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 DOI: 10.1177/1534765612441975

published online 19 April 2012TraumatologyWahiba Abu-Ras, Farid Senzai and Lance Laird

IdentityAmerican Muslim Physicians' Experiences Since 9/11: Cultural Trauma and the Formation of Islamic

  

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The September 11 Events: Cultural Trauma and Conceptual Framework

The September 11, 2001, attacks on the World Trade Center and the Pentagon (“the 9/11 attacks”) were—and remain—a defining moment for all Americans, including American Muslims. According to Alexander, Eyerman, Giesen, Smelser, and Sztompka (2004), a “collective trauma” occurs “when members of the collectivity feel they have been subjected to a horrendous event that leaves indelible marks upon their group consciousness, marking their memories forever, and changing their future identity in fundamental and irrevocable ways” (p. 1). They also fit Neal’s (2005) notion of “national trauma”: something “that cannot be easily dismissed and will be played and replayed in the national consciousness” (p. 3). Both types of trauma involve a “meaning struggle” to identify the “nature of the pain and the nature of the victim and the attribution of responsibility” (Alexander et al., 2004, p. 62).

It is very important to distinguish between cultural and psychological trauma. According to Eyerman (2004), cul-tural trauma refers to a

dramatic loss of identity and meaning, a tear in the social fabric, affecting a group of people that has achieved some degree of cohesion. In this sense, the trauma need not necessarily be felt by everyone in a community or experienced directly by any or all. (p. 61)

In contrast, psychological trauma “involves a wound and the experience of great emotional anguish by an individual” (p. 61).

Cultural trauma theory includes certain components. By most accounts, the 9/11 attacks meet all of its requirements, as detailed by Smelser (2004a). For most Americans, the attacks produced an “initial reaction of shock, disbelief, and emotional numbing” (pp. 265-267). They also produced a “collective-behavior reaction” such as fear, anxiety, terror, and some evidence of mental disturbances. These common reactions transcended ethnicity, religion, social class, or geo-graphic proximity (Abu-Ras & Abu-Bader, 2008, 2009; Fredrickson, Tugade, Waugh, & Larkin, 2003; Galea et al., 2002a, 2002b; Smelser, 2004b). In addition, both spontane-ous and official “collective mourning” for the innocent vic-tims were observed throughout the country. Many Americans were left with a “sense of the indelibility” of the event that a turning point had been reached in their lives. This generated a “sense of national brooding.” Moreover, the 9/11 attacks

441975 TMTXXX10.1177/1534765612441975Abu-Ras et al.Traumatology

1Adelphi University, Garden City, NY, USA2Santa Clara University, Santa Clara, CA, USA3Boston University, Boston, MA, USA

Corresponding Author:Wahiba Abu-Ras, Adelphi University, One South Avenue, Garden City, NY 11530, USA Email: abu-ras@adelphi.edu

American Muslim Physicians’ Experiences Since 9/11: Cultural Trauma and the Formation of Islamic Identity

Wahiba Abu-Ras, PhD1, Farid Senzai, PhD2, and Lance Laird3

Abstract

The September 11, 2001 attacks, a defining moment for many Americans, have had a traumatic effect on their collective well-being. The attacks fit Alexander’s definition of “cultural trauma.” Using his conceptual framework, we explore how 9/11 and the ensuing discourse and events have affected one particular segment of the American public: American Muslim physicians (AMPs). We examine how these traumatic events have shaped their individual and collective response and changed their sense of collective identity. A semistructured individual interview protocol was used to collect data from 62 AMPs. A grounded thematic analysis guided the processing of qualitative interview data. The results show that the mistreatment and prejudice faced by many AMPs have left an indelible impression on their memories and sense of identity. Despite the initial negative response, September 11 led to other positive changes in their religious identity and facilitated adaptive action. The study implications are discussed.

Keywords

9/11 events, cultural trauma, Muslim physicians, coping, resiliency, religious identity

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stands as a “monumental instant in the history of the nation” that has been “commemorated through public ceremonies and anniversaries” and to “sustained public interest in the remembering process.” Finally, it has fundamentally altered American identity by wounding and strengthening it (Smelser, 2004a, pp. 265-267). In other words, this trauma became a cultural crisis because “the collective actors ‘decide[d]’ to represent social pain as a fundamental threat to their sense of who they are, where they came from, and where they want to go” (Alexander, 2004, p. 10).

