Sadeghi N. Islamophobia as a structural determinant of mental health among Muslims in the US. HPHR. 2021;53.10.54111/0001/AAA8
Islamophobia is highly prevalent and has measurable impacts on the mental health of Muslims. On a backdrop of growing research and theoretical literature on racism as a determinant of health, much remains to be understood about how Islamophobia distinctly contributes to poor health outcomes. This commentary seeks to apply a framework of structural racism and health to conceptualize the impact of Islamophobia on the mental health of Muslims in the US. This public health issue requires targeted efforts to improve research, advance culturally sensitive mental health care, and evaluate policies through the lens of anti-Muslim oppression.
Islamophobia is a ubiquitous yet insufficiently understood phenomenon that harms contemporary society. It functions as a system of oppression that traverses social and identity groups and negatively impacts the mental health of Muslims, including in the U.S., which constitutes the focus of this piece.
While Islamophobia functions in unique ways to oppress millions of individuals, its ability to pervade society at every level is reminiscent of, and parallel to, other forms of oppression, including anti-Black racism. In this commentary, I examine the interpersonal, individual, and structural nature of Islamophobia and apply a well-established framework of structural racism and health to elucidate and attempt to mitigate the mental health impacts of Islamophobia. I posit that efforts to improve the mental health of Muslims in the U.S. require improved research on Islamophobia, inclusive health care delivery, and a critical lens on U.S. policies that perpetuate structural discrimination.
Leading epidemiologist Dr. Camara Phyllis Jones first described a framework for understanding racism at three levels: personally mediated, internalized, and institutional racism.1 Scholars have since explored the relationship between racial/ethnic health disparities and racism at each of these levels. Scientists have studied the adverse health impacts of interpersonal racism, which manifest through discrimination within the healthcare system and implicit racial bias in patient-provider interactions, as well as the negative physical and mental health outcomes of internalized racism.2 For example, racism in its various forms has been directly associated with dysregulated blood pressure, poor sleep, and higher adult and infant mortality rates.3
Emerging literature has highlighted the health impacts of structural racism through policies like redlining and police violence. The literature posits that health inequities cannot be fully explained without examining the laws, institutional practices, and societal beliefs and norms that sustain the oppression of racial minority groups.4,5
Driven by gaps in health equity research, scientists have also attempted to measure racism in its different forms and quantify its impact on health. One of the most widely used measures of interpersonal racism is the Everyday Discrimination Scale, developed by Dr. David Williams, a leading researcher on racism, discrimination, and health. This Scale seeks to measure individual experiences of discrimination, with questions that aim to elicit the perceived reason (e.g., religion, race, gender, etc.) for these experiences, and has since been adapted for medical settings.6,7 Dr. Nancy Krieger, a renowned social epidemiologist, has written about the importance of “developing measures of anti-isms” and has published innovative research on the need to investigate both conscious and unconscious awareness of experiencing discrimination.8 This nuanced framework for conceptualizing the dimensions of oppression and their relationship with health outcomes should be studied in relation to other forms of oppression, including Islamophobia.
