The National Catholic Review
New and ancient paths to better mental health

There is no address for Holland’s largest refugee camp. The national refugee department has nothing about it on its website. When I asked for directions to the camp—which closed after my visit—people at the several restaurants and gas stations I visited blinked with incomprehension. Concealing the presence of nearly 3,000 Muslim immigrants from the largely secular citizens of a densely populated country is no easy feat. What is especially surprising is that immigration centers all over the country, to which this large camp sent many refugees before it closed, have been the scenes of vicious protests against refugees and have dominated the headlines for months. The police have recently reported a large number of violent incidents at these centers, committed by refugees and directed at one another but also by outsiders. Some police departments report that they are called daily to settle conflicts. The Dutch government has outsourced the work of creating and managing these massive centers to a semi-private organization that rarely comments to the press.

Heumensoord, as the refugee center is known, shares its name with the national forest in which it is situated, near where the Netherlands meets Belgium. In order to get a closer look, I had to park near a day spa and hike in. After about 20 minutes, I came upon light poles leaning to the side in hastily dug holes and temporary fences, the kind used for concerts and protest marches, linked by plastic ties and wobbling unsteadily in the Dutch autumn winds. And through the trees I saw rows of stark, white tents made of the thick, elastic vinyl usually used for wedding parties and outdoor business gatherings and steepled like the Denver International Airport.

There is only one road leading in and out of this massive encampment. One must pass a security gate, dozens of guards and use a single road that goes through at least a half-mile of forest. When the refugees are allowed to take the occasional trip into town, they trickle into an adjacent hamlet, Malden, a suburb of Nijmegen. Malden is supremely upper-class Dutch—straw thatched roofs, trimmed hedges, gravel driveways, each with petite-bourgeois name-boards like “Water’s Edge” or “Little Castle.”

Malden has a McDonalds where the refugees shuffle to the counter, then quickly retreat to the back with their dollar meals. They are mostly young Syrian mothers or boys who stare out at the town shyly, with a fascination that suggests their troubled pasts. Even from a distance, it is easy to see that these refugees are suffering not only psychologically but also physically. Scars stand out in this clean, orderly Dutch town.

Over the last few years there have been dozens of suicides across the country by asylum seekers whose application for asylum is taking too long or by those whose traumas have not been treated. Protests against refugees contribute to an acute sense of anxiety and unwelcome felt by refugees. When plans are released for building asylum centers in distant Dutch towns, riots break out, as in the town of Heesh, where a dead pig was hung on a rope with a sign warning immigrants to go away.

In November 2016, a leading polling organization announced that the Dutch anti-immigrant party, the Partij voor de Vrijheid, or Party for Freedom, was leading all other political parties. The P.V.V. leader, Geert Wilders—who was recently convicted of inciting discrimination for his comments about Dutch Moroccans—was also tapped as most likely to become the next prime minister in March. In 2014 the Netherlands took in 23,000 asylum seekers; in 2015 it was 45,000, almost twice as many. This year it dropped back down to 23,000. That is almost as many people as in the town Geert Wilders is from, Venlo.

There are an estimated 10 million immigrants arriving in Europe, a mass migration fleeing war and brutality. And while the shootings in Paris in November 2015 remind us that a miniscule number of these refugees have come with the intention of violent jihad, the vast majority are desperate and weary, seeking solace in the safety of Europe. An international study in 2008 linked mental illness and immigration. Immigrants living in white, Dutch neighborhoods were more than twice as likely to have some form of schizophrenia. It was a startling find, one that reminded psychologists and many others that bringing immigrants to the supposedly safe, white bastions of Europe might have very complicated results.

A recurring controversy in the Netherlands focuses on the fact that Moroccan and Turkish citizens, who largely come from Muslim backgrounds, visit the hospital far more than white Dutch citizens, costing taxpayers more. Geert Wilders has brought this up repeatedly in his speeches.

Very few people have taken the time to ask why Muslim immigrants visit the hospital more than other Dutch people. The answer could be that most immigrants reach the Netherlands after long struggles and in their new home face significant economic, cultural and social challenges, which affect both physical and mental health. The Calvinist Dutch have a long history of believing that suffering through pain is a path to righteousness, which is a difficult culture for most immigrants (including for me, as an American immigrant) to enter into. It is also quite possible that Muslim immigrants are returning to doctors and hospitals more often because their ailments are not being adequately treated or addressed.

Unfortunately, Dutch mental-health service offerings are meager. Most insurers allow visits to psychologists only in 8- to 10-week bursts. By then, they assume, a patient should have the tools to deal with mental distress independently. Within those limitations, patients who are not healed are left to their own devices. There are chat rooms filled with Muslim mothers and fathers searching for ways to help their children who are bipolar or emotionally distressed. Their children have stopped going to the mosque. They sit in bedrooms, in the dark or behind a computer all day long. The Dutch medical system has failed them, these parents write. Now they are looking for alternatives.

