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RELIGION AND SPIRITUALITY

RELIGION and SPIRITUALITY

Psychiatry and Islam

Saxby Pridmore and Mohamed Iqbal Pasha

Objective:

To explore psychiatry in Islam, with a view to informingWestern psychiatrists working with Islamic patients, and Islamic medicalstudents studying in Western countries.

Methods:

The first necessary step was to acquire some understanding ofIslam, Sharia and Sharia law, as the basis on which the available psychiat-ric literature was considered. Standard textbooks on Islam and English-language papers in the psychiatric literature were examined. Discussionswith knowledgeable Muslim people were conducted.

Results:

Islam shares roots with the other Abrahamic, monotheistic reli-gions: Judaism and Christianity. A central issues is unity: the unity of God,unity with God and unity within the Islamic community. Islam is more thana religion, because it informs all aspects of behaviour and has been describedas a comprehensive way of life. Individualism is less important than thewelfare of the community. The Sharia is a list of rules and regulationsderived from authentic sources. Psychiatric services in Islam, according toWestern standards, are somewhat limited. This issue is being addressedthrough epidemiological studies, provision of new services and policy devel-opment. Although mental health legislation is not universal, forensic psychi-atry has a role, in many ways similar to that in the West.

Conclusion:

Islam is based on unity and core values of compassion,justice and benevolence. Islamic psychiatry has a proud early history, andadvances are occurring. There is an opportunity for the profession of psychi-atry to bridge religious, ethnic and cultural boundaries.

Key words:

forensic psychiatry, Islam, psychiatry, Sharia.

he aim of the present paper is to explore psychiatry in Islam.Such an exploration may inform psychiatrists working in Westerncountries with Islamic patients, Western psychiatrists travelling to

Islamic countries, and Islamic medical students studying in Westerncountries. Like any important issue, the role of the psychiatrist in Islamcan be understood only in context.

HISTORY AND PRINCIPLES

Islam is the religion whose founder is the Prophet, Mohammed. AMuslim is an adherent of the Islamic religion. Muslims represent themajority population in 56 countries, and form more than one-fifth(1.2 billion) of the world population.

The Christian, Jewish and Islamic religions have the same roots and moresimilarities than differences. All believe in one (monotheistic) and thesame God/Allah. All believe in the prophets Abraham and Moses.

Abraham and his wife Sarah lived in Canaan (Palestine) and were childless.When it seemed that Abraham would not have an heir, Sarah suggested heattempt to procreate with her servant, Hagar. This union produced a boywho was called Ishmael. Sarah then became pregnant herself, and gavebirth to Isaac. Sarah became concerned that, as the first born, Ishmaelwould be the prime inheritor and eclipse her own son. Accordingly, Sarahprevailed on Abraham to send Hagar and Ishmael away. This happened,and Hagar and Ishmael went to a location at or near where Mecca

Saxby Pridmore

Clinical Professor, Discipline of Psychiatry, University of Tasmania, Hobart, Tas., Australia.

Mohamed Iqbal Pasha

Psychiatrist in private practice, Melbourne, Vic., Australia.

Correspondence

: Professor Saxby Pridmore, 67 Davey Street, Hobart, Tas. 7000, Australia.Email: spridmore@iprimus.com.au

T

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currently stands. The descendants of Isaac became theHebrew tribes who became Jews and the descendantsof Ishmael became the Muslims. Abraham is promi-nent in the Old Testament (Christian scripture); thus,these are the three Abrahamic religions.

Muslims also believe in Adam, David, Solomon, Noahand John the Baptist. They believe in angels, heavenand hell, and the Day of Judgement. They believethat Jesus will return to Jerusalem prior to the Day ofJudgement. They believe that Mary (who is men-tioned more times in the Koran than the New Test-ament) had a virgin conception. They believe herpregnancy was a miracle, but not that Jesus was theson of God. They believe in large passages of theTorah (Jewish scripture) and the Old Testament.

Muslims believe that God revealed himself to Mosesand Jesus, and that the Jews and Christians receiveda perfectly valid revelation, but that they deviatedfrom the teachings. Some extant Moslem scholarsbelieve that other people such as the Hindus andBuddhists have received their message from the samedivine source.

