Islamic Values and Ethics in Prevention and Treatment of Emotional Disorders
by Basheer Ahmed,
God says about Qur'an ..It (Qur'an) is a:-guide and a healing to those who believe" (S.41: V. 44). Religion plays a significant role in satisfying our physical as well as spiritual needs: Islam teaches us a code of behaviour and gives us a meaning for our existence. Unfortunately, in today's western society the religious, moral and ethical values have been declining. The families are falling apart, divorce rate is increasing sharply, substance abuse and excessive sexual indulgence are common in adolescents and young adults. These factors lead to conflicts, resentment, loss of self-respect, loneliness, depression, anxiety and a host of psychological symptoms. Despite progress in the behavioural sciences, there remains the question of whether current technique of treatment and prevention of emotional disturbances are effective in making a significant impact on psychiatric problems.
Psychotherapy is in reality a form of education which directs the patient to recognize his behaviour, to conform with prevailing standards. It helps in motivating the patient to adopt the alternate ways of behaviour. In our opinion, the Islamic principles which are based on Qur'an and Hadith are the best form of prevention and treatment of emotional disturbances. Muslims physicians and mental health professionals should incorporate the Islamic values and ethics in techniques of psychotherapy.
God says about Qur'an IT (Qur'an) IS A GUIDE AND A HEALING TO THOSE WHO BELIEVE (S.41: v. 44). God says in Qur'an about psychological and social diseases and cures in several surahs. In our opinion, Islamic principles which are based on Qur'an and Hadith are the best form of prevention and treatment for psychological and social disturbances.
In western society many psychiatrists and psychotherapists discourage the use of any religious concept in treatment of emotionally disordered. Of course, Freudian theories have a great deal of influence on western thinking. Freud's focus on sex as the driving force of human behaviour and repression of sexual desires as a cause of neurosis, made a considerable impact on medical and social scientists. Individuals are encouraged to express freely aggressive and sexual desires, which further contribute in changing the sexual attitudes and lack of inhibition in the society at large. Freudl and his followers have tried to explain religion as the ..universal obsessional neurosis". It is prejudiced, irrational statement and many psychoanalysts contradict Freud's statement. Erich Fromml defines religion as ..A system of thought and actions by a group which gives the individual a frame of orientation and an object of devotion". ArietiJ elaborates further the role of religion in human life. He states that religion gives people faith for survival of man and to achieve human ideals. Religion becomes an incentive to greatness of spirit. It offers new insight which opens up new dimensions of understanding and feeling. Higgins 4 further supporting the importance of religion states that modern psychiatry has not yet significantly tapped the fund of information about the human condition ranging from the inspirational writing about the aims of living to highly systematized doctrine about organization of behaviour .
Our religion, Islam, plays a significant role in satisfying our physical as well as spiritual needs. Islam teaches us, a code of behaviour, conservation of social values and gives us a meaning for our existence. It helps in toleration and developing adaptive capacities for stressful events of life. It gives us a sense of self-respect and teaches us about the virtues of family life and a cohesive society with a sense of brotherhood. Shall Muslim psychiatrists and psychotherapists incorporate the Islamic values, ethics and code of behaviour in techniques of psychotherapy?
In order to answer this, we should examine the causes of emotional disorders, effect of current principles of psychotherapies and explore the importance of incorporating Islamic values and ethics in psychotherapy. Mental health 5 can be defined as a state of emotional wellbeing in which a person is able to function comfortable within his society and in which his personal achievements and characteristics are satisfactory to him. Emotional disorders are defined as disturbance of behaviour and affect which results in disturbance of a person's function in society. During the last few decades it is becoming more and more clear that biological, social and psychological factors influence the human behaviour and that the health disturbing factors operate within the individual, within the group and within the social system in which he functions. In certain forms of emotional disorders we see predominant biological factors and in others psychosocial factors. In the interest of time, I will focus primarily on the psycho-social factors which contribute to emotional disorders and the use of psychotherapy to bring about the needed improvement.
