The Propher MUHAMMAD's last Sermon in WORDLE format

Eastern Europe Muslims

“In East European countries like Albania, Bosnia, Kosovo and Macedonia Muslims make up the majority of populace,” Ayman Sayed Ahmad, director of Eastern Europe Department at the Federation of Islamic Organizations in Europe (FIOE), told IslamOnline.net’s visitors in a live dialogue on Thursday, February 3.

He added that in other countries such as Bulgaria, Ukraine and federal Russia Muslims are considered “influential minority communities”.

Ahmad put the number of Muslims in Eastern Europe at some 35 million, most of them natives.

Russia comes first with 21 million Muslims, followed by Bulgaria with 2.6 million, Albania with 2.4 million, Bosnia with 2.2 million and Ukraine with 2 million Muslims.

http://www.islamonline.net/English/News/2005-02/05/article05.shtml

It's one thing to create an empire, it's an entirely different thing to maintain it and administer it.
by Alexander the Great

Fiqh info

Bismillah hir-Rahman nir-Raheem
al hamdulillah Rab il alammen
Wa Salaat wa salaam ala Rahmatul lil alameen, saydina wa mawlana MUHAMMED wa ala Alihi wa sahbihi ajmaeen

I have started to restudy Fiqh again. I first studied "Nur-al-Idah" a book of hanifi Fiqh shortly after I took My shahda in Damascus almost 25 years ago. I was taught by one of the teachers in Masjid Abder-Rahman bin Abu Bakr Sidiq on Shariah Baghdad where I stayed for a while. The imam of the Masjid was Sheikh Ahmed Khorshid.
Currently I am studying Imam Akhdari's Matn of Maliki Fiqh, with a teacher at Zaytuni.
I have found a number of on-line resources for Fiqh
Some of them are as follows:

1. Talimul Haq
Talimuul Haq is a book of Hanifi Fiq used primarily with south Aisn Hanifi's in South Africa and England

A. On-Line copy of Talimul Haq found at the web site Inter-Islam.org run by Darul-Uloom, Holcombe, Bury,U.K.

B. On-line Talimul Haq found at sunnipath.com

2. Nural Idah

A. Inter-Islam also has a partial translation of Nural-Idah for the The Book of Taharah

Muslim Survival Guide: Nasiha for Muslim Men: by IMAM ZAID at ZAYTUNA INSTITUTE

Monday, May 28th, 3:00pm - 5:00pm
SPECIAL LECTURE BY IMAM ZAID AT ZAYTUNA INSTITUTE
Muslim Survival Guide: Nasiha for Muslim Men

The first of a special three-part lecture series, focused on providing essential advice and guidance in light of the unique dynamics and diverse challenges facing Muslim men striving to hold strong to their faith in today’s age.

I was blessed to attend the First part today.
These are the notes I took from todays lecture for the first part.

Imam Zaid Began with the Tahmed and Salawat and then started the lecture with quotes form two disparate sources; The first was a Hadeeth of the Prophet MUHAMMAD, Peace be upon him (SalALLAH Alayhi wa Salim) and the second was from the US Army Survival Guide.

1. The Messenger of Allah said, "The deen is nasiha (good counsel/sincere conduct). The deen is nasiha. The deen is nasiha." They asked, "To whom, Messenger of Allah?" He said, "To Allah and His Book and His Messenger and the Imams of the muslims and the common people." 1

Imam Zayid explained this was a obligation to show respect and give advice in sincerely following the guidence and example

He then quoted from the US Army Survival Guide
the need for 2 charecteristics to survice
1. The WILL to Survice and
2. Proper Planning to Survice
He went on...
"We have to want to survive. If we don't have the "Will", then our chances of survival are slim. But where do we find the "Will".
a person has to want to be a Muslim to survive as a Muslim. IF we are unsure or waver in our "will" to be a Muslim, we need to beware because there are a lot of fources and influences waiting for the opportunity to strike, to attack and to mislead. "

"There are 3 levels of Survival
Physical
Mental/Intellectual and
Spiritual"


"Where do we find the will. How do we find the will to want to be a Muslim ?
Know that ALLAH, subhan ALLAH wa Tala.
ALLAH loves those who strive for excellence.
We should not be satisfied in mediocracy, but should always strive to bring excellence to everything we do and to all 3 levels of our survival. "

Allah loves those who repent and loves those who are pure (who strive to make themselves pure)

If a Boxer know he has a wekaness, that he drops his left hand and leaves his left side and face unprotected, then he will have to work extra hard to break himself of the habit to survive in the ring. If he knows his weakness , or if his trainer knows his weakness and shows him what it is, then he will need to focus on correcting himself. Being aware of our own weaknesses in the first step in correcting ourselves. We also need to realize and know that we all fall short, we all sin, weather openly or hidden. We need to also focus on repenting (making Tauba) and correcting our behavior that caused us sin or wrong ourselves and stive for Taqwa.

Wa ALLAH yahibu As-Sabareen
ALLAH loves those who are patient

Wa ALLAH yahibu Al-Mutawakaleen
ALLAH loves those who put their entire trust in ALLAH

To be continued....

Kuran-Coran-Quran-Mustafa taskaya-(1.Bølum)-Beysehir-Konya

From "Tears for Fears" to Muslim Psychiatry

Tears for Fears' link to psychology
While listening to the song "Mad World" by "Tears for Fear" (There was a remake of the same song by Gary Jules that has a wonderful music video. This remake was originally in the Danny Darko Movie that has seen increased interest- both the movie and the song) I clicked on a link in Win Amp and discovered that they took their name from Arthur Janov's primal scream therapy
Since I am going through major personal changes, on ended up clicking link after link reading article after blog until I ended up at islamica magazine reading articles by Dr. Ibrahim Kreps of Montreal, an old aquantance I met in London back in 1985 while we both were visiting Sheikh Nazim at the Pekham Mosque in South west London, an old converted cathedral type church.
Anyway, I've posted the articles by Dr. Kreps with Links. Here are some other interesting links

1.
The Muslim Mental Health Incorporated is an organization committed to promoting research and educational activities, introducing Muslim mental health (MMH) concepts and advancing culturally sensitive therapeutic approaches.

2.
Snakes and Ladders,
Aphorisms for Modern Living


the spiritual and worldly insights of Dr. Ibrahim Kreps from 34 years of psychiatric
practice, 30 years on the spiritual path and 59 years on the path of life.
It is divided into chapters on the essential dimensions of modern living -
Psychology, Spirituality, Philosophy, Daily Living, Politics, Law and Medicine.
The structure is based on aphorisms (short statements of essential truths),
vignettes (case studies from life and from psychiatric practice) and
commentary. Through the means of aphorisms it is hoped that the reader can
gain insight into the myths and realities of modern life and in this way manage
better his own existence.


3. Wikipedia article on Dr. Arthur Janov

Dr. Arthur Janov (born August 21, 1924) is an American Clinical Psychologist, and the creator of Primal therapy.

Born in Los Angeles, he directs a Primal Center in Venice, California, USA. He is the author of ten books, including The Primal Scream, which claimed that mental illness could be eliminated by a therapy that consists of repeatedly descending into, and expressing, long-repressed childhood pain. His writings were the inspiration for the names of British pop bands Tears For Fears and Primal Scream, as well as John Lennon and Yoko Ono's 1970 Plastic Ono Band albums.