1

In the centuries following the time of Jesus, in whatis now Saudi Arabia, there had been the continuationof polytheism (belief in more than one god) andreversion to tribal practices. In this setting Moham-mad was born, in 570

CE

.

Mohammad was an illiterate member of a low-prestige tribe, but a respected and capable trader. Hewas in the habit of meditating in a desert cave nearMecca. At 40 years of age, he began to hear the wordsof Allah, which were transmitted to him through thearchangel Gabriel. This continued for 23 years untilhis death in 632

CE

. He remembered and recitedthese words to others who wrote them down, soforming the Koran (recitation), the Islamic scripture.Mohammad was neither the author nor the editor,but the messenger. He is for Islam the most importantprophet and inspired interpreter of the word of Allah,and the Perfect Man.

The Koran is 114 chapters, mostly arranged in order oflength, the longest first. The early chapters cover manypages in English script, the late chapters less than one.

The Koran is a reminder, not a revelation of newtruths. A central message is that submission to theone god results in peace. The primary act of faith is toimplement Allahs will in both private and public life.The Koran informs that responsibility to the Islamiccommunity (united by the belief in one god) is ofcentral importance, overriding other social, tribal,ethnic and national ties. This increases the opportu-nity for living according to Allahs will, and decreasesthe likelihood of fighting. As the building block ofcommunity, the importance of the family is empha-sized. The integration of the whole of life in a unified

community gives believers intimations of the Unitywhich is God.

1

Critics point to the disadvantages of Islamic womenand claim evidence of a cruel religion. This is adiscussion beyond the scope of the present paper.However, defenders point to Koranic passages pro-moting peace and justice, the prevention of harm andthe protection of the disadvantaged.

Islam is a comprehensive way of life. Muslims believethat religion cannot be separated from social andpolitical life, because religion informs every action aperson takes. Many passages of the Koran support astrong relationship between Islam, the state and soci-ety. Thus, the secularization of the state as exists in theWest is considered incompatible with Islam, and is notdesired by a significant proportion of Islamic people.

Sharia means the path, and refers to the path thatMuslims should follow. Sharia is a set of regulations,principles and values from which Islamic legislationand law are drawn. It is a guide to every action, anddivides them into five divisions: obligatory, meritori-ous, permissible, reprehensible and forbidden.

In a setting of political unrest and disenchantmentwith leaders, Abu Hanifah (699767

CE

) began col-lecting information leading to the formulation of theSharia. Thus, this legal system began as a protestmovement, an attempt to rebuild society and estab-lish compassion and social justice.

Sharia law provides the guidelines and requirementsfor two types of interactions: those between humansand Allah (worship); and those between humans (socialtransactions). Classical Sharia manuals are divided intofour sets of laws concerned with worship, commercialdealings, marriage and divorce, and penal laws.

The are four main roots or sources of Sharia.

(1)The Koran details the manner in which Allahshould be worshipped, but is not a comprehensivecode of law. It sets out general and ethical prin-ciples that guide all aspects of Islamic life. It doesprovide rules on a range of matters includingmodesty, marriage, divorce, inheritance, intoxi-cants, gambling, feuding, diet, theft, murder andadultery. Certain crimes (

hudud

) are listed, alongwith the appropriate punishments. However, itdoes not help with a range of other issues. Accord-ingly, because Mohammed was considered thePerfect Man and the most inspired interpreter ofthe Koran, his behaviour and utterances are takenas additional source information.

(2)The Sunna includes all the known sayings andactions of Mohammed, his decisions, and hisresponses to life situations and to philosophicaland legal questions. Six collections of Sunna thatwere written in the 9th and 10th centuries areaccepted as authoritative.

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(3)Analogy (

qiya

) is a source of rules, when directinstruction cannot be found in the Koran or theSunna. For example, the Koran forbids the use ofwine, because of the threat intoxication poses tothe Islamic community. By analogy, the use of anyintoxicant is banned.

(4)Consensus (

ijma

) among scholars may also be takenas law. Ijma follows from Mohammeds statement,My community will never agree on an error,which is taken to mean that if all agreed, a lawcould be safely made.

