ceremonies.
Practical Implications

According to some scholars “Spirit possession is
a culturally specific way of displaying symptoms
of psychosis, dissociation, social anxiety, etc.
and is a fairly global idiom of distress. That is,
whereas a person with psychosis in the West
may believe he is being controlled by a
computer, a member of a community that
26
believes in spirit possession may believe his
body to be taken over by a demon11”.

In some cases Jinns may have the function to
express ideas or thoughts that cannot be
expressed under normal conditions due to taboo
or shame. It help the person to express her ideas
and thoughts, feel calm and also it is a kind of
“cries for help” as well.

More or less subconscious themes can be
expressed in a projection as “conversations”
with Jinns. Such communications and
connections with Jinns- sometimes resembling
delirium or hallucinations- could be mistaken as
signs of schizophrenia.

Clinicians should be careful and distinguish
between culturally sanctioned beliefs and
psychotic symptoms to avoid unnecessary
treatment with antipsychotics where other kind
of treatment (talking treatments, for example)
may be more suitable. On the other hand,
clinicians need to be cautious and not assume
that all unusual beliefs in a patient from an
unfamiliar culture are culturally sanctioned, lest
psychosis goes undetected.12
11
Jinn and mental health, Simon Dein MRCPsych, PhD, Senior
Lecturer, University College London and Abdool Samad
Illaiee MGPhC, BPharm(Hons), Psychiatric Pharmacist and
Chaplain, North East London NHS Foundation Trust.
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Jinn and mental health, Simon Dein MRCPsych, PhD, Senior
Lecturer, University College London and Abdool Samad
Illaiee MGPhC, BPharm(Hons), Psychiatric Pharmacist and
Chaplain, North East London NHS Foundation Trust.
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
Most traditional healers (Shaykh, Dervish, or Pir)
promote the idea that mental health
deterioration is caused by Jinns and the solution
is to exorcise the spirit via holy readings, prayers,
music, dancing, and beating spirits out of the
“client's” body. Although some Muslims
recognise these practices as NOT Islamic, some
Afghans still believe in them and the healing
methods provide confidence to the patient and
their support network and therefore may have a
level of healing power.
Glossary of Terms
Aspand or Esphand: it is the seed of a plant called
Peganum harmala. The Aspand seed is the richest natural
source of two alkaloids, harmine and harmaline (their
names come from the Indian name for the plant, Harmal)
and have been used in the treatment of clinical
depression. In moderate doses, they produce a feeling of
well-being and contentment.
Dervish: a member of various Muslim ascetic orders,
some of whom perform whirling dances and vigorous
changing as act of ecstatic devotion.
Dua: The word is derived from the Arabic root meaning
to call out. It is the act of supplication. It is calling out to
God and a kind of conversation with God.
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Fasting month – Ramadan: Is a month in which Muslims
fast from just before sunrise to sunset each day.
Fitr: is charity given to the poor at the end of the fasting
in the Islamic holy month of Ramadan
Hadiths: is the record of the sayings of Prophet
Muhammad (swas).
Halal: is any object or an action which is permissible to
use or engage in, according to Islamic law.
Iftar: is one of the religious observances of Ramadan
when Muslims break their fast. Iftar is taken right after
Maghrib time, which is around sunset.
Jinn: According to Islam, Jinns were created before
humans they are made out of smokeless fire and are
connected to the human world; we cannot see them but
they can see us. According to traditional beliefs, Jinns live
in old, dark and destroyed houses, in graveyards and
mostly regarded damaging.
Khanaqa: is a building designed specifically for
gatherings of a Sufi brotherhood and is a place for
spiritual retreat and character reformation.
Malang: is a person who doesn't care for the world and
is always busy with religion.
MoPH: Ministry of Public Health of Afghanistan.
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Mullah: A teacher or scholar of Islamic learning, or the
leader of a mosque who also leads praying in mosque.
Muraqaba: is the Sufi word for meditation. Literally it is
an Arabic term which means "to watch over", "to take
care of", or "to keep an eye".
Naht khiwani: Gathering of people and singing songs
(most of the time without music) about Prophet
Muhammad (swas).
Pir: A master who guides and instructs his follower on
the Sufi path.
Ramadan: Is the ninth month of the Islamic calendar, and
a time when Muslims across the world will fast during the
hours of daylight.
Riyaza: means spiritual exercise to get rid of all the
causes of diverting attention from Allah, to set the inner
and spiritual faculties in a proper order and to gain
inward composure. It could be considered a kind of
meditation.
Sahar: It is early morning before sunrise when Muslims
start fasting during the month of Ramadan (see
Ramadan).
Shaykh: is a title of superior authority in the issues
of Islam.
Shoyest: Is a piece of paper written by Tawiznews to be
submerged in some water and to be taken by the person
or wash the body with.
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Sufi: A Muslim ascetic and mystic.
Tawiz: Is a piece of paper with Qu’ranic verses and duas
people keep them for protection.
Tawiznewis: Is the person (meanly people with religious
background) who writes Tawiz.
Zakat: is one of the 5 Pillar of Islam and is the practice of
taxation and redistribution, including benefits paid to
poor Muslims, imposed upon Muslims based on
accumulated wealth.
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The organisers:
BRENT MIND – Wellbeing Engagement of Brent
Adriana Santos-Davila, Community Engagement Worker
Hampton House
1b Dyne Road, Kilburn
London NW6 7XG
Tel: 020 7604 5183
Mob: 07794 033 002
adriana.santos-davila@brentmind.org.uk
www.brentmind.org.uk
Afghan Association PAIWAND
Dr. Ghulam Farooq, Mental Health Advocacy Project
Manager
10th Floor
Hyde House
The Hyde
London NW9 6LH
Tel:
02089058770
Mob: 07476351734
Ghulam.farooq@paiwand.com
www.paiwand.com
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