The Islamic Worldview on the Preservation and the Restoration of Mental Health

Abdul Latif Abdul Razak ABSTRACT A worldview has direct impacts on ones feeling and behavior. Ones positive feeling, for example, is normally the products of ones positive worldview and vice versa. There are many worldviews available in which some are religious, while some are irreligious or secular in nature. Some are comprehensive covering all realms of existence, while some are limited to the material world only. Since feeling and behavior are closely related to worldview, therefore a persons state of mental health strongly depends on the nature of worldview that he or she embraces. This paper aims at analyzing the significance of Islamic worldview in preserving mental health as well as in restoring its healthy state. For this purpose, the paper begins with the discourse on the weaknesses of the existing modern Western psychotherapies which are founded upon secular and materialistic worldviews. This is followed by an elaboration of the elements of the Islamic worldview that have great significance in preserving mental health and curing its illnesses. The outcome of this is the introduction of a new psychotherapeutic approach which is divinely rooted (al-rabbniyyah), characterized by comprehensiveness (al-shuml), consistency (al-thubt), certainty (al-yaqn), and suitability with the nature of man (firah) in coping with modern challenges. It is hoped that this paper which is based on the study of the Quran, Sunnah and the works of early Muslim psychologists and psychotherapists will enlighten us on the importance of religious worldview especially Islamic worldview on mental health. Keywords: mental health, Islam, worldview, psychotherapy

INTRODUCTION Worldview is simply defined as the overall perspective that from which one sees and interprets everything in this world.1 This overall perspective is indeed the manifestation or the products of ones belief or worldview. If the person is a Muslim, his worldview is therefore Islamic

worldview. He or she is supposed to see and interpret everything in this world according to Islam. Meanwhile, mental health refers to a state of emotional and psychological well-being that enables an individual to function effectively in the society. Preserving it is one of the objectives of Sharah (maqid al-shariah). Worldview and mental health is significantly related. This is best explained in A-B-C theory of personality. A is the existence of fact which is an event that
Yahoo Dictionary. Definition of worldview. Accessed Mei 11, 2011, http://education.yahoo.com/reference/dictionary/entry/worldview
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activates ones reaction. B is the belief or the worldview of the individual, while C is the emotional and behavioral consequence or reaction. The reaction can be either appropriate or inappropriate. A (the activating event) does not cause C (the emotional and behavioral consequence). Instead, B, which is the persons view about A largely, causes C. For example, if a person experiences depression after a divorce, it may not be the divorce itself that causes the depressive reaction but the persons view about being a failure, being rejected, or losing a mate. It is the view about the rejection and failure is what mainly causes the depression, not the actual event of the divorce.2 It is therefore very clear that a persons worldview has significant impacts on his or her mental health. Islam, as the religion of Truth, sent with the purpose to bring blessing (ramah) for all mankind, is imbued with theories and practices that engender mental health. Al-Quran for example, in many places condemns negative thoughts and propagates positive ones.3 Throughout this chapter, the author tries to relate the Islamic worldview with the mental health. This provides a substantive ground for the introduction of a new psychotherapeutic approach which is divinely rooted (al-rabbniyyah), characterized by comprehensiveness (al-shuml), consistency (al-thubt), certainty (al-yaqn), and suitability with the nature of man (firah) in coping with modern challenges. Sliding away from this right path (ir al-mustaqm) by engaging secular irreligious worldviews, as discussed below, will expose mankind to various harms to their mental health. Modern Western Secular Worldview on Mental Health: Causes and Treatments of Psychological Disturbances. There are many schools or perspectives of psychological therapy which have arisen in the West. Among the leading approaches are Psychoanalysis, Behaviorism, Cognitive Psychology, and Humanistic counseling. Each perspective has its own distinct worldviews and approaches with regard to the nature of man, causes of psychological problems as well as their treatments. In other words, the same psychological problem is interpreted, diagnosed, and treated differently by each school. By following a secular medical model of conceptualizing the human psyche, psychoanalysis views psychological illness as something caused by the internal conflict between opposing forces, namely id (the animalistic impulses in man), ego (the "I" or conscious part of
2

Corey, Theory and practice of counseling and psychotherapy (London: Brooks/Cole Publishing Company,1996), 323. 3 Srat Ysuf 12:87; Srat al-ijr 15:56 and Srat al-Zumar 39:53.

