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• Primary Prevention
Primary prevention is the prevention of a specific undesirable state, whether it is a state of disturbed feelings, a state of disturbed thoughts, a reaction pattern that is undesirable, a
Stress reaction, a formal illness or a disease state (Freedman, 1980).
Robert (1970) has suggested that “prevention” is the removal of the noxious agent, strengthening host resistance and preventing contact between the agent and the host. Elaine Cummings (1968), in this respect, suggested two approaches: to find out the causes of the phenomenon and to remove the cause and to discover the characteristics of immune populations, through epidemiological research and find methods to get other at-risk populations to resemble immune populations (Freedman, 1980).
Although the bases of the above suggestions are acceptable, in the field of mental health, i.e. prevention of psychiatric diseases and especially the reactive manifestations, we confront a great deal of problems. First of all, the removal of noxious agents depends on many factors.
Let us begin with the anxiety state and neurotic depressions, the most common symptoms in the world. These two mutual symptoms are fundamental modes of response in the normal adaptation to environmental circumstances. The stresses that help in producing anxiety and reactive depression may be many and various. The stresses may be external or internal, but usually both are combined. The symptoms, indeed, may arise as much from the personality and special meaning of stresses for the individual as from the actual situation (Curran, 1965).
Then, how should we remove the stressful life events, and how can we prevent contact between stressful life events and the individual? According to Islam, man is responsible for his voluntary behavior, so he can and should prevent voluntary stressful life events. According to the Islamic principles, preventing and eradicating the main source and cause of involvement should be considered in primary prevention strategies. I will mention some of these preventive strategies in personality disorders, alcoholism and drug dependence.
By very extensive and repetitive teachings, Islam has clarified the duties and rights of everyone. Every human being is responsible to God for considering and observing these instructions and behaving according to the principle of the unity of God, i.e. to use the Divine instructions as a model for everyday practice of life .Over all, man is responsible for arranging and programming his activities according to the Divine laws.
Islam has a very special instructive plan for every basic circle (system) of human life, i.e. family circle (system), occupational circle (system), the circle (system) of friendly and group relationships, the relations between the human being and nature, the political circle (system), and the relationship between man and his Creator (Divine system). (Ref. Diag. 2)
Islam’s Prophet teaches that:
O, slaves of Allah, you are as patients, and the Lord of the World as a physician.
The well-being of a patient is due to the knowledge of the physician and his policy, not due to the desires of the patient and what he likes. So, do surrender to the commands of God in order to gain prosperity.F1
Consequently, Islam teaches us to control our instincts and desires and not to relax them; and it considers this control of instincts as a criterion of mental health.
According to Imam Ali:
The authority of passions (instincts) is like fatal calamities and the best remedy is to resist them. When wisdom is developing, passion will diminish. In one who overcomes his passions, wisdom will appear.F2
So, instincts should be under the supervision of conscience and free will as well.
Conscience, which has been defined as a natural and non-acquisition power and called in Arabic “Fetrat”, is responsible in preventing human beings from lapsing in conduct.
The complete teachings and instructions in Islam, either the fundamentals of ideology and laws, or moral suggestions and ethics of this redeemable school, can and should be considered as effective instruments and measures to fortify the conscience and free will in order to control the instincts and human desires. The overall teachings and educations by this strategy facilitate the development of human beings and prevent him from lapsing in conduct.
These teachings, which are quite popular, can adjust personal and social life processes .So one is responsible for considering and using these rules which have been suggested by his Creator to facilitate safety for himself and social aspects of life.
Of course, we can compare the lives of true Muslims with others through research, and it is a wide field for the future. But it is conceivable that these rules will have their automatic preventive results, if people consider their rights and duties according to the Divine laws and they act accordingly. With respect to these approaches, Islam’s Prophet defines a Muslim as follows:
A Muslim is one who is secure in his actions and speech (Thoughts).F3
Consider, if one’s deeds and thoughts are proper, can he not prevent voluntary stressful life events, and remove the causes of many reactive psychiatric disorders whose causes are voluntary stresses in inter-individual relationships?
In order to prevent extravagant reactions to involuntary life events, such as natural calamities and catastrophes, wars, etc., we can also use the Islamic instructions as an instrument to increase psychic capacity and change the meaning of the accidents.
All accidents and involuntary stressful life events have special meanings in Islam.
