Islam and Mental health

Islam and Mental Health Care, Part 2

The physical and physiological benefits of salah are multiple to say the least. Most of the body muscles and joints are exercised during Salah.”

Unfortunately I found no link to the original resource and have decided to share this directly on my blog. Please note that this text is not written by myself. Not all what is stated here is a reflection on my personal opinions. I believe Islam is a very big house with many families living under one roof. This text is a typical orthodox Indian approach to Islam with a high emphasis on gender seperation, rules, nutrition and yoga.

The Islamic prayer (Salah/Namaaz) and yoga togetherness in mental health, Part 2, by Shabbir Ahmed Sayeed and Anand Prakash

(Part 1 can be found here)

Ablution – Purification and preparation
Any act of worship in Islam requires the devotee to make an intention and perform physical cleansing and ready himself spiritually. The term Wodu broadly translates to ablution which Muslims perform before the salah by washing their hands, face and feet in a specific order. This in itself is an act of worship since it preconditions the person to perform a serious and sacred duty. The Prophet (PBUH) has said that Wodu does not only clean the person physically but also washes off his sins committed by the washed parts through the dripping water as evident from this Hadith-A Muslim who purifies (himself) and completes purification as enjoined upon him by Allah and then offers the prayers, that will be expiatious (of his sins he committed) between these (prayers). Before every mandatory salat or when one intends to recite the Holy Qur’an the Muslim performs Wodu and thereby maintains a high level of physical cleanliness and spiritual purity. The mind is put to rest from worldly distractions and stress as the act of ablution conditions the psyche to focus singularly on the act of obedience and submission to His will. By commencing the salat with clean body and clear intention the worshiper enters into a state of mind appropriate to communicate with Allah. This is an exclusive act performed at least five times by the Muslims and has scientifically been noted to relax the mind and reduce stress levels as the spirituality overtakes any worldly concern.

Islam and Mental health

Islam and Mental Health

Niyyah – The intention
Expression of intention called Niyyah in Arabic to perform the salat is an essential precondition and is usually done within one’s heart appropriately for the Salah of the time. With the intention the worshiper is committed to complete the action as prescribed and obey all the rules therein in order that his prayer is accepted and rewarded.

Salah – The formal prayer
The five mandatory salat are spread over various parts of the day in such a way that the devotee is not only in contact with the Creator frequently and receives peace and blessings as his reward but also experiences physical well-being that has now been scientifically confirmed. Importance of Salah can be appreciated from the following Hadith-The Messenger of Allah (peace be upon him and his progeny) said: “The first thing that Allah made obligatory upon my Ummah was the five prayers; and the first thing from their acts of worship that shall be taken up will be the five prayers; and the first thing that they will be questioned about will be the five prayers (Kanzul Ummal, Volume 7, Tradition 18859). Each prayer has a certain number of repetitive units called Raka’a and a total of seventeen are prayed during the day. Each of the physical and spiritual movements of salah demonstrated by the Prophet Mohammed (PBUH) is accompanied by supplications to be recited in Arabic. The practice of all Muslims following the prayers globally in exactly the same manner and reciting the Qur’an in Arabic is unique to Islam and reaffirms its strong message of equality and universal brotherhood.

