The Intersection of Islamic Jurisprudence and Mental Health: A Collaborative Care Model for Islamic Clergy and Mental Health Professionals Presenter: Bilal Ali Ansari
The Intersection of Islamic Jurisprudence and Mental Health:
A Collaborative Care Model for Islamic Clergy and Mental Health Professionals
Presenter: Bilal Ali Ansari
Disciplinarity
Approaches to Collaboration
Intradisciplinary: working within a single discipline.
Crossdisciplinary: viewing one discipline from the perspective of another.
Multidisciplinary: people from different disciplines working together, each drawing on their disciplinary knowledge.
Interdisciplinary: integrating knowledge and methods from different disciplines, using a real synthesis of approaches.
Transdisciplinary: creating a unity of intellectual frameworks beyond the disciplinary perspectives.
Should Integrated Islamic Psychotherapy be Interdisciplinary?
Advancing the social sciences through the interdisciplinary enterprise by Marilyn Stember
Importance of Interdisciplinary Expertise
Between blindness and emptiness
Disciplinarity without interdisciplinarity is blind, & interdisciplinarity without disciplinarity is empty. (Dr. Lisa Moone 2017)
Ideals vs. Realities: Interdisciplinary vs. Multidisciplinary
Health Care
Conceptual Framework of Multi/Interdisciplinary Collaboration
Islamic Scholars vs. Mental Health Specialists?
Transmitted vs. Empirical knowledge
Understanding ethico-legal issues in Islam:
Is the issue manṣūṣ ʿalayh (explicit in religious texts)?
Is the issue mujtahad fīh (contentious)?
Is the issue one of certainty (qatʿ) or ẓann (probability)?
Multidisciplinary Working Group
Academic psychotherapists
Mental health practitioners
Islamic theological and juridical theorists
Imams and chaplains
Khalil Center’s Approach to Effective Collaboration
Intradisciplinarity
From communication to appreciation to education
Diverse advisory board
Leadership outreach
Religious consultation department
Education
Theologian Training:
1-week chaplaincy intensive (Hartford Seminary, Online)
Muslim Mental Health First-responder Certification
Community workshops
Undergraduate and graduate internships
Therapist Training:
Clinical graduate internships (future APA approval)
Affiliation with Islamic colleges
Personal and spiritual development mandates
Mandated Islamic studies for therapists
Khalil Center’s Approach to Effective Collaboration
Crossdisciplinarity and Multidisciplinarity
From communication to appreciation to education
Cooperative research and co-authored papers
Didactic trainings
Interdepartmental collaborative care
Appreciation
Service Delivery: Religious consultation services
Therapists
Theological, legal, and ethical consultations
Standards of practice documentation
Clients
Affirmation from religious authority
Validation of therapist’s spiritual/behavioral recommendations
Legal liability (taklīf) issues related to ritual law
From Multidisciplinary to Interdisciplinary
1. Creation of a common language, borrowing of concepts and methods
2. Problem-oriented multidisciplinary collaboration between therapists, academic psychologists, religious consultants, and academic theologians
3. Defining boundaries of expertise and increasing unification through testing integrated interventions
4. Emergence of a new inter-discipline (TIIP)
Case Study 1
Client background:
Unmarried middle-aged female physician
Referred to religious consultant by KC therapist
Father resides abroad with step-mother and son from second marriage
Client’s mother died when a teenager. Felt step-mother was taking advantage of father to now paint her in a negative light and take advantage of her finances
Client suffers from excessive guilt, particularly for not wanting to maintain relationship and support father financially
Challenges
Full history was neither presented through therapist nor through a single session
Therapist, however, was able to provide assessment and concerns, and indicated towards abuse in client’s early life
Temptation to follow a script without empathic listening
Client lead consultant in direction of issue of rights of parents rather than rights of children
Long history of abuse of father, physical and mental, shared only after multiple sessions
Client sought clear answers, even lecturing. Needed empathy first.
