Islamophobia, mental health and psychiatry: South Asian perspectives

Asia is the largest and the most populous continent on earth. South Asia has a population of around 1.8 billion,thus constituting about one fourth of humanity. India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, the Maldives and Afghanistan are the countries in South Asia and many of them are Muslim-majority nations. Although India is predominantly a Hindu nation with a total population of 1.4 billion, there are more Muslims in India than in Pakistan and other South Asian nations. Hindus, Muslims, Christians, Sikhs and followers of other religions have lived peace fully in South Asia for centuries. However, certain incidents of communal violence and other untoward occurrences in SouthAsia suggest that Islamophobia is present here too. The authors discuss demography, cultures and the possible effect of Islamophobia on the mental health of the people of South Asia.


INTRODUCTION
"Usually the term phobia refers to the psychological fear of the human mind from something that poses a threat. But when a species starts using the term fear against a biological portion of itself, there is nothing more demeaning than this." -Abhijit Naskar (The Islamophobic Civilization) The origin of Islam as a religion/civilization in the year 610 CE in Saudi Arabia, added a novel religious faith and culture to the many existing contemporary religions [1].
Over a period of time, Islam attracted people across the boundaries of nations, geographical locations, cultures and creeds, and has spread rapidly in the past 1,400 years emerging as the second largest religious group in the world, today constituting 24% of the world population [2].
In contrast, in the past few decades there has been a rise in anti-Muslim sentiment and global hatred [3].
The basic principle of Islam remains unchanged since its inception and there could be several reasons for the rising anti-Muslim sentiment. One reason could be the difference between the basic principles of Islam and the way it is followed. There is a strong possibility that, due to a lack of religious knowledge, poverty and ignorance, the followers of Islam may have distorted Islamic rituals and culture [4][5][6]. The repercussions of inflexible attitudes and cultures of various religions may be responsible for rising anti-Muslim sentiment. The other reason could be that others misunderstand Islam's principles, practices, cultures and rituals. In addition, there might be various reasons such as cross-border terrorism, economic exclusion, war for sovereignty and materialistic gains, along with maintenance of supremacy between countries of the region, e.g., between India and Pakistan, giving religious colours to these conflicts [7].
Fortunately, despite wide variation in religious beliefs, with the cohesiveness and respect of cultural differences and religious views, the South Asian society has been considered resistant to religious hatred for centuries [8], but this bond seems to be weakening. The recent increase in religious intolerance in South Asia is a matter of serious concern.
South Asia is already facing various challenges in raising the standard of living of its people and in terms of economic growth, social progress and cultural development [9].
Alongside these existing challenges, rising Islamophobia deserves special attention as a major threat to health outcomes and health disparities in South Asia with the largest population of Muslims in the world [10]. There is a need for intervention with social psychiatry initiatives to prevent rising Islamophobia and religious intolerance which acts as a persistent chronic stressor for the whole community. This will also prevent the emergence of mental health problems due to Islamophobia.

AND THE MUSLIM POPULATION
Eight countries, Afghanistan, Bangladesh, Bhutan, the Maldives, Nepal, India, Pakistan, and Sri Lanka, together form South Asia and are known as the South Asian Association for Regional Cooperation (SAARC) [11]. This

Concept of Islamophobia
The concept of Islamophobia emerged from Western nations [3,15], where Muslims are a minority. For Us All" [15].
The introduction of the term was justified by the report's assessment that "anti-Muslim prejudice has grown so considerably and so rapidly in recent years that a new item in the vocabulary is needed" [17]. In recent times, Islamophobia has been conceptualized as social stigmatization of Islam and Muslims, dislike of Muslims as a political force and a distinct construct referring to anti-Muslim stereotypes, racism, or xenophobia [18,19]. Although, anti-Muslim sentiment is increasingly common globally, it has taken a form of social stigma in the Western world where Islamophobic sentiment has already gained scientific attention, particularly after the terrorist attacks of 11. September, 2001 [3].

