RTB DISSERTATION SUMMARY BY TASNIA CHOWDHURY
Background:
The premise of this dissertation was based on my own experiences of always feeling at war with myself when it came to mental well-being and spirituality. Too many times I heard emphasis on the healing power of God’s words and the spiritual explanations of mental health symptoms but scarcely the acknowledgment of mental health as a biomedical concept. The aim of this dissertation was not to divide the two concepts at all, rather, I hypothesized that acknowledgment of mental health as a biomedical concept within the Muslim community, in particular, was the foundations of any efficient form of intervention that would marry together the concepts of faith and medicine. Although the dissertation focused on a variety of concepts within the scope of spiritual and mental well-being, below I have summarized the key findings and elements of this dissertation in the hope that it will reflect the ways in which faith can intervene with mental health rather than be a barrier to a person’s mental well-being.
Literature Review:
– Mental health in the British Muslim community –
The late 1960s and 1970s saw the arrival of migrant Muslims from Kenya, Uganda, Southeast Asia, Turkey, Cyprus, Iran and then eventually, Somalia, Iraq, Afghanistan, Kosovo and Bosnia; seeking refuge across the UK, reflecting the diversity of the Muslim population in Britain (Hussain, 2009). Muslims make up around 5.1% of the British population and according to the Office of National Statistics (ONS), the Muslim community have one of the highest rates of illness and disabilities in the UK; 13% men and 16% women (Laird et al, 2007). This is an overview of the general poor health of Muslims in Britain; however, there are no official statistics on what percentage of this poor health pertains to mental health. Discrimination, racism, migration, language, education and adjustment in early migrant communities, are all examples of the several contributing factors of mental health problems in the Muslim community (Pilkington, 2011; Hussain, 2009). Mental health symptoms and disorders are talked about under the guise of superstitions and spiritual
– Methodology and cohort of participants –
The participants of this study were comprised of 8 Islamic healers in East London. Due to the ethical considerations, I was unable to approach any vulnerable individuals, and thus remained the focus on the healers. The healers were interviewed using a qualitative approach, all 8 interview transcripts were deductively coded, identifying the themes and concepts that emerged.
Key Themes: Treatment modalities implemented by the Muslim healers
In addition to the attitudes, beliefs and values of the healers, the interviews also revealed the various treatment modalities that the healer’s practice during their treatment sessions. The most commonly practiced Islamic treatments were hijama and ruqya.; other treatments involved dietary adjustments, bathing in holy water, massaging with holy oils and Qurantherapy. 6 of the 8 healers were also psychiatrists and medical professionals who incorporated elements of Cognitive Behavioral Therapy (CBT), interpersonal therapy and meditation. Each one of the spiritual healers revealed a strong passion for the implementation of religious and spiritual healing within the biomedical mental health sector. All of the healers held very personal attachments to the specific treatment modalities and believed that spiritual healing could be proved beneficial to all, regardless of whether the patient was from a Muslim background or not.
Acknowledging the nature of the healer’s treatment was important in understanding what the treatment modalities were aiming to cure. Ruqya was the most commonly practiced spiritual healing method used by the healers. One participant explained: “ruqya is the Arabic root term for progression or to make better. So ruqya is the name given to the Islamic version of talking therapy using the Quran and words of God.” This was the general consensus across all healers and Islamic practitioners. Ruqya involves reading verses from the Islamic holy book, namely, the Quran. Special verses pertaining to the patient’s symptoms are recited and then blown over the patient; this aids in warding off evil spirits and the effects of curses that have been laid on the patient, by enemies. Amongst all the healers this method of healing was thought to hold extreme benefit to people from all faiths and backgrounds. The process of reciting Quranic verses is thought to bring the soul comfort; this healing method is also used for meditating amongst Muslims; for relaxation and comfort. A participant described ruqya: “people tend to think that ruqya is some sort of exorcism, but it’s nothing of the sort, we use it as more of a talking therapy and with the aid the power of the Quran it cures all ailments, not just mental disorders, even if you’re like feeling stressed or anxious about something, listening to recitation of the Quran can bring great comfort to a person because of the special healing effects the words of God have on the soul.”
The next most common type of practice was hijama; this is the Arabic term for wet cupping. Hijama is the method by which small incisions are made on the body in the area of concern; small glass cups are then placed on the incisions, and ‘bad’ blood is removed. As the participant explains: “hijama is completely safe, while it looks a little bit bloody and scary, it is completely painless and just removes the blood which is toxic.” The participant was asked to elaborate on the explanation of ‘bad blood’: “bad blood is basically blood that contains the negative effects of Sihr [black magic], and sometimes it’s just blood that has a lot of bad toxins in it. Removing the blood; removes the harms as well.” Although hijama involves a physical extraction, the process has spiritual connotations. The practice of hijama was only performed by three of the participants. To qualify as a hijama practitioner, “you have to have a diploma in cupping therapy and also you have to have Islamic knowledge on the after care.