4. in the blogosphere

perplexxed :: blog ( http://perplexxed.vox.com/)

Is Marriage Sinful? Understanding Mutual Responsibilities By FARAZ RABBANI

Is Marriage Sinful?

originally published in Islamica Magazine
to subscribe, click here

Understanding Mutual Responsibilities By FARAZ RABBANI At a recent dinner invitation, I noticed that most of those present had business relationships with each other. I feared that if there wasn’t some radical intervention, the conversation would center on things like guerilla marketing and such—not my cup of tea. So I decided to say something radical, hoping to shift the flow of conversation to human relationships instead. I said, “You know, I think that it is haram for many people to marry.” Heads turned very fast. Some asked me whether I’d lost my mind. Others simply asked me what I meant. I wasn’t joking, I said. No, I was very serious. Many people fall into sin by marrying. Why? Because they enter marriage without understanding the serious responsibility that marriage entails. Then they fail to fulfill their duty as husband or wife, and end up wronging their spouse. Such failure is sinful, even if one’s spouse is similarly remiss. This returns to an important principle in the Shari‘a that hurting another is worse than hurting oneself. In fact, you have the full right to hurt yourself—in effect, you have the right to go to Hell, if you so wish. However, you have absolutely no right to hurt another—whether materially, emotionally, or in any other way. In marriages, spouses do amazing things to hurt each other, both directly and indirectly—through remissness in fulfilling their rights; and through simple inability to maintain a healthy marital relationship. So, what can be done about it? The answer to this returns to individuals, parents, and society at large. As individuals, we have to develop an understanding of the keys to healthy human relationships in general and healthy marriages in parti-cular—before and after marriage. Parents have to inculcate an understanding in their children, especially in the later teen years and after, of good character, of taking the rights of others seriously, and of how to maintain strong relationships. With that, as parents we ourselves have a duty to be examples of successful marital life for our children. In society, we have a communal responsibility to raise awareness of what is needed to make marriages work—practical manner, not just through yet more lecturing on “The Importance of Early Marriage,” because early marriage without sufficient preparedness is as likely to fail as late marriage, if not more. We need to train our community leaders, imams, and activists in marriage counseling. Seminars and programs must be held within the community for those seeking to get married and for those married. Trained counseling and suitable literature needs should be made available in accessible ways for those married, especially for those having trouble in their marriages. People have to be made aware of the (often many) resources available in the wider society on marriage. Often, Muslims are wary of going outside the community for counseling (and yet fail to find capable counseling within the community). We need develop lists of reliable counseling services—services that uphold the core marital values Muslims hold dear (and which they fear for when seeking outside counseling). Likewise, there is a lot of good literature on marriage that those marrying and married should seriously consider reading. As Dr. Ibrahim Kreps and other leading Muslim counselors concur, one of the very best books on marriage is John Gottman’s The Seven Principles for Making Marriage Work. This or similar books give practical guidance on improving marriage relationships in our times. With this, as Muslims we have to look at the radiant example of the Prophet (peace and blessings be upon him) himself. He reminded us that, “The best of you are those best to their spouses, and I am the best of you to their spouse” (Tirmidhi, on the authority of ‘A’isha, God be pleased with her)). We should look regularly and with reflection at the life and example of the Prophet (peace and blessings be upon him), as these give us beautiful examples and clear principles on how to have a successful marriage built on the Qur’anic paradigm of love and mercy, and of striving to live together with a mutual commitment to excellence in dealings. Faraz Rabbani is a researcher in Islamic law who answers religious questions and teaches at www.SunniPath.com

Copyright 2006 Islamica Magazine.
All rights reserved. Reproduction in whole or in part in any form or medium is prohibited.

Depression: A bio-psycho-social-spiritual analysis by By Dr. Ibrahim Kreps

Depression: A bio-psycho-social-spiritual analysis

originally published in Islamica Magazine
to subscribe, click here

By Ibrahim Kreps

As the days grow shorter and nights grow longer, many people find themselves falling under the sway of what is commonly known as depression. In this article, Dr Kreps explores the types of depressive disorders, their origins and causes and various types of treatments available. What may surprise many readers is how widespread the problem is, how little control its victims have over it, and why telling someone 'just lighten up' may do nothing but aggravate the problem

The telephone rang at the office one morning, while I was busy sorting out my paperwork.

“It’s Munir, calling from Boston,” he said, clearly distraught. His voice was cracking, his speaking interrupted by quiet sobbing.

“What’s up?” I asked, playing innocent, “You were doing so well last time I saw you in Montreal. Did anything happen?”

“Wel-l-l …” I could sense there was something he didn’t want to tell me, but I pushed ahead.

“You can say it Munir, I won’t judge you or scold you,” I said.

“Well, my friends convinced me I didn’t need the pills. They said I was a smart guy and I could talk myself out of my negative state and get myself together with positive thinking and the right attitude. And, well I listened to them. I just

wanted to see if I could do without the meds.”

He was clearly feeling remorseful. “If you give me another prescription, I promise I won’t do it again …”

We had talked about this many times in our sessions. Munir had a chemical imbalance and he needed his medication. I had explained to him about neurotransmitters and given him the analogy of diabetes and insulin. He seemed to be convinced when we had talked about it but wanted to prove it to himself one more time. And now he was in “meltdown” mode.

Munir represented every immigrant Muslim family’s dream. He was studying at Harvard Law School and he was near the top of his class. He had a brilliant analytic mind and he captured ideas very quickly. But he also had depression—– major depression—–with a strong family history of mood disorders. He had tried many forms of non-chemical therapy from psycho-dynamic psychotherapy to cognitive therapy. In his more radical period he had even tried cathartic group therapy. But nothing worked effectively, except serotonergic anti-depressant medication, known as SSRIs. This was the only treatment that had brought long term relief—–as long as he took it. Reluctantly over many years, he had come to accept this reality.

This brief anecdote opens the door to discussing current approaches to psychiatric problems and depression in particular. The term “bio-psycho-social” was coined by Dr George Engel, an internist and psychiatrist in the s. He based his ideas on the work of Adolph Meyer who talked about “psychobiology” and Franz Alexander, the founder of the Chicago school of psychosomatics. Dr Engel developed his ideas working in the area of psychosomatics and more specifically what is now called Consultation- Liason Psychiatry i.e. psychiatrists working in medical and surgical departments to help other physicians understand the psychological concomitants of physical diseases. Engel’s paradigm concluded that psychological factors interact dynamically with biological and social elements in both health and disease. The model goes further in stating that the cause and effect relationships are not usually linear but rather interactive and reciprocal. This model is proposed as an antidote to two other theoretical approaches common at the time and still today—–that is “dualism” (the mind/body dichotomy ) and “reductionism”—–an ever-present danger in medicine, whether it be biological reductionism common in today’s high-tech environment, or psychological reductionism, common in the Freudian era.

All of this may seem very abstract and inconsequential. In fact, it has very practical relevance in the everyday practice of psychiatry and medicine as well as in everyday decision-making, outside the context of illness. We can, for example, think of our human needs in each of these spheres: the biological needs for food and shelter; the psychological needs for harmony and understanding ;the social needs for community and relatedness; and the spiritual needs for a meaningful relationship with the Absolute. I find it personally useful to consider these various dimensions in my own attempts at living a balanced life. A similar paradigm would be to think in terms of the needs of our bodies, minds, hearts and souls. We can begin to reflect in this manner so as not to become too one-sided in our approach to life. The superficial social context in which we live would bias everything towards the physical, the mind being a distant second. Heart and soul remain for the exceptional ones in this materialistic context.

