on a Vital Issue
By Hilary Diack
Ten years ago therapy was a taboo subject, something to be discussed in hushed tones, if at all. Now there is a greater public awareness, thanks to media coverage and the establishment of more professional facilities, the stigma has been lifted. Cairo West Magazine had an insightful chat with Dr. Abdel Nasser Omar, Professor of Psychiatry at Ain Shams University and CEO of Al Mashfa Hospital about the ins and outs of therapy.
CWM: The perception is that women are more likely to seek the services of a psychiatrist than men, especially in Egypt. Why is this case?
AO: In Egyptian culture and society males have traditionally been raised to hide any emotions, which are considered a sign of weakness, and maintain an image of being in control. This is why they do tend to leave situations until they are really unmanageable before seeking professional help. Nowadays, thanks to more information being disseminated to the public at large via television, such as my weekly programme, and other forms of media, we see an increasing number of men coming for consultations and opening up about their problems.
What ratio do you see?
Currently it is around three to one, with women predominating. There is an increase of males seeking help though, often with the support of their spouses, couples come together much of the time.
What do you attribute this increase to?
Much of it has been since the events of January 2011, through the economy being hit and a related drop in job security and family incomes. Again, this goes back to the traditional male role of being breadwinner and provider for his family. It is not only a matter of personal self- esteem and confidence, in Egypt there is a limited amount of privacy, so the parents, in-laws, and even the grandparents can be a source of criticism and pressure. It is not surprising to see so many men struggling with severe depression, anxiety and loss of self-esteem as they find it more difficult to make ends meet. It is worth noting that the middle classes tend to fare better, where both the man and woman are working and sharing the financial burden and domestic responsibilities. There is more empathy due to the shared interest in survival and stability.
Wouldn’t the higher income brackets also suffer fewer cases?
Not necessarily, they have also been impacted. They are under even more pressure to maintain their social standing and lifestyle; it can be hard for family members to accept reduced financial circumstances. It can be difficult for both wives and children to cope with peer pressure if they can’t “keep up”.
Do men and women handle stress differently?
Definitely. Women have more acceptance of emotional behaviour and therefore are more able to open up with friends and discuss matters. Men find this difficult as exposing any insecurity impacts their ego and pride. Men have a different schematic of the brain and tend to find an outlet through physical activity, such as sport, which can provide a temporary solution.
What general issues do men come to you for?
Apart from substance addiction, which is an issue that can be linked, we encounter stress and depression, and sexual issues.
We see a lot of issues related to sexual dysfunction. We must remember that this is a conservative society with limited recourse to sex education for most of the community. Many men enter the physical side of marriage either in a state of ignorance, or armed with a warped vision of their role due to hours of internet porn-watching. This results in stress for their partner, either way. Should sensible sex education be added to the high school curriculum we might see a healthier approach. The normal awakening of a person’s libido that occurs at puberty has no outlet due to the conservative nature of our society and often leads to sexual situations within the domestic environment, resulting in a high incidence of incest.
Obviously this type of sexual activity is furtive and rushed, and has accompanying feelings of guilt and remorse. A pattern of premature ejaculation can follow through into adult years.
In many cases the wife will bring her husband, as it is considered a marital duty for him to ‘perform’. In spite of the fact that erectile dysfunction can occur normally 30 to 40% of the time in sexual intercourse due to tiredness or stress, a women may feel that she is not doing enough to attract him.
What benefits do men usually recognize after they have undergone therapy?
We focus on cognitive behaviour therapy, men need to understand the patterns, and change their perception of problems. By becoming solution-oriented they can learn to handle stress in a healthier way. They also learn to become more at home with expressing emotions and tenderness in relationships and not see them as a sign of weakness. In critical cases we sometimes need to use short term medication in conjunction with counselling.
What signs should a man be on the lookout for as an indication that he should seek help?
He should look out for an increased edginess, restlessness, irritability, insomnia, forgetfulness, lower libido, anhedonia (the inability to find pleasure in any normally enjoyable activity), and domestic disharmony.
What about domestic violence?
Certainly, this can occur more in situations where a man feels unable to cope. It is interesting though to note that for every five instances of wife-beating there is one of a wife beating her husband.
Does infidelity crop up?
Yes, and contrary to my pre-conceived expectations as a young doctor, I have found over the years that in cases of a wife straying generally the husband seeks reconciliation rather than the retribution or revenge I had thought would be the traditional reaction. It is often blamed on a temporary lapse of sanity or being the influence of a shaitan, or devil, absolving the woman of any blame.
When a husband is unfaithful it often seems to be more easily accepted by the wife, being put down to a natural part of male behaviour. Whichever the case, counselling can be therapeutic for both parties.
Is there a co-relation between socio-economic class and people coming for psychiatric help?
Now that psychiatric counselling has become more widely accepted we have patients from all segments of the community, including far-flung areas. Again, having the subject aired on television has helped open up people’s willingness to address issues.
What advice would you offer parents when it comes to raising their sons to be psychologically healthy?
Roles of dependence, independence and interdependence are at the core.
It is just as damaging to be over-protective as it is to be hostile, it is better to take the middle road and balance discipline with shared fun. A child should be given autonomy as early as possible, they should learn to think, analyse, and become emotionally and psychologically independent, but be there to discuss things with them when they ask for guidance. By developing their judgment and self-respect they will be able to cope with the situations they face socially as they grow up. They should be given tasks and responsibilities from an early age as well to develop their self-confidence and self- discipline. That doesn’t mean you shouldn’t give them plenty of love and affection as well, that is essential for the bonding of the whole family.