Lived Islam and Healing: An Ethnographic Study among Muslim Migrant Women in Amsterdam-West

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Lived Islam and Healing

An Ethnographic Study among Moroccan Migrant

Women in Amsterdam-West

Master Thesis

Research Master Religious Studies

Department of History, European Studies and

Religious Studies

Faculty of Humanities

June 2018

Lisette van de Burgwal, B.A. - 10113754

Supervised by Dr. C. Ivanescu

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ACKNOWLEDGEMENTS

Writing this thesis would not have been possible without the help of certain people. Firstly, I would like to thank my supervisor and mentor, Dr. Carolina Ivanescu. I could not have wished for a better supervisor, providing me tremendous support and guidance throughout the process of writing this thesis. Her thoughtful comments and suggestions along the way have been extremely useful and taught me a lot about doing ethnographic research. I am also very thankful to my second reader, Dr. Richard van Leeuwen, who was always willing to provide me advice whenever I needed it, during the process of writing this thesis, but also over the entire course of my studies. I would also like to express my gratitude to my friends and family who have provided their support and encouragement. Finally, and perhaps most importantly, I would like to thank all the women who participated in this research study. The women of the foundation Samen Sterk Vrouwen West were welcoming and helpful in connecting me to the women participating in the programs of their foundation. I thank my respondents for offering their time and emotional energy to share with me their experiences with illness, wellbeing, and healing. Thank you for allowing me and others to learn from your experiences and practices.

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ABSTRACT

This study looks at the role of religious beliefs and practices in how Moroccan migrant women experience illness, wellbeing, and healing. Experiences and perceptions of what it means to be well and what can be done to improve wellbeing, can differ from one culture to another. In the Netherlands, the dominant discourse and healing system are based on secular views, in which the religious views and practices of Moroccan migrant women can easily be marginalized. The present study aims to contribute to a more inclusive understanding of healing, by exploring the role of lived religion of the Muslim group affects their ideas and experiences of illness, wellbeing, and healing. Ethnography was used as a method, including eleven semi-structured interviews and participant

observation among Moroccan migrant women at a community center in Amsterdam-West. As the findings indicate, religious beliefs and practices provide ways of dealing with illness in a meaningful and empowering way, giving Moroccan migrant women a sense of agency of which they often feel deprived in the dominant secular healing context of the Netherlands.

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INTRODUCTION

Moroccan immigrant women are more vulnerable in terms of health-related problems than other people living in the Netherlands. Certain mental and physical illnesses are more prevalent among this ethnic minority, such as depression and diabetes.1_When

struggling with illness, they most often reside to healthcare providers in the dominant healing system, which is characterized by evidence-based medicine and secular views on illness. Within this system, there is little room for the role of religion and meaning-making as parts of the healing process.2_{However, as e.g. anthropologist Meredith}

McGuire has argued, this is only one model and perceptions on illness, wellbeing, and healing can differ from one cultural group to another.3_{Within the dominant model, the}

religious beliefs and practices of Moroccan migrant women can easily be marginalized.

The current study aims to explore this role of religious beliefs and practices in how Moroccan migrant women experience illness, wellbeing, and healing. The focus lies on those women living in Amsterdam-West because this is one of the urban areas in the Netherlands with a particularly large minority of Moroccan migrants.4_{In order to}

answer the research question, the present study explores what role religion plays in how how Moroccan migrant women experience and give meaning to wellbeing and illness; actions they take when they do not feel well; how they experience healing practices, both conventional and alternative/complementary; and how they deal with illness on a

personal and social level.

Existing academic research on this topic, particularly quantitative research in the fields

1_{Van der Wurff et al., 2004: 34.} 2_{Knipscheer et al., 2005: 378.} 3_{McGuire, 1986: 269.}

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of public health and clinical psychology, is often goal-oriented and focused on an evidence-based approach of healing.5_{The academic discipline of medical anthropology}

offers a more inclusive image of what healing may entail for people from different

cultural groups. Laurence J. Kirmayer, for example, has argued that healing can provide a sense of meaning and process through which the identity of a patient can change profoundly.6_{Little research exist that examines how Moroccan migrant women}

experience healing through this more inclusive perspective.

In order to take the cultural context into account and gain a better understanding of what healing entails for Moroccan migrant women, qualitative research is necessary. For the current study, ethnography was chosen as a method. The fieldwork consists of eleven semi-structured interviews and participant observation among Moroccan migrant

women at a community center in Amsterdam-West. The aim of this fieldwork was to gain proximity to their lived reality and experience of this ethnic and religious minority group. In the process of acquiring data, it was therefore important to constantly reflect on the research questions and work hypotheses, and make changes whenever these questions and hypotheses were no longer in line with what the data indicated to be relevant. Because the data of this study sometimes differed from the prior expectations of the researcher, this process has become similar to grounded theory, where the

researcher continuously reflected on the theories and research questions while acquiring data.7_{This reflective method proved beneficial in order to do justice to the experience of}

the respondents and to let their ideas and experiences, and not preconceived theories, prevail.8

5_{See e.g.: Schrier et al., 2017.} 6_{Kirmayer, 2004: 34.}

7_{Goulding, 2005: 296.} 8_{Cerwonka and Malkki, 2007.}

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1. HEALING AND DISCOURSES OF POWER

Illness, wellbeing, and healing can hold significantly different meanings for different people and cultural groups.9_{Over the course of the last century, a process of}

secularization of health has created a separation between religion and healing. As a result, secular views on illness, wellbeing, and healing have become dominant in Western societies.10_{This secular perspective is characterized by an evidence-based}

approach to illness and healing and a strict divide between body and mind.11 _Medical

anthropologists have argued, however, that this perspective is merely one of many possible models.12_{The division between these different models is not always clear and}

there is much overlap between them, particularly in the way people experience healing on a personal level. Yet, this distinction is visible in mainstream discourse, in which healing practices that are not evidence-based are marginalized and even ridiculed.13_In

this chapter, the perspectives of different healing systems and the underlying discourses of power will be discussed. Furthermore, alternative frameworks for understanding healing, which focus on meaning-making and lived religion, are presented.