Coming back to the case of Munir, he was unable to accept the biochemical underpinnings of his illness. Nor could his friends. We could say they were suffering from psychological reductionism. The “get a handle on it” or “pick yourself up by your bootstraps” mentality implies a strength of will-power and initiative that is not always present in people. In fact the nature of depressive disorder is such that this is the very capacity that is undermined by the illness itself. This is difficult for anyone who has not experienced serious depression themselves to understand.

THE CASE OF BARBARA

Barbara’s story was quite different from that of Munir. She was raised as a Catholic by practicing Christians. They took her to mass every Sunday but were not very concerned about religious matters for the rest of the week. She had decided to pursue her spiritual interests by practicing Christian meditation with a local group founded by a Benedictine monk. He had attempted to introduce Orthodox meditation techniques into his Catholic practice. But this approach was not working for her and she was hitting a wall.

The main stumbling block for her was Christian theology. She could not accept the Divinity of Christ nor the doctrine of “Vicarious Redemption” —–that Jesus died on the cross for the sins of others. It just didn’t make sense to her. Most Christians accept these beliefs as part of the credo and pass over any logical contradictions therein. They believe that these concepts are mysteries that the human mind cannot possibly comprehend, and they accept them. For Barbara this was not possible. And so she entered into a spiritual crisis. This was certainly not the only factor in her depression. She had also broken-up with her live-in partner a year previously and there was as well a modest family history of depression in the mother and grandmother .

When Barbara entered treatment she had all the hallmarks of a major depression. She had lost all motivation for work and even recreational activities. An active walker and mountain climber, she now stayed at home and watched TV. She was barely able to keep up with her job at an accounting firm. Soon after her treatment began I had to put her on sick leave at least until the effects of the medication kicked in. Normally Barbara was a very dynamic woman. Once the medication started working, in about a month’s time, she was back at her spiritual quest. She knew the problem wasn’t solved simply because she was feeling somewhat better. She began studying other religions and philosophies and asked me about Islam. I explained to her that I was her doctor, not her spiritual mentor (although in the modern context one wonders at times if the mental health professionals have not taken over many priestly functions). In my practice, in fact, I have people from all of the major faiths. In a way, I have developed a certain specialty: a professional niche, with respect to people interested in the spiritual path as well as the psychological one. Most of the people who come to see me are content with their faith and happy to be treated by another person of faith, even if different from their own. I try to avoid theological debates whenever possible but especially in my practice. Barbara’s case was different, however. There was a burning desire to know and she would not let me adopt the usual stance of neutrality. So I did suggest certain books she could read and organizations that could give her more information about Islam. She went about these pursuits with more and more energy. She visited Buddhist monasteries and Yoga Centres and mosques and eventually chose to become a Muslim.

But that was not the end of her story, unfortunately. After a while Barbara married a Pakistani man and went to live in Saudia Arabia where her husband had a contract as an engineer. Having been raised as a “liberated” Western woman, she was now confined to a foreigners’ compound, unable to drive and found herself uncomfortable with both the Saudi approach to religion—– stodgy and dry and formalistic—–and with the Westerner’s liberal and often decadent lifestyle. She became socially isolated and then relapsed into depression; a serious one.

By the time she came back to Montreal, she was in a lamentable state. Her gaze was fixed and blank, she was constantly fearful of others and she was non-functional at home. We were back to square one—–or worse. We began slowly with both antidepressant and antipsychotic medications. Gradually we withdrew the antipsychotics and left her on the anti-depressants. She began her recovery by doing a little housework and gradually started taking classes in her field, accounting, in order to renew her skills. Fortunately, her husband was patient and understanding and with his help and support within a few months she was back on her feet. Her faith remained strong throughout this period, a somewhat surprising occurrence as I have seen many people wavering in their faith during an intense depressive assault.

There was only one more obstacle to her complete recovery and that was her employer. After two previous depressions, the insurance company was reluctant to insure her for future disability. I had to have long talks with the insurance company psychiatrist to convince him that she was a good risk. He in fact had good evidence to the contrary. After two major depressive episodes the risk of a third one is very high. I argued that we had got through several major risk factors—–a spiritual crisis and a social crisis and that my client was very collaborative in treatment and now understood the precipitating factors causing her depressions. The employer relented and decided to give her a chance. Slowly she returned to work—–at first for one day, then two and eventually back to fulltime employment for years without a single missed day on account of illness. I bring up this case not to congratulate myself or modern psychiatry. Our results are not always as decisive or rewarding as they were in this case. Rather, I think the unfolding of events helps us to be aware of both the social and spiritual elements involved in psychiatric illness. For this reason, I have argued for a long time that the Engelian Model of bio-psycho-social should be expanded to include the spiritual. I had even proposed a presentation at the Canadian Psychiatric Association on this subject years ago but it had been refused. Unfortunately there is still a reticence to include the spiritual in the psychiatric paradigm because it is viewed as dubious, unmeasurable and thus scientifically “soft”. There are voices in the community, however, mostly from the Christian sector, arguing for the importance of faith and of prayer in the psychological sphere—–but they are still voices in the wilderness.

The issue of using the bio-psycho-socio-spiritual model in psychiatry and in life, for that matter, is not purely theoretical but eminently practical. One of the major sources of error in medicine—–as in life—–is what I like to refer to as “dimensional confusions”. We can see this in the case of Munir where his friends reformulated his inherently biological problem into a psychological one—–with potentially disastrous results.

We see this as well when patients refuse to take “chemical treatments” and want “natural ones”—–as if our own bodies were not functioning on the basis of chemical and bio-chemical reactions already. And as if “natural treatments” were necessarily benign. They could profitably reexamine the assumption of the innocuousness of natural products—–take tobacco and arsenic for starters, let alone snake venom—–all very natural indeed.

Another frequent “dimensional confusion” is referring essentially medical and other specialized matters to religious authorities. Although we have Islamic precedents to warn us of this kind of error (see the story of the Medina date farmers requesting advice about grafting date palms from the Prophet, may Allah Bless him and grant him Peace) many people continue to bring their ear infections and diabetes questions to the shuyukh. For du‘a and baraka that is fine. For medical advice, beware. I have personally witnessed numerous near-tragedies and several actual ones due to this misunderstanding. We must seek out the appropriate asbab (causes) and understand the limitations of the human condition, even in highly evolved spiritual beings.

In the case of Munir, spirituality seemed to play a minor role. He was a believer but his practice was modest at best, like many modern Muslims. Yet he was comfortable with his lukewarm faith and the sense of identity it gave him. In the case of Barbara the spiritual dimension was much more acute. Her himma (desire to know the truth) was strong and she could not be satisfied with half-measures. Her faith was strong and as in the case of many believers it maintained her through the turbulence and anguish of her depressive periods. As a psychiatrist frequently confronted with people who have suicidal ideas and fantasies, it is a relief to work with people who consider suicide an act forbidden by God. Not wanting and not able to impose our beliefs on others, we have to deal with people on a regular basis who see suicide as an exit strategy. And, of course, this is stressful for everyone in their surroundings —–both the physicians treating them and their family members. In this era of judicializing every untoward event in our lives, the threat of lawsuits and professional complaints hang over our heads constantly.