Turning to Hijama and Ruqya

While immigrants struggle to find essential mental health treatment, practices of exorcism related to Islam are growing in popularity. These exorcisms target demons called jinn. Many Muslims believe that the jinn, like humans, are either believers in the Quran or they are evil. Almost all jinn, however, are unable to resist the words of the Quran.

Though not all Muslims recognize exorcisms as part of their faith (in fact, some Muslims see these practices as incompatible with their religion), clinics that prescribe so-called Islamic remedies are sprouting up around Europe. Examples of such remedies are hijama, a traditional method of cupping and bloodletting, and ruqya, a ritual that includes the recitation of the Quran.In some countries exorcist practices are growing so quickly that conservative political parties are trying to ban them.

Abdurrahmaan Miro, a 21-year-old, Syrian-Dutch man from Tilburg, is one of these exorcist practitioners. Miro speaks fluent English, and his office, located above a gym, is clean and modern, the room decorated like a Westin hotel.

Miro was proud of his vast collection of oils and herbs, and he explained in rich detail how he performs ruqya: by first anointing with oils and then placing his hand upon the patient’s forehead while reciting the Quran. For Miro, jinn are different from mental health problems, which is why Western psychology and psychiatry have failed so many of his patients. Most of his patients had gone through Western psychoanalysis, he told me, but psychoanalysis could not exorcise jinn or genies from a person suffering strange maladies, and he said the jinn account for more than 70 percent of his patients’ maladies.

In his practice, Miro says he has come across jinn that are thousands of years old, grumpy and stubborn, fighting to stay inside a woman’s body. Just the other day he was working with a particularly troubled patient. A sihr, or curse, was placed upon a local Dutch-Moroccan man, a curse that had been administered in Morocco but had been transposed to a man in Tilburg.Miro said he was able to remove the jinn and the man was healed.

The Dutch Exorcist-Doctors

In addition to Islamic ritual remediesand limited Dutch medical options, Muslim immigrants experiencing mental distress in Holland have another option: the Parnassus Group, which falls somewhere in the middle. My first introduction to the Parnassus Group was through Jan-Dirk Blom, head of the Outpatient Clinic for Uncommon Psychiatric Syndromes. Blom is a clean-cut, white Dutchman with a soft demeanor and endlessly calm tone. He exudes a gentle, if limited, patience. He is the author or co-author of dozens of works on schizophrenia and immigration, and is now a professor in Leiden.

In much the same way that Abdurrahmaan Miro described his own clinic, Blom sees the Parnassus Group as an outpost of last resort, a place where immigrants with a range of psychological ailments come when they run out of options.

Often, Blom will see a Muslim patient who is struggling with certain psychological issues. This patient will likely have seen psychologists for years without any alleviation of the symptoms. Then Blom will ask this patient about jinn possession. Slowly, the patient will tell a story about a cousin who had ruqya or hijama back in Morocco, before admitting that he or she has also received Islamic treatment for jinn possession or sihr.  

Blom has a jinn check-list. If a patient believes he or she is possessed, the patient is asked to describe the encounters in detail, so that Blom’s team can get a better understanding of what the patient is actually experiencing. He receives patients who see green jinn lurking in every corner, dark shadowy jinn and jinn pressing down on their chests.

Like Blom, Anastasia Lim, his colleague at the Parnassus Group, is the author of several papers linking immigration, assimilation, integration and jinn possession. Lim’s parents are from Indonesia—a country with one of the largest Muslim populations, as well as the source of countless YouTube clips of jinn possessions and exorcisms.

Even though Lim was born in the Netherlands, few people consider her Dutch. Lim admits that for most of her life she has felt she doesn’t fit in Holland or in Indonesia. Compounding the dissociation, the Parnassus patients often say to Lim, “But at least you understand.” Since she is non-white Dutch, they feel a connection with her.

Unlike her patients, however, Lim is decidedly Western-scientific. Instead of talking about the jinn as powerful, real creatures mentioned in the Quran, she sees these possessions as “cultural-bound syndromes.” Her thinking is closer to Blom’s than to Miro’s. For Lim, the project is not to figure out whether or not the jinn are real but to treat the psychosis that is present.

Where East Meets West

With anti-immigrant parties rising to power in Europe, vulnerable immigrants will be under even more pressure to integrate into society—pressure that in itself negatively affects mental health. In this context, the Parnassus Group has found that the most humane and effective response to mental distress takes into account all causes and thus all treatments—even exorcism.