According to Islam, all accidents are trials to discover and present man’s initiatives. So he is responsible for enduring them, and to consider that his situation of development will be arranged according to his approaches to the events. Thus, no accident should be considered as an occasional event.
According to the Qur’an:
No affliction befalls, except it be by the leave of God. Whosoever believes in God, He will guide his heart, and God has knowledge of everything. (Mutual Disillusion: 11)F4 or:
And we try you with evil and with good for a testing. (The Prophets: 35)F5
Or:
Your wealth and your children are only a trial, whereas Allah with him is an imminent reward. (Mutual Disillusion: 15)F6
Or:
Blessed is He in Whose hand is the sovereignty, and He is powerful over all things who hath created life and death that He might try you, which of you is best in conduct; and He is the Almighty, the All-Forgiving. (The Kingdom: 1-2)F7
Or:
Do men reckon that they will be left (at ease) because they say: We believe, and will not be tried with affliction?
Lo, We certainly tried those who were before them (you). (The Spider: 2-3)F8
Or:
And surely We shall try you with something of fear and hunger and loss of wealth and lives and crops: Yet give glad tidings unto the steadfast, who when they are visited by a misfortune say: Lo, surely we belong to Allah, and Lo, unto Him we are returning.
(The Cow: 155-156)F9
Sometimes, these trials and ordeals are instruments for punishment in order that the individual might compensate himself. According to the Qur’an:
And we seized them with distress and adversity in order that they might grow humble.(Cattle: 42)F10
So, a true Muslim will never be pessimistic due to stressful life events; and considers himself as completely dependent upon God, in whom he believes and considers Him as his guide, director and supporter. According to the Qur’an:
Say: Nothing will befall us save that which Allah has decreed for us. He is our patron; and in Allah let believers rely and put their trust. (Repentance: 51)F11
Or:
Allah is the protector of the believers. (The Cow: 257)F12
Oh Men, you are the ones that have need of God; and Allah is He the All-sufficient, the owner of praise. (The Creator: 15)F13
Islam considers the world as a place in which the difficulties and calamities are natural ones of its components. According to the Qur’an:
Certainly we have created man in distress. (The City:4)F14
By this very realistic teaching, man should expect difficulties and sufferings, and should be ready to solve and endure them. This principle will increase the rate of individual tolerance against stressful life events by assuming the difficulties to be world-wide, and not to be his exclusive and allocated problems.
As we mentioned before, according to the Islamic laws a Muslim is not allowed to harm himself or others, so any drug which would harm any aspect of man is forbidden.
According to the Qur’an:
Who slays a soul, not to retaliate for a soul slain, nor for corruption done in the land, shall be as if he had slain mankind altogether; and whose gives life to a soul , shall be as if he had given life to mankind. (The Table : 32)F15
Or:
And whose slays a believer willfully, his recompense is Hell (Jahanna), there in dwelling forever, and God will be wroth with his mighty chastisement. (Women: 93)F16
The subject of retaliation has been produced as an instrument for continuing human life; so it prevents murder and harm to others.
To prevent sexual deviation, Islam suggests, encourages and facilitates the marriage procedure. It has forbidden other sexual experiences. This approach has been supported by moral instructions and legal punishments as well.
The Islamic laws have forbidden drugs which cause disturbances in inhibitory system of the brain and make the user unrealistic. Alcoholic beverages have been forbidden, too, because of the above reasons. In accordance with these legal regulations, there are many moral teachings which increase disgust against these drugs and alcoholic beverages. One of these teachings considers alcoholic beverages unclean.
Thus, as in the case of any other uncleanness, one is supposed to avoid, in order to be able to fulfill his religious duties. Alcoholism, however, has never been a great problem in our country, although there have always been hands at work to tempt our people to drink.
After the Islamic Revolution, all factories which produced alcoholic beverages changed to medical-alcohol or non-alcoholic beverage producers. All bars and those shops which sold alcoholic beverages were closed. The Islamic laws which suggested whipping wine drinkers were put into practice, and hard punishment was approved for the peddlers of drugs and/or the users.