Returning to our main topic, let us return to a basic definition. What is depression? In some ways it is difficult to talk about. Depression as a term is very vast, indeed. It can include anything from a mild feeling of “the blues” to a state of such excruciating psychic pain that death seems like the only way out, or yet again to a state of catatonic mutism that looks like a severe form of schizophrenia. That being said, according to the DSM-IV (Diagnostic Manual of the American Psychiatric Association, th edition), there are three major categories: 1) Major Depressive Disorder; 2) Dysthymia; and 3) Adjustment Disorder with Depressed Mood. This does not include the various forms of Bipolar Disorder—–formerly known as Manic-Depressive Illness. In former times, psychiatrists talked of endogenous (biological) versus reactive depression (environmental) and psychotic versus neurotic depression; a vocabulary from the psychoanalytic era. There were also terms such as “melancholic depression”, a particularly severe form with psychomotor retardation or agitation and total loss of pleasure and “atypical depression” which included increased rather than decreased appetite and sleep in addition to interpersonal problems. All of these terms have now been excluded as independent entities and appended to the three major categories.

CRITERIA FOR MAJOR DEPRESSIVE EPISODES

Five or more of the following symptoms have been present for a two week period and represent a change from previous functioning. At least one of the symptoms is either, (a) depressed mood, or (b) loss of interest or pleasure:

1. Depressed mood most of the day as indicated either by subjective report (feeling sad or empty) or observation made by others (e.g. appears tearful).

2. Markedly diminished interest or pleasure in all or almost all activities most of the day.

3. Significant weight loss when not dieting or weight gain (e.g. change of more than % in body weight in a month).

4. Insomnia or hypersomnia.

5. Psychomotor agitation or retardation.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive guilt nearly every day.

8. Diminished ability to think or concentrate; or indecisiveness.

9. Recurrent thoughts of death, recurrent suicidal ideation or a suicide attempt or a specific plan of suicide.

This is the basic depression paradigm. Modifiers of the general description may be “catatonic” (self-explanatory) “melancholic” (particularly profound or incapacitating) and “atypical” (having to do with characteristics like personality disorders and interpersonal dysfunction).

DYSTHYMIC DISORDER

Dysthymic Disorder is a milder form of the disease and it includes: (a) depressed mood for most of the day indicated by subjective account and observation by others for at least two years, and (b) presence while depressed of two or more of the following:

1. Poor appetite or overeating

2. Insomnia or hypersomnia

3. Low energy or fatigue

4. Low self-esteem

5. Poor concentration or indecisiveness

6. Feelings of hopelessness.

Dysthymic patients may function for long periods of time without any noticeable impair-ment in their functioning. They may just appear negativistic and pessimistic or have chronically low energy and variable effectiveness at work and in family life. However, occasionally a Major Depressive Episode may occur within the background of Dysthymia and then we have “Double Depression”.

ADJUSTMENT DISORDER WITH DEPRESSIVE MOOD

Adjustment Disorder with Depressive Mood has the following criteria:

a) The development of emotional or behavioral symptoms in response to an identifiable stress or occurring within months of the onset of the stressor.

b) These symptoms or behaviors are clinically significant as evidenced by either of the following:

1. Marked distress that is in excess of what would be expected from the stressor event;

2. Significant impairment in social or occupational functioning.

This disorder corresponds to the older idea of reactive depression. It is usually short-lived (by definition less than six months) and resolves on its own. It is caused by the ongoing ups and downs of daily living of which we see more and more in the modern world, causes such as job loss, financial difficulties, or marital breakup, for example. At times however what may appear to be an Adjustment Disorder turns out to be a Major depression and then we have a more serious situations on our hands.

In summary we have herein three forms:

1. acute incapacitating depression, or a Major depressive episode;

2. chronic smoldering depression, known as Dysthymia; and

3. depressive reaction to stressful events and life’s inevitable tests or Adjustment reaction depression.

CAUSES

So, what causes depression? Here we have to return to our bio-psycho-social spiritual model.

Biology

No other subject with the possible exception of schizophrenia has been as extensively researched as the biological concomitants of depression and yet we are still a long way from having any kind of definitive answers. Perhaps this is due to the heterogeneity of the disorder (depression is a vast category) or perhaps it is due to the complexity of human existence in general, as Allah has designed it.

Regardless of the reason, these are the facts. There is no specific biological test which can confirm depression as an EEG may confirm epilepsy or a Creatinine Clearance can confirm renal failure. We are unable to predict which patients will respond to which anti-depressants on the basis of their biochemical profile. And we have no genetic test that can tell us which children of which depressed or bipolar parents are more at risk for depressive episodes themselves. So we are far indeed from a definitive biological description of depression.

There are some interesting biological and genetic findings, however, that point in the direction of certain parameters. Twin studies, for example, have shown that the concordance rate for mood disorders in monozygotic twins is 2-4 times that of dizygotic twins. This means that an identical twin (monozygotic) is 2-4 times more likely to have the disorder than a fraternal twin (dizygotic)—–when the other twin is affected. Since monozygotic twins have identical genetic make-up and dizygotic twins have 50% of their genes in common, the comparison between the two is very useful in determining the geneticity of a disorder. However the concordance rate of identical twins is not 100% even though they are genetically equal. Depending on the study, the rate may vary between 60-90%. Environment factors then have some impact—–in some cases a determining one.

As to the familial tendency of depression, the rates in first-degree relatives of affected individuals is 2-3x that of the general population. In bipolar disorder (formerly manic-depressive disorder) the rates are even higher: 3-8x that of the general population. In addition there is significant crossover between the two disorders so that people who have a bipolar relative in the family are much more likely to have depression themselves than the rest of the population. All in all, we are talking of a strongly inherited trait. Within the context of an article such as this we cannot attempt to cover all the other biological factors involved in the genesis of depression. This is a vast field of research. However, we will attempt to look at a few of the more interes-ting findings.

One of the more consistent findings in the field of depression is the disturbance of cortical secretion. Increased cortisol secretion is apparent in 20-40% of depressed patients and 40-60% of depressed inpatients. In this way we have a window on the cortico-hypothalamic-pituitaryadrenal (HPA) axis or the stress-response, since elevated glucocorticord activity is the hallmark for mammalian stress response. Cortisol can be tested via urine or blood levels or then again through its feedback loop via something called the Dexamethasone Suppression Test. The sensitivity and specificity of these tests is not sufficient however for clinical use and cortisol hypersecretion is observed in many other psychiatric disorders. The link between the stress response and depression is an intriguing one. Is depression simply an effect of an overly stressed organism —–a form of burn-out to use a popular term. Or are depressives simply people unable to manage stress because of some inherent deficiency in the HPA axis? At this point we are still in the realm of speculation. Much of the discussion with regards to the biological origin of depression in recent history has been about the neuronal synapse and neurotransmission across the synapse—–i.e., the passing of information along neuronal circuits via neurotransmitters. The three neurotransmitters that have been referred to most often are serotonin, norepinephrine or noradrenaline, and dopamine.

