Management of Psychiatric disorders in Islam

Dr. Bilal A. Bhat & Intizar Ahmad

The word Islam in Arabic means “submission,” reflecting the central core of Islam, which is the submission to the will of God. According to the statistics from new population projections by the Pew Research Center’s Forum on Religion and Public Life, there are 1.65 billion Muslims worldwide and it is expected to increase by about 35% in the next 20 years, to reach 2.2 billion by 2030; making Islam the second largest religion in the world after Christianity. Islam provides a code of behavior, ethics, and social values, which helps people in tolerating and developing adaptive coping strategies to deal with stressful life events. Islam teaches how to live in harmony with others, Quran says “Seek the life to come by means of what God granted you, but do not neglect your rightful share in this world. Do good to others as God has done good to you. Do not seek to spread corruption in the land, for God does not love those who do this” (Quran, 28:77). In Islam Sharia means ‘the path’ and it refers to the path that Muslims should follow in their life. It provides the guidelines and requirements for two types of interactions: Those between humans and God (worship); and those between humans to humans (social transactions). The main sources of Sharia are the Holy Quran and Sunna. The Quran describes the way in which Allah should be worshipped. The Sunna includes all the known sayings, advices, and actions of Prophet Mohammed (PBUH), his decisions, and his responses to life situations and to philosophical and legal questions, which usually derived from what’s called Hadith. According to attachment theory by John Bowlby (Geneva: Monograph World Health Organization; 1952), we know that having a secure attachment has been linked to the over-all wellbeing, coping, better mental health outcomes, enhanced self-esteem, and stronger relationship functioning. Thus, having a “healthy attachment” to God would also be linked to better psychological functioning: “… And whosoever puts his trust in Allah, then He will suffice him…” [Quran, 65:3]. Researchers found that many Muslims worldwide feel uncomfortable in seeking psychiatric help from the mental health professionals. The aim of writing this article is to highlight the role of Islam in the management of different psychiatric disorders. Treatment in psychiatry follows the bio-psychosocial model, and religion is considered to be one of the most important psycho-social factors in human life, especially in Muslims’ population. Hence it is necessary to recognize how Islam can modify the treatment and prevention of different mental disorders.
Islam from a bio-psychosocial model perspective
In Islam, religion and spirituality are not mutually exclusive as you cannot have one without the other. Other religious and spiritual traditions may see them as separate where you can have one over the other. This can be applied to Islam in the way it helps with drug adherence through encouraging Muslims to look after their health by seeking advice and receiving treatment as health is considered a gift from God, which should be cherished. The Prophet Muhammad (PBUH) has reported “down a cure even as He has sent down the disease.” In many societies especially Western societies believe that mental illnesses are due to demons or bad spirit-related, it was in fact the Europeans in the Medieval Period who viewed mental illness as demon-related, Muslim scholars of that time, including Ibn Sina (known in the West as Avicenna – the founder of Modern Medicine), rejected such concept and viewed mental disorders as conditions that were physiologically based. This led to the establishment of the first psychiatric ward in Baghdad, Iraq in 705CE by al Razi (one of the greatest Islamic physician). This was the first psychiatric hospital in the world. According to al Razi’s views, mental disorders were considered medical conditions, and were treated by using psychotherapy and drug treatments. Regarding the psychosocial model, there is Islamic counseling, which is similar to Western counseling in the way the clients seek assistance from a suitably qualified person to deal with their psychological problems, the same may be effectively obtained from a religious leader or Imam. The main role of the Imam in for this purpose is to provide advice which would be in accordance with the Quranic principles and teachings of the Prophet Muhammad (PBUH). This form of counseling proved to be effective in improving social life. The traditional healing is another model of Islamic counseling in which a traditional healer who may be a shaykh, derwish, or pir depending on their geographical location, practice various rituals to heal a client. Despite the support of some studies to the value of traditional healing, many Muslims do not believe in this form of healing nor consider it Islamic, which in these instances would make its use inappropriate and even banned in certain Muslim countries. Nowadays, there are growing interests in Islamic psychotherapy i.e., therapy which includes using of Quranic metaphors, the Sirah of the Prophet and his traditions, as well as the biographies of the Prophet’s companions, which will provide detailed instructions for implementing successful therapy. During the golden era of Islamic civilization, the Islamic scholars had discussed the concept of psychology, psychiatry, psychotherapy, and their relationship to mental health. For example, Abu Bakar Muhammad Zakaria Al-Razi (925 CE) is the first Muslim physician who introduced the methods of psychotherapy and he had achieved a lot of success in discovering the definition, symptoms and mental health. The discussion on mental health was published in his book entitled ‘El Mansuri’ dan ‘Al Tibb al-Ruhani’. Consultation with an Imam (a Muslim religious leader), a Muslim social work professional, or another respected community member can also be helpful. They can help identify concepts, which are consistent with Islam, as well as language from Islamic teachings such as halal and haram concepts in Islam, which mean what is allowed and what is prohibited, respectively.