personality which deals with reality), and superego which is the moral structure of personality which introjects the ethical values of the parents. This is when the aggressive and sexual impulses of the id which is governed by the pleasure principle of obtaining immediate pleasure and avoiding pain, irrespective of time and place, are supposed to be constrained by the ego which, on the other hand, is governed by the reality principle of reason and common sense and the superego which abhores these animalistic impulses since it represents the conscience of man. This conflict leads to anxiety which is for psychoanalysis the main cause of psychological disorders. Conflicts mostly originate in early childhood and thus they are suppressed in the unconscious mind. Concerning treatment, the therapists somehow try to bring the repressed unconscious conflicts into consciousness so that the very cause will be clearly understood and then properly treated. Among the techniques used are free association and dream analysis.4 This beautifully constructed psychoanalytic theory about psychological disorders and their treatment is now considered as one of the greatest failures of modern psychotherapy. Repeated controlled studies comparing patients who received psychoanalytic therapy with those who received no therapy at all, failed to show any differences between the two groups.5 This led to disenchantment and psychoanalysis fell into disrepute to the extent that in many Western Universities, it is now mainly taught as history of psychology. It also failed because it downgraded the importance of thinking and the conscious responsibility of man to improve himself. By exaggerating the role of unconscious motivation, psychoanalysis deprived man of his moral responsibility and his conscious effort to repent, redeem, forgive or purify himself. So, after the demise of psychoanalysis, Western psychologists started looking for a new model to explain psychological disorders and their treatments; and soon, behaviorism was ready with its new more practical approach. It is well known that behaviorism revolves around the principles of learning and conditioning. Behavior therapists hold that the causes of maladaptive behaviors have nothing to do with unconscious motivation but are simply learned habits. Since these abnormal behaviors are learned, they can also be unlearned. Thus, as for treatment, the therapist will use extinction (the elimination of the tendency to make a response) and inhibitory processes together with positive and negative reinforcers to change these abnormal behavior patterns.
Freud, New Introductory Lectures on Psycho-analysis (London: Leonard and Virginia Woolf, 1937). Eysenck, The effects of psychotherapy: An evaluation, Journal of Consulting Psychology 16 (1952): 319-324.

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Among the techniques used are systematic desensitization and modeling. This secular theory is also unable to fill the vacuum left by psychoanalysis in explaining psychological disorders and their treatments. Since it considered man as simply an animal, different from other animals only in the type of responses he performs, it was doomed to fail in spite of its success in treating minor psychological phobic anxieties. Behaviorism severely criticized psychoanalysis as the unscientific endeavor that it was. However in trying to be scientific, it went to the other extreme by downgrading the importance of thinking.6 These "thoughts, feelings, and ideas" which

behavior therapy neglected are the core of human personality, and for the true Muslim, they are the very foundation of his belief and religious awareness. By neglecting them, behavior therapy has failed to give man real happiness and a permanent cure of his psychological problems. Cognitive psychology whose figures like Beck and Ellis believes that most of psychological disorders are resulted from irrationalities that people stored in their minds. Thus, the solution for the problems is by confronting and finally removing all those irrationalities.7 Without denying that this technique is very effective and seems to be harmonious with religion, it still cannot substantially serve as a complete remedy for human psycho-spiritual problems because of its secular and soul-free outlook of man. To this, Badri says that although this cognitive school liberated modern psychology from constricted scientific and medical models, it still limits itself only to the trio of psychological, biological and socio-cultural components of human behaviors and mental processes and ignoring the spiritual aspects.8 These few examples of the leading schools of western therapy reflect their compartmentalized views towards human nature which consequently leads toward their different perceptions on mental health. Due to their incomprehensive view and despritualizing man, they have

difficulties to provide a proper solution to man. Islamic View of Human Nature (Haqqat al-Insn)

6 7

Beck, Cognitive Therapy and the Emotional Disorders (New York: New American Library, 1976), 8.

Beck Cognitive therapy and the emotional disorders; Ellis, Fundamentals of Rational Emotive Behavior Therapy for the 1990s, in Rational Emotive Behavior Therapy, ed. Windy Dryden (London: SAGE Publications, 1995), 130. 8 Badri, Contemplation: An Islamic Psychospiritual Study (Kuala Lumpur: Medeena Books, 2000), 9.

The Islamic view of human nature is mainly based on revelation, the third source of knowledge, and not assumption. As He creates man, the Creator creates also a manual for man to know about his self and to maintain his wellness.9 As to facilitate man in understanding and practicing this manual, He sent the most perfect model to be exemplified, namely the Prophet Muhammad (PBUH). Thus, unlike any Western school of therapy whose view of human nature is based on assumptions, the Islamic view of human nature is based on the two reliable and authentic sources, namely al-Quran and Hadith of the Prophet (PBUH). These two sources describe human nature in a very optimistic way. Man is born on his essential nature created for him by God (firah). This firah makes man know that he is a rational being and having duties towards God. He is endowed with the reason (aql) by which he can distinguish between good and bad. In short, man by nature is good and having all the potentials to remain as such throughout his life. Another important point mentioned in the Quran and Hadith is that man by nature is of body (jasad) and soul (rh). The soul is the driver of the body whereas the body is created as the vehicle of the soul.10 The soul therefore is the reality of man (aqqat al-insn). The relation between the two is like a camel with its owner who uses it to arrive at his destination. Undeniably, the well being of the camel should be taken care of by him, for otherwise the camel will get sick and he will not arrive at his destination and consequently not achieve his goal. 11 Human behaviors reflect the activities of the soul. Laughing reflects that the soul is happy, and likewise weeping reflects that the soul is sad. In short, the reality of man is the soul, namely the one we used to pronounce as I. When a person says, my hand or my head, it shows that someone claims that those physical organs belong to him. That someone is the soul. Since the soul is spiritual in nature and therefore cannot be experimented, modern secular psychology has set it aside. This leads to the removal of the very essential aspect of man. Islamic psychology therefore comes to reinstate mans true nature and thus gives the correct and comprehensive conception of man. Islamic View of Psychological Disturbances Unlike any therapy which is based on secular and irreligious worldview, Islam attributes to the spiritual aspect of man a major role in causing psycho-spiritual and physiological illnesses. This
Srat al-Insn 76:3. Srat al-ijr15:26-29 & Srat al-Muminn 23:12-14. 11 Al-Ghazl, The Alchemy of Happiness, trans. C.Field (New Delhi, Kitab Bhavan, 2000), 37.
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is based on a presupposition concerning the direct relation of body, mind and spirit. Of the three, the spirit is the most central since its state can greatly influence that of the mind and the body. As an illustration, an obese person is the one who is unable to restrain his desire of eating. This means that his desire is in control of his reason. This unhealthy spiritual state leads to physical illness (obese) and psychological problems such as low self-esteem. Realizing this great

