This is the second part of a talk by Shaykh Dr Asim Yusuf on approaches to depression and anxiety in Classical Islam. Here he presents the author and physician Abu Zayd Balkhi.
I want to move on to a couple of these therapists. I say therapists. That’s a Freudian slip. The first of them is called Abu Zayd Balkhi. He was a ninth century physician, so he was a doctor. He was from Afghanistan but spent most of his life in Baghdad, which was the center of the Muslim world at the time. The second is very famous: Imam Ghazali, the great Reviver of Islam, who is called the Proof of Islam.
They took different approaches to the question of mental health. I will more on Abu Zayd Balkhi because he is by far less well known, and yet what he had to say, I kid you not, it reads like a manual of psychology. Remember, we are talking about somebody who is writing 1,200 years ago, when the styles were very very different. If you read it, it is astonishing.
There was a paper published on this particular work. When it went to peer review they said: “We’re not going to approve this. We don’t believe it is genuine, because this is not written like 9th century manuscripts are written.” The reviewers then did about three or four years of background research to determine its veracity. Then they wrote back eventually to the people that wrote this paper and said: “You do realize we are going to have to rewrite the history of psychology?”
Abu Zayd Balkhi
So who is Abu Zayd? He is a polymath as many of these people were. He wrote on a whole number of different topics – religious and so forth. Primarily, however, he was a physician. His great work is called Mas’alah al Abdan wa al Anfus, which means: The ways of bringing about restoration of the body and the soul. He is unique among writers of that time.
There were many great works on medicine produced around that period, but he is unique among them in that he had a separate chapter at the end of the book specifically for psychological illnesses. And the way he approached those psychological illnesses was first to acknowledge their existence. To acknowledge that they were very important. And to bemoan the fact that many physicians of his period felt that these things did not exist. And that if they did they were just extensions of physical illnesses.
He said no this is a real thing and it needs to be tackled. One of the things I really got from reading his work was the seriousness with which he treats especially depression. He says that this is a really horrible illness. He distinguishes very clearly, very lucidly, between sadness, which he calls huzn in Arabic, and depression, which he calls jaza‘. Jaza‘ has the sense of being cut open, of being cut off from things, of pain, and of being unable to endure something.
That is the basic meaning of the word in Arabic, and he coins what in his time was a neologism for what we would now consider to be depression. Something that goes way beyond what you would expect a person who is experiencing sadness to suffer. He also distinguishes firstly in very brief form, four types of mental distress. He says there is mental distress that relates to sadness; mental distress that relates to anger; mental distress that relates to anxiety; and mental distress that relates to obsessions, or obsessive misgivings.
Within each of those categories there is a normal variant and a pathological variant. They exist on a spectrum, but at some point on the spectrum it becomes pathological. There is a way in which you approach the normal variation and a different way in which you approach the pathological variation. They require different types of treatment.
Where depression specifically was concerned he is, I think, the first person in history to distinguish between endogenous depression and reactive depression. And again he does this very, very lucidly. He said there are two types of depression. One that has a clear cause, a clear precursor: some stressor has occurred, which has caused the person to feel like this. That needs a particular type of treatment.
Supportive Therapy and Treatment
There is another, however, where there is no apparent cause. This, he says, is down to an impurity of the blood or an upset of the humors, and what it requires is “supportive psychotherapy.” His words are “to talk to someone wise and loving who can give you comfort and allow you to put things in perspective.” That is supportive psychotherapy which he distinguishes from actual psychotherapy.
Very interestingly he said the other thing that helps with this is music therapy, i.e. singing. Get the person to sing the songs they know. Songs that remind them of happier times. This is very effective. However, the primary treatment for endogenous depression, he says, is medication.
Reactive depression on the other hand requires particular forms of psychotherapy. He mentions a number of different types that we today would recognize as cognitive behavioral therapy; rational emotive therapy; reciprocal inhibition; and interpersonal therapy.
Remember, these are things that have come about in the 20th century. He is describing them in the ninth century and he describes them very cogently. As I say, it is like reading a manual written in the 20th century.
The Root of Mental Illness
He also acknowledges the root of all mental distress. He said the root of mental distress is concern about the future, which he calls anxiety. He distinguishes anxiety from what he calls terror. When he describes the symptoms of terror, he’s describing a panic attack. He says this is different from anxiety. Anxiety comes from three sources. One is internal, one is situational, and one is about your history. That is to say biological, psychological, and social.
These manifest in the disorders of which he he mentions four. He doesn’t actually talk about psychosis at all. What we would now call a manic state. I don’t know why that is. I think that and the only person that I know of in in classical Islam who mentioned what we would now consider symptoms of psychosis like hallucinations and so forth was Ibn Sina who considered them to be neurological disorders.
