AN EXPLORATORY STUDY OF KNOWLEDGE, ATTITUDES, AND
PERCEPTIONS OF PAKISTANI AMERICANS REGARDING WHAT
CONSTITUTES A HEALTHY AND PEACEFUL FAMILY
Iffat Hussain
B.A., University of Karachi, Pakistan, 1982
M.A., University of Karachi, Pakistan, 2000
THESIS
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2011
AN EXPLORATORY STUDY OF KNOWLEDGE, ATTITUDES, AND
PERCEPTIONS OF PAKISTANI AMERICANS REGARDING WHAT
CONSTITUTES A HEALTHY AND PEACEFUL FAMILY
A Thesis
by
Iffat Hussain
Approved by:
__________________________________, Committee Chair
Maura O’Keefe, Ph.D., MSW
__________________________________, Second Reader
Chrystal Ramirez Barranti, Ph.D., MSW
____________________________
Date
ii
Student: Iffat Hussain
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
__________________________, Graduate Coordinator
Teiahsha Bankhead, Ph.D., LCSW
Division of Social Work
iii
___________________
Date
Abstract
of
AN EXPLORATORY STUDY OF KNOWLEDGE,ATTITUDES, AND
PERCEPTIONS OF PAKISTANI AMERICANS REGARDING WHAT
CONSTITUTES A HEALTHY AND PEACEFUL FAMILY
by
Iffat Hussain
Parallel to the experiences of other migrant communities, Pakistani-Americans continue
to deal with post-migration stressors. These stressors affect the overall peace and healthy
environment of families. This exploratory study examines the knowledge, attitudes and
perceptions of Pakistani-Americans in the Sacramento area regarding what constitutes a
healthy and peaceful family. Data were obtained through interviews with five Pakistani
females and five males, using the snowball sampling method. The findings suggest that
stressors for Pakistani-Americans are related to acculturation issues and living in a post9/11 environment. Religious belief is the only coping mechanism for this community.
Cultural barriers and concerns related to cultural competency of service providers prevent
them from seeking mental health services. Recommendations are discussed based on the
findings.
_______________________, Committee Chair
Maura O’Keefe, Ph.D., MSW
_______________________
Date
iv
DEDICATION
I dedicate this study to my late father Riaz Khalique Raufi, as I proudly fulfill his dream.
v
ACKNOWLEDGMENTS
Firstly, I would like to thank my Ammi (mother) Dr. Naseem Riaz, whose strong
beliefs regarding female empowerment inspired me to finish this program. A very special
thanks to my older cousin Zafar Masud who first introduced and envisioned the idea of
me achieving a post-baccalaureate degree, at the young age of seven. I thank my husband
Asim Hussain, for his unwavering support during my three year journey of social work.
Thanks to my courageous son Zohair for being there for me, and allowing me to vent
when things got stressful, especially during this past semester. Thanks to my princess and
beautiful daughter Khushboo who believed in me, even when I didn’t believe in myself.
Thanks to my nephews Haisum and Hatim (more like my own sons) for bringing me
books from the UCD library, for returning home during school breaks for home cooked
meals and my love (even when I was unavailable). Thanks to my younger siblings, Ishrat,
Nikhat, Mohsin and Saroosh for their faith in me, and for being understanding,
especially when I forgot to remember their birthdays, and anniversaries. They all knew
that regardless of how overwhelmed I was, they all were right here close to my heart.
Last but not least thanks to my 8 year old niece Aria, my darling, who was considerate
enough to allow me to excuse myself from her ‘Mommy, baby and sister’ game because
of my studies. Aria, I am now ready to engage in games.
Thanks to Dr. Maura O’Keefe who was always available with her valuable
advice, and without whose guidance I would have been unable to graduate on time. Dr.
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O’Keefe, not only supported and reinforced my optimism during this arduous journey,
but also counseled me as I needed. I cannot even find words to thank Dr. Chrystal
Barranti, she advocated on my behalf and introduced me to Dr. O’Keefe. Dr. Barranti
also listened to me when I had personal challenges. She is a true social worker. Thanks
to all my Professors, including Dr. Cooper, Dr. Bein, and Dr. Taylor, who have always
supported me. A special thanks to the entire social work department, and my colleagues,
especially Laurie Thompson for her unconditional support.
A very special thanks to David Reynolds from the tutoring center for his constant
reviews, feedback, and effort to understand my specific linguistic challenges, which
provided me with the confidence to continue with this thesis. Thanks to Whitney Clark
from the Student Technology Center/ IRT for her assistance during the formatting
process.
Finally, I would like to acknowledge the large debt I owe to the Pakistani
American community, without whom I would have been unable to complete this thesis.
vii
TABLE OF CONTENTS
Page
Dedication ........................................................................................................................... v
Acknowledgements ............................................................................................................ vi
List of Tables .................................................................................................................... xii
Chapter
1. THE PROBLEM ............................................................................................................. 1
Background of the Problem: Anecdote ................................................................... 1
Introduction ............................................................................................................. 2
Statement of the Research Problem ........................................................................ 2
Purpose of the Study ............................................................................................... 3
Social Work Implications and Significance of the Study ....................................... 4
Methodology Overview .......................................................................................... 5
Research Question .................................................................................................. 5
Objectives ............................................................................................................... 6
Theoretical Frameworks ......................................................................................... 6
Definition of Key Terms ....................................................................................... 12
Assumptions.......................................................................................................... 13
Limitations ............................................................................................................ 13
Delimitations ......................................................................................................... 14
2. LITERATURE REVIEW ............................................................................................. 15
viii
Introduction ........................................................................................................... 15
History of Pakistan ................................................................................................ 15
History and Demographics of Pakistani Immigrants in the United States............ 18
Religious Values of Pakistani American Community .......................................... 21
Cultural Values ..................................................................................................... 24
Family Values ....................................................................................................... 26
Stressors for Pakistani-Americans ........................................................................ 32
Raising Children ................................................................................................... 33
The Process of Assimilation and Acculturation.................................................... 38
Coping Mechanisms, and Attitudes Regarding Seeking Mental Health Services 40
Issues in Seeking Mental Health Services ............................................................ 42
Summary ............................................................................................................... 44
3. METHODOLOGY ....................................................................................................... 45
Research Design.................................................................................................... 45
Research Question ................................................................................................ 45
Sample Population/Participants ............................................................................ 45
Instrumentation ..................................................................................................... 46
Data Collection Method ........................................................................................ 47
Data Analysis ........................................................................................................ 47
Bias and Error ....................................................................................................... 48
Protection of Subjects ........................................................................................... 49
ix
Summary ............................................................................................................... 50
4. STUDY RESULTS ....................................................................................................... 52
Introduction ........................................................................................................... 52
Methodology Summary ........................................................................................ 52
Results ................................................................................................................... 54
Stable Family Life................................................................................................. 55
Lack of Support..................................................................................................... 55
Intergenerational Conflict, Living in a Post 9/11 Environment ............................ 58
Arranged Transnational Marriages ....................................................................... 61
Religious Belief and Extended Family System as Coping Mechanisms .............. 66
Ego, and Stigma as Cultural Barriers .................................................................... 67
Transition to Chapter Five .................................................................................... 68
5. INTERPRETATIONS AND RECOMMENDATIONS ............................................... 69
Introduction ........................................................................................................... 69
Discussion of Results ............................................................................................ 69
Implications for Social Work Research and Practice ........................................... 72
Limitations and Implications for Future Research................................................ 74
Summary ............................................................................................................... 75
Recommendations ................................................................................................. 76
Conclusion ............................................................................................................ 79
Appendix A:Individual Interview Guide .......................................................................... 83
x
Appendix B: Consent to Participate in the Research Study.............................................. 84
Appendix C: Support Letter .............................................................................................. 87
References ......................................................................................................................... 88
xi
LIST OF TABLES
Page
Table 1: Profile of Participants ......................................................................................53
xii
1
Chapter 1
THE PROBLEM
Background of the Problem: Anecdote
I am a twenty five year old male Pakistani-American Muslim living in San
Francisco. I was born and raised in Sacramento. Coming from a respectable and
financially stable family, I had every imaginable privilege in life. However, I was never
allowed to make decisions for myself. Since the time I was five, a path was laid out for
me. The expectations included achieving higher grades in school, staying focused on the
path, excelling in sports and simultaneously shadowing my parents. I was not allowed to
hang out with my school friends. I was only allowed to hang out with Muslim friends.
One of my friends also belonged to a Pakistani family but a non-traditional one; he did
not come to mosque or integrate with the rest of the community so I was not allowed to
visit him as he could be a bad influence on me. I knew I could never have a girl friend.
After graduating from Sac State I met a girl online and fell in love. It took me six months
to reveal my feelings to my parents. My parents were unhappy, and I went through
serious emotional trauma and became depressed. Had it not been for the support from my
siblings and friends I would have committed suicide. All my life I did what my parents
wanted. I even selected a Muslim girl, from the same ethnic background. They never
approved that decision I made for myself at the age of twenty five, and so I broke up with
the girl and moved out after finding a job in San Francisco. I have to drive every weekend
to Sacramento as my parents believe I should be with the family rather than in San
Francisco. Every day, I am still hurt and feel rejected by my family.
2
Parallel to the experience of this young man, many young girls and boys suffer
from the double standards developed by their first generation immigrant parents. The
unrealistic expectations of these parents generate intergenerational conflict and an
unhealthy environment that makes it difficult for the children to develop and thrive.
Introduction
The above narration describes the problem and the background of the study. The
process of migration for many families is a stressful experience coupled with challenges
of settlement in the host country, including maintaining traditions and culture from the
country of origin. Pakistani-American immigrants, like other immigrants, often take
extreme measures in order to preserve their cultural and religious beliefs which can affect
their families negatively. The tensions and conflicts in these families result in unhealthy
and unstable lifestyles for their members. These conflicts often turn into emotional,
verbal, or physical abuse. However, in many cases the turmoil families go through is not
acknowledged. For instance, the boy in the opening anecdote suffered emotional abuse,
and pressure from his immediate family members because of his attempt to make an
independent choice in his life.
Statement of the Research Problem
There is a limited empirical research that has examined the knowledge,
perceptions and attitudes of Pakistani-American immigrants in the Sacramento region
regarding what constitutes a healthy and peaceful family. Post 9/11 Pakistanis feel they
have become the center of attention, and the level of stress has increased for Pakistani-
3
American immigrants. Outside stressors often affect the families either directly or
indirectly. There are various ways in which communities are affected if the members are
not living healthy or productive lifestyles. In the Sacramento region there is a significant
number of Pakistanis residing and it is thus important to explore their knowledge,
attitudes and perceptions about maintaining a healthy and peaceful family environment.
Purpose of the Study
The intent of this study is to explore the knowledge, attitudes and perceptions of
the Pakistani-American community in the Sacramento region related to the factors which
constitute healthy and peaceful families. This study also attempts to explore the stressors
for this community, and how they cope with these stressors. It is anticipated that this
study may result in achieving a better understanding and awareness of the cultural and
social issues related to the barriers experienced by the Pakistani-American community in
Sacramento, California in acknowledging any form of abuse or violence within the
family structure.
Many immigrants face similar issues, and according to the knowledge of the
researcher, Pakistani-American communities are also not free from the adverse effects of
domestic violence and intergenerational conflict. Nevertheless, these issues become
particularly salient because they have not been identified or sufficiently explored within
the Pakistani-American community. Being an advocate of ‘Personal is Political’ (a
feminist approach) the researcher tend to gravitate towards this social justice issue for
several reasons. The researcher has seen a few women in her family who have
4
experienced one or other form of abuse in their marital life or relationships. It is a cause
close to her heart. In addition to the researcher’s personal knowledge of the problem, the
Muslim American Society-Social Services Foundation (MAS-SSF) also has identified the
existence of violence and intergenerational conflicts within Pakistani Muslim families.
On several occasions during family counseling sessions, a MAS-SSF counselor could not
go any further as the victims refused to acknowledge the conflict as a form of abuse.
Other areas worth exploring are the barriers in seeking mental health and the stressors
which can affect healthy family lifestyle and how the challenges stemming from the
overall process are handled and resolved within families.
Social Work Implications and Significance of the Study
Living in a multiethnic society and maintaining cultural competence is an
important component of practice. In order to conduct accurate assessment and
interventions, it is crucial that social workers understand the stress of Pakistani-American
immigrants and the coping mechanism of this community. For the first and second
generation Pakistani-American immigrants there is a unique set of challenges that affect
family life style in a healthy and unhealthy way. The way this community addresses these
challenges is also novel in some ways. Their coping mechanisms either isolate them
further within their own community or often make them over-involved or over-dependent
on the community for any resolution. As an advocate for the most vulnerable population,
and a would-be social worker, it is critical to understand the prevalent attitudes and
beliefs in order to protect the rights of this vulnerable population and ensure the optimal
5
bio-psycho-social and emotional well-being of the Pakistani- American community in our
society.
This research can provide further knowledge and insight on the attitudes/beliefs of
the Pakistani-American community towards recognition of an unhealthy family
environment and can be used to develop services for children and families. If it is
identified that family conflict can turn into abuse then the present study can contributes
towards consciousness raising activities, and community organization against violence. It
is important for a social worker to be aware of any negative or positive attitudes or
beliefs carried by the Pakistani-American community, and the ethical/ legal
considerations centered around this topic. This study also provides an insider perspective
because of the Pakistani-American background of the researcher.
Methodology Overview
This study has incorporated a qualitative grounded theory design to explore the
attitudes and perception towards a healthy family life style. Due to the exploratory nature
of the study, the data has been collected thorough in-depth interviews. Thus, data analysis
involved the examination of recurring themes, patterns and their interrelationships to
yield a better understanding with the possibility of generating a hypothesis that can lead
to future research for this community.
Research Question
What knowledge, attitudes and perceptions do the Pakistani-American community
have regarding what constitutes healthy and peaceful families?
6
Objectives
The present study was designed for initial exploration regarding the knowledge
and perceptions of Pakistanis in Sacramento regarding what constitutes a healthy and
peaceful family. It was hypothesized that among Pakistani-Americans in the Sacramento
region, just like any other group, there have been ongoing issues of family conflicts
which have not been addressed, and the majority of people have not been reaching out for
the services which are available. The purpose thus is to investigate and see if these issues
were identified. If the issues are identified then it must be determined what resources are
being utilized to address/resolve the issues and whether there is enough knowledge about
the resources or if there any barriers in seeking those resources.