Alexander (2004) used Weber’s (1968) term carrier groups to describe a specific group as collective agents of the trauma process. This group is situated in particular places in the social structure, and its members have a particular way of articulating their claims. This might be called “meaning making” in the public sphere (p. 11). Using this conceptual framework of “cultural trauma,” we explore how 9/11 has affected American Muslim physicians (AMPs). This study perceives and treats AMPs as a “carrier group” because they were targeted after 9/11 and received attention after the June 2007 attack on Glasgow airport and the subsequent foiled London bombing plot. In addition, they are perceived as the trauma process’ collective agents because of their profes-sional status and social standing.

AMPs: The Post-9/11 Experience of National and Cultural TraumaArab American and Muslim Americans’ initial reactions to 9/11 included fear, anxiety, disbelief, and emotional numb-ing (Abu-Ras & Abu-Bader, 2008, 2009). However, these two groups experienced negative consequences that were not reflected within the American mainstream population: increased suspicion, hostility, attacks, discrimination; as a result, many became more anxious, fearful, and experienced an intense loss of security and feeling of safety (Abu-Ras & Abu-Bader, 2008, 2009; Abu-Ras & Suárez, 2009; Alvi, 2003; Akram, 2002; Brown, Abernethy, Gorsuch, & Dueck, 2010; Cainkar, 2004, 2010; Council on American-Islamic Relations [CAIR], 2005; MSRG Special Report, 2004; Singh, 2002). In the attacks’ immediate aftermath, Congress passed the USA PATRIOT Act, which authorized the federal government to arrest, detain, interrogate, and deport non-American citizens. Immediately after the attacks, the gov-ernment’s domestic counterterrorism practices and policies resulted in the arrest, detention, interrogation, and deporta-tion of an estimated 2,000 to 5,000 Muslims and Arabs (Akram & Karmely, 2002). Alexander et al. (2004) provide similar historical examples of collective societal and govern-mental reaction to trauma, including the internment of Japanese Americans after the bombing of Pearl Harbor.

The backlash against AMPs’ European counterparts after the highly publicized trial of British Muslim doctors for con-spiracy in the June 2007 terrorist attacks at Glasgow airport and London (Wessely, 2007) only exacerbated this trend.

The following year, the Journal of the American Medical Association (JAMA) published a review article of Adam Dorin’s Jihad and American Medicine (McIsaac, 2008) that cast AMPs as potential terrorist sympathizers. It even sug-gested that “hospitals [as well as physicians’ offices and sur-gical centers] are soft targets that can be exploited to create terror in the population” (p. 734). Furthermore, the reviewer noted that Dorin “points to the Achilles heel of all free sys-tems: the assumption of trust,” adding, “One story that I found especially troubling was that of a group of physicians cheering in a Baltimore hospital on 9-11” (McIsaac, 2008).

Dorin’s thesis is part of a broader discourse that has acquired an increasingly virulent Islamophobic undertone, especially since 9/11. For example, Americans polls indicate that one quarter (CAIR, 2004, 2006a) to one half (Dean & Fears, 2006, Pew Report, 2007, 2010) of Americans hold negative views of Islam and Muslims. Islamophobia and anti-Muslim hate crimes have increased significantly in the United States (CAIR, 2006b) and in Europe (Allen & Nielsen, 2002; Runnymede Trust et al., 2004) since 2001. The Islamophobic discourse portrays Islam as monolithic and threatening, Muslims as using Islam to gain advantages or for ideological goals, and Muslim cultures as significantly and adversely dif-ferent from other cultures. Anti-immigrant attitudes fre-quently accompany such messages (Commission on British Muslims and Islamophobia, 1997), building on a history of Orientalist representations of Muslim societies as deficient or deviant versions of a modern, rational Europe (Said, 1978).

Although the European media originally focused on Muslim physicians after the Glasgow and London incidents, many American journalists quickly targeted AMPs. For example, columnist Debbie Schlussel (2007) profiled Muslim doctors as top-ranking terrorists who were either directly involved in terrorist plots or provided support for terrorist activities. During the course of our research (2009-2010), AMPs attending national and regional conferences com-plained of how such a discourse affected their interactions with colleagues, patients, and community members. Some saw it as an attack on their social, religious, and professional identities. Hence, AMPs may have experienced both the 9/11 attacks and the anti-Muslim backlash as cultural trauma. Therefore, it is important to study their collective initial reac-tions, how their sense of identity was altered, and how they coped with this. Although studies have addressed the post-9/11 impact on Muslims worldwide, this study is the first one to address it on AMPs, explore the “trauma process,” and analyze their responses and coping mechanisms.

