Mental health: A primer for Muslims: Wahbie Long
Department of Psychology University of Cape Town
Distinguished ulema, respected elders, and dear brothers and sisters in Islam, Assalaamu alaykum wa rahmatullaahi wa barakaatuh.
It is an honour to have been invited by Imam Rashied to address you this afternoon, during this waqt of Jumuah, and on a topic that is relatively neglected within our Muslim community. The oversight is unusual when one considers that mental health has become a regular fixture in our media headlines, whether one reflects on the Life Esidimeni tragedy that claimed the lives of more than a hundred psychiatric patients, or, more recently, the death-by-suicide of one of the University of Cape Town’s leading lights, Professor Bongani Mayosi. To be sure, the question of mental health or, more pointedly, mental illness, has always been among us. Even the prophets (alayhim as-salaam) suffered psychologically. As Allah informs us about Nabi Ya’qoob in Surah Yusuf, verse 84:
And he turned away from them and said: “Alas, my grief for Yusuf!” And his eyes turned white [he lost his sight] because of the sorrow that he was suppressing.
Indeed, the question of mental illness is now in the public domain, both here in our country and across the world. By way of illustration, in the year 2020 depression is expected to be the number one-ranked health problem in wealthier countries, and the number-two ranked problem in poorer countries in terms of lost productivity, health costs and decreased quality of life.
It may surprise you to learn, therefore, that a world leader in neuroscience, Tom Insel, admitted recently – and I quote – “While I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
Why the staggering lack of progress? Because – and this is probably the single-most ignored fact when it comes to the question of mental illness – mental health researchers still do not know what causes mental disorder. There are no blood tests, no genetic markers, no brain scans for psychiatric disturbance. In fact, there is a growing consensus within the psychiatric mainstream that there are likely hundreds of causal pathways for any given mental illness.
The situation is no more encouraging in professional psychology, where suffering tends to be viewed as the result of unconscious conflicts that are relatively removed from the hurly burly of everyday life. In fact, most forms of psychotherapy endorse the notion that suffering is located inside the individual, who then becomes the source of his or her own recovery. All the while, “We’ve had a hundred years of psychotherapy – and the world’s getting worse,” according to the title of one classic text from the early 1990s. I am not suggesting that psychiatric and psychological treatment do not work. What I am saying, is that mental health service providers are beginning to acknowledge this simple fact – that practitioners cannot cure patients; instead, they care for them. What they offer is a special kind of helping relationship that allows one to think through any number of hurts and conflicts, and to do so in a space that is supportive and non-judgmental.
Of course, as unthreatening as that may sound, the average person still harbors all sorts of prejudices about the mental health patient and what it means about someone who approaches a mental health professional for help. I have often heard it said, for example, that mental illness develops because one lacks eemaan and that the decision to ask a psychologist or a psychiatrist for help, serves only to confirm that deficiency. And yet nothing could be further from the truth. I see many Muslim patients, some of them religiously observant to a fault, others less so. But they all suffer internally – regardless of their religiosity. No matter their status as tahajjud makers, students of deen, or experts in the so-called secular sciences, they agonize without exception.
So what is mental illness? Without a solid understanding of its causes, it turns out that mental illness is impossible to define. That is why – with some exceptions – I prefer to think of mental illness as ‘problems in living,’ to use Thomas Szasz’s phrase; it is less stigmatizing and everybody has them. Specifically, in my experience problems in living are constellated almost always around two core issues: love and work. By ‘love’ I mean relationships involving attachment figures, and by ‘work’ I mean relationships that involve a sense of one’s personal effectiveness, whether in regard to one’s studies or occupational life. In short, what seems to be a common denominator in the distress of patients is a sense of estrangement from the relationships that matter. As Freud observed almost a hundred years ago: Love and work… work and love… what else is there really?
Inevitably, as the rate of mental illness continues to spiral, we are forced into asking ourselves some rather uncomfortable questions. In particular, is there something about life in the modern world – about modernity itself – that compromises people’s relationships with their loved ones, with work activities – indeed, with themselves? In other words, might we approach the problem of what causes mental illness by looking not at neurotransmitter levels or unconscious conflicts, but by examining the nature of modernity, by which I mean our uncritical embrace of economic development, industrialization, and science and technology? Long ago, in 1936, in the silent movie, Modern Times, Charlie Chaplin observed how the automation of working life was driving people mad. Unable to experience the joys of creative activity, most modern workers now function as robots in a world run increasingly by machines. Unlike pre-industrial times, human beings no longer produce goods for their own use; instead, they manufacture products and provide services for faceless consumers living thousands of miles away. Workers no longer oversee production processes from start to finish, being left instead with highly specialized tasks that render the activity of work largely meaningless. And when they are not at work, workers are at home either recovering from work or getting ready to go to work.
As for their spouses, they too live lives of quiet desperation; they too are hamsters on corporate wheels – if they haven’t already succumbed to the drudgery of domestic life. Meanwhile, the attention-hungry children start harassing the parents who, now thoroughly anesthetized to life itself, are too tired to care, having settled for watching series or trawling through multiple social media platforms – in short, doing anything to induce artificial feeling states in order to stop the numbness that has long since taken over. Alienated from their work and from each other, the parents no longer recognize one other; some, in fact, can barely tolerate the sight of each other as they begin to raise their children on a steady diet of computer screens, TV screens, tablet screens and mobile screens – in other words, a mediated reality rather than reality itself – socializing their children inadvertently into becoming the next generation of mindless cogs in a massive corporate machinery. Thoroughly atomized and isolated, parents and children become strangers to one other, like ships passing in the night.