Theoretical Frameworks
Social Constructivist, Feminist, People of Color Identity Model, and Relational
Cultural Perspectives are the theoretical frameworks used for this study. These
frameworks with their overlapping themes, assist us in understanding how PakistaniAmericans perceive a healthy/unhealthy family environment, and what barriers prevent
them from acknowledging problems and seeking assistance.
The Social Constructivist approach suggests “that local or personal
understandings help reduce stereotypes and promote firsthand understanding” (Blundo &
Greene, 2008, p.237). Social constructivist as a postmodern approach emphasizes
exploring different culturally sensitive models with no precedence given over others as
there is no one subscribed way to help people. The theorists suggest that subject and
7
object are inseparable, and knowledge is a constructed reality based upon the subject.
Henceforth, meaning is constructed according to the individual’s perception. As opposed
to the modernist approach it is believed that people develop meanings and understanding
of themselves and their world views based on their perceptions “shaped by cultural bias,
myth, metaphor, and political context” (Greene, 2008, p.238). Through this approach it is
assumed that for Pakistani-American immigrants the construction of meaning is
embedded within culture and language, and how one member perceives him or herself is
based on the cultural interpretations of the world around them. Thus, the basic
assumption is that interpretations and personal perceptions of the Pakistani-American
community continue to evolve and change during their interactions with the host country
and their environment. It is important to utilize the social constructivist framework to
understand the experience of immigration and how Pakistani- American immigrants give
meaning to their perceptions and values separate from the dominant culture.
Land (1995) as cited by Greene (2008) asserted that “feminist practice has moved
into the core of social work practice because of its attention to the social work practice”
(p.285). The basic assumptions of feminist perspective are as follows: 1) the differences
among gender do not equate to the inferiority of women in general; 2) it is the patriarchal
social structure that privileges men and oppresses women and; 3) knowledge and values
are integrated and not separated from each other. Feminist theory resonate a person-inenvironment approach (Greene, 2008). Feminists believe in diversity and relate to
interrelatedness of all events in public and private sector leading to the main principal of
“Personal is Political” (Greene, 2008). Rather than just focusing on a nuclear family of
8
Pakistani-Americans, this writer would like to see how a nuclear family is affected by its
community in particular, and public laws and policies, in general. Van Soest ( 1997)
suggested that, “ just as people do not develop in isolation, a society or nation cannot
develop without the participation of community”(p.6). It is vital to understand the
personal issues of Pakistani American immigrants at the national and global level. As a
social worker this writer likes to distinguish the individual cases of family violence in the
light of the nature of power structure, whether it is community that perpetuates violence
against women by condoning such behavior.
The cultural feminist perspective of connectedness and relatedness is highly
applicable to understand this community. Pakistani-Americans place a high value on the
family unit, include and respect the decisions of their elderly and members seek strengths
from each other. Nevertheless, the patriarchal and hierarchical structure within the family
environment also plays a vital role in perpetuating oppressive environment for women.
From a feminist perspective an egalitarian approach is a key to maintain a healthy and
peaceful family which is often not prevalent in Pakistani-American families. Greene
(2008) asserted that social workers should be cautious that many women may not be able
to recognize their oppression. Pakistani women from different cultural backgrounds
accept the non-egalitarian practices within the family as a norm and do not question it.
For this reason a cultural feminist approach encourages social workers to actively engage
and listen to the experience of these women and what meanings they associate with it. It
is during this process that women tend to gain power by narrating and explaining “how
their way of being is ‘right’ given the context of their situation” (Greene, 2008, p. 281).
9
The key assumption of Relational Cultural Theory (RCT) is a movement towards
mutual empathy, and the idea that people develop positive self-esteem in growth
fostering relationships. For individuals, experiencing vulnerability as a potential for
growth, and developing strategies for connection or disconnection are some of the core
tenets of RCT (Comstock & Qin, 2005). The principles of interdependence and mutual
empathy within family can be used to appreciate the resilience of this community.
Pakistani-Americans believe in mutual dependence within family members.
Cohesiveness among family members is the most valued attribute of this community.
Many studies have concluded that the support and interconnectedness among family
members, although criticized by the western model, often resolve many issues at the
familial level. Nevertheless, RCT posits that during the development years “authentic
expression” is the key to growth. Some of the obstacles that impede that growth are
shame, guilt at the personal level, and marginalization at the public level. For PakistaniAmerican youth ‘authentic expression’ can be challenging due to the family’s
expectations and pressure to comply within their culture. Hence, a healthy growth
fostering relationship within the family can turn into a situation where young adults like
to disconnect from family. Miller and Striver (1997) as cited in Comstock & Qin (2005)
asserted that, “ hiding large parts of their experience and engaging inauthentically in
order to reconnect in a non-mutual relationships often becomes a strategy for survival”
(p.30).
Janet Helm (1999) expanded her White Identity Model, and introduced her People
of Color model (POC) that has five stages that minorities go through in relation to the
10
dominant cultures. According to Helm (1999), People of Color include; Asians, African
Americans, Latinos/Latinas, and Native Americans. These ethnic minorities “ have been
in their collective experiences, subjected to appalling economic and political
circumstances for not being similar to White people ( Howard- Hamilton, & Frazier,
2005 p. 76). According to this framework, people of color have internalized the negative
messages and it is hoped that this framework will assist them in abandoning those
negative messages and creating a positive self-identity. The five statuses in the POC
model are: 1) Conformity, 2) dissonance, 3) immersion/emersion, 4) internalization, and
5) integrative awareness.
1) Conformity: In this phase, according to Helms & Cook (1999) people display the
idealization of the dominant culture and usually believe that there is racial equality.
Literature supports that a majority of Pakistani students upon their arrival to the
United States have been in this phase.
2) Dissonance: People of color enter into this stage when they find that due to their race
they cannot enjoy the privileges that the dominant culture enjoys. During this phase
the strategy is to “ repress anxiety provoking racial information” (Howard-Hamilton
& Frazier, 2005, p.77). The migration of Pakistanis under the Family Reunification
Act often placed immigrants in this phase who were dealing with stereotypes and
discrimination.
3) Immersion/Emersion: Following the dissonance stage, people of color immerse
themselves into the culture of their country of origin. At the emersion phase they
disregard the dominant culture, and idealize their own culture in some rigid fashion.
11
At the emersion phase both strengths and weaknesses of their own culture are being
discovered; they become more aware of the sociopolitical implications and become
hyper-vigilant. Literature suggests that the post 9/11 political environment has placed
many Pakistani-Americans in this stage. This applies to even those who entered in
this country as students and assimilated well. They have come to this stage after they
have settled in marriage and have children as stated in the literature of ‘second
immigration’ (Maira,1995 as cited in Leonard, 1999).
4) Internalization: At this stage persons of color can apply their developed identity to
their everyday living, and are able to develop social relationships with the dominant
group by rejecting racism altogether. A majority of Pakistani-Americans experience
this phase because of their work or school experiences.
5) Integrative Awareness: According to Helms this is a refined and more developed
status as an individual is able to “accept, redefine, and integrate aspects of himself or
herself that may be the characteristics of other cultures and groups” ( HowardHamilton & Frazier, 2005, p. 78). Among Pakistani-Americans, second generation
immigrants are more likely than their parents to reach this stage as they identify
themselves as Americans first, then Pakistanis. Some of the first generation
Pakistani-Americans who have advanced their education in local universities and
have good positions in the public or private sector often reach this stage.
When looking back at the experiences of Pakistani- American immigrants, the
People of Color theoretical model explains the perceptions, behavior and attitudes of
a majority of Pakistanis. The stages of dissonance and immersion can be easily
12
identified, particularly in relation to child rearing. They become wary of their
children’s desire to conform to the dominant group. Some of the Pakistanis in this
study have reached the fifth stage of ‘integrative awareness’, and, for many members
of the community, the number of years spent in this country also have assisted them
in reaching the internalization and integrative awareness stages.
Definition of Key Terms

Pakistani-Americans: This term is used for the populations who have migrated
from Pakistan and have made America their home. This includes all generations
of immigrants living in the United States. Pakistani-Americans in this study refers
to the ones settled in the Sacramento region.

Knowledge: What is learned and acquired as a way of knowing over a period of
time. Knowledge can be gained through different sources (i.e., scholarly sources
or through actual experience). The knowledge explored in this study is that of
Pakistani-Americans living in the Sacramento region regarding what constitutes a
healthy and peaceful family

Attitudes/Perceptions: A person’s perspective and way of saying or doing things.
In this study, attitudes/perceptions imply that Pakistani-Americans share
regarding what constitutes healthy and peaceful families.

Healthy: The term healthy is used to encompass both the physical and mental
health of individuals functioning at familial, group, cultural, and societal levels. In
13
this study this term is used to describe the lifestyle of Pakistani American
immigrants encompassing both physical and mental health.

Peaceful: This term is used to describe a family environment free of violence and
abuse. It also implies maintenance of boundaries and a balance of power within
Pakistani American families.

Families: This term is used to refer to both nuclear and extended families.
Assumptions
Immigrant families often experience difficulties in a new environment, leading to
an unhealthy family environment; Pakistani-American immigrants are not free from the
adversities of such struggles. It is crucial for them to acknowledge these issues, and reach
out for assistance. All family members, including women and children, have a basic and
inherent right to be treated with respect and dignity. It is also assumed that the
participants in this study responded with honesty, and to the best of their knowledge, as
identifiable information was not gathered and confidentiality was stressed.
Limitations
The limitations of the current study include a lack of empirical evidence in the
literature concerning Pakistani-American immigrants in the Sacramento region and their
knowledge, perceptions and attitudes regarding what constitutes a healthy and peaceful
family. Furthermore, the reluctance of the participants to come forward and share their
views also proved to be a limitation in the study. The convenience sampling also has
14
limited the heterogeneity in the sample as far as variations in socio-economic status are
concerned.
Delimitations
This study is delimited in generalizing the findings by using a small sample size
limited only to the Sacramento region. The snowball sampling method using a key
contact person also delimited the representation of those who were not the acquaintances
of the initial contact person. Therefore, there was a lack of representation of the
population, as those not in the study may have different opinions or knowledge sets from
study participants. Furthermore, a lot of demographic information was intentionally not
obtained (for the sake of building comfort and the trust with respondents), especially their
educational and occupational background information. Thus it is not possible to compare
participants’ knowledge base and the perceptions with those from different
socioeconomic backgrounds within the Sacramento region.
15
Chapter 2
LITERATURE REVIEW
Introduction
The purpose of this chapter is to establish an understanding of the knowledge and
experiences of Pakistani immigrants concerning a healthy and peaceful lifestyle by
reviewing previous studies and research. The scholarly reviews will be presented in three
different sections, the introduction, the body, and the summary of the literature review.
The introduction will include a brief history of Pakistan and the demographics of
Pakistani immigrants in the United States in order to provide the background and
characteristics of this community. The second section will be the body of this chapter and
it will examine the empirical studies in the following context: 1) the family, religious, and
cultural values of this community; 2) stressors affecting healthy family life. The
subthemes in this section will include the stressful experiences of Pakistani immigrants in
the family environment in relation to acculturation and the assimilation process, raising
children, and the post 9/11 experience. 3) the last theme will focus on the coping
mechanisms of this community and their attitudes and perceptions of seeking mental
health services.
History of Pakistan
Pakistan was founded in 1947 when it was separated from India in a process to
end British rule (Malik,2006). The partition lines drawn between India and Pakistan
were based on the idea that these new nations would represent the concentration of Hindu
16
and Muslims in those specific geographic locations (Purkayastha,2005). As a result,
Pakistan became an independent nation with two separate land masses with India in
between. The western region, named West Pakistan, had a diverse culture and
population; the eastern region, called East Pakistan, had a homogenous Bengali
population (Jeffrey,1976). Though Pakistan is a predominantly Muslim country, it shares
religions, languages, culture, and traditions with its neighboring countries (Malik, 2006).
From the time of its inception, Pakistan has been in dispute with India over Kashmir.
This dispute led to a major war between India and Pakistan in 1965 and a lasting political
rivalry between the two countries (Jeffrey,1976). During the 60 years following its
independence, Pakistan had been mostly under military dictatorships rather than under
democratic governments, with military regimes ruling from 1958 to 1971, from 1977 to
1988, and from 1999 to 2008 (Critelli,2010). After the first democratic elections in 1971,
there was a civil dispute between East Pakistan and West Pakistan. East Pakistan wanted
to claim its unique language and cultural autonomy by becoming an independent nation
(Purkayastha,2005). India at that time took advantage of the civil dispute and aided East
Pakistan to declare a war against West Pakistan. After seventeen days of war West
Pakistan surrendered and East Pakistan declared its independence from West Pakistan.
The newly found country was named Bangladesh (Jeffrey, 1976). This conflict led to a
bitter rivalry between these two nations. The political history of conflicts and rivalries
between India, Pakistan and Bangladesh is pertinent because it has influenced immigrants
from these nations to define their ethnicity and develop a new identity in the United
States (Purkayastha, 2005).
17
According to the Washington-based Population Reference Bureau, quoted in
Dawn Karachi, 20 August 2004 and cited by Malik (2006), the land area in Pakistan is
approximately 803,940 square kilometers, of which 25, 220 square kilometers are
covered with water. Pakistan is slightly smaller than twice the size of California and has
an estimated population of 159 million. Pakistan has China to its north, the Arabian Sea
to the south, India to the east, and Iran and Afghanistan to the west. Pakistan has four
provinces Punjab, Sindh, North West Frontier Province (NWFP), and Baluchistan. Some
other areas such as Northern Tribal areas, and Azad Jammu and Kashmir are federally
administrated units (Critelli, 2010).
The climate of Pakistan varies in different regions: it has a dry and hot climate in
the plains and deserts, while the mountains in the north have a cold and glacial climate.
