Spirituality and religion are key strengths in personal well-being. This holistic paradigm brings into balance all aspects of the human experience, addressing those maladies and character flaws which would otherwise be considered out-of-scope for contemporary clinical psychotherapy. The goals of this approach are not only to provide hope and relief to the care-seeker, but also to bring meaning and illuminate purpose to the particular difficulties they are experiencing in life. Muslims have historically been pioneers in this field, offering hospices and mental health care to those suffering from mental illness in a time when other civilizations were treating the mentally ill as another sort of prisoner. There is a growing body of work in spiritual psychology that showcases the wisdom of the classical Muslim scholars of spirituality and the efficacy of Islamically-integrated therapies. As exemplified by the Prophet Muhammad (pbuh), the caregiver offers their care-seeker a welcoming presence, an active listener, and a compassionate connection.
For many Muslim youth leaders, imams, and mentors, pastoral interventions are required to remedy the spiritual or mental maladies that are presented. Cognitive behavior therapy (CBT) is a useful technique for many Muslim pastoral caregivers because the “therapist” and “patient” share common core values, even if the patients come from culturally diverse backgrounds.
CBT is designed to produce changes in behavior by changing the way care-seekers process their thoughts and feelings about particular triggering events. In order to do this, the caregiver models the problematic behavior in the following “A-B-C” pattern: an activating event (“A”) leads to a behavior or set of beliefs (“B”), which then results in an emotional disturbance consequence (“C”). The caregiver’s task is to help the care-seeker detect, dispute, and discriminate (“D”) the self-defeating, dysfunctional, or irrational beliefs (“B”) that lead to the emotional disturbance. This therapeutic technique has proven effective at treating a variety of mental health diagnoses, including post-traumatic stress disorder, bi-polar disorder, generalized anxiety disorder, substance abuse, and depression. By focusing on the self-talk and presumptions that lead a care-seeker to the emotional disturbance, the Muslim pastoral caregiver can help identify this train of logic, debate with the care-seeker the validity of that logic, and redirect or offer an alternative track of thinking that avoids the undesired emotional response. It is interesting that this technique was inspired by the ancient Greek Stoic philosopher, Epictetus, who observed, “People are disturbed not by events, but by the views which they take of them.”
This is in line with classical Islamic philosophy of the soul. For example, Balkhi’s 9th century treatise: Sustenance of the Body and Soul outlines how a person’s irrational or self-defeating thoughts about a situation often turns into obsession, anxiety, and other mental debilitations. He also advised as a form of therapy that one should counter maladaptive beliefs with positive ones; the point being to choose alternative interpretations of observed events that lead to positive, self-affirming conclusions, which is basically the core goal of modern CBT. Muslim caregivers can help care-seekers explore their thoughts, actions, and attitudes and gain a full awareness of their conflicting feelings to work together to modify problematic beliefs and practices. It is eye-opening to see that the “description of obsessional disorders found in al-Balkhi’s manuscript echoes the description of Obsessive-Compulsive Disorder (OCD) found in modern diagnostic manuals of psychiatry such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).”
In addition, a comparison of Balkhi’s therapeutic interventions for managing obsessions is practically identical to modern CBT. Therefore, we see that this philosophy of treating the mind, body, and the soul as an integrated whole is not new. On the contrary, Muslim philosophers and doctors were pioneers in this area, and contemporary Muslim caregivers do not need to “start integrating” their treatments; they only need to “return to” this rich heritage of Muslim scholarship to deliver relevant pastoral care to their care-seekers.
Muslim caregivers are not only concerned with clinical pathologies and dysfunctions; they are concerned with the holistic health of those Muslims under their care. From the Islamic point of view, this means that the care-seeker’s character flaws that present “spiritual” pathologies are taken into consideration even if these flaws are not significantly impairing from a clinical perspective. This rich heritage is available for Muslim youth leaders, imams, and mentors to provide context for their care-seekers, allowing the seeker to tune into the quiet parts of their psyche, to remind themselves that everything in life happens according to a benevolent divine plan, and to balance their temperaments such that they accept themselves despite their personal imperfections and even if events do not transpire as they would prefer. Keshavarzi and Ali point out that “behaviors that may not be clinically significant according to the DSM or ICD may be seen as pathological in Islamic terms.”
This fundamental difference in definitions makes a Muslim caregiver’s task more delicate and involved with his or her Muslim care-seekers. For example, in a clinical setting, the care-seeker can only be in one of two states: clinical pathology vs. clinical health. However, in an Islamic framework, the care-seeker’s spiritual status is also factored in, so there is another axis of states: spiritual pathology vs. spiritual health. This is what is meant by an integrated or holistic approach. A simple example is that a seeker may not be clinically anxious about or obsessed with money (i.e., absence of clinical pathology) but he or she may still have a spiritual sickness of greed or avarice (i.e., presence of spiritual pathology). Another example is that of a seeker who is clinically functional (i.e., presence of clinical health) but disconnected or distant from his or her faith, family, or community (i.e., absence of spiritual health). This treatment of “character flaws” is core to the principle of holistic health, in which sound mind, body, soul, and character are incorporated into the definition of health and wellness.
For further discussion on the spiritual aspects of mental health, read this article by Yaqeen Institute.
 (Keshavarzi and Ali, Islamic Perspectives on Psychological and Spiritual Well-Being and Treatment 2019, 47)
 (Corey 2009, 300)
 (Corey 2009, 278)
 (Corey 2009, 278)
 (Corey 2009, 276)
 (Awaad and Ali, Obsessional Disorders in al-Balkhi’s 9th Century Treatise: Sustenance of the Body and Soul 2015, 188)
 (Awaad and Ali, Obsessional Disorders in al-Balkhi’s 9th Century Treatise: Sustenance of the Body and Soul 2015, 187)
 (Awaad, Mohammad, et al. 2019, 4-5)
 (Keshavarzi and Ali, Islamic Perspectives on Psychological and Spiritual Well-Being and Treatment 2019, 44)
 (Keshavarzi and Ali, Islamic Perspectives on Psychological and Spiritual Well-Being and Treatment 2019, 45)
 (Elzamzamy and Keshavarzi 2019)