Socio-political aspects of mental health practice with Arabs in the Israeli context.
Since the 1948 establishment of the Israeli state, an event described by Arab peoples as "Al-Nakbah" (catastrophe), the Arab minority in Israel has experienced oppression, trauma and social exclusion; they feel defeated, disempowered and poorer. There are huge gaps in quality of life between Arab and Jewish Israelis. Such social inequities, as well as other issues such as polygamy, have been identified as risk factors for psychological distress. This situation puts the Israeli Arab, like other post-colonial peoples, in an attitude of ambivalence towards modern mental health services. On the one hand, certain forms of intervention, particularly medicinal, may improve peoples' lives. On the other, mental health services, as part of the colonial process, continue to present limited cultural sensitivity towards Arab peoples. A cultural gap leading to mistrust is a given when a non-Arab mental health provider comes into contact with an Arab client. Religious beliefs, the importance of the family and the stigma attached to mental health problems have substantial influence on the Arab's perception and reaction toward mental health problems and their treatment. The expression of conflict and negative feelings are not well accepted within Arab culture. For this reason, mental illness is often denied and kept away from professional help or expressed as a physical illness. There is also a difficulty for a male being treated by a female and for the individual to ask for help outside his family or community. Arab Muslims also generally have a tendency to resign themselves to God's care and thus may neglect or deny symptoms. Another tendency is the preference for using traditional healers and folk medicine. Other problems in mental health work are the passive attitude of the patient and the degree of authority vested in the therapist. To facilitate bridging this cultural gap, the therapist's first task is that of educating him/her self about the religious, cultural and national background of the client. Cultural competence and self-reflection are key components to effective cultural practice.