In September 2022 in Iran, Mahsa Amini was detained and beaten by morality police over an inadequate hijab. She had a few hairs edging out from behind her headscarf. She was later killed in police custody. After the story broke, Iran erupted in widespread protests demanding justice for Mahsa and freedom and civil rights for all women. In unprecedented revolution, women and men took to the streets in large enough force to get global attention and the protests have continued for months now. Women’s traumatic experiences arising from patriarchal oppression are human rights violations (Critelli & McPherson, 2019). The personal is political and as traumatologists, we must not be afraid to traverse this topography with our clients. Violence and oppressive action toward women have had devastating effects on many women in Iran. One study reported the rate of physical aggression victimization in single and married female samples in Tehran was 55% and 60%, respectively (Ghahari et al., 2006). Other studies examining rates of interpersonal violence (IPV) in Iranian cities report prevalence rates as high at 83% (Faramarzi et al., 2005; Vakili et al., 2010). In Iran, women have high rates of suicide and the prevalence of self-immolation in young married women has risen significantly over the years (Ahmadpanah et al., 2017; Cleary et al., 2020; Mirhlashari et al., 2017).
How can we as a community of traumatologists work with women faced with such systemic forces? How can we support the larger global communities as they face the sequelae of constant oppression? Can traditional psychotherapy based in a medical model help, especially when most manifestations of oppression are not even recognized as a Criterion A trauma? Perhaps unsurprisingly, very little research has been conducted on this topic. One study found narrative exposure therapy to significantly reduce PTSD and depression in women currently living under continuous interpersonal threat and violence in Tehran, Iran (Orang et al., 2018). In another study that provided group-based compassion focused therapy, Daneshvar and colleagues reported reductions in suicidal ideation (2022a) and increases in meaning of life (2022b) in Iranian women exposed to IPV. Overall, results show some improvements, but effects reported ranged from small to moderate. It is also reasonable to question how long lasting the effects of these approaches are. Further, it is important to consider what adaptations to standard therapy approaches need to be made to support these women. Perhaps most radically, what about stepping out of the westernized clinical psychopathological framework?
First and foremost, person-centered approaches may help counter the sense of disempowerment many Arab women experience (Beaini & Shepherd, 2022). This person-centered approach is not to be conflated with an individualistic lens. In Arab cultures, the family system is the center point through which individuals organize their internal experiences. Rather, this approach may be effective in supporting women to find their own unique balance of maintaining cultural identity while uncovering safe and supportive perspectives, practices and resources. Another framework that may offer great value in working with Arab women and other women facing culturally sanctioned human rights violations is liberation psychology. Liberation psychology offers emancipatory approaches to understanding and addressing oppression and its sequelae (Rivera & Comas-Diaz, 2020). This alternative lens invites practitioners to step out of individualist, colonial, pathologizing, Eurocentric and hierarchical perspectives and into dialogues, conceptualizations and approaches that place people in a larger, interconnected praxis. Recovery does not lie solely within the people experiencing trauma but requires official accountability and larger systemic changes. A simple illustration of how this lens can be applied is to provide reflections that acknowledge the political structures associated with inequality. Instead of simple reflections such as, “you’re hurting,” a provider might say, “it makes so much sense you’re feeling this way when your context has an oppressive structure that continues to harm you.” Providers may encourage clients to explore what it may look like to react, share and respond from a place of already being liberated from oppressive systems – even if not fully liberated. Instead of shifting to the all-too-alluring tendency to “fix” or make someone “better,” providers can practice stepping back from labels like cognitive error and limited ability to cope. Providers may explore the rich cultural tapestry of each individual for resources, including mythology, art and the reclamation and possible customization of certain spiritual practices that feel liberating and connecting. In fact, one study reported reinforcement in faith in God to be one the most important resources Iranian women use for gaining piece of mind (Mirabzadeh et al., 2014). Of note, it will be critical for providers to also stay awake to their own tendencies to pathologize collectivist culture. An additional important area of exploration will be to help individuals identify whether and how any symptoms of shame, self-doubt, guilt or fear become embodied as internalized oppression. In sum, women who face culturally sanctioned oppression may need additional therapeutic ingredients beyond traditional therapy. Rather, these women may benefit from oppression-focused perspectives and approaches that ultimately serve to empower and liberate. By doing so, we commit to healing that is in collaboration with our clients’, our own and all culture’s past and future ancestors.
About the Author
Dr. Amanda Khan (she/they) is first-generation daughter of a Muslim Pakistani immigrant and third-generation of a Germanic-Scandinavian parent. She is a licensed clinical psychologist and researcher working in private practice in California and at Sage Integrative Health, a Bay Area holistic psychedelic clinic. She also serves as a psilocybin therapist on the UCSD clinical trial for phantom limb pain. Dr. Khan specializes in the assessment and treatment of PTSD, depression and anxiety and provides depth and somatic-oriented trauma work, ketamine-assisted psychotherapy, and post-psychedelic integration. Dr. Khan has completed ketamine-assisted psychotherapy training with Polaris Insight Center, MDMA-Assisted Therapy with MAPS and psilocybin training with the University of California-Berkeley. Dr. Khan served as Chair for the ISTSS Moral Injury SIG for three years and currently serves as Contributing Editor for the Trauma and Diversity column in StressPoints. She volunteers her time mentoring minority trainees, has led numerous diversity-related efforts across several institutions and gives regular invited talks, presentations and workshops.
References
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