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Case Study: A Muslim experience of OCD

Dr Yusuf presents a case study of providing support for a Muslim who was experiencing scrupulosity OCD
Let’s take a look at a case study now. So I will tell you the case of a young man, K, who came to me for some help with a scrupulosity OCD. He was based in another city and he came to me in a very high level of stress and agitation. He had had, he’d been diagnosed with OCD, and he had had about ten months of counselling as well as medication. The intensity of his symptoms and his distress had dropped in all of that time from nine out of ten to eight out of ten that he had measured subjectively.
So we’ve got the history, this is what we were talking about before, a paralysis around prayers and and worship, a deep sense of guilt relating to that, a sense that he maybe had committed disbelief because of the types of thoughts that he was getting and so forth. Now he had had an intervention that was holistic in the sense that it was bio psycho social. He was assessed. He was put on medication. He was referred to counselling. All the types of things that we would expect to be done. But he was still very distressed. Why? Because he considered the religious aspects of what he was going through to be different to any mental health concerns that he might have had.
He felt that his religious belief was seen as problematic by the therapist, although the therapists themselves never necessarily said anything about that, but he thought that the therapist would say, Well, why don’t you just stop praying? If this is causing you so much Distress, just stop doing it In the same way that if the obsessionality had been about playing football, a therapist might have said to him, Well just stop playing football.
He felt equally that the therapist’s suggestions or interventions as related to his acts of worship were not qualified and even intrusive. What do you know if the therapist said, Well, you don’t need to wash so much, you don’t need to pray as much as you do. He would think to himself, Well, what do you know, you’re not a Muslim person, you don’t understand the importance of these things in my faith. He also took medication intermittently. Why? Because he saw this as a spiritual issue or a matter of faith. He saw it as waswasa. And because he saw it as that, he found it very difficult then to conceptualise it as a mental disorder as well.
Equally, though, he had gone to an imam because it was a religious problem and the imam had given him the types of advice that I mentioned earlier on, but then became frustrated with him because that person was not able to take simple advice on board. Why not? Because the imam did not recognise that this was a mental disorder. If you go back to that triangle of OCD, there is a thought that provokes anxiety, there’s an action you take to reduce the anxiety, and that should be the end of it. But the disorder bit is the completion of the triangle. The compulsion does not reduce the anxiety or prevent it coming back again.
So what you have here is the patient and the therapist unable to move forward in terms of the religious aspects of the condition. And the imam and the patient unable to move forward because of the mental health aspects of the condition. In the middle of all this, you have the patient who is left feeling extremely guilty, feeling like they are doomed, like they are going to hell feeling isolated, feeling helpless. After ten months of this, this patient comes to me. And they said, I want, I want to ask you one question. I said, what? They said, is this a mental health problem or is it a spiritual problem? And I said, the problem with your question is the word ‘or’.
Why does it have to be either a mental health disorder or a spiritual problem? Why can’t it be both? Why can’t it be both together. And that was the point that he made a realisation, K made the realization that something could be both a mental health disorder that was having an impact on his spirituality, as well as a spiritual problem that was having an impact on his mental health. And the bringing of those two together into the same domain was what then allowed that person’s recovery to begin. In this person’s case he dealt with myself, so I am both a psychiatrist and an Islamic scholar. Obviously, that’s quite a rare combination.
But this would be equally replaced with the idea of an integrated MDT where you have as you would have a psychologist, a psychiatrist, a nurse and a social worker sitting around one table discussing a case. Similarly, you include an imam or a religious scholar in that and you would have this integrated MDT. What you have now is the history that can be taken with the recognition of the religious basis of the issue. The therapist recognising the importance of the concern that the person has about their religion and spirituality, they can demonstrate that to the patient, whilst at the same time not making what might be seen as overly intrusive or, or unqualified forays into the religious aspect.
But rather, they are able to signpost this person to a spiritual therapy, or a spiritual intervention that is part of the MDT. Similarly, the imam recognises the mental health part of the issue, takes this into consideration. The patient gets joined up care. They feel understood. They feel supported. They get appropriate expert support from those who are recognised as experts in their own individual fields. You get psychotherapy from the psychotherapist. You get spiritual support from the spiritual specialist. You get medication support from the medic. They’re not left now feeling guilty, alone and helpless. In this person’s case, we were able to do that in one setting, one session.
And in one session, that person’s levels of anxiety, self-reported anxiety, measured again two weeks after that session, had reduced from eight out of ten to two out of ten. I followed this patient up for about a year or 18 months after that, and and using the techniques that we had described the RIDA that we will describe later on, this patient was able to maintain that remission from the OCD scrupulosity for fully 18 months up to the present day. This is a good example of how bringing all of these aspects together can really make an enormous difference to a client.
Similarly, I’ve had patients who’ve got the spiritual stuff, got the therapy, but the thing that’s really made the difference is the medication. And equally, there are patients who have had the medication and the spiritual therapy, and the thing that’s really made the difference is the systematic psychotherapy. What we’re looking for here is a joined up approach, Bio, psycho, socio, spiritual.

In this video, Dr Yusuf presents a case study of providing support for a Muslim who was experiencing scrupulosity OCD.

The person in the case study had previously received mental health support that was informed by the bio-psycho-social approach, receiving both talking therapy and medication. However, he felt that this treatment plan had not addressed his spiritual and religious concerns, experiencing the non-Muslim practitioners support as intrusive and not sufficiently informed about Islam to provide advice and guidance. He had also sought support from an imam, but because the imam had not received sufficient training around recognising OCD as a mental health problem that may require medical intervention, his advice was insufficient to address the problem.

Dr Yusuf explained the person’s OCD to him as both a mental health problem that impacted on his spirituality, and as a spiritual problem that impacted on his mental health. Dr Yusuf provided religious guidance on the spiritual aspects of the problem, and healthcare support for the mental health problem (or disorder). The outcome of Dr Yusuf’s intervention meant that the person’s self-reported anxiety reduced from eight out of ten, to two out of ten after two weeks, and he maintained this reduced level of anxiety thereafter.

As a psychiatrist and an Islamic scholar, Dr Yusuf was able to provide both mental health support and spiritual support to this person. He suggests that an integrated multi-disciplinary team (MDT), that includes an imam or religious scholar alongside mainstream (e.g. NHS) health and social care practitioners, might also be an effective solution to providing mental health support from a bio-psycho-social-spiritual framework.

Over to you

Do you make use of multi-disciplinary teams, or consult other specialists more informally, in the mental health support you provide?

  • If you are a religious practitioner (e.g. imam or chaplain), how would (or do) you feel about working with mainstream mental health care practitioners?
  • If you are a mainstream practitioner, how would (or do) you feel about working with a religious practitioner?

Share your responses to this question below.

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Understanding Mental Health in Muslim Communities

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