The concept of Islamophobia derives from various schools of thought, and its origins are still debated. According to some scholars, Islamophobic discourse and practice in the U.S. emerged during the era of American slavery, when Black Muslim slaves were punished for not converting to Christianity, and later flourished during the 18th and 20th centuries when Muslim immigrants were prohibited from becoming naturalized citizens of the U.S.9 Others argue that Islamophobia did not fully materialize in contemporary discourse until the 20th century. One of the earliest attempts to define the term was in a 1997 report by the Runnymede Trust, a think tank in the U.K., which described Islamophobia as endorsing “closed views of Islam.”10 Since then, Islamophobia has been studied through various theoretical frameworks. For example, the post-colonial framework posits that anti-Muslim discrimination has little to do with Islam and Muslims, but rather results from a dominant culture and society.11 Iman Attia, whose research centers on anti-Muslim racism, describes Islamophobia as a form of cultural racism that relies on the “culturalization” of religion. As scholar Hafez writes, Islamophobia is different from a genuine critique of Islam, and the former “operates by constructing a static ‘Muslim’ identity, which is…generalized for all Muslims.”10 Some have argued that the lack of consensus on a shared definition of Islamophobia limits the ability to compare anti-Muslim incidents and juxtapose them with other forms of oppression.12
Moreover, many scholars have highlighted the importance of distinguishing between Islamophobia and anti-Muslim oppression. Authors have proposed that studies of Islamophobia must be careful to denote a distance between criticisms of Islam and Muslims. Such critiques refer to an early theorem proposed by philosopher Jean-Paul Sartre, who wrote, “If the Jew did not exist, the anti-Semite would invent him.”13 According to this school of thought, Islamophobia serves to create a Muslim “Other” and has more to do with the Islamophobe than about the Muslim. Others have also suggested that Islamophobia semantically and conceptually fails to distinguish between targeting of “perceived Muslimness” and the oppression of Muslim individuals.14 Moreover, the concept of Islamophobia is also criticized for its potential to conflate discrimination based on religion and race/ethnicity, given that religious identity may be difficult to identify while race/ethnicity are thought to be more outwardly visible features.15 This distinction is important to capture the scope and diversity of anti-Islam and anti-Muslim sentiment. To advance this theoretical argument, I will use the terms Islamophobia and anti-Muslim oppression interchangeably, referring to hostility, prejudice, discrimination, and other manifestations of oppression that are directed at Muslims and have an undue impact on health outcomes.
Islamophobia can be challenging to identify because Muslims, who are most often the target of this bigotry, have other diverse identities beyond being Muslim. Of the estimated 3.5 million Muslims living in the U.S., three quarters are immigrants or children of immigrants. Among those born outside of the U.S., 35% come from South Asia, 25% from the Middle East/North Africa, 11% from Iran, and 9% from Sub-Saharan Africa. No single racial or ethnic group characterizes the majority of Muslim Americans: close to a third of U.S. Muslims identify as Asian, 20% as Black, 8% as Hispanic, with the remaining cohort identifying as “white,” a group that includes those who further describe themselves as Arab, Middle Eastern, and Iranian.16 Muslims in the U.S. are also diverse in age, education, income, as well as in how they self-identify: most Muslims living in the U.S. state that they embrace the “American” identity, though younger Muslims are less likely to share this sentiment compared to older Muslims.17 This diversity of identities underscores the importance of challenging monolithic depictions of Muslims in studies of Islamophobia.
Recognizing the layers of Muslims’ heterogeneous identities is also important to deconstruct Islamophobia, given that hostility toward Muslims can be multifaceted. Dr. Kimberlé Crenshaw, a pioneering scholar of critical race theory and American civil rights advocate, criticizes the notion that subordination occurs along a single-axis and instead proposes an intersectional approach to describe the experiences of individuals who are “multiply-burdened.”18 Given that Muslims are often homogenized, scholars have drawn from Crenshaw’s work to reject the male gendered paradigm of Islamic studies by highlighting the challenges that Muslim women face at the intersection of gender, race, and religion.19 The experiences of Muslims with diverse gender identities and sexual orientations in the U.S. are also fraught. In a survey of more than 800 American Muslims, none identified as gay or lesbian, and only 31% of Muslim Americans held a “favorable” view of gay, lesbian, and transgender people.20 The story of Tynan Power, a transgender Muslim activist, exemplifies the discrimination faced by many LGBTQI+ Muslims; he describes the challenge of being “out” about his religion in the LGBTQI+ community while also withdrawing from his religious community for some time after transitioning.21 Thus, attempts to tackle Islamophobia, and its mental health implications should center the unique challenges of Muslim group membership while also recognizing the layered oppressions faced by Muslims in the U.S.
