Role of Islam in the management of Psychiatric disorders.

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.

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.[34]

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.[910]

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.[1112]

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.[1617]

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.[20]

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.[21] Further, evidence suggests that Islamic traditional healing works mainly for treating neurotic symptoms, as opposed to severe mental or physical illness where it will fail.[22]

Sufism is a third model of Islamic counseling, in which a trained Sufi master (shaykh) guides the person to the path to God, Initially the person needs to show his/her desire to serve God and humanity and show a commitment to act according to the master's guidance.[23] In his/her interaction with the master, this person expresses her/his concerns to the Sufi master who then deals with these concerns by directing the individual to the goal of detachment from the world and to the presence of God. This is usually done through the Islamic daily prayers and worship with continuous invocation of prayers and the names of God to elevate the spirit (zikr).[24]

Sufism can have beneficial therapeutic outcomes. Even those scholars who do not agree with the traditional counseling for Muslim clients frequently consider Sufism as the basis of an original counseling model in Islam.[2425]

Nowadays, there are growing interests in Islamic psychotherapy from Western countries perspectives, which means incorporation of Islamic views of human nature while using different psychotherapeutic strategies and evidence-based treatments to help treating Muslim patients. This therapy includes using of Quranic metaphors, the Sirah of the Prophet and his traditions, as well as the biographies of the Prophet's companions, with Muslim patients, which will provide detailed instructions for implementing successful therapy.

It has been widely known that psychotherapy is a unique art developed by the Western society during the 20th century; however, as we can find that psychotherapy was widely used in treating mental disorders all over the world for many ages before it has been started by the West.

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’.[13]

We think that Western practitioners can enhance their ability to skillfully practice Islamically modified interventions through knowing the basic concepts of Islam and cultural norms among Muslims.

Consultation with an Imam (a Muslim religious leader), a Muslim social work professional, or another respected community member can also be helpful.[26] 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.[27]

Nowadays, modifications have been added to different psychotherapeutic techniques in order to comply with Islamic values, for instance, Motivation-enhanced psychotherapy may be facilitated through the use of Islamic concepts, as patients’ desire to address a given problem may be aided through the knowledge that this intervention enhances their relationship with God.[28]

Psychoanalytic approaches are not widely accepted among Muslims,[29-31] in contrast to the concept of individualism used by Western counseling. Islam highlights the importance of community rather than looking inward to establish their identity. Muslims tend to look outward, identify their identity in religious teachings, culture, and family.

Group therapy also may be problematic for many Muslims.[3132] Although this might seem opposite to the emphasis of Islam on the value of the community, group therapy as practiced in Western settings often conflicts with a number of Islamic values. For instance, some Muslims may feel uncomfortable sharing personal details in group settings, particularly if members of the opposite gender are present. However, the functions of such groups may be enhanced if they are composed of members of the same gender and involve values taken from the Islamic faith.[32]

Practitioners may consider using spiritually modified cognitive therapy, by replacing certain concepts used in Western cognitive therapy with concepts drawn from Islamic teaching.[3033]

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. Similarly, a study conducted on Muslims with bereavement showed significantly better results with cognitive-behavioral therapy that had been modified to incorporate Islamic beliefs and practices.[30]

Another striking study was conducted on Muslim patients with schizophrenia in Saudi Arabia, which revealed spiritually modified cognitive therapy was either similar, or superior, to the results achieved with traditional cognitive therapy.[33]

Although these researches revealed how effective the cognitive interventions based on Islamic principles for Muslim clients was, there are concerns regarding various methodological issues used in these studies, particularly small sample sizes. This reflects the utmost need for more research in this area to make definitive statements about the empirical soundness of such approaches.[34-36]

In spiritually modified cognitive therapy, we follow the cognitive restructuring model, where the therapist identifies the patient automatic thoughts and core beliefs. The process would then involve an evaluation and modification of automatic thoughts, followed by modification of core beliefs and assumptions. Modification occurs mainly through examining the evidence and looking for alternative explanation.[28]

Therapist can use cognitions from the Islamic faith and offer it as an alternative explanations to dysfunctional thoughts associated with a variety of conditions or disorders.[36]

There are several significant cognitive themes from the Islamic faith that can help to adapt the patients’ cognitive errors.

We have reviewed different studies and books and tried to explore the impact of Islamic values and beliefs on modification of the patient cognitive errors, and how these Islamic values can even help in prevention of different psychiatric disorders.

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.” (Quran, 12:87)

To counter maladaptive thoughts related to hopelessness and feeling overwhelmed with life, as there is no place for despair because Muslims believe that it is God Himself who is in charge of everything, the all Seeing, All Knowing, and All Fair and Wise God.[36]

As God says: “And for those who fear Allah, He always prepares a way out, and He provides for him from sources he never could imagine. And if anyone puts his trust in Allah, sufficient is Allah for him. For Allah will surely accomplish His purpose: verily, for all things has Allah appointed a due proportion.”(Quran, 65: 2-3)

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.[37]

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 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.)