A brief look at each of the five prayers will illustrate this point. The first prayer of the day is at dawn before sunrise comprising of two units. Beginning the day with remembrance of Allah and seeking His protection from all that is evil for the day and asking for His benevolence tunes the attitude in the right direction and does wonders to the heart and mind of the individual. The noon prayer of four raka’a comes at a time when the individual is in the middle of his daily activities. The welcome break from materialistic aspects of life gives him an opportunity to return to God and seek guidance for righteous life and prosperity. The physical activity breaks the monotony of chores he is involved in besides being an excellent form of exercise. In the afternoon or midway between noon and sunset, when the worldly involvements are at a peak, the third prayer of four units befalls the believer. Just when the mind and the body are stressed from the pressures of daily involvements, the believer is rewarded once again with spiritual as well as physical benefits of the prayer thus, an opportunity to resume reenergized. The fourth salat is offered in three units soon after the sunset when the day has folded successfully. It is time to express gratitude to Allah for a well ended day and seek his forgiveness for all sins. The four units of the night Salah are offered about an hour and half after sunset before the bed time. A look at the distribution of these prayers tells us how effectively remembrance of God is intermingled with the daily activities of man without having to stop one for the other. A few minutes of pause from the material world to go back at regular intervals in submission to Allah and to thank Him for all His bounties not only puts the believer in connection with God but also equips him better to go ahead with his worldly endeavors. Spiritual enlightenment and a sense of peace and tranquility relieve the worshiper from stress anxiety and negativity.

Congregational prayers
Although prayers like the noon prayer of Friday, Eid (festival) prayers of Ramadan and Day of Sacrifice and funeral prayers must only be offered in congregation, all Muslim men are strongly encouraged to perform the five obligatory prayers in congregation in a mosque in the vicinity. The Prophet (PBUH) indicated that “The prayer in congregation is twenty seven times superior to the prayer offered by person alone.” (Sahih Bukhari – Book 11; Hadith 618). The purpose of congregation is to unite the Muslims in a cohesive community locally and a well-structured society at large. All forms of discriminations, inequalities and prejudices are left behind when a Muslim enters the mosque for a prayer. By meeting several times a day in the mosque and learning to be responsive to each other’s needs and problems, the Muslim neighborhood establishes a good model of social integration and compassion. This serves a bigger purpose of removing psychological complexes, anxiety, stress and apprehensions from their minds and reinforces a sense of security and inclusiveness in the individual. (…)

Salah in practice
It is important to inspect the act of salat in close detail as each of the positions and moves hold significance to the worshiper (musalli) both from physiological and psychological points of view. Typically, a single Raka’a has three major movements. Firstly, after the silent expression of intention to perform the prayer the individual raises his hands to the level of his ears and utters ‘Allah is the Greatest’ and folds his hands above the navel. During this brief standing of a few minutes the opening chapter of the Holy Qur’an followed by any other verses from the holy book in Arabic is peacefully recited either silently or aloud depending upon the time of the prayer. Focusing on the recitation and contemplation over the meaning is known to soothe the believer’s senses. In this serene atmosphere, the worshiper standing before Allah is supplicating for his guidance.

The second movement is that of bowing with hands rested on the knees and the back held straight for a few seconds enough to utter the supplication glorifying Allah for at least three times and the person rises back to erect posture. In these few seconds, the worshiper’s back and head are held flat, perpendicular to the legs.

After more supplications praising Allah, the individual goes down on his knees and rests his hands and forehead on the ground in prostration known as Sajdah for the third and the most cherished position of all in salah. In this uniquely Islamic act that a human performs in front of Allah the Muslim is nearest to The Almighty. In a Hadith, the Messenger of Allah (PBUH) said “the nearest a servant comes to his Lord is when he is prostrating himself, so make supplication (in this state)” (Saheeh Bukhari). The psychological advantage of realizing that one is in a physical posture best liked by the Lord and that his supplications will be answered; besides the humility attained in the act of stooping to the lowest bodily position is incomparable. The sublime supremacy of sujood (in plural) is evident in the fact that this position has been referred to over 90 times in the Holy Qur’an. Arrogance and egoistic tendencies not only take a severe beating at this moment but also relieve stress and anxiety arising from worldly concerns. Few moments later he rises to sit on his legs and repeats the prostration.

This way, one unit of salat is completed. A typical prayer of a couple of raka’as will be completed with a position of sitting on the legs (Qaa’dah) for more supplications and salutation. This only takes a few minutes of the believer’s time but the spiritual, psychological, physical and social gains are enormous; truly, a blessing from the Lord!

