YJHM: Nurdeen Deuraseh, "Physical Medicine and Spiritual Medicine in Islam: An Interweaving"

The term “Health” has been defined by the World Health Organization (WHO) as a state of complete physical, mental and social well-being. This included two major aspects namely mental health and physical health. The former is known in Islamic medical literature, as al-Tibb al-Ruhani or Tibb al-Qalb, while the latter is known as Tibb al-Jasad or Tibb al-Jismani. It is not possible to separate spiritual medicine from physical medicine (al-tibb al-jismani) since man’s construction is from both soul and body. In other words, there is a symbiotic relationship between the two kinds of medical knowledge, as one would find it impossible to achieve one form of medical science without the other. For this reason, Muslims should be fully aware of spiritual and physical medicine because, in Islam, the breath and the body, the soul and matter, the faith and the world have been accorded equal importance. One is able to obtain the happiness in this world and in the hereafter as long as he is physically and spiritually healthy, and it can be achieved by the art of medicine, which preserves and restores the health.

In the mid-decades of the tenth century, the spiritual and physical medicines for the first time began to associate in the real sense and from then on the science of medicine-concerned spirit and physic of human being became a crucial factor in preventive medicine and healing of disease. At this time, Abu Zayd Al-Balkhi (d. 322/934) wrote an important psychological book entitled Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul). As a brilliant Muslim whose psychiatric contributions needed more than ten centuries to be appreciated, he, for the first time, successfully discussed simultaneously and comprehensively on both the body and the soul, together with the diseases to which they are subject, in one volume. Al-Balkhi (d. 322/934) argued that since man’s construction is from both his soul and his body, therefore, human existence cannot be healthy without the ishtibak (interweaving or entangling) of soul and body. For this reason, al-Balkhi criticized medical doctors who only concentrated on physical illnesses but neglected psychological aspects or mental illnesses of the patients. This is because, according to al-Balkhi, if the body gets sick the nafs loses much of its cognitive and comprehensive ability and fails to enjoy desirous aspects of the life. If the nafs gets sick, the body may also find no joy in life and may eventually develop a physical illness. Hence, the psychological condition is considered one of the main factors for physical health. Subsequently, when a man’s psyche becomes strong, the bodily nature is also strengthened because the two cooperate in repelling and overcoming diseases.

In discussing psychosomatic aspects, al-Balkhi (d. 322/934) recognized that the body and the soul have the possibility to be healthy or sick, balanced or imbalanced. Imbalance of the body is like fevers, headaches and other physical illnesses, while that of the soul is like anger, anxiety, sadness and similar symptoms. While al-Balkhi (d. 322/934) accurately observed that the former diseases, physical diseases, should be treated through medical methods involving the use of drugs or surgery, he nevertheless, encouraged one to use psychological treatments. This is because in seeking treatment for diseases of the body, the patients bear the bitterness of medications, the suffering of cauterization, surgery, as well as, spending large sums of money for medical treatment and care. On the other hand, the care and refinement of the soul which is far more important, is more pleasant and rewarding and less costly to treat and restore. This idea, in fact, is in harmony with what the Prophet (s.a.w) said: “Verily Allah does not consider your appearances or your wealth in (appraising you) but He considers your hearts and your deeds.” Again the Prophet (s.a.w) said: taqwa is right here, taqwa is right here, and he pointed to his chest.”

In order to establish that spiritual and physical medicines are closely interwoven, many Muslim psychologists pay attention to al-huzn (sadness) and considered as one of the most disturbing problems in human life. Al-Balkhi (d. 322/934), like other Muslim psychologists, observed that al-huzn, sadness or depression, is one of the spiritual diseases caused by loss of loved ones, personal belongings or failure to obtain what one is looking for or wish to possess. Before al-Balkhi (d. 322/934) turned to the question of how to cure this spiritual disease, he felt that it was necessary to point out two types of al-huzn, sadness or depression. The first is referred to as al-huzn, which is clearly known by reason, i.e., the loss of a loved relative, bankruptcy or loss of something the depressed person values greatly. It follows that if the cause of sadness was understood, then cures could be found. Since, everyone faces this kind of problem, al-Balkhi (d. 322/934) suggested that if one cannot obtain what he or she wishes, then, they must correct their negative behavior in order to be free from sadness, worries and fears. Furthermore, one has to beautify one’s self with good behavior as well as with contentment that lead to a life which is free from sadness and worries. In addition, one has to train one’s self in the right way so that the pursuit of contentment and the enjoyment of spiritual happiness become an ingrained habit and an acquired feature. Al-Balkhi (d. 322/934) says:

