I was going to post a link to an article by a Muslim doctor in the Albany, NY area, but it has been pulled from the med.yale site. (is this a positive sign?)

Kobeisy tries to explain why medical institutions must understand Muslim culture in order to understand shame. Seems to me that shame or discomfort in undressing or in the context of various medical examinations, especially for women, but also men, is universal. If Muslim shame is worthy of special notice and accomodation, then the fault lies with Islam.

At any rate, here is a bit from the article in my files:

The Yale Journal for Humanities in Medicine

“Shame in the Context of Illness: An Islamic Perspective”

Ahmed Nezar Kobeisy, Ph.D.
akobeisy@syr.edu

In the beginning, I would like to acknowledge the complexity and the limitations that surround this topic.The complexity arises from the intersection of the many Muslim cultures represented in the American Muslim community and the Islamic religion in ways that make religion and culture confused and defused with each other in determining the type and level of shame in the context of illness.

snip

Generally, it can be stated that the main influences on Muslims’ views of illness and treatment include religion, cultures, and individual preferences. American Muslims, like all other groups, can be described in terms of universal, group specific and individual values and attitudes towards illnesses.

Because shame is equated with dishonor, disgrace and something that brings regret, censure or reproach, Shame is often associated with conscientious of guilt, shortcoming, or impropriety. It, therefore, leads to the assessment that the current situation affects negatively one’s identity

Religious and cultural factors that may cause shame in illness:

1. The way patients and their families view illness: While some Muslims view illness as a test from God to examine their submission to His well and, at the same time, as an opportunity to seek rewards and expiations for their sins, other Muslims view illness as a punishment from God for their past wrong doing. Individuals from the latter group are likely to feel ashamed of their illness which is, in their own minds, indicative of their sinfulness.

2. Illness as a cause of dependency: when illness causes patients to be dependent on others for usual daily needs and basic necessities, particularly for an extended period of time, the patient is likely to feel ashamed and less dignified.

3. The type of illness: while internal illness may not cause shame, social and visual illnesses may bring a great deal of embarrassment and shame to the patient particularly those linked to life-style practices such as sexually transmitted diseases, HIV, and sexual dysfunctions.

4. Mental illnesses have been always seen across many Muslim cultures with stigma and shame associated with them.

5. Terminal illnesses: for both religious and cultural reasons, most Muslims would not want to communicate the diagnosis of terminal illness to their loved ones. They would feel ashamed to inform the patient with such bad news. In such cases, shame is considered one of the feelings and emotions that the patient and his/her family members develop as a defense mechanism. The sequence of reaction ranges from uneasiness, a need for reassurance, denial and minimizing, anger and blame, guilt and shame, confusion and finally the acceptance of reality. Patients themselves feel ashamed for being inflicted with such diseases.

6. Illnesses that result from the violation of religious values or cultural norms can also produce shame. Alcoholism and out of wedlock pregnancy are but a few examples.

7. Uncovering one’s body: The Islamic religion commands modesty and specifies general criteria for what men and women can wear in public as a manifestation of modesty and respect in public. Men and women, for instance, are discouraged or even prohibited from uncovering their bodies, to various degrees, in the presence of related or unrelated members of the opposite sex. Spouses are exempted. In illness, many Muslim individuals reported feeling ashamed for being forced to uncover, sometimes, unnecessarily or longer than it is necessary. The complaints included the way the instructions are given (e.g. commanding and humiliating tone), lack of explanation as to why it is necessary to uncover, and the lack of accommodation for Muslim patients.

8. Discrimination: Stereotyping Islam and Muslims is commonplace particularly in media, workplace, schools, etc. Such negative images and stereotypes have paved the way for institutional discrimination which has been cited as one of the forms of societal shaming practices. Whether discrimination is real or perceived, Muslim patients may translate such discrimination into being labeled as being defective, deficient and unworthy, all of which are shaming messages.

9. Illnesses that are related to intimacy and infertility. Both Islam and most Muslim cultures value and respect the confidentiality of private life. Shame is likely to be prevalent if the Muslim patient is forced to uncover details of intimate and private life that may expose one’s own self or other related ones let alone faulting one’s self or relatives. The feeling of shame could be intensified for having exposed one’s own weaknesses and for violating the confidence of loved and respected ones. Illnesses related to sexual inadequacy, impotence, and infertility for both men and women are considered shameful in most Muslim cultures and looked at as signs of defectiveness and deficiency in one’s manhood and womanhood.

10. Excessive demand for personal information that may reveal weakness or inadequacy (e.g. unemployment for males, not having children for both men and women particularly of married women, poverty, lack of family support, or lack of adherence to religious or cultural norms) may produce shame in Muslim patients that takes roots in either religion, culture or both. Recent immigration, refugee status, low income and less education could intensify such feeling.

11. Lack of friends and family presence on the bedside could be shameful especially for families who have been accustomed to living with their large extended families. Muslims value close family ties among members of the extended family which in turn serve as strong social support system. In most Muslim cultures, patients are always surrounded by relatives for support and service. Furthermore, individuals are accustomed to bragging about the strength of the support they receive from their families. In the United States, most Muslims, whether immigrants or converts, lack the existence of family support systems for many obvious reasons including immigration policies, economical reasons, and religious differences as in the case of converts.

12. The cultural pressure which focuses on image and appearance could be the source of shame for the patients who do not fit this image. Failure to have the perfect body image or to display the correct public etiquette is likely to cause embarrassment and shame. This includes issues like overweight, disability, dependence on others for basic needs among other things. Fear of not adhering to the rules of the medical personnel or institutions is likely to cause shame as well.

13. Gender interaction is a highly sensitive concern among Muslims that may produce shame if not observed correctly. To explain, male’s affection and attention to female patients often cause shame and possibly concern for the female and her family to a higher degree more than that of the female medical staff showing the same with the male Muslim patient, although both situations could produce shame to the patient. Direct touching and affectionate expressions should, therefore, be avoided. Direct eye contact may be seen as threatening and/or expressive of sexual feelings or interest.

14. Invasive and intrusive medical procedures particularly those that relate to the examination of the patient’s private parts could be seen by Muslim patients as shameful. For men, it may be seen as humiliating and ill-driven especially when it is not well explained and/or un-necessitated medically. For women, if vaginal examination or delivery done by a male without medical emergency, it may cause shame to the patient and family. It would be helpful if the medical personnel inform the patient of the procedure, the purpose and the gender of available staff for such procedure and allow the patient to freely express his/her preferences not only as to what can be done but also as to who should they feel comfortable with doing it.

15. The tendency in the medical field culture that assigns responsibility and blame to the patient as explanatory for the cause of illness. According to this model, the patient is responsible for the onset, and outcome of the medical condition Finerman and Bennett, 1995). According to Finerman and Bennet (1995):

Connie on October 7, 2007 at 1:31 PM

Reading the comments section at the site gives one hope that the Brits may be able to save their country after all.

Connie on October 7, 2007 at 1:49 PM

leepro on October 7, 2007 at 2:33 PM

Did he really need a sarc tag? This is Hot Air, after all.

Connie on October 7, 2007 at 2:37 PM