Health benefits of salah
The physical and physiological benefits of salah are multiple to say the least. Most of the body muscles and joints are exercised during Salah. In the most noteworthy movement of prostration besides the limb muscles, the back and perineum muscles as well are exercised repeatedly.[3] The neck muscles, in particular, are strengthened such that it is uncommon to find a person offering regular salah prostrating at least 34 times a day to suffer from cervical spondylosis or myalgias. Sajdah is the only position in which the head is in a position lower than the heart and therefore, receives increased blood supply. This surge in blood supply has a positive effect on memory, concentration, psyche and other cognitive abilities[3,12]. During Sajdah dissipation of the electromagnetic energy accumulated from the atmosphere takes place by the grounding effect at regular intervals resulting in a calming feeling. A recent study investigating the alpha brain activity during Muslim prayers has reported increased amplitude in the parietal and occipital regions suggestive of parasympathetic elevation, thus indicating a state of relaxation.

Khushu refers to a state of mind in salah when we stand in front of Allah and fully direct our minds and hearts towards Him. Anything less not only diminishes the rewards of our worship but a lost opportunity for our spiritual rejuvenation as well. In psychological terms, we can liken this state of mind to a single-minded immersion of oneself with a deep focus on the activity at hand and one that leads to maximum performance. We know that our state of mind, directly or indirectly, impacts almost everything that we do in life. Being in a good state of mind make us feel livelier and more productive, and life generally seems more fulfilling. That is the ultimate objective of prayers and of course, of any therapy as well.

Urban or rural, most Indian Muslims are, by and large, conservative in their outlook when it comes to mental health issues. Social stigmatization often leads to self-denial or underplay of seriousness of the complaint and the mainstream medical assistance is perhaps their last resort. Many Muslims are unwilling to abandon cultural traditions or spiritual and religious methods of treating psychological diseases and behavioral deviance. Only counselors who attempt to work within the religio-cultural framework find acceptance, yet are approached with suspicion. Traditionally, in India, socio-cultural practices transcend the religious barriers in close-knit neighborhoods and often find cross cultural reception in application of home remedies for a spectrum of minor issues. In this context, a review of such trust and confidence in the across-the-border therapeutic attempts may well be worthwhile in our pluralistic society.

Salah and yoga: Complement or contradiction?
A number of attempts have been made to relate salah to a popular ancient Hindu form of physical acts and meditation. Yoga has been known for its scientific basis as a healthy lifestyle practice for thousands of years.[13] Today, Yoga, regardless of its religious affiliation, has become one of the most popular fitness practices all over the world. In India, it has been consistently applied for centuries for its curative powers of movement. Albeit, several ‘asanas’ (physical postures) of Yoga may not be possible to follow in healthcare practices in the absence of the professional supervision for desirable advantage, Muslims have had the blessing of Salah that has since fourteen hundred years become an integral part of their daily activities with physical, psychological, social and spiritual benefits. Here, the authors would suggest that yoga be treated as a lifestyle, rather than just a group of ‘asanas’, which is completely related with health, happiness and longevity of individual. A careful and judicious combination of these two (i.e., salah and yoga) therefore, could possibly double the advantages in enhancing mental health.

Yoga: A completely healthy and spiritual lifestyle
The history of India overwhelmingly evidences that its civilization and culture were blessed with diversified and scientifically remarkable achievements in all spheres of life including health care, when other parts of the world were in their ‘infancy’ of development and maturation.[13] The globally accepted heritage of ‘Ayurveda’ and ‘Yogic practices’ is an unique contribution of the ancient Indian health care system to the rest of the world.