Causes and Prevalence of Islamophobia
The term Islamophobia gained prominence following terrorist attacks such as 9/11 in the United States, the The religious demography of South Asia is important from the point of view of rising Islamophobia [29].
In some of the populous countries in the region, nationalism is sometimes judged by the hostility towards the neighbouring country and its predominant religion [30,31]. In this way, the minority populations of both the countries, i.e., Hindus in Pakistan and Muslims in India, are at greater risk of discrimination by the majority.
This could be one of the major reasons for the alleged rising Islamophobia and hate crimes against Muslims in India, and similarly, the rising hate crimes against Hindus in Pakistan.
At present, the concept of Islamophobia seems to be ingrained in the lifestyle of Western societies [32]. A post-9/11 poll in the United States reported that 60% of Americans had unfavourable attitudes toward Muslims. Many Americans relate to Muslims with fearrelated terms such as violence, fanatic, radical, war and terrorism [33]. While Muslim immigration may be the cause for Islamophobia in the West, the large number of minority Muslims in some countries in South Asia could be the cause in this region. [34] Although the common perception is that Islamophobia is growing in South Asia too, there is a lack of scientific evidence to support this argument [23]. Many believe that there has been a growing feeling of unease and insecurity amongst Muslims in India [35]. A recently published meta-analysis [23]

ISLAMOPHOBIA AND MENTAL HEALTH PROBLEMS
The recent rise in terrorism has led to widespread fear of Islamophobia among followers of Islam and other religions. The constant fear, agony, hatred, apprehension, etc., will definitely have a psychological impact on all people, as human beings are socially inseparable.
Islamophobia can negatively influence health by disrupting many systems, i.e., individual (stress reactivity and identity concealment), interpersonal (social relationships and socialization processes) and structural (institutional policies and media coverage) [3]. However, there is a dearth of scientific data on this topic from South Asian countries. Like many traumatic events, e.g., family disputes, interpersonal conflicts, death of loved ones, earthquake, major road traffic accidents, chronic physical diseases and wars, the impact of Islamophobia will also be traumatic on the concerned individuals and groups.
Islamophobia can also be a source of stress. Although, the seeds of psychological problems may be implanted well before birth in the form of genetic predisposition, significant environmental stressors, social support and coping skills play important roles in the causation/ precipitation of the majority of mental health problems [39,40]. Stress has been reported to play a major aetiological role in acute stress reaction and adjustment disorders, and a precipitating role in schizophrenic episodes [41]. Hence, it could be inferred that a variety of mental disorders are associated with significant stress [39,42,43]. Islamophobia acts as a significant source of stress as it encompasses a range of anti-Muslim sentiments varying from derogatory remarks, discrimination and stigmatization to hate and targeted crimes against Muslims [44].
Stressors have a major influence on mood, sense of wellbeing, behaviour and health [45]. in psychiatric patients such as the Perceived Stress Scale [48] and the Holmes-Rahe Stress Inventory [49]. These scales measure the types and severity of stress. These scales also explore the degree to which situations in one's life are appraised as stressful. In this regard, scales have also been developed to measure Islamophobia regarding fearful attitudes towards, and avoidance of Muslims and Islam, arguing that Islamophobia should "essentially be understood as an affective part of social stigma towards Islam and Muslims, namely fear" [50,51].  However, there is no scientific research that can reveal the impact of Islamophobia in terms of discrimination in the health service, workplace, job opportunities and in terms of the increased scrutiny in South Asian countries on the basis of appearance and religious background [61,62]. Literature from Western countries regarding how Islamophobia affects the mental health of Muslims [20,63] indicates that religious prejudice in the form of Islamophobia is a major obstacle to Muslims' integration because it increases the incongruity between majority and minority members' acculturation attitudes. In the West, various forms of religious stigma can affect Muslims' national identity and engagement in the public and private sphere in distinct ways. In the absence of scientific data, we are unable to draw such conclusions for South Asia.
Communal and religious harmony is important for the social, cultural and economic growth of countries.
It is also imperative to protect the human rights of all and especially of minorities. Islamophobia can be a double-edged sword, with demoralizing effects on the psychology of human beings irrespective of their religious faith. The more it rises, the more severe will be the after-effects and there will be an increased likelihood of psychological illness and violation