significance of spirituality, that is why the term "psycho-spiritual" is used instead of merely "psychological" as widely used in modern secular psychology and psychotherapy. Since the heart is the abode of the spiritual, these illnesses and disorders are caused by its sickness. This significance of the heart is mentioned in many places in the Holy Qur an. In some of its verses, the Quran certifies that there are diseases in the hearts of the Hypocrites, In their heart is a disease",12 "Truly if the Hypocrites, and those in whose hearts is a disease, and those who stir up sedition in the City, desist not, We shall certainly stir thee up against them".13 In

other places, Allah describes the diseased hearts as the ones which are being sealed, wrapped and locked, "Allah hath sealed their hearts; so they know not",14 that their "hearts are enwrapped",15 or that He has "set a seal on their hearts and on their hearing".16 Upon apprehending the above mentioned verses, we come to know beyond all doubt that the heart is the causation of psychospiritual illnesses. Thus, the prescribed treatment must also be something related to this spiritual entity. In relation to the heart, faith is its most effective defense mechanism and protection from all psycho-spiritual illnesses. Faith increases with the increase of knowledge of God and the fulfillment of all commands, and avoidance of all prohibitions. The illness of the heart is due to the void or dispossession of the light of faith. This is so because the outer layer of the heart is being stained and covered with the dirt and pollution of the passion (haw) and desire (nafs). The winning of the passion and desire over the reason is the starting point of mans psycho spiritual problems. This is due to the light of mn within the heart becomes weaker and weaker

Srat al-Baqarah 2: 10. Srat al-Azb 33: 60. 14 Srat al-Tawbah 9: 93. 15 Srat al-Baqarah 2: 88. 16 Srat al-Baqarah 2: 7.
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and finally loss.17 The passion and desire will conquer and control the heart and give no chance to reason to function properly. On top of that, they indeed enslave the reason for their evil interests. Man at this state as illustrated in the Quran is worse than animal.18 This constant struggle with alternate success between reason and passion takes place in the heart.19 Since the heart is the one that controls the organs of the body, authority goes to whichever of the two parties overpowers the heart. If the heart is overpowered by reason, its affairs will be good and consequently the organs of the body will function well. On the other hand, if the heart is overpowered by passion, it will be corrupted and its affairs will be incorrect, and consequently the organs will be in a state of malfunction.20 This is stated very lucidly in a well-known tradition of the Prophet (PBUH)," Beware! There is a piece of flesh in the body. If it is healthy, the whole body is healthy. If it becomes unhealthy, the whole body gets unhealthy that is the heart" (authenticated by al-Bukhari in his sa). Since the lack of mn is the major cause of these illnesses, the right and proper treatment, therefore, must be centered on restoring and increasing it.21 Preserving and Restoring Mental Health: The Comprehensiveness (shumuliyyah) of Islamic Approach Islam takes into consideration all aspects of man, be it spiritual, psychological and behavioral. This reflects its comprehensive view on man. To cater these three realms, three main components are therefore identified to be in an effective psychotherapeutic approach, namely knowledge instilment which is theoretical, and inner struggle (mujhadah) and discipline (riyah) which is practical in nature. Knowledge instilment revolves around seeking types of knowledge upon which our beliefs are founded. True and certain knowledge will therefore generate true and certain beliefs. Having these beliefs will help a person develop spiritual drives to fight against irrationalities and negative thoughts which are later, if not removed, transformed into negative
Al-Geyoushi, Al-Tirmidhi's Conception of the Areas of Interiority, The Islamic Quarterly vol.16 no.3 (1972): 175-178. 18 Srat al-Arf 7:179. 19 Al-Tirmidhi, Al-a wa al-Nafs wa al-Aql wa al-Haw, ed. Wajih Ahmad Abdullah (Cairo, Dr al-Marifah Jmiiyyah, 1991), 167. 20 Al-Geyoushi, "Al-Tirmidhi's Conception of the Struggle between Qalb and Nafs", The Islamic Quarterly vol.18. no. 3 (1974): 4. 21 Al-Ashqar, Manhaj al-Islm f Tazkiyyat al-Nafs (Amman, Dr al-Nafis,1992), 19. See also al-Baynn, AlQalb: Maknuhu, Awaluhu, Maruhu wa Shifuhu (n.p.,Dr al-Salmah, 1986), 138.
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behaviors. Those negative behaviors should be replaced gradually with positive behaviors. The last two processes are called inner struggle and discipline respectively. Knowledge Instilment The abode of faith is the heart. Any defect in faith must be due to the spiritual illness of the heart.22 The most dangerous disease that afflicts the heart is the disease of ignorance. Ignorance causes a person to have all false beliefs and confusions. Like the physical body that has weak immunity that can easily succumb to diseases, the heart with weak spiritual immunity too can be easily 'infected' and misdirected. In order to strengthen the immunity of the body, a person needs to take specific antibodies, drugs or good nourishment; for the heart, the best immunization is by instilling true and certain knowledge (yaqn). According to al-Ghazali, this principle is quite similar to the principle of treatment for bodily illnesses. The body which becomes sick when there is no balance (tawzun) of the humors may only be cured through its opposite. For example, high temperature is treated by cold water, and vice versa. So, with respect to the heart, the disease of ignorance is treated by seeking