Patanjali is regarded as the ‘father of yoga’. It was also discovered and developed during the Vedic period. Yoga derives from the Sanskrit word ‘yuj’ which means ‘to yoke’, to join the Supreme power ultimately through simple, healthy, sacred and spiritual lifestyles. Thus, yoga implies union and integration of total human being from the inner most to the external nature or the Almighty. It is a path of self-discovery bringing about balance and harmony in life.[14,15] This is a science of strengthening human mind and elevating the level of consciousness to a maximum. At one hand, it helps the normal people in living a healthy and contented life, and on the other hand, it bestows relief, solace and tranquility of mind to the persons with mental distress. Hence, the meaning and eventual purpose of Yoga appear to be fundamentally very similar to the messages of other religions of the world including Islam and its prayer (in the context of this article), despite differences in their fundamental concepts of origin, as per the understanding of the authors.

Therefore, a combination of the salah and Yoga could be an unique pair in relation to the mental healthcare in particular.

Mental health in yoga
According to yoga, the human personality is composed of ‘purusha’ (man) and ‘prakriti’ (nature). The ‘prakriti’ is comprised of ‘gunas’ or ‘vrittis’(mental trends or channels of psychological functions). These ‘gunas’ are ‘Sattva’ (true, pure, consciousness), ‘Rajas’ (erotic activity, dynamism) and ‘Tamas’ (the black, the low, dullness, inertia, and passiveness). Although ‘purusha’ is pure, at times it is contaminated by the ‘gunas’ of ‘rajas’ and ‘tamas’. Hence, abnormality begins from the point of contamination of ‘purusha’ by ‘rajas’ and ‘tamas’, and such contamination incepts at the time of birth when ‘purusha’ takes human form and essentially comes in contact with ‘rajas’ and ‘tamas’. However, ‘ sattva’ is pure and doesn’t cause abnormality. So, yoga aims at control of ‘vrittis’, since lack of control over ‘vrittis’ can lead our mind to abnormal channels.
In addition to the above mentioned ‘gunas’ there are three more but distinct constituents known as ‘Doshas’ of the human body. These ‘doshas’ are ‘Vata’ (wind), ‘Pitta’ (bile) and ‘Kapha’ (phlegm or mucus). An adequate balance between these ‘gunas’ and ‘doshas’ is necessary for origin, development and maintenance of normal and healthy personality and behavior.[13] On the contrary, lack of balance in this equilibrium of ‘gunas’ and ‘doshas’ is most likely to lead to disturbance in personality as well as physical and mental disorders, especially imbalance in the ‘gunas’ of ‘rajas’ and ‘tamas’, and ‘doshas’.

In addition to the above, the concept of ‘klesa’ (affliction) which constitutes the bedrock of all human misery and pain,[16] is sufficiently and purposefully addressed to in yoga. These ‘klesas’ are ‘avidya’ (ignorance), ‘asmita’ (egoism), ‘raga’ (worldly or materialistic attractions), ‘dvesa’ (repulsion or jealousy), and ‘abhinivesa’ (lust for life). Among all, the first is considered as the root of the remaining four ‘klesas’. ‘ Avidya’ is not a lack of knowledge, rather a mistaken knowledge, lack of fundamental differentiation of ‘self’ from ‘non-self’. “‘Asmita’ is pure consciousness (I-am-ness) but is attached to bodily characteristics and its ‘degenerative’ components, e.g. needs and desire, traits, character and other material possessions. Thus, ego is a degenerated form of real or true self with involvement into things, which are unreal to self (i.e., maya). When desire or temptation is supported by the ego (individual), it acquires great strength, which is likely to result into a strong drive and frustration leading to ‘dvesa’”.

Yogic intervention in mental health
The techniques and practices of mental healthcare in Yoga are: (A) Somatogenic and (B) Psychogenic techniques. The former includes shodhan (purification) comprising six karmas (sacred acts) Dhouti (cleansing sense organs, scalp, stomach, anus; Bhasti (colon cleansing), Neti (nasal cleansing), Nauli (abdominal purification through massage and churning), Kapalbhati (a kind of Pranayam, tratak (purifying optic and cognitive facilities) and Swar-yoga (studying flow of breath through nostrils according to the position of celestial bodies). Similarly, the latter (i.e., psychogenic techniques) is known as ‘Astanga’ or ‘Eight Limbs of Yoga’ which are as follow:

