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Sunday, January 11, 2009

Baseline on Clinical Psychology of Islam

Clinical and medical approach (Courtesy of Wikipedia)

Unlike medieval Christian physicians who relied on demonological explanations for mental illness, medieval Muslim physicians relied mostly on clinical psychiatry and clinical psychology, and clinical observations on mentally ill patients. They made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other new forms of treatment such as baths, drug medication, music therapy and occupational therapy.[32]

[edit] Al-tibb al-ruhani and diseases of the mind

The concepts of al-tibb al-ruhani (translated as "spiritual health" in Arabic) and "mental hygiene" were introduced in Islamic medicine by the Persian physician Abu Zayd Ahmed ibn Sahl al-Balkhi (850-934), who often related it to spiritual health. In his Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul), he was the first to successfully discuss diseases related to both the body and the soul. He used the term al-Tibb al-Ruhani to describe spiritual and psychological health, and the term Tibb al-Qalb to describe mental medicine. He criticized many medical doctors in his time for placing too much emphasis on physical illnesses and neglecting the mental illnesses of patients, and argued that "since man’s construction is from both his soul and his body, therefore, human existence cannot be healthy without the ishtibak [interweaving or entangling] of soul and body." He further argued that "if the body gets sick, the nafs [psyche] loses much of its cognitive and comprehensive ability and fails to enjoy the desirous aspects of life" and that "if the nafs gets sick, the body may also find no joy in life and may eventually develop a physical illness." Al-Balkhi traced back his ideas on mental health to verses of the Qur'an and hadiths attributed to Muhammad, such as:[3]
"In their hearts is a disease."
Qur'an 2:10
"Truly, in the body there is a morsel of flesh, and when it is corrupt the body is corrupt, and when it is sound the body is sound. Truly, it is the qalb [heart]."
Sahih al-Bukhari, Kitab al-Iman
"Verily Allah does not consider your appearances or your wealth in (appraising you) but He considers your hearts and your deeds."
Musnad Ahmad ibn Hanbal, no. 8707

[edit] Mental hospitals

As a result of the new positive Islamic understanding of mental illness, the first mental hospitals and insane asylums were built in the Islamic world as early as the 8th century. The first mental hospitals were built by Arab Muslims in Baghdad in 705, Fes in the early 8th century, and Cairo in 800. Other famous mental hospitals were built in Damascus and Aleppo in 1270.[4][33]

[edit] Al-‘ilaj al-nafs and tibb al-qalb

Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah written in the 9th century was the first work to study 'al-‘ilaj al-nafs (translated as "psychotherapy" from Arabic)[10] in the treatment of patients. His ideas were primarily influenced by early Islamic thought and ancient Indian physicians such as Sushruta and Charaka. Unlike earlier physicians, however, al-Tabari emphasized strong ties between psychology and medicine, and the need for al-‘ilaj al-nafs and counseling in the therapeutic treatment of patients. He wrote that patients frequently feel sick due to delusions or imagination, and that these can be treated through "wise counselling" by smart and witty physicians who could win the rapport and confidence of their patients, leading to a positive therapeutic outcome.[14] In his chapter on mental illness, al-Tabari first described thirteen types of mental disorders, including madness, delirium, and Fasad Al-Khayal Wal-Aqo ("damage to the imagination, intelligence and thought").[34] He also clearly highlighted mental illness as a speciality of its own.

The Tunisian Arab Muslim physician,[35] Ishaq ibn Imran (d. 908),[36] known as "Isaac" in the West,[37] wrote an essay entitled Maqala fil-L-Malikhuliya, in which he first described psychosis, and also described a type of melancholia: the "cerebral type" or "phrenitis". He described the diagnosis of this mental disorder, reporting its varied symptoms. The main clinical features he identified were sudden movement, foolish acts, fear, delusions, and hallucinations of black people.[36] This work was later translated into Latin as De Oblivione (On Forgetfulness) by Constantine the African.[35]

The Persian physician Muhammad ibn Zakarīya Rāzi (Rhazes) (865-925) wrote the landmark texts El-Mansuri and Al-Hawi in the 10th century, which presented definitions, symptoms, and treatments for many illnesses related to mental health and mental illness. Razi's texts made significant advances in psychiatry. Razi also managed the mental ward of a Baghdad hospital. Such institutions could not exist in Europe at the time, because of European fears of demonic possession.[32]