knowledge, that of avarice by generosity, that of arrogance by humility, and that of greed by restraining oneself from the things one craves.23 Based on this principle, early Muslim scholars like al-Ghazali (1989) in Mizn al-Amal on the chapter of Mudwat al-Ghamm wa Izlat alKhawf; Miskawayh (N.d.) in Tahzb al-Akhlk on the chapter of Ilj al-uzn; al-Kindi (1978) in Rasil on the chapter of al-lah li dafi al-Ahzn; and al-Balkhi (1984) on the chapter of Tadbr Idat Sihhat al-Nafs, Tadbr Taskn al-Khawf wa al-Faz and Tadbr Daf al-uzn wa al-Jaz in Malih al-Abdn wa al-Anfus have urged people to have sufficient knowledge especially about four fundamental issues, namely God, human nature, this world, and the Hereafter. Knowledge about these four main aspects, as al-Ghazali says, is therapeutic and that ignorance is a deadly poison for the heart.24 Inner Struggle and Discipline

Al-Kalbz, Al-Taarruf li Mazhab ahl al-Taawwuf, ed. Mamd Amn al-Naww (Azhr: Maktabah alKulliyyah al-Azhriyyah,1969), 105. 23 Al-Ghazl. Iy Ulm al-Dn, vol. 3 (Beirut: Dr al-Marifah, 1982), 187. 24 al-Ghazl, "Kimy al-Sadah", in Majmt rasil al-Imm al-Ghazl, vol. 7 (Beirut: Dr al-Kutub alIlmiyyah,1994), 44.
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Besides equipping oneself with sufficient knowledge, two other important and indispensable methods are inner struggle (mujhadah) and discipline (riyah). These techniques are highly recommended by our early Muslims psychotherapists. Ibn Qayyim, for example, in his Medicine of the Prophet stated that inner struggle is an effective treatment to ward off worry and sorrow for when the soul abandons its duties and searches for dominance and mastery, its sadness, anxiety and fear grow strong. When it fights these, for the sake of God, God turns that sadness and anxiety into joy, energy and strength.25 Another early Muslim psychotherapist, al-Razi, also regards this gradual training of the soul in suppressing the passions and opposing their natural inclinations to be the most important aspect of treatment in psycho-spiritual illnesses. He then compares them to the medicines that are used to treat physical illnesses. He says that in treating the body we use medicines, however, the medicines of the soul come through inner struggle, discipline, and the refinement of the character.26 These two terms mujhadah and riyah have slightly different meanings but they are related like the two sides of the same coin. The former refers to an individual's struggle against his animalistic soul to prevent him from indulging in Islamically forbidden desires (shahwah), and the other, discipline or riyadah, refers to acquiring good habits which secure the pleasure of God.27 These methods are very effective in treating the root causes of psychological disorders which are mostly, as already stated, due to the illness of the soul or heart. It is interesting to point out that healing by the opposite or as is termed today, reciprocal inhibition, is in fact the essence of inner struggle. It is to wean the soul from its habits and compel it to oppose its passions at all times.28 In order to understand this statement, we have to understand the nature and reality of the soul. A healthy soul is the soul which is in a state of balance (tawzun). By the state of balance here, we mean a balanced state of the functioning of the faculties of the soul, namely the faculty of desire (al-quwwah al-shahwniyyah), the faculty of anger (al-quwwah al-ghaabiyyah) and the reason (aql). To be balanced, all these faculties must be in a correct proportion to each other, in which the passion and desire submit to the reason.
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Ibn Qayyim, Medicine of the Prophet (United Kingdom: The Islamic Texts Society, 1998), 151. Al-Razi, ibb al-Run, trans. Arberry, The Spiritual Physick of Rhazes (London: John Murray, 1950), 22. 27 Al-Ghazl. Iy ulm al-Dn, 68. 28 Al-Qushairi, Al-Rislah al-Qushayriyyah f Ilm al-Taawwuf (Beirut, Dr al-Kitb al-Arab, n.d.), trans. B. R. Von Schlegell, Principles of Sufism (Berkley: Mizn Press, 1990), 99.

