Crossing boundaries between psychiatry, religion and society
Driss Moussaoui, a Moroccan psychiatrist, is a man with a mission: improving the mental health of his patients and of society at large. Being sensitive to people’s religious beliefs is imperative, he says in an interview with Annemarie van Sandwijk.
Moussaoui started studying medicine by chance, but felt he was particularly attracted to specialize in psychiatry. After graduating at the Hôpital Sainte Anne/Université Paris René Descartes at the age of 29, he started working as a psychiatrist in Casablanca in 1979. At that time he was the only public psychiatrist active in an area covering four cities with five million people. In the same year, he founded the Ibn Rushd University Psychiatric Centre in Casablanca, which he directed until 2013.
This centre, of course, does not bear the name of the well-known 12th century Muslim scholar by chance. Indeed, Ibn Rushd’s treatises about medicine, among which his famous medical encyclopedia Kulliyat (“Generalities”, translated in Latin as Colliget), were solidly grounded in Hippocratic medicine, Moussaoui emphasises – as were the ideas of Ibn Rushd’s Muslim contemporaries, including Ibn Zuhr, Ibn Tufayl, and, somewhat earlier, Ibn Sina.
Their work had nothing to do with traditional healing, or to what Moussaoui would rather call “traditional practices in health care,” as he does not see much healing in them. “If the Prophet would have been alive today, he would have gone to the best specialists in medicine, and not to traditional healers,” he says with historical reference to the Prophet’s advice to the people around him to visit
Al-Harith ibn Kaladah in case of illness, an Arab physician who was trained in Persia.
An eclectic psychiatrist
Moussaoui is a fan of the bio-psycho-social model in psychiatry, in which different approaches interact. Because culture is part of people’s social environment, psychiatry must take it into account, as well as its component religion, he says. “If we dismiss our patients’ religious background and beliefs as less or even irrelevant, we hamper the doctor-patient relation and provide our patients with less good care.”
The Moroccan psychiatrist has conducted several studies on the relation between religion and mental health in a Muslim context. He has repeatedly stressed the importance of being sensitive to the religious experiences and interpretations of psychiatric patients. This does not only imply that psychiatrists should be knowledgeable concerning the religious backgrounds of their patients; they should also be able to find ways to speak their patients’ &ldquldquo;religious” language by including religious references in their communication. Moussaoui has been quite creative in mastering this specific skill, especially when it comes to addressing patients who believe they are possessed by invisible spirits (jinns).
The concept of being possessed by living, invisible beings is often put forward by Muslim patients and their families as an explanation for several mental disorders, including hallucinations, epileptic and neurotic fits, nightmares, and manic episodes. Although the notion of jinn is clearly mentioned in the Quran, Moussaoui stresses that it existed long before the arrival of Islam.
In any case, for many Muslim people not to believe in the power of jinn would be to shed doubt on the word of God. The traditional treatment would be to read the Quran, to visit tombs of saints, and to refrain from taking medication.
Moussaoui has found an innovative way to address the issue of jinn, which he calls his personal ijtihad (independent reasoning) as a psychiatrist. Instead of maintaining the supernatural approach as the dominant explanation, he suggests an alternative interpretation to his patients:
“According to the Quran, jinns are indeed living, invisible beings,” he confirms his patients to begin with. “They can be good or bad, and they may enter the body, which is a kind of possession.” “To me”, he continues, “that sounds just like microbes, bacteria, and viruses entering the body. They can be friends or enemies. The enemies need treatment – medical treatment.”
To reinforce this interpretation, Moussaoui often tells his patients about an episode in the life of the Prophet Muhammad:
“One day, the Prophet was with his followers, and they had a small bowl with water inside. And the Prophet said: ‘please cover it, as jinn might enter it, and it will become impossible to drink.’ You cannot imagine a living being of 5 or 6 metres jumping into a small bowl, can you?” Moussaoui says to his patients.
His patients initially react a bit surprised, but in the end most of them smile and accept their psychiatrist’s interpretation, and they start talking about other aspects of the illness: symptoms, diagnosis, family and social aspects, and – last but not least – adequate treatment.
Ramadan and mental health
As a response to bipolar patients who ask if they can fast without harming their health, Driss Moussaoui – together with Nadia Kadri and Siham Eddahby – conducted two studies on the impact of Ramadan on patients with a bipolar disorder (1 - 1,5% of the total population worldwide). In earlier studies, it had already been clearly and scientifically reported that during fasting, several disturbances of people’s biological rhythm related to sleep, food intake and physical activity occur.
In their research on the impact of Ramadan on bipolar patients, it was found that the relapse rate among bipolar fasters was no less than 42%. Moussaoui therefore recommends bipolar patients not to fast during Ramadan, and to maintain their usual day-and-night rhythm.
Another way to improve mental health are Moussaoui’s efforts to reduce the age of Moroccan boys’ circumcision. In Morocco, boys are usually circumcised when they are between 3 and 10 years of age. Nadia Kadri and Driss Moussaoui conducted a study that showed that age was positively correlated with higher mental disturbances in sleep (insomnia, nightmares) and behavior (anxiety, level of stress). He therefore strongly recommends to have little boys circumcised when they are 7-8 days. To strengthen this recommendation, Moussaoui, again, refers to the Prophet Muhammad, who circumcised his two grandsons Hassan and Hussein when they were 8 days, which is also the age at which Muslims in the Middle East usually circumcise their boys.
Engaged with society
With his extensive research and years of clinical practice experience in hand, Moussaoui has been fighting a laudable battle for a mentally healthier society, not only as a researcher and psychiatrist, but very much also in society at large. From my conversation with him, I get the impression that although traditions may seem persistent in Morocco, things are definitely changing in the medical community, as a start for a change in the entire country.
Peter J. Verhagen, Herman M. Van Praag, Juan J. López-Ibor, John L. Cox and Driss Moussaoui (eds.), Religion and Psychiatry. Beyond Boundaries (Wiley-Blackwell, 2010). Online available here.
Driss Moussaoui delivered the LUCIS annual lecture on 12 April 2016. Read about his lecture here.