In the centuries to come, Islam would serve as a critical waystation of knowledge for Renaissance Europe, through the Latin translations of many scientific Islamic texts. Razi, al-Tabari and Ahmed ibn Sahl al-Balkhi were the first known physicians to study al-‘ilaj al-nafs.
Ali ibn Abbas al-Majusi (d. 982) discussed mental illness in his medical text, Kitab al-Malaki, where he discovered and observed a type of melancholia: clinical lycanthropy, associated with certain personality disorders. He wrote the following on this particular mental illness:[36]
"Its victim behaves like a rooster and cries like a dog, the patient wanders among the tombs at night, his eyes are dark, his mouth is dry, the patient hardly ever recovers and the disease is hereditary."

Avicenna (980-1037) often used psychological methods to treat his patients.[23] One such example involved a prince of Persia who had melancholia and suffered from the delusion that he was a cow. He would low like a cow, crying "Kill me so that a good stew may be made of my flesh," and would not eat anything. Avicenna was persuaded to undertake the case, and sent a message to the patient, asking him to be happy, as the butcher was coming to slaughter him, and the sick man rejoiced. When Avicenna approached the prince with a knife in his hand, he asked, "Where is the cow so I may kill it." The patient then lowed like a cow to indicate where he was. By order of Avicenna in his role as the butcher, the patient was also laid on the ground for slaughter. When Avicenna approached the patient, pretending to slaughter him, he said, "The cow is too lean and not ready to be killed. He must be fed properly and I will kill it when it becomes healthy and fat." The patient was then offered food, which he ate eagerly and gradually "gained strength, got rid of his delusion, and was completely cured."[38]

[edit] Music therapy

Al-Kindi (801–873) was the first to realize the therapeutic value of music. He was the first to experiment with music therapy, and he attempted to cure a quadriplegic boy using this method.[39]
Later in the 9th century, al-Farabi also dealt with music therapy in his treatise Meanings of the Intellect, where he discussed the therapeutic effects of music on the soul.[15]

[edit] Cognitive therapy

Al-Kindi developed cognitive methods to combat depression and discussed the intellectual operations of human beings.[14]
According to the psychologist Amber Haque, the medieval Islamic scholar Abu Zayd Ahmed ibn Sahl al-Balkhi (850-934) was "probably the first cognitive and medical psychologist to clearly differentiate between neuroses and psychoses, to classify neurotic disorders, and to show in detail how rational and spiritual cognitive therapies can be used to treat each one of his classified disorders."[40]

Al-Balkhi classified neuroses into four emotional disorders: fear and anxiety, anger and aggression, sadness and depression, and obsession. According to Haque, al-Balkhi further classified three types of depression: normal sadness (huzn) which is "today known as normal depression", "endogenous depression" which "originated within the body", and "reactive depression" which "originated outside the body".[40]

Al-Balkhi also wrote that a healthy individual should always keep healthy thoughts and feelings in his mind in the case of unexpected emotional outbursts in the same way drugs and First Aid medicine are kept nearby for unexpected physical emergencies. He stated that a balance between the mind and body is required for good health and that an imbalance between the two can cause sickness. Al-Balkhi also introduced the concept of reciprocal inhibition (al-ilaj bi al-did), which was re-introduced over a thousand years later by Joseph Wolpe in 1969.[40]

[edit] Physical and psychological disorders

The Muslim physician Abu Zayd Ahmed ibn Sahl al-Balkhi (850-934) was a pioneer of al-‘ilaj al-nafs, and the first to compare "physical and psychological disorders" and show "their interaction in causing psychosomatic disorders." He recognized that the body and the soul can be healthy or sick, or "balanced or imbalanced", and that mental illness can have both psychological and/or physiological causes. He wrote that imbalance of the body can result in fever, headaches and other physical illnesses, while imbalance of the soul can result in anger, anxiety, sadness and other mental symptoms. He recognized two types of depression: one caused by known reasons such as loss or failure, which can be treated psychologically through both external methods (such as persuasive talking, preaching and advising) and internal methods (such as the "development of inner thoughts and cognitions which help the person get rid of his depressive condition"); and the other caused by unknown reasons such as a "sudden affliction of sorrow and distress, which persists all the time, preventing the afflicted person from any physical activity or from showing any happiness or enjoying any of the pleasures" which may be caused by physiological reasons (such as impurity of the blood) and can can be treated through physical medicine.[3] He also wrote comparisons between physical disorders with mental disorders, and showed how psychosomatic disorders can be caused by certain interactions between them.[40]