The sertonergic system is an important regulator of sleep, appetite and libido. It is also important in goal-directed behavior and certainly plays a role in mood. Reduced serotonin levels have been implicated in impulsive and aggressive behavior and especially in suicidality. Serotonin’s claim to fame however was the discovery of fluoxetine or Prozac—–the first SSRI. From there we see the development of the most commonly used family of antidepressants in clinical practice; which now includes Paxil, Zoloft and Celexa amongst others. Although these anti-depressant agents have been the subject of recent controversy due to a reported increase in suicidality in the early days of treatment, their place in psychiatric practice is wellestablished. I certainly have seen many lives transformed in a positive way through their use. Some patients have even claimed to feel “normal” for the first time in their lives and this kind of result, although by no means universal, is frequent enough to be highly encouraging.

The SSRIs do have their downside however. They often disturb the sleep-wake cycle and tiredness during the mid-afternoon is a frequent accompaniment. They also inhibit sexuality and for young couples beginning their relationship and even for those further into their marriages, this inhibition can be upsetting and disruptive. So they are by no means a perfect solution. The norepinephrine (the second neurotransmitter) system is largely responsible for initiating and maintaining limbic and cortical arousal as well as modulating the function of other neurotransmitters. It is involved in stimulating goal-directed and reward-seeking behavior. Some nor-epinephrine specific antidepressants have been developed but generally they have not proved as effective as the SSRIs. One of the most recent ones was Reboxetine, which was eventually refused by the American FDA because it was not clearly superior to a placebo. However anti-depressants that work on serotonergic and norepineprine systems at the same time (the so called dual-action antidepressants) have proved to be highly effective and in some studies more effective than SSRI’s. Examples of such medications are Venlafaxene (Effexor) and Mirtrazapine (Remeron). The other neurotransmitter that has been studied with respect to depression is dopamine, although its relation to schizophrenia and other psychotic disorders is more clear-cut. Dopamine is probably best known for the controversial and at times illegal substances that stimulate it. Thus both Ritalin (Methylphenidate) and Amphetamines used in the treatment of children with Attention Deficit Disorder and Cocaine, a drug of abuse, are dopaminergic substances. Dopamine is naturally responsible for the regulation of emotional expression, learning, concentration and complex executive and cognitive tasks. Its role in depression is less clear than serotonin but some of our current antidepressants such as Buproprion also known as Wellbutrin act on the dopaminergic system, while Ritalin (Methyphenidate) has been used as an augmenting agent in treatment-resistant depression.

The neuro-transmitter question has become more complicated over the last decade. For one thing, we now realize that all the activity does not occur only at the post-synaptic receptor sites. Important functions occur at the pre-synaptic sites through auto-receptors and heteroreceptors. And there is an increasing realization of the role of secondary messenger systems as well as genetic transcription and translation factors. Added to this are other neurotransmitters systems such as the glutamate and glycene neurotransmitters which are excitatory and continue to assume increased importance over time. So, the biological picture becomes more and more complex. (Subhanallah for the subtlety and complexity of created beings!) Our treatments, however, remain based on more simplistic notions.

Another fascinating part of the evolving biological dimension is the use of cerebral imaging techniques—–at first the simple CAT scans and MRI (magnetic resonance imaging) techniques. Recently techniques have been developed not only to see the anatomic structures within the brain but also to image the physiology and metabolic activity of the brain. These methods include the PET scan (Positive Emission Tomography), functional MRI and Magnetic Resonance Spectroscopy.

The most widely replicated finding on PET scan in depression is decreased anterior brain metabolism, more pronounced on the Left side. This is also known as hypofrontality. This refers to a lower level of brain activity in the more highly evolved areas of the brain, where cognition takes place. Increased glucose metabolism has also been observed in several limbic regions (areas responsible for emotions and memory) in severe recurrent depression. Although many of these findings are intriguing and do make sense in terms of the phenomemology of depression, none have yet proved useful clinically.

Psychological Dimensions

As in many areas of psychiatry the first theories of depression came from the School of Psychoanalysis and specifically the ideas of Sigmund Freud. The psychoanalytic approach attempts to understand the inner workings of the mind and the processes of the unconscious. Much of the theorizing is based on the idea of defense mechanisms such as “introjection” and “projection” and “libidinal energy” and “cathexis”. Although the terms are at times arcane and hermetic they do provide a useful vocabulary for discussing inner mental processes once the terminology is mastered. What they do not provide is a reliably effective means of changing these processes. Freud was well aware of this problem and predicted, quite remarkably, that neurophysiology not psychoanalysis would provide the ultimate answers!

As to his psychological formulation, in his classic paper, “Mourning and Melancholia” Freud hypothesized that depression was a form of bereavement gone wrong. In this theory depression represents anger directed at the lost object (person) that becomes re-directed against the self. This process involves the “introjection” of the lost object, identification with it, followed by a turning against it. This anger or hatred then takes the form of lost self-esteem and of self-reproach and self-loathing, often seen in the profoundly depressed. Abraham, one of Freud’s colleagues added in the dimension of disturbed “infant–mother relationship” which renders the child more vulnerable to depression at a later age.

Here we have the elements of the classical psychodynamic theory of depression: 1) early disturbance in the mother-child relationship; 2) real or imagined loss; 3) introjection of the lost object as defense mechanism; and 4) anger and hostility directed at the self. Although some of the concepts, such as introjection, and turning against the self have proven to be useful and informative, the psychoanalytic formulation of depression has not proved to be very clinically useful and rare is the contemporary psychiatrist who would use it as his basic model for treating depressed patients. In fact, psychoanalysis has proven to be particularly ineffective in treating serious depression. Other theoreticians following Freud have elaborated other psychodynamic theories. They have included Melanie Klein (the arch-rival of Freud’s own daughter Anna), Edith Jacobsen, and Heinz Kohut, the pioneer of the empathic approach to psychoanalysis. Melanie Klein believed that the depressive stage was a normal stage of development and depression was simply a fixation at this stage. Edith Jacobsen saw depression as a state in which the ego (self) was persecuted by the superego (conscience) which had become a sadistic and powerful mother taking delight in torturing the child. And Heinz Kohut, founder of Self-Psychology believed that children had an instinctive need for mirroring (recognition by adults) and idealization (looking up to the parents) and if these weren’t fulfilled, depression could be a later outcome. Many other theoreticians have come along through the years to try their hands at formulating a theory of depression. Two of the more interesting recent ones were Margaret Mahler who studied mother-infant interactions in laboratory situations and John Bowlby who looked more closely at the issue of attachment and separation in children and its effect on later psychopathology.

Despite a plethora of theories many clinicians have become disenchanted with a purely psychodynamic approach to treating depression. Dr Peter Kramer in his ground-breaking work Talking to Prozac relates many cases of blindalley psychotherapy of depression that only unblocked when Prozac or other SSRIs were added to the mix. Almost every psychiatrist in practice has had numerous referrals from psychologists who had reached dead ends in their treatment of depressed patients by purely psychological means only to see the impasse unblocked once anti-depressant medications were prescribed.

The overall tendency in the field has been to look to more active forms of psychotherapy in dealing with depression. From this vantage point two newer therapies have emerged: Cognitive –Behavioral Therapy and Interpersonal Therapy. We will describe more of the underpinnings of cognitive therapy in the remaining part of this section and look at interpersonal therapy under the rubric of the social dimension.

