Holistic Healing: Islam’s Legacy of Mental Health
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How Muslim Scholars Understood Mental Illness a Thousand Years Ago | Holistic Healing Series
Has anyone ever uttered these words to you, “A Muslim is not afflicted with depression?” If so, you are not alone. However, this phrase actually contradicts the teachings of our beloved Prophet ﷺ. It’s important to truly understand the factors that influence mental health illnesses in order to begin healing. In this episode, Dr. Rania Awaad discusses how early Muslim scholars understood the complexities of such illnesses.
This series was brought to you in collaboration with the Stanford Muslim Mental Health Lab.
Transcript
This transcript was auto-generated using AI and may contain misspellings. Be honest. How many times have you heard or thought to yourself, I can't possibly be depressed? Muslims don't get depressed. They just need to pray more. This kind of thinking is unfortunately all too common in the Muslim community. In fact, I've heard enough shuyukh themselves actually make statements like, al-mu'minu la yusabu bil-iqti'ab, that believers do not get afflicted with depression, to know that this kind of denial runs really deep in our community. This rhetoric is incredibly problematic and actually goes against the way of the Prophet Muhammad, salallahu alayhi wasalam, as we discussed in the first video of this series. Then, there's the many of us who ignore the biological, genetic, and environmental explanations for mental illnesses and instead insist that mental illnesses can only be cured spiritually. When in reality, mental illnesses are multifactorial. They can be any combination of biological, genetic, environmental, and or spiritual. These kinds of attitudes towards mental health become barriers for us and our loved ones to access help when we need it. But all of the stigma and the barriers against mental health wasn't always this way for Muslims. In fact, our Islamic intellectual history used to be filled with the brim with Muslim physicians and scholars that even by contemporary standards had a very rich and sophisticated understanding of mental illness. In some cases, strikingly similar to modern classifications of mental illnesses. And believe it or not, our Muslim predecessors pioneered and developed an entire system of health care, including treating and managing psychological conditions. In this video, we're going to discuss the work of two of the greatest Muslim physicians in our Islamic intellectual history, Abu Zayd
al-Balkhi and Ibn Sina. Their work in the field we today call psychology demonstrates just how seriously and comprehensively physicians from within the classical Islamic heritage approached mental illness. And perhaps more importantly, that their work also demonstrates that their incredibly advanced understanding of mental illnesses was very much from within our Islamic tradition, not outside of it. Let's start with one of my very favorite scholars of all time, Abu Zayd al-Balkhi. Al-Balkhi was a ninth century encyclopedic scholar, a polymath skilled in many fields such as psychology, geography, philosophy, science, literature, Islamic theology, and theoretical medicine. Although he never actually practiced as a physician, he contributed immensely to the field of medicine. And what he was most famous for actually was geography. He had an entire school called the Balkhian School of Geography named after him. And one of his main surviving treatise is essentially a psychology manual. It's a book called Masalih al-Abdan wa l-Anfus, recently translated by Dr. Malik Badri, A Sustenance of the Soul, where he dedicated half of the book entirely to psychological illnesses. And what's striking about al-Balkhi's treatise is as a medieval text, it's urgency and seriousness with which he implores the reader to grasp psychological illnesses, especially depression. Al-Balkhi argues that psychological illnesses are just as, if not more important and more serious than physical illnesses. He says this is because people are affected by their consequences far more frequently and throughout their lives, and because virtually everybody will face some symptoms at some point in their lives. Now, given the importance of Balkhi took great care in refining the definitions and understanding of several psychological
illnesses, and this included depression, anxiety, and even obsessive compulsive disorder. Let's start with depression. Although depression has been in some terms described by Greek physicians long before him, al-Balkhi's classification of depression was considered to be pioneering. Not only did he distinguish between everyday sadness, which he called huzun, and clinical depression, which he called jaza, he may even have been the very first in history to distinguish between environmental or reactionary versus endogenous or intrinsic forms of depression. He postulated that endogenous depressive states are the result of internal biological factors rather than external environmental factors, like for example, the death of a loved one. Even though al-Balkhi explained that endogenous biological factors, the way most physicians of his time did explain them as an imbalance of the four humors, today some physicians might actually call this instead an imbalance of certain hormones or neurotransmitters. The key point here though is that al-Balkhi was able to distinguish environmental depression from a depression that was endogenous or biological in nature back in the 9th century. He may also be the very first to suggest treatments that are more effective in treating each type of depression. For example, he suggested that medications might be necessary for endogenous depression, whereas talk therapy might actually work just fine for environmental depression. And interestingly, he actually said that a combination or a mixture of these two treatments are probably optimal. And that sounds a whole lot like how we treat depression today. He even described therapy for depression very similar to cognitive behavioral therapy that therapists use today. Some say that he was even the first to suggest talk therapy.
