VOICE OF GLOBAL UMMAH

VOICE OF GLOBAL UMMAH
Volume 36, July 13, 2008
St. Louis, Missouri

Editors: Mohamed and Rashida Ziauddin

In the Name of Allah, the Most Beneficent and the Most Merciful

A CHRONICLE FROM "GENDER WARS":

SHARING HOUSE RESPONSIBILITIES - A MUSLIM COUPLE'S DILEMMA
SHOULD THE CULTURAL VALUE BE CHANGED OR SHOULD CLINICAL TREATMENT BE INITIATED. YOU DECIDE FOR YOURSELF ?

BACKGROUND:

Apparently during their "halal" dating times, a young college educated, practicing Muslim couple had identified several common points that quickly fueled and enriched their relationship. However in terms of the few differences they had, they both had discussed about it and formulated mutual agreements to deal with such differences.

One such mutual agreement was that the husband per his wishes would never step in the kitchen to help with cooking. However per her wishes, he promised to take care of most of other household work including cleaning the house. The only exception would be if the wife gets sick or has a medical problem that prevents her from cooking, then he would step in and do the cooking.

INTERVIEW:

In terms of:

(1) General appearance: The husband seemed expressionless while the wife appeared sad.

(2) Motor Activity: Both seemed to be normal.

(3) Speech: Husband seemed to have excessive amount, while wife had soft speech.

(4) Interview behavior: Husband seemed to be apathetic while wife seemed to be passive.

(5) Flow of thought: Both husband and wife were normal

(6) Mood and Affect: Husband had flat affect while wife seemed anxious

(7) Content of thought: Normal for husband but wife seemed to verbalize many somatic complaints.

(8) Sensorium: Both husband and wife had normal orientation.

(9) Intellect: Both husband and wife seemed to have normal intellect

(10) Insight and Judgement: Husband seemed to have poor insight into his wife's illness while wife was unrealistic regarding her own degree of illness.

(11) Asset and Strengths: Both claimed to be practicing Muslims and seemed motivated to get help to resolve their current worsening marital conflict.

PROBLEM FROM WIFE'S PERSPECTIVE:

The wife complained that lately her husband has not been keeping his part of the promised agreement because even though she is sick and unable to stand in kitchen and do the cooking, he has stopped helping her and the burden of cooking still falls on her and it is increasing her level of stress. Despite above conflict, both still had a common point of not eating "junk food" from fast food restaurants.

PROBLEM FROM HUSBAND'S PERSPECTIVE:

Husband complained that she is deliberately exaggerating if not faking her medical and psychological symptoms in order to get him more and more involved in cooking which he so intensely hates. As a evidence he told that despite her several visits to various doctors, hospitals and multiple lab tests, they have not been able to pinpoint any particular problem with her, except that it may stress related.

The clinical picture gets further complicated by below complexity. The husband stated that one of her own family members confided to him of overhearing her (wife) saying that she was deliberately pretending to have health problems in order to get him (husband) regularly involved in cooking. Wife denied the above and angrily demanded to know who was the family member that was spreading such rumors. She believed that some of her family members are jealous about their strong marital relationship and are trying to break it up by spreading such rumors. Husband refused to disclose the name of the person who revealed above information saying that he had to keep his promise to the particular person of not disclosing the person's identity.

BRIEF ANALYSIS:

Wife complained that nobody understands what medical and emotional problems she is going through, not even her husband, nor the Dr's and others at the hospital.

Husband complained that she is trying to capitalize and exploit on his initial agreed upon offer of helping with cooking when she is sick. When asked of his broken promise to help with cooking, he clarified that his offer was meant on situations when she was "genuinely" sick and not when she was "faking" her medical and psychological symptoms. He added that he completely stopped helping her with cooking after he heard the above ("information" per husband, "rumor" per wife).

MULTIPLE PERSPECTIVES:

Depending upon various backgrounds of the individual, the responses are going to be markedly different.

(1) Some may fault the husband for his inflexibility, indifference towards her medical and psychological problems and having broke his initial agreed upon promise. They may label him old-fashioned traditionalist.