Studies on Muslims that used spiritually modified cognitive therapy for anxiety and depression showed faster results as compared with the therapy that is not Islamically modified. On the basis of different studies and books, we explain how Islamic values can help in prevention of different psychiatric disorders like (a) Depression: Negative life events are one of major risk factors for depression. Islam plays an important role in helping Muslims to cope with negative life events, which helps them in both prevention and treatment of depression. Muslims are not superhuman, however, if one experiences negative feelings, he is encouraged to resist them with positive thoughts and actions if possible, or to seek professional help if the case is clinical, exactly like any other form of illness. “So, verily, with every difficulty, there is relief: Verily, with every difficulty there is relief.” (Quran, 94: 5-6) Islam encourages people to stay hopeful, even if someone has committed the worst sin or faced with most troublesome life event as there is always God’s mercy. “And never give up hope of Allah’s soothing Mercy: truly no one despairs of Allah’s soothing Mercy, except those who have no faith. (b) Suicide: Islam helps to prevent suicide by two ways, directly by prohibiting it and indirectly, by lowering the causes of suicide such as substance abuse and maintaining mental/emotional well-being. In Islam, suicide is considered to be strictly prohibited. The Quran mentions “… [do not] kill (or destroy) yourselves, for surely God has been Most Merciful to you” (Quran, 4:29). And like Prophet Muhammad (PBUH) said “He who commits suicide by throttling shall keep on throttling himself in the Hell Fire (forever) and he who commits suicide by stabbing himself shall keep on stabbing himself in the Hell-Fire.” (Sahih al-Bukhari, 2:23:446.) Muslims should remember God in times of suffering and pain and have faith and hope in God’s mercy and compassion to ease the suffering. (c) Grief: It is a normal reaction toward any life losses. Muslims believe that all suffering, life, death, joy, and happiness are derived from God and that God is the one who gives us strength to survive. They believe that any loss or deprivation experience is a form of a test from God to his slave of how he will stand this suffering with patience and full trust in God’s mercy. These beliefs usually help to comfort and aid the healing process. For example, in accepting grief and loss, the relatives of the deceased person are urged to be patient (sabr) and accept God’s test. ‘Be sure we shall test you with something of fear and hunger, some loss in goods, lives and the fruits of your toil, but give glad tiding to those who patiently persevere. Who say, when afflicted with calamity: To Allah we belong, and to him is our return’ (Quran: 62). People who have patience in accepting God’s decree will be given a reward from Him. The Prophet Muhammad said: “No person suffers any anxiety or grief, and says this supplication but Allah will take away his sorrow and grief, and give him in their stead joy. However, Muslims are not immune against the feeling of grief. It is permissible to cry and express grief over the death of a loved one. For instance, when the Prophet’s son, Ibrahim, died, the prophet said ‘We are very sad for your death, O Ibrahim’,Islam encourages Muslims to talk about and remember their loved one and recall the good deeds of their life. Prophet Muhammad (PBUH) himself never forgot his love for his beloved wife, Khadijah, even years after her death. (d) Anxiety: The cognitive errors are common to be similar in anxiety and depression. Other way of cognitive restructuring is to help Muslims to learn from the Prophet Muhammad teachings that do not regret for things that have happened (e) Obsessive–Compulsive Disorder: In Islamic perspective, these unwanted obsessive thoughts are called wasawis (plural of waswasah), which are whispered into the minds and hearts of people by Ash-Shaytan (Satan). We can find evidence of this in the holy Quran and Hadith .We find in the holy Quran the counter adaptive thoughts for these obsessions (wasawis as called in Islam) [So when you intend to recite the Quran, seek refuge with Allah from Shaytan, the outcast. Verily! He has no power over those who believe and put their trust only in their Lord (Allah). His power is over those who obey and follow him (Shaytan) and those who join partners with Allah] (Quran 16:99-100). [And deceive among them those whom you can with your voice. Verily! On my true servants, you would have no authority. Sufficient is your Lord as a guardian] (Quran 17:64-65). Moreover it can help to relieve the guilt feeling which is associated with the obsessions of religious nature.
