Rejection of Hijab as a Psychiatric Problem in Iran
An illustration of political weaponization of healthcare
The legitimacy of scientific conclusions and medical diagnoses is a product of social coordination, a set of situated practices, and the more rigorous and transparent these practices are, the more confidence we have in their validity. Science does not happen on its own; facts do not speak for themselves. It is common for the “all-too-human processes” to be erased when scientific results are presented to the public.1 As
puts it, the achievement of truth is “an exceptional, fragile, improbable achievement.”This has been on my mind as I contemplate our tendency to talk about the “reality” of mental disorders and psychiatric diagnoses as if these characterizations were some transcendent, capital-T truths, even though their legitimacy depends on a set of complex, and at times quite fragile, social practices.
When it comes to political abuses of psychiatry, an illustrative contemporary example is that of Iran. Subtle, less-obvious abuses are commonplace in the Western world, but they pale in comparison to what is happening in Iran: a sustained effort by the Iranian government to frame rejection of the hijab as an expression of psychopathology.
In Nov 2024, the Iranian state announced plans to open a “hijab removal treatment clinic” for women who defy the mandatory hijab laws that require women to cover their heads in public. This was announced by Mehri Talebi Darestani, the head of the Women and Family Department of the Tehran Headquarters for the Promotion of Virtue and Prevention of Vice, and she said that the clinic will offer “scientific and psychological treatment for hijab removal.”
This announcement was preceded by an incident in Nov 2024 involving Ahoo Daryaei, a doctoral student at Islamic Azad University, Tehran, which had generated considerable global outcry:
“After being confronted and harassed by Basij paramilitary forces over Iran's compulsory hijab laws, with her clothing torn during the encounter, she responded in protest by removing her clothes and sitting partially undressed in the university courtyard on 2 November 2024. The Iranian state violently arrested and detained her, leading to her forced disappearance from public view. University officials denied any physical encounter with the student and claimed she had mental health issues… After her arrest, she was reportedly taken by police to Iran Psychiatric Hospital on the Special Road under the orders of the IRGC intelligence and placed under the supervision of a doctor and psychiatrist.” (wikipedia)
On Nov 19, 2024, she was released without charges.
Earlier in 2023, three Iranian actresses—Afsaneh Bayegan, Azadeh Samadi, and Leila Bolukat—had been arrested for violations of the hijab laws. Iranian judges characterized them as “mentally ill,” and their sentences required them to attend biweekly psychological counseling sessions. Bayegan was described as having “anti-family personality disorder,” and Samadi was said to have “anti-social disease.”
The response from the Iranian psychiatric and psychological community in 2023 was critical and focused on the use of unscientific diagnoses and judges acting outside medical expertise.
“Iran’s major psychiatric bodies pushed back on this latest move, with the heads of four psychiatry boards going public with their criticism in an open letter to Iran's judiciary chief, RFE/RL reported.
“The diagnosis of mental disorders is within the competence of a psychiatrist, not a judge,” the letter said, per the news outlet. “Just as the diagnosis of other diseases is in the competence of doctors, not judges.”
Calling the diagnoses “unscientific and strange,” the open letter demanded that authorities amend the sentences against the three women, according to RFE/RL.”
“In 2023, four Iranian psychiatric associations issued a joint statement condemning the government’s use of non-scientific diagnoses such as anti-family personality disorder as a pretext for punishing hijab protestors.
The statement decried the practice as a violation of professional ethics, highlighting specific principles from Iran’s Professional Ethics Charter for Psychiatry, which has been in place since 2015.”
In Feb 2025, Lancet Psychiatry published a letter by Siroos Mirzaei and colleagues, “Rejection of the hijab is not a psychiatric diagnosis.”
“… the ICD contains no psychiatric diagnosis related to whether someone wears a hijab or not. This event must be seen as the latest, but not the first, in a series of violations that have been criticised internationally (eg, by Amnesty International) and by Iranian psychiatrists in a recent letter. Such involuntary hospitalisation brings to mind Soviet and East-German Stasi practices of committing political dissidents to psychiatric institutions for so-called treatment, often with invented diagnostic labels such as sluggish schizophrenia (in the former Soviet Union). This action not only contradicts medical standards, but also violates international standards officially supported by Iran, such as the International Covenant on Civil and Political Rights.”
“… the ICD contains no psychiatric diagnosis related to whether someone wears a hijab or not” is true, but the formal recognition of a diagnosis in diagnostic manuals is downstream to a lot of other activities, and it’s worth talking about their significance.
