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DOI:
10.1177/1049732318803094
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Citation for published version (APA):
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