Role of Islam in Psychiatric disorders

 Abstract

With the significant growth of the Muslim population all over the world, there exists a corresponding increase in the need for mental health services that suit this group of patients. Research demonstrates the effectiveness of the integration of spirituality and religiosity into psychotherapy and how religious beliefs could affect the management plans. This article discusses the impact of various beliefs in the Islamic faith on the bio-psychosocial model for the management of different psychiatric disorders including focusing on the modification of psychotherapeutic techniques as cognitive restructuring. It also shows other types of therapies such as music therapy, meditation therapy, and aromatherapy. The main emphasis remains to ensure that Muslim psychiatric patients get ethical, acceptable, and effective treatment.

Keywords: Bio-psychosocial, compliance, Islam, mental health, Muslims, religious psychotherapy, spirituality

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INTRODUCTION

Islam is a monotheistic religion based on revelations to the Prophet Muhammad 1400 years ago, which were recorded in the sacred Quran (Koran). 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.[1]

Islam provides Muslims with a code of behavior, ethics, and social values, which helps them in tolerating and developing adaptive coping strategies to deal with stressful life events. Islam teaches how to live in harmony with others “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, 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,[2] 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].

Despite the growing size of the Islamic community in the western countries, most western practitioners appear not to have been very well exposed to Islamic values and teachings during their educational careers.[3,4]

Researchers found that many Muslims are hesitant to seek help from the mental health professionals in Western countries[5–7] due to the differences in their beliefs and lack of understating of the helping professionals about Islamic values in their treatment modalities. Consequently, Muslims might feel uncomfortable in seeking psychiatric help to avoid being in conflict with their religious beliefs.

The aim of this review article is to highlight the role of Islam in the management of different psychiatric disorders; and provide psychiatrists especially those working in Western countries with Muslim patients or Western psychiatrists travelling to Islamic countries or to those who are not familiar with Islamic values with therapeutic modalities that are congruent with Islamic values.

We think it is highly beneficial to integrate certain Islamic views in Westernized therapeutic techniques to make them more acceptable by Muslim societies.

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 imperative 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.[8]

From the biological perspective, different studies have found that being religious increases patients’ satisfaction and adherence to treatment.[9,10]

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 has reported “down a cure even as He has sent down the disease.”

On the contrary to what is commonly thought among Western societies that Muslims 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.[11,12]

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.[13]

Another fact which clinicians need to be more aware of is that adherence to psychiatric medications may be affected during Muslim fasting periods as in Ramadan (in which Muslims fast from just before sunrise to sunset each day), so clinicians should adjust the dosing interval according to timing of iftar and suhoor (i.e., the Muslim fasting and eating times). This can also be achieved by using alternative dosage forms for medication during Ramadan. However, if the patient's mental condition necessitates frequent dosing, or his physical wellbeing will be adversely affected by the combined effect of fasting and psychotropics intake, which may lead to dehydration, the clinician can then advise the patients not to fast as Islam exempts them from fasting in such conditions. “And whosoever of you is sick or on a journey, let him fast the same number of other days. Allah desired for you ease; He desired not hardship for you”. (Quran 2:185).

Another detrimental factor in pharmacotherapy adherence is the presence of inert ingredients in psychotropic medications, which might be derived from pork products that may pass unnoticed by the clinicians.[14] As ingestion of pork or any of its products is totally forbidden in Islam and it may be considered as committing a sinful act. So if this issue is not identified and addressed, then patients may not only stop taking their medications, and hence leading to relapse of symptoms, increasing hospitalization rates, and increasing healthcare costs but also lead to a poor doctor-patient relationship.[15] The inert substances derived from pork products and frequently used in medications include gelatine and stearic acid. We believe that, in order to maintain a good doctor–patient relationship and improve medication adherence, psychiatrists should have a basic familiarity with religious dietary restrictions and they should discuss such issue frankly with their patients as a part of informed consent. This does not have its implications for patients alone but may also have ethical and potentially legal consequences for physicians as well. Information on the gelatine or stearic acid content of medications can be obtained from the physicians’ desk reference or electronic databases such as www.PDR.net or www.rxlist.com

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.[16,17]

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. Muslims approach Imams for counseling on social and mental health issues and particularly marital and family problems.[18] This form of counseling proved to be effective in improving marital adjustment levels of incompatible couples.[19]

Another model of Islamic counseling is the traditional healing, here a traditional healer who may be a shaykh, derwish, or pir depending on their geographical location, practice various rituals to heal a client. This model explains the illness or personal problems as a possession by spirit (jinn). The solution for a healer is to exorcise the spirit, through reading Quran, prayers, playing music, dancing, and beating spirits, out of the “client's” body, which then frees the person from misery