MethodSample Recruitment

The data were collected from January 2009 to June 2010. This study is part of a larger national study that used both qualitative and quantitative methods, including a national

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survey and employed multiple recruitment strategies. Semistructured interviews were conducted with 62 Muslim physicians licensed to practice in the United States: 20 from New Jersey, 22 from Arizona, and 20 others from other states, and they were interviewed over the telephone. We used three recruitment steps: (a) we obtained a list of initial contacts from key Muslim physician leaders in New Jersey and Arizona; (b) invited them, via email and telephone, to participate in a face-to-face interview; and (c) we scheduled and conducted an interview ranging from 60 to 90 min. Some interviewees referred us to colleagues to generate a snowball sample. Each participant was informed of the study’s purpose and asked to sign a consent form (verbal consent for tele-phone). Telephone interviews drew potential participants from a list of 55 physicians who indicated their interest in our larger quantitative survey study; after being contacted, 16 agreed to participate. The remaining four were drawn from a geographically diverse group known to the interviewer. Face-to-face interviewees were offered a US$50 gift card; tele-phone interviewees were offered a US$25 gift card. The unexpectedly large number of interested physicians led us to interview another 20 participants; however, budget limita-tions prevented us from paying them the same amount as we had for the face-to-face interviews. The Adelphi University Institutional Review Board (IRB) approved this study.

In the larger study, we used a semistructured interview protocol to collect data on the participants’ civic involvement, career path development, religious values, and pre- and post-9/11 challenges. This article only examines the AMPs’ major post-9/11 challenges and how these shaped their reaction to this trauma; their standing in the community; and what this traumatic event means for this group, the health professional community, and the broader American society.

Data AnalysisA grounded thematic analysis guided the processing of qualitative interview data. ATLAS.ti, a computer-assisted qualitative data analysis software package, was used to develop an initial codebook of emerging themes and pro-cesses. Four interviews were coded separately, after which the coding choices were compared and the differences resolved by mutual agreement. Code definitions were clari-fied for the second round and then retested after half of the coding was completed. The software was used to develop theme and subtheme hierarchies across individual inter-views. Theme summaries were then integrated into theoreti-cal memos to explore emerging perspectives on the data.

ResultsParticipants’ Demographic Background

We conducted face-to-face interviews with 20 participants from New Jersey and 22 from Arizona. Twenty other

participants were interviewed by telephone. Members of this latter group came mostly from California, Michigan, Illinois, New York, and Texas, where the highest concen-trations of Muslims and Arab Americans live. The majority of interview participants (67.7%, n = 42) were male; 32.3% (n = 20) were female. Ranging in age from 24 to 72 years, with a mean of 45, and 86% of them were married. All married participants lived with their spouses, had an aver-age of three children, and all but one were born Muslim and raised in Muslim households. The majority (41.5%) self-identified as Sunni; one identified as Shi’a and another as Sufi. The remainder did not answer this question or identified as nonspecific. Roughly, an equal number of respondents described their religiosity level as weak, mod-erate, or strong; the majority described themselves as Muslim before any other classification. About 44% identi-fied as South Asian and 37% as Arab. About 91% were born abroad, and 20.4% graduated from an American medical school.

More than 53.4% of the foreign-born AMPs had lived in this country for 25 years, and 32.3% had immigrated at least 40 years ago. Very few arrived after 2001. One-third were certified in internal medicine; the rest were certified in family practice, general practice, general surgery, cardi-ology, radiology, anesthesiology, ophthalmology, and other specializations. Some (12.3%) reported having an MA and/or a PhD.

Initial Reactions to the 9/11 AttacksParticipants’ initial reactions ranged from shocked disgust to fear, leading many to assert that the 9/11 attacks conflicted with the principles of Islam. They identified several negative repercussions for themselves, such as alienation, seclusion, and discrimination. Commonly reported negative feelings were fear, avoidance, insecurity, cautiousness, reservation, and anxiety. Many spoke of intimidation or violence, of not being able to get jobs or fly on airplanes. The widespread perception that Islam was synonymous with terrorism made some respondents afraid to go out in public. They spoke of “mistrust” and “pointing the fingers” at Muslims. Many respondents felt that the media were making “everybody feel . . . as if it is a whole group,” as if extremism were charac-teristic of all Muslims, and that now “the community at large looks at [foreign graduates] differently,” making them feel even more like “outsiders.” One said that whenever he walks through a hospital lobby or an airport, he “wonder[s] what [people are] thinking about me . . . you cannot stop from thinking like that.” A female participant related, “I would not go and approach people anymore, because you really don’t know how they are feeling.” She felt some “hesitance,” even among the doctors at her practice, for “everybody’s going to be cautious.” Similarly, another remarked, “I became very cautious. I wasn’t sticking my neck out or giving my opin-ions freely . . . I became more reserved.”

