I was sitting next to my father, caressing his hair. I noticed some black pimples on the bold part of his head. I thought that perhaps I had found the cure for my father`s strange illness. I needed to remove them one by one, which I did. I waited with anticipation to see my father coming out of the shadow of this strange illness and smiling again, hugging me and telling me stories of successes and struggles. I waited for a day… nothing happened. I waited for a week …nothing happened. It was the same – my father lying in bed and repeating like a mantra, “Allah (God) grant me death; I cannot bear it anymore!” on and on… day and night. Our family believed it was a test from Allah that he had to go through. There was no cure for it. Now, as a trained psychotherapist, I know that he had been suffering from severe clinical depression, and he did not commit suicide just because of his religious belief that it is a great sin to destroy your body, which is a precious gift from Allah. He would regularly recite the Quran and perform prayers as a cure until his last day. This widely resonates with Muslim families worldwide, from Morocco to Indonesia. Mental illness is treated like a test from Allah. You must pray and go through it. Sometimes, people go to the Imam (faith leader) for solace (Razali & Tahir, 2017). It is mainly kept out of the health care system.
Religious Barriers
I recall a traumatic incident I encountered when I was very young. A lady was delirious – now I recognised it as a psychotic episode. The community called a faith healer. He came to our place and started shouting at her, telling the Jinn (bad spirit) to get out of her body. Then he started physical abuse – he was hitting her with a broom and shouting, “Go away, you evil Jinn, if you want to spare your life”. I was shocked and started crying. My mother explained that Jinn had taken possession of her, and we must drive Jinn away. A belief in Jinn as the cause of psychosis is widely held in all Muslim countries. My mother used an asymmetrical black mark on my forehead and an amulet necklace to make Jinn disinterested. It is a common practice among Indian Hindus, Christian and Muslim families to distract the `Evil Eye` or Jin (Weatherheads & Daiches, 2010). Young ladies are traditionally barred from wearing perfumes at night for this reason. The Muslim communities are gradually moving away from this traditional attitude towards mental illnesses due to education, social mobility and globalisation. However, there is still a long way to go to see a significant shift in the attitude among the majority in Muslim communities.
As we can see, religious belief in Muslim communities plays a significant role in forming attitudes and subsequent behaviours about mental health. This persistent influence forms the basis of Pan-Islamic cultures. However, regional cultural influence affects and localises attitudes, which can be seen in local cultures that go beyond a particular religion. For instance, the attitude and practice about mental health are influenced by the common belief in Bhuut (Ghost) (Freed & Freed, 1990), a local synonym for Jinn, and a similar practice of exorcism across religions in India. The terms are used interchangeably among Indian Muslims. However, in the Arab world, there is a strong tendency to incorporate all supernatural evil spirits into the term Jinn mentioned in the Quran (Shimizu, 1992). Those who have mental illness are called Majnoon (possessed by Jinn).
Cultural Barriers
Among Muslims across the nations, there are strong beliefs that mental illnesses are hereditary and contagious. Revealing that someone has a mental illness in the family is avoided. This carries a stigma and affects the reputation of the family. Since most Muslim communities in the Islamic world are collectivists – the group reputation and shame are more important than individual achievement and guilt – the mental illnesses in the family are guarded secret. This prevents those suffering from mental illness from seeking help from outside. Especially, seeking help from a physician from the same community is avoided due to fear that others would know about the illnesses. Therefore, it is common for Muslim families to seek help from physicians away from their community or a different ethnicity. The role of female members of the family in dealing with mental illnesses is unique in these communities. They are typically tasked with looking after the mentally ill member of the family. Any sign of mental illness in the female member of the family is taken very seriously because of the fear of the stigma and difficulty with finding a marital match. Married women are generally prevented from seeking professional help due to the fear of stigma. Due to collectivism and the hierarchical nature of social interactions, the family with the family head typically decides whether someone would seek help. This is a strong barrier against seeking help for any mental illness in the Muslim community.
Way Forward
History tells us that the first hospitals dealing with mental illness were established during the 7th Century AD in Baghdad, Damascus, Aleppo and Cairo. The mental illnesses were treated holistically with fresh air, a flood of natural light, the sound of running water and music. This indicates an excellent example of psychophysiological interventions during the heyday of Islamic civilisation. Sadly, the attitude towards mental illness changed after the fall of Islamic civilisation and the emergence of nation-states with the tight grips of kings and dictators who favoured strong orthodoxical stances of Quranic interpretations. Since then, metaphysical interpretation of mental illnesses has been dominant in the Muslim community. Recently, there has been a significant surge in acceptance of modern theories of mental health in the educated and elite class in Muslim communities (Elshamy et al. 2023). New interpretations of the saying from Prophet Mohammed are that we are obliged to look after the precious gift of our existence and not destroy it, which is taken seriously. Some recent studies indicate that those who hold this religious belief are more inclined to seek help from modern mental health services (Andrade et al., 2022). Also, a sizable group of Western-trained psychotherapists are integrating the core concept of collectivism in the self theories of psychopathology. In future, it would be crucial to interact with the faith leaders and Imans to develop a shared narrative around an integrative approach to psychotherapy, which could open the doors to those who suffer in silence like my dad and those who are physically abused like the poor lady from my childhood. I have a strong urge to travel back in time and relieve them from their misery.
References
Andrade et al. (2022). Attitudes towards mental health problems in a sample of United Arab Emirates residents. Middle East Current Psychiatry, 29:88
Elshamy F, et al.(2023). Mental illness and help-seeking behaviours among Middle Eastern cultures: A systematic review and meta-synthesis of qualitative data. PLoS ONE 18(10)
Freed, R. & Freed, S. (1990). Ghost illness in a North Indian village. Social Science & Medicine, 30, 617-623
Hind, A., et al. (2023). Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of Cognitive Behavioral Therapy as a treatment: systematic review and thematic Synthesis. Discover Mental Health, NP
Miller, A. C. (2006-12-01). “Jundi-Shapur, bimaristans, and the rise of academic medical centres”. Journal of the Royal Society of Medicine, 99 (12), 615–617.
Razali Z, & Tahir M.(2017). The Role of Psychiatrists and Muslim Faith Healers in Mental Health Issues. International Medical Journal Malaysia, 17, 31–35.
Shimizu, Y. (1992). The Arab Muslims’ Belief in Ghosts and Spirits: A Case Study of a North Jordanian Village in Comparative Perspective. Annals of Japan Association for Middle East Studies, 7, 273-310
Weatherhead S, Daiches A. Muslim views on mental health and psychotherapy. Psychological and Psychotherapeutic Theory, Research and Practice. 2010;83(1):75–89.
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