Sharia law is unique in that the texts are of divinerather than of human origin, and substantial partsof it can never be modified. However, independentconscience and reasoning (

ijtihad

) has been used tomake law. Ijtihad has, at times, been acceptable onlyto a proportion of Islam.

Differences exist between the major law schools, ref-lecting the diverse geographical, social, historical andcultural contexts in which the respective jurists werewriting. For example, the Shii, an influential minority(who believe that succession to the political and reli-gious leadership of the community should be hereditarythrough Mohammads daughter, Fatima) accept theKoran, Sunna and their recollections of Ali (Moham-mads cousin and son-in-law) and other authority fig-ures. The Sunni, the majority of Muslims (who believethat succession to leadership should belong to the mostqualified and pious person, and not blood relationship)do not hold Ali in the same regard. Nevertheless, thereis close agreement on Sharia across Islam.

There are two groups of crime/punishment. Thehudud, mentioned earlier, are specific crimes, whichare considered attacks against Allah and social order.They attract specific hudud punishments such asstoning, flogging and amputation, as described in theKoran (see later). The other group is the

tazir

, whichattract punishments such as imprisonment and fines,as decided by a judge (

qadi

).

The Western media has made mention of blood-money, amputation and stoning. The judicial systemsand the relative importance placed on the differentroots of Sharia vary throughout Islam. Blood-moneyis compensation paid by a murderer or his/her familyto the family of murdered individuals, and is listed inthe Koran. Supporters state that this mechanismovercomes the need for capital punishment, does notinjure the perpetrators family in the same way as dothe alternatives, reduces the need for expensive pris-ons and gives something back to the surviving rela-tives. Amputation of the hand of the thief is a matterof debate. Some translations of the Koran (5:38) stateonly that the hand is cut or marked and notremoved. The most commonly available English-language translation of the Koran in Australia, how-ever, does use the words cut off. The principle of

compensation also applies in theft, and if the thiefcan provide goods or undertake work for the victim,this course may be taken. Stoning to death has beenconsidered a punishment for married adulterers.However, on this point there is a difference betweenthe Koran and the Sunna (example set by Moham-mad). The Koran (24:2) makes no mention of stoning,but states that the appropriate punishment is 100strokes of a whip in public. The public nature of thewhipping is to shame the offender, and provide anexample to the audience. The strokes may be appliedsymbolically. Stoning appears in the Sunna literatureand was ordered by Mohammad in adultery. This isone of the relatively rare instances of disagreementbetween the Koran and the Sunna, and is the cause ofmuch discussion.

3

Sharia law has been replaced in part, in most of Islam,by the impositions of colonialists. Saudi Arabiaapplies the most pure form. In Egypt, the majority ofMuslims would like to see Sharia as the law of theland, whereas in Turkey (the first and only state inthe Islamic world to claim secularism), only 3% areof this view.

1

Nasr believes there is a desire by themajority of Muslims to preserve their religious andcultural identity, to reapply the Divine Law that wasreplaced by European legal codes .

2

Commonly,states embrace a combination of Western and Sharialaw, a weird mixture of medieval family law and analien commercial and civil law.

3

COMMON FEATURES OF ISLAMIC CULTURE

Culture is influenced by history, place and time.Although different groups experience different influ-ences, Islamic cultures around the world share com-mon features. These include the following: (i) familyinterdependence and loyalty are strongly encouraged;(ii) societies are mainly patriarchal and hierarchaland keenly support deference to authority; (iii) theseare relatively collectivistic societies in which theindividuals behaviour is determined more by norms,roles and goals of their collective, than by personalattitudes, perceived rights and dislikes; and (iv) tradi-tional values are emphasized in favour of socialconstancy, and cultural change is perceived as threat.

MENTAL HEALTH AND SERVICES IN ISLAMIC SOCIETIES

The first psychiatric hospitals of the world wereprobably built in Arab cities: Baghdad in 705

CE

,Cairo in 800

CE

and Damascus in 1270

CE

.

4

In Turkey,special psychiatric wards were built onto a generalhospital in 1555 and a specific psychiatric hospitalwas built in 1583.