The second type of al-huzn (sadness), which according to al-Balkhi (d. 322/934) related to physical medicine, is caused by no known reasons. It is a sudden affliction of sorrow and distress (ghummah), which persists all the time, preventing the afflicted person from physical activity or from showing any happiness or enjoying any of the pleasures (shahwah). According to al-Balkhi, this type of huzn, with no known reasons, is caused by bodily symptoms such as impurity of the blood and other changes in it. Thus, its treatment is a physical medical method, which aims at purifying the blood. In relation to this `Ali b. al-`Abbas al-Majusi (d.383/994), a well-known medical physician, in his Kamil al-Sina`ah al-Tibiyyah, pointed out the relations between certain psychological events and physiological changes in the body which in turn affect both physical and mental health. He advised that a person who has this kind of huzn, has to cure it as soon as it occurs because such bad condition can negatively affect the body’s temperaments which may cause injury to the health. He argued that the health of people is based on the way they express and direct their emotions. For example, pleasant and peaceful feelings can be regarded as means for well-being, and with disturbing emotional impulse such as sadness, worry, fear and anger, people inherit sickly constitutions and death. In other words, those who resist anger and control themselves against sadness, worry and similar injurious habits by balanced mental power are able to preserve their good mental exercising and physical health. This shows that joy and contentment can bring a better living status to many who would otherwise be sick and miserable due to unnecessary sadness, fear, worry and anxiety.

As we pointed out before, in order to preserve human's spiritual and physical health, one is advised to use psychological methods of treatment notably by strengthening spiritual and psychic powers of man, i.e., by listening good music and creating an environment that makes one happy and pleasant. In talking about music, Al-Balkhi (d. 322/934) was of the opinion that music beautifies and refreshes the soul and the body. The best part of singing is, of course, the melodious recital of the Qur’an because, apart from the beauty of its words, the soul and the body benefit from its lofty ideas. It is in this sense that there are a number of ahadith exhorting the faithful to visit the sick and give them hope and comfort. According to one tradition, whenever the Prophet (s.a.w) visited a sick person, he would say: “No fear, it (illness) is a catharsis, God willing.” It is from this teaching that people visiting the sick are asked to say such things to them as would make them happy. The Prophet (s.a.w) also encouraged visitors to request the sick person to pray for them because the state of the sick and the helpless are so pure that God hear their prayers. So, not only should the healthy pray for the recovery of the sick, but the sick may be profitably requested to do so for the healthy. This has a great psychological effect on the sick person. The sick Muslim is not a person receiving punishment but on the contrary, he receives blessings and reward for all aspects of his sufferings if he faces the problem with patience and confidence in what Allah (s.w.t) has determined for him. To take care of the patient who is sick, al-Balkhi (d. 322/934) recommended psychological therapy, which brings about pleasure and happiness. He says, as for psychological therapy, help should be limited to bringing about happiness and pleasure through friendly companionship, pleasing conversation and other activities, which may stimulate a depressed person to reduce his suffering such as by listening to music.

Although Al-Tibb al-Ruhani concerns mainly with spiritual and psychological health, however, spiritual medicine cannot be separated completely from physical medicine (al-tibb al-jismani) since man’s construction is from both the soul and the body. As a medical doctor, he should concentrate on both physical illnesses as well as spiritual illnesses of the patient. This is because, good health does not only results through the balance of air, earth, fire and water, embodying the four qualities of hot, cold, dry and wet, and disease is a deviation from the normal state of those elements of the body, but a good health also results from the balance of spirituality, emotion and mentality.

