WORLD ISLAMIC ASSOCIATION FOR MENTAL HEALTH
Vol. I, No. III, Third Issue , July 1999
q CONTENTS / SOMMAIRE
q MESSAGE FROM THE SECRETAIAT GENERAL / Dr. Gamal Abou El-Azayem
q The Islamic Approach to Treatment of Post Traumatic Stress:
q SUMMARY / RESUMES
q MESSAGE FROM THE SECRETAIAT GENERAL / Dr. Gamal Abou El-Azayem
In response to the plight of refugees from Kosovo Dr. Gamal Abou El-Azayem, WIAMH’S secretary general, sent a letter to the high commissioner for refugees, UNHCR, in Geneva. The letter was designed to promote population-based and culturally appropriate means of evaluation and care for traumatized populations-victims of trauma and extreme violence.
As you see from the following letter its aim was to adapt the evaluation, care and rehabilitation of Muslim victims of trauma to the Islamic cultural context. The letter sent to the UNHCR is as follows: WORLD ISLAMIC ASSOCIATION FOR MENTAL HEALTH: SECRETARIAT GENERAL,
SECRETARY GENERAL: DR. GAMAL ABOU EL-AZAYEM
ASSISTANT SECRETARY: DR. FAROUK SENDIONY.
HEAD OFFICE: NASR CITY P. O. BOX NO. 8180.CODE NO. 11971
HIS EXCELLENCY: HIGH COMMISSIONER HIGH COMMISSION FOR REFUGEES. UNHCR,
I am taking the liberty to write to you concerning the needs of refugee victims who are being currently traumatized in KOSOVO. In December 1993 UNHCR issued a focused work targeting the needs of refugee victims of trauma and torture. Entitled “Evaluation and care of victims of trauma and violence, they were forged by UNHCR, Harvard Program of Refugee Trauma and WFMH. The world Islamic Association for Mental Health founded two decades ago to look after the mental health needs of Muslims all over the world would like do its humble share regards the recent traumatization in KOSOVO.
As the guidelines of the UNCHR stipulate, WIAMH would like to promote culturally appropriate means of evaluation and care for traumatized populations, in KOSOVO. You might find knowledge of the Islamic cultural background essential not only in order to determine what is culturally accepted as normality among the traumatized, but also to assess their faith as a resource in the management of the trauma.
As, the Secretary General of WIAMH, I would be more than happy to help in any direction if required.
PLEASE ACCEPT OUR BEST REGARDS,
Dr. Gamal abou El-Azayem : Secreatry General.
There is a consensus amongst anthropologists that religion holds a supreme sway over behavior, thinking and feelings.
This is particularly true of Islam, which defines self and hence mental health in a religious rather than a secular term.
In Islamic view, religious and mental health forces are intimately intertwined (Dubovsky 1983). These observations have lead a number of Muslim psychiatrists and mental health workers around the world to develop innovative methods for the promotion of mental health. The world Islamic Mental Health Association founded a decade ago to promote these efforts is sponsoring this workshop.
With respect to the treatment of “post traumatic stress, a number of mental health workers from Islamic countries have developed treatment programs utilizing the Islamic principles.
In this paper I will present my program on the treatment of Muslim migrants in Australia who suffer from “Post-traumatic stress”. I will also report on the work of world renowned psychiatrists who worked in the same field. Dr. Osama Al Radi from Saudi Arabia and Dr. Arshad Hussain from U. S. A. have developed therapeutic modalities for the treatment of “post traumatic stress” in Saudi Arabia and Bosnia. UNHCR ISSUES GUIDELINES ON TRAUMA VICTIMS:
In December 1993, united nation health commission for trauma victims issued for the first time a focused work targeting the needs of victims of trauma and torture. Entitled “Evaluation and care of victims of trauma and violence,” these draft guidelines are the first product of the tripartite agreement forged in October 1992 between UNHCR, WFMH and the Harvard program in refugee trauma. Reliance on psychoeducation as a basic tool in treatments, Focus on realistic, non-stigmatizing, culturally sensitive interventions, and encouraging maintenance of the family as a unit are reflected strongly in Guidelines. The central theme of the work is stated in the introduction and is summed up:
“An individual’s response to traumatic experiences is, in general, poorly served by medicalization, that is labeling the response as abnormal, requiring specialized intervention by the medical community”.
Guidelines display an unusually strong commitment to demeicalizing the personal responses to trauma. It repeatedly designates as “normal” the typical and widespread reactions to these experiences and advances this approach as a most effective means of ensuring “normalcy”. By so doing, it appears to question the wisdom of using medical diagnostic labels to quantity distress and justify services for victims of trauma. Treating the wounds:
“How do you cure” post-traumatic stress?” it’s not something you can simply talk victims out. Despite this fact, the “treatment” for post-trauma stress does not have to be done by a health professional. In essence it is simple, free and available from any trusted person who knows how to ask the right questions and then be a good listener.
One of the main jobs is to bring the victim out of his or her shell”, says Inge Kemp Genefke, a doctor and head of the Copenhagen center of victims of trauma (1985). The first step is usually to get the patient talking. Painful though it might be, trauma survivors need to be asked gently but persistently about everything they can remember about their trauma. They need to “talk through” their traumatic experience step by step and detail by detail-including all the thoughts and feelings involved. Professionally, this question and answer process is known as “de-briefing”, a vital part of crisis intervention work in the wake of major accidents, disasters, public shooting sprees, etc.