The people of Pakistan have descended from the ancient Indo-European communities
who arrived in the region as invaders or immigrants (Malik, 2006). The first among them
were Dravidian, joined later by Aryans, Persians, Greeks, Arabs, Mongols, Turks, and
Asian tribes over the centuries (Leonard, 1999). In spite of the dominant uniformity
because of common religion and historical background, Pakistan is comprised of diverse
ethnicities with significant variations in languages and regional roots. The largest ethnic
group is Punjabis from the province of Punjab, and they speak Punjabi; the second largest
ethnic group is Sindhis, and they are located in the southern province called Sindh, they
speak Sindhi. The Pushtuns share their ethnicity with the Afghans and settled in the
northern region along the border of Pakistan and Afghanistan. Pushtuns speak different
languages such as Pushtu, and Hindku. The province of Baluchistan shares its border
18
with Iran and the people from this province speak Baluchi language (Malik,2006).
Pakistan has diverse religions. The predominant religion is Islam and Pakistani are
further divided into two sects: Sunnis and Shias. Sunnis account for approximately 77%
of the population, Shias are 20%, and the remaining 3% of the population is divided
equally among Christians, Hindus, and other religions (Blood, 1994 as cited by Critelli,
2010). In addition to the religious and ethnic divisions, Pakistani society is also
comprised of variations in rural, urban, and tribal culture which plays an important role in
the process of acculturation of Pakistani immigrants in the United States. For instance,
urban Pakistanis from the cities of Lahore or Karachi are more open to acculturation than
the Pakistani immigrants from smaller cities or villages (Malik,1989).
History and Demographics of Pakistani Immigrants in the United States
Pakistani-American immigrants can be defined as people who migrated from
Pakistan with the intention of making United States their home. They are often
categorized as South-Asians (Dadi, 2006). The term South Asians includes the
immigrants from these six countries, India, Pakistan, Bangladesh, Bhutan, Nepal and Sri
Lanka (Rajan, & Sharma, 2006). In recent years researchers have been cautioned not to
generalize as the broader definition may fail to notice the specific ethnic and cultural
differences, including religious preferences of South-Asians ( Stein,Christie, Shah,
Debney, &Wolpert, 2003). For the purpose of this literature review the focus will be
maintained on the Pakistani immigrants of the South Asian population.
19
Pakistanis in America are considered as a new immigrant community (Najam,
2006). Soon after the independence from India in 1947, a small number of Pakistani
Immigrants started arriving in the United States. Nevertheless, the migration of
[Pakistani] Immigrants took place in three different waves (Gupta, 1999). The first wave
of these were Punjabi agriculturalists from India, (Pakistan was at that time part of India)
arrived in the late nineteenth century as original knowledge based workers and settled
mostly in California. The second wave of Pakistani immigrants came during 1960s and
consisted of highly skilled professionals (Gupta, 1999). The passage of the 1965
Immigration and Naturalization Act significantly affected the “number and the nature” of
Pakistani immigrants coming to the United States (Najam, 2006 p. 49). These Pakistanis
settled in urban and suburban areas all over the U.S. (Williams, 1988). Many Pakistanis
who arrived during this phase came to attain higher educational degrees and later turned
out to be major contributors in science and technology in the United States (Bagai,
1972). There had been a significant increase in the number of annual immigrants during
the period of 1965-1990 approximately from 187 to 9,729. Moreover, during this time a
large number of Pakistani physicians, engineers, and scientists arrived in the United
States. This defection of so many academics, introduced the concept of a Pakistani brain
drain (Najam,2006). It was during this twenty five year period that most of these
professionals immigrated directly, as their vocation was in high demand in the United
States. They were followed very soon by a large number that arrived as students (Malik,
1989). The third and final wave of immigration took place in the 1980s, when the
relatives of the post-1965 immigrants arrived under the category of Family Reunification
20
Act (Gupta, 1999). Despite the high number of professionals who immigrated, it is worth
mentioning that there is a wide socio-economic gap between Pakistani immigrants. Those
who arrived earlier between the 1960s and 1980s were mostly upperclass Pakistanis from
Pakistan who settled in the United States as professionals. This is in contrast to those who
arrived in the 1980s and later, who were from working class and less affluent. Pakistanis
who arrived under special visa category settled down by taking jobs in infromal sectors.
Due to this disparity in socio-economic and educational background, it is important to
include class, race and ethnic division within Pakistani Americans when studing this
specific community (Dadi, 2006).
Initially, Pakistani immigrants settled in New York, California and the Detroit,
Michigan area. Later, as they settled in the U. S. society they built mosques (a place for
mass prayer similar to church), opened grocery stores, and introduced ethnic cuisine such
as Tandoori chicken and mango Lassi (Bagai,1972). Today Pakistani Americans can be
found in all 50 states but they are still mostly concentrated in only a handful of states
such as New York, Illinois, Michigan, Texas, and California (Najam,2006). A majority of
Pakistani immigrants seem to prefer urban living as opposed to rural, because of the
skilled and non-skilled work opportunities available in the urban areas (Gupta, 1999).
According to Najam (2006) there are approximately 500, 000 Pakistanis in the
United States with three fourths of this population as first generation immigrants, and a
quarter of this population are American born citizens. According to the estimates from
the Pakistani Embassy in Washington D.C as cited by Najam (2006) just a little under
75% of Pakistanis in America have become U.S citizen through naturalization or by birth.
21
These statistics are significant because they designate that Pakistani immigrants intend to
make America their home, and they want to stay here on a long term basis. Gender
balance is fairly equal among Pakistani-Americans and the majority of Pakistanis are of
workforce age. An average household income is estimated at approximately $70,000 per
year due to the skilled jobs and professions such as doctors, engineers and entrepreneurs
(Najam,2006).
Religious Values of Pakistani American Community
Pakistan was founded in 1947 as a homeland for Indian Muslims with the idea to
provide them a modern Islamic secular nation. Therefore, Islam plays a vital role in the
lives of Pakistanis; it is incorporated in their daily lives (Malik, 2006). The founder of
Pakistan, Mohammad Ali Jinnah wanted to ensure that women, children and minorities
have equal protection and freedom to exercise their rights (Critelli,2010). Nevertheless,
religious freedoms, beliefs, and teachings have been manipulated for many years in
Pakistan for political and social reasons. Religious beliefs and interpretations are
implemented in a specific, formulaic method, allowing the growth of faltering, unstable
regimes to hinder key aspects of social and economic equality (Jahangir, 2000; Malik,
1997; Qadeer, 2006; Women Living Under Muslim Laws, 2000; as cited by Critelli
2010). This has affected the overall progress of Pakistani society (Malik, 2006). This
instability in the religious and political environment, particularly between the years from
1977 to 1988, encumbered the progress of liberal ideology and civil society. Women, in
particular have suffered due to the misleading interpretations of Islamic doctrines (Asian
22
Development Bank, 2002 ; Malik, 1997; Women Living Under Muslim Laws, 2000 as
cited by Critelli, 2010).
Islam literally means submission to Allah, therefore, followers of Islam are
expected to surrender to God’s will in their everyday lives (Springer, Abott, & Reisbig,
2009). Muslims follow the Quran (Holy Book), and Hadith (the accounts of Prophet
Mohammad’s actions and preaching) (Hodge, 2005). Muslims seek guidance from the
Quran for their daily living and they must follow it (Hall & Livingstone, 2006, cited by
Springer et al. 2009). Muslims have two major divisions: Sunnis and Shias. The
ideological differences between the two sects is related to the succession of the Caliphate
(Ruler) after the demise of the Prophet Mohammad. Shias believed that succession
should have gone to the descendants of Prophet Mohammad while Sunnis believed that
merit was the key factor to determine the Caliph (Jeffrey, 1976). Sunnis make up 80% of
the Muslim global population, compared to Shias who are 15% and mostly settled in
Iran, and Iraq (Springer et al. 2009). There are five pillars of Islam commonly accepted
and followed by both Sunnis and Shias ( Jeffrey 1976). These pillars include: 1)
Shahadah, which is proclaiming that there is only one God, Allah and that Muhammad is
the messenger of Allah, 2) Salat, the five daily prayers, 3) Sawm which is fasting and it is
practiced in the month of Ramadan, 4) Zakat, it is charity that is given to the poor, from
2.5% of one’s profit from the income or from accumulated wealth, and 5) The Hajj,
which is traveling to Mecca for pilgrimage at least once in a lifetime if health and
finances permit. (Haneef, 1996 as cited by Springer et al. 2009).
23
Some theologians strictly believe that Islam provides a complete framework for
Muslim societies covering economic, political and family relationship (Khalid & Frieze,
2004). Beside the Quran and Hadiths, Sharia law (Islamic jurisprudence) is another
important aspect that guides Muslims in issues related to family structures such as
divorce. Many other Muslim countries such as Afghanistan and Saudi Arabia follow
these laws (Hashim, 2008, as cited by Springer et al. 2009). Pakistani Muslim
immigrants, like other Muslim immigrants in America, also prefer Sharia law to guide
them in issues related to family in particular, and community in general (Springer et. al,
2009).
In addition to being a religion, Islam also serves as an impetus in determining
many cultural practices, and Pakistanis living outside Pakistan continue to maintain those
bonds by being in the forefront of Muslim Organizations (Malik,1989). Many Pakistani
religious groups were formed initially on the basis of national identity (Williams,1988).
The Muslim Students’ Association of North America (MSA), founded in 1963, is one of
the oldest and most highly organized student associations, whose membership includes
prominent figures from Pakistan (Malik,1989). Haddad & Smith (1995) as cited by
Hodge (2005) have estimated approximately 2,300 Muslim institutions throughout the
United States that support Muslim communities. According to Rajan and Sharma (2006)
the challenges South Asian Immigrants [Pakistanis] face as they create their religious and
ethnic identities in the United States, involve citizenship and identity issues. These are
also the same issues that are relevant to many other immigrant communities within the
U.S.
24
A majority of [Pakistani] immigrants exist at the crossroads of the two cultures
while they are part of the process in maintaining and retaining their cultural and group
identity (Williams,1988). Conversely, it has been a relatively easier transition for those
immigrants who are English speaking professionals to maintain their economic security
in the United States. Once they become financially secure their focus is on maintaining
and passing their culture and traditions to their children (Gupta, 1999). Many Pakistani
Americans have lived a modern lifestyle even in Pakistan, but their traditional values
remain dominated by their religion and culture (Malik, 2006).
Cultural Values
Culture implies the passing of beliefs, language and rituals along with values from
generation to generation (Atkins as cited by Howard-Hamilton & Frazier, 2005).
Pakistani culture is an eastern culture where family, religion, profession, and ethnic
origins largely establish the cultural role of an individual (Malik,1989). According to
Gupta (1999) tradition in general, can be understood in terms of passing the knowledge,
beliefs, or even customs from one generation to another whereas culture can be
understood as the “way of life of an entire society…[including] codes of manners, dress,
language, rituals, norms of behavior and systems of beliefs” (p.122). Traditionally, in
Muslim societies, men and women have defined roles in order to maintain healthy and
stable family relationships (Khalid & Frieze, 2004).
The most prominent feature of Pakistani culture is the preservation of kinship or
the family unit. Each family member is thus responsible to maintain stability at both
25
familial and societal levels (Gupta, 1999). Pakistani society is based on a collective
family orientation rather than an individual orientation, although the family orientation is
more synonymous with the patriarchal culture (Gill 2004, cited by Critelli, 2010). The
majority of [Pakistani] Muslim families maintain patriarchal values, where men of the
houses (patriarchs) dominate and ensure that traditions of the family are being followed
by each family member (Springer et al., 2009). Under these patriarchal cultural values,
women are subjugated to adhere to family norms through gender segregation and specific
codes of behavior to maintain family honor (Moghdam,1992; Critelli, 2010). Pakistani
women are expected to follow the cultural rules and traditions without question (Ahmed,
1999). Traditionally, Pakistani women are expected to be the caretakers of home and
family members and they are allowed to seek education and work outside the home
(Faizi, 2001). Gender division of labor is also maintained in many families even after
their migration to a new country, such as the United States. Although women have
actively sought education and joined the workforce, they continue to assume the
household responsibilities of cleaning, cooking and child rearing (Gupta, 1999).
Another aspect of the Pakistani culture is the theme of honor, around which most
interpersonal life is organized. This theme of honor revolves around women, and they are
pressured to maintain the family honor by curtailing practices that have a negative effect
on family and community, i.e. challenging the traditions such as arranged marriages
(Bari, 2000; Ahmad, 2000, as cited by Critelli, 2000). These values are being carried over
into their new countries even after migration and first generation [Pakistani] women
attempt to hold on to them (Gupta, 1999). The prevalence of the patriarchal system in
26
Pakistani traditions is due to the lack of education (Bari, 2000; Moghdam, 1992; as cited
by Critelli, 2010). According to Gupta (1999), following their traditional family
structures, [Pakistani-Americans] have specific gender roles established in family, which
they believe to be the epitome of family stability. However, it is unfair to generalize that
all Pakistani-immigrant women are submissive and passive (Malik, 2006). It is often
interpreted that adapting to western culture by educated South Asian [Pakistani] women
is a healthy transformation, and to remain traditional means, “uneducated and backward”
(Ahmed, Reavy, & Majumadar,2009). Many [Pakistani] immigrant women are trying to
merge both traditional and contemporary values to create a middle ground (Gupta, 1999).
Family Values
Over time the definition of family has changed, regardless of its diverse nature,
family continues to provide care and interconnectedness for its members (Hepworth,
Rooney, R., Rooney, G., Strom-Gottfried, & Larsen, 2006). Values and behaviors in a
family setup are considered the most important factors of the majority of cultures
(Atkinson, 2004, as cited by Howard-Hamiton & Frazier, 2005). Minuchin (1974) as
cited by Sayger & Horne (2000) argued that healthy families posses the strong internal
structure, reflected in their ability to deal with all types of problems including the
unexpected. A clinicians’ perspective on the determination of a healthy or unhealthy
family is also based on the evaluation of the role of family system in assisting its
members for their successful and unsuccessful attempts in accomplishing their goals
(Sayger & Horne, 2000).
27
Family is the basic unit in Pakistani social structure that promotes the mutual
dependence on family members (Malik,1989). The concept of family includes several
households living in different locations, but counted as one family. Typical households
comprise parents, children, grandparents and other relatives living together (Hashwani,
2005). An important aspect of Pakistani family life is the extended family system. In
Pakistani culture it is commonly believed that with age comes wisdom, followed by
respect and authority. Based on this belief, the elder of Pakistani community are usually
approached for consultation when arranging marriages, because it is considered a vital
institution (Malik,1989). The oldest family member makes the decisions in the family in
concurrence with the other members of the family before the final say is made
(Hashwani,2005).