Case Study 2
Client background:
21 yr old male, religious family, socially active
Self-reported: PTSD, anxiety, and panic attacks
Medications: discontinued anxiety medications
Not seeing a KC therapist, but frustrated with past experiences with psychiatrists
Self-medicating with marijuana, which began using recreationally
Hospitalized once. Arrested for assaulting family member.
Referred to KC through religious consultant
Client concerns
Client’s parents requested religious consultation to convince son of impermissibility of marijuana consumption
Client convinced of the permissibility of marijuana consumption, particularly due to their condition
Client claims marijuana consumption calms his nerves and helps with his anxiety
Client claims medication prescribed for him has not worked. In fact, side effects make him feel worse
Client believes his personal research online has sufficiently convinced him that there is nothing impermissible with his marijuana consumption
Collaboration Benefits
Consultant recommended multiple sessions to allow client to have privacy
Consultant arranged separate sessions with parents and son
After multiple sessions with client, consultant recommended sessions with therapist
Therapist and consultant collaborated on researching the Islamic and medical views on marijuana consumption for people suffering from anxiety, depression, and PTSD
Client only satisfied after therapist’s medical journal, peer-reviewed research was presented to client
Case Study 3
Client's Diagnosis:
PTSD, generalized anxiety, and depression (on psychiatric medications)
Background:
Married convert (4 years) with negative past experiences with religious legal consultation (suspects opinion was harsh)
Dizziness & fainting when fasting
Increased anxiety last two years when fasting. Anti-anxiety medication increases difficulty in waking for pre-fast meal
Intermittent and unpredictable back pain requiring immediate pain medication
Was recently in car accident, adding to her physical and psychological symptoms
Counselor Concerns
Studies mostly described fasting (no food just liquids or simple fruits for 2 to 7 days) as enhancing mood and vigilance. Does not mimic Ramadan fasting exactly.
Only one study refers to Ramadan, which fasting in depressed clients, but noted their depression was very low to start with and they started restricting intake 3 months before. Difficult to generalize the data on people with more severe/acute symptoms.
Counselor reports potential bias with convert clients, with counselors trying to make things easy for them. Counselor is concerned that she may want to tell her not to fast to make things easy for her.
From client’s prior reports and with her pre-existing condition, counselor believes it is obvious that fasting physiologically and psychologically triggers some of her symptoms and increases her suffering.
Counselor Concerns
Counselor also agrees the her symptoms based on the nature of her illness are real for her (e.g. catastrophizing, etc…), although we might understand how and why they happen
clinically, but for the patient, this is a real feeling that they don't have control over.
Not sure how or if fasting is the direct cause of the heightened level of symptoms in Ramadan. Throughout the year, client’s symptoms fluctuate. However, from her past experience in 2 previous Ramadans (with lots of distress in her life in general), her symptoms got worse with fasting. I am little hesitant on why or how this is connected to fasting.
She received a fatwa in 2014 to not fast and to give a kaffārah ($300) to feed the poor. She is considered poor herself, and is on Khalil Center's Zakat program so she can't afford giving the kaffārah.
Legally Applicable Factors
Sorting through potential legal factors:
Mental incapacity (from depression or anxiety)?
New Muslim?
Marriage
Harm (physical or mental?)
Significant harm (ḍarar)
Loss of life, limb
Exacerbation or elongation of illness
Criteria for Permissibility of Prohibited Substances in Medication
Necessity
Absence of permissible alternatives
Certain of satisfactory knowledge that treatment is effective
Religious Consultant’s Conclusion
Per the specialist’s assessment, the physical as well as psychological symptoms appear severe enough to mandate an exemption from fasting on the basis of the legal principle of avoidance of harm (ḍarar), until such time that the client recovers and is able to make up for such fasts. The make-up fasts are to be performed as soon as possible after recovery. Although no kaffārah is obligatory, a fidyah may become mandated for the client if the illness becomes prolonged without hope for recovery.