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Islamically informed mental health support

Islamically informed mental health support
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Previously I was working for a small mental health charity that only work those from minority communities. My work was at that time primarily with women. So there was a young girl who was age 13 and she was referred to the charity that I was working form, via the school. All the school had said was that she is experiencing strange symptoms, OCD like symptoms, but they’re not really sure what is or why. And the girl herself, she actually requested she felt like she didn’t really connect well with school counsellors. She felt like people don’t really understand her faith, didn’t understand her culture. And she needed someone to talk to.
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She knew she needed help, but she didn’t know what kind of help she wanted. And even when she was referred to me, it took me a while to actually engage with her in terms of she wasn’t answering the phone. I couldn’t get hold of her parents for kind of arranging appointments. So I was like, you clearly need help reading previous case notes and you’ve asked for help. So I know there’s something there that’s causing you distress and I want to try and help. And what transpired is that young girl, only 13 bless her, living in a large family extended family.
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So she had her grandparents living there, her parents and quite a few siblings Her mum at the time I believe was actually pregnant as well. So that was the whole thing going on with that time. She was the eldest so having to almost take on that role of looking after everybody else while she was going through her own thing. And primarily, and her main concern was that whenever she was performing ablution, wudu, she would spend around 20 minutes, 30 minutes, just performing wudu and bathing time was sometimes hours because she had this constant fear that she wasn’t clean. She had a constant fear that her prayers weren’t accepted.
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And she also had this constant fear that whatever she was doing wasn’t good enough almost. And it did take a little bit of unpicking and a little bit of understanding of firstly, why are you doing this? And was a bit hard because she just couldn’t explain it herself, she just wasn’t sure what was going on. She said, this is happening, it’s stressing me out, my skin really dry. You know, essentially there were scabs all over her arms at one point as well because of what was going on, especially in the winter, because she’s constantly doing it and things like that. And it was like, well what is it that’s going on? What is it that’s happening?
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And it did take a bit of rapport building initially. And I think she was a little bit apprehensive initially because obviously I wear hijab and I’m Muslim. And she said I do want you but then are you going to judge me? I said, I’ve heard many stories. I’ve been working here for seven years. I’ve got carers experience, my own family members have experienced psychosis, mental health distress, so I’ve cared for them since I was 13. Trust me, I’ve pretty much heard it all. You’re not going to shock me. And there were a few elements that were causing her distress. Her OCD was rooted in some childhood sexual trauma and sexual abuse that ad occurred.
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And she had disclosed this to her family members, but it was it wasn’t really dealt with. What I mean by that is it was kind of brushed under the carpet, for lack of a better term. And she wasn’t taken seriously, she wasn’t protected, and she felt like she wasn’t protected. So what that did was leave her with feelings of guilt it left her with feelings of dishonour, of dirtiness and uncleanliness, Not only because in her mind she’d engaged in the sexual activity, which obviously she hadn’t because she was a child. She wasn’t able to consent in any way, shape or form.
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And it was also that thing of I’ve engaged in this before marriage and when she’d disclosed this and obviously what the perpetrator had actually spoken to her about was, it’s you’re fault and God’s going to punish you, Firstly you’ve going to be punished in the world but you’re also going to be punished in the hereafter. And obviously it was a way of essentially keeping her quiet and not allowing her to speak about it outside of the family almost.
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So then she had this deep-rooted fear of actually, I’m going to be punished constantly. I’m going to be judged. I’m going to be constantly in a state of impurity. And for a 13 year old girl, for anyone, but especially for a 13 year old girl, it’s massive because it’s like the rest of her life. Am I ever going to be good enough for another male? Am I ever going to get married? There were just so many layers to her distress. And I mean, the first thing that I’d kind of done with her was actually it’s not your fault. But then also, you know, for me, Islam is a religion of peace. It’s a religion of acceptance.
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It’s a religion, I mean, not just Islam, all religions speak of empathy and kindness and love. And too often, and I think this happens quite often in maybe it’s cultural upbringing, that we’re always told about the negatives of Islam, the negatives of religion, about punishment. Punishment is a big thing. It’s almost a fear thing. But actually, I feel it works Better in any case is talking about the peace of religion, talking about the beauty of religion and how amazing it is and how benevolent the, you know, the God or the law that you believe in is. So it was actually breaking down her socialisation, Actually your religion is a religion of peace.
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They might mention anger, or it might mention punishment. And I haven’t remember the times right now in the Quran, but actually I can definitely say that the word of peace and the word of forgiveness is mentioned at least three times more than punishment. So why don’t you focus on that? So that was the first thing. And then also, I think it was really interesting that she then eventually disclosed about the sexual abuse, but she wasn’t comfortable sharing this with
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anyone that wasn’t from her religion, or culture, because there was that fear of if I disclose that this is happening in Muslim Pakistani community, then the impression that’s given of Muslims, it’s like feeding into that stereotype around how abusive Pakistanis are, how many South Asians are and how their religion is so stigmatised against. Again, so many layers that she was holding within her. And I was like, you are not responsible for the religion. One person cannot be responsible for how your religion is perceived, how your culture is perceived, how families are perceived. And I just thought, it was really interesting that you didn’t want to say it to me because I’m Muslim, South Asian.
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But, you know, why didn’t you talk about it to your teachers? Why didn’t you talk about it with anyone that wasn’t in your religion or culture? And it was just that weight of it. So, yeah, the first thing was about actually the peace of the religion, the benevolence of the religion. And then actually in a way of bringing the religion and peace into her, it was techniques such as mindfulness. And I know NHS we talk about mindfulness and deep breathing quite a lot. I was like, why don’t we marry that with some actual some dhikr, so some praying, you know, rosary beads that we still use. Use them together.
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You know, you don’t have to have spirituality and religion on one side and then what is mainstream in terms of therapies on one side, you can actually combine the two. Let’s talk about them in conjunction with each other. So a therapist telling you about mindfulness. Okay, let’s do mindfulness, but let’s do it with dhikr through breathing in, praying something, breathing out something and let’s see if that almost doubles your peace in a way. And then it’s the same with the ablution. You’ve done it once. I can provide you with books and scriptures that say actually, this is what the ruling actually says, and this is what the ruling actually says in terms of doubt and how we deal with that.
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That kind of helped a lot, thankfully. And then also, it was going back to again, you know, using techniques around confidence and empowering people. How do we instil confidence within you? how do we instil happiness within you to do something? And you’re actually, you’re confident that what you’re doing works and how it works. I mean, obviously, you know, it was, it’s a long process of healing and overcoming OCD, or living with and overcoming sexual abuse. It isn’t done in twelve weeks, It isn’t done in 23 weeks. It is a constant, not a constant, but it’s a long road of healing. But if you like that that really helped her.
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Being being able to marry together the psychological talking therapies with actually her spirituality and say actually spirituality is a part of that, let’s bring it together. And if you’ve got guilt within the spirituality let’s see how we can work within that to change that almost. Because also you like I said, you know, when you’re brought up with this whole thing around guilt and religion being a negative thing at times, There is this like psychological disconnect that happens. And consciously or subconsciously, that does affect affects you. If you’ve been socialised with a thought process and you’ve been socialised with certain ideologies, when you are then breaking away from them it brings some kind of disconnect.
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So we need to try to bring that Disconnect internally together. It’s almost like your your soul and your mind and the emotions are all connected within one, which I think is what does causes a lot of discomfort for people because it’s all just all over the place. Bring it back together, bring it within you, bring that peace within you, and then let’s see how we do. Thank you.
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Asma: Thank you for sharing that Masira and how long did you work with this young person? So I worked with her for around well it was 12 sessions, but that was over a few months. Because we didn’t have a session every week. I said, take it at your own pace kind of thing. You don’t want to talk this week, why don’t we talk in two weeks? And what I’d also done is, firstly we did once a week for four weeks. Now move to two weeks, now let’s move to a month. And then okay, now let’s do a little bit longer. So it’s a slow and gradual drop-off.
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It’s going to be hard for someone when you’re speaking to someone once a week and you’ve got a routine and then it almost goes, you don’t want a relapse. So I try to provide people with a bit of an anchor, but a slow release Almost. So people are still being supported, but they’re also feeling empowered that I feel like I can get better and I don’t need someone there, it is actually within me, not another person, or another kind of ideology that will make it work.
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Asma: And what do you think was the outcome after twelve session with you. What were the
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I guess both objective and subjective kind of outcomes? What was the difference for her? She did, like her routine because of how many times she had to perform ablution or the bathing reduced significantly. But she did have some relapses. One week it was fine, I’m only going to wudu once, that’s it, fine, move on. But sometimes she would go back and do wudu five times. But for me that was still, it was still an improvement. And I think for me the biggest thing was that she started to feel confident within herself. She felt a lot more comfortable with her religion. She felt a lot more confident in her own abilities.
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And also she began that journey, eventually realising actually, this isn’t my fault. You know, I’m a young woman this shouldn’t have happened And, bless her, I think she eventually she started going into, I want to start doing what you’re doing, I want to go into this field and help other people. And to me, it was just, it was great to see Because I feel like we need more Muslim counsellors and more Muslim people working in mental health. So to almost start that spark in her for me, obviously very subjective, but for me that was really nice. And I saw blossom almost and become happier and come out of her shell. And for me, that was the biggest thing, definitely.

