Young Muslim Pakistani Women's Lived Experiences of Izzat, Mental Health, and Well-Being.

TL;DR: This article explores how six Pakistani Muslim women interpret cultural concepts of izzat (honor and self-respect); what role, if any, it has in their lives; and whether there is interplay between upholding izz at and the participants’ help-seeking strategies for mental health and well-being.

Abstract: This article explores how six Pakistani Muslim women interpret cultural concepts of izzat (honor and self-respect); what role, if any, it has in their lives; and whether there is interplay between upholding izzat and the participants' help-seeking strategies for mental health and well-being. Semistructured interviews were conducted and analyzed with an interpretative phenomenological analytic framework. Three themes were identified: (a) "the rules of izzat," (b) "negotiating tensions," and (c) "speaking out/breaking the 'rules.'" Findings highlighted new insights into the understanding of izzat and the implications these cultural concepts have for strategies in managing or silencing of psychological distress. Interviews illustrated tensions the participants experience when considering izzat, how these are negotiated to enable them to self-manage or seek help, and possible life experiences that might lead to self-harm and attempted suicide. Notably, cultural codes, in particular izzat, appear to vary over the life course and are influenced by migration.

Summary

Background

• One of the key issues for second-generation South Asian individuals is the development of their cultural identity (Berry, 1997; Bhugra, 2003).
• The current study focuses on the concept of izzat, acknowledging it as one of many cultural codes or practices (e.g., how relationships are formed and social encounters between members of the opposite sex are conducted,) that may impact the lives of South Asian women as it relates to experiences of psychological distress and well-being.
• In maintaining the izzat of the family and following cultural practices that have been handed down the family through older generations, South Asian women may experience entrapment while retaining a subordinate role.
• Previous research found a lower prevalence of psychological distress in South Asian groups in comparison to other ethnic groups and attributed this to being psychologically healthier and having ‘cultural resilience’ in dealing with adversity (Anand & Cochrane, 2005; Cochrane & Stopes Roe, 1981; Hsu, Davies, & Hansen, 2004).

Sample and recruitment

• A purposive sample of six women, were recruited for this study (Newberry, 2011) living in the London area (UK).
• London is one of the most ethnically diverse cities in the UK, with the largest South Asian UK population residing in London (Office of National Statistics, 2011).
• Inclusion criteria included being UK-born (second generation) with parents born in Pakistan and having English as a first language.
• Participants were recruited through advertisements placed at two universities, a community centre attached to a mosque in East London and charitable organisations.
• In accordance with Interpretative Phenomenological framework, the target sample size was 6, to allow for detailed and in-depth exploration of the participants’ experience.

Data Collection

• This study involved conducting semi-structured interviews consisting of open-ended questions and additional prompts aimed to collate detailed, specific, individual narratives different to those narratives seen in the previous research studies reviewed previously.
• Interview topics and questions tried to enable descriptions of the participants’ ethnic and cultural experiences and also included questions about experiences of mental health (psychological distress and well-being) and help-seeking.
• Each interview was digitally recorded using a dictaphone.
• The interviews were transcribed inclusive of non-linguistic elements of conversations as these can also affect the meaning (Willig, 2001).
• All identifiers were removed and participants were given a pseudonym in order to maintain confidentiality.

Data analysis

• The researcher (first author) began Interpretative Phenomenological Analysis (IPA; Smith, 2009) with an in-depth examination of each individual transcript through multiple readings with attention to the individual’s choice of language, parallels, variation in speech and the language used, repetition, exaggeration and incongruence in the individual’s narrative.
• Ultimately, the analysis aimed to attend to what is being communicated about the individual’s sense of self.
• The analytic approach included the following steps: initial themes were noted; possible links between themes were examined; sub-themes were created and arranged into clusters to form master themes; quotations were selected to illustrate each theme (Smith, 2009).
• The transcripts were collated and re-examined by the first author, paying particular attention to thematic overlap and distinct differences in accounts.
• This enabled the researcher to make links to existing theoretical knowledge within this area of research.