(2) Certain others may fault the wife for exhibiting psycho-somatic symptoms as a form of resistance to do all the cooking at home. They may see her as somebody that has been influenced by the WEST and in a passive-aggressive way is trying to force him to break from his cultural roots in terms of gender roles within a family.

(3) Others may medicalize the whole issue and add a mental health component by giving the wife a provisional diagnosis of "FACTITIOUS DISORDER". Cognitive Behavioral Therapy would be a major part of the treatment which would include psycho-education to make her aware in detail of how her negative perception of her current gender specific role and subsequent emotions are having an adverse impact on her physical and psychological health.

(4) While another group may be offended and totally dismiss the medicalization of above problem by stating that all the husband needs to do is help with the cooking for as long as the wife is ill and forget his cultural roots or gender specific role. They may go one step further and ask, what is wrong with him helping her cook on a regular basis ? Why is he so "hung up" on gender specific cultural values.

(5) There may be many other perspectives including the one from members of the tablighi jamaat to the above marital conflict but from a clinical perspective, let's review in detail what is FACTITIOUS DISORDER ?

REVIEW OF CLINICAL PERSPECTIVE:

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders)

300.19 FACTITIOUS DISORDER WITH COMBINED PSYCHOLOGICAL AND PHYSICAL SIGNS AND SYMPTOMS:

This subtype describes a clinical presentation in which both (A) psychological and (B) physical signs are present, but neither predominates.

(A) FACTITIOUS DISORDER WITH PREDOMINANTLY PSYCHOLOGICAL SIGNS AND SYMPTOMS:

Above subtype describes a clinical presentation in which psychological signs and symptoms predominate. It is characterized by the intentional production or feigning of psychological symptoms that are suggestive of a mental disorder. The individual’s goal is apparently to assume the “patient” role and is not otherwise understandable in the light of environmental circumstances. This subtype may be suggested by a wide-ranging symptomatology that often does not correspond to a typical syndromal pattern, an unusual course and response to treatment, and the worsening of symptoms when the individual is aware of being observed.

Individuals with this subtype of Factitious Disorder may claim depression and suicidal ideations, hallucinations, memory loss and dissociative symptoms. These individuals may be extremely suggest able and may endorse many of the symptoms brought up during a review of systems. Conversely, they may be extremely negativistic and uncooperative when questioned. The presentation usually represents the individual’s concept of mental disorder and may not conform to any recognized diagnostic category.

(B) WITH PREDOMINANTLY PHYSICAL SIGNS AND SYMPTOMS:

Above subtype describes a clinical presentation in which signs and symptoms of an apparent general medical condition predominate. The individual’s entire life may consist of trying to get admitted to, or stay in, hospitals (known as “Munchhausen Syndrome”). Common clinical picture includes severe right-lower-quadrant pain associated with nausea and vomiting, dizziness and blacking out, massive hemoptysis, generalized rashes and abscesses, fevers of undetermined origin, bleeding secondary to ingestion of anticoagulants, and “lupus-like” syndromes. All organ systems are potential targets, and the symptoms presented are limited only by the individuals medical knowledge, sophistication and imagination”.

THE ESSENTIAL FEATURE OF FACTITIOUS DISORDER IS THE INTENTIONAL PRODUCTION OF PHYSICAL OR PSYCHOLOGICAL SIGNS OR SYMPTOMS.

(Criterion A). THE PRESENTATION MAY INCLUDE FABRICATION OF SUBJECTIVE COMPLAINTS (eg., complaint of acute abdominal pain in the absence of any such pain). THE MOTIVATION FOR THE BEHAVIOR IS TO ASSUME THE "SICK ROLE".