5

The great Muslim physiciansinclude al-Razi (d. 925) who wrote a 24-volumeencyclopedia of medicine and who treated psychiat-ric patients, and Ibn Sina (Avicenna; d 1037) who

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wrote the 14-volume

The Cannons of Medicine

, whichwas used in the West for 700 years. Ibn Sina rejectedthe notion that mental illness was caused by evilspirits (

jinns

).

Because there are more than 50 Islamic states, thereis no satisfactory single description of mental healthservices possible. Little English language informationis available. The first modern psychiatric hospital inthe Middle East was the Roozbeh Psychiatric Hospital,in Tehran, Iran, which opened in 1937 and whichwas staffed by two European trained psychiatrists.

In some Islamic states, the promise suggested by theauspicious beginnings, mentioned earlier, have notpersisted. In Saudi Arabia, the popular view is thatmental illness is the punishment of Allah or inflictedby evil spirits. There are some regions providingadvanced treatments but other treatments include cau-terization, beatings and exorcism.

6

Before 1950 therewere no proper arrangements for mentally ill patients,and they were warehoused in residential houses. Thefirst modern psychiatric hospital in Saudi Arabia wasbuilt in 1962.

7

The picture is similar in Pakistan, wherethe majority believe mental illness is caused bydemonic possession. Patients are still kept in bondage chained, beaten, parts of their bodies burnt.

8

Murad and Gordon, however, report that Psychiatryin contemporary Arab societies is well established.

4

Malaysia is pushing ahead with major policy reformin mental health, including mental health legislationand attention to the quality of services.

9

Mentalhealth services in Egypt are receiving active atten-tion.

10

Lebanon prepared a national mental pro-gramme in 1987, but progress has been slow.

11

Thereare two large mental hospitals, which are full tocapacity most of the time, and only 1.2 psychiatristsper 100 000 population. Kuwait and Bahrain hadlarge custodial hospitals that have, to a large extent,been replaced by more progressive psychiatric serv-ices. Qatar (population 500 000) has never had adedicated psychiatric hospital and services have beenprovided through psychiatric wards attached to gen-eral hospitals.

12

Iran (population 60 million) has a range of psy-chiatric services and a dozen universities graduate50 psychiatrists each year. A recent Iranian study,which sampled 35 000 individuals, found the preva-lence of mental disorders to be compatible withinternational studies.

13

A World Health Organization(WHO) study of depression in different culturesaround the world showed the clinical features ofpatients in Tehran to be similar to those elsewhere.

14

Post-traumatic stress disorder has been reported insurvivors of the IranIraq war

15

and in response to theBam earthquake.

16

In Malaysia, depression and anxiety commonlypresent as somatic symptoms. Obsessivecompulsive

disorder is most frequently associated with religiousrituals and observances.

17

In the Arab Gulf communi-ties, somatization and dissociative symptoms arecommon psychiatric conditions,

18

and in Saudi Ara-bia, Munchausens syndrome by proxy is probablythe leading form of child abuse.

19

Drug and alcohol use are offences that attract severepunishments. The Koran proscribes 80 lashes, towhich may be added penalties determined by localauthorities, but charges rarely proceed against thosewho seek help. Severe punishments exist for dealersand distributors. Specialized hospitals and services forthe treatment of substance and alcohol addiction canbe found in Saudi Arabia

6

and Iran.

20

Suicide is a crime under Islamic law and attempts maylead to prosecution. Nevertheless, it remains a majorproblem for Turkey,

21

Uzbekistan

22

and other centralAsian countries.

23,24

The suicide of a young Muslimwas reported in Australia.

25

The authors observed thatthe family was rejected by the local Islamic commu-nity because of the stigma associated with this event.

Malaysia, Egypt, Iran and many other Islamic stateshave active university departments of psychiatry thatprovide high-quality inpatient and outpatient serv-ices to mentally ill and substance-addicted persons.In Iraq, medical ethics is a prominent subject at theUniversity of Basra.

26

FORENSIC PSYCHIATRY IN ISLAM

Again, the large number of Islamic states and the verylimited amount of English-language information makesa comprehensive statement difficult. Kutaiba Chalebyhas provided the first English-language monograph onforensic psychiatry in Islamic jurisprudence.