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Some lost their sense of security and identity; worried about surveillance, retaliation, or interrogation by the FBI; or (especially Middle Eastern-born) started mistrusting govern-ment security forces and/or the FBI, based on personal expe-rience in their native lands. A respondent who was describing his experience in Syria told the interviewers, “I want to make sure neither of you are connected to the Syrian Intelligence Agency . . . because you’re recording here.” Another respon-dent said, “I’m sure there’s always an FBI agent in the mosque. Actually, I know one of them. . . . She dresses like a Muslim and she goes and she spies.” Some worried about losing their competitive edge, feeling unsafe in their com-munities, losing patients, or losing their jobs for participating in or donating to Islamic charitable activities. Several par-ticipants mentioned being “careful” about “getting involved in any religious activity in the mosques” and being unable to “donate to big charities anymore, because everybody is being watched.” They also recounted patients’ stories and cautionary tales about donating. Participants “don’t want to get in trouble with the government,” so they only donate to organizations that are “approved and licensed by the U.S. government.” Some said that this attitude has “undermined the relief efforts for Muslims in America to help.”

Forms and Types of DiscriminationRespondents from all interviews reported common forms of both overt and covert discrimination after the 9/11 attacks. Overt discrimination, which is more direct and blatant, con-sisted of racial slurs, jokes, or patients explicitly requesting a non-Muslim doctor. Some respondents felt that patients did not trust them. Covert discrimination involved more subtle forms, such as avoidance, the communication of negative or denigrating messages about Muslims, or exclu-sion by colleagues and neighbors.

Many respondents reported experiencing overt racial dis-crimination, which they felt placed them at a disadvantage. One respondent noted, “In general, patients . . . prefer to see physicians who are Caucasian.” Others reported that dis-crimination based on skin color was experienced more in public than other forms of discrimination: “I have had a lot of discrimination against me [for] being non-white, being of brown-colored skin.” Several physicians mentioned blatant discrimination during airport security checks. One had been “randomly selected” every time he and his children flew back to Syria. Another recalled having a stranger “go off” on him, saying that his “parents will die for this [9/11]” and his “brother will die for this [9/11].”

Some female physicians experienced direct gender-based discrimination. One female respondent spoke about the intersection of gender and foreignness in being rejected by a patient: “First of all being a girl, female and being in a medi-cal field, I’m a nurse until proved otherwise.” One of her patients was shocked that she had graduated from an Egyptian medical school. She therefore transferred her

patient to another doctor, reasoning that if something went wrong with a male American doctor, there would be less of a problem.

Several female physicians mentioned their patients’ overt fear of the hijab. In some cases, they were informed during employment interviews of the organization’s hesitation to hire them for that very reason. One director asked a respon-dent to stop wearing it because she was “frightening chil-dren.” Beyond the professional setting, one respondent reported an incident involving his mother who, soon after 9/11, experienced “people . . . throwing stones at her, mostly kids, and they were cursing her, and she had to actually take off her headscarf and wear [it] like a hat.”

Many physicians experienced both interpersonal and insti-tutional discrimination after 9/11. Direct, interpersonal dis-crimination occurred most often within the workplace, where they cited more problems with coworkers than with patients. One physician’s coworkers posted, “distasteful pictures” of Muslims and Islam at work. People made “offensive or nasty comments about Muslims in general,” and Muslims were sin-gled out “in public.” As one said, “I felt really alienated, like an outsider,” as his coworkers, friends, and colleagues became less fun and more formal toward him. Another described receiving a “rigid attitude and response from the people I speak with,” although he acknowledged this was “very short lived.” One surgeon mentioned being rejected by a parent who did not want a Muslim operating on her Jewish son.