Results

• Six British Pakistani Muslim women born in the UK, aged 24-40, were included in the sample.
• Two of the participants were married with children and two were divorced with children.
• All participants were in the process of completing or had completed higher education.
• Analysis of the transcripts generated three main themes and sub-themes within each of these to further illustrate the overarching main theme.
• The section below describes sub-themes and presents data to support each theme.

Learning the Rules

• Interview questions facilitated conceptualisations of izzat from the participants’ narratives.
• Erm, when you speak to men outside, that you’re not, erm, familiar with, or you don’t know, lowering your gaze….
• As seen within this extract, “if you like it or not, you just.
• Deal with it”, individuals might take on passive roles in the process of learning the codes of izzat and their adherence to them throughout their lives.
• One participant spoke of “unwritten rules” which are reaffirmed by the family and community and handed down to subsequent generations.

Pressure to be “Perfect”

• In response to a query about what it means to uphold the honour of the family, a participant described her own personal desires to be “perfect” which she suggested stemmed from her familial experiences.
• An example discussed by some participants was how pre-marital sex could result in a woman’s izzat being “ruined”.
• It was not my life, it’s the aunties and the uncles around me.
• It would appear that she internalises her distress rather than expressing (what sounds like) frustration which in turn manifests in physical reactions and ill-health.

Tolerating Distress and Isolation

• A key sub-theme identified by some of the participants was that many young Pakistani Muslim women are expected to “put up” with and ‘tolerate’ their psychological distress over long periods of time.
• Similarly, it appears that there was an expectation, from her mother, for this individual to stay in her marriage: P: … mum’s only advice if you like she gave me was you have to stay there - your dead body will leave the house.
• Participant responses suggested that these women’s choices to tolerate unpleasant experiences are also motivated by their own to protect their izzat.
• If her son’s having trouble getting the right grades.
• Her family never spoke to her, wouldn’t, couldn’t try to get in touch with her.

Managing distress

• One of the Pakistani Muslim women emphasised the personal resources and possible coping mechanisms required to be able to manage difficult experiences.
• Alternatively, the view might be that suicide was considered in the individual’s perception that they have failed to be “perfect”.
• They chose to disclose their experiences of distress to those deemed appropriate (e.g. friends, older family members and their “Asian community”) and “…highly unlikely, sadly to say, that they would go to the point of telling their GP for instance.”.
• Similarly, Islamic teachings were perceived as guiding some of the participants in this study to empowerment and standing up for their human rights which, also parallel British legislation and are protective against attempting suicide.
• It makes a HUGE difference when you know you got back-up.

Leaving their Family

• As theme 1, sub-theme ‘Tolerating their distress’ showed, this was not an option for many of the participants because of preserving their own and their family’s izzat.
• In turn, this may impact on their izzat and how others perceived them.
• Now days divorces are quite common and it’s, it’s ok to get married again and stuff like that, erm, also known as P.
• For one participant, when a friend suggested that she should leave her husband and end her abusive marriage, she spoke of her initial hesitation to accept this advice.
• There were examples given by the participants of families who supported and encouraged abused women to leave an abusive marriage and to return home, as one of the participants witnessed in her family: P: I think I stayed there, the time that I did stay there.

Finding Acceptance

• Some participants spoke about a need to find acceptance as individual Pakistani women in western society and being less restricted by the rules of izzat.
• There was a suggestion that some Pakistani Muslim women are less accepting of situations that cause them psychological distress and more accepting of finding alternative ways, to manage and even alleviate their distress as set out by cultural codes of conduct.
• In discussing her friend’s experience, a participant makes comparisons across generations: P: She does, and carries on and this is her life.
• And people not really prepared to, to put up with what they used to.