Islamophobia in the U.S. manifests most visibly as interpersonal discrimination, which negatively impacts mental health among Muslims. Studies have shown that discrimination against Muslim youth is pervasive: 42 percent of Muslim adults with children in K-12 schools reported that their kids had been bullied for their faith, compared to 23 percent of Jewish children. In one case, a teacher in Arizona told an 11-year-old Muslim Somali refugee boy that he would “be the next terrorist.”22 Violence against Muslims particularly ballooned after the September 11 attacks. The Federal Bureau of Investigation’s hate crime database found that “anti-Islamic religion incidents” increased by more than 1,600% between 2000 and 2001.23 In a population-based survey of Arabic-speaking adults in the U.S., half of Muslims and 30% of Arab individuals reported instances of discrimination in the eight months following September 11.24
Islamophobia, and specifically interpersonal discrimination that targets Muslims, also thrives at the level of communities. According to the American Civil Rights Union, twelve states have experienced at least 11 “anti-mosque incidents” in the last decade.25 Several reports have described mosques being vandalized and destroyed in the U.S., including the well-known burning of a mosque in Victoria, Texas in 2018.26 Interpersonal acts of Islamophobia must also be viewed through an intersectional lens that calls attention to experiences of racism and xenophobia. This was evident during and after the 2012 U.S. presidential election when opponents of former president Barak Obama advanced false theories that he was Muslim and not born in the U.S.,27 and weaponized anti-Muslim rhetoric to spur distrust in his candidacy. While hate crimes and assaults against Muslims represent acts committed by individuals, the wave-like, recurring pattern of discrimination that responds to policy and societal changes also suggests that Islamophobic discrimination is, at least in part, embedded in larger societal structures.
Interpersonal racism has harmful effects on mental health. There is a well-documented association between discrimination and psychological distress among Muslims, across race and area of residence.28 In one study, discrimination, measured as having been called an offensive name in the last year due to being Muslim, was predictive of higher levels of depressive symptoms. Interestingly, this same study found that adherence to spiritual practices in the Islamic tradition, including daily prayer, Quran recitation, and ablution, were protective of mental health.29 Another study found that post-September 11 abuse was associated with increased psychological distress and a greater risk of adverse health outcomes.24 The mental health impact of anti-Muslim discrimination has been explored using a “stress and coping framework” in which stress responses correlate with depressive symptoms or substance use.29 Islamophobia has also been found to contribute to negative mental health outcomes by inducing hypervigilance and anxiety in an environment of insecurity and hate-driven incidents.30
Islamophobia can also be internalized, reflecting the acceptance of dominant conceptions and stereotypes among Muslims. Internalized racism was studied in 1947 during “the doll tests” study by Kenneth and Mamie Clark. The researchers sought to elucidate racial perceptions among youth and found that Black children associated “beauty and positive themes with white dolls.”31 Researchers have since expanded and applied the findings of this study to Muslim youth, concluding that American Muslim children often distinguish between “American” and “Muslim” identities to adapt to different contexts: a third of children did not want to share with others that they were Muslim, and 1 in 6 pretended to not be Muslim. Recurrent incidents of discrimination have contributed to what some authors call an “identity crisis of American Muslim youth.”32 In one qualitative study, young girls described feeling as though they needed to wear their hijab “in a way that tells Americans I’m not oppressed.” This tension between an American and Muslim identity is a common theme among youth: one individual described navigating a discourse in which “being American and being Muslim are just (…) antithetical to each other.”33 The internalization of stereotypes has even led young Muslims to consider leaving their faith or not fully expressing their faith in the way they desire by foregoing use of the hijab. Researchers have also compared levels of Islamophobia across faith groups based on negative stereotypes and found that Muslims have the lowest degree of Islamophobia compared to White Evangelicals. Notably, Muslims who experienced discrimination endorsed greater internalized Islamophobia, and Muslims were more likely than other groups to believe that Muslims were likely to commit negative behavior.34
This internalization of racist stereotypes is linked to negative mental health outcomes in the anti-Black racism literature35: internalized racism has been found to adversely impact psychological well-being and self-esteem and has been associated with being overweight, alcohol consumption, and other markers of disease, including abdominal obesity and high blood pressure.3 This relationship carries forward to the Islamophobia context. A qualitative study found that Islamophobia led some Muslim youth to struggle with feelings of insecurity and low self-worth.33 Internalization of stigma has impacted self-esteem and “self-efficacy” among some Muslims, and research has found that Muslim women are particularly prone to internalizing this stress and see measurable impacts on their psychological well-being.36 One study showed that Muslim Americans faced high rates of depression, anxiety, and post-traumatic stress disorder (PTSD) after 9/11, and “feeling less safe” was the primary predictor of developing PTSD in this group.37 PTSD, particularly in the context of recurring racial discrimination, has been found to negatively impact mental health and overall well-being.38 More research is therefore needed to understand the measurable mental health implications of internalized Islamophobia.
