Islamic Perspectives on Psychological and Spiritual Well-being and Treatment

by Keshavarzi, H & Ali, B (2018)

In H. S. Moffic,, J. Peteet, A. Hankir, R. Awaad, Islamophobia & Psychiatry: Recognition, Prevention, and Treatment. Switzerland: Springer.

Chapter Introduction

One of the most significant barriers for seeking treatment among American Muslims is the limited availability of Islamically integrated mental health services that correspond to their desire for an incorporation of Islamic spirituality into their treatment [8, 27, 30, 52]. Given such barriers, coupled with behavioral healthcare disparities for American Muslims, it is important for mental health professionals working with Muslims to become familiarized with the Islamic spiritual and intellectual heritage as this can be a means of empowering oft-marginalized American Muslim communities. As opposed to Eurocentric frames of reference, Islamic theological concepts can be incorporated in order to advance therapeutic rapport and to optimize psychiatric treatment with this population [17]. Thus, a presentation of the Islamic intellectual heritage that is not confined by the European historical or modern developments of the field of medicine or behavioral science is necessary in order to gain a true appreciation of Islamic traditional views on health and pathology. An unbiased presentation of the Islamic tradition can engender a fuller grasp of Islamic conceptions of well-being that are built upon Islamic epistemology and ontology. Though there is considerable convergence between modern psychiatric practice and Islamic views on well-being, it is important to understand some key underlying distinctions as well. One such key distinction is the complete absence of a process of secularization of healthcare practice that was more characteristic of Western Europe and which was later inherited by the Muslim world due to colonialism. In fact, the holistic outlook on mental health as an aspect of spiritual and physical health has long been a defining characteristic of Islamic civilization. Classically, Islamic scholarship did not disengage rational, sacred, or empirical knowledge, as all were viewed as valid sources of knowledge and manifestations of God’s signs [5]. Thus, strong empirical evidence was not seen as being at odds with sacred knowledge; rather empirical evidence has always been an important aid to under- standing the sacred and the adjudication of Islamic ethics and law [45]. It is critical to appreciate this lack of tension between the secular and sacred in understanding classic and holistic Islamic perspectives on health. More specifically, Islam’s inherent recognition of mental illness, the field of medicine, and expert testimony that is inherently built into the Islamic legal process in the determination of the applicability of Islamic legal injunctions to cases is a testament to the complementary role of medicine and Islamic law [4].

Historically, in the nineteenth through fourteenth centuries, the diversification of health systems in the Muslim world may have included such conversations between various sectors of human services and helped inform the development of spiritual lodges, or zāwiyahs/khānqāhs, that functioned in conjunction with and oftentimes in close proximity to the colleges (madrasah) and/or hospitals (bīmāristān/māristān) (see Fig. 4.1) [48].

Physicians were typically trained in Islamic theology and law and thus did not solely focus on external dysfunction but rather interacted with Islamic legal jurists in determining the ethics of medicinal practice, offered religiously oriented psycho- therapy, or referred patients to hospitals or spiritual lodges who needed more intensive care [11, 40]. At the same time, much of medical or psychiatric treatment was in communal care settings, and only during extreme duress or severity of illness was institutional care warranted [40]. Community practice was commonly offered by local physicians or through visitations to spiritual practitioners [31]. Understandably, during this era the Muslim world also witnessed an explosion of literature on human behavior (tahdhīb al-nafs), character reformation (tahdhīb al-akhlāq) and works on human ontology, incorporation of Hellenistic philosophies, medicine, and meta- physics [43]. For example, in the formal works and, in some cases, written exchanges between the erudite scholars Abū Bakr al-Rāzī (d. 311 AD/925 CE), Ibn ʿAlī ibn Miskwayh (d.421 AD/1030 CE), Ibn Sīnā (d. 427 AD/1037 CE), Ibn Rushd (d. 595 AD/1198 CE), and later Abū Ḥāmid al-Ghazālī (d. 505/1111), one can find rich and diverse contributions to the Islamic intellectual discourse in addressing the physical (ḥissī), metaphysical (ghaybī), and rational (ʿaqlī) branches of knowledge. These conversations demonstrate a clear intersect between theology (kalām), law (fiqh), philosophy (falsafah), medicine (ṭibb/ḥikmah), and spirituality (taṣawwuf) and contribute to the abundance of literature related to human cognition, behavior, emo- tions, and spirituality despite the absence of a distinct field of psychology. During this era, the seminal publication of the ninth-century Muslim polymath Abu Zayd al-Balkhī’s (d. 322 AD/934 CE) Maṣāliḥ al-Abdān wa al-Anfus (which translates as “The Sustenance of the Body and the Soul”), the first known documented manuscript on mental health that incorporates discussions of the treatment of both physi- cal and mental disorders within an Islamic context, is a clear evidence of such an integration [11]. The sophistication of al-Balkhī’s discussions is indeed fascinating, as Awaad and Ali’s [10] recent comparative analysis of the classical text indicates a complete convergence between the current symptomology for obsessive-compulsive disorder (OCD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) and Abu Zayd’s delineation of obsessive disor- ders in his original manuscript.

The richness of intellectual discourses during this era included classical Muslim contestations on human ontology. Al-Ghazālī’s writings are replete with discussions on the composition of the human psyche and its division into mind, spirit, and behavioral inclinations, or ʿaql (intellect), rūḥ (soul), and nafs (ego) [29]Over two centuries later, the Ḥanbalī polymath Ibn Qayyim al-Jawziyyah (d. 751 AD/1349 CE) challenged whether the nafs (ego) and rūḥ (soul) were truly distinct entities [1]. The Ashʿaris, one of the two main categories of Muslim dialectic theologians (mutakallims) (the other being the Māturīdīs), provide a wealth of information on the role of the mind (ʿaql) and its distinctiveness from the spirit (rūḥ). While some of them maintained that the spirit is physically localized in the heart, some jurists argued that the mind is localized to the brain [28].

The richness of this Islamic intellectual heritage is rarely documented in modern texts of psychology/psychiatry. Due to the limited presentation of mental health perspectives that draw from this rich intellectual heritage, an introduction to some theological perspectives on the role of mental health in the Islamic tradition is pre- sented below.