A majority of Pakistani Muslims deem marriage as an obligatory ritual (Jeffrey,
1976). Moreover, for Pakistanis marriage is an alliance or partnership between two
families and such a relationship can contribute to the long term security and stability of
both families. Due to this reason there is a predominance of arranged marriages
(Abraham, 2000, cited by Critelli,2010). A married couple is considered balanced and
mature. A marriage is also a strong institution to carry out sexual desires, pre-marital sex
and dating is not only prohibited, it is considered a sin (Malik,1989). Pakistani-American
parents prefer transnational marriages for two possible reasons: first to evade the
likelihood of their children marrying someone born and raised in an open society of the
West. Commonly, it is believed that those born and raised in the [United States] tend to
shy away from religion and become involved in immoral activities. And secondly, the
28
transnational marriages will help to keep bonds strong with their families back home in
Pakistan (Charlsey,2006).
Therefore, the concept of arranged marriages is still preferred among PakistaniAmerican immigrants as manifestation of patriarchal values (Jeffrey, 1976; Springer et. al
2009). It is the similarities in age, ethnicity, religious beliefs, education level and socioeconomic structures and not romantic/sexual compatibility that form the foundation of
the marital success (Rauf, 2007 as cited by Springer, et al. 2009). In Pakistan, 30 years or
younger is deemed as an ideal age for marriage for men, and for women it is often
between the age 18 to the early 20s. Hence, if individuals do not get married and settle
down while they are within this age range it tends to provoke anxiety for Pakistani
parents and other family members (Suhail & Chaudry, 2004).
Williams (1988) asserted that most of the students who arrived in the U.S. during
the period of 1960s and 1970s were single, and conformed to the host culture up until
they got married and established their career and family. At that time due, to the pressure
from their families they tried to retain the values and world views of their native country.
One of the major reasons for this behavior according to Ali et al. (2004) as cited by
Springer et al. (2009) is that, in the Pakistani family structure, there is a strong emphasis
on the collective whole rather than individual wants; conformity with expected roles and
family norms is crucial. Family members are interdependent and are more concerned
about the family unit than about themselves (Hashwani, 2005). The Western ideology of
promoting individualism often discourages, and implies a negative connotation for the
relationship between self and others (Qin & Comstock, 2005). This Western ideology
29
creates alienation within many ethnic communities such as Pakistanis, as this ideology is
in sharp contrast with the world views of giving priority to a collectivist approach
(Chaleby 1992, as cited by Springer et al. 2009). Western values such as self-sufficiency,
individualism, and freedom are thus contradictory to the Muslim family values (Carter &
Rashidi, 2003 as cited by Springer et al. 2009).Thus, it is important to please family
members by being loyal, by being obedient to parents and religious leaders, and by
conforming to family expectations and cultural norms (Hashwani,2005). When Pakistani
immigrants, especially first generation immigrants who arrived as students, start their
own families they return to these same modes of behavior (Malik,1989). Moreover, when
Pakistani-American immigrants start their nuclear families, they crave support from their
extended families from back home (Williams,1988).
Purkayastha (2005) supported this need for family by stating that grandparents,
uncles, aunts, cousins and those that play an important part in South Asian American’s
[Pakistanis] lives are spread across many countries. These relatives across many countries
provide foundations of identity, acceptance, and support. With the internet access and
calling cards to make cheaper telephone calls to Pakistan and elsewhere in the world,
Pakistani Americans maintain consequential connections with their family members,
transnationally.
According to a study by Maynard and Harding (2009), it was reported that a
majority of Pakistani immigrants expressed that the presence of grandparents in the lives
of their children is a vital aspect of extended family system. When this support is not
available, a family can experience stress to be a nuclear family.
30
In Islam, dissolution of marriage is not prohibited (Jeffrey, 1976) yet, seeking
divorce is considered a rebellious and defiant behavior against the traditional practices
and family honor (Abraham, 2000; Amnesty International, 2002, as cited by Critelli,
2010). Whenever, there is a family conflict or distress, the members seek advice from
their extended family members. Mediation is encouraged by the Quran and by a family
member or religious leader of couple’s choice before they decide on separation or
divorce, they do not seek professional counseling (Abdul-Rauf, 2007 as cited by
Springer, et al., 2009).
For women in Pakistan, marriage guarantees not only economic security, but also
promotes respect in society. In contrast, if they seek divorce or separation it can bring
shame and a significant amount of suffering (Khalid & Frieze, 2004). PakistaniAmerican women feel more stress than men to comply with these traditions (Leonard,
1999). Although many women in their familial roles as mothers and wives find strength
with other females in the community or at a family level, they continue to care for others
at the expense of their personal needs (Ahmed, 1999). [Pakistani] women represent
diversity as far as their education, occupation and income levels are concerned
(Zachariah, 2003). A majority of Pakistani working women continue to assume
household responsibilities with minimal support from their husbands (Hashwani, 2005).
When these women have to challenge cultural practices by attempting to leave an abusive
relationship; they often have to deal with a number of factors at the individual, familial,
and community level in order to become independent (Critelli, 2010).
31
Ahmed (1999), stated that American relational psychologists showed concerns
that women are placed at risk due to their unwillingness or inability to leave an abusive
relationship. Just like their counterparts in the Western countries, a majority of PakistaniAmerican immigrant women face barriers in order to separate themselves from abusive
relationships (World Health Organization, 2002 as cited by Critelli, 2010). The intricacy
in this situation is mostly due to the predominant gender disparities prevalent in Pakistan
(Critelli, 2010). Although the immigrants have lived in North America for more than a
few decades they still retain same cultural values and customs (Zachariah, 2003).
In Pakistan, women’s rights of marriage and divorce are compromised due to the
discriminatory rule of law and age-old customs and traditions against women, although
the constitution of 1973 emphasizes the equal status of women and grants them the rights
of marriage and divorce (Jamal, 2006, Jilani, Ahmed, 2004, as cited by Critelli, 2010). It
is often because of these cultural values from their homeland that creates barriers, that
Pakistani-American women fail to seek assistance after the recognition of violence or
abuse in the family. There are multiple reasons for the reluctance of South Asian
[Pakistani] immigrant women to seek help (Ahmed, Reavy, & Mujamadar 2009).
According to Song (1996) as cited by Aga, Shah, & Maker (2005), the prevalence of
abuse or domestic violence among [Pakistani] immigrants may be higher as compared to
their homeland [Pakistan] as a result of stressors related to migration and acculturation.
32
Stressors for Pakistani-Americans
McKenry and Price (2000) as cited by Hepworth et al. 2006, have defined family
stressors as an incited change or change in some features of family life such as
boundaries, goals, roles, or values or anything, and this can create stress. A migrant
family often struggles to maintain cultural values from its country of origin and adapt
selective values from the host country which usually becomes stressful. (Hepworth et al.,
2006). Moreover, immigrants and ethnic communities when experiencing marginalization
in various forms either feel excluded or hyper-visible, which adds stress (Reynolds ,
2005).
After the tragic events of September 11, Pakistan, a country previously barely
known to most Americans, came into the international spotlight (Ahmed, 2005, as cited
by Critelli, 2010). The dynamic of the community has been revolutionized (Dadi, 2006).
Hepworth et al. (2006) affirmed that the increased surveillance and deportation following
9/11 created stressor for many [Pakistani-American] families. September 11th has had a
significant impact on the American community, but it has also made Pakistani Americans
distinguishable in front of the American public (Dadi, 2006). As a result, a large number
of Pakistanis and other communities were subjected to hate crimes due to ‘Islamophobia’
(Maira, 2009, p. 267). The tragic events of 9/11 placed a majority of PakistaniAmericans in a dilemma, as they suffered from marginalization, hate crimes, verbal
abuse, cases of job denials and media denigration. ( Dadi, 2006). According to Maira
(2009), the increased climate of suspicion and fear especially with the disappearance of
Muslim males and deportation, led to two opposing affects: binding Pakistani-American
33
community together and also shattering the community apart. Some elite Pakistanis were
also questioned and suspected (Dadi, 2006). As Islam bashing has become a norm in
America, many Pakistani Muslims now face the additional burden of setting a positive
and moderate example of Islam, altering interactions between the Pakistani-American
community and American society at-large (Malik, 2004). Post 9/11, there is a significant
reduction in the numbers of Pakistanis traveling to America on non-immigrant visas. For
example, significant drop in the visas approximately of 45% was observed from 2001
and 2003 (Najam, 2006). Rajan and Sharma (2006), pointed out that [Pakistanis], like
other South Asian communities, are unable to bring changes at the both political and
personal levels because they continued to remain cautious and guarded in their homes
and possess political apathy. Over the last several years there has been a major change
unfolding of American perceptions of Pakistani immigrants in regard to their interactions
with the civilians and the U.S. administration (Dadi, 2006). After 9/11, Pakistani youth
have a clear understanding of their experiences of being Muslims and PakistaniAmericans, which extends beyond religious practices but includes their family, and
cultural practices.
Raising Children
Much like most developmental phenomenas, adolescence occurs within an
environmental context containing large social and structural implications. This
developmental stage is fostered by the world views, behaviors and expectations within
that particular environment(Ahmed, 1999). In American culture, adolscents are guided
34
by their parents but they make their own choices and accept responsibility for their
actions. In western society individuation is promoted (Qin & Comstock, 2005). In
contrast, South Asian [Pakistani] parents have difficulty understanding the need for
individual autonomy. Pakistani culture perceives identity of individuals more in the
context of the family and the larger community (Ahmed, 1999).
Among first generation Pakistani migrants, there is some reflection of hierarchical
family structure in terms of age and gender. Gender roles and relationships are clearly
defined. Relationships between husband and wife and between parents and children are
both formal and close (Hashwani, 2005). Children are expected to obey parents, and they
are expected to respect others, especially the elderly (Leonard, 1999). Culturally, young
children are overly protected, and rarely allowed to make decisions independently. It is
considered respectful to always seek the guidance of elders regarding education and
career decisions (Hashwani, 2005).
According to Ahmed (2005), youth from Asian and Middle-Eastern countries are
pushed by their parents to stay away from mainstream western culture, which is
perceived as “immoral and hedonistic”(p.37). Consequently, Leonard (1999), believed
that for first generation immigrant parents maintaining cultural values at home, pushing
academic excellence, and economic success are crucial. Simultaneously, in the new
country [Pakistani-Americans] want to protect their children from adapting the American
values. All this often create stress for children as well. As far as [Pakistani] adolscents
are concerned they feel the pressure of conformity with American culture along with the
existing pressure at home to maintain their religion and culture (Ahmed 1999). The
35
second generation immigrants are being raised with the combination of values from the
dominant culture and the traditional values of their parents. These mixed messages create
questions and conflicts on issues such as religious, culutral, social and health issues.
(Zachariah, 2003). This also affects the process of identity formation, and these second
generation Pakistanis can often easily negotiate their newly formed identities within the
new contexts (Leonrad,1999).
Protecting their children from the American youth culture of dating, sex and
drugs, Pakistani-American parents try to set appropriate limits on social activities of their
children (Williams,1988). Pakistani-American parents also perceive that dominant
cultural values of gender equality and freedom of sexual expression as a serious threat to
their religious (Islamic) values (Leonard, 2006). As a result, they try to socialize their
children within the Pakistani community (Williams,1988). Islam prohibits pre-marital
and extra-marital sexual relationships for both the genders, but in Pakistani culture,
sexuality of girls is more closely monitored and discouraged. A majority of firstgeneration Pakistani-American immigrant parents are concerned about monitoring the
choices of marriage for their children (Leonard, 1999). Acculturated second generation
Pakistanis females and males usually keep interfaith/interracial romantic relationships as
a secret from family members (Ahmed, 1999). Furthermore, sex is considered a private
matter, hence the disclosure of the sexual orientation and same sex relationships is not
approved (Hashwani, 2005).
According to Leonard (1999), the intergenerational clashes are more common on
the issues of marriage. Young Pakistani-American immigrants often frown on arranged
36
marriages (Malik,1989). Nevertheless, Pakistani-American parents are accustomed to the
involvement of extended family and community members in arranging the marriages of
their children, and they believe that it is necessary for family stability. This practice of
arranged marriages by Pakistani Americans is further supported when they see the
prevalence of high divorce statistics in the United States and other western countries
(Leonard, 1999).
Traditional Muslim marriage is not only between two individuals but also
between two extended families (Hodge, 2005). A majority of Pakistani immigrants are
therefore trying to enhance the socialization of youth within the community. The venues
for the soicalization can be a mosque or community events where young adults can safely
look for potential suitors. This lead to semi-arranged marriages which allows youth to
also participate in making the decisions related to their marriage (Williams,1988).
Pakistani-American Muslim communities usually uphold patriarchal values which
perpetuate discriminatory practices at family and community level. Pakistani-American
young girls are not prepared to address the cross cultural issues of dating and courting
(Zachariah, 2003). This prevailent fear is especially related to the social interactions of
girls. The engagment in pre-marital sexual behavior is unacceptable because it is
considered that it will bring shame and disgrace to the family (Goodwin, 2000, as cited
by Springer, et al., 2009). Therfore, in order to curtail the opportunity of sexual intimacy,
youth, especially girls are not allowed to attend parties or dances without adult
supervision (Springer et al., 2005).
37
Overall, the process of adolescence brings anxiety and concerns related to the
major changes for all young people, however, it brings numerous problems pertinent only
to girls within the [Pakistani] immigrant community (Ahmed 1999). For second
genreration immigrant girls, even those born and raised in the United States, parents have
lot of expectations including academic excellence, and being conscious of religious and
cultural values ( Zachariah, 2003). There is a lot of pressure on young girls to do well in
school and participate in extra curricular activities but also to be home when they are
needed ( Leonard,1999). These girls are not allowed to date or to be sexually active and
teen pregnancy, especially is considered as source of shame and guilt for both the parents
and girls (Zachariah, 2003).