The soul which is in this state will produce good characters such as generosity, patience, love of knowledge, wisdom and many others. All these qualities are the necessary elements in the treatments of psychological disorders. Generosity prevents from the excessive love of wealth and material possessions. This excessive love causes a person to have constant anxiety of the possibility of losing his property. Patience prevents a person from being afflicted with excessive anger and severe depression. Without these two maladaptive emotional reactions, the person will be able to have proper and rational thinking and tranquil emotionality. He will not be enslaved by negative and irrational thoughts. Love of knowledge and wisdom is ultimately necessary because ignorance, as we have already stated, is the true underlying cause of most psychological disorders. On the other hand, the soul which is not in a state of balance will produce blameworthy characters such as greed and excessive love of wealth, impatience, anger, less interest to acquire knowledge and wisdom. All these qualities bring about anxiety and other psycho-spiritual illnesses. Therefore, in order to get rid of them, this equilibrium must be maintained. In order to maintain it, one has to constrain the soul from being led by its base desires. This principle, according to al-Ghazali, is quite similar to the principle of treatment for bodily illness. The body which becomes sick due to lack of the equilibrium of the humors may only be cured through the opposite. If it proceeds, for example, from heat then the treatment should be with something cool, and vice versa. So, with respect to the soul, the disease of ignorance (jahl) is treated by learning (taallum), that of avarice by generosity, and that of impatience by forcibly restraining oneself from quick and immature thinking.29 The soul by nature is inclined towards worldly enjoyment and pleasure. It utilizes any possible means including trickery or deception in order to achieve this purpose. If it is left in such a condition for a long time, it will become blind and deaf with respect to good deeds and spiritual attachment to Allah. It will be in love with the world. This love for the world makes the soul blind to the next world. This is what the Prophet (P.B.U.H) means when he says, Your love for something will make you blind and deaf to others.30 In order to treat excessive love of the world and to get out from this blindness and deafness, one has no choice other than fighting the

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Al-Ghazl. Iy ulm al-Dn, 187. Dawd, Sunan Ab Dawd (Riyadh: Maktabah al-Makkiyyah, 1998.), no. 127.

whims and desires of one's soul because, as Ibn Qayyim describes, desire is the greatest of its illnesses, and opposing this is the strongest of its remedies.31 Thus to accomplish this task, it requires a person to endure the unending struggle against one's passion and desire until he gains mastery over them. The mastery of intellect upon the desire will keep Satan which is the source of evil obsessions away from the heart. In this state, Satan will lose its sustenance, that is, passion and desire. Without them, Satan will have no place of attraction in human psyche. A good analogy concerning this matter is like a house that becomes the aim of a thief because of what it has. However, if it has nothing attractive to the thief, he will leave it. Allah says in the Holy Quran, "As for My servants, no authority shalt thou (Satans) have over them".32 In due course, the patient needs to discipline his soul towards acquiring good habits which secure the pleasure of God. This gradual process of cultivating good traits and to make an established habit is what is known as self-discipline or riyat al-nafs. The word "riyah" is derived from an Arabic word "rawaa" which has the meaning of "to tame, to train, and to domesticate" in a way which generates docility, tractability, and gentleness.33 The soul, as we have mentioned before, is accustomed to enjoyment and desire. It has to be tamed and trained by cutting it off from its customs and replacing them with good traits. Therefore, we may say that discipline simply means the process by which the soul is gradually trained to cultivate good traits. A stingy patient, for example, in his struggle against his A hot-tempered patient, in his

excessive love of wealth, has to train himself to pay charity.

fighting against his aggressiveness, has to discipline himself with the opposite behavior such as tolerance and forgiveness. A person who is too obsessed with this worldly life and forgets God has to train and discipline himself with ibdah (acts of service to God) and zikr Allh (remembrance of God) that will bring him nearer to God. It is clear therefore that inner struggle and discipline are not only necessary but also very effective in changing one's blameworthy behaviors to the praiseworthy ones. Applications of the Elements of Islamic Worldview in the Treatments of Mental Disorders
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Ibn Qayyim, Medicine of the Prophet, 151. Srat al-Isr, 17:65 33 Al-Manzur, Lisn al-Arab, vol.7 (Beirut: Dr Iy al-Turth al-Arabi, 1997), 154.