27

Mens rea

(guilty intent) is well accepted as necessaryfor guilt, and there is no crime where there is nointention. The Prophet Mohammed regarded theyoung, the sleeping person and the insane as beingfree of guilt for acts they may commit. In the West itwas not until the 15th century that the first insanityacquittal was recorded; Islamic law was dealing withthe issue in the 7th and 8th centuries.

27

Insanity(

junun

) in Islamic law is determined by the court onpsychiatric advice.

4

Insanity has not been univer-sally defined, but generally it takes the form ofimpairment of the mind, where it prevents actionand speech from operating on reason, except rarely.In Turkey, when a significant psychiatric disorderis believed to have contributed to the commission ofa serious crime, the perpetrator is sentenced to aspecially guarded section of a mental hospital andtreated for at least 1 year.

5

Islamic law recognizes sudden perplexity (

dahish

),which may also be translated as startled or stunned.This is associated with sudden loss of reason and,according to some schools of jurisprudence, with

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respect to criminal responsibility, should be dealtwith along the same lines as insanity.

27

Competence to stand trial involves the psychiatrist.

28

Islamic justice principles hold that the defendantshould have the same access to the judge as theplaintiff, and this may be impaired by mental illness.

Most Arab countries have no mental health law as such,or they have only remnants from the colonial period.In Saudi Arabia, the mentally ill were assigned a guard-ian who had to agree to confinement or treatment.

7

Under Islamic law, dangerousness need not be amajor issue in involuntary hospitalization; theemphasis is not on protection of liberty, butthe provision of care.

27

Throughout Islamic history,the State has had the authority to take over a personsfinancial affairs under the principle of

Al-Hajjer

. Thisis relevant when the person is behaving with extremefolly (

safahah

), such as squandering money. Hajjer isdeclared by a judge if an individual is acting contraryto his own best interests, irrespective of the presenceof mental illness. However, Hajjer does not affect theindividuals ability to manage other personal affairs.If this principle is extended by analogy (

qiya

) toinvoluntary hospitalization, it can mean the involun-tary hospitalization of drug- and alcohol-addictedpersons and those with psychopathic personality.

In Turkey, it is considered that people who cannotcontrol their behaviour cannot practice their rights.Article 89 of the Turkish Civic Law states that onlypeople with reason have the right to get married.Article 112 states that if a husband or wife wassuffering from a psychiatric disorder at the time ofmarriage, the marriage can be considered invalid.These provisions are to save people from probablematerial and moral risk.

5

Islamic law, being concerned with family and com-munity, has prescriptive rules regarding inheritance.An individual can leave only one-third of his estateto interests outside his natural heirs. The law doesnot recognize a will that has been written by amentally incompetent individual. The test of mentalcompetence to make a will is yet to be fully defined.

As aforementioned, although suicide is illegal, it doesoccur. In some places, rules, regulations and hospitalpolices have been established that limit confidentiality,such that attempters can be reported to police.

28

Recentreports from Central Asia describe a harsh economicclimate and a dramatic rise in suicide. In Kyrgyzstan, aMuslim leader recently decreed that those who suicidemay receive religious rites at their burials, and thisrepresents a departure from Islamic law.

23

Although penal and commercial law have been cir-cumvented to some extent by Western thought,Islamic family law has generally remained in force.

29

In divorce, in general, Islamic law will place a child

under the age of 7 years with the mother.

28

After7 years of age, the father will have the right tocustody. There are some gender factors: a male childmay choose which parent he goes to, irrespective ofage, a female child does not have that choice. Thefather remains the guardian, wherever the child isliving. The best interests of the child are consideredand psychiatrists may be provide information on themental health of parents and the most appropriateplacement of children.

Islam very strongly supports confidentiality. Someauthorities believe that if physicians are pressured incourt to break confidentiality, they are permitted togive false testimony without being punished byAllah.

28

The Islamic legal system recognizes the princi-ple of the expert witness. However, only a Muslim cantestify in court against a Muslim defendant. and itfollows (

qiya

) that a psychiatrist should be a Muslim ifpresenting an opinion about a Muslim patient.

For centuries, the responsibilities of the physicianhave been clearly defined. Liability for malpracticeexists in a wide range of circumstances, includingintentional harm, unintentional harm, violation ofprofessional standards, ignorance, treatment withoutconsent, deception, refusal of treatment, and breachof confidentiality.