Dr Aaron Beck, the founder of Cognitive Therapy, noted in his early writings that “the early promise of Psychoanalysis that I had observed in the early s was not borne out—–as my fellow psychoanalytic students and other colleagues entered their fifth and sixth years of psychoanalysis with no striking improvement in their behavior or feelings. Furthermore I noted that many of my depressed patients reacted adversely to therapeutic interventions based on the ‘reflected hostility’ hypothesis.” He then began an agonizing reappraisal of his own belief systems about depression. From this reflection emerged cognitive therapy.

Dr Beck eventually postulated the cognitive triad of depression. The first component of this triad concerns the patient’s negative view of himself. He sees himself as defective, inadequate and deprived. Secondly he has a negative interpretation of ongoing experiences—–he is, in other words framing his current experiences as defeat and deprivation. In current parlance he has become the opposite of political “spin-doctors”. He is spinning everything in a self-condemnatory rather than a self-congratulatory way. The third component is a negative view of the future—–believing his current difficulties will continue indefinitely and manifesting an overall pessimism in whatever he undertakes. From a spiritual point of view, we can see that this is the opposite of how we ought to think. Instead of having a positive opinion of God and of man, the depressed person has developed a negative opinion. Instead of trusting in God’s plan (Tawakkul as it is called in Islam and Sufism) the depressed person thinks everything will work out badly. And instead of being grateful and thankful for what is occurring; the depressed person is grumbling and complaining.

This does not imply that it is easy to change one’s way of thinking. Aaron Beck and the cognitive therapists have been described by one of my psychiatric teachers as the equivalent of Marines landing on the shore of hostile mental terrain. In direct contradistinction to the passive, empathetic analysts they are active, willful and even pushy at times and they encourage their clients to work hard and energetically against their dysfunctional belief systems. They direct, structure, provoke and coach their clients out of their lethargy and into the realms of ‘rational thinking’. This is not a simple task. Another of the important contributions of cognitive therapy has been identification and correction of “cognitive distortions” that lead to “automatic thoughts” of a self-defeating nature. I think these cognitive distortions are particularly interesting as they can be used by any of us—–whether depressed or not. Mental health and realistic-thinking can be developed in each of us by taking account of these cognitive distortions. We will look only at the most important of these:

1. All or none thinking ... (black and white thinking). For example, after a poor performance in a tennis match the patient concludes “I suck at sports”.

2. Catastrophising. For example, after losing a job, one thinks “I’ll never be able to find another well-paying job” or after having trouble understanding a particularly complex lecture he tells himself “I’m no good at chemistry… I’m going to fail this course and ruin my entire academic career”.

3. Discounting the positive. I have noticed this one often in depressive patients. I must not tell them when they are doing better or they will make it a point of honor to prove me wrong. This is a common phenomenon. I like to call it the “onesided” balance sheet of mental accounting —–only the debits are registered; the credits are ignored.

4. Labelling—–“I’m a loser”, “I’m a nerd”. This can also be applied to others and tarnishes any possibility of a fruitful relationship, “She’s a user”, “He’s a manipulator”. All of this falls into the zone of the unproductive.

5. Magnification/Minimization. Often depressive people will devalue themselves and overvalue others. “That teacher is so clever, I’ll never be able to express myself as well as him” he thinks to himself.

6. Tunnel vision or Mental Filter. “I had one critical comment on my evaluation concerning time utilization, so I’m a lousy worker” (when in fact the evaluation included comments about her creative problem-solving and her good relations with other employees but these were discounted).

7. Personalization. “My boss was curt with me today as he passed in the hallway so he must not like me” (Many other explanations —–such as excess work stress, difficult home situation or a generally irritable personality could all be explanations for the same behavior). This list could go on and on. Cognitive therapy attempts in an active way to transform these distortions into more rational/realistic thinking. We can all at times fall into these distortions and it is interesting to try for ourselves to identify and correct them when possible.

Research seems to validate this approach as highly effective in dealing with depression. In some studies, in fact, cognitive therapy is equally effective to medication although these studies are usually designed by cognitive therapists themselves. Part of the reason for its effectiveness may be its more active stance and its willingness to advise, coach and encourage—–something psychoanalysts were taught not to do. Part of the reason also may be the commonsense approach it has adopted as opposed to the more elaborate abstractions of psychoanalytic thinking. The short-term format used is also an advantage both in terms of economics and in terms of time.

The Social Dimension

Depression is a major social problem. 10-25% of women and 5-12% of men will have Major Depressive Disorder in their lifetime. Another 3-6% will suffer from Dysthymic Disorder sometime during their lifetime and 25-33% of people with Major Depressive Disorder will have Dysthymic Disorder as well, this phenomenon being called Double Depression. This does not include Bipolar Disorder, Cyclothymia and Adjustment Disorder. So we are dealing with a significant segment of the population. Almost everyone has known someone in their circle of friends or family who has suffered from serious depression—–often known by euphemisms such as “burn-out” or “nervous breakdown”. All epidemiological studies have confirmed a higher prevalence of major depression in women than in men—–generally about :. It is possible however that this is an artifact of our current criteria for depression. Men may express the depressive affect in others ways—–for example by alcohol abuse and violent behavior. They would then receive another diagnostic label.

Several social factors appear to contribute to depression as well:

1. Lower socio-economic status.

2. Separated and divorced people have a higher rate.

3. Family history of depression and bipolar disorder.

4. Parental loss before adolescence is a risk factor for adult-onset depression. A deprived, disrupted home environment also constitutes a risk factor.

5. Stressful life events, such as divorce or death of a spouse, loss of employment.

6. Lack of social support and social disintegration.

7. Unemployment: the rate of depression is three times higher in those not working. Homemakers were also three times more likely to experience major depression. An interesting reflection of contemporary values.

Most of these factors are self-evident. However one may begin to see how modern societies with their lack of community, high divorce rates, unstable employment situations and consumer lifestyle may be particularly “depressogenic”. Generally there is not much we can do to change the social context in which we live. However it is important to be aware of what is happening around us and to see it in a some kind of historical perspective. I am struck in my daily practice of psychiatry at how many of the problems that people have are social rather than individual. From lonely, aging women seeking desperately for companionship, to men having suffered recent job losses, to constant conflict over the multiple tasks and responsibilities facing couples dealing with rebellious teenage children, the majority of the problems seen in therapy have a social context. And yet, one has to deal with them on an individual level in order to survive. Much of psychotherapy is about managing these dilemmas.

One of the more recent forms of psychotherapy called Interpersonal Therapy was developed by two research-orientated practitioners who were well aware of the problematic social context after long years researching the epidemiology of mental illness. They are Gerald Klerman and Myrna Weissman. Based on the earlier ideas of Adolph Meyer and Harry Stack Sullivan, the individualistic ideas of Freud were re-interpreted in an interpersonal context. The patient’s current interpersonal experiences and attempts to adapt to social change and intercurrent stressors are seen as critical factors. Interpersonal therapy is much more active and interventionist than classical psychoanalysis. The therapists are willing to work on problem- solving and not reluctant to give advice— –something taboo in the psychoanalytic process mentioned previously. Patients are encouraged to become more active and to socialize. This is of course not a new idea. Mulay al- Darqawi, a great Sufi saint from Morocco, in his Risalat explained how he himself—–burdened with waswas (obsessions)—–was only able to escape from his inner preoccupations by constant socializing and avoiding solitude for a certain period of time. One has to balance our social needs, however, with our needs for contemplation and quiet reflection—–and thence the spiritual dimension.