Family is an important socio-cultural institution which makes a considerable impact on personality development and a potential factor in emotional disorders. Bowlby 6 confirms from his longitudinal studies, that the permanent loss of a parent during childhood may result in increase vulnerability to certain forms of psychopathology e.g., depression. The child can be sensitised by the loss of a loved one, and he breaks down in various ways in later life when faced with similar situations of loss or rejection. Similarly permanent loss of father was found in the history of delinquent children. Longitudinal observations have further confirmed that children reared in an atmosphere of love, care, consistency and firm limitations develop healthy personalities with trust and self confidence. Those reared in a hostile environment with rejection and humiliation may develop apathy, anxiety or aggressive behaviour. Similarly, culture has also been described 7 as a causative factor for a host of mental disorders. Culture may produce and maintain a mental disorder by creating basic vulnerable personality , establish pathogenic child-rearing practices, fostering sanctions against selected behaviour and by rewarding certain malad- justed deviants. Further emphasizing the role of family and culture on human development, Karen Horney 8 pointed out: Man is no longer an instinct ridden creature but being capable of choice and responsibility. Hostility is no longer innate but reactive, egocentric and antisocial cravings like greed or the lust of power were not inevitable phases of man's development but the expressions of a neurotic process. By growing up under favourable conditions man would develop his inherent constructive forces and like any other living organism would want to realize his potentialities.
Unfortunately, today's western society, the religious, moral and ethical values have been declining. The society is plagued with moral decay. Families are disintegrated, divorce rate and number of unwed mothers have increased sharply. Drug abuse and excessive sexual indulgence are predominant in adolescents and young adults. These events lead to conflict, loneliness, guilt, loss of self-esteem which result in manifestation of a variety of pathological disorders. Many young persons are confused about self-identity, lose meaning in life and often turns toward pseudo religious cults, drugs or suicide. Recent research studies 9 confirms that both socio-cultural and personality aspects are responsible for high incidences of drug use in youth. In order to protect an Islamic society and culture from the abovementioned influences, the moral, social and inspirational forces of the Islamic religion are to be enforced.
Despite progress in the behavioural sciences there remains the question of whether current techniques of psychotherapy and preventive measures for emotional disturbances are effective in bringing about necessary changes in individual, family and society. Obviously the answer is no. In my opinion, one of the reasons for ineffectiveness is the predominant influence of Freudian theories on western medical and social scientists. Freud gives us a clear understanding of psychosexual development and unconscious motivation of behaviour. He described unconscious inner self as if and conscious self as ego. Ego is regarded as active portion of personality adapting to forces of id, external reality and superego. Freud further postulated that the sexual urges of the child remain active from childhood and express in activities such as sucking and swallowing. He further explains that child's love for his parents is due to his sexual urges. The child develops a sexual attitude toward parents of the opposite sex and a simultaneous rivalry toward the other. Freud calls this is "Oedipus complex". As a child grows the odious complex resolves. This is the foundation of Freud's psychoanalytic theory.
Freud's focus on sex as the driving force of human behaviour and sexual repression as a cause of neurosis is used as a basis of psychodynamic therapy. According to Freud, our higher activities like art, science and religion have no intrinsic worth. These activities are attempts of man to compensate for his unsatisfied sexual desires. Criticizing Freud's over-emphasis on sex, Rafilo outlined that Freud give a person three alternatives to choose as a desired behaviour: He must follow the instruction of his sexual urges, becomes wicked and face the disgrace of society; repress his sexual desires to please society and expose himself to the danger of suffering from neurosis or renounce his instinctual desires and try to deviate himself by substitutes as art, religion and morality. Obviously, Freud portrays a miserable picture of human beings. The apparently distorted and disappointing view of Freud about the lot of man is necessitated by his hypothesis that the nature of our unconscious desire is sexual.
Freud's theory of sex as the driving force of human behaviour and his theory of the universality of Oedipus complex have been widely criticized. Even Freud's own followers, Adler and Jung, found it difficult to agree with Freud. Adler maintained that the unconscious urge is the impulse to power while Jung emphasized on collective unconscious. Karen Horney and Erich Fromm, the renowned psychoanalysts, also rejected Freud's ideas about sexuality as the basic force of life. Horney 11 stated that Freud's focus on sex as the driving force of human behaviour was one-sided and led to other distortions. She emphasized on influence of family in development of personality and pointed out that Oedipus complex occurs only in distorted parent-child relationship.
As an alternative to Freud's theory, Rafilo explains that the child loves his parents and feels an admiration for his parents and ascribes a perfection to them. Thus, superego which develops as an interaction between parent and child demands an ever-increasing perfection. Therefore, one can say that the individual is under powerful influence of a desire for the perfect and admirable throughout his life. In childhood his desire finds an outlet in the persons of the parents and teachers. As his knowledge increases he finds other and better objects and ideas worthy of love and devotion and he is naturally attracted to them, being compelled by the urge of his nature. It appears that the repression of the sexual urge is the cause of neurotic symptomatology but it can also be explained that the symptom may be due to obstruction of the urge of consciousness for perfection and conflict created by sexual urges. The fundamental cause of emotional trouble is the choice of the love of a wrong ideal. Therefore, the cause of cure may not lie so much in the discovery of conflict as in the changing or the raising of the ideal. Therefore, the focus of therapy should be toward achieving the ideal.