27

DISCUSSION

Islam is the predominant religion in more than 50non-English speaking states, and encompasses manydifferent ethnic groups. There is a limited amount ofinformation about psychiatry in these regions in theEnglish language. The aim to examine psychiatry inIslam may therefore be considered unduly ambitious.Our approach has been to provide as comprehensivea coverage of Islam as space allows, to provide acontextual base on which the available informationon psychiatry can be laid.

There a number of points of interest. The roots ofChristianity, Judaism and Islam (the three Abrahamicreligions) are intertwined. Islam accepts much of theTorah and the Gospels, that Jesus was a true prophet,and that Mary had a miracle virgin pregnancy.

The Koran is believed to be the direct word of God/Allah, spoken to an illiterate man who recited whathe was told, in the 7th century. The Sharia (thepath) and consequent Sharia law is a set of principlesand regulations, arising from academic work, whicharose as a result of discontent with the Umayyadgovernment (661750

CE

).

30

They ruled autocraticallyand were seen to contravene the scriptures. Thus,Islamic jurisprudence began as a protest movement,a desire to return to true Islamic principles.

Central to Islam is the notion of unity. This is acomplex matter with many facets, including thatthere is only one god, and there is only one religion

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(the prophets who came before Muhammad carriedthe same message from the same god, but the messagewas unclear or lost). There should also be unitybetween all Muslims and, importantly, the believershould seek unity with Allah. Submission to and unitywith Allah will result in peace. Unity with Allah meansbehaving in the manner laid down in the Sharia. Islamtherefore is not simply a religion, but a way of life.

The quest for unity underlies many of the laws ofthe Koran. Activities that might disrupt the Islamiccommunity and the basic building block, the family,are punished. These include adultery, gambling andalcohol consumption. The shrouding of women andthe laws of inheritance also attach to preservation ofthe community and family.

Although Islam established psychiatric hospitals asearly as 705

CE

, and although at least one prominent11th century physician (Ibn Sina Avicenna, d. 1037)published important information on the nature ofpsychiatric disorders, psychiatric services in Islamicstates, by Western standards, are limited. This isbeing addressed through epidemiological studies, theprovision of new services and policy development.

Mental Health Legislation, by Western standards, isin the process of development. Nevertheless, forensicpsychiatry has a place in Islam. The ability of anindividual to stand trial is considered, and the insan-ity defense is recognized. Involuntary hospitalizationis achieved through a legal process. Here, the empha-sis is not on the protection of liberty, which isconsidered to have abandoned some needy patientsto the streets, but on the provision of care. Psychiatricopinion is sought if divorce is based on psychiatricdisorder, and psychiatrists may be involved in theassessment of children when custody is in question.

Islam was disrupted by the Crusades, colonialism,imperialism and, now, modernity and the powerfulsecular world. There is a desire held by a sizableproportion of Muslims for the retention and resusci-tation of traditional teachings and the core values ofcompassion, justice and benevolence that character-ize all world faiths, including Islam.

Like Islam, the profession of psychiatry cuts acrossethnic and national boundaries. The profession canmake a contribution to world peace through thought-ful respect, inclusion and cooperation.

ACKNOWLEDGEMENT

I am grateful to Dr S Sh Sadr, Chief of the Legal Medicine Organization of the I R Iran,for the opportunity and assistance to visit colleagues in Tehran.

REFERENCES

1. Armstrong K.

Islam: A Short History

. London: Phoenix Press, 2001.

2. Nasr S.

Islam Religion, History, and Civilization

. San Francisco: Harper, 2003.

3. Brown D.

A New Introduction to Islam

. Oxford: Blackwell Publishing, 2004.

4. Murad I, Gordon H. Psychiatry and the Palestinian population.

Psychiatric Bulletin

2002;

26

: 2830.

5. Cifter I, Kemp D, ed.

International Handbook on Mental Health Policy

. Westport, CT:Greenwood Press, 1993; 367390.

6. Alyahya F. Saudi Arabia: acknowledging problems in a transitional culture. In:Appleby L, Araya R, eds.

Mental Health Services in the Global Village

. London:Gaskell, 1991; 99108.