1.1 Illness, wellbeing, and healing

The present paper attempts to discuss illness, wellbeing, and healing from an emic perspective; the aim is to stay close to the personal experience Moroccan migrant women have of these three concepts. In this sense, it is crucial to start this process with the terminology, as labels for practices and phenomena carry with them connotations. Being

9_{Kirmayer, 2004: 33.} 10_{McGuire, 1986: 269.} 11_{Vellenga, 2008: 335.} 12_{E.g. Kirmayer, 2004: 33.}

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aware of these connotations is necessary in order to make informed choices when attempting to describe experiences and practices of cultural groups without marginalizing them.14

In the present study, the term “illness” is used to describe a general experience of affliction, which can include pain, suffering, distress, and agony.15_{This definition is}

based on the distinction between illness and disease, as posed by medical anthropologist Arthur Kleinman. He describes illness as “a person’s perceptions and experiences of certain socially disvalued states including, but not limited to, disease.”16_{Disease, on the}

other hand, is described by Kleinman as an isolated function of the body or psyche that is not working properly.17_{According to Kleinman, the experience of illness is largely}

culturally constructed and the term describes how disease is perceived, experienced, and coped with.18_{The experience of illness can be shaped or influenced by religion and}

spirituality.19_{This understanding will be complemented by the data of the present study.}

Similarly, the term wellbeing is used in this study to describe a general positive experience of existence. This can include many aspects of the personal experience and surpasses the biomedical definition of health, which can easily be interpreted as “lacking disease”.20_{Wellbeing is a subjective experience of being happy, healthy, and living a good}

life, which can be understood differently from one cultural group to another.21

The term healing will be used to describe all forms of dealing with illness and of working

14_{Bourdieu, 1977: 166.} 15_{Kirmayer, 2004: 33.}

16_{Kleinman, in: Hanegraaff, 1996: 42.} 17_{Kleinman, 1988: 3.}

18_{Kleinman, in: Hanegraaff, 1996: 42.} 19_{Hanegraaff, 1996: 44.}

20_{The World Health Organization has chosen a broader definition of “health”, see: <http://www.who.int> 15}

April 2018. However, in practice the term is often used in a more reductive way, pertaining to the lack of mental and physical disease.

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towards a better wellbeing. These practices are usually based on underlying perspectives on wellbeing and illness, which may or may not be (partially) shared between the healer and patient. Medical anthropologist Laurence J. Kirmayer distinguishes the term healing from curing. According to Kirmayer, curing describes a more mechanic way of dealing with illness, in which separate dysfunctions of the body and mind are attempted to be restored.22_{Healing, on the other hand, is described as a transformation of identity,}

both of the experience (from being ill to being well) and of the identity of the patient (from victim or ill person to a healed person). According to this perspective, the experience of healing may bring patients a sense of general wellbeing, balance, and wholeness.23_{Following this perspective, curing could be, but does not have to be, an}

aspect of healing.

Perspectives on illness, wellbeing, and healing can differ from one cultural system to another, as well as from one religious or cultural group to another. Additionally, they shape and influence the healing systems that are in place in particular cultural contexts. In the next subchapter the different healing systems that can be distinguished in the Netherlands are described, as well as the discourses that underlie these different healing systems. It will be argued that in the Netherlands, the dominant healing system is based on secular views.

1.2 Dominant and marginalized healing systems

In the Netherlands, as well as in other countries in Western Europe, there is a mainstream view that religion is no longer a valuable component of modern society.24

22_{Kirmayer, 2004: 33.} 23_{Ibid: 34.}

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This view can be described as a secular perspective.25_{However, for many people, this}

view does not reflect reality. Even though church attendance has decreased significantly since the 1960s, it has become clear that religion is not going to disappear, as many people initially believed it would.26_{Rather, religion is changing form and has become}

more individualistic and commercial.27_{Additionally, the large influx of migrants from}

Muslim countries has made Islam into the second largest religion in the Netherlands.28

Despite this persistence of religiosity, secular thought affects the way people perceive religion. According to this perspective, as science and modernity are evolving, religion will soon no longer be necessary and even hold modern society back from evolving and becoming more liberated. Many Dutch people consider religion to be backwards, old-fashioned, dogmatic, and intolerant.29_{Secular views are also present in Dutch politics,}

through which religion has been separated from public institutions, such as education, politics, and, particularly relevant for the present paper, healthcare.30

The separation of religion and healing can be seen as a result of the process of the

secularization of healing. In this process, important functions of religion, most notably of providing meaning, have been removed from public healthcare institutions. Public institutions for healing include hospitals, general practices, psychotherapy clinics, and the pharmaceutical industry.31_{They make up a healing system which is dominant in}

Dutch society, due to their visibility, and the governmental and societal recognition they receive.32_{This dominant healing system is often called biomedicine.}33_{This term,}

however, is limited in the sense that healthcare providers who are not medical doctors

25_{Verkaaik, 2009: 115.} 26_{Borgman, 2011: 27.}

27_{Bernts and Berghuijs, 2016: 182.} 28_{Habermas, 2008: 20-21.}

29_{Verkaaik, 2009: 115.} 30_{McGuire, 1986: 269.} 31_{Ibid: 271.}

32_{Commissie Alternatieve Geneeswijzen, 1981: 17.} 33_{E.g.: Vellenga, 2008.}

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but also part of this dominant healing system, such as psychologists, are not necessarily included. In the present paper the term “conventional healing” will therefore be used instead, because this healing system is dominant and considered conventional in secular societies.34

Secular views on illness, wellbeing, and healing are at the core of conventional healing and because these views are part of a dominant discourse, they also influence how people think about healing on a personal level. In this dominant cultural system, the focus lies on science and evidence-based medicine and religion and meaning-making are

considered private matters which should not have a place in the public sphere, including public healing practices.35_{In this way, secular views on healing exclude religion as a}

valuable option for healing. Unlike religious practices pertaining to healing,

conventional healing is based on and legitimized through government-funded, public institutions, such as universities, insurance and legal systems.36_{It is characterized by a}

strict separation between body and mind and a distanced approach of curing defects of isolated functions of the body and mind.37_{There is little focus on the broader process of}

healing as described by Kleinman.38_{This means that the relationship between the}

provider of healthcare and patient is a distanced one, where the focus has turned away from consoling and inhabiting a social relationship to investigating the different

functions of the body and mind.39

In the dominant cultural system, the outcome of healing practices are evaluated by

34_{Brown, 2013: 2.}

35_{Hirshkind defines the secular as “having a religious shadow” and definitions of religion often include}

systems of meaning. Here, the religious shadow of healing practices is therefore interpreted as viewing affliction in objective, functional way and not as part of the personal experience and meaning-making processes of the patient. See: Hirshkind: 2011 and Pargament 2011 (for a definition on religion as a search for significance).

36_{Comissie Alternatieve Geneeswijzen, 1981: 17.} 37_{Asad, 2003: 48.}

38_{Kleinman, 1988: 253.} 39_{Asad, 2003: 48.}

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practitioners by focusing on the measurable effects from healing practices. This is evident in the case of doctors curing physical ailments, but also apparent in clinical psychology. The history of how this discipline has become a science illustrates the importance of measurements and experiments in the field of clinical psychology.40_Pain

and suffering have become part of the scientific experiment and thereby partially taken out of the context of personal experience, as many aspects of personal experience are not measurable with scientific experiments.41

Biomedicine and clinical psychology are considered the norm and most easily accessible due to its basis in public institutions. All other forms of healing fall into the category of “alternative medicine”.42_{American scholar of religion, Candy Gunther Brown, has opted}

for the more inclusive term complementary and alternative medicine (CAM), as these healing practices are not always used as an alternative to conventional healing, but often simultaneously.43_{CAM includes religious(/spiritual) and traditional healing practices,}

such as the ones that will be discussed in this paper.