One thing to recognize is that public removal of hijab could plausibly be a manifestation of a psychiatric disorder just as disrobing in public can be a sign of mania, psychosis, cognitive impairment, substance intoxication, or some other disturbed psychological state. I recently came across a video on social media of a woman who took off her clothes on a plane during a flight and walked around naked in an erratic manner, forcing the pilots of the plane to return to the airport, where she was detained for medical evaluation. Now consider a very different example of public nudity: women from the Femen activist group marching topless on International Women’s Day as a form of political protest.
We don’t need to say “ICD contains no psychiatric diagnosis related to whether someone is naked in public or not” to recognize that people appear naked in public (in contexts where nudity is not the norm) for a variety of reasons, and when we have an obvious, intelligible reason for that behavior (e.g, political protest), we don’t have good reasons to further invoke psychopathological explanations for it.2
Let’s bypass the philosophical complexity of “dysfunction” and “disorder,” and consider the matter practically: experiences and behaviors become problematic in a particular context, and then these problems are brought to clinical attention.
Why do some experiences and behaviors emerge as “problems”? Typically because these are distressing, disabling, or disruptive, and they are understood to be (based on common-sensical, folk-psychological judgments) excessive, disproportionate to the circumstances, unintelligible, lacking meaningful connections, persisting beyond sociocultural expectations, etc., etc.
Why do some problems come to clinical attention? Because we have reasons to think that healthcare clinicians can do something about them in a way that other social institutions (education, law, religion, etc.) cannot.
When these processes of problem recognition and clinical attention occur transparently, democratically, and with good intentions, they go reasonably well. But because these processes are value-laden, socioculturally dependent, and susceptible to various biases, they can be corrupted if the guiding values are ignoble and villainous. A clear perversion of this process is when clinical services are used by the government for the purposes of confinement, control, and delegitimization of politically undesirable behavior.
Preventing political abuse of medicine starts with an explicit recognition that treating political protest as a clinical problem is wrong for both ethical and scientific reasons. The DSM, for example, explicitly notes, “Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders…” (DSM-5-TR, Introduction). Conflict between an individual and society on its own is not a sufficient reason to bring a problem to the attention of medicine.
As I noted earlier, we recognize situations where social deviance occurs due to mental illness. A person acting erratically on a plane and disrobing is different from a person in a Femen protest. Characterizing social deviance as being secondary to mental illness requires consideration of the entire context. If a person is taking off their clothes in Iran because they are manic, they will show behavioral characteristic features of mania other than the mere fact that they are not following the dress code. If political dissidents in Russia were indeed suffering from a psychopathological state of “sluggish schizophrenia,” empirical demonstration would not have been a problem, but there was nothing to show other than political resistance.3 Authoritarian governments intent on the political weaponization of medicine have no interest in public accountability. Just as scientific inquiry cannot proceed adequately in a situation where researchers are motivated and willing to fabricate data, medicine cannot operate adequately in a society where diagnostic judgments come from government officials and scientific questioning is penalized.
When frank political abuse of psychiatric diagnoses occurs, it is done with malicious intent and with full knowledge. As far as I can tell (and I may be wrong), few in Iran genuinely believe that violating hijab rules constitutes a state of mental illness. They may fiercely support hijab laws for moral and religious reasons, and may be in favor of harsh punishments for violators, but presumably, anyone sufficiently attuned to political motivations would see through the medicalization of hijab rejection for what it is.
Matters would be more complicated if the majority of Iranians genuinely believed that a rejection of the hijab constitutes a psychopathological condition. Broadly speaking, there was an analogous situation to this hypothetical with homosexuality in the Western world until 1960s-70s. People genuinely thought it was an abnormal and pathological condition. The reasons were partly empirical and partly social. The empirical literature at the time was full of inaccuracies, mainly because it was driven by strong presuppositions and consisted mostly of psychoanalytic case studies, and it took sexological research in community samples to dispel many myths about the psychological functioning of homosexual individuals. Secondly, homosexuality was a highly disvalued state, and discrimination and stigma were so culturally reinforced that many homosexual individuals internalized it and sought treatment willingly. Even now, there are religious communities in the US where homosexuality remains abhorred, is treated as pathological, and off-the-books conversion therapy is practiced.
