Islamic beliefs and mental health

by Huseyin Abdul

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.

Furthermore, research has found that black ethnic groups are more likely than the ethnic majority to be admitted to hospitals under compulsory sections of the Mental Health Act (1983), deemed to require urgent treatment and placed on locked wards.

Black groups are also more likely to be diagnosed as suffering from schizophrenia, given high doses of neuroleptic drugs and less likely to be offered non-drug based treatment such as talking therapy. In short they get the rough, hard end of mental health care. Black writers (Kareem & Littlewood, 1992; Fernando, 1995; Robinson, 1995) have highlighted the mistreatment of black patients arguing that this stems from racial stereotyping and cultural imperialism adopted by mental health professionals, who view black ethnic groups as being: unable to express their emotions, hostile in attitude, not motivated for treatment and not psychologically minded.

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.

Sarwar (1998), describes the belief system or articles of faith in two dimensions, the internal and external forms of worship (ibadah). The internal form of worship is referred to as 'imaan' and has seven facets, which include belief in:

1. Oneness of God (Allah),

2. Allah's Angels,

3. Allah's Books,

4. Allah's Messengers,

5. The Day of Judgement (the hour of reckoning),

6. Destiny or fate (At-Qadar), and

7. Life after death.

Five basic duties or pillars constitute the external form of the worship. These include:

1. Shahadah (a deep understanding and verbal acceptance of oneness of Allah and prophet Mohammed [pbuh] as the final messenger),

2. Salah (five compulsory daily prayers),

3. Zakah (giving charity to the poor),

4. Fasting (abstaining from eating and drinking during the month of Ramadan),

5. Hajj (pilgrimage to Mecca, if means provide).

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.

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