 I'm going to start my conversation with a story. And it's a story related to two of my own patients. The setting takes place before COVID. So we are still all in person at the Stanford clinics. And I just completed a session with one of my patients and was walking her out to the waiting room to call back the next patient. Both patients are Muslim women. And as one exits, and I call back the other one, I could see the second patient is quite disturbed. She's very anxious. She's trembling, literally. And she's very upset. I think to myself, she must have had a really rough day or a rough week. We walk back to my office, have her sit down. I shut the door. And I say to her, you look really anxious. What's happening? How can I help? And when she finally catches her breath, which takes her a few moments, she says, why? And I'm not following. So I say, why what? And she says, why does that woman have to be in this building dressed like that? I mentioned to you, these are both Muslim women. One, the one that had just left, is a woman who wears full makeup, the full face and body covering, all in black, including the face covering. My second patient who's in my office right at that moment doesn't cover and was quite disturbed by how the first patient looked. And she kept saying to me, why does that woman come into Stanford looking like that? She doesn't belong here. She shouldn't look like that. And on and on, this went very upset. Now, because of confidentiality, patient confidentiality, I can't share any details about the first patient, of why she's there. Although as their psychiatrist, I know them both quite well. And if I could have shared, I would have been able to tell the second patient actually, the reason why she's here is very similar to why you're here. And it has nothing to do with her niqab. In fact, the patient who wore niqab fought really hard to wear that niqab and was the only one in her entire family who covered in that way and was very prideful. But he took a lot of pride in that niqab that she wore and it had nothing to do with why she was in therapy. After some time talking to the first patient and trying to calm her down a bit, and then to ask her questions like, what does it mean to have in this country in America to have freedom of expression, freedom of speech, freedom of being able to wear what you wish and be who you are? What does that mean to you? And it took her a little bit of time and she kind of collected herself a little bit and then she sat back on her chair like this, sighed and said, man, the media has done a number on me too. I think that was probably the first time it really clicked for me. What does internalized Islamophobia actually mean? What is its effect on the mental health and the psychology of even Muslims? Some time into the session, she said to me, you know, if anybody should be standing up for my niqabi sister, it should be me. I'm a Muslim too. I know what Islamophobia feels like, maybe not for hijab, but for other things. I know what that feels like. I should be the one standing up for her. I can't believe I said what I said. In the course of really understanding this and also studying this, one of the things that we attempted to do was to further the literature and the study about it because as academics, many of you here know, but unless it's in the literature and sightable, it doesn't exist. Well, in 2019, we published a book called Islamophobia and Psychiatry, which Dr. Hatem Bazian is the leader author and the first chapter of the book, in fact. And it's been a wonderful connection between his research lab and my own to really figure out how do you bring to light the effect of Islamophobia in all the different domains? My own domain is mental health. That book was really the first attempt to bring clear in the literature, actually in book form, at least, academic citations on exactly how does Islamophobia affect the mental health of those who are experiencing it? And one of the main things that I can tell you in terms of ramifications and beyond anecdotes is to say that the increase of depression and anxiety is high amongst those who have experienced Islamophobia. You've heard this, you've seen the stats and now understand what that may look like, but let me bring it to you kind of a very clear point, I hope, in mental health, those of us in the field when we treat anxiety and depression, one of the things that we worry about the most is the end line. Where is the end of the line that depression and anxiety takes you? What happens when a person starts to feel so down and so unaccepted by the current, either family structure, friend structure, societal structure, community structure, in general, it feels like they no longer belong. They are told that they are foreign, that they don't belong here and that they are a burden or their people are a burden on this society. What happens? Well, in our field, the end of the line that we worry about is very difficult and triggering subjects, but one that I have to bring up. And so I give my trigger warning, but I will talk about suicide for a few moments. But that is the end of the line when a person is so clinically depressed and so down that they cannot see or wait out, they don't see a light at the end of the tunnel anymore. We know that the rates of suicide go up. Now with the ISPU, one of the things that we wanted to study was what are the data points on American Muslims and their mental health, but also on things like suicide, which I consider to be the taboo within the taboo of mental health. In 2019, senior that we published the book, we put some questions related to mental health