In the early 10th century, Muhammad ibn Zakarīya Rāzi reported a psychotherapeutic case study from a contemporary Muslim physician who treated a woman suffering from severe cramps in her joints which made her unable to rise. The physician cured her by lifting her skirt, putting her to shame. He wrote: "A flush of heat was produced within her which dissolved the rheumatic humour."[32]

Ali ibn Abbas al-Majusi (d. 982) elaborated on how the physiological and psychological aspects of a patient can have an effect on one another in his Complete Book of the Medical Art. He found a correlation between patients who were physically and mentally healthy and those who were physically and mentally unhealthy, and concluded that "joy and contentment can bring a better living status to many who would otherwise be sick and miserable due to unnecessary sadness, fear, worry and anxiety."[3] He also first discussed various mental disorders, including sleeping sickness, memory loss, hypochondriasis, coma, hot and cold meningitis, vertigo epilepsy, love sickness, and hemiplegia. He also placed more emphasis on preserving health through diet and natural healing than he did on medication or drugs, which he considered a last resort.[15]

Avicenna (Ibn Sina) (980-1037), considered a father of modern medicine,[41] was a pioneer in neuropsychiatry, physiological psychology and psychosomatic medicine in The Canon of Medicine, and contributed to the nature versus nurture debate with his theories of empiricism and tabula rasa.

Avicenna (980-1037) recognized "physiological psychology" in the treatment of "illnesses involving emotions" and develop "a system for associating changes in the pulse rate with inner feelings" which is seen as an anticipation of "the word association test of Jung." Avicenna identified love sickness (Ishq) when he was treating a very ill patient by "feeling the patient's pulse and reciting aloud to him the names of provinces, districts, towns, streets, and people." He noticed how the patient's pulse increased when certain names were mentioned, from which Avicenna deduced that the patient was in love with a girl whose home Avicenna was "able to locate by the digital examination." Avicenna advised the patient to marry the girl he is in love with, and the patient soon recovered from his illness after his marriage.[32]

Avicenna also gave psychological explanations for certain somatic illnesses, and he always linked the physical and psychological illnesses together. He described melancholia (depression) as a type of mood disorder in which the person may become suspicious and develop certain types of phobias. He stated that anger heralded the transition of melancholia to mania, and explained that humidity inside the head can contribute to mood disorders. He recognized that this occurs when the amount of breath changes: happiness increases the breath, which leads to increased moisture inside the brain, but if this moisture goes beyond its limits, the brain would lose control over its rationality and lead to mental disorders. He also wrote about symptoms and treatments for nightmare, epilepsy, and weak memory.[23]

[edit] Nosology and psychopathology

In nosology, the Arab Muslim physician and psychological thinker Najab ud-din Unhammad (870-925) described in detail nine major categories of mental disorders, which included 30 different mental illnesses in total. Some of the categories he first described included obsessive-compulsive disorders (anxious and ruminative states of doubt), delusional disorders (which "manifested itself by the mind's tendency to magnify all matters of personal significance, often leading to actions that prove outrageous to society"), degenerative diseases, involutional melancholia, and states of abnormal excitement.[42]

Unhammad made many careful observations of mentally ill patients and compiled them in a book which "made up the most complete classification of mental diseases theretofore known." The mental illnesses first described by Najab include agitated depression, neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).[32]
Unhammad also listed nine classes of psychopathology. This included the earliest description of Souda a Tabee (febrile delirium), which was in turn subdivided into Souda where patients showed impairment of memory, loss of contact with the environment, and childish behaviour; and Jannon (agitated reaction) which occurs when Souda reaches a chronic state and is characterized by insomnia, restlessness and sometimes "beast-like roars."[43]

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