Theme Three: Speaking Out/Breaking the ‘rules’

• (Dis)Respecting Izzat For some young Pakistani Muslim women, attempts to maintain their izzat place them at risk of experiences that cause psychological distress.
• Therefore these individuals are mindful of how help-seeking impacts on their izzat, how they are “judged” and whether this is disrespecting of their family, friends and the Pakistani Muslim community: P: When it comes to izzat.
• One thing why women do stay in certain situations, marriages, because they think about the RESPECT for, for the parents….
• And how their respect will be affected by their friends, families, neighbours and their aunties and uncles.
• Till you know, it, it err, that specific case led to her death.

Losing Personal and Cultural Identity

• For some participants, loss of their personal and cultural identity seemed to be an internal barrier to help seeking.
• And you’re not allowed to go and see, se him… and when she comes back, people criticise her….
• Within the sub-theme of ‘Learning the Rules’ it was demonstrated how Pakistani Muslim women are regarded as not having izzat if they are unable to maintain relationships and particularly if they are divorced.
• But then again, you’ve got people like my cousin that wouldn’t take that, the support of what the government offers to women in this situation…, also known as P.

Losing Social Acceptance

• Izzat can also place a woman in a position where she experiences shame and being disregarded by members of the local community: P: You know that whole thing I said to you that about erm, not having people from outside come and know your business.
• That’s the whole, that’s whole izzat thing as well.
• You know, to, not, to not air your dirty laundry in public.
• This sub-theme was also evidenced in one of the participant’s reflections of how seeking help could possibly impact an individual’s positioning or standing in their community, the experience of shame and embarrassment.
• They don’t, they feel shy actually, they think that it’s not er, a good thing to go to, go to er Psychiatrist right…”.

Discussion

• Suicide has also been regarded by some women as a strategy for coping with abuse (Gilbert et al. 2004).
• Yet it is acknowledged that izzat is only one element of South Asian culture, and there may be other relevant and even more pertinent features that impact the lived experiences of the individuals involved in this study (Sari & Gençöz, 2015).
• The researcher recruited a small sample of Pakistani Muslim women living in London, which has a diverse ethnic population, for the purpose of this study.
• Merits of previous research by Gilbert et al. (2004) were their use of focus groups, which appeared to enable individuals to discuss issues of a sensitive nature that are closer to real-life than in quantitative studies.

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DOI:
10.1177/1049732318803094
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Gunasinghe, C. M., Hatch, S. L., & Lawrence, J. (2018). Young Muslim Pakistani Women’s Lived Experiences of
Izzat, Mental Health and Well-being. Qualitative Health Research. https://doi.org/10.1177/1049732318803094
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Download date: 09. Aug. 2022

Young Muslim Pakistani Women’s Lived Experiences of Izzat, Mental Health and Well-
being.
Cerisse Gunasinghe
a
, Stephani L. Hatch
a
& Jane Lawrence
b
a
Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience. King’s College
London, Denmark Hill, London, United Kingdom
a
Student Support Centre, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ.
United Kingdom
Correspondence: Cerisse Gunasinghe
Department of Psychological Medicine, King’s College London, Institute of Psychiatry,
Psychology and Neuroscience, London, United Kingdom
Email: cerisse.gunasinghe@kcl.ac.uk
Keywords: culture / cultural competence, mental health and illness, well-being,
self-harm, suicide

Abstract
This article explores how six Pakistani Muslim women interpret cultural concepts of
izzat (honour and self-respect), what role, if any, it has in their lives and whether there is
interplay between upholding izzat and the participants' help-seeking strategies for
mental health and well-being. Semi-structured interviews were conducted and analysed
with an Interpretative Phenomenological Analytic framework. Three themes were
identified: 1) “The rules of izzat”, 2) “Negotiating tensions” and 3) “Speaking
out/breaking the ‘rules’ ”. Findings highlighted new insights into the understanding of
izzat and the implications these cultural concepts have for strategies in managing or
silencing of psychological distress. Interviews illustrated tensions the participants
experience when considering izzat; how these are negotiated to enable them to self-
manage or seek help and possible life experiences that might lead to self-harm and
attempted suicide. Notably, cultural codes, in particular izzat, appear to vary over the
life course and are influenced by migration.