In 2012 Jamila Zacouri, one of the few female imams, joined the Parnassus Group to help carry out this mission to branch out from a purely Western medical model of mental health. Zacouri speaks Arabic, Berber, English and Dutch. She attended the Free University of Amsterdam, studied Islam, received a master’s in mental health care and is married to a Turkish man.  

Her first experience with the jinn was in a hospital where she worked with a woman who did not want to eat, because the woman thought there was something in the food: sahir,  black magic. Unlike Miro, Zacouri was convinced of the possibility of mixing Eastern and Western medicine effectively. When her patients asked for ruqya only, she told them that they should take their medicine as well.

By the time she was 16,  Zacouri herself had been sick for almost four years. The doctors were unable to reach a diagnosis. Her illness returned when she was 30, and after visiting a host of psychologists and doctors, she was still disappointed. She experimented with Islamic medicine, mixed it with Western psychology and discovered, for the first time in her life, a new yet ancient method of healing.

While Dutch doctors break jinn possession down into medical language and treat it with medication and therapy, hijama practitioners like Miro see jinn possession as a spiritual malady beyond medicine. To Zacouri and the rest of the Parnassus Group, however, jinn possession is both a psychological problem and a social, spiritual and cultural ailment. Healing thus comes from medicine and doctors, but only in conjunction with cultural understanding and spiritual community. While it may seem eccentric or absurd to some, a jinn exorcism coupled with mental health therapy can be far more effective, not to mention cheaper, than years of antidepressants on their own.

Erik Raschke is the author of The Book of Samuel, a novel. He lives with his family in Amsterdam.

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Susan Jacobson | 12/31/2016 - 9:48am

Erik Raschke’s article Immigrants and the Jinn in America January 2, 2017, was a pleasant surprise. I do
not expect to find mental health continuing education articles in America. But here it was!

The culture-bound syndrome of Jinn is not found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The nine culture-bound syndromes identified are related to Oriental and Hispanic cultures. Raschke’s article today sheds important light on a consideration for mental health professionals.
Visiting mosques is a healing experience for some. For prayer observant Muslims, a prescriber must consider and discuss the risks and benefits of a highly sedating medication as prayer times vary according to the sun. Mental health clinicians must remember that medications are not the only path to wellness.
Susan E. Jacobson
Psychiatric Nurse Practitioner
Co-Chair Northern Virginian Coalition of Refugee Wellness
Fairfax, Virginia

Christine Smith | 12/30/2016 - 2:04pm

Oh my! Where to begin?
'An estimated 10 million immigrants arriving in Europe'! Incredible! This is an enormous problem to start with. I would like to add that all are not fleeing war and brutality. The migration tsunami has drawn in all kinds of opportunists, adventurers, and people looking for a better life. Unfortunately, as Milton Friedman said, you can't have open borders and a welfare state.
A much better idea is that of the 'safe zone' in the Middle East for refugees, attended to and protected by international efforts. All those encamped in Heumensoord could be in a camp much closer to home, keeping their own customs, in a similar environment. There would be no adventurers or opportunists looking for admission here. The mental health problems you enumerate would be eliminated. Those you attribute to the stress assimilating would be eliminated. Assimilation is a big problem. I have to comment on the lack of gratitude exhibited by the migrants I noticed. I've seen offers of water & food refused and thrown on train tracks, muslim mobs protesting, burning cars in Paris and London, demands for accommodations to their dress, food, and religious practice. There is little effort at assimilating. The Europeans protesting the camps, the influx of muslims, are threatened and afraid. They see their values and efforts disrespected and taken advantage of. The crime spikes resulting from this mix of cultures is seen everywhere the migrants are. A certain amount would be understandable. But these are alarming stats. For example, Malmo is now the #2 rape capital of the world after Lesotho. Last New Year's Eve in Cologne was a disaster. Was the Berlin attacker, who was not granted asylum status, possessed by a jinn? I don't know.
I am shocked to read that migrants Miro describes have been through Western psychoanalysis! or that Blom sees Muslim patients that have been seeing psychologists for years!
Finally- seeing the pressure to integrate into society as a pressure in itself negatively affecting mental health! This has never been such a problem. I can only attribute it to the cultural differences for Muslims. It appears that these differences are irreconcilable. To say the Dutch medical system failed them is unfair. The 'white Dutch suburbs, the supposedly safe, white bastions of Europe,' where immigrants suffer from schizophrenia, are not to blame. In fact, if a study similar to the 2008 one cited on immigration and mental illness, were done on the white Dutch inhabitants of the white Dutch villages, or of Cologne, Berlin, Nice, Rouen, Paris, or Brussels etc., I'm sure you would find they are suffering as well.