1. 1 23
Journal of Religion and Health
ISSN 0022-4197
J Relig Health
DOI 10.1007/s10943-016-0234-7
Integration Between Mental Health-
Care Providers and Traditional Spiritual
Healers: Contextualising Islam in the
Twenty-First Century
Nayeefa Chowdhury
2. 1 23
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4. health, prosperity and satisfaction with life are directly linked to the overwhelming change in
the family set-up and accommodation of modern western culture, replacing conservative
Islamic society as a whole (Al Mualla 2011; Ghubach et al. 2004). Life satisfaction is
universally considered to be a key facet of human welfare. The findings of a nationwide
survey of UAE nationals (n = 610) conducted by the Faculty of Medicine at the UAE
University suggested strong and significance correlation between low scores on life satis-
faction and psychiatric disorders, especially depressive disorders, whereas no significant
association was identified between life satisfaction and physical disorders (Ghubach et al.
2010).
In the United Arab Emirates, neuropsychiatric disorders are estimated to account for an
alarming fifth of the global burden of disease (WHO 2008). A community-based survey of
Emirati nationals in Al Ain shows that only 38 % of randomly selected participants
(n = 325) indicated that they would seek help from mental health specialists in the event of
psychiatric problems developing in a family member (Eapen and Ghubash 2004). When
asked about the reasons for not consulting a mental health specialist for mental health
symptoms, three themes emerged. 28 % of those, who preferred not to seek help from
mental health specialists, reported stigma attached to at tending mental health services as
the main reason. 21 % expressed doubt about the usefulness of mental health services,
especially the use of medication (ibid). Noteworthy that the majority of the participants
surveyed preferred to seek help from a generalist health professional (GP) over a mental
health professional, even though the illness in the family was directly related to mental
health (ibid). According to Mental Health Atlas (2011) statistics, the majority of primary
health-care doctors and nurses working in the country have not received official in-service
training on mental health within the last 5 years (WHO 2001).
Our religious mindset and cultural background play vital roles in how we perceive of
mental illness, care for our mental health and seek specialist support when necessary. UAE
nationals predominantly attribute mental illness to metaphysical forces such as the demon
(jinns), evil eye (‘ayn), sorcery (sihr) or envy (hasad) (Al-Adawi et al. 2002; Al-Issa 2000;
Al-Krenawi and Graham 2000; Al-Subaie and Alhamad 2000; Thomas et al. 2015).
Literature Search: An Overview of Past Studies
Search Strategy
A literature search (dated on 22 October) for the general key terms ‘Islam’, ‘mental
illness’, ‘mental health’, ‘mental disorders’, ‘Arab’ and ‘United Arab Emirates’ from
January 1990 through 2015 using metasearch engine, namely EBSCO Discovery Service
(EDS), generated 218 results. EDS furnishes access to CINAHL, Academic OneFile,
Academic Search Complete, Business Source Complete, Psychology and Behavioral Sci-
ences Collection, SocINDEX, MEDLINE and other databases.
Study Selection
Search results were further refined to peer-reviewed journal articles only. Relevance to the
present research project was the criteria for selection of past studies. Arab cultures are not a
monolith. Each Arab country has its distinct historical, socio-political and ethno-demo-
graphic profile. Thus, a broad-brush representation and sweeping generalisation concerning
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5. attitudes and trends of Arab societies is essentially misleading. As for our study selection, a
focus of attention was given to the literatures concerning the UAE nationals only. There is
a dearth of systematic studies dealing with citizens of the UAE. Fourteen articles were
selected as references for past studies on the subject matter.
Discussion
As far as the Emirate of Abu Dhabi is concerned, the past literatures on psychiatric survey
cover only the eastern region of Al Ain municipality. No survey data were found on the
Abu Dhabi Central. Studies relating to the UAE nationals were done largely by the Faculty
of Medicine at the UAE University.