According to the research conducted by Ahmad (1999), [Pakistani] first
generation immigrant parents are possibly striving to preserve their cultural values
because they fear that there are chances for their children to lose these values under peer
pressure. In a study conducted by Ahmed (1999) with South Asian girls, she found that a
strong majority of the girls hoped to untie their South Asian and American identities. It
can be challenging as Springer, et al. (2009) pointed out that single female adults are not
expected to live indpenently even while they are working.
According to Leonard, (1999) in order to transmit adequate knowledge of
religion and culture, parents are willing to give up their Urdu literary heritage because
they believe that American English is sufficient to convey the religious Islamic teachings.
William (1988), pointed out that older children are more exposed to native language,
cultural, and traditional ways to behave and conform to the parental expectations. They
38
are also expected to not only avoid dating but also have transnational arranged marriages
(Williams, 1988). As a result, according to Leonard (1999) for a majority of young
[Pakistani] boys and girls growing up in the United States has not been a homogenous
experience. During their early years they identify with the dominant culture and then in
later years with their traditional culture as called by one writer as a “second migration’ in
late adolescence or young adulthood, and an emotional return to the ancestral country
(Maira 1995, p. 10).
Currently, a majority of South Asian second genreration immigrants identify
themselves first as Americans, then they identify with their heritage or see themeselves as
part of larger community (Rajan & Sharma, 2006). According to William (1988) the two
national identities are involved in the development of an immigrant group: the nation of
origin (Pakistan) and the nation of residence (United States). These two identities often
cause tensions between parents and their immigrant children. “Will they [second
generation immigrants] be sufficiently Pakistani to respect me when I am old? is one
unspoken question” (Williams, 1988, p. 287). Pakistani-Americans value Eastern
extended family system and feel concerned if this value will be maintained by their future
generations (Leonard, 1999).
The Process of Assimilation and Acculturation
According to Malik (1989) acculturation is a process by which minorities
integrate themselves into the dominant culture. Assimilation on the other hand is a
complete adaptation of the dominant cultural values and world views including behavior
39
and attitudes. Portes (1995) and Zhou (1997) as cited by Purkayastha (2003) believed
that assimilation occurs in fragments and suggested that the second generation
immigrants often depend upon their ethnic communities during their process of
assimilation.
Upon the arrival of Pakistani immigrants to the U. S., their interaction with
Americans is minimal. Pakistani-Americans arrive in the new land with the cultural
images based on the second hand information. Due to the vast difference in the Eastern
and Western cultures these immigrants have to adapt with the new language, and new
style of living (Malik 1989). As the number of Pakistani immigrants has grown in large
urban areas, they have become more visible as a community which has assisted in the
assimilation of new immigrants. They do not feel lost and far away from their homeland
(Najam, 2006). The skilled Pakistani professionals as immigrants have better opportunity
to interact with local Americans and this assists in the process of acculturation (Malik
1989). Therefore, the acculturation of Pakistanis into American society, owes a lot to the
socio-economic status and the personal background of the individuals. The role of socioeconomic class cannot be discounted because the acculturation experience and
perceptions of a Pakistani-physician is explicitly poles apart from someone who is
serving in Pakistani-restaurant and making minimum wage (Dadi, 2006). It is due to this
class difference between skilled and unskilled workers that impact their assimilation
process. The unskilled worker continue to follow and a lifestyle identical to that of their
homeland (Leonard, 2006). With fewer resources and less economic power, the recent
immigrants continue to sustain the important contacts from back home (Williams,1988).
40
The age, religious beliefs, profession and ethnic background of husband plays a very
important role in the acculturation of their wives, especially for those who are from rural
areas (Malik, 1989).
Second generation immigrants and young students from [Pakistan] are more open
to cross cultural context as compared to the first generation immigrants (Springer et.al,
2009). There is an immense pressure placed on the young, married couples by their
families to retain cultural practices and as a result, most go through some form of culture
shock and nostalgia and end up socializing with only the Pakistani community (Malik,
1989). It is for this reason, that Springer et al. (2009) cautioned that the acculturation
level should be assessed by therapists and counselors during their work with [Pakistani]
Muslims, specifically in clinical settings.
Coping Mechanisms and Attitudes in Seeking Mental Health Services
Many immigrant families demonstrate psychological distress as a result of their
migration experience (Hepworth, et al., 2006). The acceptance of mental health issues in
minorities or migrant communities is related with stigma and requires cultural
understanding (Knifton, Gervais, Newbigging, Mirza, Quinn, Wilson, & HunkinsHutchinson, 2009). A family’s lifestyle or relationships can be compromised because of
many factors, including family life transitions, structural arrangements, patterns of
communications, and roles. (Hepworth et al., 2006). Among Pakistani communities,
mental health issues are not addressed until they are prominent enough to get attention
from individuals and family members (Knifton, et al., 2009).
41
Minority families place a strong emphasis on privacy, because of embarrassment
associated with involving others. (Hepworth, et al., 2006). In a study conducted by
Knifton et al. (2009) it is noted that when it comes to minority community[Pakistanis]
there are many factors such as family structure, beliefs about mental health, and
experiences of racism that shape levels of stigma. Nevertheless, the study also pointed to
an important variation in the level of stigma based on the socioeconomic status of
Pakistani community. Some of the coping approaches minority families utilize are based
on how their group cope with the same problem (Hepworth et al., 2006). For instance, for
the Muslims reading Quran daily and consulting hadiths assist them in making choices
related to family issues (Sherif, 1995 as cited by Springer, et al., 2009). Religious beliefs
thus, act as coping mechanism for this community. Kamali (2008), as cited by Springer,
et al. (2009), also pointed that Sharia law is another area to seek assistance if there are
family issues.
Depending upon the education, profession, acculturation level, and religious
affiliations, many [Pakistani] Muslims may wary to seeking mental health services. A
common belief is that Islam as a religion, has the capacity to address individual and
family issues (Sayed, 2003 cited by Springer et al., 2009). According to Lum (2004), as
cited by Hepworth et al., (2006), minority families due to their experiences often believes
that they might be perceived as unhealthy, therefore they hid their issues some . It has
been noticed that individuals from South Asian communities are usually assessed in
terms of their adaptations to western culture or with a ‘clash of cultures’ (Chantler et al.,
2001; Brah, 1996, as cited by Ahmed et al., 2009, p. 9). Clinicians often tend to ignore
42
their own biases and perceptions toward strengths and resilience of the community. In a
study conducted by Maynard and Harding (2009) with Pakistani immigrant families for
the adolescent mental health, they found that the two parent family household and joint
family activities result in family cohesion and often assist in dealing with the problem
behaviors such as deficient social and academic skills.
Issues in Seeking Mental Health Services
For many families minority status and culture can be barriers in accessing mental
health services. Families may fear “what might happen” if their problems are brought out
into the open (Nichols & Schwartz, 1998, as cited by Hepworth, et al. 2006, p.132). One
study conducted by Stein et al., (2003) suggest that Pakistani mothers were only willing
to address these issues and receive a referral of mental health care for their children if the
problems were severe. These Pakistani mothers preferred to address mild and moderate
behavioral issues at the family level or discuss it with their primary care physicians. In a
comparative study between Pakistani and British mothers, it was concluded that both
Pakistani and British mothers accurately identified the problem behaviors of their
children, however Pakistani mothers were reluctant to seek help as compared to British
mothers. In yet, another study conducted by Knifton et al., (2009) a focus group
comprised of Pakistanis brought up the issue of stigma including “shame and
concealment.” Some of the causes of mental health issues were perceived as either God’s
punishment, black magic, possession by spirits or jinns, affecting individuals. The lack of
utilization of mental health services among Pakistani immigrants for their children may
43
provide an insight in knowledge and attitudes of this ethnic community (Stein et al.,
2003).
Mental health problems with the levels of stigma and shame associated within
specific minority affects their attitudes about seeking help and the recovery process. Due
to this stigma many individuals are being at disadvantage (Knifton et al., 2009 ). Mental
health services are not often utilized by ethnic groups. Moran et al., (2004) cited by
Paiva (2006) has suggested that the way these services are often presented and delivered
to clients may not be culturally acceptable. Often clinicians and the way services are
delivered, are guided by stereotypical images. For instance, a [Pakistani] or South Asian
women may be considered as submissive and dominated by rigid culture which is not
always true (Ahmed et al., 2009). Ergo, Abi-Hashem (2008) as cited by Springer et al.
(2009), cautioned that the therapists should not ask direct questions especially related to
marital, personal and family issues, as there is family honor and shame associated with it.
Carolyn et al., (2000) as cited by Springer et al. (2009), also cautioned that apart from the
cultural and religious components it is also important to consider the uniqueness of each
individual client during therapy. The emphasis upon shame may be related to holistic
beliefs and cultural differences especially when it comes to Pakistani communities
(Knifton et al., 2010). In as far as reporting of intimate partner violence or any other
forms of violence are concerned, South Asian women have a number of barriers
constructed culturally or stereotypically by the dominant society. The barriers also
include the apprehension related to the treatment and the fear of a breach of
confidentiality (Ahmed et al., 2009).
44
Summary
Pakistani-Americans are newcomers (as compared to Europeans and other
Asians) to the American immigrant sphere (Purkashtaya, 2005). These Pakistani
immigrants put strong emphasis on family as a vehicle in modifying their characteristics
at societal level (Williams, 1988). Pakistani family values are based on hierarchical and
patriarchal systems therefore, Pakistani-American females are expected to play a vital
role in preserving cultural and religious values at family level. As an immigrant
community, Pakistani-Americans often face challenges and stressors especially related to
preserving their culture while raising their children. The impact of tragic events of 9/11
has resulted in higher stress at the family level, impacting the Pakistani community at
large. The stressors at family and community level often affect overall family health,
nevertheless, there are cultural barriers to seeking mainstream mental health services.
Based on these scholarship/ literature review there is a need to explore the attitudes,
knowledge, and the beliefs that Pakistani-Americans have about healthy families, and
whether they have specific coping mechanisms to deal with the stressors found in the host
country.
45
Chapter 3
METHODOLOGY
Research Design
This study is an exploratory study with a qualitative design. The reason for
utilizing qualitative design is due to the sensitivity attached to this topic. According to
Neale, Allen and Coomes, (2005) cited in Royse (2008), the qualitative design is
effective to investigate a “hard to reach population” and when the study focuses on the
process rather than the outcome. Royse (2008) asserted that the qualitative design is vital
when the investigation focuses on how individuals give meaning to their experience and
narrate their lived experiences. The limited empirical research found in a literature review
and investigation of scholarship establishes the need for the exploratory design.
Moreover, the exploratory design was considered because it does not necessarily generate
a hypothesis or come to a conclusion. It opens avenues of more research in the areas
relevant to the study.
Research Question
This study explores the knowledge, attitude and perceptions of PakistaniAmericans living in the Sacramento region regarding what constitutes a healthy and
peaceful family.
Sample Population/Participants
The sample population consists of five adult Pakistani-American males and five
adult Pakistani-American females living in the greater Sacramento area. The sample was
46
derived using snowball sampling, and the inclusion requirements for this population were
residence within the vicinity of Sacramento, California, and age over 18. No incentives
were offered; participation was on a voluntary basis.
Instrumentation
Data were collected while conducting face to face in-depth interviews with
participants residing in Sacramento. This interview technique allowed the researcher to
gain further insight into the beliefs and attitudes of Pakistani American immigrants at the
conversational level. The assumed benefit of the interview (semi-structured) was that it
brought in-depth perspectives, which assisted the researcher because the interviewees
were the insiders/experts on the issue. Another reason for the semi-structured interviews
was to enhance the reliability of the key concepts and themes. To maintain the credibility
of the interviewing process there were no leading, vague, or complicated questions (See
Appendix A for interview guide), rather there were probing statements such as ‘Tell me
more’. The face-to-face interview was preferred because of the sensitivity of the topic for
some of the respondents. It was also preferred because of the possibility of the emergence
of any feelings of discomfort or pain experienced by the interviewees, at which point
interview could be stopped immediately. To ensure that participants felt safe and
comfortable there were no questions asked regarding the demographic information. The
interview questions were posed to elicit the knowledge, attitudes, and perceptions of
Pakistani-Americans regarding what constitutes healthy and peaceful families. The
participants were asked to state what they believe are the important factors that contribute
47
to a healthy and peaceful family environment. The interview also attempted to identify
the stressors on family life, and what role their belief system plays in coping with those
stressors. Finally, questions were asked to identify resources needed to address family
issues, and whether the community would be willing to utilize those resources. See
Appendix A for the interview questions.
Data Collection Method
An active community leader was contacted by the researcher and the consent form
was provided to her after a thorough explanation of the study. She was the first person to
be interviewed. The informed consent forms were provided along with the self addressed,
stamped envelopes to the contact person so that she could distribute them to people that
she is acquainted with. See Appendix B for the consent form. She then personally
contacted the participants and provided them with the researcher’s contact information.
This allowed the potential participants to think about the process by reading the informed
consent paperwork before deciding to become involved. The participants then contacted
the researcher via phone and email to set up an interview appointment. The participants
chose the location of their choice. Interviews were conducted at the coffee shops,
shopping malls, participant’s work place, and, in one instance, outside a public school
while the participant was waiting for her kids to finish their karate lessons.
Data Analysis
All ten of the interviews in this research study were audio taped and later
transcribed for analysis. Each interview lasted one hour to one and half hours. Due to the
48
length of the responses, it was not feasible to include a verbatim transcription of each
interview. However, each interview was assessed to examine recurrent themes, patterns,
and differences between the responses from the participants. The cluster of responses
with commonality were identified and combined. Then the responses to each question
were summarized and direct quotes from participants were included. The questions were
divided into following categories for the analysis: 1) the factors contributing to a healthy
or unhealthy family life style; 2) stressors for and coping mechanisms of PakistaniAmericans; and 3) the knowledge and attitudes of the community members towards
seeking mainstream resources for mental health.
For the first category, participants identified that open communication and stable
family lives contribute to a healthy and peaceful family. Simultaneously, the lack of
education, a new environment, language barrier, and a lack of support from the extended
family system can contribute to an unhealthy family environment. Some of the stressors
identified by the respondents were raising children, financial instability, and the process
of acculturation. According to the participants, religious beliefs and rituals are the main
sources of coping mechanisms. Participants were not sure about the attitudes of their
community towards seeking mainstream mental health care if needed. Some of the
relevant barriers include issues related to cultural competency and confidentiality.