The Muslim psychiatrist and psychotherapist must have a clear understanding about the development of a healthy personality and ego ideal. Mother satisfies the need of the child since birth which gives him a sense of possession and omnipotence. Gradually the child realizes that he has to share mother's love and attention with siblings and father and he also learns that mother expects him to restrain his urge for immediate gratification. From this prohibition and discipline the conscious and superego develops. Discipline creates conflict but the child overcomes the conflict by introjection mother and her authority and maintains the affectionate relationship. In a healthy mother-child relationship the child must believe "I am so strong in my mother's love that I can yield to her without fee long defeated" 12 The same mechanism involved when a Muslim interjects the image of God as Qadeer, Raheem and- Benevolent. The introjection of God's love and authority influences a Muslim's behaviour incorporating ethical and moral values of Islam. Once you incorporate the image of God in inner self there is no conflict with external reality and superego. A child's religious orientation is influenced by the kind of family relationship that exists at home. Qur'an emphasizes again and again, about healthy parent-child relationship and parents' responsibility toward upbringing. In a home where parents playa role of strong loving and protective figures, with proper attention toward developing a sense of self-worth and dignity, the child develops trust, self-confidence and interjects the love and authority of parents and God. In a home where parental figures are unloving, show no respect toward each other, rejecting and punitive towards their children, then the concept of God is distorted.
Psychotherapy is in reality a form of education which directs the patient to recognize his behaviour, to conform with prevailing standards and to help in improving the patient to adapt the alternate ways of behaviour. Muslim psychiatrists and psychotherapists must have familiarity with Islamic religion and culture and must incorporate Islamic values, ethics and code of behaviour in techniques of psychotherapy. Many patients suffering from emotional disorders have lost the ability to lead responsible lives. For them therapeutic guidance in an environment of care, respect, dignity and understanding is necessary. The goal of therapy need not be happiness but acceptance of reality and strengthening the coping mechanisms. A trustful relationship with therapist, a clarification of problem and conflict, influences the positive outcome. Moral and ethical issues should not be avoided and problems should be clarified so that patient can judge for himself the quality of his behaviour and his ideals.
BUT HE GUIDETH TO HIMSELF THOSE WHO TURN TO HIM IN PATIENCE, THOSE WHO BEL/EVE AND WHOSE HEARTS FIND PEACE AND SATISFACTION IN THE REMEMBRANCE OF GOD: FOR WITHOUT DOUBT IN THE REMEMBRANCE OF ALLAH DO HEARTS FIND SATISFACTION AND PEACE .
1. FREUD, S.'.The future of an Illusion". Livenright, New York, 1949.
2. FROMME, E. '.Psychoanalysis and religion". Yale University Press, New Haven, Conn, 1950.
3. ARIETI, S. "The intrapsychic self". Basic Books, New York, 1967.
4. HIGGINS J.W. .'Psychiatry & Religion". In American Handbook of Psychiatry Ed. S. Arieti. Basic Book, 1974.
5. Comprehensive textbook of Psychiatry/111. Ed. by H. ,. Kaplan, A.M. Freedman & B.J. Sadock. Williams & Wilkins Press, Baltimore, Md. 1980, page 3339.
6. BOWLBY, J."Maternal care and mental health". Monograph World Health Organization. Geneva 1952
7. ARMANDO FAVAZZA & MARY ORMAN '.Anthropology and Psychiatry" in Comprehensive Textbook of Psychiatry. Ed. A. Kaplan, A. Freedman and B. Sadock. Published by Williams & Wilkins, Baltimore, Md. 1980, page 488.
8. HORNEY, K.'.Neurosis and human growth". Published W.W. Norton, New York, 1950.
9. KANDEL, D.B. Editor .'Longitudinal research on drug abuse". Halstead Press, New York, 1978.
10. RAFIUDDIN, M. "Ideology of the future". Published by Sh. M. Ashraf, Lahore, 1970.
11. HORNEY, K. "New ways in psychoanalysis". W. W. Norton, New York, 1939.