1. Cognitive Methods: Disputing Irrational Belief To give an effective help to their patients, therapists need to make use of those four aspects of knowledge, namely the knowledge about the nature of God, man, this and the next world in diagnosing and treating their clients. Examining the thought processes of patients and correcting their negative and pessimistic thoughts are what we refer to today as cognitive psychotherapy. When it is based on religious and spiritual aspects, it will be cognitive psycho-spiritual therapy. As an illustration of the significance of this knowledge in the treatment, we may have a look at problems that underlie a suicidal attempt which is often triggered by unbearable severe anxiety, depression and stress. According to a survey, the majority of reported reasons for suicidal attempt are the feeling of hopelessness which is the result of high anxiety and depression. The patient appears to have a particular disposition to over-estimate the magnitude of the insolubility of his or her problems. Thus small problems are perceived as big and big problems are

overwhelming. Furthermore, these individuals show an incredible lack of confidence in their own resources for problem solving. As a result, they tend to project a picture of doom into the future. Beck, Rush, Shaw, Brian and Gary say that they exhibit the cardinal features of the Cognitive Triad, namely an exaggerated negative view of the outside world, themselves and the future. This would finally lead them to hopelessness and suicide.34 It is worth noting that those negative trio concerns the nature of man, the world and the future. This is indeed what our early Muslim therapists were discussing, only adding the fourth fact or about the Hereafter that Beck and friends as secular therapists naturally refuse to accept. Thus, a psychotherapist should demonstrate and explain to his patients the fallacy of their beliefs. He then should correct these false beliefs and irrational reasoning. If the case that sparks anxiety is the lost of a job or the death of the family's breadwinner, they should be told about the reality of this life that all beginning has its end, and all existences except al-Mighty God are subject to perish.35 It is irrational to expect the eternity of the non-eternal.36 They have to be always

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Beck, Rush, Shaw, Brian and Gary, Cognitive Therapy of Depression (New York: The Guilford Press, 1979), 11. Srat al-Qaa 28:88. 36 Ifahn, Al-Dharah il Makrim al-Sharah, (Egypt: Dar al-Waf, 1987), 333. See also Miskawayh, Tahdhb al-Akhlq wa ahr al-Arq (Beirut: Dar al-Maktabat al-Hayh, n.d.), 193.

reminded about themselves, namely who are they; what is their purpose of life; and where do they come from and where they are going? Their knowledge of these fundamental issues gives them meaning and purpose of their worldly lives which is to serve God and be obedient to Him or at least to accept the problems of life with an optimistic approach. Having meaning and purpose in life and engaging oneself with the realization of this meaning and purpose will save oneself from existential anxiety and frustration. A psychotherapist should also explain to his patient about the true nature of God and that He is always available, Omnipotence, Oft-forgiving, and Most Merciful. He also knows best what is good for his servants (Quran, 2:216), and that anything that happens is nothing but a Divine decree (Qa and Qadar) of Allah.37 Having true knowledge and right conception of God brings about security and safety, peace of mind and positive thoughts. All these are qualities that a person with severe anxiety disorders does not have. Security is gained through the conviction that he is not alone, even at those times when he feels temporarily separated from other people. The feeling of safety increases as he comes to believe that there is a source that he can always turns to in times difficulty, and that there is no difficulty, however great, that cannot be resolved through the help of God. This feeling of a deep, abiding sense of security and safety leads to peace of mind.38 This peace of mind is increasingly felt when all misfortunes that incur are seen and understood as a test to his faith and patience.39 By knowledge, one can produce and nourish healthy thoughts as an emergency aid for unexpected emotional outburst. After having the knowledge, one is able to give all the right and proper answers and solutions to the problems he faces in life. This knowledge will bestow him with the ability to think rationally and positively, eliminating the irrational and negative thoughts that cause emotional disorder. His reason will be able to analyze and test any incoming

thoughts. It is comparable to the conscientious and well-trained security guard who allows no one to trespass without proper and conscientious scrutiny. Any detected negative thought which is indeed the cause of anxiety and other psycho-spiritual diseases will be negated while the positive ones will be welcomed. Such healthy thoughts and cognitions, according to al-Balkhi,

Srat al-add 57:22-23. Bourne, The Anxiety and Phobia Workbook (Oakland: New Harbinger Publications, Inc., 1997), 384. 39 Srat al-Baqarah 2:155; and Srat Muammad 47:31.
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should be initiated and stored in the memory when a person is in a tranquil and relaxed condition.40 A person should therefore nourish himself with knowledge and good deeds to prevent from the problem of longing for this world, and not to detest leaving it as the baby who leaves his mother's womb crying in anxiety.41 These are some examples on how the true knowledge and conceptions of those four fundamental issues can help a person to get rid of anxiety disorders. With this knowledge as part of their expertise, therapists have rich resources to carry out effective psycho-spiritual therapy. What they use in their cognitive healings is the Truth that patients have faith in, and not merely superficial conjecture. Besides providing the patient with this knowledge, the first phase of psychotherapeutic process, the treatment will be more effective if the patient proceeds to the second phase which is inner struggle and discipline. 2. Behavioral Techniques: The practitioners use most of the regular behavior-therapy procedures, especially relaxation techniques and modeling. 2.1 The Application of Tawd in Relaxation techniques 2.1.1. Prayer (alh) Prayer, a true reflection of Tawd Ulhiyyah, offers a lot of physical and spiritual benefits that are essential in preventing or treating emotional disturbances. The Holy Quran , in short verses, clearly describes the behavior of the unbeliever who does not offer his daily prayers as one who is always anxious, fretful when faced with problems and grudging when good things happen to him. Those who worship, as Allah says, are saved from these neurotic symptoms. The