Psychiatric surveys are available across specific age cohorts. A prevalence rate of
22.2 % for overall psychiatric morbidity was observed among school-going children (under
the age of 18 years) in the Al Ain municipality according to an epidemiologic study
(Eapen, Jakkahm and Abou-Saleh 2003; Swadi 1999). One in seven children had signifi-
cant functional impairment as a consequence of psychiatric morbidity; however, none in
the sample had received any professional help (ibid). A lifetime prevalence of psychiatric
disorders was reported to be 19 % among the adult counterparts of UAE citizens, according
to another Al Ain community study (Abou-Saleh et al. 2001). In a nationwide sample of
the UAE senior citizens, diagnoses of depressive and anxiety disorders accounted for about
one-fourth of the age cohort (Ghubach et al. 2010) (Table 1).
Table 1 Prevalence of mental illness among the UAE citizens during 2000–2015
Age cohort
(years)
Community
location
Mean
age
(years)
Sample
size (n)
Selection method Instruments used Psychiatric
morbidity
rate (%)
School-
going
children
(6–18)
Al Ain 10.8 620 Random-walk
technique of
Cochrane and
Stopes-Roe
(1980)
RPQa
K-SADSb
22.2
Adults
(18+)
Al Ain 34.2 1394 Systematic
sampling
CIDIc
SRQ-20d
SCID-Ie
New screening
tool (Daradkeh
et al. 1999)
19
Seniors
60+
Al Ain, Dubai
and Ras
al-Khaimah
68.6 610 Random sampling,
stratified cluster
GMS-A3f
25
a
Rutter Parental Questionnaire
b
Schedule for Affective Disorders and Schizophrenia for school-aged children
c
Composite International Diagnostic Interview
d
Self-Reporting Questionnaire
e
The Structured Clinical Interview for DSM-IV Axis I Disorders
f
Geriatric Mental State Interview
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6. Emirati Mindset Towards Seeking Professional Psychological Help
Two systematic studies of selected cohorts are available with reference to the mindset of
the Emirati citizens towards mental health care in general. The first group comprised of
university students with the mean age of 21 years. Three hundred and fifty undergraduate
students enrolled at the UAE University completed measures of attitudes towards seeking
professional help (Al-Darmaki 2003). The studies observed that only a small fraction of
college students who experienced significant mental health issues actually sought mental
health support. This ‘red flag’ warning was confounded by the study outcome that the
group who sought some forms of counselling that addressed their mental health issues were
reluctant to get professional support from mental health professionals. Reluctance to come
to therapy primarily underscores UAE citizens’ attitudes towards seeking psychological
help (ibid).
Study results reveal that mental health services are not yet well accepted among the
UAE nationals. Individuals belonging to the UAE nationality seem to rely more on tra-
ditional methods (e.g. family, friends, spiritual healers) for help with psychological
problems. Seeking psychological help is still considered a sign of ‘weakness’ and ‘failure’
in the UAE culture. People may experience psychological problems in the form of physical
complaints (Sayed, Collins and Takahashi 1998). It is more acceptable to seek help from a
physician than from a mental health-care provider. In effect, mentally ill patients usually
prefer to get help from a medical doctor; whereas seeking help from a psychiatrist or a
psychologist may be considered last (Al-Darmaki 2003).
The second study focused on attitude of parents in relation to help-seeking patterns for
their children when it came to mental health care. A total of 325 parents, who were all
UAE citizens residing in the Eastern region of Al Ain, were surveyed. The study results
show that only 37 % of the parents surveyed agreed to seek help from a mental health-care
provider if their children exhibited potential psychiatric symptoms (Eapen and Ghubash
2004). An alarmingly large segment, one-fourth of the total respondent parents, preferred
to seek help from a friend instead (ibid). 5 % of the parents mentioned they would seek
help from an Imam or spiritual healers, and a third preferred to seek help from a physician
(ibid) (Fig. 1).
A few years ago, a research team developed a model depicting Arab Muslims’ attitudes
towards seeking professional mental health care (Aloud and Rathur 2009). Four inde-
pendent variables were selected in the model, which is illustrated in Fig. 2.