There is a difference between circumscribed, intentional, and voluntary behaviors (such as disrobing in political protest) and canalized behaviors over which we have limited control (such as sexual orientation). Nonetheless, if there were such a thing as a tendency to violate hijab laws, it would be at risk of being wrongly treated as a clinical problem in a society where such behaviors are severely despised and punished. Especially when the alternative to medical care is legal punishment, many are drawn to clinicalization as the more humane option.
Recall my emphasis on an emotional and behavioral condition being a problem and being brought to clinical attention. When something becomes a problem for sociopolitical reasons and is brought to clinical attention for sociopolitical reasons, the primary safeguards we have in a situation like this are sociopolitical as well. Authoritarian governments and societies are able to weaponize medical diagnoses precisely because democratic values and scientific transparency are no longer able to function as effective safeguards.
As Derek Bolton puts it:
“… a principled reason why frank political abuse of psychiatry—for example several decades ago in the then Soviet Union—is wrong and illegitimate. So far as I can see the response... has to be that the principled reason, the nature of the error and the illegitimacy, is not going to be made out in the philosophy or in the science of medicine and psychiatry, but has to be interpreted in terms of human rights legislation and the other principles and institutions of democracy.” Derek Bolton, What is Mental Disorder? (2008, p xxvii)
I wrote in a previous post:
“It’s inevitable for the practice of medicine and psychology to be colored by social prejudice to some degree, and I think our notions of psychopathology are particularly vulnerable. This isn’t to say that most of what we call psychopathology is simply a reflection of social prejudice. I don’t think that is the case. But because this vulnerability exists, we have the responsibility to guard against it… I think the best way to do that is to have an open discussion about why something is a problem, for whom it is a problem, and to have a democratic dialogue between the stakeholders about the value judgments and practical needs involved.
The empirical aspects of diagnosis have to be settled via scientific inquiry. However, facts about causal mechanisms don’t determine whether we see the condition as problematic or undesirable, the contexts in which the condition comes to clinical attention, and decisions regarding whether we should try to change the person or the environment around them, whether our attitude needs to be one of acceptance, accommodation, or cure, and whether we should pay for the care involved through money devoted to healthcare needs.”
The fundamental problem with Iran treating dresscode violations as clinical problems is not merely that they are using diagnoses absent from DSM/ICD. The problem is that there is a clear malicious intent, a willingness to use healthcare services for confinement, control, and delegitimization of politically undesirable behavior, a lack of democratic oversight that ensures human rights, and an absence of scientific transparency and empirical scrutiny around diagnostic assertions.
See also:
From the 2018 New York Times story “Bruno Latour, the Post-Truth Philosopher, Mounts a Defense of Science”:
“Latour believes that if scientists were transparent about how science really functions — as a process in which people, politics, institutions, peer review and so forth all play their parts — they would be in a stronger position to convince people of their claims.”
“At a meeting between French industrialists and a climatologist a few years ago, Latour was struck when he heard the scientist defend his results not on the basis of the unimpeachable authority of science but by laying out to his audience his manufacturing secrets: “the large number of researchers involved in climate analysis, the complex system for verifying data, the articles and reports, the principle of peer evaluation, the vast network of weather stations, floating weather buoys, satellites and computers that ensure the flow of information.” The climate denialists, by contrast, the scientist said, had none of this institutional architecture. Latour realized he was witnessing the beginnings a seismic rhetorical shift: from scientists appealing to transcendent, capital-T Truth to touting the robust networks through which truth is, and has always been, established.”
On treating diagnoses as explanations, see my discussion here:
Western countries also recognize that involuntary commitment and involuntary treatment require specific criteria that go beyond merely having a mental illness.
This is excellent, Awais. Unfortunately, conversion therapy is alive and well in large parts of the US, not just "off the books", as only the minority of states have banned the practice.
The APA has taken a position against conversion therapies, appropriately: https://www.psychiatry.org/getattachment/3d23f2f4-1497-4537-b4de-fe32fe8761bf/Position-Conversion-Therapy.pdf
But this example goes to show that science and medicine do not simply get to declare what is considered or treated as pathological. The law is not bound to our conception of pathology. If we believe in the way we understand mental health and disorder, we must argue for it, and for the role of psychiatry and the psy disciplines to do so, as these brave Iranian doctors are doing.
This is all in response to your admittedly passing mention:
"Even now, there are religious communities in the US where homosexuality remains abhorred, is treated as pathological, and off-the-books conversion therapy is practiced."