Religion and Spirituality in Psychiatry

310 Sasan Vasegheye weeps and the heart is sad, but I do not sayanything that angers God” (p. 360). (13)3.3.6. Physicians’ Credit in IslamSometimes guilt is the result of a sin that theclients cannot quit. Such excessive guilt can causehopelessness and decreased self-esteem, resultingin even more repeating of that sin. One way todecrease this guilt is to use the physicians’ creditin Islam. One Islamic rule is that if a trusted physicianrecommends a basically prohibited actionto treat an important disease, doing that action isnot regarded a sin anymore and even may becomemandatory. For instance, breaking one’s fasting atRamadan holy month is not regarded a sin if itis prescribed by a trusted physician as necessaryfor a patient’s health. Similarly, some Muslimpatients feel excessive guilt and are severely anxiousor depressed because of doing masturbation.If a trusted physician considers this to be animportant element in a patient’s severe anxiety ordepression and recommends that he or she occasionallyperform masturbation to decrease his orher tension, this act is not regarded a sin anymoreand can sometimes be done.3.4. Hopelessness and SuicideSuicide is regarded as an unforgivable great sinby almost all Muslims. (24) It is unforgivablebecause one has no time to repent from and compensatefor it, for repentance is only allowed untildeath. In an aggregate study involving seventynations (1989), it was found that after controllingfor a large number of socioeconomic variables,the percentage of Muslims in the populationwas negatively correlated with suicide rates. (22)Considering suicide a great sin may be the onlyfactor preventing some Muslim patients fromcommitting suicide, so it should be encouragedin these patients.Losing one’s hope in God’s mercy too isregarded as one of the worst sins in Islam (HolyKoran 12:87). Some patients think of suicidebecause they feel hopeless, and consideringhopelessness a great sin may aggravate their guiltand hopelessness. The following example showshow to use Socratic questioning to decrease thisguilt feeling.Patient (crying): I am completely hopeless. Noone can help me. I know hopelessness is a greatsin so I have lost both my life and afterlife.Therapist (sympathetically): Certainly this feelinghurts you so much. It is a very unpleasantfeeling. How many sessions have you come totherapy by now?Patient: About eight sessions.Therapist: Are you going to continue yoursessions?Patient: I think yes.Therapist: You have patiently come to eight sessions,and you want to continue. Do you thinkthis could be a sign that you hope that thesesessions may be helpful?Patient (stops crying): Yes. Actually if I thoughtthese sessions were useless, I never wouldhave attended them.Therapist: That is definitely true. So, can we saythat you have not lost your hope, but you havebeen bravely fighting hopelessness by continuingyour sessions?Patient (after a pause): I don’t know. I neverthought of it that way before.Therapist: If someone like you fights against agreat sin, doesn’t she deserve God’s rewardand great mercy in spite of punishment, aspromised in Koran?Patient: Maybe that is true. Yes, I have not lost allof my hope.3.5. Saints as ExamplesProphet Muhammad himself, all Shia Imams,and other significant Muslims suffered a greatdeal in their lives. They tolerated many kinds ofeconomic and social pressures and physical tortures.(25) Some of them were martyred and othersremained, both fates being regarded as victories inIslamic culture. This can be used in psychotherapy,because when religious Muslims compare theirdifficulties with those of the Prophet Muhammadand significant Muslims, they usually feel somewhatrelieved. One Iranian woman who had lost