Discrimination varies according to one’s “foreign” look, dark skin, and gender, all of which intersect with other forms of institutional discrimination. Most participants linked these experiences to a larger, long-term pattern of discrimination against foreigners in social institutions. A few physicians reported institutional discrimination in their residency pro-grams. One respondent thought that administrators in his or her program purposefully failed foreign residents year after year so they would not progress. Another commented on how much harder it was to join a prestigious residency pro-gram, since local graduates were preferred. Yet another replied that a lot of foreign medical graduates are no longer welcome and that many deserving applicants “have been rejected several times.” Moreover, he felt, there “are almost no physicians coming anymore.” The most severe incident reported by a respondent occurred in 2007: he was rejected by the military and diplomatic corps because, as he asserts, he called his mother, who lives in Egypt, too often. In addi-tion, he had purchased some investment property there. Even after writing a statement explaining how much he loved the United States, he was still denied. His case is pending judi-cial appeal. He stated,

For me to be willing to sacrifice my life to protect this country and for the country to reject me was a very painful thing. . . . I mean I love both cultures. I love being Muslim and I love being American, of course . . . they’re a common ground.

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A few respondents from New Jersey (n = 4), Arizona (n = 7), and nationwide (n = 4) had felt little or no personal post-9/11 repercussions. However, they had witnessed acts against the broader Muslim community, including arson at a mosque and slurs directed toward other Muslim.

Group and Public Coping StrategiesAlthough many AMPs felt intimidated, others sought to dis-pel negative perceptions of Muslims by using their respected social status to educate others about Islam and their coun-tries of origin. Some women purposely started to wear their headscarves and express their religious identity more pub-licly; several men began speaking at community events in order to “regain control of our image.”

Respondents sometimes received curious questions from patients. One remarked that his patients asked many ques-tions, especially about Pakistan, that led to “helpful” and “healthy” discussions. Despite misgivings about living in the United States after 9/11, this physician subsequently had the “privilege” of influencing patients positively. In addition, he spoke to the sheriff and the hospital administrator about “intimidation” and other challenges faced by the local Muslim community. The results of these conversations have been positive.

After 9/11, AMPs started to assert their religious identity. Many respondents described higher levels of personal religi-osity and a desire to become “examples” for non-Muslims by improving society’s perception of Islam. Another com-mented that despite the negative environment, medical pro-fessionals were more highly educated and American pluralism allows Muslims to “embrace their faith and make it a part of their professional lives.” Others felt that 9/11 has made Muslim physicians “more aware of the fact that we are Muslim.”

Most respondents felt a greater need to become visible. For example, “I want to get more involved, to try to set an example”; “I became more Muslim after [9/11]”; “[It] made me a stronger Muslim”; “I think [9/11] kind of woke us all up and made us realize that . . . we needed to be more outspoken or out in the public,” and characterized many Muslims as “trying to come out of their cocoon.” One respondent elabo-rated, “For me, I became more active in my community, because I didn’t want someone else to be describing [or] blaming our faith; or I didn’t want someone else to be explaining what Islam is in the local newspaper.” Another physician echoed,

I think that Muslims need to . . . regain control of our image to represent ourselves, because there’s 98% of Muslims who are not monolithic. We’re a very varied, broad group . . . I think we all share common values of respect, human dignity, love for our families, love for this country . . . and we get represented all too often by a fringe, crazy group.

Almost all of such people felt obliged to exemplify “real” or “true” Islam. One physician, a Sunday Islamic school-teacher said, “I teach youngsters about terrorism and how Islam condemns terrorism . . . [it is more important to teach] love and not hatred and not discriminating between people of faiths.” Others stressed the importance of interfaith coopera-tion and “interfaith meetings” with neighbors and Catholics, as well as hosting a Muslim speaker’s bureau.

Despite the negative reactions experienced by many AMPs, several participants did receive positive responses and support from friends, family, neighbors, coworkers, and patients. One respondent, who had prayed with a Christian patient on the day of 9/11, said the experience “was a good moment, and I was really . . . touched by it.” She noted that such support has actually “opened up avenues” by generating more outreach in her hospital and motivating people to pray more often. In general, respondents observed that “a lot of people went out of their way” to help and that patients showed “care” or “concern” for their safety and that of their families. Another respondent, who started wearing the hijab after 9/11 and feared that her patients would not come back, said that she was asked “strange questions” for a week. However, dur-ing that same period, she was able to have “the most open questions and discussions” she had ever had with her patients.