In this video, Masira Hans, Severe Mental Illness Programme Manager for Mind in Bradford, provides a detailed case study of providing support using an Islamically-informed approach. Masira studied Islamic scripture for a number of years before completing a degree in Psychology.

This case study is from Masira’s previous work for a BME mental health charity. Masira describes supporting a young person who was displaying symptoms of OCD around ritual washing (ablution or wudu). Masira worked with the young person over twelve sessions, over a number of months.

Masira outlines the trauma that the young person experienced that contributed to her mental health problems, including sexual abuse. If learners are affected by any of the issues described in this video, contact details for sources of immediate support are included below.

Masira describes how she built rapport with the young woman, this included reassuring the young person that Masira would not be judgmental from a religious perspective. As you can see in the video, Masira is visibly Muslim because she wears the hijab. This was significant to the young person because her own religious identity and practice formed part of her understanding of her mental health problem, the distress she was experiencing, and her response to mental health support.

Masira was able to incorporate her knowledge of Islamic scripture and religious practices with psychological talking therapy in the support she provided for the young person. She worked with the young person to reframe her understanding of Islam, from seeing it as a source of punishment to one of acceptance, forgiveness, and peace. Masira guided her to incorporate dhikr (remembrance of Allah) into breathing exercises as a form of mindfulness. With regard to wudu, Masira provided guidance to the young person, backed up by Islamic scripture, on how to correctly perform ablutions and how to deal with doubt from an Islamic perspective.

The young person’s anxiety around wudu decreased over the time Masira worked with her and she became more confident and happier and, over time, was beginning to realise that the trauma she had experienced was not her fault.

Sources of support

Muslim Youth Helpline (online chat). Helpline: 0808 808 2008. Email – Muslim Youth Helpline.

Samaritans. Helpline: 116 123

NHS 24 Helpline number. Dial 111 and select the mental health option.

The Mix (under 25s only). Helpline number: 0808 808 4994. Text service: 85258

Over to you

Make a note in your reflective diary about whether, how, and why you might consider including this approach as part of your practice so that you are ready to take part in the discussion step for this week (Step 2.27).

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Understanding Muslim Mental Health

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