Islamophobia also thrives insidiously through institutions and societal structures. Several policies in the U.S. have perpetuated structural forms of oppression against Muslims. Among the most well-known pieces of Islamophobic legislation is the USA Patriot Act, which was signed into law by President George W. Bush shortly after the September 11 attacks. This law claimed to prevent acts of terrorism through enhanced surveillance and regulation of individuals and thereby contributed to profiling and overt discrimination.39 By enabling increased racial profiling, this policy produced fear among Muslim Americans and embedded a common “enemy,” represented by Muslims, into the nation’s political agenda. Though anti-Muslim discrimination far preceded the enactment of the Patriot Act, this legislation contributed to countless instances of individuals who were detained because they fit images of perceived Muslim-ness or conversed in Arabic despite not being Muslim.40 Drawing on Mary Hawkesworth’s theories of embodied power, anti-Muslim policies further disempower Muslim Americans through the construction of a shared adversary and “state-sanctioned oppression” of certain groups under the guise of border security.41
Several other laws and policies have codified Islamophobia. In 2002, the federal government launched a “Special Registration” program that required all male visitors from Arab or Muslim countries to the U.S. to register and be fingerprinted.42 During the nine-year duration of the program, tens of thousands were obligated to register despite the absence of any terrorism-related convictions.43 In 2017, the Trump administration’s “Muslim Ban” prohibited travel to the U.S. from seven predominantly Muslim countries.44 Studies have found that 464 anti-Muslim bias in 2017 were related to this “Muslim Ban,” and the Council on American-Islamic Relations noted a 57% increase in anti-Muslim incidents after Donald Trump’s election to presidency.45 Anti-Muslim sentiment is also embedded in the nation’s institutions beyond the reaches of legislation: Muslim charities have had their assets frozen,46 banks have used the Patriot Act to blacklist Muslim account holders,47 and schools have defended teachers who violated Muslim girls’ use of the hijab.48 Islamophobia also thrives in institutions in less conspicuous ways, including in the health care setting where medical providers lack cultural competency training and hospitals house church spaces but lack neutral praying areas for Muslims.49
Structural Islamophobia adversely impacts mental health outcomes. Scholars have argued that structural racism is at the root of racial health inequities in the U.S., and that tackling racism requires “dismantling the policies and institutions that undergird the U.S. racial hierarchy.”50 In a similar way, Islamophobic rhetoric, policies, and institutions sustain societal systems of inequality that contribute to poorer mental health outcomes among Muslims compared to non-Muslim Americans. A cohort study found that after the Muslim Ban was issued, there was an increase in missed primary care appointments and emergency department visits among individuals from Muslim ban-targeted nations in the US.51 The relationship between racial profiling and psychological disorders such as post-traumatic stress disorder is also well-documented.52 Furthermore, anti-Muslim governmental actions have intimidated and spurred fear among Muslim communities, contributing to heightened levels of stress. In a recent case, the FBI launched an undercover operation at a mosque in California to capture those suspected of training terrorists. The U.S. Supreme Court’s decision to block a lawsuit led by Muslims at the mosque reflects the state’s role in sustaining structural Islamophobia and further perpetuates fear, anxiety, and anger among Muslims.3,53 Moreover, Islamophobic policies create an “alarmed state of mind” that impacts the psychological well-being and habits of Muslims54: concerns about public harassment, stereotyping, and discrimination disproportionately reduce social and community engagement among Muslims, which can further contribute to adverse health outcomes.46
Here, I attempt to clarify that the similarity between structural racism and structural Islamophobia is through the creation/perpetuation of unequal systems of power — rather than to suggest that both forms of oppression function in the same way or have the same implications.
