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.

For this tree, the seed is intelligence, water is determination, air is patience, and effort is excitement. One thing to consider is that imagination and fantasy are not the same concept. Whereas imagination is the seed of realistic, logical plans and projects designed in accordance with long term goals regarding life and the future, fantasy involves short term projections out of proportion with reality, emotion, and rational thought. In this sense, there is no imagination that does not sprout its roots towards the goal and does not disperse the seeds of excitement to the human soul. This is because imagination is like a pile of emotions that sustain us in the years ahead. It is the energy that powers the heart, the mystery juice which injects excitement into our minds, a framework of desires that bind us to life. It helps us to believe that one man’s expectations for life are as good as his dreams; his earnings will match his excitement. Imagination and the resulting “excitement” is a great blessing that brings out treasures, love, and skills hidden inside us. Above all, imagination can help us to achieve success in all of our endeavors. This is true of science, too.

Defining scientific success can be tricky. It requires effort, hard work, and observation to achieve scientific success. But most importantly, it requires intelligence which is a blessing. Just like a licensed driver controlling a car, the brain’s performance improves with the skill of its driver. To maximize the brain’s potential, it is very important to integrate the heart and conscience with the use of intelligence.

Can we explain the reality that there is only a limited number of scientists because they were born as such or inherited this quality genetically? The reality is thousands of babies are born with brain capacities similar to that of scientists’ in terms of anatomy, histology, physiology, and biochemistry. Even though human intelligence is partly determined by inheritance, there are other factors. If the case was as simple as inheritance, would Einstein say, “I do not have any special skill, but I am passionately curious”? When Thomas Edison said, “1% of genius is inspiration and 99% is sweat,” he captured perfectly that one needs more than just intelligence to achieve success – one also needs to maximize that intelligence through hard work.

Scholar Bediuzzaman Said Nursi summarized the stages of knowledge development of the human mind in seven steps. “One first imagines something (tahayyul), then conceives of it, and clothes it in a form (tasawwur). Afterwards, one reasons and reflects on this thing (taaqqul), then confirms it (tasdiq), and then has full conviction of it (iz’an). Then they fully support it (iltizam); then they become committed or devoted to it (itiqad)” (The Words, Gleams of Truth).

Each of these stages is subject to different rulings. They form the ladder to higher meanings. Thus, if a person is unaware of the step occupied, he/she ends up remaining in the lower stages and acts according to the necessities of that particular level.

Therefore if we do not want to leave our scientific approach at the dimension of “sophistry,” which starts with imagination (tahayyul), we have to continue our intellectual and ideological journey all the way to the end. Imagination, which is often overlooked, bears the seed of intelligence, which is a blessing offered from the infinite ocean of God’s wisdom. Imagination is the unprinted photo of our intellectual aptitudes. How do you like to print and uncover your dreams?

The Qur’anic descriptions and those in the Hadith are remarkable for their accuracy in relation to what is known about the subject now. But, what was known then? Until 1688, among Muslim as well as European scientists, the Aristotelian account dominated, no one daring to question it. The two theories in Aristotle’s time were: (a) the embryo is preformed as a miniature in either the male semen or the female secretion and then grows in the womb; and (b) the embryo is actually formed and created out of the menstrual blood. Aristotle favoured the second view, adding that male semen caused the menstrual blood to coagulate, like milk curdling into cheese. The Qur’anic description tells us, by contrast, that (a) the embryo is not pre-formed but grows in successive stages (71.13-14, 23.12-14,22.5); and (b) is formed equally of male and female fluids (76.2). The relevant ahadith re-state what is in the Qur’an. Interestingly, while exegetes of Qur’an and Hadith did not fall into error in their account, many Muslim scientists and doctors, under the spell of Aristotle, repeated Aristotle’s (incorrect) view. Thus, about 700 years after the Revelation, Ibn Hajar al-Asqalani commented: ‘Many of the anatomists claim that the semen of the male has no role in creation of the baby. Its role, they claim, is limited to curdling the menstrual blood… The saying of the Prophet denies what they say. The semen of the male actually participates equally to that of the female in formation of the embryo.’

The pre-formation theory lasted in Europe into the 18th century when it was believed that a full miniature existed either in the female ovum or in the male sperm, then simply got bigger in the womb. This theory was destroyed gradually and was no longer held in any form after 1900. Von Baer (1829-37), called the ‘father of embryology’, identified the human ovum. Subdivision of the egg, i.e. growth of the embryo in successive stages, was properly demonstrated and understood in 1839 by Schwann and Schleiden. And in 1875, Hertwig described the fertilization of an egg by a sperm. Then in 1883, Von Benden showed that male and female cells contribute the same number of chromosomes to the embryo.

