An Islamic Appraisal of Minding the Gap:Psycho-Spiritual Dynamics in the Doctor-

Patient Relationship

Faiz Khan MD FACEP FAAEM FACP

• With respect to personal financial relationships, contracted research includes research funding where the institution gets the grant and manages the funds and the person is the principal or named investigator on the grant.

• Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

• The ACCME considers financial relationships to create actual conflicts of interest in CME when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The ACCME considers “content of CME about the products or services of that commercial interest” to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used.

• With respect to financial relationships with commercial interests, when a person divests themselves of a relationship it is immediately not relevant to conflicts of interest but it must be disclosed to the learners for 12 months.

• The provider collects disclosure information from all • Individuals in control of content. Those who refuse to disclose this • information are disqualified from participating. For any person • who reports a relevant financial relationship, the provider uses • a peer review process to resolve the potential conflict of • interest. For presentations that have the greatest potential for • bias, the provider asks an independent third party reviewer to • conduct a second peer review as an additional mechanism to • resolve conflicts of interest. (SCS 2.1, SCS 2.2, SCS 2.3)

disclose relevant financial relationships to me and to the learners who participate in my activities?

Disclosure Information

In compliance with the guidelines established by ACCME

I have NO actual or potential conflict of interest in relation.

I have no relevant financial interest

to this program or presentation.

Khan F, Miraculous Medical Recoveries and The Islamic Tradition, Southern Medical Journal- Feb. 2008.

Khan, Faiz, An Islamic Appraisal of Minding The Gap: Psycho-Spiritual Dynamics in the Doctor Patient Relationship – Journal of Religious Ethics, Vol. 36, March, 2008.

What do we mean by ‘gap?’

- perceived absence or alienation felt by patients within certain medical settings in addressing or exploring ‘spiritual’ concerns.

a. recurrent contact (primary care); inpatient settings (acute , critical).

- psychological impact = ‘mudhakkirs’

- ‘gap’ highlighted in the medical literature: a. feeling like doctor/team won’t care b. look down /belittle

Trauma:

Distress and need for coping

Inclination / Opening (Fath) to deeper understanding - existential crisis requiring pastoral intervention

- pastoral care departments exist for institutional settings …but is it enough?

Should it be role of clinicians in some fashion?

Is it OK if the patient view the most important player(s) in their situation as disinterested or even cynical to a deep issue?

- “spiritual distress screening tool” as part of intake protocols

a. uniform?

b. Which Psychometric measures?

Importance of terms and the clash of paradigms:

- theocentric versus theophobic (secular humanism)

- what does ‘spiritual ‘ wellness / distress mean? How is it defined? Whose job Is it to address it? How is it remedied?

- theo-phobic spirituality ?

- non-religious spirituality ?

- ecumenical theo-centricity?

It depends on what underlying assumptions we make about the nature of human existence

In the clinical context :

patient centered issue - what they feel matters most making an effort to comfort the patient in this domain is driven by reflexive self-perception

The Theocentric perspective using Islamic Terms:

Contemp english

Catholic Greek Arabic Hebrew

Spirit Spiritus Pneuma Ruh Ruoch

Psych Anima Psyche Nafs Nefesh

Body Corpus Soma Jism(Badan)

Beten

Ruh (spirit) in its qur’anic and technical usage is not an object for distress or damnation – it is a Holy Infusion and we know little of its nature…

- many sages likened it to a factor mysteriously linked to the Divine which, if we allow it to - focuses as a ‘touchstone’ of illumination and guidance (the locus of synderesis).

- to be spiritual ?

The theocentric perspective using Islamic Terms:

So the Spirit can never be in distress…spiritual distress in not a valid term.

If we fail to be guided by our Spiritual Faculty – that is a problem.

How about the term soul?

- the original term psyche did not mean the locus for mental process / mentation. The mindAnd its mental process was always a subset within the psyche.

- The nearest english equivalent to the term psyche and nafs is soul.

Contemp english

Catholic Greek Arabic Hebrew

Spirit Spiritus Pneuma Ruh Ruoch

Psych Anima Psyche Nafs Nefesh

Body Corpus Soma Jism(Badan)

Beten

So distress and problems happen at the level of the soul…and this is entirely consistentWith the qur’anic usage of the term nafs.

Contemp english

Catholic Greek Arabic Hebrew

Spirit Spiritus Pneuma Ruh Ruoch

Psych Anima Psyche Nafs Nefesh

Body Corpus Soma Jism(Badan)

Beten

So properly speaking – what we are talking about is psychological distress (Soul-logical).

The term psyche has become so dysmorphic through the ambiguity cast on it from modern speculative errors, that it has become cut-off from its metaphysical precedents.