CAM is popular among people who are dissatisfied with conventional healing, who argue that the latter healing system focuses too much on curing symptoms and thereby fails to take into account the broader healing process and alternative perceptions on illness, wellbeing, and healing.44_{A wide variety of CAM practices exists across many different}

cultures. Thus, there can be many different underlying perceptions on illness, wellbeing, and healing for different CAM practices. However, many CAM practices contradict the dominant view of a strict separation between body and mind and emphasize the holistic

40_{Shamdasani, 2003.}

41_{Following Asad’s argument on the secular perspective on healing, which he does not explicitly apply on}

clinical psychology. See: Asad, 2003: 48.

42_{Vellenga, 2008: 335.} 43_{Brown, 2013: 3.}

44_Hammer,

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nature of healing.45_{Rather than perceiving the body and mind as strictly separate, CAM}

practitioners often view them as interrelated and even inseparable. Physical symptoms can be placed in an emotional, social, and/or spiritual context, providing a meaningful framework for patients through which they can make sense out of their experience of illness.46_{The focus in CAM often lies on the personal experience of the patient, and in}

many CAM practices, consoling the patient is an important part of the healing practice.47

There is no strict division between conventional healing and CAM and the two healing systems often overlap. The illusion of this clear divide can be ascribed to a gap between discourse and practice, as described by sociologist Pierre Bourdieu.48_{Whereas in popular}

discourse CAM is either stigmatized or defended as a marginalized group, the reality of practice shows that this is not as black-and-white. For example, scientific research methods do not exclude a focus on a broader perspective on healing, and many attempts have been made at making clinical psychology and biomedicine more culture-sensitive.49

Examples of this include Bhui and Bhugra’s literature on cultural psychiatry, advocating cultural competence as an important qualification for healthcare providers.50

Furthermore, there are healing practices that fall somewhere in between the two categories, receiving only partial recognition as legitimate, scientifically backed healing practices in society.51_{The distinction between conventional healing and CAM is}

therefore not so easily made when it comes to the actual practices, but more visible in the mainstream discourse and the extent to which they are socially and scientifically recognized in Dutch society.52

45_{Brown, 2013: 3.} 46_{Sointu, 2008: 266.} 47_{Hirshkind, 2011: 640.} 48_{Bourdieu, 1977.}

49_{See e.g.: De Jong and Colijn, 2010.} 50_{Bhui and Bhugra, 2007.}

51_{Van Dijk, 2003.}

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CAM practices are marginalized in the dominant secular cultural system of the Netherlands. They are often stigmatized as “the other”, in a similar manner in which religion is stigmatized. Both CAM and religion are often criticized as being irrational and backwards.53_{CAM practices are evaluated in hierarchical way, based on secular}

perspectives on illness, wellbeing, and healing. In other words, criticists focus on the question: does it work? The answer to this question is sought in measurements and curing diseases is perceived as the ultimate goal of healing practices.54_{This approach to}

healing, however, overlooks the meaning and purpose that is ascribed to healing in different cultural groups. In the following subchapter, alternative frameworks for understanding and evaluating healing are discussed.

1.3 Alternative frameworks for understanding healing

The present study focuses on the lived experience of Muslim migrant women in

Amsterdam-West. In order to gain proximity to their experience, reductive concepts and theories should be avoided. Using a definition of healing that includes the myriad of functions rather than only the curing of a specific dysfunction of the body or mind, enables us to perceive healing in a broader sense and allows us to pay attention to the variety of experiences people have with illness, wellbeing, and healing. As argued above, it can be experienced as a transformation of identity.55_{When healing is perceived as}

such, all personal and social acts and practices, inside and outside of the healing

practices and clinics, can be part of the healing experience of the person who suffers from

53_{Many examples of this attitude can be found in popular media, such as this episode of tv-show Zondag met}

Lubach: ‘Alternatieve Geneeswijzen.’ Another example is the existence of the (government-funded) association against quackery (Vereniging tegen de Kwakzalverij).

54_{For example, in her book on CAM, Brown argues that many CAM practices are “religions in disguise”,}

which she believes makes informed consent impossible. In her line of reasoning, however, she emphasizes the question “does it work?” and thereby uses the secular discourse to evaluate practices that operate differently. See: Brown, 2013.

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Healing practices can help alleviate suffering, but also restore social structures and provide a patient with a sense of meaning. Healing practices often provide a framework for patients which can help them in order to make sense out of their illness and personal experience.56_{Furthermore, it can create a platform for working on this personal,}

transformational healing process.57_{What follows are two examples of ethnographic}

research about the healing experiences of groups whose experiences are marginalized in the societies they live in. Both of these studies illustrate these different functions healing can have beyond curing disease.

The first example illustrates the role of gender in healing and demonstrates the function of certain healing practices to empower women, who feel marginalized in a society in which gender inequality persists. Sociologists Eeva Sointu has done extensive

qualitative research on women using CAM in the United Kingdom. She found that for many women, CAM practices provide a platform to express themselves freely in a male-dominated society. The women of her study described how they felt more in control in the more marginalized CAM practices, compared to their experience with dominant, conventional healing practices where they are expected to take on a more passive role as a patient.58

A similar function of healing can be found in traditional healing practices in Islamic countries. An example are the possession cults, such as the Zar in Egypt and the Gnawa in Morocco.59_{Here, Muslim women who are believed to be inflicted by evil jinn or other}

56_{Kirmayer, 2004: 37.} 57_{Sointu, 2008: 260.} 58_Ibid.

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entities, are initiated into a possession cult, where they attain a special status as a “bride” of their possessing spirit. Anthropologist Gerda Sengers has described the practices of the women who were initiated into the Zar in Egypt.60_{Rituals of these}

possession cults include trance ceremonies in which the women can let their possessing entity take full control over their bodies and dance to the music in a way the women ordinarily would not be expected to do.61_{Other aspects of the rituals may include}

drinking alcohol and wearing excessive jewellery and extravagant clothing, which can also be interpreted as a way for the women to feel liberated in their personal expression from the restrictive bounds of the society they live in.62

These examples show how healing practices can give patients a sense of agency and control, which is another important function of healing. The healing practices described in this chapter do not only provide an alternative method to the conventional healing system, but also alternative frameworks for understanding illness. These frameworks offer ways for the patient’s to make sense out of their experience with illness and attach meaning to this experience. Additionally, it provides a way to communicate their

experience within their cultural community.