(f) Alcohol and substance abuse: Alcoholism is not a huge mental health problem among Muslims in comparison with Western society as Islam prohibits alcohol and substance use among Muslims. There are two main features of Islamic prohibitions: (i) Islam stops the wrong doing from its roots and not at the end. There is no specific age for drinking, or safe drugs to get high. Islam prohibits drinking completely (total abstinence) for all Muslim of any age and sex. It is the reason why the West finds it a difficult issue to manage the problems of drugs and alcohol, because it has made double standards. (ii) Islam prevents Muslims from following the path, which may lead to drug and alcohol intake. As mentioned in Quran. “They ask you concerning wine and gambling.” Say: “In them there is great sin, and some profit, for men, but sin is greater than the profit” (Quran 4:43) (g): Smoking: Muslims are forbidden to harm themselves or others. We all know that cigarette smoking causes a number of health problems that may lead to heart disease, emphysema, oral cancer, stroke, etc., and finally death as well as the risk to others, which is known as passive smoking. The Quran, does not specifically prohibit smoking, but gives behavioral guidance. Allah says, “…make not your own hands contribute to your destruction…” (Quran 2:195); “…nor kill yourselves…” (Quran 4:29) Prophet Muhammad (PBUH) said that “Whomsoever drinks poison, thereby killing himself, will sip this poison forever and ever in the fire of Hell.” In many parts of the Muslim world, the legal status of smoking has further changed during recent years, and numerous religious edicts or fatawa, including those from notable authorities such as Al-Azhar University in Egypt, now declare smoking to be prohibited. (h) Homosexuality: In Islam homosexuality is considered ‘sinful’. Humans are not homosexuals by nature. People usually become homosexuals because of their surroundings. Of utmost importance is the environment during puberty. All creatures are created in pairs each with certain physical and psychological characteristics to complement and complete one another and to serve certain function. The main function of the human being is to build up the society. Homosexuality is harmful for the health of the individuals and for the society. It is a leading cause of sexually transmitted diseases. Homosexuality degrades a person and the family structure and hence the society. This is the reason why homosexuality is forbidden in Islam. Islam enforces the family role in Muslim’s life and emphasizes the religious, moral, and ethical values, on the contrary to Western society, which started nowadays to suffer from moral decay leading to broken families with increased divorce rate and number of unwed mothers and single parent families. Drug abuse and excessive sexual activities are predominant in adolescents and young adults. These events lead to conflict, loneliness, guilt, loss of self-esteem, which results in manifestation of a variety of pathological disorders. Meditation by focusing on God’s creatures (plants, animals, space, human body, etc.) is considered one of the most efficient and powerful forms of Islamic worship. Muslims prayers themselves can be considered as a form of meditation and remembrance as while praying, Muslim feels that he is in extreme connection with the controlling power of this world (God) and that from Him he receives maximum support. Prophet has said: “your prayers are like a flowing river at your doorstep you wash yourself in it five times a day.” Recent studies showed that praying reduces depressions and it is recommended that praying can be used as an alternative therapy as successfully as meditation, exercise, or herbal treatments. It is concluded that that there is a huge impact of Islam and spirituality within psychiatric clinical practice. Using Islamic values and beliefs can be beneficial in treatment of mentally illness, through incorporation of Islamic beliefs that help in drug adherence and modification of different psychotherapeutic techniques to suit patients.
(The authors write regularly on Islamic topics exclusively for “Kashmir Horizon”. Views are their own)
bhat_bilal@rediffmail.com

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