translation of these verses runs as follows: "Truly man was created very anxious, fretful when evil befalleth him, and when good befalleth him, grudging; except those who are devoted and remain steadfast to their prayer".42

Al-Balkh, Mali al-Abdn wa al-Anfus (Frankfurt: Institute for the History and Arabic-Islamic Science, 1984), 342. 41 Isfahani, Dharah ila Makrim al-Sharah, 336. 42 Srat al-Marij 70:19-23.
40

Prayer is indeed a comprehensive set of exercises and techniques that unites the three aspects of man, namely his physical, spiritual and psychological aspects. Before praying, one has to ensure that his physical body is clean by performing ablution (wu). Using clean and cold water to wash is able to refresh one's body and cool down his emotion. This is the reason why the Prophet (P.B.U.H) advises those whose emotions are overwhelmed with anger to perform ablution.43 Besides bodily cleanliness, clothes and the place of prayer must also be clean. As a matter of fact, cleanliness contributes to tranquility and peace of mind. Prayer begins with intention (niyyah) that cuts the person from bothering with worldly affairs and problems. It is as if saying "stop" to chain of thoughts that keep penetrating and bothering one's mind. Although we know that it is artificial to equate prayer with any modern Western technique of treatment, this, in a way, reminds us of a technique used by rational emotive therapists known as thought-stopping in which the patient interrupts an undesirable thought process by the simple expedient of yelling "Stop!".44 Intention is then followed by the recitation of al-Ftiah, a verse that contains a lot of remedies to the heart. This verse which is recited at least seventeen times per day functions as an important and continuous reminder for Muslims. It reminds us of the Mercifulness, Compassionate and the Omnipotence of Allah, to our purpose and duty, and to the fact that we have a Higher Source of help, support and guidance. All these elements, as was mentioned, give security and safety, peace of mind, self-confidence and meaning of life. The physical positions in prayers have also some significance in the treatment of anxiety. While praying, one is asked to stand still in a relaxed mode while the mind is in full concentration on what we recite. This relaxed physical state will also cause the psyche and inner emotions of the person to be in a relaxed state. This is due to, as already mentioned, the intertwinement and interaction between physical body and the inner aspects of man. Ibn Qayyim in his Medicine of the Prophet has summarized these benefits of prayer saying that it has an exceedingly important place in giving joy and strength to the heart, so that it expands, rejoices and has pleasure. For it contains the capacity to let the heart and the spirit come near to God and approach Him, to take delight in remembering Him, to rejoice in having intimate dialogue with Him, to stand in His

43 44

Dawd, Sunan Ab Dawd, vol.5, 269. Reber, The Penguin Dictionary of Psychology (England: Penguin Books,1985), 773.

presence, to use the whole body and its powers and faculties in His worship, to let every limb share therein, and stay free from any attachment to created beings or involvement, or converse with them, to allow the powers of his heart and limbs to be attracted to His Lord and Creator, and rest from his enemy at the time of prayer. All these can be among the greatest of remedies and causes of joy, and the foods which are suitable only for sound hearts.45 With these physical and psycho-spiritual relaxational benefits that prayer can offer, it is no wonder why the Holy Quran and the Sunnah highly urge Muslims to resort to prayer when they encounter problems in their lives. Allah says: "Nay, seek (Allah's) help with patient

perseverance and prayer." The Prophet (P.B.U.H) was said to have recourse to prayer when he (P.B.U.H) met with problems that bothered his mind. In a narration, Abu Huzaifah says," When the prophet (P.B.U.H) faced a difficulty, he prayed".46 It is also reported that the Prophet (P.B.U.H) used to say to Bilal, "O Bilal, let us relax by prayer". 47 In this statement, the Prophet (P.B.U.H) ordered Bilal to call for prayer so that they spiritually rejoice and relax by performing it. It is worth to recall that our early Muslim scholars like al-Ghazali (450-505 A.H.), alMuhasibi (165-243 A.H.) and al-Hakim al-Tirmidhi (d. 225 A.H.) had also recourse exclusively to prayer when they were overcome by perplexities that caused them much anxiety. They clearly stated that prayer provided them with relief and tranquility. 2.1.2. Supplication (Du) Like alh, du is also a true reflection of the application of Tawd. It is a direct

communication between a servant and his Creator, the Owner of the glorious Names and Attributes (al-Asm wa al-ift). This means that a person can voice out his problems and hopes to Him without any intermediary. Voicing out ones problems, as already mentioned, brings relief, what is more when it is done before the Most Omnipotent and the Most Compassionate Who has promised that He always accepts the du of His servants, And your Lord says: Call on Me, I will answer your prayer. In another verse, He the Most High Says, And when My servants question thee concerning Me, then surely I am near. I answer the prayer