These examples of how healing can affect different spheres of experience for

marginalized groups, are relevant for the present study in that they show that some cultural groups have views on illness, wellbeing, and healing that differ from the views that are dominant in the society they live in. The latter example also shows how religion can play a role in providing interpretations of illness and directions for healing. For the sake of the current study, religion is defined on an individual level rather than from the perspective of religious authorities and institutions. As sociologist of religion, Meredith

60_{Sengers, 2000: 99.} 61_{Ibid: 93.}

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McGuire, has rightfully noted, religion to the individual is “an ever-changing,

multifaceted, often messy – even contrary – amalgam of beliefs and practices that are not necessarily those religious institutions consider important.”63_{This gap between lived}

religion and religious orthodoxy can be understood as a gap between discourse and practice, which is also apparent in Islam.64_{On the one hand there are the ´ulama and}

other religious authorities, as well as Islamic jurisprudence (fiqh), forming the dominant discourse of what Islam constitutes. On the other hand there are the personal beliefs, sensations, acts, and rituals of the people who identify as Muslim. This lived. This lived religion is often a mix of orthodox Islam, folk-belief, and other cultural or individual beliefs and practices.65

Lived religion can be related to illness, wellbeing, and healing in several ways. Psychologist of religion Kenneth Pargament has written about the different

relationships between religion and illness, wellbeing, and healing. Pargament argues that for many people, religion plays an important role in coping with illness. According to him, in times of distress, religion can help someone to find meaning, gain (a sense of) control, experience consolation and proximity of God, bring people closer together, and transform someone’s life.66_{Furthermore, religious beliefs and practices can be organized}

in the form of a healing practice, such as in the case of the possession cults. Many CAM practices draw on religious traditions and beliefs.67

A sense of meaning is an important aspect of wellbeing. People need to feel as though their lives are meaningful and worth living.68_{In present society, working on personal}

development has for many people become an important and meaningful purpose of life. 63_{McGuire, 2008: 4.} 64_{Bourdieu, 1977.} 65_{Ramey, 2015: 4.} 66_{Pargament, 2011: 276.} 67_{Brown, 2013: 3.} 68_{Baumeister, 1991: 61.}

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Contemporary spiritual movements often facilitate ways of working on self-improvement while providing a meaningful framework for understanding this life-long process.69_This

process is deeply intertwined with healing, in the sense that various CAM practices aim to aid people in their spiritual path towards self-improvement. Within this framework, illness can be interpreted as a starting point of this spiritual path.70

The present study focuses on how lived Islam influences the way in which Moroccan women experience healing. In order to study this personal experience, the measurable effects of healing practices are not so relevant. Instead, the focus will lie on how healing can contribute to a general improvement of wellbeing, giving groups whose views and practices are marginalized a sense of empowerment and agency.

1.4 Conclusions

The present chapter has shown that illness, wellbeing, and healing can hold significantly different meanings for different cultural groups. In the Netherlands, the dominant perspective is based on secular views. Conventional healing is the dominant healing system in the Netherlands, with a focus on evidence-based medicine. Secularization processes have removed religion out of the public sphere, including public healthcare institutions. As was argued in this chapter, however, there are many alternative perspectives on illness, wellbeing, and healing and these shape and influence the practices of complementary and alternative medicine (CAM). In these alternative perspectives, religion can play an important role. In the next chapter, the role of the religion of Moroccan migrant women, Islam, is further explored.

69_{Bernts and Berghuijs, 2016: 182.}

70_Hammer,

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2. LIVED ISLAM AND HEALING

As the previous chapter has shown, religion can play a role in how people view and experience illness, wellbeing, and healing. This study is focused on how religious beliefs and practices play a role in the experience of healing among Moroccan women in

Amsterdam-West, who generally identify as Sunni Muslim.71_{In this chapter, the}

relationship between lived Islam and healing will be discussed.

2.1 The heterogeneity of lived Islam

Like any religion, Islam is not a homogenous religion. The previous chapter has shown how lived Islam stands in relation to Islamic orthodoxy. Lived Islam can include elements of formal Islam, folk-Islam, and Sufism.72_{Ethnographic literature on lived}

Islam, e.g. by Hoel and Shaikh (2013), shows that Muslims all over the world use references to the Qur’an and Hadith to understand and explain their actions and decisions.73_{These references may not always be considered correct interpretations by}

religious authorities, such as the ulama. In addition to Islam scripture and formal Islam, pre-Islamic traditions and folklore have strongly influenced the lived religion of Muslims all over the world, including Moroccan Muslims in the Netherlands.74_{Many of these}

traditions and folk-beliefs have become part of what Muslims understand as Islam. Despite these many influences and differences, a common thread for all Muslims is the importance of Qur’an and hadith.75

71_{<https://www.ois.amsterdam.nl/nieuws/aantal-moslims-in-amsterdam> 29 March 2018.} 72_{Hoffer, 1994: 36.}

73_{E.g. Hoel and Shaikh, 2013.} 74_{Hoffer, 2000: 109.}

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The complex relationship between formal Islam and folk-belief can also be observed in healing practices.76_{This context of Islam and healing is similar to the context of CAM in}

the secular Netherlands. In the previous chapter, it was described how secular views are dominant in institutionalized healing practices and CAM is stigmatized as a

marginalized other.77_{Similarly, CAM practices in an Islamic context are stigmatized}

among Muslims. This is illustrated in the work of medical anthropologist Cor Hoffer, who found that Islamic authorities were often negative about traditional healers who legitimized their practices based on Islamic scripture and dogma. The religious authorities distanced themselves from these healers and criticized them as being

dangerous or non-Islamic. As Hoffer also found in his study, however, Islamic folk-belief and Islamic healing practices were a big part of the lived Islam of many of the Muslims in the Netherlands.78_{This can be interpreted as a gap between discourse and practice, in}

which the power discourse of the religious authorities do not represent the lived religion of the Muslims in practice.

2.2 Interpreting causes of illness

Western medicine and secular views on illness have become mainstream in most parts of the world, including Muslim countries like Morocco. As such, Moroccan Muslims

commonly attribute illness to biological and psychological or social stressors rather than to religious causes.79_{However, Islam, as a lived religion, can affect how Moroccan}

Muslims experience and interpret wellbeing and illness. An example of a widespread folk-belief among Muslims is the belief in the evil eye (al-‘ayn in Moroccan-Arabic).

76_{Hoffer, 2000: 213.}

77_{Many examples of this attitude can be found in popular media, such as this episode of tv-show Zondag met}

Lubach: ‘Alternatieve Geneeswijzen.’ Another example is the existence of the (government-funded) association against quackery (Vereniging tegen de Kwakzalverij).