Political Action: The Liberating Effects of Cultural TraumaDespite their ongoing cultural trauma, participants empha-sized their increased levels of political engagement and public service. Several said that as Americans, they have a “respon-sibility, being Muslims,” to help uninsured people. One stated, “As a Muslim you value justice, you value the right of health-care for everyone. And as an American Muslim you value that, and you try to make sure that that’s made available in America.” One participant remarked, “I’m very much involved in the Association of Muslim Health Professionals and [we have] a huge movement, and I would call this a movement for health reforms since Obama got elected.”

Many of those who called for affordable health care had worked at a free clinic sponsored by a Muslim organization or local Islamic center. One respondent did so in Arizona, where he felt that he could set an example for his community by doing charity work, for “that’s my dream, that we correct [ourselves], [for] then people will follow.”

A few participants served on local government boards, public health committees, and in political campaigns. Others called for greater political involvement and for helping local members of Congress gain more political clout. One of them stated,

[I] have very actively participated in the political pro-cess. Me and my wife support very openhandedly with finances [in] the elections because this is very, very, very crucial in America. You have to support your

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lawmakers, because if you give them money, they always will keep you in . . . mind. I’m talking about big money.

Most respondents who mentioned political involvement also mentioned supporting presidential candidates or partici-pating at the national level.

DiscussionUsing case studies of Jews during the Holocaust, slavery in the United States, the American government’s internment of Japanese Americans citizens during World War II, and Americans during the event of 9/11, Alexander et al. (2004) propose an open-ended theoretical framework to analyze how traumatic events gain significance for entire groups of people, even when the events did not directly affect all mem-bers of that particular group. Though 9/11 is, of course, not comparable in scale or severity to the Holocaust or slavery, it does align with their theory that trauma is socially con-structed through the meanings attributed to it later, as opposed to being natural or intrinsic to an event. The American population’s post-9/11 reaction toward American Muslims in general, and toward AMPs in particular, devel-oped from a type of patriotic sentiment that reflects the mainstream community and cultural solidarity and that demonizes the suspected perpetrators (by affiliation). This reaction was justified to strengthen “homeland” security. Americans’ reaction to 9/11 is relatively similar to the internment of Japanese Americans due to national hysteria about a Japanese invasion. Both groups’ loyalties were ques-tioned in the exact same way, and both responses were gen-erally justified as a type of “nationalism and patriotism—as context for response to crisis” (Smelser, 2004a, p. 277). Alexander et al. (2004) describe the similarity between these events: “more people in the respective populations coped with the same or similar reactions—such as fighting off their anxiety, dismissing or denying the significance of the event, and depersonalizing” (p. 48). In other words, they describe the so-called “aggregation of individual responses . . . as it involved many people having the same reactions and assign-ing the same meaning” (p. 48).

The “war on terror” is one such collective attribution of this “meaning struggle.” For many Americans, this involves identifying the “nature of the pain and the nature of the vic-tim and the attribution of responsibility” (Alexander, 2004, p. 62). However, “Islamophobia” or “losing control of our image” may be another type of collective attribution of “meaning struggle” among Muslim Americans. Alexander calls this “the trauma process” when the collective experi-ences massive disruption, a social crisis becomes a crisis of meaning and identity” (p. 62). AMPs, as a “carrier group,” articulate the pain and meaning to the wider society by rep-resenting and giving voicing both their own and that of the entire American Muslim community.

Traumatic events translate into a group’s collective and cultural identity through representations, including film, lit-erature, oral history, and the silences that attest to the pres-ence of painful memories (Cho, 2008). The 9/11 attacks and its ensuing aftereffects have been widely documented. Muslims have been perceived as both victims and perpetra-tors. The media have produced and published educational stories about them, as well as their cultural diversity and experiences. However, the old stereotypical images of Islam as violent (Pew Report, 2007; Shaheen, 2001) and of Muslims as killers and terrorists remain common. Therefore, literature and media productions can ignite painful memories for Muslims in general, and for AMPs in particular.

