|
|
|||
|
|
|
||
|
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 Introduction
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
TEL: 4013978
FAX: 202-2600541
HIS EXCELLENCY: HIGH COMMISSIONER HIGH COMMISSION FOR REFUGEES. UNHCR,
CH-1211 GENEVA,
Dear Sir,
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,
Sincerely
your,
Dr.
Gamal abou El-Azayem : Secreatry General.
q
Introduction
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”.
Practical Implications:
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
contentment.
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.
|
|||