78_{Hoffer, 2000: 214-215.}

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Although the belief in the evil eye was prevalent in Muslim countries before Islam, it has become incorporated in the lived Islam of Muslims all over the world. According to the

hadith, the prophet Muhammad has confirmed the existence of the evil eye.80_{The belief}

in the evil eye entails that looking at someone or someone’s property with envy can have negative consequences for the person who is envied.81_{The evil eye is believed to be able}

to harm both someone’s physical and mental wellbeing.82_{There are several ways in}

which people can protect themselves against the negative consequences of the evil eye. For example, when looking at someone or something with envy, someone can say a word or sentence of blessings to avoid doing harm through the evil eye. A common brief blessing Muslims use, is ma sha’ Allah. It is very common to say this to someone by way of a compliment, for example about their children or house.83_{If Muslims are afraid of}

being personally harmed by the evil eye, they can use amulets with Qur’anic texts on them or blue beads with an eye painted on them.84

Another Islamic belief that can have negative impact on someone’s wellbeing is the belief in jinn. In the Qur’an, jinn are described as imperceptible creatures, created by God out of fire. They are believed to live between the realm of humans and the realm of angels and demons. Like humans, but unlike angels and demons, jinn are believed to have free will and there are therefore both good and evil jinn. Some jinn are Muslim and some are not. Beliefs in jinn were already present in pre-Islamic Arabia.85_{Although Muslims}

generally agree on the existence of jinn, there are many different opinions and beliefs about the specific attributes of jinn and their ability to affect humans.86_{The belief that} jinn can take possession of a human’s body is widespread among Muslims and this belief

80_{Marçais, <http://dx.doi.org/10.1163/1573-3912_islam_SIM_0908> 24 May 2018.} 81_{Hoffer, 2009: 109.}

82_{Khalifa et al., 2011: 70.}

83_{As observed during the fieldwork of this study. See also: ‘‘Masha’ Allah’,}

<http://dx.doi.org/10.1163/1573-3912_islam_SIM_5002> 25 May 2018.

84_{Hoffer, 2009: 109.} 85_{Sengers, 2000: 32.}

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has a basis in Islamic scripture. In the sunna, there are many accounts of the prophet Muhammad healing people who are possessed by jinn.87_{Many Muslims also believe that} jinn can affect human’s wellbeing in ways other than possession. Jinn are believed to be

able to influence the personal life by keeping someone from getting married, making a woman infertile, making someone tired or confused, and interfering with someone’s sleep.88_{Dutch-Moroccan ex-politician Tofik Dibi described in his autobiography how he}

initially blamed evil jinn for his homosexuality.89

It is often believed that certain circumstances make a person more vulnerable for jinn infliction. Examples include people who are physically or mentally transitioning, such as pregnant women or people who are traveling. Women are also generally believed to be more prone to jinn infliction because they are often considered both morally and physically weaker than men. Especially women on their menstrual period, who are considered impure, and women who are pregnant are believed to be at risk.90_Another

popular belief is that jinn roam in wet and dirty places. The night is also considered the time of jinn and certain activities should therefore be avoided at these hours, especially when water is involved. Many Muslims therefore refrain from cleaning in the night. Another precautionary practice that is widespread among Muslims is to say bismillah (in God’s name) before flushing the toilet, eating or drinking, and before traveling.91

These examples of dealing with jinn and evil eye show that Islamic practices can provide Muslims with a sense of protection against evil forces.

87_{El-Zein, 2009: 84.}

88_{See: Hoffer, 1994: 28 and Sengers, 2000: 88.} 89_{Dibi, 2015.}

90_{Strasser, 2005: 438.} 91_{Hoffer, 1994: 28.}

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2.3 Lived Islam and dealing with illness

The Qur’an is a central aspect of Islam for all Muslims. As a holy scripture that is believed to be revealed by God, the words of the Qur’an are thought to have healing powers. Reading verses from the Qur’an or listening to other people recite them, is believed to be a powerful tool of working on wellbeing.92_{This practice can be done}

individually or in some cases in a social context, where Muslims read the Qur’an to one another or listen to recordings of recitations by experienced reciters.93

Besides reading or listening to the Qur’an, prayer, or salat, is an important part of religion for Muslims all over the world. There are five set times a day for prayer and the Friday prayer (jum‘a) is particularly important. Praying is done according to certain guidelines, including hygiene practices before prayer and a set of repeated movements during the prayer. These guidelines make salat a ritual or liturgical prayer. A more personal type of prayer in Islam is called du‘a. Du‘a can be done after prayer, or at any other time during the day. This is a prayer of invocation or request. Unlike the salat,

du‘a provides space for Muslims to speak to Allah about what they personally wish to

speak about and to request things from Allah.94_{This may include health and wellbeing}

for themselves and for others.95_{Even though du‘a is a type of prayer that can be done}

however the believer pleases, there are some advisory guidelines. These include recommendations for the times of the day at which it can be performed, the proper intention and mood, which can be useful to get one’s wishes granted by Allah, and the posture one should take while doing du‘a (typically one of the different postures taken during salat). Many Muslims also choose to recite verses of the Qur’an as part of their

92_{See e.g.: Hoffer, 2000: 130.} 93_Ibid.

94_{Gardet, <http://dx.doi.org/10.1163/1573-3912_islam_COM_0195> 24 April 2018.} 95_Ibid.

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du‘a practice.96_{The revealed words of the Qur’an are often utilized in prayer because}

they are believed to have certain powers.97

2.4 CAM in Morocco

Besides the personal religious practices Muslims can perform to deal with illness and to attempt to work on their wellbeing, there are also many different institutionalized healing practices that use Islam as a basis for their interpretation of illness and for their treatment of illness. These healing practices can be anywhere on the spectrum of formal Islam or folk-belief and are typically a mixture of both.98_{Because these healing practices}

do not receive scientific, governmental, and social recognition in secular society, they fall into the category of complementary and alternative medicine (CAM). Islamic CAM practices are a clear reflection of the tension between formal institutions of Islam, such as jurisprudence (fiqh) and local mosques on the one hand, and folk-belief on the other hand.99_{This tension plays out in the power struggles between different institutions and}

practices, in which particularly those practices that are not governmentally or religiously institutionalized are often stigmatized by Islamic authorities as being non-Islamic, even though these CAM healers legitimate their practices through Islamic sources.100_Because

the present study is focused on Moroccan immigrant women, some examples of CAM practices that are used by Moroccans in Morocco and the Netherlands will be described in this subchapter.