The “trauma process,” which fills the gap between an event and its representation through a culturally constructed claim of monumental injury and restitution (Alexander et al., 2004), also produces contested meanings and identities. Alexander et al. (2004) use Weber’s notion of “carrier groups” (Weber, 1968) who act as representatives, dissemi-nating claims for the traumatized cultural group in the con-text of other collective identities in a society. AMPs may thus constitute a carrier group, a group of professionals who usu-ally enjoy some professional privileges and social prestige in their communities. Moreover, many of them belong to elite echelons of society. At the same time, they may be character-ized as a denigrated and marginalized group, as many have been targeted since 9/11 and accused of supporting terrorist activities. This was especially so after the Glasgow airport and the foiled London bombing plots. Hence, this study’s results that the 9/11 attacks negatively affected participating AMPs aligns with Alexander (2004) observation that “what was a trauma for the victims was not a trauma for the audi-ence” (p. 221). Using the post-Holocaust example, Jews took “the lead in reconstructing a new moral order” and “in put-ting an end to anti-Semitism in the United States” (p. 221). Many AMPs seem to be following this path by defending Islam and presenting a positive image of Muslims. Their ulti-mate goal is the same: to end stereotypes, hate crimes, ill treatment, and discrimination against Muslim Americans.

Like many of their fellow Muslims, AMPs have been tar-gets of hate crimes or subjected to mistreatment that has left an indelible mark on their memories and sense of identity as Americans. Legislation such as the USA PATRIOT Act and the National Security Exit Entry Registration System overtly surveyed and implicitly criminalized both Muslims and Americans of Arab descent. Many lost their sense of safety, security, and community (Tirman, 2006). Although not all AMPs were directly affected by the 9/11 attacks, as a collec-tive group they experienced an initial dramatic loss of reli-gious and professional identity, “a fundamental threat to their sense of who they are, where they came from, and where they want to go” (Alexander, 2004, p. 10).

Alexander et al. (2004, p. 281) assert that cultural trauma is characterized primarily by negative effects followed by a positive response, as part of the defense mechanism for

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coping with negativity. According to Sztompka (2004, p. 160), a “truly collective trauma” first appears when people start to share their observations and experiences and become aware that they are not alone. The true cultural trauma is when people and the community manifest tangible social forms, including “intense interaction, outbursts of protest, forming of groups collective mobilizations, creating social movements, associations, and organizations” (Sztompka, 2004, p. 160). Our results are consistent with both Alexander et al.’s (2004) and Sztompka’s (2004) arguments.

As previous research suggests, 9/11 has had both positive and negative impacts on the American Muslim community. Many of our respondents’ experiences were similar to those of the larger Muslim community (Abu-Ras & Abu-Bader, 2009; Abu-Ras & Suárez, 2009; Akram, 2002; American Civil Liberties Union, 2009; Brown et al., 2010; Cainkar, 2004, 2010; CAIR, 2005; Kira et al., 2008). Their collective positive response was an integral part of the American public’s general response. Their response sought to cope with their fear and anxiety from exposure to immediate threats and backlashes, as well as with discrimination against them as individuals and their religious institutions. Their collective positive reaction may also suggest that our participants’ discussions of their common negative experiences made them aware of their com-mon plight, shared responsibilities, and similar circumstances faced by Muslims nationwide. By using their high levels of resiliency and positive coping mechanisms, many turned the trauma into an opportunity to work harder and to become more active, involved, and vocal in educating their fellow Americans about Islam. They sought to mobilize others by forming new collective social and professional groups or joining existing ones like the Association of Physicians of Pakistani Descent of North America (APPNA), the Islamic Medical Association of North America (IMANA), and the American Muslim Health Professionals (AMHP). This collective positive response indi-cates their desire to transform the mainstream’s negative per-ception about Islam and Muslims and to preserve and strengthen their Islamic identity and sense of community.

For many American Muslims, the cultural trauma of the 9/11 attacks strengthened their religious identity and facili-tated positive, adaptive action at the individual and commu-nity levels. These findings are supported by Zogby (2001) and Pew Report (2007), which suggest a stronger sense of ethnic identity, even pride, in the face of post-9/11 adversity. This adversity caused participants to reflect on the causes of their fear; advocate new mechanisms for ensuring their safety; and educate the American public about their culture, Islam, and their community’s concerns.

A theory of cultural trauma that considers collective memory and identity formation is necessary to fully appreci-ate American Muslims’ post-9/11 experiences. Some have argued that this event did not mark a new chapter, but only amplified tendencies that had begun at least a decade earlier (GhaneaBassiri, 2010). Alexander et al.’s (2004) theory on “trauma process” helps us make sense of the phenomena.