Hence the term “Psycho-spiritual”

The theocentric perspective using Islamic Terms

Conation / Decision--net behavior- net attitude/outlook

Jism / Body-action

Mental faculty

PSYCHOLOGICAL INTEGRATION AND THE RELIGIOUS OUTLOOKRama P. Coomaraswamy, M.D.[1]

THE PROBLEMS THAT RESULT FROM LOCATING SPIRITUALITY IN THE PSYCHERama P. Coomaraswamy, MD

THE FUNDAMENTAL NATURE OF THE CONFLICT BETWEEN MODERN AND TRADITIONAL MAN – OFTEN CALLED THE CONFLICT BETWEEN SCIENCE AND FAITHRama Coomaraswamy, M.D.

THE DESACRALIZATION OF HINDUISM FOR WESTERN CONSUMPTIONRama Coomaraswamy, M.D.

ON “GURUS” AND SPIRITUAL DIRECTIONRama P. Coomaraswamy, MD

http://web.archive.org/web/20060516052244/http://www.coomaraswamy-catholic-writings.com/articles.htm

The theocentric perspective using Islamic Terms

psychological health is to possess a soul pleasing to God (implies Salvation)- oriented to ‘taqwa’ (consciousness of God and the nature of life)- cope in a certain manner (sabr…etc)

concerns about ‘psychological’ health are indeed prompted by medical conditions (balaa / museeba),

- may catalyze the orienting of an individual to seek ‘taqwa’ and its resultant nourishment

- if a patient feels open to exploring this – and a doctor’s attitude/demeanor or overt actions serves to stifle the patients inclination – that is unacceptable.

- Evangelize??

Noa. Discomfort from perceived compulsionb Violate Ultimate definition of psycho-spiritual wellness?

**what from the modern perspective qualifies as psychological health may not be reflective of psycho-spiritual health… (screening tools? )

- in coping with illness/injury : may exhibit psychological stability,/comfort but not necessarily be a sign of psycho-spiritual health:

- examples: 1. any belief system will do; 2. music/art; 3. cults; 4. abu -jahl anecdote

The theocentric perspective using Islamic Terms

- Ghaflah/delusion/heedless = psychologically anesthetized / falsely comfortable

- Qur’anic suggestions (status appears goodly….etc)

- hadith ul nasara (obstinacy leads to delusion…Damnation in serenity)

Agreed upon definition:

“ The personal quest for understanding answers to ultimate questions aboutlife, meaning, and about relationship to The Sacred or Transcendent, which may Or may not lead to, or arise from the development of religious rituals and the Formation of community.”

Koenig HG, Arch Int Med 2004 164(14)

How do we serve the psychological coping needs of patients?

heterogeneity of patient outlooks found in the US –

a. Open to formal religion b. Theo-centrically spiritual – non-affiliated c. Psychological burden relieved through other activity

- do not wish to pursue theocentric precedents – may make use of practices- formally reject existence of metaphysical precedents

Why the gap in the modern occidental world?

- The roots of western medical education –

a. tied to science

b. advent of secular humanism and scientism (versus actual science)

- theocentrism - theoreductionist - theophobia

– kick God and Ontological precedents out of the equation

What to do with concepts such as psyche, spirituality…etc?

- morph them away from their true context, precedents and implications

- Godless ethics,

- Godless rules for commerce,

- Godless ways to restore psychological and physiological health

- ….etc

- but WAIT – it seems that many patients remain regressed - they have not caught up to this ‘enlightened’ view yet, as the medical literature demonstrates.

- Calls for re-emergence for understanding this element of care…cannot separate the physiological from the psychological, and further – the psychological from the authentically spiritual.

a. A patient would like to NOT feel intimidated, belittled, or alienated by medical experience – which may include interacting with the doctor.

b. do many patients feel the therapeutic bond is enhanced by shared theo-centricity? Specific religious concordance?

So how does the secular-humanist or scientismic position view this?

a. Ethical mandate to comfort patients

- OK to support patient with whatever brand of psychological teddy bear they need if the SSRI is not working.

“don’t believe in what they believe, but I believe THAT they believe – so allow that delusion to yield psychological stability.”

Versus Theocentric:

a. Psychologically comfort patients – yes.b. Not teddy bear, has objective reality and consequences.

* sectarian?

Classical physicians were minimally conversant…

Clinical Scenarios:

1. Will you pray for me?

- analysis of resistance in discussing psycho- spiritual matters:

a. discomfortb. right to a ‘no fly zone’c. physio is my only gamed. too much time / effort

2God will take care of it…

•It’s shabbas…

•No FFP – I am a jehova’s witness

•Join us in a prayer?

Advice given to a young muslim physician:

As a physician you are a servant of God first and foremost.

-You serve God by serving and comforting the ill.

- It is sometimes not enough to restrict yourself to serving their physiologic matters only.

- At least allow them to feel comfortable in discussing spiritual matters with you.

- Pray for ALL of your patients daily…

Once you realize how hard it is to approach all of your patients withDeep caring concern, you realize how exalted Muhammad is – for to Love humanity deeplyIn all that you do is the way and station (Maqaam) of Muhammad.