Muslim psychologists and psychiatrists recently published an eye-opening book titled Applying Islamic Principles to Clinical Mental Health Care. I had learned about Dr. Rania Awaad and her work in mental health at a talk hosted by Salaam Islamic Center. She is a Clinical Associate Professor of Psychiatry at the Stanford University School of Medicine and the Director of the Muslim Mental Health Lab. Discussing how traditional Islamic texts meet with the modern disciplines of psychology and psychiatry, Dr. Awaad uses the “biopsychosocial” approach; she claims that psychology, mental health, spirituality, and religion cannot be separated. As someone who shares the same understanding, I was deeply impressed with her and her team's clinical treatment methods and their new book. It is a book about introducing Traditional Islamically Integrated Psychotherapy (TIIP), which is the culminating result of the Khalil Center's research.

I attach importance to this book because I truly believe in the power of holistic approaches to healing. I am also involved in the Association for Psychological and Spiritual Sciences (APSS), which is similar to the Khalil Center because it also encourages psychologists, psychiatrists, students of medicine, theologians, and researchers of human sciences to discuss and conduct studies to solve many problems of individuals and societies. Additionally, the APSS mirrors the Khalil Center due to its similar work of analyzing conceptual religious and spiritual sources of oriental history with an emphasis on Sufism. Thus, predominantly Islamic sources are discussed to develop universally applicable theories, concepts, and therapeutic strategies.

Two halves of a coin

The recently published book, Applying Islamic Principles to Clinical Mental Health Care, is built upon three profound principles. First, researchers combed through traditional and foundational Islamic texts, such as the holy Qur’an, sayings of the Prophet Muhammad (hadith), actions of the Prophet (sunnah), and other general Islamic guidelines for spiritual and material well-being. Then, this well-established and prosperous literature review was evaluated, and then combined, with modern psychology. Last but not least, practical methods were then synthesized by using traditional Islamic literature in the psychology field and current modern psychotherapy techniques.

The book delivers a detailed and lucid account of the differences between the approaches utilized by modern psychiatry and the TIIP. Contemporary psychiatry is largely based upon “The Diagnostic and Statistical Manual of Mental disorders” (DSM) and “The International Classification of Disorders,” (ICD) which are used for diagnosing mental disorders. The TIIP utilizes these texts and the vast amount of clinical research that they possess, but on the other hand it also takes the Qur’an, hadith, sunnah, and other Islamic spiritual traditions into consideration. The critical difference in between the two is that the TIIP advocates for a more holistic approach to mental health that includes a person’s spiritual well-being, while modern psychiatry does not consider a person’s spiritual pathological character in order for them to require clinical treatment. 

The TIIP's perspective is that the concept of health and pathology cannot be adequately addressed with current clinical diagnoses. According to Islam, proper psycho-spiritual health is heavily associated with each person achieving a strong understanding of their own unique ethereal purpose, and the proper treatments for gaining and maintaining psycho-spiritual health can be achieved through training. For instance, a person that suffers from an abundance of arrogance, which negatively affects various aspects of their life, does not require modern psychiatric clinical treatment. Since arrogance is mentioned as a spiritual disease in Islamic sources, a TIIP practitioner addresses this condition with a psycho-spiritual integrative approach.

The APSS explains this concept in more detail by arguing that the human being is a vast, profound, and complicated creation that longs for a sense of eternity, permanence, understanding behind creation and life, and connection to one’s Creator. Spiritual health is seen to be equally important as one’s physical and mental health since neglecting one’s spiritual health can have adverse consequences upon many facets of a person’s life. Thus, eternal satisfaction may be gained via spiritual contentment. 

Furthermore, these techniques are not exclusive only to Muslims despite their backing in Islamic theology; they could be applied to non-religious and religious individuals alike, regardless of their belief system, since Islam aims to take a holistic look at life in a way that everyone can relate to in some form.

Our “inner senses” cannot be ignored

Humans have external senses and internal senses. External senses include sight, hearing, smell, taste, and touch, and we communicate with the external world via these senses. On the other hand, internal senses are spiritual senses and are used to communicate with the inner world. They include metaphysical concepts such as the spiritual heart (qalb), soul (ruh), and different modes of cognition (sır), (hafi), and (ahfa), and much more. They are the separate depth of the heart. Humans have a wide range of uses for internal dynamics and mechanisms, and our internal and external senses should work together like two wings on a bird. Just like how we take vitamins to strengthen our physical body, we strengthen our spiritual “body” by honing our inner senses.

