CAIRO - Abdallah Seleem doesn’t watch the news anymore. It’s disheartening, he says, to see how far Egypt has slid from its initial optimism after Hosni Mubarak stepped down last year. It causes him too much stress about the future.
“You’re too frustrated to talk about it,” says Seleem, 25, who is unemployed. “It’s like despair, it’s like you’ve lost faith in people. You’ve lost faith in the process.”
Seleem used to talk politics with friends, but now sees it as a waste of time and energy. He prefers to focus on moving and finding a job outside Egypt. “My goal is to leave here,” he says, “because it’s driving me insane.”
Continued exposure to violence, upsetting news, and worsening economic conditions have left many Egyptians feeling stressed, and mental health professionals say the psychological effects of the last 20 months have remained widely unaddressed.
Egyptians now feel less safe due to rising crime rates, as well as confused and anxious about the future because of the prevailing political instability and deteriorating economic situation in the country.
Witnessing violence — either firsthand or through news reports — has proven traumatic for many people, leaving them insecure, according to the student researchers at the American University in Cairo during a study carried out this spring in partnership with the Ministry of Health’s General Secretariat of Mental Health.
Mental health issues in Egypt have long been stigmatized, a challenge for practitioners who have observed an upward trend in anxiety, insecurity, and stress among patients and the general population since the revolution began last year.
The goal of the study was to determine whether a special government program specifically targeted at those feeling the psychological effects of the revolution was necessary, and if so, how it could best reach those who needed treatment the most.
The program, named Nawafez, Arabic for “windows,” endeavors to channel mental health resources toward Egyptians across the socioeconomic sphere.
“We are helping all people who ask for help and who are victims of violence either in a direct or indirect way, and we shall be addressing the more vulnerable groups,” said Basma Abdelaziz, who led the media and awareness office in the General Secretariat of Mental Health when students carried out the study this spring. “People in poor areas, people who have no access to psychological help, and also those do not know that they have a problem.”
Hotlines, radio shows
A lack of awareness about mental health issues and the symptoms associated with them has created a barrier to mental health services, said mental health professionals, who have found themselves coming up with creative ways to reel people in.
They have set up hotlines, and a radio show about violence aims to connect listeners in need with mental healthcare services.
Any changes must overcome the strong stigmatization of mental health issues in Egypt, particularly the perception of Abbasseya Hospital as a “loony bin” where only the most severely disturbed patients seek care, an image cultivated in the media.
“That’s unfortunate, because you would want people to think of these hospitals as a place of safety and healing,” says Mona Amer, an assistant professor of psychology at the American University in Cairo, who supervised the study with Abdelaziz.
Lack of faith in the Ministry of Health has further turned people off, Amer adds.
“These are intimate services, to ask for help for these types of personal problems,” she says, “particularly when we are coming out of a revolution where people felt little trust in the government.”
Mental health professionals generally employ an outpatient model, where patients are expected to come to them, according to Amer. Clinics, which take on a form similar to practices in the West, often cater to the upper class, she says.
People from lower income brackets must rely on state services at public hospitals or clinics, but, Amer explains, generally only come forward when their psychological problems have reached a severe state.
This confluence of factors hits members of the middle class the worst, she adds; they cannot afford private clinics but avoid public services due to the stigma attached to them.
Nongovernmental organizations that do work with lower- and middle-class populations typically do not focus on mental health, Amer says. “The mental-health experts don’t often go into the streets, and the people who do go into the streets don’t often have any mental health expertise.”
Religion and family support
With their hesitancy to use institutional services, Egyptians often turn to more traditional means.
Religion and family support have helped many people cope with increased stress and anxiety since the revolution, the AUC researchers found.
A woman in one of the researchers’ focus groups said a rise in crime in her neighborhood made it hard for her neighbors to sleep well and continue life as normal, whereas before the revolution, neighbors would leave their doors open, according to Tiya Abdel Malek, who helped lead the focus groups this spring.
“The woman explained, ‘All of a sudden you wouldn’t trust your own neighbor anymore,’” Abdel Malek says.
Nearly 60 percent of survey respondents gave answers that suggested a diagnosis of post-traumatic stress disorder could be appropriate.
In addition, researchers reported “no significant differences in trauma levels or coping styles between those who were active protesters and those who were not.”
Meanwhile, the Psychological Health Awareness Society in Egypt (PHASE), a nonprofit founded in 2006, recently rolled out a media campaign to raise awareness of the social and psychological phenomena of violence.
PHASE cofounder and psychiatrist Heba Habib says the revolution had given her organization a new urgency.
From the Maspero clashes to the battles on Mohamed Mahmoud Street, violence and news of it have led to an increase in sleeping disorders, depression and anxiety among the general population, Habib says.
The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.
Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.
Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."
Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.
Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.
Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.
Oppressive home situations
As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.
Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.
Calls from lesbians and trans men to prevent forced marriages during lockdowns.
Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.
"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."
Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."
Lack of spaces
Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.
"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.
The pandemic has forced some queer people to come out
Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.
Lockdowns force coming out
According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.
"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.
Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.
Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.
"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.
The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling
In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.
"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."
Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.
Medical care is dismal
Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.
Isolation triggered my depression
"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.
What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.
During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.
As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."
Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.
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