Fig. 1 Pie chart: Emirati parents’ preference for mental health treatment (based on the published survey,
Eapen and Ghubash 2004)
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7. Contextualising Islamic Principles and Ethos to Contemporary Clinical
Practice
Psychosocial models rooted in Islamic tradition will unequivocally increase the accept-
ability of contemporary clinical practice in mental health in the eyes of the Emirati citizens
(Amer et al. 2008; Hall and Livingston 2006). Paradoxically, the rise of organised, insti-
tutional psychiatry originated from the Qur’anic prescription of ethical treatment of the
mentally ill, as opposed to the medieval practice of isolation of the mentally ill in ‘lunatic
asylums’ (O’Donnell 2013). The Qur’anic Weltanschauung differed greatly from the
reigning view in which the mentally ill were viewed as ‘under the influence of the devil’,
thereby needing to be isolated from society.
The Muslim world pioneered in modern health-care practice known today. The first
psychiatric hospital in history was built under the tutelage of the Umayyad dynasty in 705
AD (Murad and Gordon 2002). The earliest world-class psychiatric institutions were all
built under the leadership Muslim leadership in Cairo (800 AD) and in Damascus (1270
AD). Modern models of mental health management including prescription of pharma-
ceutical drugs, occupational therapy and music therapy were pioneered by Muslim
physicians (O’Donnell 2013).
Crucial figures in the history of medicine include Ibn-Sina (980–1037 A.D.) and Razi
(854 CE–925 A.D.), also known as Avicenna and Rhazes, respectively, who made fun-
damental and enduring contributions to the field of psychotherapy. One of the greatest
Medieval Muslim theologians, Ibn-Sina, in his book titled The Canon of Medicine
Fig. 2 Factors affecting Arab Muslim’s attitudes towards seeking professional mental health services (from
Aloud and Rathur 2009)
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8. (al-Qānūn fī aṭ-Ṭibb), which he authored in 1025, provided detailed discussion on
depression and its treatments.
In clinical practice, Qur’anic verses may be directly quoted during meditation therapy
(3:191) and treatments of psychiatric disorders such as depression (94: 5–6, 12:87, 65:2–3,
12:87) or anxiety disorder (3:159) (Sabry and Vohra 2013).
Recommendations on Future Research Initiatives
● It is recommended that future research initiatives be taken to focus on the regional area
of the Central District of Abu Dhabi, where no survey has been conducted to date.
● All past studies have pinpointed the urgent need for mass awareness concerning mental
illness and available professional treatments in the country. It is recommended that
concrete, time-framed, measureable steps be taken to raise awareness of mental health
care through collaboration with specialist channels and industry engagement.
● Future research projects should cater for a number of training and mentoring programs
specifically designed for relevant target groups as well as age cohorts.
● It is recommended that efforts be made to facilitate dialogue between professional
mental health-care providers and key sectors whom Emirati individuals often turn to for
mental health support, such as spiritual healers and GPs. To that end, we recommend
that small-scale pilot programs be launched that would act as a hub for dissemination of
knowledge and creative transferral of experiences, as an overlapping consensus of
response to mental health issues.
● Past studies have investigated the factors that come into play in barring the Emirati
nationals from seeking professional help for mental health care. Future research
initiatives should be made with an aim to developing a culturally sensitive and relevant
psychosocial model of mental health care, infusing into it elements rooted in Islamic
tradition. To that end, we recommend that future projects collaborate with professional
mental health-care practitioners in drafting a modified Islamic version of cognitive
therapy, replacing certain concepts with concepts drawn from Islamic teaching.
● We recommend that efforts be made to facilitate Imams’ participation and tap into their
wisdom in order to deepen mutual trust and social cohesion. Imams will help identify
concepts, which are consistent with Islamic principles, as well as adapt to the lexical
variation of the religious terms such as ‘halal’ and ‘haram’.
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