7. Al-Radi O. Saudi Arabia. In: Kemp D, ed.

International Handbook on Mental HealthPolicy

. Westport, CT: Greenwood Press, 1993; 353366.

8. Niaz U. Pakistan. In: Kemp D, ed.

International Handbook on Mental Health Policy

.Westport, CT: Greenwood Press, 1993; 273286.

9. Mubarak A. Malaysias social policies on mental health: a critical theory.

Journal ofHealth and Social Policy

2003;

17

: 5577.

10. Okasha A. Mental health in the Middle East: an Egyptian perspective.

ClinicalPsychology Reviews

1999;

19

: 917933.

11. Tabbara D. The Problems for mental health promotion in Lebanon.

American Journalof Health Promotion

2001;

4

. http://www.healthpromotionjournal.com/publica-tions/global/2001-11/#lebanon

12. El-Islam M. Psychiatry in Qatar.

Psychiatric Bulletin

1995;

19

: 779781.

13. Noorbala A, Bagheri Y, Yasamy M, Mohammad K. Mental heath survey of the adultpopulation in Iran.

British Journal of Psychiatry

2004;

184

: 7073.

14. Sartorius N, Davidian H, Ernberg G

et al.

Depressive Disorders in Different Cultures

.Geneva: World Health Organization, 1983.

15. Kalafee Y, Adib M. Survey of association between combat related post-traumaticstress disorder and quality of life among Iran-Iraq war veterans.

Iranian Journal ofMedical Science

2000;

25

: 147149.

16. Ahmad K. Iranian government draws up plans to rebuild Bam. Restoration of heal-care facilities is a priority for the Iranian government and international aid agencies.

Lancet

2004;

363

: 131.

17. Azhar M, Varma S. Mental illness and its treatment in Malaysia. In: Ai-Issa I, ed.

Al-Junun: Mental Illness in the Islamic World

. Madison: International UniversitiesPress, 2000; 163186.

18. El-Islam M. Arabic cultural psychiatry.

Transcultural Psychiatry Research Review

1982;

19

: 524.

19. Kattan H. Child abuse in Saudi Arabia. Report of ten cases.

Annals of Saudi Medicine

1994;

14

: 129133.

20. Assadi SM, Radgoodarzi R, Ahmadi-Abhari SS. Baclofen for maintenance treatmentof opioid dependence: a randomized double-blind placebo-controlled clinical trial.

Biomed Central Psychiatry

2003;

3

: 16.

21. Corsar B, Kocal N, Arikan Z, Isik E. Suicide attempts among Turkish psychiatricpatients.

Canadian Journal of Psychiatry

1997;

42

: 10721075.

22. Makhsumkhonov K, Giyasov A. Some forensic medical aspects of suicide. The FirstIslamic Countries Legal Medicine Congress. Tehran 2325 June, 2004, p. 68.

23. Alimov S, Baituova G, Orozobekova C.

Central Asians Driven to Despair

. RCA No. 14,2 August 2000. London: Institute of War and Peace Reporting, 2000. http://www.iwpr.net/index.pl?archive/rca/rca_200008_14_01_eng.txt

24. Yeganeh R, Rafie N, Kazemi A, Dortaj F, Ahmadi M. Ingestion of plaster: a new andstrange method of committing suicide in Lorestan province.

Iranian Journal of LegalMedicine

2003;

9

: 8589.

25. Sarfraz M, Castle D. A Muslim suicide.

Australasian Psychiatry

2002;

10

: 4849.

26. Yacoub A, Ajheel N. Teaching medical ethics in Basra: perspective of students andgraduates.

East Mediterranean Health Journal

2000;

6

: 687692.

27. Chaleby K.

Forensic Psychiatry in Islamic Jurisprudence

. Herndon, VA: InternationalInstitute of Islamic Thought, 2001.

28. Chaleby K. Issues in forensic psychiatry in Islamic jurisprudence.

Bulletin of theAmerican Academy of Psychiatry and the Law

1996;

25

: 1724.

29. Esposito J.

What Everyone Needs to Know About Islam

. New York: Oxford UniversityPress, 2002.

30. Bloom J, Blair S.

Islam: A Thousand Years of Faith and Power.

New York: TV Books,2000.