Bias and Error
There was no conflict of interest in the study except the fact that the researcher
shares the same ethnic background with the participants. The researcher was aware of the
49
potentiality of bias due to the researcher’s personal values and beliefs regarding the
importance of addressing the issue of healthy relationships within the family structure.
Nevertheless, the awareness of this potential bias made the researcher proceed with
caution. The strategies from Pyrczak (2003) to minimize biases and error through selfreflexivity were utilized. This allowed the researcher to be more aware of her own world
views, and monitor and control them as much as possible. Additionally, participant
selection employed the snowball sampling method making the researcher unaware of the
demographic, socio-economic, and marital status of the participants. This served as an
advantage as Johnson, cited in Pyrczak (2003) mentioned there was no ‘negative case
sampling’. The snowball sampling method was beneficial as it provided the insider’s
view without the inherent bias of handpicking a sample. However, the disadvantages,
such as the small sample size and lack of knowledge of the participants’ demographics
resulted in the participants sharing a similar (homogenous) socio-economic status which
posed a barrier to include a statistically representative sample with diverse views within
the study.
Protection of Subjects
Once the participants voluntarily contacted the researcher for their participation the
informed consent forms were provided to them. They were offered the options of
deciding a location of their choice to meet with the researcher to discuss all the aspects of
confidentiality before proceeding to the interview process. Only two participants asked
the researcher to email them the informed consent forms to review it by themselves. The
50
suggested time frame of the interview, ninety minutes, was also mentioned on the
informed consent form. To further ensure the safety and comfort of the participants they
were encouraged to choose a public place where they could feel comfortable, such as a
mosque, public library, or coffee shop for their interview. A mosque in Northern
Sacramento provided a support letter to allow the researcher a private and safe location to
conduct the research. (See Appendix C for the support letter).
The participation was completely voluntary with minimum risk. Participants were
well aware that they could refuse to answer any question, or even withdraw from the
study at anytime if they chose to, regardless of any reason. All of the participants agreed
to be audio taped. The researcher explained that the use of the tape recorder was only for
the transcription and accuracy. All the collected information including tapes, and signed
consent forms will be kept at a safe and secure place that can only be accessed by the
researcher. The recorded information and other material will be destroyed upon the
completion of the study. The participants were also informed that if they were to feel
uncomfortable with any painful memories, the researcher would stop the process and they
would be referred for consultation. The contact information of the referral agency was
provided with the informed consent form.
Summary
This chapter discussed the qualitative design used as a framework for this study. This
chapter also explained the interview process as a method of inquiry that underpins this
study. Furthermore, the issues related to the qualitative process of inquiry and its
51
importance, were discussed. Chapter four will now discuss the results of this study and
lead towards the possibility of conclusions and recommendations.
52
Chapter 4
STUDY RESULTS
Introduction
This chapter provides an analysis of the data obtained in order to explore the
knowledge, attitudes, and perceptions of Pakistani-Americans regarding what constitutes
a healthy and peaceful family. The data were obtained using the snowball sampling
method with 10 open-ended and audio taped interviews. Ten participants were asked a set
of seven questions. The first two questions concerned the identification of the
contributing factors which keep families either healthy and peaceful, or unhealthy. These
questions were then followed by questions related to stressors in the new land, how the
families usually deal with stressors, and the coping mechanisms of the community
including the use of a belief system. The final set of questions dealt with available
resources, and whether the Pakistani-American families were willing to seek those
resources.
Methodology Summary
Though each interview was intended to be conducted as an in-depth interview,
personal information was intentionally not obtained. The specific age of the participants
was not asked, in order to reassure the participants of anonymity. Similarly, information
on socio-economic status, the year of immigration, or the purpose of immigration was not
investigated to make the participants comfortable in sharing an insider’s views but
53
without conveying personal history. For the reader’s convenience the following table is
included to provide the demographics of the participants.
Table 1: Profile of Participants
Name Sex
Age
Occupation Marital Education Other
status
characteristics
Banu
Female
Early
forties
Home maker
Married
College
Volunteer
Sara
Female
Early –
mid
forties
Part time
worker
Married
College
Active member of CoExist, and other
organizations
Zainab
Female
Late
thirties
Home Maker
Married
College
Raised in England
Volunteer work
Fatima
Female
Midlate
twenties
Unemployed
at the time of
interview
Single
College
2nd generation
immigrant
Tara
Female
Earlymid
thirties
Employed
Divorced
College
2nd generation
immigrant
Jamal
Male
Late
forties,
early
fifties
Employed
Married
College
degree
Actively involved in
community. Migrated as
an international student
Hasan
Male
Late
twenties
Employed
Married
2nd generation
immigrant
Sajid
Male
Employed
Married
Amir
Male
Mid or
late
fifties
Early
thirties
Some
college from
US
US college
degree
Employed
Single
Migrated as an
international student
Zain
Male
Midlate
fifties
Employed
Married
College
degree from
US
College
Serves on the board of
different organizations
Interviewees ranged in age from early twenties to late fifties. The majority of the
interviewees were first generation married immigrants except two females and one male
who were second generation immigrants in their twenties and one unmarried male in his
early thirties. Every participant was a resident of the Greater Sacramento Area. All the
54
participants were able to communicate in English and did not require translation of the
consent form or the posed questions. To maintain confidentiality, pseudonyms were
given to individuals so that readers can appreciate the demographics and background.
Results
As noted in chapter 3 the findings of the study have been categorized in three
major sections with some overlapping themes. Recurrent responses were analyzed with
special attention as those responses demonstrate knowledge, beliefs and perceptions of
the community members related to specific issues. As a result, some recurrent themes and
patterns of responses emerged as follows: 1) Stable family life, is dependent upon
compatibility between spouses, financial stability, and open communication. 2) Lack of
an extended family system, lack of emotional support, poor communication, financial
instability, lead to an unhealthy environment 3) Intergenerational conflict, living in a post
9/11 environment, and acculturation issues related to migration were identified as
stressors, 4) Arranged marriages, 5) Religious belief and an extended family system are
coping mechanisms; 6) Ego (pride) stigma, and concerns regarding confidentiality and
cultural competency are major barriers to seeking counseling. Some of the themes
overlapped during the interview process, for instance migration was identified as a factor
affecting the peace of families and also as one of the stressors. The majority of the
responses supported the existing scholarship on Pakistani-American immigrants.
55
Stable Family Life
These factors are repeatedly identified by the participants as crucial to
maintaining a healthy and peaceful family. Jamal believed that having a stable family life
is the most important contributing factor to a healthy family.
Whereas Sara believed:
It is important to preserve cultural and family values, for example eating together,
children respecting adults, and an open communication between parents and
children.
The opinion of Amir, the only unmarried male in the study, was interesting. It
was not easy for him to identify what factors contribute to a healthy family
environment. His first response was “having a physically healthy life style.”
When the question was repeated he paused and said, “compatibility between
spouses”. It is critical to see how demographics and personal background plays an
important role in forming opinions. Moreover, while first generation married
participants emphasized stable family and financial security, the second
generation females mentioned that being obedient to parents is the most important
factor in maintaining a healthy and peaceful family life.
Lack of Support
A majority of the respondents were able to identify some common factors which
make Pakistani-American families unhealthy. For example, it was recognized by many
respondents that an unstable marriage and poor communication among family members
56
can disrupt the peace at the family level. Some respondents emphasized that the process
of migrating to a new country with an entirely different culture, combined with a lack of
education can cause tension in the family, especially when there is a language barrier for
first generation immigrant. Language barrier is significant in impeding the capacity of
first generation Pakistani immigrant women to involve in school activities or
socialization with the mainstream population. They experience difficulty interacting at
parent teacher meetings. Children take advantage of this situation and cross boundaries.
These factors impact communication between parents and widen the gap between parents
and children. Lack of a nearby extended family system was identified as an unhealthy
factor by Banu:
Women felt left alone in a new country with no support. In Pakistan there is a
joint family system which provides immense support. Grandparents usually keep
an eye on children and get involved in child rearing.
Jamal affirmed it by stating:
Because grandparents bring wisdom and unconditional love into the lives of the
children. Especially when mom and dad are busy then grandparents in the
household give attention and a listening ear to the children. Without a doubt in my
mind I have seen a qualitative difference between families where children are
being raised where grandparents are involved vs. families who single handedly
raised the children
Another theme emerged when discussing factors contributing to unhealthy relationships
was a lack of emotional support. Female respondents mentioned that Pakistani-women
57
are under more pressure to assume responsibilities outside the house and within the
family with no help or support from their spouses. As a result, there is tension and
ongoing conflict within family.
According to Banu:
A traditional Pakistani woman comes home after work and fixes meals. There is
no help available from her husband. The time that husband and wife spend
together in Pakistan is less but with more quality and open communication. All
these factors contribute towards frustrations, anger, and unhealthy relationships.
Additionally, there are self-imposed stressors such as socioeconomic competition
within the Pakistani-American community.
As a husband, Sajid interestingly shared a different perception,
Pakistani women are accustomed to the life styles of back home and do not
comprehend the challenges and difficulties their husbands go through at work or
outside their homes. When husbands return home, women expect them to be
available for them and to take care of household issues. If the husband cannot do
that then there is a friction and it becomes an unhealthy relationship.
Responses vary on the same issue possibly because of the differences in the prevalent
beliefs among unmarried, married, male and female participants. For instance Amir, a
single male, mentioned lack of education as a contributing factor for an unhealthy family,
as compared to Fatima, a single female who point out the differences in cultural and
religious beliefs among parents can be an impetus for conflict. Married females
mentioned loneliness, and a lack of personal freedom as compared to married males who
58
never mentioned loneliness but, rather were concerned about boundary issues, financial
instability, and lack of communication.
Intergenerational Conflict, Living in a Post 9/11 Environment
The major stress identified by all respondents is raising religiously and culturally
conscious children. This stress largely results from a clash of cultural and religious
values. Again the language barrier and acculturation issues were also identified as
stressors for parents.
Sara has been actively involved in the Pakistani-American community for more than a
decade, and, according to her:
Stress levels vary between genders because of the significant difference in
worldviews and values between men and women. As mothers are more involved
in child rearing they feel more stress and pressure to ensure that their children turn
out to be good kids.
Other participants also affirmed that though raising children and keeping them safe from
drugs, alcohol and other harmful practices can be challenging for all parents across
cultures, these challenges are accelerated for Pakistani-American parents in a new
country with an open society. The level of freedom people enjoy in American society is
entirely different from the social structure that Pakistani-American parents have migrated
from. As a result, Tara mentioned:
To allow each family member to have their own freedom goes directly against the
unified family structure that Pakistani families try to maintain.
59
Another interesting issue mentioned by the participants includes the difference in the
intensity of stress while raising girls compared to boys. Girls are not prepared to deal
with cross cultural issues and they grow up with mixed messages. They are expected to
excel academically and participate in extracurricular activities but discouraged to make
independent decision related to their college, career and life choices. Females are
especially not allowed to date, or engage in sexual activities as it is considered a sin
(Hashwani, 2005).
Fatima, a young unmarried girl, said:
Second generation immigrants face a lot of stress in avoiding peer pressure while
growing up in this society and they also have to find a medium ground to avoid
arranged marriages.
She said that while it is not easy for parents to accept the marriage of their sons to girls
from a different religion and culture; they cannot even allow their daughters to marry
someone from another religion or culture.
Zain (middle-aged married male) echoed this discrepancy:
Although it is not a right practice, we as a community accept a few things our
sons do i.e. marrying outside the culture and religion or drinking, but not our
daughters. This is the way it is.
According to the other participants such expectations create stress and pressure on young
girls as well, and if the lines of communication are not open then this leads to an
intergenerational conflict. As supported by previous scholarship, the patriarchal culture
60
demands that females preserve the cultural values and they are prohibited from exercising
their basic rights such as autonomy in making decisions.
As for post 9/11 stress, it was mentioned by the participants that nearly every
facet of the lives of Pakistanis in America have been affected. The second generation
immigrants especially boys, can no longer enjoy the same privileges as they had before,
whether it is choosing a career in chemical/nuclear engineering or a vacation to Pakistan;
they will be under surveillance.
Another response from the participants is that there is a shift in the balance within
the community in response to the mistrust of the Federal Bureau of Investigation (FBI)
shortly after the 9/11. Many Pakistanis according to Hasan, are reluctant to disclose their
identity as a Pakistani or a Muslim, or they go to the other extreme and become
fundamentalist and overtly project anti-western sentiments. This has also increased stress
for a number of families who have been interrogated or been subjected to discrimination.
Zainab expanded this idea:
Now people notice us more and directly question our ethnicity followed by the
identification of religion and then more and more questions. Now we have to
equip our children beyond regular Islamic teaching by training them on how to
portray the positive image of Islam by being tolerant and non-violent. For many
parents this is an added stress at the family level.
She added that 9/11 has caused a different sort of stress, and now Pakistani-Americans
have to focus more on improving communication, not just within the community but with
61
authorities as well to clear the misperceptions and address the subtle marginalization.
Pakistani girls have also been affected in a more covert manner.
According to Sara (a middle aged married woman):
In the past students from Pakistan used to be potential suitors for young Pakistani
American females. Now there has been a marked reduction in the granting of
student visas, which has reduced the options for parents here to marry their
daughters to a Pakistani male. The majority of Pakistani-American parents are
reluctant to marry their daughters to Pakistani males settled in Pakistan due to the
political environment and unstable relationship with the United States. This has
limited the options for many Pakistani girls already at a marriage age.
This underscores the prevailing pattern of arranging marriages trans-nationally or locally
for second generation female immigrants as compared to males.
Arranged Transnational Marriages
Early in the interview process participants did not mention domestic abuse or
violence, but as interviews progressed, five out of ten participants volunteered their
knowledge of existing physical and verbal abuse in which help was never sought. The
identified barrier in these situations was family’s reluctance to report due to the desire to
hide family matters from the rest of the community. Most abuse and conflicts occurred in
the community recently due to the arranged marriages of second generation immigrants,
specifically transnational marriage. According to Charlsey (2005), transnational
marriages involve risks and often put brides in a vulnerable position for two reasons: the
62
waiting period of the bridegroom to be granted the visa, and also ill intentions of groom
of using the marital route to enter into the [United States].