On the contrary 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. Despite suicide being prohibited and considered as a great sin, it should not be viewed as “black and white”, as it is widely acknowledged that a person with a mental illness who is not fully capable of making decisions is not held accountable for his/her actions. Most Muslim scholars agree that it is God alone who will judge the actions of each individual. This may help to reduce the guilt feeling that may affect the mentally ill patients after attempting suicide. Although it is reported that the Prophet did not pray at the funeral of a man who killed himself, he did not forbid his companions from praying at the man's funeral; this indicates a possibility for forgiveness.

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 himself never forgot his love for his beloved wife, Khadijah, even years after her death.[38]

During grief reaction a person may have negative thoughts such as “Why is this happening to me?” “Why not someone else?” “Why did Allah choose me for this unbearable trial?” or “Allah is punishing me for my disobedience”. This is accompanied with anxiety and fear of Allah's punishment, both in this present world and the hereafter. Most of these patients come from families raised with a strong faith in Allah, but with an exaggerated sense of His punishment; God's love and mercy are diminished in their relationship with Him. In therapy these patients may improve with interventions, such as modification of cognitive errors that focus on these thoughts and beliefs.[39]

Prophet Muhammad said, “No Muslim is struck with an affliction and then says Istirja’ (‘Truly, to Allah we belong and truly, to Him we shall return’) when the affliction strikes, and then says, ‘O Allah! Reward me for my loss and give me what is better than it,’ but Allah will do just that”

Anxiety

As cognitive errors are common to be similar in anxiety and depression, the above examples can be used in anxiety as well.

In addition, anxious patients may have maladaptive thoughts such as “I feel that I am no longer able to cope,” “Life is too difficult for me,” or “No one is there for me.” It can be helpful for those who are suffering to recall that Allah is always there and can assist those who place their trust in Him.

One of the foundations of Islamic belief is the understanding that Allah is able to do all things and He runs all affairs. This is an aspect of tawheed (belief in the oneness of Allah) that specifies oneness in Allah's Lordship.

“And when you have decided, then rely upon Allah. Indeed, Allah loves those who rely [upon Him]” (Quran, 3:159).

It is reported in a Hadith on the authority of Abdullah bin Abbas, who said: One day I was behind the prophet and he said to me: “Young man, I shall teach you some words [of advice]: Be mindful of Allah, and Allah will protect you. Be mindful of Allah, and you will find Him in front of you. If you ask, ask of Allah; if you seek help, seek help of Allah. Know that if the Nation were to gather together to benefit you with anything, it would benefit you only with something that Allah had already prescribed for you, and that if they gather together to harm you with anything, they would harm you only with something Allah had already prescribed for you. The pens have been lifted and the pages have dried” (Zarabozo, 1999, Hadith 19, pp. 729-730).

Other cognitive adapting techniques that can be used to relieve stress and help in anxiety as well as depression, is to count how much God has blessed us and trying to focus on what we have and not on what we are deficient in.[31]

Prophet Muhammad said, “Look at those who are less fortunate than yourselves, not at those who are better off than yourselves, so that you will not be little the blessings that Allah has bestowed upon you” (Al-Mundhiri, 2000, n.d., book 68, chapter 13, p. 1115).

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 in the past, which one cannot go back and change, and to worry about what may happen in the future is useless. The person should think only about the present, focusing his energy on doing his best today, because this is what results in perfect work, and helps him to forget his worries and regrets and as the prophet said: ‘The strong believer is better and more beloved to Allah than the weak believer, and both are good. Pay attention to that which could benefit you, seek the help of Allah and do not feel incapacitated. If anything befalls you, do not say, “If only I had done such-and-such, such a thing would have happened.” Say instead, “It is the decree of Allah, and what He wills, He does,” for saying “if only…” opens the way for Shaytan.’”

Obsessive–Compulsive Disorder

From an 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 .

Allah says, “Then Shaytan whispered suggestions to them both,in order to uncover that which was hidden from them of their private parts” (Quran7:20).

[Say: ‘I seek refuge with Allah, the Lord of mankind, the King of mankind, the God of mankind, from the evil of the whispers of the Devil, who whispers in the hearts of men’] (Quran 114:1-4).

And the Prophet Muhammad said “Shaytan comes to one of you and says, ‘Who created so-and-so and so-and-so?’ till he says, ‘Who has created your Lord?’ So, when he inspires such a question, one should seek refuge with Allah and give up such thoughts” (Al-Bukhari and Muslim).

