This book is outstanding. Beneath the surface of a collection of dry, scholarly discourses lie a fascinating dissection of mental illness and well-being, its definitions and treatment in the Islamic world. The phrase ‘al junun’ means madness but not exactly that which presents itself in psychiatric clinics in the western world. If there is a consensus here it is that insanity is culturally delineated and that its treatment must therefore be culturally based.

I approached this book with apprehension. Firstly, I am a mental health consumer of forty years standing and a fledgling research scholar with no knowledge of Islamic culture. I also had all the western prejudices that go with that ignorance. Finally, psychiatrists wrote the papers and I have an in-built suspicion of psychiatry as a discipline. Thus I decided to challenge my academic and cultural impartiality and I wasn’t sure that I could persevere. The rewards of doing so have been huge, not least a new understanding of the fundamental role culture must take in the shaping and treatment of mental illness.

Before I delineate in detail these cultural influences, I want to touch on the methods used in these research papers. The context of Islamic psychopathology is carefully placed both within its history and religion. Epidemiological studies are used and, where possible, meaningful statistics presented to support hypotheses. Case studies are meticulously reported and analyzed. I cannot therefore fault the way in which data was collected or presented, nor the contextual framework perceived to be necessary to understand the central facts presented.

It is the cultural difference that is so revealing and transforming to the reader. Cease judging the Islamic way of being and a whole new perspective appears. This is grounded in the history of the medieval Islamic society (Chapter 2), in the Muslim religion, with its nexus with individual, social and communal behavior, and in its traditional medicine.

Ihsan Al-Issa states in the book’s opening paragraph:

‘…the roots of Islamic ethnopsychiatry and ethnopsychology go back to the heights of Islamic civilisation during the medieval period between the seventh and the twelfth centuries.’

Furthermore, ‘basic sources for an understanding of abnormality as well as attitudes toward the mentally ill in Islamic society are the holy book, the Qur’an and the prophet tradition (hadith)’ (both quotes p. 43)

The author continues by pointing out that the expansion of the Muslim empire brought other influences – Greek and Arabian for example – and goes on to detail this history. Astonishing was the mention of an early form of ‘cognitive therapy’ practiced by Al-Razi (d. 932) for obsessive behavior (p. 46) This physician creatively reformulated Greek medical theory, particularly Galen. ‘He combined clinical experience in the Islamic hospital with his familiarity with Greek theories and Indian authors to produce his well known medical encyclopedia called Kitab al-Hawi or Continens.’ (p. 45).

This is just a taste of the fascinating history of a group of practitioners who treated the mentally ill and documented their disorders in medieval Islam.

Next to these reformulations were the popular approaches to madness. Islamic society placed sanity and insanity on the same continuum. The separation between sanity and madness remains narrowed. Thus there are the traditions of the Romantic Fool. This is a profane love that causes love sickness. Then there is the Wise Fool that may be compared to the Shakespearean fool in that he/she may behave outrageously but this is balanced by poetic gifts and the clever critique of society. Again, the belief that ‘we cannot separate insanity form sanity’ is evident. (Al-Naysuburi in ‘Uqala al-majanin’ quoted, p. 53)

Treatment included relaxation, wine and music. Hallucinogens and hashish were also used.

In contrast to our individuality-focused society, in the Islamic communal society sickness is seen as an opportunity for the group to show social support and charity to those who are ill.

If medieval understanding and treatment was so enlightened, where lies contemporary practice? Unlike Christianity, illness is not seen as a punishment. The mind and the body are united in health and in sickness. Prayer is a recognized path to healing. It is part of a greater path of a prophetic medicine that still sends those with psychological problems to a traditional healer. The jinn or spirits is recognized in the Qur’an and traditional methods are first used to be rid of them. The Qu’ran is central to the life of a Muslim. In their chapter on Psychotherapy in Islamic Society, Jawahir Al-Abdul-Jabbar and Ihsan Al-Issa list spiritual support and reassurance as an integral part of treatment. The therapist reinforces the practice of prayer with hope. Islamic belief also endorses patience and acceptance. Finally, there is the comfort that while the Qur’an insists upon personal responsibility, it stresses forgiveness and mercy. It distinguishes between intention and action and thus there can be no guilt caused by sins of the heart that are unrealised actions.

This chapter also points to another enormous cultural difference. Islamic culture is

‘strongly patriarchal,….(and) group oriented; the interests of the society are considered to be far more important than those of the individual. Such a social context may affect the development of the concept of self as an independent entity’ (p. 279)

The impact on traditional psychotherapeutic practice is thus huge. There is an intolerance of clients of insight-oriented therapy. Necessary modifications by an Islamic therapist are -:

• An assertive, direct approach.
• A constant reevaluation of the client as problem-solver.
• The use of consolation (Muwasat)
• Self expression as the relationship instigates change
• Teacher-based learning rather than student-based
• There is no dependency versus independency dichotomy in this communal society
• Outcome assessment is by the ability to perform social roles NOT independent individuation

(Summary of Pages 282-283)

This is a very complex work. It is also very thorough. Because it is impossible to present the detail, I have written of the Islamic flavor of mental illness and its treatment across the Islamic world and its contrast with the West together with the cultural reasons for it. This has been gleaned from the whole book. The differences between the experience of mental illness and treatment in Algeria, Qatar, Kuwait, Iran, Malaysia, Pakistan, Saudi Arabia, and the Diaspora are also dealt with in separate chapters. Included also is a thoughtful discussion on the possible effect of the Muslim religion on psychopathology and an examination of sex and sexual dysfunction in an Arab-Islamic society. Altogether, the editor is to be congratulated on the comprehensiveness of this collection.

When I quickly looked at the chapter headings in this book I thought ‘Typical – no input from a consumer’. I now realize how inappropriate that would be in an Islamic setting. This book has been such a revelation to me, an unexpected reward for setting aside my own preconceived ideas. I would make it mandatory reading for anyone interested or involved in the world of mental illness and well-being.

 

Fran Gillespie writes about herself:

I am a mental health consumer of forty years standing. My family is steeped in this experience as we have traced it through four generations I therefore have also a personal understanding of caring in this difficult area. In the last five years I have moved from hiding under the blankets to giving evidence to an enquiry into the human rights of the mentally ill in Australia to spearheading an understanding of the mental health consumer as a resource in our community in Hobart, Tasmania. With the support of likeminded people a system of paid consumer consultants arose from this activism. I am at present on leave from studying for a research Masters in Medicine that centres on an analysis of the development of mental health consumerism in Tasmania. I believe that it is necessary to set aside anger generated from personal experience in this area in order to achieve lasting solutions. Thus I also work as a consumer advocate.

Categories: MentalHealth, General, Philosophical