in the annual Muslim poll. One was related to access to mental health. One was related to mental health in general. And one was very specific to the topic of harm to oneself, suicide. What we received back was alarming anecdotally and clinically, I could tell you that that's what we expected, but not quite to that level. The end results were published in JAMA, the Journal of American Medical Association. Talk to your journal. And there were many who understood the importance of why we did that work and there were others who were quite upset with it. Thought that maybe we were airing the community's dirty laundry. But how else do you start to solve the problems and address it unless you can actually pinpoint it and have data points speaking to it? The numbers that we published were close to 8% of American Muslims in this cross-sectional poll. Compared Muslims, Christians, Jewish people, Hindus, Buddhists, atheists, agnostics all the way across and found that Muslims had a higher rate than any of these groups to report lifetime suicide attempts. That's the attempts of suicide. And this is coming in the context of the previous administration in which there is and was a very explicit Islamophobia. Nothing new, but very explicit in its Islamophobia. At this point, the question becomes, what are the theories behind Islamophobia, behind suicide? There are two. Two main theories that the literature and those who studied suicidologists, which we had a massive convening of suicidologists, those who've published the hundreds of papers on suicide and brought them all together and said there is an issue in this Muslim community regarding this topic and it's really hard to crack. What do you all say? We have a paper coming out on that analysis of there about convening. Two main theories. Number one, when you have an increased sense of burdensomeness, when you feel like a burden or you've internalized that you are the problem. And therefore some of this could happen on an individual level, family level, community level, but for others it's happening on a societal level. And the second theory is an increased sense of lack of belonging, which absolutely matched very much the American Muslim story, especially in the era in which we were studying this. I just said 2019. That was right before the global pandemic. So we are looking at research now on one of the later 2022 annual polls that ask the same questions to see how do Muslims do within and after the pandemic? We're told the pandemic ends next week, apparently. So maybe soon, we'll say after the pandemic. What I could tell you although that paper is not yet published, is that it's definitely more than eight percent. And that is very concerning and very troubling because for me, what it means, and you're going to ask, I know, if I tell you bad news, you're probably going to want to know, well, what is the solution? The solution from the mental health and psychiatric perspective would be get mental health help. So that leads me to the second point that I'd like to make tonight, which is that if the solution is get mental health help, professional mental health help, that a person has internalized that they are inferior. They have internalized that they don't belong. They have internalized that they are foreign. And when they look at the available resources in the current mental health system, they say, it's not for me. I can't benefit. What's the point of going to therapy? You want me to talk about the private matters of my house and household and the way I grew up and my family and my parents? This is so un-Islamic or un, you know, whatever fill in the blank, whatever culture they may come from. Not realizing that actually, and I'm not going to go into a whole big discussion on this because I, as if you've ever heard me speak before, you know I get on my stage and get very excited about talking about the history of mental health in Islam. I shall walk, but there is an incredible connection between Islam and mental health. So despite that heritage, despite the fact that Muslims talk the rest a thing or two or three or four or five related to mental health. And we're the ones who really actually instituted psychiatric cares within their own hospital systems that then spread to the West. That today, Muslims have a very hard time, some have a very hard time accessing mental health. And when you ask why, often the answer is, they won't get me, they don't understand my struggles. They're going to judge me. They will blame me or my religion. And while anecdotally, we've definitely heard such stories, I'm not actually minimizing the reality behind those statements. But a part of it is a form of internalized Islamophobia where someone says, subconsciously, I am foreign, I am different. Therefore that system won't help me. But that simply isn't the case. And so there is much here to look at and to really try to figure out what are these next steps. And I hope in the next part of our panel here, we'll talk about this a little bit more. Because from a mental health perspective, when you dichotomize health and healing to otherness and fullness, there is a real problem in actually trying to bridge the mental health care and support. And now you might realize why when I get on my soapbox, I talk quite a bit about that mental health is part of your Muslim heritage. And now you see why there is some behind that, to bridge the two worlds that typically do not talk to each other much, the mental health world or the medical world or scientific world and the world of religion and faith. I thank you very much for your attention and I look forward to our conversation.