Background
Over a decade ago, a series of studies exploring cultural and ethnic variations of
psychological distress highlighted that family pressure and abuse (Hicks & Bhugra, 2003);
cultural conflict (Bhugra, Baldwin, Desai, Jacob & Baldwin, 1999); familial expectations of
women to maintain traditional gender-specific roles and acquiring an education and
professional career were contributors to suicidal acts in British South Asian women (Bhugra,
2003; Bhugra et al. 1999; Hicks & Bhugra, 2003). It has been observed that allegiance and
preservation of cultural concepts, practices and values occurs within these ethnic groups
residing outside of South Asian countries (Krause, 1989; Peach, 2006). One of the key issues
for second-generation South Asian individuals is the development of their cultural identity
(Berry, 1997; Bhugra, 2003). In particular, the processes of acculturation and maintaining
cultural practices have been considered to impact well-being and psychological distress
(Padela, Kilawi, Forman, DeMonner, & Heisler, 2012; Krause, 1989; Triandis, 1989). While
there is some dilution in cultural concepts from first generation immigrants to subsequent
generations, these processes can be difficult to navigate for individuals born in countries,
such as the UK, with parents who migrated from Southern Asia (Dwyer, 2000; Faver, Narang
& Bhadha, 2002). The basis of identity formation and culture related behaviours often stems
from generational “life-histories” produced by familial and social kinship (Das, 1976).
However, modern conceptualisations of personhood (i.e. the individual in relation to the self,
others, the community and society) can only be understood in the context of non-Western
historical, cultural and community influences on its development (Fowler, 2004).
Cultural concepts, such as izzat, often inform and impact the coping and help-seeking
strategies utilised to manage such experiences. The concept of izzat (i.e., the semantic
meaning and the associated practices) translates across the diversity of South Asian cultures

and has particular impact on women (Chew-Graham, Bashir, Chantler, Burman, & Batsleer,
2002; Gilbert, Gilbert & Sanghera, 2004). In observations of Indian culture, Takhar (2005)
explains izzat as “honour”, “self-respect” and “prestige”. Maintaining honour and kinship
with the family, community and society are integral to South Asian culture and considered to
be protective against shame and ill-health (Das, 1976; Krause, 1989). Therefore, upholding
izzat may strongly inform and influence the social interactions; moralistic values; the
sexuality of men and women; what is deemed as accepted behaviours; obligations of women
in particular social roles, experiences of health and illness, of those from many South Asian
ethnic backgrounds (Krause, 1989; Gilbert et al, 2004; Toor, 2009). Furthermore, family
dishonour can have an impact on individual members’ self-identity or self-respect, and
externalised to immediate and extended family members, as there is less of a distinction
between the self and others (Takhar, 2005). Literature suggests that some South Asian
women may be positioned in roles inferior to men and often susceptible to being shamed and
family dishonour can have an impact on both immediate and extended family members
(Takhar, 2005; Triandis, 1989). Takhar (2005) suggests that izzat often dictates the
obligations of South Asian women who often sacrifice their own desires for the sake of their
family’s izzat. In her observations of Indian culture, Takhar (2005) suggests that izzat
translates as “honour”, “self-respect” and “prestige”. Accepted behaviours, particularly in
social interactions, of those from many South Asian ethnic backgrounds may therefore be
strongly influenced by the notion of izzat (Gilbert et al, 2004; Toor, 2009). The current study
focuses on the concept of izzat, acknowledging it as one of many cultural codes or practices
(e.g., how relationships are formed and social encounters between members of the opposite
sex are conducted,) that may impact the lives of South Asian women as it relates to
experiences of psychological distress and well-being. Gilbert et al. (2004) further developed
this area of research by demonstrating that entrapment was also associated with izzat. In