In order to compare the prevalence of drug dependence and alcoholism among the students of the Islamic Republic of Iran, we chose 311 students of Mashhad University as a random sample; and we used the World Health Organization Questionnaire to Survey the Use of Drugs and Alcoholism in Youth. Thirteen percent of the students were chosen at random for opium derivations. The results were then compared with the prevalence of alcoholism and drug dependence in the students of several Western and Asian countries. The data which we collected showed that the prevalence of alcoholism and drug dependence among Iranian students is approximately zero. Although it may be necessary to survey the same study in different parts of the country, since the result is very much striking and there is not much difference in the various cities of our country, the result may be roughly generalized; and one can assume that this is the trend of alcoholism and drug dependence in all Iranian universities. The results show a significant and meaningful difference between our culture and other places mentioned above (the detail of this study will be published in the future issues of the Journal of
Fundamentals of Mental Health).
• Discussion and conclusions
Now that we have reached the end of our debate, what lessons and results can be drawn from it? Although we should consider research activities in the field of neurochemistry, we are supposed to consider the ecological factors, which sometimes intervene in psychiatric disorders by changing the environment or the patient’s approach to stressful life events.
The life style of the individual and population is quite important in this respect.
So, the Islamic instructions which cover the style of life of about 1,000,000,000 of the world’s population should be evaluated.
Islam confirms scientific activities and research, and considers these methods as very essential and indispensable procedures for which every Muslim is responsible. In addition to this approach, it has special theoretical and practical methods for prevention of diseases generally, and for psychiatric disease particularly. These methods are more or less used by the Islamic population; but even more instructions are necessary in this field. We can see the results more clearly in an educated Islamic population and well-trained Muslims. It may be assumed that the approach which makes everyone responsible in taking part in preventive methods of disease is the more striking policy of Islam in this field. If we consider the extension of these teachings among the population and more supportive ways in the fields of ethics and legacy, the applicability of this strategy would be more clear.
In conclusion, when reality testing is not disturbed, the individual is responsible for his behavior .In this case, preventive methods have been severely supported by sanctions. These methods are not considered only in suggestion, and every one is responsible in following them up; and in case of neglect, he will be punished by legal authorities .We can mention this trend in murder. There are warnings and threats about the otherworldly punishments which have been fixed by God.
For example, as we mentioned before, according to the Qur’an: Suicide in all cases and murder without God’s permission are synonymous with killing all human beings, and they shall dwell forever in Hell (Jahanna).
These instructions have great affects, even on laymen Muslims. We are repeatedly told by our clients, that if God had not forbidden suicide, they would have already committed it.
We can see effective Islamic laws with the above strategy in the realms of alcoholism, drug addiction, homosexuality in both sexes, masturbation, violation of the rights of others, homicide, cruelty to the family or others and even to animals, etc. which should be studied from the mental health view.
All these teachings which have been put on a logical basis have been confirmed by the Islamic laws “to prevent any probable harm and no one is allowed to harm himself or others”.
Finally, in conclusion, we can say that according to Islam preventive methods of disease is considered a duty for which the whole population is responsible. Of course, repeated teachings and instructions can help to give more insight and warning to the population, and that is our duty.
References
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Al-Harrani: Tohafol-oghool. Eslamiye Pub., 1400 Hej., p. 45
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Amodi: Ghorarol-Hekam, vol. 2. Tehran University Press, 1981, p. 22
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Curran D and Partridge M: Psychological Medicine. Livingston, 1965
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Glorious Qur’an: Interpreted by Arthur J. Arberry. Center of the Islamic Studies
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Gross, Mayor, Slater E. and Rother M: Clinical Psychiatry. Billoiere, 1970, pp. 85-102
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Holy Qur’an (The): English translation by M.H. Shakir. Muslimgroup
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Hosseini S.A: Fundamentals of mental health, vol. 1. Mashhad UniversityPress, 1981
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Hosseini, S.A: Fundamentals of mental health, vol. 2. Mashhad UniversityPub., 1982
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Hosseini S.A: An elementary study on the principles of individual and group psychotherapy and mental health in Islam. Indian J Psychiatry (1983), 25(4), 335-337
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Kaplan H, Freedman A and Sadock B: Comprehensive textbook of psychiatry. Williams and Wilkins, 1980, pp. 546-47, 2859-2867, 2860- 2862
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Majmoii Varram, pp. 117
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Makarem: Al-Ghavaedol-Fegh-hiya. Sadr Pub., 1382 Hej., pp. 22-101
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