Between the eighth and fifteenth century, Arabic-Islamic medicine was a flourishing science in Islamic countries. This medical science was based on Greek and Indian

96_{Gardet, <http://dx.doi.org/10.1163/1573-3912_islam_COM_0195> 24 April 2018.} 97_{Bartels, 1997: 112.}

98_{Hoffer, 2000: 97.} 99_{Ibid: 213.}

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medicine and influenced Western medicine as well.101_{In comparison to modern Western}

medicine, Arabic-Islamic medicine at this time was much more holistic and emphasized the relationship between the physical, psychological, and social/cultural realm of

wellbeing and illness.102_{Many of the CAM practices in the Islamic world today are a}

mixture of this traditional Arabic-Islamic medicine, Islam, and folk-beliefs.103

An example of CAM healers are the saints of Sufi traditions.104_{Sufism has remained}

influential in Morocco’s contemporary society. People who are believed to possess a blessing, or baraka, are often referred to as saints in Sufi traditions. There are several Sufi brotherhoods in Morocco, including the Buffis. Moroccans visit shrines of the

deceased Buffi saints or of those who are still alive, to receive a blessing. When a person is believed to be possessed by a jinn, a Buffi saint can negotiate with their possessing

jinn by letting the jinn speak through the patient to find out what the jinn wants in

order to leave the patient alone.105_{The Buffi saints are often illiterate and therefore}

incapable of reciting the Qur’an, but because they possess baraka they are still

considered capable healers.106_{Whereas most Sufi saints recite Qur’anic verses in their}

healing practice, Buffis use their own local formulas to heal their patients, in which they typically praise Allah as a healer.107_{Their appeal lies in their ability to communicate}

with jinn, which ordinary Muslims cannot do. In this way, they create a platform in which the patient and the jinn can communicate their wishes and needs.108

Besides the different Sufi orders in Morocco, there are many traditional healers who are regaining popularity in modern society, especially among youths. These traditional

101_{Hoffer, 2009: 103.} 102_Ibid.

103_Ibid.

104_{In Morocco this is also referred to as the “Maraboutic system”. See: Maarouf, 2007.} 105_{Maarouf, 2007: 10.}

106_Ibid.

107_{Ibid: 10 and 148 (for examples of formulas).} 108_{Ibid: 10.}

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healers are referred to as faqih.109_{Similar to the popularity of some of the new religious}

movements in Dutch society, faqihs are popular because they base themselves on ancient knowledge and practices.110_{These healers practice ruqya, which translates to}

enchantment. Ruqya entails the pre-Islamic belief and practice of casting spells on other people and thereby influence them in some way. It can also be used as a healing

practice.111_{Unlike Sufi saints, faqihs do not possess a hereditary blessing or baraka.}

Instead, they studied independently to gain their expertise on traditional healing. Furthermore, many faqihs have memorized the Qur’an in order to be able to recite verses from memory for healing purposes. People visit faqihs for all sorts of physical, mental, and social problems, ranging from heart diseases to unemployment.112_Problems

associated with the evil eye or jinn are also popular reasons for visits to faqih. To heal their patients, faqihs often recite Qur’anic verses, particularly the verse ayat al-Kursi. They also often recite the names of God, which many Muslims believe to have healing powers as well.113_{Another part of their healing practices is the use of amulets. These}

amulets are pieces of paper on which the faqih writes short prayers, Qur’anic verses, or images, numbers, and words with magical meanings. These pieces of papers can be hung around the neck in a necklace or placed under the pillow of the patient. The amulets are believed to have protecting powers against evil influences such as the evil eye. A written text may also be placed in a glass of water, after which the patient can drink the water to take in the healing powers.114

Neither faqih nor Sufi saints are generally seen as part of formal Islam and both are often stigmatized as folk-belief. Many of the methods used by faqih contain both aspects

109_{Faqih is a more general term which can also be used to refer to other Islamic healers, such as those in}

Sufi brotherhoods (see e.g.: Maarouf, 2007: 87). In this context, faqih refers only to the more commercial, independently operating healers as described by Spadola (2009).

110_{Spadola, 2009: 159.}

111_{Fahd, <http://dx.doi.org/10.1163/1573-3912_islam_SIM_6333> 24 May 2018.} 112_{Spadola, 2009: 157.}

113_{Ibid: 162.} 114_{Hoffer, 1994: 248.}

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of pre-Islamic healing traditions and formal Islam. As described above, the position of Sufi brotherhoods in Morocco is more complex. Visiting shrines of deceased saints can be seen as an act of worship towards people instead of God, and this practice is generally not accepted by Islamic authorities. However, Sufi brotherhoods have a longstanding tradition in Morocco and the Moroccan government has often supported these

brotherhoods as a way of exercising power through these Sufi orders.115_{A more}

peripheral CAM practice in Morocco, are the trance rites performed in possession cults. These are not as widely used and accepted as saints and faqihs for healing purposes, but still worth mentioning here as a healing practice mixing orthodox Islam and pre-Islamic traditions to heal people. An example of such a possession cult is the Gnawa. The Gnawa is visited by Muslims who believe they are possessed by an evil jinn. Instead of evicting the jinn, like faqihs generally do in this situation, the Gnawa healers forms a binding agreement to unite the jinn with the person it possesses, much like a marriage.116_The

healing practice consists of honoring the jinn by making offerings and performing ritual trance ceremonies in which the patients dance to repetitive drum music to let the jinn take over their bodies. As has been argued by anthropologists such as Sengers, trance ceremonies can be a way for people from marginalized groups of society to express themselves freely.117

An interesting development in the context of Islamic healing practices, is the rise in popularity of healers who exclusively focus on Islamic scripture. These healers are typically imams, who attempt to distance themselves from healers who practice what they consider non-Islamic practices or superstition.118_{This makes them popular among}

the younger generation of Muslims in Western Europe, who consider themselves more

115_{For more on this relationship between Sufism and Moroccan politics, see: Knysh, 2000 and Maarouf,}

2007.

116_{Spadola, 2009: 160.} 117_{Sengers, 2000.}

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modern, higher educated and therefore more Islamic and less superstitious than the older generation of Muslim migrants.119_{While their practices seem to be often similar to}

those of faqih, they distinguish themselves by their organizational authority as working from a mosque, and by staying away from beliefs do not come directly from the Qur’an or Hadith. Similar to faqih, however, they practice rukya and use Qur’anic recitation and amulets in their healing practice.120

Another CAM practice that has regained popularity in Morocco and among Moroccans in the Netherlands, is hijama.121_{This is the practice of cupping or bloodletting, based on}

ancient (pre-Islamic) Arabic medicine.122_{According to the sunna, the prophet}

Muhammad has also used hijama. Because of this, hijama practices in contemporary society often use Islamic rhetoric to legitimize their practices.123_{Hijama can be used for}

all sorts of ailments, including depression and high blood pressure.124

Finally, a popular healing practice in Morocco is herbal medicine. Many Moroccans use herbal remedies at home or visit herbal doctors for treatment.125_{Herbal medicine is}

generally used for physical ailments, which can be considered diseases according to Kleinman’s distinction between illness and disease, described in the previous chapter. Additionally, herbal medicine can be used for cosmetic purposes.126_{Similar to the other}

