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.