All human beings experience at some point in their life wasawis, regardless of age, sex, faith, or creed. However, the nature, content, severity, and influence of these wasawis vary from one person to the other. For some, they only cause mild anxiety and worry, while for others may be more severely affected to the point of becoming spiritually, mentally, emotionally, psychologically, and socially incapacitated.

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.

As the Prophet (peace and blessings be upon him) said “Allah Most High has forgiven the wasawis that arises in the hearts of the people of my nation until one acts upon them or talks about them” (Al-Bukhari, Muslim).

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. th

There are two main features of Islamic prohibitions:

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. As in Western countries most of the teenage alcoholics do not buy the alcohol from the store but get it at home. 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.

Islam prevents Muslims from following the path, which may lead to drug and alcohol intake. Therefore not only promiscuous sex is prohibited, but casual mixing of sexes freely is also prohibited, obscenity and pornography is also prohibited. The drinking of alcohol, or to come in contact with alcohol or any other spirits such as making, selling, keeping them, or even growing grapes for the sole purpose of selling it to winery for making wine is prohibited. 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)

“O you who believe! Approach not prayers, with a mind befogged, until you can understand all that you say”(Quran 2:219).

“O you who believe! Intoxicants and gambling, (dedication of) stones, and (divinations by) arrows, are an abomination of Satan's handiwork: Avoid such (abomination) that you may prosper” (Quran 5:93).

“Satan's plan is to sow enmity and hatred among you with intoxicants and gambling, and to hinder you from the remembrance of Allah and from prayer. Will you not then give up” (Quran 5:93).

Prophet Mohammed said:

“Of that which intoxicates in a large amount, a small amount is haram” (Ahmad, Abu-Daud and Al-Tirrnizi).

“Khamar (intoxicants) is the mother of all evils” Reported in Bukhari.

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 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.

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.

The physical–psychological–spiritual development through marriage and mating, followed by procreation that may continue for more than one generation should help humans to understand the wisdom of God and his favors in creating life to build up a balanced society.

Homosexuality is harmful for the health of the individuals and for the society. It is a leading cause of sexually transmitted diseases. Men having sex with other men leads to greater health risks than men having sex with women not only because of promiscuity but also because of the nature of sex among men. Male homosexual behavior is not simply either ‘active’ or ‘passive,’ since penile–anal, mouth–penile, and hand–anal sexual contact is usual for both partners, and mouth–anal contact is not infrequent. Mouth–anal contact is the reason for the relatively high incidence of diseases caused by bowel pathogens in male homosexuals. Trauma may encourage the entry of micro-organisms, which lead to various infective diseases. In addition to sodomy, trauma may be caused by foreign bodies, including stimulators of various kinds, penile adornments, and prostheses.[40]

Homosexuality degrades a person and the family structure and hence the society. This is the reason why homosexuality is forbidden in Islam as Allah says:

We also sent Lut: He said to his people: “Do ye commit lewdness such as no people in creation (ever) committed before you? For ye practice your lusts on men in preference to women: ye are indeed a people transgressing beyond bounds.” Quran 7:80-81.

“What! Of all creatures do ye come unto the males, and leave the wives your Lord created for you? Nay, but ye are forward folk.” Quran 26:165.

Many Hadiths discuss liwat (sexual intercourse between males). Two examples are:

“When a man mounts another man, the throne of God shakes.”

There is at least one mention of lesbian behavior mentioned in the Hadith: “Sihaq (lesbian sexual activity) of women is zina (illegitimate sexual intercourse) among them.”

Role of family as a part of social therapy from an Islamic perspective

Family is an important socio-cultural component as it is the unit of the society, which has a huge impact on personality development and a potential factor in different psychiatric disorders. Bowlby revealed that the permanent loss of a parent during childhood may increase the vulnerability to certain forms of psychopathology, for example, depression.[2]

Karen Horney explained that hostility is not an innate instinct but reactive so egocentrism and antisocial cravings like greed were not inevitable phases of human's development but the expressions of a neurotic process. By helping individuals to grow up under favorable conditions they could develop and lead a healthy life and realize his potentialities.[39]

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.[41]

Despite the fact that the trials of Western societies to substitute the role of family in the life of the mentally ill patients through the help of social workers and care coordinators is a step forward in their care plan, but it is not as beneficial as family role is. There is nothing like a family especially if this is a supportive family, which can have a great impact on the illness outcome and the patient's quality of life.

Psychiatrist and social workers need to consider the impact of family's involvement on individual mental health, which may be a double-edged blade. On one hand, it may be helpful as the family may help in supporting the patients regarding his medications and psychotherapy, which help to improve the outcome.