CAM practices described in this chapter, the hijama focuses on illness/lack of wellbeing of the body, mind, and spirit. These domains are typically believed to be interrelated by the Islamic healers, which is similar to the holistic approach of other CAM practices as

119_{As described by medical anthropologists Simon Dein et al. in: 2008: 32.} 120_{Muslim Eneborg, 2012: 1090.}

121_{Hoffer, 2000: 171.} 122_{Alnazer, 2016: 18.}

123_{Examples of this rhetoric can be found at websites of hijama practices, such as: <https://www.hijama.nl>}

26 April 2018.

124_{Hoffer, 2009: 111.} 125_{Hoffer, 2000: 160.}

126_{As the data of the present study will show, as well as discourses on for a, such as: <http://www.nayali.nl>}

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described in the first chapter of this paper.127_{Furthermore, the social context is often}

incorporated by the Islamic healers, by taking social stressors and conflicts into account as possible causes for (mental and physical) illness and sometimes including this social context into the healing practice, attempting to heal not only the patient, but also the people in the patient’s social environment.128

2.5 Conclusions

The present chapter has shown that healing and lived Islam can be related in several ways. Prayer and the observance of other religious practices can be used to seek healing and improve one’s wellbeing. Similarly, the Qur’an is believed to have healing powers and its verses can be read or used in another way to improve wellbeing. Besides the many different personal religious practices, there are CAM practices in the Islamic world as well. CAM in Morocco, as well as in other countries of the Islamic world, is often a mixture of traditional Islamic-Arabic medicine, Islam, and folklore. CAM practices are often marginalized by Islamic authorities and accused of being non-Islamic. As has been argued in this chapter, traditional healing in an Islamic context is often based on a holistic approach and includes physiological, psychological, and social aspects of

wellbeing and illness. The fieldwork of the present study will explore the relevance of the themes discussed in this chapter for the experience of Moroccan migrant women in Amsterdam-West.

127_{Hoffer, 2000: 206.} 128_{Sengers, 2000: 101.}

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3. MOROCCAN MIGRANT WOMEN IN A LARGER CONTEXT

This study focuses on first-generation Moroccan migrant women in Amsterdam-West because these women form a vulnerable group in terms of wellbeing.129_{These women can}

be considered in between two different worlds, as they often grew up in Morocco, but have been living in the Netherlands for several decades.130_{The big cultural shift from}

the poor and traditional working class in Morocco to the urban, secular context they moved to in the Netherlands, may explain why many of the women do not feel like they fully belong in either Morocco or the Netherlands. As such, they make up a new,

distinguishable cultural group that needs to be studied in its own rights.131_{The current}

chapter places these women in a larger context of Moroccan migrants in the

Netherlands, providing demographic and socioeconomic details on this ethnic group, as well as data on their wellbeing and help-seeking behavior.

3.1 The larger Moroccan migrant population

Statistical data from governmental sources that were consulted for this chapter often focused on the larger Moroccan migrant population, sometimes including second-generation migrants without distinguishing between the two second-generations of Moroccan migrants. However, literature in social sciences, on demographic and socio-economic details of the first- and second-generation, show that these two population groups are very different.132_{Limited availability of quantitative data on this specific group makes it}

necessary to also use the data on the broader population of Moroccan migrants. When

129_{Van der Wurff et al., 2004: 34.} 130_{Hoffer, 2009: 268.}

131_Ibid.

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quantitative research is available, information specifically on first-generation Moroccan migrant women in Amsterdam-West will be provided as well.

The multicultural population of the Netherlands, in combination with the context of secularization, makes the Netherlands an interesting country to focus on when studying differing interpretations of wellbeing and healing. Immigrants from Morocco make up a large percentage of the diverse immigrant population of the Netherlands.133_{According to}

sociological publications, most Moroccans arrived alongside Turks as guest laborers in the 1960s and ‘70s.134_{Statistics obtained from the Dutch bureau of statistics (CBS),}

however, show that the majority came between 1965 and 1995 (see figure 1).135_This

earliest group of Moroccan migrants is older than 55 years now.136_{Figure 2 shows how}

many years ago the Moroccan migrants who were living in Amsterdam-West in January 2018 established themselves there.137_{During the fieldwork, some of the women said they}

immigrated to the Netherlands years or even decades later than their husbands and some came as the daughter of a guest laborer.138_{This may be explained by the fact that}

it was initially thought that the guest laborers would stay temporarily, but when it became clear that most of them would settle permanently, the men often had their wives (and sometimes children) come to the Netherlands.139_{This tendency is not clearly visible}

in figure 2, which might be explained by the fact that part of the early guest laborers is no longer alive now and is therefore not included in the table. Prior to their migration,

133_{First generation Moroccan migrants make up approximately 8 percent of the total non-Western}

immigrant population, and when the second generation is included, this percentage is more than 18 percent. See: <https://www.cbs.nl/nl-nl/achtergrond/2016/47/bevolking-naar-migratieachtergrond> 30 May 2018.

134_{E.g. Maliepaard et al., 2012: 361.}

135_{<http://statline.cbs.nl/Statweb/publication/?DM=SLNL&PA=37556&D1=145&D2=1,11,21,31,41,51,61,71,}

81,91,101,111,117-118&VW=T> 5 June 2018.

136_{Maliepaard et al., 2012: 361.}

137_{Data obtained from the Amsterdam municipality via e-mail, 1 June 2018.} 138_{E.g.: D. Personal interview. 9 January 2018.}

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both the men and women had often been part of the Moroccan working class, had little to no vocational education, and identified as Sunni Muslim.140

Figure 1.

Immigration from Morocco to the Netherlands per decade by number of people (in thousands).141

Figure 2.

Establishment of Moroccan migrants in Amsterdam-West per five years.142

140_{<https://www.ois.amsterdam.nl/nieuws/aantal-moslims-in-amsterdam> 29 March 2018.} 141_{Data obtained from Centraal Bureau Statistiek.}

142_{Data obtained from municipality of Amsterdam (department research, information, and statistics) on 1}

June 2018. 0 2 4 6 8 10 12 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 0% 5% 10% 15% 20% '13-'18 '08-'13 '03-'08 '98-'03 '93-'98 '88-'93 '83-'88 '78-'83 '73-'78 '68-'73 '63-'68 '58-'63 Women Men

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Most of the Moroccan guest laborers migrated to the big cities, such as the largest and capital city of the Netherlands, Amsterdam.143_{In Amsterdam, Moroccan migrants}

represent 9 percent of the population, making them the largest ethnic minority of the Dutch capital.144_{Many Moroccan families ended up living alongside one another in a few}

districts of the city, with a large population in the East, North, and West.145_{The present}

study focuses on the Western district of Amsterdam, which has a percentage of nearly 10 percent of Moroccans (not including the district of New-West). More specifically, the fieldwork has been conducted at a community center in the neighborhood