Individuals with Factitious Disorder usually present their history with dramatic flair but are extremely vague and inconsistent when questioned in greater details.THEY MAY ENGAGE IN PATHOLOGICAL LYING IN A MANNER THAT IS INTRIGUING TO THE LISTENER, ABOUT ANY ASPECT OF THEIR HISTORY OF SYMPTOMS. They often have extensive knowledge of medical terminology and hospital routines. COMPLAINTS OF PAIN AND REQUESTS FOR ANALGESICS ARE VERY COMMON. AFTER AN EXTENSIVE WORKUP OF THEIR INITIAL CHIEF COMPLAINTS HAS PROVED NEGATIVE, THEY OFTEN COMPLAIN OF OTHER PHYSICAL OR PSYCHOLOGICAL PROBLEMS AND PRODUCE MORE FACTITIOUS SYMPTOMS. INDIVIDUAL WITH THIS DISORDER MAY EAGERLY UNDERGO INVASIVE PROCEDURES AND OPERATIONS.

While in the hospital, they usually have few visitors. Eventually a point may be reached at which the factitious nature of the individuals symptoms is revealed (e.g, the person is recognized by someone who encountered the patient during a previous admission, other hospitals confirm multiple prior hospitalizations for factitious symptomatology). When confronted with evidence that their symptoms are factitious, individuals with this disorder usually deny the allegations or rapidly discharge themselves against medical advice AMA. Frequently, they will be admitted to another hospital soon after.

Above is NOT a detective story with a definite end. Instead it is a hot unacknowledged, uncomfortable topic to be discussed during Muslim get togethers or at parties. But each couple who have difficulties in SHARING their marital and parental responsibilities can easily connect with above reality of the couple described in this issue. Even the best of Islamic speakers tend to shy away on giving spotlight for above issue for obvious reasons. Based on the cultural, historical traditions, there is an assumption that the GENDER ROLES ARE CLEAR AND SPECIFIC and people of such group DO NOT FIND A NEED to even discuss above topic. However the taste of REALITY is felt when a Muslim woman at her work place during lunch hour hears some of her other female colleagues praising an excellent food dish that their husband had made at home and in a subtle way she may be put under invisible PRESSURE.

TO WHAT EXTENT ARE CULTURAL FACTORS INVOLVED IN ABOVE MARTIAL DISCORD ?

Was the husband trying to follow the footsteps of his father who proudly told him that she (the son's mother) was so caring to him and the whole family that he never had to step into the kitchen to cook all his life except on three occasions when she was sick and hospitalized.

Was the wife trying to live a marital life on par with the contemporary times, which called for increased participation of the husband ?

What is the Islamic perspective ?

How does the Islamic perspective come into play in the resolution of above conflict, especially when both the husband and wife believe that there is nothing more important to them than to practice Islam to the fullest practical extent. Then why.......? Lots of unanswered questions ?

What is the central role of a Muslim woman as a wife ? What is the central role of Muslim man as a husband ? What are the areas and responsibilities they can share together ? Should emphasis be to maintain the strict gender roles ? Should the focus shift on calling for more flexibility ? Or should it be left entirely upon the couple to decide what works out best for them as long as they are happy, that's what ultimately counts ?

Are there socio-cultural factors involved in labeling a husband who does most of the cooking as "henpecked" and "why" do most men see it from a negative perspective ? Has it something to do with the male dominated society attempting to maintain its historic "status quo" ? Why do they undervalue the importance and uniqueness of each couple, each family and their own personal situations and circumstances ?

Ultimately. is not the marital bliss and happiness of a couple and family more important than the rigidity or flexibility of gender roles they may adapt to their unique circumstances ? How best could we strictly enforce values of Islam in our day to day life, while being flexible and selective in implementing our past cultural values from our previous generations ? ARE MANY MUSLIMS STILL STRUGGLING TO SEPARATE THE CULTURAL FROM THE ISLAMIC VALUES ?

What are the areas of co-operation between the Imam and the Islamic Psychotherapist in working as a team to resolve above marital discord ? Can we come out of our individual boxes that we pigeonholed ourselves in and work for the common good of the UMMAH, starting with assisting a COUPLE that forms the smallest social unit - A FAMILY ?

PHOTOS FROM OUR UMMAH IN PAKISTAN:
(Associated Press of Pakistan)