On the other hand, as the family unit is sacred among Muslim people and it is very common to find different families with over involvement and enmeshment patterns, who are considered a continuous source of support to the individual. In some cases the family will interfere on behalf of the identified patient, although they too lack in trust, whereas they expect much. For example, they might try to control the interview by answering the questions directed at the client while they withhold information that may be perceived as embarrassing, they may interfere with his medications and choice of treatments.[42]

Therefore the psychiatrist and social workers should educate themselves regarding Islamic values and nature of Islamic family patterns, so that they can in turn sensitively educate the family about the necessary requirement for a workable helping relationship.

Music therapy

Reported evidence shows the magical effect of music to heal the body and strengthen the mind.[43]

Researchers found that music has a great effect on treatment of depression, insomnia, stress, schizophrenia, dementia, and childhood-related disorders like autism.[44-46]

Regarding the concept whether music is allowed or forbidden in Islam (Halal or Haram), we can find different views from Islamic scholars, however, generally music is not considered forbidden in Islam as long as it is a therapeutic need.[47]

A thousand years ago, Muslim physicians were at the leading frontiers of medicine and used innovations and different therapeutic techniques that are now considered modern. They treated mental illnesses by confining patients in asylums with twenty-first-century techniques of music therapy.[48]

Al-Mansuri hospital in Cairo, which was established by Malik al-Mansur Sayf al-Din Qalawun in 1284, just like today's advanced hospitals; provided patients with entertainment by light music. The Sufis mention that mental and nervous disorders are cured by music. The great Turkish Islamic scientists and doctors Al-Razi (854–932), Farabi (870–950), and Ibn Sina (980–1037) established scientific principles concerning musical treatment, especially of psychological disorders.[49]

According to Farabi, the effects of the makams of Turkish music on the soul vary according to the type of makam (i.e., Rast makam: brings a person happiness and comfort). He also outlined the effects of the makams of Turkish music differs according to the times they were effective (i.e., Isfahan makam: effective at dusk). Then the great Islamic thinker and philosopher Ibn Sina (980–1037) applied Farabi music work in his practice with mentally ill patients.[50]

The work of these two scientists became the base for the developing Turkish music therapy.

Meditation therapy

Meditation is based on concentrating on any one idea or object to the exclusion of all other ideas or objects.

Meditation works by eliciting the relaxation response. The relaxation response is characterized by decreased heart rate, respiratory rate, oxygen consumption, and muscle tension.[50] Studies revealed that meditation helps in the reduction of total and low-density lipoprotein (LDL) cholesterol, decreased anginal symptoms, and regression of coronary artery disease.[51]

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. In fact, the Quran describes Muslims involved in such a process of meditation as:

Men who celebrate the praises of Allah standing sitting and lying down on their sides and contemplate the (wonders of) creation in the heavens and the earth (with the thought): “Our Lord! not for naught hast thou created (all) this! Glory to thee! give us salvation from the penalty of the fire: (Quran, 3: 191)

Other forms of meditation may be enhanced by the recitation of one word or a few words that give the person a sense of internal peace and calm, which is known as remembrance (zikr) in Islam; for example, by repeating the words subhan Allah (glory be to Allah) or al-hamdu lillah (all praise be to Allah). It also adds an additional factor that helps in stress elimination and that is giving the individual the feeling that he or she is in extreme proximity with Allah, the Controller of the whole world.

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.

O ye who believe! seek help with patient perseverance and prayer: for Allah is with those who patiently persevere. (Quran, 2: 153).

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 postoperative complications following open-heart surgery. Praying also lowers the incidence of depressions in patients following hospitalization. Recently, it is recommended that praying can be used as an alternative therapy as successfully as meditation, exercise, or herbal treatments.

Aromatherapy in Islam

Generally aromatherapy is considered one of the relaxation techniques both physically and mentally and it can help in different psychiatric disorders like anxiety, depression, and dementia.

Reviewing Islamic history, one will find many references to musk, rose, sandalwood, oud, bakhoor, frankincense, myrrh, jasmine, lilies, citrus oils, and other fragrances.

Avicenna (Ibn Sina, the Islamic philosopher) writings record over 800 medicinal plants and essential oils including chamomile, lavender, and countless others. He was the first to perfect the distilling of oils from plants, which is used today to make concentrated forms of aromatherapy oils. In the thirteenth century, the Arab physician Al-Samarqandi wrote on the aromatherapeutic use of herbs and flowers.[52]

CONCLUSION

In summary, there is a huge impact of Islamic religion and spirituality within psychiatric clinical practice. Using Islamic values and beliefs can be beneficial in treatment of mentally ill Muslims, through incorporation of Islamic beliefs that help in drug adherence and modification of different psychotherapeutic techniques to suit Muslim patients. Such aspects provide the basis for specific guidelines in working with Muslim mental health clients.