Dismantling Islamophobia is necessary to improve the physical and mental health of Muslims in the U.S. Given the interpersonal, internalized, and structural forces of Islamophobia, policy solutions and responses to Islamophobia and its health impacts must address these various domains. Far beyond focusing on the health implications of interpersonal anti-Muslim violence, society must also contend with the mental health consequences of structural Islamophobia.
Greater research is needed to define and understand Islamophobia as a structural determinant of mental health. The continued controversy surrounding definitions of Islamophobia limits the ability to measure outcomes and pursue comparative studies. Understanding and countering anti-Muslim sentiment thus requires a critical examination of the terms used to describe this phenomenon, including “Islamophobia,” and their implications for sustaining fear-based narratives about Muslim Americans. There is also a scarcity of literature that explores methods of measuring Islamophobia in health research. Existing frameworks of measuring discrimination can be evaluated for their ability to capture Islamophobia and adapted, if warranted, to the context of anti-Muslim discrimination.
Moreover, while Islamophobia has been well-described in sociological circles, this concept warrants further study in health sciences research. Just as the Department of Health and Human Services has aptly increased grant funding to study structural racism and health,55 public health agencies should commission and fund research to explore the overlap of Islamophobia and mental health, including the health impacts of intersectional anti-Muslim discrimination (such as for Black or LGBTQI+ Muslims). Research should also build on existing literature that describes faith as a protective mechanism for mental health and elucidate the ways in which Islam-related factors may correlate with health outcomes.56 As scholars have described the importance of documenting the historical and present health impact of racism, the research community should commit to actively studying the health effects of Islamophobia and elucidating the factors, including race, religion, ethnicity, and culture, that distinctly contribute to anti-Muslim oppression. Importantly, such studies must also seek to understand how Islamophobia might intersect with and compound systemic racism, as well as how it might differ from anti-Black racism, xenophobia, and other forms of oppression.
Within the U.S. health care delivery system, the medical community, including mental health providers, social workers, and allied health professionals, must question whether the mental health care system meets the needs of Muslim patients. While implicit bias training is a necessary first step to mitigate interpersonal acts of Islamophobia, it is not sufficient. Health care providers should strive to bring culturally and religiously sensitive mental health services with the understanding that the clinical environment excludes many Muslim Americans. Community participatory approaches to mental health care, which involve community members in health promotion projects, have been found to increase engagement among Muslim Americans with mental health care through improved trust with the medical community.57 To improve the cultural competence of mental health providers, teaching about Islamophobia and its adverse health impacts should be embedded in medical training curricula. Medical schools should seek to disrupt misconceptions about Islam and other faiths, name Islamophobia when teaching about health equity, and educate students on the impact of structural forms of Islamophobia on health and well-being.
Finally, there must be an understanding that mitigating Islamophobia and its health impacts requires more than interventions in the domain of health care. Policymakers must turn a critical lens on Islamophobic policies and their health implications. Given the ways in which immigration policy, law enforcement and policing, and health care practices contribute to structural Islamophobia, policies across these societal domains should be challenged, and their mental health impacts should be highlighted. Moreover, the mental health provider community can serve as a powerful voice of advocacy for the health implications of policies by describing the adverse effects of policies like the Muslim Ban and the Patriot Act. Given the structural nature of these oppressions, centering the voices of Muslim patients and Muslim-identifying mental health providers in these conversations will be a precondition to moving the needle forward.
The author has no relevant financial disclosures or conflicts of interest.
Nakisa Sadeghi is a fourth-year medical student at the University of North Carolina School of Medicine. She recently completed an MPH in Health Policy at the Harvard T.H. Chan School of Public Health. Nakisa is passionate about advancing health equity, including through culturally sensitive approaches to health care, and remains committed to helping underserved communities through public health and her clinical work as an aspiring dermatologist.