The Spiritual Dimension

Of all the dimensions related to depression it is not surprising to find that the spiritual one is the least studied. Many scientific-minded people take it as point of honor to be atheistic or at least unconcerned about matters of ultimate meanings. They prefer to be highly specialized and quantitative in their approach.

There is a well-known discrepancy in the literature between psychoanalysts and their clients. While 90% of Americans believe in God, only 43% of psychiatrists (according to the APA) do. As a believing psychiatrist I can confirm that many patients regardless of their religious background are pleased to be treated by a person with faith. I suspect that some of my clients choose me as their physician for this reason. One of the exceptions to the dearth of research on religious issues in psychiatric practice is the work of David Larson, a psychiatrist and president of the National Institute for Health Care Research. He has extensively reviewed the research in Health Sciences and found positive associations between religious involvement and measures of physical health such as high blood pressure, cancer, heart disease, stroke and suicide. In the review Health Psychology (May 2001) he presents a meta-analysis (a form of study combining the results of many others studies) of independent samples showing a significant effect in lowering mortality due to religious involvement.

As to what the intervening variables might have been, Larson hypothesized such factors as reduced smoking, drug and alcohol abuse, unsafe sexual practices as well as improvements in social support and marital-family stability. To maintain his scientific credibility he doesn’t dare suggest that rewards from God for good actions may be an important factor as well! Of course, religion and spirituality go well beyond providing health benefits and prolonging life. The real purpose of spiritual practice is to give meaning and direction to our lives and to solidify our relationship with the Absolute. None of this can be measured quantitively and scientifically. I have attempted, outside of any quantitative research model, to look into the spiritual implications of various psychiatric disorders. And I have noticed certain things about depressive people. They tend to be both realistic about life in the world and sensitive about what is going on around them, especially in other people. And almost by definition they are not willing to buy into the hype of the marketers and “good-time Charlies” of the modern world, where everything is about enjoying oneself and having a good time.

On this basis, I have come to the conclusion that depression is about seeing the world (i.e. dunya—–the earth-plane if you wish) as it is. If one only sees this lower world, of suffering and pain and testing, then depression is the only possible affect. The rest is illusion. In order to get out of this depression, one has to get a sense of the other world—–the Akhira (the after-life) and also a sense of the ghaib (the unseen worlds). From these latter points of view, life takes on new meaning, and the heaviness of the material world can be alleviated. “So why is everyone not depressed?” you may ask. Many are, in fact, living in delusion—–the delusion of arriving at some kind of paradise on earth—–though money, or social acclaim or through intimate relationships or through retirement planning—–through a whole host of false gods. These delusions break down, of course, when confronted with the realities of sickness, tragedy and death. Depression then becomes the inevitable consequence. For the meantime, despite these reflections, I am not recommending a purely spiritual approach to treating depression. We still need modern medications and therapies and social supports. But the spiritual approach allows us to frame all experiences, including that of depression, in a positive manner and gives meaning to every aspect of existence.

May Allah help us to see our lives clearly and to use all phenomena, animate and inanimate, as ways to His Holy Presence.

The details of the case histories have been altered to protect the identities of the persons involved. Any resemblance to persons alive or deceased is thus only very partial the identities of actual persons should not be inferred.

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Couple Relationships (Part 2) By Dr. Ibrahim Kreps

Couple Relationships (Part 2)

http://www.islamicamagazine.com/issue-14/couple-relationships-part-2-28.html

Article Index
Couple Relationships (Part 2)
Page 2

Page 1 of 2

By Ibrhaim Kreps

There is little doubt about it. Marriage,and couple relationships in general, are in crisis. The chance of a first marriage ending in divorce over a 40-year period is 67%. Greater than twothirds. As to second marriages, the chances go up another 10% to three-quarters. And “cohabiting”couples, an increasingly popular option in the West, are even less successful.What’s going wrong? In this second of a two-part article, Dr.Ibrahim Kreps analyzes the psychological nature of the problem and explores the Qur’anic ways of resolving relationship issues.

I have seen numerous clients over the years that are able, all alone, to destroy relationships one after the other. And the mechanism is invariably induction. They can induce others to violence or induce others to hate them, or to betray them or belittle them—even if this was not part of the usual behavior of the perpetrator. Sometimes the induction is behavioral and you can see it. Other times it is an inward process and you can only see the results in its effects. This is the most sinister type.

I suspect that some of the worst behaviors of people in war situations are “induced”—by a climate of hatred and paranoia. There is actually “collective induction,” and the harm is then multiplied by the number of people involved. Perception, the second of the three modalities, although the easiest to detect, is probably the least potent. Through perception, we interpret current situations in terms of historical experience. We are not in touch with the actual reality but are in fact projecting our past reality into current events. In the case of Yvonne for example, her violent father is perceived in each of her male partners. It is not always an easy task to disentangle the projected reality from the actual one. What if the chosen partner is, in fact, an aggressive, violent personality?

In this context, sometimes it is helpful to bring in the partner to see them, in flesh and blood, if possible. The result is, at times, surprising.

THE CASE OF EDNA

Edna was a lady of Portuguese origin, going out seriously for the first time—in her early thirties. Her father had been a laborer with violent outbursts who died early in her life but left an indelible impression on his daughter’s psyche. Edna had begun dating John but would get very anxious at times when he showed the least amount of impatience or irritability. She herself wasn’t sure whether he was in fact a violent man or not. I suggested that she bring him in.

Evaluating people in one session is not always an easy maneuver as people can give a false impression in the first interview. I have seen experienced and competent psychiatrists making serious diagnostic errors in the emergency room—being misled by a patient’s “good behavior”. At other times the aggression is there for all to see—just pouring out in front of you.

So we brought in John and there was little doubt as to what was happening. He was a soft-spoken, mild and shy man who reminded one more of a teddy bear than of the fierce grizzly that Edna was perceiving. I confronted him a few times about his lack of initiative and generally passive stance in life but despite the provocation got only the mildest of reactions. I probed his previous relationships and violence had never been an issue. And I checked carefully his family history and again came up empty-handed. In fact, I ended up referring him to a colleague for assertiveness-training as he had considerable employment problems due to his lack of assertiveness. I can now say, more than fifteen years later, that they are still together and violence has never been an issue in their marriage. Almost all of the perceived violence was a projection from Edna’s past.

What about the “S” modality-selection? This is actually the heart of the matter, as it is the easiest to manipulate. People invariably choose partners that correspond to their self-object models explained in the previous section on Object Relations Theory. In other words they choose the appropriate complement. And this is the basis of the “Relationship Pattern”—a now commonly accepted term in pop-psychology. The victim chooses a bully. The bully chooses a victim. The unloved one chooses a narcissist and the narcissist chooses an admirer.

We are speaking here of pathology, of course. If we want to counsel people properly, we would have to identify the pathological pattern and work to avoid and undo it. This is often more difficult than it sounds. You cannot get someone interested in a partner if there is no attraction whatsoever. If the potential partner is other than the complement, the chooser may well find them uninteresting or boring.

