More schizophrenia. More often depressed. More psychosis, more fear. Moroccan Dutch – like many other migrants – are more likely to develop psychological problems. And it does not matter whether it concerns first generation migrants or their children. How is that possible, psychiatrist Madelien van de Beek wondered. “You don’t see that with someone who migrates from Germany to the Netherlands.”
Last week, Van de Beek obtained his doctorate at the University of Groningen for a study into the mental health of Moroccan Dutch people. There is scientific consensus that social factors play a role in the recipient country. Van de Beek wanted to know what these factors are: whether discrimination makes, for example, more vulnerable to depression. Whether living between two cultures affects mental health. And also: how Moroccan Dutch explain their psychological problems themselves. How do they deal with it? Are they looking for help? Or are there thresholds?
She talks about it the day before her PhD, in the kitchen of a corner house in Zwolle – while the children trickle into the house after school.
The discussions on the forum were mainly about the question: what do I have and what can I do about it?
“When I started my psychiatry training,” that was in 2009, “the focus was on genetics.” The prevailing thought at the time was: anyone who searches for causes for psychological problems will find the answers mainly in the patient’s genes. Van de Beek visits conferences, does genetic research during an internship. She sees how pleased the field is that finally something can be measured in the field. Van de Beek, while trying to suppress a laugh: “I just didn’t see it! I thought: does this now bring us closer to better care?”
She feels especially related to social psychiatry, a movement that has been ‘snowed under’ at that time. This movement revolves around the patient’s environment: what is the role of poverty, for example, of debts, of a divorce? Pragmatism also plays a part in her preference: “Genes cannot be changed,” says Van de Beek. “But suppose you find factors in society that influence a person’s mental health? Then maybe you can do something about that.”
wealth of information
Over the past eleven years, Van de Beek has mapped out existing literature and has interviewed Moroccan Dutch people with psychological problems, among others. In addition, she tapped into a new source: Morocco.nl. In those days – around 2013 – the website was a lively forum, with 50,000 unique visitors every day, mainly young Moroccan Dutch from all over the Netherlands. No subject was left untouched, says Van de Beek. “If you googled ‘I have a stain’, you either ended up on the Viva forum or on Morocco.nl.”
Even when it came to psychological problems, there was a wealth of material, as it turned out. “The fascinating thing was that people there anonymously put their story on the table. And then a long discussion often ensued.”
Religious approach
Van de Beek analyzed more than two thousand contributions on this subject. She saw visitors who suffered from discrimination, had difficulty finding a job or an internship “because their name is Achmed”, and did not feel part of society: factors that directly linked the forum visitors to their psychological problems.
Incidentally, not only the ‘inhospitable’ Dutch culture played a role. Elements from Moroccan culture were also mentioned: the ‘strict upbringing’, in which emotions are not easily shared and one prefers to keep one’s problems quiet, is associated with psychological complaints.
Van de Beek: „I then thought: this is serious. We cannot prove that problems caused by discrimination or social exclusion to arise. But you do see that the way in which a society treats a population group can have consequences for psychological well-being.”
Teased by a jinn
Van de Beek saw more. “The discussions on the forum were mainly about the question: what do I have and what can I do about it? There were people who approached such questions religiously, she explains. “Someone thinks he is being plagued by jinns, for example, invisible beings, and the solution that comes with that is: go to a religious healer.” Others viewed their complaints as ‘regular medical’. They said: go to the doctor.
“But just as often, those two views simply exist side by side,” said Van de Beek. “That was a very important finding for me.” Because with that, she says, you can do something in the consulting room. “Now the therapist’s reflex may be: a jinn? Oh dear, then I can stop my treatment.” That is not necessary at all, she says. Different treatments can co-exist. “People also advised each other that: try first” roqyarecite Qur’anic verses, and if that doesn’t help, go to the doctor.”
But how should a doctor deal with someone who says: I’m being teased by a jinn? Or by whisperings? “First of all, don’t let it scare you. Because the question is: should you, as a practitioner, work with that jinn? You can help someone who is depressed with a daily routine, perhaps praying and visiting mosques will provide structure. One explanation or treatment need not exclude the other.”
People said: I didn’t learn to talk about emotions
In the conversations and analyses, she also saw confirmation of how strongly it is taboo to talk about psychological problems. Contrary to her expectations, this taboo does not so much stem from faith. There is a parenting effect: “People said, I didn’t learn to talk about emotions.”
But migration itself also plays a role. “Migration is drastic. You have to imagine: father went to the Netherlands and mother stayed behind, with three or four children. They had to rebuild everything. Their children say: my parents had a very hard time, I have a roof over my head, I have bread on the table. Then you don’t go to your mother: Mom I’m gloomy.”
It was not the approach of her research, she says, but Van de Beek has become convinced along the way that the health care for migrants could be improved. She pleads for care providers who are aware of the supportive role that faith can offer. Aid workers who ‘take off their medical glasses’ more often. And also for cooperation with Islamic healers or imams. “If care providers know better what is going on around taboos and the way in which people explain their illness themselves, then you can only bridge a gap.”