According to Hasan, Sajid, Sara, Jamal, Banu and Zainab, a few transnational
arranged marriages in Sacramento have resulted in abusive relationships and finally in
divorce. Nevertheless, many Pakistani-Americans still insist on arranging marriages for
their children with potential suitors in Pakistan.
Participants from the study showed concerns related to the increased rates of
divorces within the second generation immigrants often due to arranged transnational
marriages which is a stressful factor for the community in general and families in
particular. As the literature supports participants mentioned the prevalence of domestic
abuse within family environment. Zainab, who is volunteering at a local shelter, stated
that abuse is prevalent. It is just not recognized and; females suffer from depression but
do not get help. She said it is underreported and especially those who are from rural and
tribal areas their women are subjugated and prefer to stay in relationships. They are
dependent on their husbands. Banu mentioned there is no discussion of sex and intimacy
between spouses. Immigrants who have migrated at a later age have difficulty with
acculturation and due to this they continue maintaining their preferred practices. Fatima
stated that arranged marriages are one area of conflict between children and parents.
During the interview process Tara shared her personal story that so poignantly
reflects the perceptions and attitudes of Pakistani-Americans in regards to prevailing
patterns of domestic abuse within the community.
63
Tara’s story:
I am a 27 year old Pakistani divorced female. I immigrated to U.S. when I was
two year old. Although, I have received all my education here in Sacramento I
was not allowed to make decisions for myself. Therefore, at the age of twenty, I
got married to a stranger and moved to a different city from Sacramento. After a
year and so I tried to inform my family members the abusive environment of my
house. No one paid attention to the seriousness of the problem, instead I was told
that it is just part of the adjustment process. After several years of emotional,
verbal abuse my husband one day raised his hand and that was the tipping point
for me. When I came to my family after the divorce, my family members said that
you should not have wasted seven years with this jerk. Now who is going to
remarry you?
The prevalence of arrange marriages among Pakistani-American immigrants is still a
preferred practice. It also manifested in how a family overlooks the initial report of abuse
and do not take the matter seriously. In certain rural areas of Pakistan, domestic abuse is
culturally accepted. Minimizing or denying of such violent behaviors is a common
practice among Pakistani-Muslim families. The culture that is dominated by patriarchal
structure pressures women to preserve the family unit. The institution of marriage is
highly valued, therefore; the family’s concern was more on diminished possibility of
remarriage, rather than Tara’s well being.
Although the error was on my husband's part who was cheating through-out the
marriage and refused to have children with me - as a female within the Pakistani
64
culture, I am still held responsible for letting my marriage fall apart. There is
tremendous amount of stigma attached to me being a Muslim, Pakistani girl who
is now divorced.
The reinforcement of dominant patriarchal practices where women are blamed for
breaking the family is obvious in this case. Ironically, although Tara managed to get out
of the abusive marriage she continues to suffer emotional abuse or intimidation within
her family structure where she is covertly blamed for her situation. She stated:
Pakistani culture is based on double standards. Even for women who have spent
most of their lives here - the cultural restrictions exist where you are not able to
marry whom you want, or even talk to men without someone saying you are
doing something Un-Islamic. Most of the time, I'm made to feel value-less within
my community. This could be personal emotional feelings - but people actually
say things that are insensitive to make me feel subordinate to females within the
community who have "successful" marriages or are unwed at this time.
Pakistani-Americans hold Islamic values as an integral part of their lives, nonetheless,
their cultural practices takes precedence over religious values. Islam accentuates equality
among spouses. The perpetuation of violent relationships is against the teachings of the
Quran and Sunnah (teachings and practice of the Prophet Mohammad). There are several
verses in the Quran that emphasizes peace between spouses, “protecting friends of one
another” referring to maintain mutual kindness and mercy in the marital relationships
(30:21,9:71). Similarly, the Prophet Mohammad, strongly emphasized to treat women
65
with respect, “be kind to your women-you have rights over your wives, and they have
rights over you” (Bukhari). Tara goes on to state:
The future is meager. My family members believe that the only hope is for me to
return to my country to get married. However, they also acknowledge that the
men back home MOSTLY want to get married to American Pakistani girls
primarily for the green card. Many of these types of arranged marriages within my
circle of family have fallen apart after the guy gets his visa. Leaving the girl to
fend for herself and deal with - again - the stigma that goes along with being a
divorced Pakistani woman.
Tara points out the failure of many transnational arranged marriages in the community.
Although, dissolution of marriage is allowed in Islam, the community continues to
perceive divorce as a stigma as it brings shame to the family. Nevertheless, the
community continues with arranged marriages. It is strange to comprehend that on the
one hand Pakistani-American families emphasize family cohesiveness, and are overprotective of their children, while on the other hand if someone like Tara suffers then the
honor of family takes precedence over their own children. Usually when divorce occurs
families withdraw in an apologetic manner from community because they feel ashamed
and dishonor. A family is considered more honorable if it displays the adherence to the
cultural practices such as preservation of marriages, rather than dissolution of marriages.
66
Religious Belief and Extended Family System as Coping Mechanisms
Religion keeps the Pakistanis’ values alive when they immigrate, and it is the
most important ingredient in order to maintain a healthy Pakistani family. When these
values correlate with those that have carried over from their homeland it becomes a little
easier to enforce them. For example, children are sent to Sunday Islamic School to learn
about their religion, creating a foundation for the rest of their lives. Keeping the family
together as one, happy unit is very important for the elders. Regardless of any arising
issues, a typical family strives to be together always and rely on religious beliefs to
resolve their issues. Many Pakistanis try to live according to Quranic teachings, to lead a
simple and conflict free life. When problems or conflict occurs they prefer to seek God’s
help by the recitation of Quran and praying. They also believe that Islam offers complete
structure to lead a conflict free life because it promotes peace and discourages immoral
practices. Therefore, solutions are sought by staying on the righteous paths and through
compromises within the family.
According to Banu, “Often reading Quranic verses in the midst of turmoil helps
people cope with their depression or anxiety.” A majority of the respondents strongly
held that religious beliefs provide a solid ground to deal with the stress; however, not
everyone agreed that going to an Imam (Priest) for counseling can be fruitful.
Sajid stated:
For help in resolving family conflicts or issues our first stop is always a close
friend whom we can trust, especially here in the U.S.
67
The matter of trust is really crucial for this small community. Sajid further
stressed the role of extended family system in resolving marital conflicts by assuming the
role of counselor and instructing the couple to accept each other, when things get out of
control. Zain had a different opinion; he believed that in urban areas even in Paksitan
there is no longer reliance on extended family, and nuclear families are dealing with their
own issues.
Ego and Stigma as Cultural Barriers
A majority of Participants in the study affirmed that cultural barriers and
personally imposed barriers play an important role in discouraging Pakistani Americans
from seeking mental health services. Culturally there is a substantial stigma with the
phrase ‘mental health’ and services related to it. A majority of participants mentioned
‘ego’ as a significant barrier. The participants explained that the ego prohibits them from
bringing their personal and family problems to the surface and letting others in the
communities know about it. The majority of the respondents substantiated the need for
resources within the community. They also believed that although mental illness and
therapy for family conflicts, are not acknowledged, people do want to resolve their issues.
Only a few respondents were aware of the Muslim Association of Social Services
Foundation (MAS-SSF) and their counseling program. It was only because those
respondents were very active members of the community. A majority of the respondents
agreed that they would prefer that the community receive culturally competent services
68
from trained professionals. They stated that confidentiality is relevant for the PakistaniAmericans, because it is a small community.
Transition to Chapter Five
Based on the above results and the knowledge shared by the participants it is clear
that, just like other families Pakistani-American immigrants experience family stressors,
and these stressors can lead to an unhealthy environment affecting each family member.
Pakistani immigrants, especially first generation immigrants, are accustomed to receive
support from the extended family system which is unavailable in the host country. They
feel lonely because they cannot always trust community members as they do not share
old ties with them. As a result, the feelings of loneliness create frustration at the family
level, especially if the work and home environments are stressful and with no support.
Some of the stressors identified by the participants included intergenerational conflict,
dealing with post 9/11 stressors and acculturation issues such as arranged marriages. The
issues such as family conflicts, depressive feelings and other mental health challenges are
usually ignored at the community level. Barriers to seeking available resources include
ego, cultural issues, confidentiality, and cultural competency. It is expected to cope by
holding religion, recitation of Quranic verses, going to Imam, and trust on God.
Culturally, families believe that if they remain within the realms of the cultural
parameters, there will be more peace and less stress. Recommendations based on the
above results will be discussed in the next chapter.
69
Chapter 5
INTERPRETATIONS AND RECOMMENDATIONS
Introduction
This chapter wraps up this study; however, it does not conclude the process of
exploration into the knowledge, attitudes and perceptions of Pakistani-American
immigrants in regards to what constitutes a healthy and peaceful family. This chapter
discusses the results from the study and implications for future research. The findings
support previous studies have discussed the impact of migration on the PakistaniAmerican families and their attitudes and perceptions that in maintaining a healthy
family.
Discussion of Results
Pakistani-American immigrants interviewed for this study believe that family is
the basic unit in their social structure and a strong emphasis is placed on cohesiveness in
the family which is supported by previous scholarship (Malik,1989). The participants
affirmed that family members are all interdependent. The majority of the respondents
agreed that a stable family structure with defined roles and expectations are contributing
factors in keeping families healthy. Among the reported factors that contribute towards
an unhealthy family, is the absence of the extended family system as participants believe
that presence of the grandparents is important in raising children. This finding was
supported in a prior study by Hashwani (2005). The majority of respondents affirmed that
the extended family system is helpful in maintaining a healthy family life style because of
70
the emotional and physical support provided by the grandparents. Acculturation is the
most identified stressor both by the participants and as illustrated by the literature. The
participants mentioned that post-migration families have to navigate their way carefully,
especially when there is a huge difference in cultural religious values and world views
between country of origin and country of residence. Additionally, the language barrier
also impedes the process. Participants mentioned that many women, even if they are
involved in the workforce, still have to assume the responsibility of household chores,
with no support from their husband. Again this finding was supported in a prior study
(Gupta, 1999). According to the participants, there is no personal space or freedom
between husband and wife; husbands often try to be rigid in exercising their power to
discourage assimilation of their wives. One of the common themes which emerged is the
existence of a lack of compatibility and communication among husbands and wives,
which negatively affects the family environment, structure, and the development of their
children. A few participants mentioned the family values which encourage
interdependence vs. independence. To bring up children with strong religious and cultural
values was a stressor identified by all participants and throughout the literature review.
Both Tara and Fatima, who were raised in the United States, stated that following
religious values and being obedient to parents keep families healthy and peaceful. This
response supports previous studies related to added pressure on young Pakistani females
as daughters to preserve cultural and religious values i.e. avoid dating and conformity
with arranged marriages (Ahmed, 1999; Leonard, 1999). Preservation of cultural and
religious values is an integral part in the lives of the community members. Participants
71
also mentioned about the increase rate of divorce among second generation immigrants
especially due to transnational marriages which are usually arranged. According to one
participant, when a bride migrates from Pakistan she manages to adjust to her new life, as
compared to the groom who migrate from Pakistan who often does not want to put up
with a wife who has been raised with American or Western values. In these situations
there have been incidents of physical and verbal abuse which lead to divorce. According
to the participants many women choose to endure this abuse because they want to keep
their families together. Some of the self-imposed stressors were also identified by the
participants, such as competing to maintain status within the community. PakistaniAmericans push their children to excel in academics and pursue only professional
careers.
At the macro level Pakistani-American immigrants have to deal with the
repercussions of 9/11. This is an added stressor on the community members as it affects
their relationships both within both community and outside the community. Some of the
participants mentioned the discrimination that Pakistani face post 9/11. Others mentioned
the stress of grooming their children as the representatives of moderate Islamic values.
Experiencing discrimination and hate crimes have increased anxiety and stress for many
families. In order to cope with this anxiety and stress, families may need counseling and
professional help.
The identification of mental health challenges remains an issue as there are
barriers to acknowledging and seeking help. The participants stated that PakistaniAmericans do not like to share their personal business. The major barrier identified by the
72
participants and supported by the literature is cultural values. The participants felt that,
for many Pakistanis, Islam provides answers to all questions and offers complete
guidance. Pakistani-Americans try to find answers in their belief system to help them
cope with stressors including mental health challenges. Participants in the study
mentioned going to the Imam and seeking assistance in regards to challenges at the
family and individual levels. However, they confirmed that it is not a common practice;
there is an issue of confidentiality that is of grave concern within the community. A
majority of the participants agreed that there is a pressing need for culturally competent
professionals to whom the community members can approach. Some of the barriers
mentioned by the participants to seeking mainstream mental health assistance are:
language, cultural beliefs (i.e. taboo and stigma associated with mental illness), and a
mistrust of the Western based mental health service delivery method as supported by
previous finding by Livingstone et al., (2008).
Implications for Social Work Research and Practice
The study was conducted for clinicians who wish to learn more about the
knowledge, attitudes and perceptions of Pakistani-Americans related to what constitutes a
healthy and peaceful family. Cultural competency is an integral part of social work
practice. Social workers and clinicians are obligated to acknowledge personal biases. It is
imperative for clinicians and social workers to appreciate the unique and novel ways this
community has dealt with stereotyping and marginalization. It is important to
acknowledge the specific ethnic and socio economic background of this community. For
73
instance, first generation skilled and professional Pakistani-American immigrants are
more open to seeking mainstream help that is provided by a culturally competent
professional as compared to their counterparts who have immigrated under the Family
Reunification Act for employment opportunities. These later immigrants are more closed
to mainstream options for seeking professional assistance, relying either on seeking
assistance within the community or not seeking help due to many barriers. In both
scenarios they are disadvantaged because primarily there is no community-based
professional assistance available. Secondly, if they do not seek help then the problems
remain unaddressed, leading to an unhealthy family environment.