45 46

Qayyim, Medicine of the Prophet, p.155. Dawd, Sunan Ab Dawd, vol. 2, 1319 47 Hanbal, Musnad al-Imm Ahmad bin Hanbal, vol. 5 (N.p: Dar al-Fikr, n.d.), 364.

of the supplicant when he calls unto Me.48 The Prophet (P.B.U.H) has taught many supplications that could be used by Muslims in treating their anxiety disorders. In the Musnad of Imam Ahmad, as authenticated by Ibn Masud, the Prophet (P.B.U.H) says If ever a servant is afflicted with anxiety or grief and he recites: "O my God, I am Your servant, the son of Your servant and of Your maidservant, my forelock is in Your hand; Your judgment is carried out with me, Your decree regarding me is just. I ask You by every Name which is Yours, whereby You have named Yourself or which You have revealed in Your book or taught to any one of Your creation, or have exclusively kept in the knowledge of the unseen with You -- that You would make the mighty Quran the pasture of my heart, the light of my breast, the cleanser of my grief and the dispeller of my anxiety -- then indeed God disperses his grief and anxiety and gives in its place joy.49 Ibn Qayyim al-Jawziyyah in his Medicine of the Prophet, went on analyzing the "formulation" of these hadith to know what they contain that are strong enough to disperse the disease of worry, anxiety and grief. He finally found that these hadith contain fifteen types of healing properties which are among others: acknowledging the unity of Lordship (tawd rubbiyyah); the unity of Worship (tawd ulhiyyah), declaration that the Lord Most High is free from any unjust treatment of His servant and would never punish him without due cause on the part of the servant to deserve this; admission by the servant that he is the wrong doer; seeking access to the Lord Most High through what is most dear to Him, that is, through His Names and Attributes; seeking help from Him alone; affirmation of the servant's hope in Him; affirmation of confident trust in Him, and entrustment of all to Him; seeking forgiveness and repentance; striving; and disclaiming all power and strength, and leaving them in the hand of the One to whom they belong by right.50 It is amazing to find that these healing properties are wonderfully formulated in this short hadith like a tiny pill that contains multiple types of medicine. 2.2 Modeling the Prophet (Ittib al-Sunnah) Another technique that seems to be very effective in treating psychological disorders is what modern psychology calls modeling. It is a procedure through which new responses are acquired,
Srat al-Baqrah 2:186 Hanbal, Musnad, vol. 1, 391. 50 Qayyim, Medicine of the Prophet, p. 149.
48 49

reinforced or extinguished at a distance through observing the behaviors of others. As a technique, it involves exposing the client to one or more individuals who demonstrate behaviors that the client wishes to adopt in reality or in a symbolic and imagined manner. For example, a woman who has a phobia of rats is presented with models, such as other women who behave towards rats in a relaxed and appropriate manner. In this case, the model encourages the client to adopt behaviors that he previously avoided because of fear or anxiety and thus promote the extinction of maladaptive emotional reactions associated with the fearful objects. Modeling in Islam is something central and important. It is because Islam is a religion personified in the life of the Prophet Muhammad (P.B.U.H). So, in order to be a good Muslim, one has to emulate the Prophet (P.B.U.H) in all aspects of his life. With regard to treatment of anxiety, early Muslim scholars have considered it as one of the most effective techniques. 51 In most cases, however, modeling procedures are involved with the covert or cognitive mediated modeling in which the client was asked to imagine himself in the role of the model showing the good behavior. CONCLUSION In conclusion, this overall perspective of mental health is the true reflection of the Islamic worldview. It is a view which is divinely rooted (al-rabbniyyah), characterized by comprehensiveness (al-shuml), consistency (al-thubt), certainty (al-yaqn), and suitability with the nature of man (firah). It is characterized as comprehensive since it integrates cognitive, emotive, spiritual and behavioral approaches. It is divine in nature because its view about man is derived from revelation. Since man is the creation of Allah, therefore His words and the words of His Messenger are the most valid and reliable explanation about man. It is a knowledge that is based on certainty (yaqn) and not assumption. It is no wonder that lately many secular

psychologists and psychotherapists have started to adopt parts of religious teachings and practices into their psychotherapeutic practices. They know that by totally rejecting religion and spirituality, they would not be able to provide a good and effective cure to their patients. In their eagerness to "spiritualize" their psychotherapeutic practices, they benefit from other religions and traditions, namely Islam, Christianity, Hinduism and Buddhism.

51

Al-Balkh, Mali al-Abdn wa al-Anfus, 308; See also Al-Ghazl, Iy ulm al-Dn, vol. 3, 329.

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