Al-Balkhi also had a very sophisticated understanding of anxiety. He thought it was actually the root of most mental illnesses. And he clearly distinguished it from panic disorders, which is in line with how we actually think about anxiety today. And it's different than how his contemporaries conceptualized anxiety. For most of them, they followed the patterns of thinking inherited from Greek medicine and had a very poor grasp of the distinctions between stuffing anxiety into a catch-all diagnosis they called melancholia. Al-Balkhi also gave insights on what he thought might cause anxiety. He mentioned three possible contributing factors, internal, situational, and social factors. In today's terminology, we would call these biological, psychological, and social origins of anxiety. Not too far off at all. Perhaps Al-Balkhi's most striking contribution to the field was his pioneering work on the topic of obsessions. And as Muslims, we often refer to this as waswasa. But here Al-Balkhi is talking about al-wiswas al-qahri, a more intense obsession than everyday wiswas. And this is where some of my own personal research comes in. Because when I came across his original Arabic treatise, as someone trained in both the classical Islamic sciences and psychiatry, as I read through Balkhi's manuscript, I really thought I was seeing maybe a pre-modern description of obsessive compulsive disorder. Now the books of history on psychology attribute the very first and very brief mention of OCD to Robert Burton in the 17th century, and say that it wasn't until the 19th century that a more complete description of OCD was found. But here was Balkhi, a full millennium, earlier in the 9th century, describing what looked to be a very sophisticated classification, diagnosis, and even treatment for what today we call OCD. So if you're interested in learning more about this, please check out the papers I have on
this topic that have been now reviewed and verified by historians of medicine. They have confirmed that Balkhi's criteria is in astonishing harmony with obsessive compulsive disorder found in the Diagnostics of Stucco Manual of Mental Health Disorders, or the DSM, which all psychiatrists and clinicians diagnose from. And when you put Al-Balkhi's criteria side by side by DSM's criteria, like I did in my paper, you can clearly see that not only did he get just about every single symptom correctly, but it was in the 9th century. Even more astonishing is that modern day psychiatrists and psychologists would immediately recognize the exposure therapy that he suggests to treat OCD. Now let's turn our attention to another giant in the Muslim intellectual world who made significant headways in the field of mental health. None other than 10th century scholar Ibn Sina. Perhaps the most famous of his hundreds of books was Al-Qanun Fi Al-Tibb, or the Canon of Medicine. This was the main textbook taught in European medical schools all throughout until the 18th century. And like Balkhi before him, Ibn Sina took mental illnesses very seriously. He proposed causes and experimented with treatments. His discussion of psychosis in the Canon of Medicine clearly demonstrates this. Where many of his contemporaries recognized psychosis as parts of other commonly discussed conditions, like the catch-all phrase melancholia that we talked about before, they hadn't yet classified or understood it as a separate condition. By contrast, Ibn Sina describes independent condition that he calls junyun lufrit, where he's understood and saw a form of psychosis independent from other conditions. So it is clear that he appreciated the distinctions between this type of junyun and other types like manic depressive psychosis, for example, as well as mania that comes from rabies and
other conditions that he dedicated separate sections to in his book. Now in the Western world, this distinction and classification was not accomplished until schizophrenia was first discussed and conceptualized as a distinct mental illness in the late 19th century. And in terms of causes, Ibn Sina suggested that psychosis originated from the midbrain. His proposal was that the cause was neurological and not due to the four humors or other liquids in the body. And this was revolutionary and far ahead of his time. Ibn Sina and al-Balkhi are just two examples of scores of Muslim scholars whose precocious genius allowed them to understand the complexities of mental illness as much more than just a weakness of faith or the result of jinn possession. And while many Muslim scholars recognize the impact of spirituality on mental health, we can see that our scholars did not stop there. They took mental health seriously, and they believed that therapies could also be found in the world of medicine and talk therapy. Perhaps we as modern day Muslims should keep in line with our own tradition and heritage and follow suit. And if you want to know more about this remarkable Muslim intellectual history as it relates to mental health, I encourage you to check out our website and if interested, even collaborate with us at the Stanford Muslim Mental Health Lab. We have an entire line of research dedicated to unearthing the brilliant works of Muslim scholars like al-Balkhi and Ibn Sina and much, much more to come, inshallah. May Allah Subhanahu wa ta'ala accept our efforts and the efforts of our predecessors and allow us to carry their legacy onward. Allahumma ameen.
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