The situation wouldn’t be nearly as tragic were it not for the fact that we are Muslims. Because – as Muslims – social solidarity is a defining feature of our religious life. For example, anyone who embraces Islam must recite the kalimah shahadah in public in order to accrue the necessary social privileges. In the case of salaah, we perform it in congregation in the interest of social solidarity. The payment of zakah fosters a sense of social responsibility. Ramadan and Hajj are institutions that build social consciousness, a sense of community. The point is this: the steady erosion of social bonds under modernity – and the ensuing social apathy – is the opposite of what Ibn Khaldun famously called ‘asabiyyah, that is, the social ethic – or group feeling – upon which every great civilization is built.
So if modernity erodes relationships and psychological wellbeing, and if compromised relationships undermine the practice of our faith, does the reverse hold as well? In other words, if we maintain the pillars of an Islamic life, can we shore up our relationships and in so doing preserve our mental wellbeing? In my view, yes – but only to a point. Because in clinical practice I am always struck by this one fact – that no matter how outwardly pious a Muslim may be, he or she is not exempt from suffering. Moreover, the idea that Muslims are a special psychological type with unique problems is a myth – and it is precisely this illusion of our own exceptionalism that leaves those of us who have mental health problems more marginalized than ever.
It is in the very nature of life on earth that it must involve suffering, whether one is Muslim or not. In Suratul Balad, verse 4, Allah declares without equivocation:
Truly, we have created humankind in hardship. From our mothers carrying us in hardship, to them giving birth to us in hardship, to us teething in hardship, to our livelihoods being forged in hardship, the various commentaries on this verse are clear: to live is to suffer.
In his al-Iqtisad fi’l-I‘tiqad, no less a luminary than Imam al-Ghazali (rahmatullahi alayhi) had this to say about earthly existence:
There would be benefit for man had he been created in paradise without pain or grief, but as for our present existence, all intelligent men desire non-being. One says, ‘Would that I were oblivious and forgotten!’ Another says, ‘Would that I were nothing!’ And still another, ‘Would that I were this piece of straw that is swept from the earth!’
It is consolation indeed that this planet is neither our original home nor is it our final destination. When Shaytaan succeeded in tempting Adam and Hawwaa’ (alayhimaa as-salaam), he would succeed in getting all of us exiled from Jannah. As per Suratul Baqarah, verse 36:
And We [Allah] said, “Go down, [all of you], as enemies to one another, and you will have upon the earth a place of settlement and provision for a time.”
Unlike Paradise, on this earth we are not spared the wounds of time – and I am not referring specifically to illness or old age. What I mean is that, as earthly creatures, we are necessarily time-bound creatures. We may live in the present moment, but we carry with us simultaneously an awareness of both the past and the future, and with that a capacity for endless mental torture. The capacity to remember the past, that is, brings with it the possibility of unceasing sorrow while the ability to envision the future, brings with it the prospect of unlimited fear. It is no wonder, therefore, that depression and anxiety are the most common psychological disturbances in the history of humankind.
Some may be thinking that, since suffering is part of life, there is no point in doing anything about it. But let us not forget the Prophetic injunction recorded in Bukhari, which urges us implicitly to seek help when we need it:
There is no disease that Allah has created, except that He also has created its treatment.
This is the objective of mental health services: to assist people who are struggling, to live relatively satisfying and productive lives. The onus is on us, therefore, to be vigilant about our mental health – just as we are about our physical health – and to consult the relevant experts when necessary. That, of course, is easier said than done: monitoring one’s own mental health is a difficult task, but it is possible to identify when one is taking undue mental strain. Signs of a mood disturbance, for example, can involve changes in sleeping patterns, eating patterns, or energy levels. In the case of depressed mood, one can struggle to concentrate; one is easily overwhelmed by feelings of hopelessness; activities that used to give you joy in the past may no longer; frequently, one thinks about ending one’s life. But more than anything, people who are struggling psychologically will find it harder to function: they will find it difficult to complete the tasks usually expected of them, whether at home, at school or at work.
Paradoxically, it is often the people closest to you who notice the changes – not you yourself – so be careful of discounting their observations. Be compassionate towards yourself, and be compassionate towards those who are struggling with themselves. Remember that life itself is painful, and don’t assume that the one who is suffering should just do as you do. People’s minds are put together in different kinds of ways, and what works for one person will not necessarily agree with the next.
Unfortunately, mental health services are expensive. For those of us who are financially resourced, finding private practitioners is not difficult – a website like www.psychotherapy.co.za lists hundreds of registered psychologists in Cape Town alone. For those who would prefer to see Muslim psychologists, there are local options too. And then there are free telephonic counseling services: the South African Depression and Anxiety Group (SADAG) runs a 24-hour counseling hotline at 0800 12 13 14, as does Lifeline at 0861 322 322.
Few of us would quibble over the suggestion that modern problems require modern solutions. Today’s talk was an attempt to demonstrate this principle, that mental health services are a modern response to a set of problems posed, uniquely, by the demands of modernity. But in the same breath, such services are also much more than just technical solutions to problems in living. In the case of my own specialty – psychotherapy – there are surely few things more fulfilling than coming to know the workings of one’s own mind.
Assalaamu alaykum wa rahmatullaahi wa barakaatuh.