The aftercare involves massaging with special holy oils and bathing with holy water”. Just as the participant explained, this particular type of therapy involves the integration of both a pseudoscientific method and an Islamic method. Out of the 8 participants, only 3 were hijama practitioners. This particular practice requires more specialized training as it involves medical procedures of incisions on the skin. Ruqya and hijama are the two spiritual forms of healing performed by the healers; the other forms of therapy involved using conventional methods of psychiatric treatments but integrating Islamic elements into the treatment. Cognitive Behavioral Therapy (CBT) was used to treat depression and anxiety, however with Muslim patients the CBT would be combined with the recital of verses from the holy Quran as well as spiritual reminders pertaining to the religion of Islam. 4 participants had medical backgrounds but were no longer working in medical settings; having established non-clinical offices of their own where they work from. As these healers were ex-mental health practitioners, they were able to effectively administer the CBT as well as combine their knowledge of Islam to motivate and help the participants symptoms.
Discussion: Collaborating between two cultures of medicine – the faith and health balance
An important aspect of the interviews that were drawn on by the participants was the nexus between the various mental health issues of their clients and their battle with ensuring compatibility of their struggles with their faith. “a substantial amount of my clients suffers from depression and anxiety disorders and its really very clear to see the symptoms and how its enveloping their everyday life. But I guess the hardest part of coming across these situations is when someone feels like they have to choose between being a good Muslim and having a mental health disorder. Depression and faith? Why does it have to be mutually exclusive?”. Participants described this struggle of having to choose between faith and mental health problems as being down to misunderstanding and lack of knowledge and awareness around mental health patterns. “Particularly here in this part of East London where we’ve got a predominantly South Asian community, people don’t know mental health disorders exist, it’s like as soon as someone shows signs of being mentally ill they want to brush it under the carpet or send them here to us to find alternative explanations for their behavior.”.
The findings demonstrate how vital the need is for having more educational services in communities in East London, to address problems of mental health and reduce stigma.
Dein and Illaiee (2013) suggest that spiritual explanations such as possession of external entities are old ways of thinking, however it is an alluring observation that beliefs still in existence in modern day British society. The findings also highlight the practicality of the supernatural explanations of mental health that Islam provides. The treatment modalities, Ruqya, hijama, and Quran therapy explained by the participants, drew out an alternative method of psychological intervention that has been made to coexist alongside conventional methods of mental healthcare. Instead of the treatment of affliction lying solely in the domain of religious figures, such as the participants of this study, working in collaboration with the two fields of medicine would help to create a more accessible mental health system.
Going Forward…
Ruqya, Hijama, Quran therapy, combined with the conventional CBT and interpersonal therapies really mirrored the successful amalgamation of two different worlds of psychiatric practices brought together. Many people still separate the two understandings of psychological distress and argue that spiritual and biomedical explanations of behavior cannot coexist (Stoll et al. 1989, Harrison 1993, Dyson et al. 1997). However, this research has demonstrated that two separate understandings of mental health can be in conversation with one another and be practiced together in order to treat unexplainable behavior. Although the effectiveness of the methods was not tested, the findings found evidence of both biomedical and spiritual practices incorporated to help people overcome their problems. This is perhaps a step towards understanding different perspectives regarding our understandings of mental health in order to broaden the scope of knowledge rather than deeming one particular idea about mental health to be the only one. The increase in our understandings could naturally increase acceptance and relatability between clients and healers of all kinds. Eneborg (2013) argued that modern day society is incorporating other forms of care including spiritual healing which is becoming an increasing popular practice. This is echoed in the findings of my research which shows the role of it plays in developing our understanding of newer ways to deal with health issues.
In conclusion this dissertation has shed light on the treatment modalities that Islamic healers implement in order to treat issues that are biomedically perceived as mental health symptoms. Through delivering interpretations of behavior from the Islamic perspective, this dissertation warrants further research on explanations of behavior amongst other cultures and religions. Collaborating positively with patients of all faiths should be good clinical practice that we should aim to implement here within the British health system. Studies like this one should be conducted in more depth to fully understand the challenges with applying different beliefs in practice with biomedical methods of treating mental distress. This dissertation presents evidence of one alternative way of understanding the mental distress people are faced with however there is a wide range of translations that should be brought to light to create more open mindedness towards various methods of treatments. Britain is an increasingly multicultural society (Mustad, 2018); and this means people bring with them a wide range of ideas, practices and understandings. This dissertation has placed together two cultures of psychiatry in conversation with one another and demonstrated the ways in which these two separate fields coexist amongst spiritual Muslims healers in East London.
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