(a)
Yama (a kind of ‘Don’ts’ behavior to be practiced in day-to-day life comprising Ahinsa (non-violence to self and others), Asatya-(don’t speak lie), Asteya (non-theft or not taking others’ belongings), Brahmacharya (abstinence from outward pleasure) and Aprigrah (Non-greediness or non-hoarding tendency).
(b)
Niyama is a kind of ‘Dos’ behavior to be practice in daily life comprising Shouch (Purity of body and of mind), Santosh (Contentment), Tapa (Penance), Swadhyay (Self-study or improvement), Ishwar Pranidhan (surrender or devoting to the Supreme Power).
(c)
Asanas and Mudras are various types of physical postures of yoga to catalyze the psychic energies. The ‘asanas’ are meant for individual’s general and mental well-being and peace of mind. Besides, these ‘asanas’ are meant for arousing the dormant centers of the nervous system, called ‘Chakras’.[19] The ‘mudras’ are advanced and highly technical form of physical acts helping individuals in curing mental disorders.
(d)
Pranayam implies pause in breathing. It is a breathing act controlling the breath and vital forces of the body of which there are several kinds e.g., Anulom-Vilom, Kapalbhati, Bhramari etc.
(e)
Pratyahar signifies ‘withdrawal’ from all ‘indriya’ or worldly ‘senses’. It is a kind of sublimation through the psychic behavior for which high level of command over the previous stages is essential. The practice of ‘pratyahar’ controls these senses which are always alive and working to distract the individual toward undesirable behavior.
(f)
Dharna is steadiness of mind which needs discipline and preparation for practicing properly. It is seen when mind concentrates on a stable object. It aims at making the period of steadiness longer by ongoing practice and decreasing distraction of mind.
(g)
Dhyan is meditation or contemplation which comes after ‘dharna’. By the help of this mind has become sole/solitary unity while concentrating only on the ultimate object, i.e., Supreme authority.
(h)
Samadhi is a trance-like state of mind and body which is the highest stage in yoga, also known as ‘kaivalya’. There are neither ‘gunas’ nor ‘doshas’ in the individual at this stage and the person realizes full liberation from the worldly pleasure and affiliations, i.e., ‘Nirvana’ or ‘Moksha’.
Out of all above mentioned practices of Yoga, only some kind of ‘asanas’ and ‘samadhi’ are difficult or seem to be impossible for a common individual especially in certain pathological health conditions. However, the entire domain of yogic sciences and its practices are only concerned with quality of life to be achieved through healthy, contented and spiritual lifestyles, and not at all related to any sect or religion. Thus, it does not involve any essence of partiality with Hinduism or superiority over Islam or any other religion of the existing world. Indeed, the aim of the authors is not to explore superiority of one religious practice over the other, rather, to prompt and suggest to the concerned clinicians as well as the clients to perceive these viewpoints as supplementary combinations toward the best possible benefits in mental healthcare.

Moreover, a direct one on one comparison between Islamic salah and the yoga will not be in order as the basic religious tenets are at variance and may result in sending inflammatory signals. Therefore, setting aside the core religious sentiments and basic tenets, and having a closer look at these two forms of worship reveal a number of similarities in their physical execution and the accrued medical and psychological improvements in the life quality of the practitioner. Central to achieving the desired outcome in either of the practices is the fact that they are rendered in the correct form and for the minimum effective duration. Physical similarities between Salah and yoga are in the body movements that are repeated in a set pattern. Salah with its five major physical movements finds corresponding movements in yoga called ‘asanas’. When performed involving just the physical movement-hatha yoga and salah have been found to evoke comparable medical benefits in all major organ systems. While yoga has trainable ‘asanas’ (but not all ‘asanas’ rather some of them) than those found in salah, where the latter on the other hand, is more of a spiritual obligatory duty. As mentioned earlier, Islam is a prescription for a complete and balanced way of life, hence, Salah besides being an act of worship doubles as a holistic health tonic.

