Religion and Spirituality in Psychiatry

Psychotherapy from an Islamic Perspective 303Islamic rules are very extensive and coverall aspects of a Muslim’s life: marriage, education,private and group worship, politics, eating,drinking, clothing, and so on. Some rules aremandatory, and others are recommended. Forexample, it is mandatory for a Muslim to pray thefive Islamic daily prayers and to avoid consumingalcohol, but it is recommended that a Muslimmarry, pray night prayers, and not sleep or eattoo much. People usually depend on Islamic clericsto learn about their religious duties.Islamic laws are remarkably flexible. Forexample, although consuming alcohol is strictlyforbidden, if a trusted physician prescribes it asnecessary to treat an important disease, it can betemporarily consumed. Or if a Muslim cannot doIslamic daily prayers in the usual standing position,she or he can do them while sitting or evenlying down in bed. This flexibility is inferred fromthe two sources of Islamic laws: the Koran andthe Sunnah. During his life, Prophet Muhammadhad many situations in which his deeds and sayingsindicated his flexibility. Some sayings of theProphet Muhammad and verses of the Koranmay seem inconsistent on a particular subject,for example, women’s rights and the rights ofparents and children. These Koranic verses anddeeds of the Prophet may be interpreted differentlyby Islamic clerics. Usually, Islamic clericswithin each Islamic division infer similar rulesand orders regarding basic Islamic elements; soIslamic divisions have many similarities (in basicelements). They also, however, have differences(usually in details). For example, all religiousMuslims believe in the five Islamic prayers, butsome parts of the prayers differ between Islamicdivisions. Usually the more they deviate from thebasic rules, the more controversial they will be,even in a particular division. For example, theremay be different attitudes toward details of parenting,women working , acceptable relationshipswith God, and forgiveness in a given Islamicdivision. This flexibility plays an important rolein psychotherapy with Muslim patients, becausemost seemingly rigid issues causing psychologicaldistress are really in fact flexible.Th ere are two main Islamic branches: Shia(about 15 percent) and Sunni (about 85 percent).(3) Shias predominate in Iran and Iraq.Although describing the similarities and differencesbetween Shias and Sunnis is beyondthe scope of this chapter, some points deservebrief description. The most important differencebetween Shias and Sunnis is that most Shiasbelieve in twelve Imams (religious leaders) afterthe Prophet Muhammad and believe that theirdeeds and sayings (Sunnah) are the continuityof the Prophet’s Sunnah and must be used as aroot for Islamic inference. This belief is similarto what Christians believe about Jesus’s Apostles.These Imams begin with Imam Ali (cousin of theProphet Muhammad) and end with Imam Mahdi(born 869 AD), who is believed to be still aliveand will come someday in the future to save theworld from oppression. Interestingly, they believethat Jesus Christ will return and will be one ofhis special aides. So in addition to the ProphetMuhammad’s Sunnah, Shias have many yearsof Shia Imams’ Sunnah and volumes of booksof their sayings and prayers that can be used inpsychotherapy.Many nonfunctional thoughts and behaviorsof Muslim patients are rooted in their culture andnot in their religion. However, they may thinkthat these thoughts and actions are religiouslyjustified (15) and may use them to resist change.Furthermore, despite many adaptive thoughtsand behaviors in Islamic sources, a Muslim clientmay not be aware of or pay enough attentionto them. If a psychotherapist can use his or herknowledge of Islam to show this to the Muslimclient, adaptive changes may be more easilybrought about.But what can non-Muslim therapists who arenot experienced with Islam do? As some casesshow, (12) if non-Muslim therapists becomeaware of their lack of knowledge, respect thepatient’s culture and religion, and seek informationfrom trusted sources, they may effectivelyhelp these clients. Indeed, some Muslim clientswith religious conflicts may prefer non-Muslimtherapists. (12)