Islamic beliefs and mental health

How much should mental health workers do to understand the beliefs of Muslims when they are affected by mental illness? Abdul Hussain asks how the worlds of belief and mental health practice can be brought closer together

In recent decades concern has developed about inequalities in mental health and health care delivery between the ethnic majority and black ethnic groups. Research (Fernando, 1995; Browne, 1997) findings have shown over-representation of black groups, many of whom are from Muslim backgrounds, in the psychiatric system.

Certainly the diagnosis of psychiatric disorders, if not carried out by white middle class psychiatrists, is based on the ethnocentric knowledge base of western medicine. No real attempt is made to develop any detailed understanding of how Muslim patients' religious beliefs influence their thinking about health, illness and treatment. Yet there are an estimated 1.8 million Muslims living in the UK (Muslim News, 1998). The few Muslim mental health professionals within mainstream mental health services, such as myself, exist in the two cultures that are worlds apart, finding it difficult to narrow the gap between them.

This paper is thus my attempt to build bridges by informing other mental health workers how they might better understand the contrasting value system of the Muslim Ummah (community) against that of secular psychiatry.
Islamic beliefs have a central role in the lives of many Muslims, such as myself.

It is generally held that our faith protects us from ill health as well as helping us manage health problems when they do occur. The fact that Islam plays a major part in shaping the Muslim's understanding, experience and expression in mental distress is well-documented (Ansari, 1992; Hussain, 1999; Badri, 2000).
Amongst Muslims there is a strong tendency to conceptualise illness as occurring according to the will of God (Allah), who is understood to be a higher power that cannot be perceived by the senses. Central to this belief is the idea of Al-Qadar.

It is believed that everyone's Qadar is written from the moment of conception. Whatever happens in life is written in Qadar and can never be changed, except through supplication, which is in the grace of Allah whether to accept or not (An-Nisa 4:48). Allah is the architect of destiny and the advancement of the individual is dependent on Him. All life events are under His control and can be changed by Him alone. This belief is fortified in the Holy Quran in Surah At-Taghabun (64: 11):

`No calamity befalls, but with the leave of Allah (i.e. what has befallen him was already written for him by Allah from the Qadar, Divine preordainment)... and Allah is the All-- Knower of everything.

Outside the spiritual sphere, biomedical psychiatry, part of western medical tradition, attaches its explanation of human distress to an individual's biological body. In this view distress is understood as a defect in the hormonal mechanisms that control the balance of emotions and thoughts, i.e. levels of serotonin and dopamine which causes chemical imbalance of the brain. It deals with the classification, diagnosis and treatment of those people it determines as mentally ill on the basis of a wide range of clinical symptoms. This means that the person is seen in isolation from their religious, social and environmental factors. This idea is based on the philosophical concepts of Cartesian dualism (the secular idea that mind and body are separate entities), which are present in western cultures. Thus the total experience of the person is divided into various components, such as `hearing voices', `feeling depressed' etc. What this means is that, other life events, such as belief in Higher Power as in Allah and the consequences of inequality, which play an important part in shaping people's experiences and concepts, are systematically played down. Ultimately then, this implies that the part religion plays in understanding the meaning of human suffering are of little value in helping us understand the origins of human distress. The biomedical model assumes that distress has no intrinsic value and so must be dealt only with anti-depressants or modern technical interventions such as cognitivebehavioural psychology.

From this standpoint, it can be gathered that learning about the concept of `after-life' (known as akheerah in Islamic terms) and how it relates to some of the symbols within `God-conscious' communities are useful starting points in increasing empathy and sensitivity towards these groups. In other words, working alongside religious discourses is a step towards realising the vision of the worlds of others. Writers from psychospiritual perspectives (Badri, 2000) say that because of the under-value of the religious paradigm, too much emphasis is now placed on `cultural differences' to the exclusion of the belief systems, which underpin a culture and are an integral part of it. More importantly they point out how a western world-view approach to understanding community mental health needs now to engage in dialogue and include the context of `faith communities'. For many people, religious faith or spirituality can act as part of the holistic healing process. It can be part of finding that 'centre' the balance - that gives calmness and peace, which is so vital to recovery. Spiritual principles and values need to be closely explored if mental health professionals are to really appreciate and work creatively with the richness of a community in all its facets.