I'm fine. It's just eye sweat.

Written for the July '22 edition of SyrProNet's Medical magazine.

My legendary dad, my fabulous superman, was the epitome of an Arab alpha: courageous, not afraid to say what’s on his mind, assertive, honest, dependable, kind, and a leader with a towering presence that no one could refute. He unexpectedly passed away in his sleep last year at the age of only 71, healthy as a horse. I’m a firm believer that death is absolutely certain for each and every one of us, and we can do nothing to change neither time nor circumstances. But, as part of coping with my grief, I strove to find an earthily explanation as to why this happened. Could the mélange of my mom’s recent cancer diagnosis, the global pandemic, the war in our Motherland, my sister and I being away from home, contributed to a state of severely heightened anxiety that ultimately caused an irreversible stress on his heart?

Without a doubt, there is a strong connection between the mind and the body. If one struggles, so will the other. Absolutely no one is immune to this, mental health doesn’t discriminate. There is an abundance of evidence that points towards mental health being a significant independent risk factor for heart health[1]. Cardiovascular disease is the number one cause of death in the Middle East and North Africa (MENA) region, responsible for more than one third of all deaths[2]. Among these patients, mental health is a significant comorbidity that leads to increased mortality and somatic symptoms of cardiovascular disease[3]. This is intensified by the intersection between gender and culture having an impact upon the attitudes of men that may be struggling towards help-seeking, especially for a subset of Arab men[4].

Following my dad’s passing, I spent prolonged periods reflecting on the stigma around men’s mental health, its roots in social norms, self-perception, and cultural beliefs. In some parts of MENA, the perceived image of an Arab man continues to be ridden with toxic masculinity. “Hajeh tibkee, shed halak. Stop crying and get yourself together; it’s not good for your reputation, what will people say if they find out? Real men don’t show weakness, you must stay tough.” These boys are taught by society and pressured by the culture to suppress emotions, equating this to mental fortitude and family dominance.

So how does this repression of mental health manifest? Often, these symptoms hide behind hostile emotions and appear as physiological ailments: anger, irritability, , high blood pressure, headaches, cardiac disorders, digestive issues. Seeking treatment for these may superficially make these men feel better, but it never gets to the root of the cause. Layer on top of that the fact that seeking Western-style medical or psychological treatment for deteriorating mental health is not yet a fully validated option in most of MENA. Rather, this may be perceived by some as personal failure, family shame, and even to the extent of a genetic weakness limiting marriage opportunities.

Despite the intricacy of destigmatizing mental health for this subset of Arab men, the Middle East has taken very few steps forward towards intervention and activism surrounding this topic. So how can we come together to fight this silent suffering before it is too late? The solution is actually quite simple: just as with chronic physiological diseases such as diabetes, mental health is a TREATABLE disease. These treatments (psychotherapy, medication, peer support, alternative medicine) need to be normalized and more accessible in the Arab nations. We must stop stigmatizing, shunning, and discriminating; we must continue to reshape our cultural dogmas, battle misconceptions, and promote awareness on this topic. It is our social responsibility as a community to normalize help-seeking, reach out if we see someone suffering in silence, and partner with governments to create awareness in academic curricula and community outreach events.

There are absolutely no signs that mental health symptoms, which have been surging globally, will slow down. How could they, amidst a global pandemic, civil unrest, political volatility, an imminent recession, and deteriorating climate change? Nurturing mental wellness for everyone has become a collective social responsibility. Leonard Cohen once said “There is a crack in everything. That’s how the light gets in.” Yallah ya shabab, let’s take that light to talk and use it to unravel unashamed conversations. Share your story to inspire other men so they know that they don’t have to struggle alone in silence.

[1] De Hert et al., Coronorary heart disease and mental illness. Dialogues in Clinical Neuroscience – Vil 20, No 1, 2018.

[2] https://world-heart-federation.org/where-we-work/middle-east-north-africa/

[3] Nemero? CB, Goldschmidt-Clermont PJ. Heartache and heart-break—the link between depression and cardiovascular disease. Nat Rev Cardiol. 2012;9:526–39

[4] Hall, R. A. (2021). No Assistance Necessary: Arab Men’s Attitudes towards Health Issues and Help-Seeking. Open Journal of Social Sciences, 9, 9-23.