However, not until this century, have a number of discoveries established how and when the sex of the embryo is determined; how and when the hones and musculature, the organs of sight and hearing, the nervous system, and so on, develop. It is rather more than remarkable, therefore, that in Qur’an and Hadith we should find unmistakably accurate and detailed references to these matters.

The earliest of the successive stages of embryo development is the nutfah, in turn distinguished as male and female nutfah (in modern terminology, gamete), the two being commingled to form the nutfat amshaj (zygote). The Qur’an clearly and explicitly states (75.3(t), 53.45-6, 59. 58-9) that the sex of the embryo is carried in the fluid ejaculated by the male (X or Y chromosome in the fertilizing sperm). Also, in the Qur’an s emphasis that growth is from a lucre drop of fluid, we find a clear pointer to the fact that the spermatozoa make up a mere 0.5% of the ejaculated fluid, in which tiny quantity are carried an average 2 to 300 million individual sperms.

The nutfat amshaj (zygote) develops into ‘alaqah (that which clings) which attaches itself to the uterine wall. The stunning precision of the term ‘alaqah for the detail of how the zygote attaches, implants and is nourished in the womb, is striking in Dr Albar’s account. (For even more on the detail, see Sikander Hussain ‘Al’Alaq: the mystery explored’, Ark Journal, London, 1986, pp. 31-6.) The ‘alaqah is transformed into mudghah (chewed lump), the somite(s) from which hones and muscles are subsequently differentiated. The mudghah stage includes also the pharyngeal arches (out of which face, ear and neck are formed) – the marked indentations give the embryo the look of a ‘chewed lump’. The Qur`an’s allusion (22.5) to mukhlaqa and ghairu mukhlaqa, formed and non- formed development of the mudghah, is now readily understood as the critical period of organogenesis, when the embryo is most susceptible to factors which can cause congenital malformations. The Qur’an says (2.259): kayfa nanshuzu-ha thumma naksu-ha tahma, ‘how We erect them (the bones) then enclothe them in flesh’. Nanshuzu-ha, here inadequately rendered ‘We erect them’ is as informative as any modern textbook description, for example ‘With time a number of needle-like spicules are formed which progressively radiate from the primary ossification centres towards the periphery.’

The pre-formational aspects of embryo development are now understood as hereditary characteristics contributed by parental genes. In the Qur’an (81). 17-19), the nutfah (male and female gametes) is said to carry these predetermined characteristics. There are several ahadith confirming this reading. One, in the Sahih of Muslim, explicitly mentions 4O -42 days after fertilization as the moment when the angel enters the womb and ‘gives the nutfah its shape and form, creates its hearing and visual apparatus, builds up the hones, the muscles and forms the skin. He then asks, 0 God, is it a boy or a girl, what is its livelihood and what will be its lifespan? God gives His answer and the angel writes all that will come. ‘The textbooks tell us that ‘In the sixth week of development the Primordial germ cells invade the genital ridges; if they fail to reach the ridges, the gonads do not develop..’ The site of formation of the gonads is indicated in Qur’an 86.5-9 as ‘between the backbone and the ribs’. This is exactly right. Once formed the gonads differentiate into either male and female and make their progress in the body accordingly. Blood and nerve supply and lymph drainage remain connected, even in the adult, to the area ‘between the backbone and the ribs’.

In this review only a few of the great many correspondences between the Quranic text or ahadith and current knowledge about human embryo development have been mentioned. What is the point of noting these? Almost all of these Qur’anic verses have as their general context a reminder of the resurrection. The re-creation of individual human life after death. We are confronted with the fact of life as a stunning miracle of the Mercy and Omnipotence of the Creator. Knowledge of the successive stages of growth from the near-nothing of a spot of bodily fluid cannot but create a sense of awe at the responsibility one carries for the miracle of one’s life. And one carries it hack to Him whose care initiated, ordained, proportioned and sustained our life – the contrasted human contribution being that drop of ‘lowly fluid’. Then, what – except perversity – could allow us to doubt that the Creator has concern for how we use our lives, or doubt that He can and will bring us again to life so that we may ourselves understand fully the worth of our intentions and actions? Also, these verses, urging a meditation upon the fact of life rather than upon the fact of death, educate a positive temperament, a positive attitude. Religious responsibility can be awakened by reflecting upon the wonder of birth, as much as by reflecting upon the mystery of death.

No textbook about human embryo development can inspire reflections of this kind. Of course, it is also of the utmost importance to know that the information in the Qur’an, given in words which are extraordinarily precise and yet remain generally intelligible, is accurate. Most non-Muslims do not believe that the Qur’an is the Book of God verbatim, as Muslims believe. In trying to make sense of the phenomenon – so copiously illustrated by Dr Albar from the field of human embryology – of how so much accurate knowledge is there in the Book, they may be led to question the assurance with which they hold to their non-belief.