Mitzi Waltz, ed., Webster’s New World Medical Dictionary (New York: IDG Books Worldwide, Inc., 2000), 173. According to Galen (130-200 C.E), health is the condition, which has the right mixture of the homogeneous parts of the body, and the right proportion of the heterogeneous parts. Specifically, it is the right measure of hot, cold, wet, and dry, and, with regard to the heterogeneous members, the right composition in size, quality, and form. By following Galenic medical system, Ibn Sina (d. 428/1037) and other Muslim physicians divided the science of medicine into two parts, theoretical and practical medicine. The latter is divided into two. One of these is called preservation of health and the other is therapeutics. The former being concerned to maintain, while the latter to modify the condition of the body. See, Galen, “On the Sects for Beginners,” trans. Richard Walzer and Michael Frede, in Three Treatises on the Nature of Science (Indiana: Hackett Publishing Company, 1985), 3; Ibn Sina, al-Qanun fi al-Tibb, 3 vols., ed. Edwad al-Qash and ‘Ali Zai‘ud (Beirut: Mu’asasah Ezzuddin li al-Tiba‘ah wa al-Nashr, 1993), 1: 13-14.

In the introduction of his commentary of Sahih al-Bukhari of Kitab al-Tibb, Ibn Hajar al-`Asqalani (773–852/1372-1449) divided the science of medicine into two types namely Tibb Jasad (physical medicine) and Tibb Qalb (spiritual medicine). Ibn Hajar praised the value and usefulness of medicine, and stresses the primary importance of Tibb al-Jasad and Tibb al-Qalb because they are associated. In trying to reconstruct an aspect of the Greek medicine, we found another division of medicine given by Ibn Ahmad al-`Ayni, in his introduction to Umdah al-Qari Sharh Sahih al-Bukhari. He divided the science of medicine into two main parts namely the theoretical (al-`ilm) and the practical science (al-`amal). The former, according to him, is the true knowledge of the intended subject in the mind of mankind by which it can administer and put into practice (ma`rifah haqiqah al-maqsud wahuwa maudu` fi al-fikr al-ladhi yakunu bihi al-tadbir) and the latter is the external part of the subject in human’s mind by which man is able to put into practice directly either through the sense or hand (surgery) (khuruj dhalik al-maudu fi al-fikr ila al-mubashirah bi al-hiss wa al-amal bi al-yadd). To give further explanation, Ibn al-Ayni asserted that the theoretical medicine comprised of three major branches. Firstly, al-`ilm bi al-umur al-tabi`ah (the science of natural affairs), that concerned with the functioning of structures, organs, and parts of the human body viewed as a living organism. It also included the science of anatomy. Secondly, al-ilm bi al-umur al-lati laysat bi tabi`ah (the science of non natural affairs). This idea, which was originally introduced by Greek medical doctors, most notably Hipocrates and Galen, was known in Greaco Islamic system as al-darurah al-sitta and later known as sex res non naturals in Latin. Non-natural affairs referred to the necessary elements for survival and yet they were not natural or to the extent that they can be in some sense manipulated by humans in order to prevent and treat diseases. These six necessary factors for the preservation of health were air, movement and rest, food and drink, sleeping and waking, retention and excretion, which include bathing, defecation, urination and coitus. The third type of theoretical medicine is known as al-ilm bi al-umur al-kharijah an al-amr al-tabi`ah (things outside nature). It is rather unfortunate that we know so little about this because Ibn al-Ayni did not explain what he means by al-ilmu bi al-umur al-karijah an al-amr al-tabi`ah. However, it would be easy to interpret it correctly, if we refer to the hadith of Prophet Muhammad (s.a.w) who said: “Truly, in the body there is a morsel of flesh, and when it is corrupt the body is corrupt, and when it is sound the body is sound. Truly, it is the qalb (heart). The hadith implies that when there is equilibrium in the nature of the body with the nature of heart, the body stays healthy. When equilibrium is lost, things become contra-natural and disease is produced. The previous discussion as has been mentioned is theoretical aspect of medicine. Having known theory alone would not permit physician to interpret medical science correctly. Thus, we see that Ibn al-`Ayni emphasized that a physician should master the second kind of medicine that is known as al-`amal (practical science). This is related to practical medicine that comprised of two braches namely preventive medicine (hifz al-Sihhah) and therapeutic (ilm al-ilaj) medicine.The former, hifz al-sihhah), is preventing and preserving the state of the body in its nature, the state in which human beings function normally and in sound and perfect condition: in healthy body, mind and spirit. It is generally acknowledged that hifz al-sihhah is the most important branch of Islamic medicine since it is primarily concerned with the prevention and preservation of health rather than with cure.

