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Contrasting Islamic and Western Frameworks of Mental Health

Dr Yusuf draws out the differences between Western and Islamic conceptualisations of mental health
In this section what we’re going to be taking a look at are some of the concepts that underlie the Western or modern approach to mental health and illness and Islamic frameworks and approaches to mental health and illness. So this section will be going a little bit deeper under the surface, taking a peek under the hood, if you like, The Western approach or the modern Western approach to mental health. There are, of course, a variety of approaches you can take, but all of them are focused on the idea of man understood as an individual. They are based on modern understandings of human physiology, neurology and so forth.
But they all tend to be fundamentally premised or based on what you might call a post enlightenment sense of what the human is. That is to say, the human as mind. It’s at this point that these approaches tend to lose people of faith who can’t really connect to this underlying premise, that the human being is understood in isolation from the divine or from God. Now, the advantages of the framework is that you have well-developed models. They are evidence based, and they’re well-supported by research and by practice. They are also systematic. They are easily available. They are well tied into mainstream services. And critically, they are quality controlled. So the people that deliver those therapies have have education.
They have been assessed and they continue to be monitored and supervised. It also of course, fits in well to other health services, particularly in the UK, where everything is tied into the NHS. So if there is a physical health condition that is underlying a mental health problem, it’s very easy to get referred in to deal with those issues.
These are great advantages but there are also some disadvantages. The first of them is that the understanding of mental health from this perspective, this what we’re calling a Western perspective, tends to be individual centred. A lot of the people that we are dealing with, however, see themselves very much as an individual in a mesh or in a web of relationships. Not just horizontal relationships, i.e. family, friends and so forth, but also what you might call vertical relationships. The relationship to God, the relationship to the hereafter, or what is to come after death. So the individual, and the individual now centred understanding often loses people. Similarly, these approaches have been criticised for being quite Eurocentric.
Every time there is a classification, a new update to the classification of mental health problems, this issue arises that the way in which we understand mental health problems, depression as separate from anxiety, as separate from psychosis and so forth, is framed in a particular way that has come about in 18th and 19th century Europe, that doesn’t really reflect the way in which mental health problems and issues have been experienced by those who have come before or in other cultures. We’ve spoken in a previous session about Aby Zayd al-Balkhi and how he described mood disorders, anxiety disorders and so forth. But what he says is that the root of everything is anxiety. An absence of tranquility.
And it is from that there all of these other conditions arise. So in subcontinent, for example, what is the difference between depression and anxiety? There isn’t really one there considered to be much the same thing. That’s not very well recognized in the way these conditions are classified in this Western framework. Another disadvantage is that there is a focus on behavioural change or symptom reduction which tends to be quite a surface level of understanding, of understanding the condition.
This perspective also doesn’t really take religious perspectives into consideration. Hence, the bio psycho social model needs to include the bio psycho social spiritual element as well. So these are some of the advantages and disadvantages of this Western framework to mental health. So what is an Islamic framework of understanding mental health and mental illness in that sense? In that case, so there are also a variety of approaches here. However, these tend to be focused on man qua god as opposed to man qua man. It is the human understood in the context of their relationship with the divine, which is an all-embracing relationship hip that impacts on virtually everything that you understand and perceive.
The approaches are also all based on certain scriptural understandings and a religious metaphysic that for a Muslim client will feel like an intuitively closer fit Although it may not differ that much in practice, it may also invoke models of physical health, classical approaches like the idea of the temperaments, the idea that there are certain temperaments or personality types that have certain psychological implications but also physical implications or physiological implications as well. Now, some of these may not be widely accepted or may have been superseded in modern times, but as a doctor, it’s interesting how these concepts, these holistic concepts, ebb and flow, both in medicine itself as well as in psychiatry and psychology.
So what are the advantages of this framework, an Islamic framework of mental health? Well, the first advantage is that for a Muslim client, it is intuitively familiar. It factors in faith, at whatever level they’re comfortable doing so, but they feel comfortable in that framework, whereas they might feel slightly disconnected from a Western modern framework because it doesn’t speak to everything about them. But there are, of course, disadvantages as well. The most important one of the disadvantages is that these frameworks and systems are not systematically available. There are wide variations in terms of approach. There are even wider variations in terms of the quality of care that you might receive.
There isn’t really a quality assurance process, and there’s a clear need for training where this is concerned. That is to say, whereas if a Muslim client goes into a Western framework, they are going to get almost always a standard of professional care. When a Muslim client goes into an Islamic framework, they’re going to get enthusiastic amateurs, most of the time. So there’s a real need to upskill and to establish quality assurance frameworks. Because of that, an Islamic approach to mental health in the real world and in the modern time may actually cause more harm than good. It may be heavy handed. It may lay on the religious stuff a bit thick. It may worsen feelings of guilt.
It may worsen ideas that you have been disconnected from God. All of these may very well occur at the hands of an inexperienced practitioner. Air quotes being important here and hence the need for a, and this is something is being worked on at the moment and some of my other colleagues who speak on this course will talk about this and may have done already, the need for training and for supervision and quality assurance in exactly the same way as you find in the Western frameworks.

In this step, Dr Yusuf draws out the differences between Western and Islamic conceptualisations of mental health, outlining the advantages and some disadvantages of each approach when supporting Muslims with mental health problems.

The core difference between the two conceptualisatons is that people who practice a religion, or who hold other spiritual beliefs, do not see themselves in isolation from God or a Divine presence (vertical relationship), and their religious or spiritual community (horizontal relationships). In contrast, the Western model of mental health is individual-centred and can be seen as Eurocentric (focusing on European culture to the exclusion of a wider view of the world).

Dr Yusuf suggests that an approach that recognises how Muslims might understand themselves, and their experiences, in the context of their relationship with God (man-qua-God) might be more appropriate.

The Western (or mainstream) model of mental health is supported by a well-developed evidence base, which is grounded in decades of research and practice. The mainstream model is systematic, easily available, tied into mainstream health service provision and, importantly, quality controlled with established systems of training and supervision.

Mental health support from an Islamic framework is not systematically available in Britain and variations in approach and quality of support can affect the standard of professional care. Systems of training and quality assurance for practitioners who provide mental health support from an Islamic framework are currently in a developmental phase in Britain.

Over to you

You may work primarily as a religious or mainstream practitioner. Think of a question you would like to ask a practitioner who works from an alternative perspective. Your question might be around systems of supervision or training, or how others overcome barriers or constraints.

For example, if you are an imam, what more would you like to know about ways of working in mainstream mental health support? Or, if you are a mental health nurse, what would you ask someone who provides mental health support in a religious setting?

Share your question below. Look at others’ questions and see if you can have a go at answering any.

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Understanding Mental Health in Muslim Communities

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