This study has implications for social work practice at the micro, mezzo and
macro levels. For culturally competent service delivery and policies it is important for
social workers to understand the cultural and religious values of the Pakistani-American
community and how these values shape their attitudes and perceptions especially, in the
host country. The National Association of Social Workers (NASW) Code of Ethics states
that social workers are obligated to advocate and assist the marginalized and
underrepresented population. According to Van Soest (1997), the development of
individuals and the development of nations are interdependent; nothing occurs in
isolation. A nation’s progress depends on the development and participation of its
communities. Therefore, for the growth of our multi-ethnic society, the participation and
development of this community is vital. As far as public policies are concerned it is
pertinent to include the voices from this community to understand and accommodate their
needs for services. Community members may need support in order to raise their
74
children in a positive and flexible environment where they can promote their cultural and
religious without violating the individual rights of each family member. It is hoped that
this study may contribute to better understanding for the social workers and clinicians in
regard to the role of religious and cultural beliefs and their impact on family dynamics
within the Pakistani-American community.
Limitations and Implications for Future Research
The major limitations of this study include its sample size and the selection
method. The sample size consists of 10 participants, too small to be used as a
generalization for all Pakistani-Americans in Sacramento region. Due to the snowball
sampling method the study did not have statistical representation of the entire population
of the Sacramento region; rather the participants were acculturated and a socioeconomically homogenous group. Also the study focused on participants’ knowledge,
perceptions and beliefs of members of the Pakistani-American community. Participants
did not share their personal experiences or beliefs. Future studies with a larger population
and random sampling method may provide deeper insights to the factors contributing to
healthy and unhealthy family life styles within the Pakistani-American community. It is
hoped that this study may lead to future research on the issues of domestic violence and
abuse among Pakistani-American immigrants covering a broad spectrum of geographical
locations.
Future research is warranted specifically on stressors related to acculturation and
the role of gender in dealing with these stressors. The study findings exposed similarities
75
with other immigrant families and communities. Therefore, a comparative study of the
families of the dominant culture and Pakistani-American immigrants can be beneficial to
appreciate the similarities within these communities, especially in regard to family
values. Furthermore, other research projects can also explore the comparison of
knowledge, attitudes and perceptions between first and second generation PakistaniAmerican immigrants regarding what constitutes healthy and peaceful families.
Summary
The participants in the study unanimously agree that some of the factors which
create an unhealthy family life style are a lack of communication between parents and
children, lack of compatibility among parents, unmanaged boundaries within the family
structure, and a language barrier for the first generation immigrants which cause their
children to assume the role of parents. Such factors then lead to a stressful family
environment. Other identified stressors were the process of acculturation especially
among first generation immigrants, raising religiously and culturally conscious children,
and the fallout from Post 9/11. The participants affirmed that some of the community
members have experienced discrimination, and it has increased anxiety and paranoia
among Pakistani-Americans as it has limited their visits to Pakistan, travel and tourism.
Nevertheless, a majority of the respondents believe that community members try to
utilize their belief system to deal with these stressors rather than seeking outside
assistance. Even when there are challenges such as mental illness, depression, and anger
management there are many cultural barriers that prevent the Pakistani diaspora from
76
reaching out. These barriers include, but are not limited to the mistrust of Western based
services and delivery methods. A few respondents were unaware of a local resource of
Muslim Association of Social Services Foundation that provides individual and family
counseling with a minimal charge. A majority of the participants voiced a need of
culturally competent services or non-profit organizations to provide mental health
services while understanding the predicaments of this community.
Recommendations
Based on the above findings, Pakistani American families in the Sacramento
region face many challenges during their acculturation process which lead to stress at the
family level. The stress level varies based on the level of acculturation of the immigrants.
Religious beliefs are identified as a coping mechanism for this community. There are
cultural barriers to seeking mental health services, and issues related to mental health at
familial and community level remain unaddressed. Before discussing or implementing
recommendations the first step is to identify the strengths of the community to utilize in
developing specific strategies. The identified strengths for Pakistani-Americans at the
family and community levels are: 1) Family cohesiveness; and 2) religious or spiritual
beliefs as coping mechanisms.
The Mental Health Service Act (MHSA) in California provides an opportunity for
underserved and un-served ethnic minorities to promote their human rights and well
being. Using the above mentioned strengths the strategies such as cultural competency
and a collaborative approach are recommended to reach out to the community.
77
1) Family cohesiveness: A majority of respondents identified the lack of a support
system due to the geographical distance from extended family system. Furthermore, they
also do not find support externally within the community. To deal with stressors families
need internal and external support systems. The external support system while
appreciating their strengths can provide them tools to gain strengths internally. These
tools can include but are not limited to: Skills for parenting, focusing on wellness and
recovery model, reducing stigma, and appreciating resilience. This will equip family
members including second generation immigrants to deal with the stressors and conflicts
at the family level.
2) Religious and spiritual beliefs: Religious beliefs are vital to this community as far as
coping mechanisms is concerned. The nation of origin does not have state funded mental
health services. Mental health services are usually received from private psychiatrists in
Pakistan, only when the condition has debilitating effects on functioning. A majority of
the population attempts to seek solutions through religion by reciting Quranic verses or
going to Imam(Priest). It is also important not to disregard entirely their coping
mechanisms, rather equip the key players such as religious leaders by utilizing outreach,
collaborative and culturally competent approach. Based on the above discussion the
following strategies are recommended:
a) Outreach is a key for hard to reach populations as far as service delivery is considered.
Culturally competent training helps providers in reaching out and assisting hard to reach
populations. Religion is very important and highly sought for answers within this
78
community. Therefore, either training of religious leaders or reaching out to the religious
leaders of this community is highly recommended.
b) Collaborative approach: Strong collaboration with mosques around Sacramento area is
highly recommended. Presentations at the mosques related to family issues can bring
awareness. Skill building activities related to parenting and dealing with acculturation
stressors can assist Pakistani-Americans to identify the issues. Family cohesiveness is
strength of the community therefore, primary care physicians, school social workers can
be the key players. If these key players are involved in building awareness, they can also
provide tools to cope with the intergenerational conflicts.
Domestic abuse or violence is a sensitive topic and it needs to be addressed with
caution. Family is the strength of these women; therefore, a parenting workshop is more
likely to attract these women as compared to empowerment workshop. Whether they are
ready or not to leave abusive relationships, collaboration with mainstream shelters for
women and children or local organizations such as Women Escaping From Abusive and
Violent Environment (WEAVE) is highly recommended. This approach will assist in
developing culturally congruent services for the victims of domestic violence while
providing them shelter or empowering.
c) Culturally competent practice: Instead of using Western based service models, this
community may be benefited by the development of culturally congruent interventions.
To meet this goal it is pertinent to understand the source and role of knowledge for the
specific immigrant minority such as Pakistani-Americans. In this manner the worldviews
of Pakistani-American and how they perceive themselves as family or as a community
79
can be incorporated. Female empowerment is crucial but it is pertinent to explore their
readiness in the area. The agencies and mainstream service providers may benefit in
thoroughly researching the cultural and traditional values that shape the attitudes and
behaviors of Pakistani-American immigrants. For instance, Western clinicians are
familiar and appreciate individualization and independence in contrast to PakistaniAmerican families. Therefore, if second generation immigrant youth have difficulty in
dealing with family issues, a clinician may not be able to understand the value this
community has placed on cohesiveness among family members or interdependence. It is
important for school counselors to understand the cultural values of this community, due
to the intergenerational conflicts faced by the second generation Pakistani-Americans
during their acculturation and assimilation process.
A cautious approach is recommended for clinicians during the assessment of
Pakistani-Americans because, although there may be uniformity in ingrained beliefs and
cultural values, each individual possesses unique ways to behave and react. Therefore,
service providers should refrain from their biases and be willing to open and develop
collaborative interventions.
Conclusion
The process of migration into a new land usually brings challenges in daily living
and can bring added stress. There is always a cultural shock, especially if there is a wide
gap in cultural and religious values between the host country and the country of origin.
Many Pakistani-American families who have migrated to the United States have gone
80
through such difficulties. The participants in the study acknowledged the stressors related
to acculturation process during their adjustment to the host country, particularly around
the intergenerational conflicts. They have also acknowledged the lack of extended family
support, and communication barriers between spouses and children. Moreover, a gender
disparity was identified as far as level of stress is concerned around the issue of
maintaining and retaining cultural and family values. Pakistani females feel more
pressure to comply with the cultural and religious practices as compared to males.
Participants identified the increase in divorce rate among second generation Pakistani
immigrants may be a result of arranged marriages, especially transnational marriages. As
a result, many families suffer emotional, verbal, and even physical abuse. Such an
unhealthy environment affects a healthy and peaceful environment of the families. Apart
from the internal family stressors, the tragic event of 9/11 has created an external stressor
for this community. A majority of participants identified religious and spiritual beliefs as
the only coping mechanism. Cultural barriers play a significant role in whether these
immigrants choose to seek support, especially from mental health professionals as there
is a stigma attached. Furthermore, there is a prevalent apprehension related to culturally
competent services.
This study attempted to identify the struggles and challenges of PakistaniAmerican families in maintaining a healthy and peaceful family environment. It is hoped
that future studies will assist Pakistani-Americans with the acculturation process. During
the study very powerful voices, especially from females, emerged depicting resilience
and the capacity to utilize the tools or skills in the areas of promoting healthy and
81
peaceful family environment. Pakistani-Americans may benefit with the services of the
mainstream professionals in this regard.
With the growing integration of different cultures and ethnicity in our society it is
the ethical responsibility of social workers to appreciate the cultural diversity and
promote the utmost capacity of individuals and communities for growth. After all, our
nation stands for the promotion of basic human values and needs.
82
APPENDICES
83
APPENDIX A
Individual Interview Guide
Q. 1 In your opinion what factors are important for Pakistani-American
families to be healthy and peaceful?
Q. 2 What are the factors, in your opinion, which make families unhealthy?
Q. 3
What are the stressors that contribute to unhealthy environment for
Pakistani-American families?
Q. 4 In your opinion what role does your belief system plays in coping with
the above mentioned stressors.
Q. 5 Apart from your belief system, what are the other sources available in
Pakistani-American community to deal with the stressors at familial
level?
Q. 6 Do you think Pakistani-American immigrants should have resources
available in the community to deal with the stressors at familial level?
Q. 7
If yes, then how would Pakistani-American immigrants access those
resources?
84
APPENDIX B
Consent to Participate in the Research Study
Salam
My name is Iffat Hussain and I am a social work graduate student at the California State
University Sacramento (CSUS), Division of Social Work. I am requesting your help for
my thesis. You are invited to participate in an individual interview in order for me to
gather some information about the knowledge, attitudes and beliefs prevalent among the
Pakistani-American community in Sacramento in regard to healthy and peaceful families.
The aim of this study is to understand the world view and beliefs of the community in
seeking family services. I am conducting this study under the direction of my thesis
advisor Dr. Maura O’Keefe, Professor at CSUS, whose contact number is 916-278-7067
Procedure:
This study will involve individual interviews. If you choose to participate in the study,
then I will be your interviewer. Your participation is strictly voluntary so you may choose
not to answer any particular question or withdraw yourself for any reason, at any time
during the study. The individual interview will include a set of questions which will last
for an hour and a half. Therefore, you will be asked to decide the convenient time and
location of your choice to conduct these interviews. As a part of the research process the
interview will be recorded. This will aid me in taking accurate notes. Again no one will
have access to the recorded information and it will be destroyed upon the completion of
the study. Participation is strictly voluntary and your decision to complete or not
85
complete this interview will have no consequences. However, if you choose to participate
you responses will remain confidential and anonymous.
Risks:
Although not anticipated, should you experience a psychological discomfort as a result of
the interview, you can stop the interview immediately. To minimize any risks feel free to
stop answering the questions for any reason; again your participation is strictly voluntary.
If you need a referral one will be provided to a non-profit agency, Muslim Association of
Social Services Foundation in Sacramento (MAS-SSF). The contact information of this
social service agency is provided for you at the bottom of the consent form.
Benefits:
The participants will not benefit directly by their participation. The resulting benefits of
this study will be the knowledge added to the social work profession and to the
community; perhaps an increased awareness related to the knowledge and attitudes of
Pakistani-American in regard to what comprises of a healthy and peaceful family.
Compensation:
Participants will not receive any form of compensation.
Confidentiality:
Your confidentiality is very important. In an effort to protect the privacy of the
participants, all answers will remain anonymous. The researcher will keep the obtained
data in a secured place where only she will have access; in no way will anyone be able to
identify you and link you to your answers. The consent form will be collected and stored
separately before the interview. No one else other than the researcher and my advisor will
86
have access to the collected information. Approximately, one –two months after the
completion of this study, all collected information will be destroyed.
Right to withdrawal:
Feel free to stop at any time if you no longer to wish to participate in this interview. Your
participation is strictly on a voluntary basis.
Thank you for your time:
Sincerely
Iffat Hussain (Researcher)
Email: iffathussain2001@yahoo.com
Phone number: 916-717-5213
Contact Information for Referral Source:
Muslim Association of Social Services Foundation (MAS-SSF)
3820 Auburn Blvd, Suite 83
Sacramento, CA 95821
(916) 585-4773
masssfsac@yahoo.com
I accept the terms of this consent form and agree to participate in the study by agreeing to
be interviewed.
Signature or initials: _________________________________________
87
APPENDIX C
Support Letter
To,
Human Subject Review Committee,
California State University, Sacramento
600 J Street
Sacramento, CA
Date: May 12, 2010
Re: Support Letter for Iffat Hussain
Dear Committee Members,
On behalf of the board members of Masjid Ibrahim Islamic Center, I am
providing you my assurance to support Ms. Iffat Hussain, a graduate student at your
esteemed institution, in conducting her research. Our board members are also willing to
permit her to utilize Masjid Ibrahim Islamic Center to interview the potential participants.
Masjid Ibrahim has been an Islamic Center for many Muslim communities for more than
a decade. A large number of Pakistani-American Immigrants come to this Masjid
regularly to pray and gather here for different community events. Therefore this location
will assure a safe, secure, and culturally competent location for the potential participants
in the above mentioned study.
We believe that this study is crucial in examining the knowledge, attitudes and
perceptions of Pakistani-American Immigrants regarding what constitutes a healthy and
peaceful family. It will assist Pakistani-American Immigrants in particular, and other
American Muslim Communities with similar cultural values in general.
Yours truly
Imam Luqman Ahmed
88
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Journal of Muslim mental health, 2(1), 5-20. doi:10.1080/15564900701238468
Ahmed, B., Reavy, P., & Majumdar, A. (2009). Constructions of ‘culture’ in accounts of
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