Staatsliedenbuurt, where many Moroccan women from other neighborhoods in the West come as well.146

The first generation, elderly Moroccan migrants on average have lower educational and occupational levels compared to native Dutch people, and even more so for women.147

Among a study with a sample of 455 elderly Moroccan migrant women in the

Netherlands, 94 percent had not completed any formal education.148_{Moroccan migrant}

women in the Netherlands are frequently unemployed. While their husbands were working in factories and on other labor sites, the women often stayed at home as

housewives and mothers, and did not acquire proficiency in the Dutch language. There is a high prevalence of illiteracy among these women.149_{They often live in neighborhoods}

with many other Moroccans, having their own personal network (including family) and Moroccan shops nearby.150_{As such, they are considered not strongly integrated into}

143_{<https://www.ois.amsterdam.nl/nieuws/aantal-moslims-in-amsterdam> 29 March 2018.}

144_{Both first and second generation migrants were included in this population count of the Amsterdam}

municipality. First generation migrants make up almost 4 percent. See: <https://www.ois.amsterdam.nl/feiten-en-cijfers/amsterdam/> 29 May 2018.

145_{<https://www.ois.amsterdam.nl/feiten-en-cijfers/stadsdelen> 29 May 2018.}

146_{It would be interesting to compare Moroccan migrants living in urban settings with Moroccans living in}

rural settings. However, there is very little literature available on this comparison.

147_{Van der Wurff et al., 2004: 34.} 148_{Agyemang et al., 2006: 545.} 149_{Bekker and Lhajoui, 2004.} 150_{Gijsberts and Dagevos, 2010: 25.}

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34 Dutch society.151

First-generation Moroccan migrants generally identify as Sunni Muslim.152_{There is a}

total of approximately 950 thousand Muslims in the Netherlands, of which the majority is from Moroccan or Turkish descent.153_{Amsterdam has a relatively high Muslim}

population of 12 percent.154_{Almost a third of Moroccan immigrants visits the mosque}

weekly and slightly more than that rarely or never visits the mosque.155_{It is relevant to}

note that many Moroccan migrants feel like there is a negative image of Islam in the Netherlands.156_{This feeling is not completely ungrounded; according to a study done by}

independent research and consultancy agency Motivaction, half of all Dutch people express aversion to Islam.157_{This has also become evident in the data of the present}

study, where respondents repeatedly defended the Islam, without anyone criticizing it.158

The Moroccan migrant women are not only a marginalized group in terms of their religion, but also as women, being less integrated into Dutch society and more often unemployed.159

Among the Moroccans who migrated to the Netherlands, two different ethnic groups can be distinguished: the Arabs and the Berbers, each having their own language.160_These

two ethnic groups have a history of power struggles and stigmatization, in which the Berbers are often marginalized by Arabic Moroccans as uncivilized farmers from the mountains. The stigmatization of Berbers by Arabs is still present among Moroccan migrants in the Netherlands and first-generation Berber migrants would often hide their

151_{Van der Wulff et al., 2004: 40.} 152_{Gijsberts and Dagevos, 2010: 245.}

153_{Both first and second generation, see: Roggeveen et al., 2017: 359} 154_{Schmeets, 2016: 10.}

155_{Gijsberts and Dagevos, 2010: 246.} 156_{Ibid: 17.}

157_{Cited in: Mepschen, 2010: 965.}

158_{E.g.: D. Personal interview. 9 January 2018.} 159_{Gijsberts and Dagevos, 2010: 256.}

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ethnic background in fear of being discriminated against by Arabic Moroccans.161_{It is}

estimated that in the Netherlands about half of the Moroccan migrant population is Berber and the other half Arab. Most research on Moroccan migrants in the Netherlands does not distinguish between Arabic-speaking and Berber-speaking Moroccans, likely because of the complex underlying conflicts and power struggles.162_{In the present paper,}

this distinction will therefore be ignored because there is not enough data available on their differences in demographic and socioeconomic background.

3.2 Wellbeing and help-seeking behavior

Moroccan migrant women are more vulnerable than other people living in the

Netherlands in terms of problems related to their mental and physical wellbeing.163_This

is even more so for Berber Moroccans.164_{Furthermore, Moroccan migrant women are less}

likely to seek help from healthcare providers in the dominant cultural system, particularly for mental health issues. A quantitative study by public health scholars Lamkaddem et al. indicated that particularly Moroccan migrant women who feel discriminated against outside of healthcare tend to avoid visits to their general

practitioner.165_{When they do seek help, the outcome is considered poor by the healthcare}

practitioners than for other people living in the Netherlands.166_{In addition to a poor}

outcome, Moroccan migrant women commonly do not (continue to) take the medication they are prescribed.167_{In this subchapter, more information about the wellbeing, the}

prevalence of illness, and possible causes for these illnesses among Moroccan migrant women will be provided. Additionally, this subchapter will provide information on what

161_{Hoffer, 2009: 69.} 162_Ibid.

163_{Agyemang et al., 2006: 545.} 164_{Bekker and Lhajoui, 2004: 3.} 165_{Lamkaddem et al., 2012.}

166_{Van Loon et al., <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037851/> 10 June 2018.} 167_{Birnie et al., 2010.}

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36 these women do when they are experiencing illness.

According to several public health and medical studies, Moroccan migrants are more likely to suffer from physical health problems than other people living in the

Netherlands, with high instances of chronic physical illnesses such as diabetes.168

Additionally, many Moroccan migrants struggle with vitamin D deficiency and physical pains as a result of this, which medical doctors often attribute to the lack of sunlight in the Netherlands compared to Morocco.169_{Moroccan women wearing the hijab are also}

less exposed to sunlight than those not wearing the hijab, making them more vulnerable to vitamin D deficiency.170_{Moroccan migrant women also tend to be more prone to being}

overweight or obese.171_{This tendency to being overweight tends to increase with}

duration of living in the Netherlands and studies have shown that changes in the environment and lifestyle changes, upon migrating, are often responsible.172_After

coming to the Netherlands, first-generation Moroccan migrants find more and easier access to unhealthy food and less opportunities for physical activities compared to their living environment in Morocco.173_{Other physical illnesses that are more common among}

first-generation Moroccan migrant women than among other people of the same age category (55+) living in the Netherlands, include arthritis, heart disease, migraines, and stomach ulcer.174

In terms of mental wellbeing, goal-oriented studies in the discipline of clinical

psychology show that Moroccan migrant women are also a vulnerable group, more often

168_{E.g.: Agyemang et al., 2006: 545.} 169_{Van der Meer et al., 2011: 1009.} 170_{Riah et al., 2012.}

171_{Nicolaou et al., 2012.} 172_{Ibid: 883.}

173_{Ibid: 883.}

Lived Islam and Healing: An Ethnographic Study among Muslim Migrant Women in Amsterdam-West