Besides, the concept of activation of the seven ‘chakras’ or energy fields in yogic movements has been anatomically related to the ganglia on the peripheral nervous system. The concept of specifically activating these nerve centers through Salah or yoga is like the chiropractic therapy. The major steps in salah have been associated with the nerve pathways or chakras in a broad sense. The standing position or Qiyaam is said to be similar to the mountain pose in yoga, which has a bearing on self-awareness. The folding of hands above the navel in this position are said to activate the solar plexus. The position of bowing or Ruku is equated with the forward bend position in yoga. The crowning glory of salah is the prostration or sujood. During this movement, the crown chakra related to the person’s spirituality is stimulated. Bending movements during sujood also activate the base chakra and the sacral chakra toning up the lymphatic, skeletal and reproductive systems at large. Resting position between the prostrations or for completion of the salah is called Qaa’dah akin to the thunderbolt pose in yoga. Completion of the salah is done by salutation and turning of the head to the right and then to the left side of the body. This is said to activate the throat chakra. A true appreciation of such activation and the resultant physiological and psychological gains can only be possible when the movements are performed in consonance with careful and correct recitation of the Qur’an verses. Unification of mind and body is brought about by the intention of Salah and focus on the recitation whereby mental distractions and stress are relieved and the physical body yields itself to the positive entrainment through the movements.

In yoga, activation of all the seven energy levels at least once in a day is advocated to realize the true potential of the practice. Since salah is procedurally less complex than yoga and is practiced ritually five times in a day without requiring any formal training it is a boon to the Muslims that they get to tune the energy chakras effortlessly integrating the practice with their daily routine. Nonetheless, combining several aspects of Yoga with salah could be able to catalyze the many more folds of advantages of activating energy chakras.

The way forward
Present day psychotherapists in the predominantly urban setup find themselves confounded with issues arising from clients with intense religious sentiments and intervention in such cases is nothing short of a challenge. The technique used in therapy, therefore, should be based on accepting and acknowledging that many religious, spiritual, and ethnic clients believe that God is the central part of understanding themselves, their core values, and being part of the solution for their worldly problems. The overwhelmingly western ‘secular’ counseling paradigms do not always find acceptance among Muslim patients due to the apprehension of potential or imminent contradiction between the therapy and the Islamic principles. If professional counselors, operating in predominantly Muslim areas, are equipped with a reasonable proficiency in the religious prescriptions, their chances of success in building a better rapport with their clients and thereby rendering effective services will considerably improve. Recently, countries like Malaysia and Indonesia have looked at yoga suspiciously as infringing into Islamic monotheistic principles since yoga is mainly a practice of the polytheistic Hindu religion. Issuance of Fatwa – the Islamic religious Rulings against the practice of yoga by members of the Muslim community in South-East Asia at large has reemphasized the need for carefully approaching the matter of employing heterogeneous cross cultural techniques in therapy. Such confrontations and lack of basic understanding of the finer sensibilities of these religions compounded with the under preparedness of a therapist would only aid in escalating the conflict in patient’s mind. The way forward for the psychotherapists operating in multi religious and multicultural setups, therefore, is to integrate the positive and possible aspects of the Yoga, mainstream western counseling with the spiritual aspects of Islam to develop a combined psycho-spiritual methodology. Multiple methods of intervention drawn from diverse sources may well be incorporated in such practice, such as the use of hatha yoga or power yoga with adequate patient education on the neutrality of these techniques to enhance its efficacy.

Part 1 of Islam and Mental Health Care

If you enjoyed this article you may also like to read:
Islam and Psychosis, Part 1: The Psychiatric Dystopia
Islam and Psychosis, Part 2:  Islamic Traditons of Mental Health Care and Treatment

On the Islamic Treatment of Psychosis and Iatro-Genesis (Over-Medication) with Psychiatric Medication

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