All of the chapters of the book are very intriguing, and it has a compelling and inspiring effect on readers to understand and apply TIIP practices. For instance, the whole chapter about “Intellect” and its methodization in Islamic Psychotherapy is remarkable. One of the most impressive indications is that the word “intellect,” which is mentioned about 50 times in the Qur’an and across various hadiths, is referred to the link between intellect and well-being. Thus, the importance of the mind is explained through a different lens. Cognitive-behavioral therapy (CBT) looks at our thoughts, feelings, and the roles that they have when it comes to how they affect our behavior. There is a direct correlation in between our thoughts, emotional health, mental wellbeing, and then our actions. The book refers to the writings of Islamic philosopher, jurist, and mystic Abu Hamid al-Ghazali and his modality in Islamic literature. Al-Ghazali offered to implement interventions among stages by addressing faulty thoughts, negative feelings, and actions. For instance, the Islamic ablution, which is often performed once before each of the five daily prayers, is given as an example during two of the stages. Those interventions would help change the focus on faulty thought and shift the state of emotion.

While the TIIP discusses the intellect it also includes three stages of “self” (nafs); the evil commanding lower self and the animalistic impulses (nafs ammarah), self-criticizing blaming stages (nafs lawwamah), and tranquil stage (nafs mutma’innah). These stages are interpreted as the spiritual elevation of the human spirit. A TIIP practitioner aims to achieve a tranquil stage for the client. TIIP gradually works with cognitive science by identifying and challenging a person’s faulty thought and then reconstructing situations, thoughts, and feelings. 

The seven stages of thought progression

In addition to the book's description of intellect, the APSS mentions seven stages of the mind's metacognitive dimensions and functioning system that are important information processing steps.

The first one is “imagination” (tahayyul); in this stage, false thoughts occur. The mind starts overreacting by imagining false thoughts, such as worrying about getting sick due to Covid-19 even if a person is self-quarantined and has almost no chance of getting it. In this phase, negative thoughts and apprehension happen. Then, the “envisage” (tasawwur) stage comes. Thoughts are conceptualized and shaped in this stage. An individual could start believing, or perhaps even convince themselves, that they have contracted the virus if they are constantly being exposed to negative news surrounding it. When both the imagination and envisage phases activate then thoughts start to attack an individual’s inner world. Toxic thoughts can begin entering the brain and can wreak havoc on a person in the form of abnormal behavior, anxiety, stress, and obsessive thoughts.

The fourth stage is “comprehending” (ta’aqqul), which also assess our thoughts with the goal of more clearly understanding them. Then, the “approval” (tasdiq) stage comes, and in this stage individuals understand and confirm positive thoughts in their heart. The next stage is foresight (iz’an) which starts where individuals begin to understand themselves very well and act according to their understanding. Next is favoring (iltizam). The last stage is faith (i’tikad), which involves having sincere belief, firmness, and not hesitating to act upon what a person believes to be right. The first two stages, imagination and envisage, compose the thought process and the outcomes of this process. To change faulty thoughts, individuals need to consciously intervene upon the first and second steps by “getting rid of habits.” Directly attacking the source of these negative thoughts allows a person to begin to change their faulty thinking processes. One should start with staying abstinent from being exposed to too much unhelpful information. Habits always need to be replaced in order to fill the void that is consequently made, and it is therefore recommended to engage in otherwise beneficial activities, such as reading the holy book, praying, spending time outside, engaging with people that bring joy and positive emotions, or pursuing a subject or hobby of interest.

Applying Islamic Principles to Clinical Mental Health Care: Introducing TIIP qualifies as a bedside book that every professional working with the Muslim population should read. The book structurally clarifies and demonstrates how Traditional Islamically Integrated Psychotherapy is utilized in therapy by discussing an overview of modern psychology and the traditional Islamic bibliography. Case examples are spectacularly and elaborately explained. After reading the whole concept and its case studies, readers will find answers to their questions. Whether the readers are an emotionally focused therapist, a cognitive-behavioral therapist, a behavioral therapist, or a spiritual therapy practitioner, they will benefit from this book. The book covers all four approaches under the “Treatment of the Domains of the Human Psyche” part. Therapeutic interventions can be practically implemented.