Abu Zayd Balkhi has this fantastic approach. One of the amazing things he does is at the beginning of his work he talks about the importance of mental health. The second chapter of his work is about mental hygiene. What he says is that everyone is going to suffer with mental distress at some point or other in their life. Some people will experience minor symptoms, some people will experience major symptoms.
There are things to do with your temperament or your upbringing and so forth that might make you vulnerable to experiencing a major episode. But everyone will experience them to some degree or another and therefore there are certain things that everybody should be doing to preserve their mental health. What he describes is what we would today, in 2017-2018, call mental health first aid.
Mental Health First Aid
This is a very, vey new concept. The idea of steps you can take yourself, that your neighbors can take, your friends can take, to help to ward off a mental health crisis, or to bring immediate relief to you in a mental health crisis. Then he also talks about preventative medicine. He says that there are certain things that we need to all be doing. One of which is effectively banking good thoughts or banking positive cognitions.
He said all mental distress ultimately comes down to negative cognitions. When you have negative cognitions you need to be able to combat them with positive cognitions. But you can’t have positive cognitions when you are in the midst of a mental health crisis. So what do is you bank them when you are calm. When everything is good in your life, think about those good things.
Remind yourself constantly about the good things, so that when you then have a negative cognition that may trigger a mental health problem, you can immediately combat it with a positive cognition. He talks about a lot about independence. About not becoming dependent on counselors, but at the same time accessing expert opinion, expert advice, and expert treatment.
Internal and External Therapy
He talks about the internal and the external. Internal therapy is what you can do yourself. External therapy is what is needs to be done for you by a practitioner: someone who is wise. Someone who is an expert, who has had dealings with this in the past. Someone who you trust and respect. That is to say, someone with whom you have a therapeutic relationship.
He says that this is because one of the first things to go when you become mentally ill is your sense of perspective and your insight. Often you will find that people do not recognize how unwell they are. That is where you need someone.
What you need is somebody who can who can intervene, but in order for them to intervene, there has to be a pre-existing relationship or there has to be an acknowledgment by that person that this is an expert. They know what they’re talking about. I really should listen to them. It shouldn’t be a family member. It needs to be – he doesn’t use the word as there was no such thing in that time – but a professional.
He ends with his discussion of depression. How serious a problem this is and how important it is that people really get a handle on it and understand it. And how a person presents in the throes of a depression. They will not look like themselves. You will look at them and sometimes, he says, they will even appear to act like a madman. You won’t recognize them. What is critical to understand is that there is a person underneath that. And we need to bring that person back. You need to work with that person to bring them back again.
Hope and Spirituality
He ends there for a very hopeful note. And hope should be the stock-in-trade of mental health practitioners. If we can’t give hope then we are not going to get very far no matter what drugs, no matter what therapy, that person goes for. Abu Zayd talks about the worst symptom of depression being helplessness and hopelessness, because once you lose hope you feel helpless.
He also mentions but doesn’t focus too much on the spiritual aspect of these conditions. You can see from everything that I’ve said so far that Abu Zayd Balkhi is approaching the question of mental illness or the question of mental distress like a physician. His focus is on symptoms, models, treatments, and so forth.
But he says that one of his points is that it is important for you internally to do this but also for the therapist to reinforce that things are really bad at the moment; things are really terrible at the moment; something really horrible has happened to you; but you’re not meant for this world. You’re meant for the Hereafter.
Seen from Eternity
Focus on that put things into that eternal perspective. When you put things in an eternal perspective they look very very different. He thereby puts into context something very important which is the notion of pathological spirituality. That is to say or think: “Bad things are happening to me because God is angry with me.” I see this quite often actually.
The idea that this is happening to me because God hates me; my child died because God hates me; or because I’ve done something wrong; this is a punishment for sins. To which the response is: So how come God did the same thing to the Prophet Muhammad, blessings and peace be upon him, who was sinless? Whom he loved.
Now if you reframe it as a test, as a trial, as an as an education, as a lesson to learn something about yourself, it is in adversity that we dig deep within ourselves and find a hidden strength that we did not know that we had. Abu Zayd Balkhi he leaves it at that but that theme is then taken up by Imam Ghazali.
This talk by Shaykh Dr Asim Yusuf was given at the Centre for the Study of Islam in the UK, Cardiff University, entitled “Approaches to Depression and Anxiety in Classical Islam.” This is not a transcript but an edited post based on the second part of the talk. The first part can be read here.