Al-Balkhi has divided his Masalih al-Abdan wa al-Anfus into eight chapters. Chapter one is an introductory remark concerning the importance of sustaining the health of the nafs (soul); chapter two is on mental hygiene; chapter three is titled “How to regain one’s mental health if one loses it.” Chapter four titled “A statement about psychological symptoms and their classification.” Chapter five is entitled “How to manage anger and get rid of its symptoms.” Chapter six entitled “How to tranquilize fear and panic (taskin al-khawf wa al-faz`). Chapter seven entitled “Getting rid of sadness and severe depression. And lastly chapter eight on “Ways of fighting obsessions and the harmful inner speech of the nafs.” For a brief analysis of this book, see Malik Badri, “Abu Zayd al-Balkhi: A Genius Whose Psychiatric Contributions Needed More than Ten Centuries to be Appreciated,” in Malaysian Journal of Psychiatry 6, no. 2 (1998): 48-53.

Ahmad b. Hambal, al-Musnad, hadith no. 8707.In dealing with spiritual or mental health, the Qur’an mentioned three components that are directly related with mental health. They are nafs (psyche); qalb (heart) and `aql (mind). (see, Ibn Manzur, Lisan al-`Arab, 6vols. (Cairo: Dar al-Ma`arif, n.d), s.v. “q-l-b,” 5: 3713-5 and “n-f-s,” 6: 4500-4; Hanna E. Kassim, A Concordance of the Qur’an (Berkerly: University of California Press, 1983), s.v. “n-f-s” and “q-l-b,” 825-30, 903-6 respectively). It should be, however, noted that the nafs (psyche) does not mean ruh (spirit), for spirit does not constitute the personality component, but it refers to the power of various passions or lusts and instincts inherent in the individual which always urge him to satisfy them. It is true that the word nafs is used in some Qur’anic verses to mean spirit i.e., ruh but this usage always depends on the context. Similarly, the qalb (the heart), in psychological context, is not meant to be an organ on the left side of the human chest, but the sophisticated cognitive and perceptive part which has many interrelated functions and unique characteristics as clearly described by the Prophet (s.a.w): “Truly, in the body there is a morsel of flesh, and when it is corrupt the body is corrupt, and when it is sound the body is sound. Truly, it is the qalb (heart).” (see, Bukhari, SahihBukhari, Kitab al-Iman,Bab Fadl man Istabra’ li dinihi). Furthermore, Allah (s.w.t) says: “fi qulubihim marad (in their hearts is a disease).” (Al-Baqarah (2): 10). From these, we understand that, the diseases of the heart do not referred to physical diseases, but spiritual. According to Ibn al-Qayyim (d. 750/1350), the diseases of the heart refer to the situation when one is in doubt of the Oneness of Allah (s.w.t). Then, when the diseases of the heart are combined together with the diseases of the nafs, they become the major impediment for the development of a normal personality. (see, Ibn al-Qayyim, Tibb al-Qulub (Kuwait: Dar al-Da`wah li al-Nashr wa al-Tawzi`, 1990), 63-64). It seems from these explanations that the relation of the organic heart to the moral heart is like the relation of the mind to the brain. Every human being has a brain but minds differ from one another because of the differences in the use and development of mental faculties. The same is true of the heart. Everyone has a heart but individuals vary because everyone differs from others in using his emotional, sentimental and perceptive powers in developing his personality.

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