The 9/11 attack acquired “traumatic status” due to its immediate and prolonged impact on the American Muslims’ collective identity. Muslims have translated and reappropri-ated this event in myriad of positive (adaptive) and negative (maladaptive) ways. As Alexander et al. (2004) assert, an acute discomfort must penetrate the very core of a collectivi-ty’s identity for a cultural trauma to ensue. This can be seen in the AMPs’ experiences of overt and covert interpersonal and institutional discrimination and racism, which translated their individual experiences into a sense of a collective identity through a shared experience of cultural trauma. Neal (2005) asserts that a national trauma frequently “has liberating effects on a social system and open[s] a new opportunity for innova-tions and change [to] emerge” (p. 7). American Muslim com-munities continue to create and adapt communal institutions (GhaneaBassiri, 2010). Rather than struggling between “good Islam” and “bad Islam,” they focus on “bridg[ing] the gap between the reality of their lives and the stigmatizing context in which they were interpolated by a polarizing discourse on ‘Islam and the West’” (GhaneaBassiri, 2010, p. 379).

Alexander et al. (2004) also point to the positive out-comes of cultural trauma: “By allowing members of wider publics to participate in the pain of others, cultural traumas broaden the realm of social understanding and sympathy, and they provide powerful avenues for new forms of social incorporation” (p. 27). In other words, they illuminate an emerging domain of social responsibility and political action. This conclusion clearly resonates with the present study. By proudly acknowledging their sense of obligation to educate the wider American public about Islam; declaring their com-mitment as physicians to quality and affordable healthcare for all people; and asserting their dedication to social justice, charity, public involvement, and political action, our respon-dents transformed cultural trauma into an opportunity.

Practical ImplicationsOur findings suggest that although most AMPs experienced some level of psychological trauma after 9/11, they also showed high levels of resiliency and positive coping. By acknowledging the trauma’s negative effect on them as indi-viduals, as well as part of a community and a professional group, they adopted a problem-focused coping approach based on religion and/or increased community activism. These results are in line with prior research (Linley & Joseph, 2004; Páez, Basabe, Ubillos, & González-Castro, 2007; Park & Ai, 2006; Updegraff, Silver, & Holman, 2008) that reveals a positive association between struggling with posttrauma adversity and heightened levels of functioning while searching for and finding meaning. Increased levels of acceptance and a positive outlook among disaffected Muslims strengthened their sense of belonging to a collec-tive, whether to their immediate Muslim community or to the broader society. A growing body of literature (Gorsuch, 1988; Jang & Johnson, 2004; Pargament et al., 1988) suggests

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8 Traumatology XX(X)

that such positive emotional traits as adaptive coping, hope, spirituality, and gratitude are linked to good health.

At the same time, given Islam’s distinctly community-based emphasis, non-Muslim physicians should be aware of their Muslim colleagues’ religious coping methods when faced with trauma or physical illness, as these link their religion and spiri-tuality to good health. At the practice level, our findings could help health professionals acknowledge religion as a protective factor and help religious clients/patients use it as a supportive resource, particularly when coping with traumatic events. The results also provide a better understanding of how nationality and ethnic identity place pressure on some Muslim Americans to exhibit their loyalty to their religion (Islam) and their coun-try of residence (the United States). Furthermore, the results will allow us to gain a better understanding of gender issues in the Muslim community and thus help reduce prejudice and ste-reotyping. For instance, accounts from female AMPs may help clarify what the hijab means to those who wear it. Finally, the results could help other professional providers forge common values-based alliances with AMPs to influence positive change at the local and national levels.

LimitationsThe snowball sampling methods used may bias the sample toward promotion of the American Muslim community. For similar reasons, our sample may overrepresent AMPs of Pakistani and Indian origin. We note, however, that these countries of origin are likely the source of the majority of immigrant AMPs (American Medical Association, 2010). Telephone interviews may present a more limited range of communication and trust than do face-to-face interviews. While AMPs were affected by the 9/11 attack just like other American citizens, they were also affected by the backlash against them specifically as physicians following the bomb-ing of a London airport. The combination of effects of trau-matic events and continuing Islamophobia, however, remain relevant to the wider discussion of the American Muslim experience post-9/11.

Acknowledgments

The authors thank Dr. Aneesah Nadir and Ms. Sana Malik for con-ducting some of the interviews. The first author also wishes to thank her research assistant, Ms. Tricia Moscato, for her technical help and support.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study has been sponsored by the Institute of Social Policy and

Understanding and funded by Association of Physicians of Pakistani Descent of North America & Islamic Medical Association of North America.

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