Good listening seem such a natural human response to another’s distress that it is surprising how often it is neglected. No doubt many people would like to help, but they say nothing because of their own anxieties, or to avoid seeming “nosey”, or for fear of causing further upset. Others have been brought up not to think or talk about their feelings … they just ignore them and get on with life. This stoical approach has probably helped many people cope with the hardships which are not out of the range of human experience, but it is bad medicine for trauma survivors. There is now abundant evidence from research and clinical experience that trauma survivors should talk about their trauma, as soon after the event as possible. The longer they keep it all bottled up, the worse the long-term damage to their mental and physical health (Baynes, 1993).
q The Islamic Approach to Treatment of Post Traumatic Stress:
How influential is the Islamic tradition in shaping human behavior and coping with “post-traumatic stress”? and how can spirituality and faith contribute to the alleviation of psychological suffering induced by “post-traumatic stress”?
The answer to these questions can be briefly presented fewer than two subheadings, namely:
1. The basic context of religious principles.
2. The practical implications of these beliefs.
The religious principles:
With regard to the religious principles, the Islamic doctrine, for example, is based on the holy commandments and rules of right living, primarily these provide the true directives for leading a healthy and a meaningful life (Beasher, 1987 p. 305).
In the Holy Koran, Surah No.2, it has been fundamentally ordained that one of the most essential requirements for the achievement of piety is to be patient in time of adversity and stress:
“………… and those who are patient in tribulation and adversity and in time of stress”.
Now let us see the practical implications of this: to attain the UNHCR guidelines concerning trauma victims of culturally appropriate means of evaluation and care, mental health workers and religious scholars may wish to pool their skills in order to properly. Use Islamic culture, as a resource in the support for victims of trauma. A theme implicit here is the clear recognition of the necessity to formulate and implement a treatment program that is based on current existing knowledge of the culture of the victim of trauma. The person in charge of treating a victim of trauma should have a deep understanding of Islamic culture. Rapport will be lacking if the victim of trauma feels that the treating practitioner does not share or understand Islamic culture; victims will then not disclose beliefs that might seem strange to the mental health practitioner and the construction of a therapeutic alliance will be difficult. Therefore, verses of the Quran or hadeeth should be used by the treating practitioner in the support of trauma victims (El Islam, 1982).
1. In the Islamic faith the victim of trauma is encouraged to overcome the trauma through dependence on Allah. In his mass and individual prayers he appeals to Allah to alleviate his sufferings and to heal his invisible wounds.
Critics complain that the Islamic approach simply makes the victim extremely dependent on Allah. Supporters or this approach see nothing wrong with fostering dependency on Allah and the group with whom the “post traumatic stress” sufferer conducts the mass prayers. “For some people, it’s exactly what they need”, says Dr. Edward Khantizian, a psychiatrist at the Danvers Sate and Cambridge Hospital in Massachusetts. They need an antidote for the terrible, progressive self-centeredness that develops as the result of trauma.
One of the main jobs is to bring the victim out of his or her shell”.
2. Islam as a religion and a way of life
is rooted in the belief that whatever happens to man in this world is the
will of Allah. The test of the true believer is piety, patience and
surrender to the divine will. The author must make a distinction between
surrender to the will of Allah and fatalism. It is a qualitative
distinction marked by intentionally, positive acceptance and even
Undoubtedly, part of the attraction of this concept for the victim of trauma is the release from accountability implied in the belief that the traumatic event (e. g. disaster, serious accidents) is the will of Allah.
“Acknowledging the trauma as the will of Allah has some of the same element of psychological forgiveness as the confessional”. “It says,” “It’s the will of Allah, it’s not completely my fault”.
3. In the Islamic faith there is an optimistic view about man’s ability to overcome sin. Dr. Taha Baashar has summed it up “there is always hope to redemption, since god is forgiving and merciful” (1983). This concept generally holds great therapeutic potential and provides a positive opening for a Muslim suffering from “post-traumatic stress”. Survivors of trauma often describe painful guilt feelings. In the Holy Quran there are many verses which deal with the problem of suffering and sin as the following verse testifies:
Say: O my slaves who have been prodigal to their own heart. Despair not the mercy of Allah. Who forgiveth all sins, he is forgiving, the merciful.
4. A side from this the treating practitioner should also have a fairly good knowledge of the religious thinking of the victim of trauma in order to asses his faith as a resource in the management of his “post-traumatic” stress. A Muslim under whatever physical, mental social and emotional circumstances is a believer in Allah. From this unshakable faith in Allah the entire treatment of the trauma victim should be grounded.
This strong belief in Allah and acceptance of his divine will may be mobilized by practitioners successfully in the support of people suffering from “post-traumatic stress” as the following verse from the Holy Quran stipulates:
And surely we shall try you with something of fear and hunger, and loss of wealth and lives and crops, but give glad tidings to the steadfast, who say, when a misfortune striketh them: Lo I We are Allah’s and Lo I unto him we are returning, such are the rightly guided (The Quran p:499).
5. It is also important that practitioners concerned with victims of trauma in Muslim countries recognize the therapeutic potential of family networks in Muslim communities. The Islamic culture is a kinship culture.
This means that Muslims have a network of family relations, which provided what mental health researchers call “social support”. Because of the cohesiveness and power of the Muslim family, therapeutic efforts that do not involve the family are unlikely to be successful, even when biological factors are reversed by anti-psychotic drugs (Dubovsky, 1983). Therefore, one lesson practitioners have learned is to avoid separating victims from their families, since fear for the life and safety of a spouse and children is usually part of the trauma.