An elderly therapist I once knew liked to tell me about one of his male clients who fell neatly into the category known by the English as the “Bitch’s Victim”. He invariably chose the nastiest females available. During the course of his therapy, he met a classmate and started dating her. He could find no obvious fault in her. She was intelligent, attractive, socially charming and a kind and sensitive person. But he would come to his therapy sessions complaining, “There’s something missing, I don’t know what it is” and the therapist would answer him, “I know what’s missing. It’s anxiety. She doesn’t create stress for you and you’re missing it.” The client eventually got the point. He had to adapt to being comfortable. He was used to discomfort and distress and looked for it in relationships.

Amidst all this pathology and negativity you may well wonder what makes for a good relationship. Here I refer to the three Cs. They are Chemistry, Communication and Circumstances.

“Chemistry” has become a popular term nowadays. We could call it attraction, affinity or even instinct but there is something in our being that says either “yes” or “ no” to the possibility of connecting with a member of the opposite sex, and it is not just a matter of physical appearance. In fact there is an element of mystery in the process—as if a higher and deeper force is actually running the show. This may well be the basis of the Islamic “Sunna” that potential partners see each other before deciding on marriage and not be forced into marriage by their parents—a Sunna that at first view seems to go against the prohibition around women displaying their beauty.

If instead of following the chemistry one engages in a marriage of reason, one may later live to regret it. Many years later one of the partners may begin complaining, “But I have never experienced love” and since human love is a reflected image of Divine love, the acuteness of the pain and the loss may be intense indeed. Marriages have broken up for less. Even the cousin of the Prophet (May God bless him and grant him peace), Zaynab, was not able to continue in these circumstances, despite being a pious and generous lady. The chemistry was missing with her husband Zayd, may Allah be pleased with them both.

THE QUR’ANIC IDEAL

Sura 7, Al-Araf verse 189 (Yusuf Ali trans.) reads:

It is He who created
You from a single person
And made his mate
Of like nature, in order that
He might dwell with her (in love).

In this succinct passage is a wealth of wisdom and a high ideal.

Being created from a single self (nafs) there is naturally a strong affinity (chemistry) in the couple. The “like nature” highlights the recognition of the other as part of the self and suggests an element of destiny in the proper choice.

And the dwelling together (in love) contains the last two of the Cs—Communication and Circumstances. The Qur’anic commentator Abdul Majid Daryabadi puts it this way: “The word dwelling (repose) puts in a nutshell the various attitudes the two sexes can adopt towards each other—of love in youth, companionship in middle age and of care and attendance in infirmity (old age).” What depth and subtlety concerning relationships!

If one looks up the Arabic word “yaskun” (translated as “dwell”) in the dictionary one comes up with the following meanings:

• To be or become still, tranquil peaceful;
• To calm down, repose, rest;
• To cease (anger, pain and the like);
• To be reassured;
• To rely on, have faith or trust in;
• To feel at home.

What a beautiful ideal is contained in these meanings.

What a contrast with the current state of marriage and couple relationships.

It would be unfair however to say that the problem is entirely new. Even in the history of the great Prophets (upon whom be peace) one can see evidence of marital tensions. The Prophet Abraham had to deal with the tension and jealousy between Sara and Hagar and one of them had to leavealbeit for a great destiny and the building of the Holy Ka‘ba.

The Prophet Muhammad (may Allah bless him and grant him peace) as well had to deal with marital tension. In a well known event in his life story, he stayed away from his wives for a full month much to the consternation of the fledgling Islamic Community in Medina. They were seriously worried about the possible disruption of their community if he actually divorced his wives. All ended well though and the Islamic community continued to flourish but not of course, without periods of tension and crises. One must add that the more general climate was one of harmony.

The level of disruption and conflict in couples has never been as high as in modern times—divorce levels of 67%, single-parent households abounding, marital harmony the exception rather than the rule. What is happening? What are we to do?

THE WORK OF JOHN GOTTMAN

There are no easy solutions for the deeper social turmoil that we are all experiencing. However, we each have the obligation of doing our best and trying to survive in difficult times. In this perspective I present the work of the Seattle Marital and Family Institute. From an Islamic point of view, I think it not unfair to consider this approach as the operationalizing of the Sunna of Muhammad (may God bless him and grant him peace). The parallels in the teachings are many despite the great difference in their sources.

I first heard of John Gottman in a newspaper article which reported the following: “research group able to predict divorce rate with greater than 90% accuracy.” This sensationalist title piqued my curiosity and I began tracing back the source via the Internet to a major work published by the Gottman Institute called, The Seven Principles for Making Marriage Work.

The Seattle Institute did something unique in the field. They observed couples in laboratory situations (actually fabricated apartments) with audio and video equipment for extended periods of time. (In order to respect the privacy and intimacy of the couple, the recording equipment was shut down after 9 pm at night and not present in bathrooms). These observations continued for many years. Included in the observations were physiological responses such as heart rate and blood pressure.

From these very extensive observations, Dr. Gottman and his team arrived at certain solid, empirically-based conclusions. This was very different from many of the other studies of family therapy—all based on theoretical positions and relatively brief therapy sessions. Here was actual data— not theory and not necessarily pathological. “Ordinary” couples were interacting in “ordinary” ways.

Firstly, the Seattle group discovered the destructive forces in marriage. There were four principal ones. They called them “The Four Horsemen” after “The Four Horsemen of the Apocalypse” from the Biblical Book of Revelations. They are: 1) Criticism; 2) Contempt; 3) Defensiveness; and 4) Stonewalling.

Criticism does not refer to ordinary complaints like “you should have done the dishes last night” or “why didn’t you take out the garbage”. It has more to do with character assassination tactics like “You didn’t take out the garbage tonight. You are just a lazy, inconsiderate slob.”

Contempt can take many forms. It may include name calling, eye-rolling, sneering, mockery, and hostile humor. According to Gottman, it is the worst of the four as it conveys disgust and it is impossible to resolve problems when a partner feels that you are disgusted with them. This is the opposite of respect and positive regard.

Contempt can also be quite subtle. The Seattle group found that just turning one’s eyes upwards as if to say, “Here she goes again” is enough to predict marital failure in over 90% of cases. The current younger generation is full of expressions of contempt such as “Whatever”, “Loser”, “Nerd”, “Geek”, “Freak” and other new terms being invented all the time. This plethora of insults is a sign of the deterioration in social relations.

Defensiveness is a way of blaming the partner. It is saying that the problem is you rather than me. Its effect is invariably to escalate the conflict. Its cause is denial and guilt. Its mechanism is a sort of psychological deafness and its effect is inevitably hostile. The ultimate effect is alienation.

Stonewalling is the end game of defensiveness. By the time one partner is stonewalling nothing is getting through. Gottman gives the example of the husband who on returning from work meets with a barrage of criticism from his wife and hides behind the newspaper. When she continues, he leaves the room. By turning away from her, he avoids the fight but at the same time is disengaging himself from the marriage.

In trying to treat these situations, Gottman began to realize that it was not enough to deal with and eliminate the negative. He had to also begin developing alternative positive behaviors and attitudes. This in itself is a very instructive conclusion. Correcting the negative can end up feeding it and becoming obsessed with it. We must strive to develop positive alternatives. From this come the seven positive principles in the title of the book.

Gottman states that the basis of an enduring marriage is a solid friendship in the couple. This friendship comes from “mutual positive regard”. The seven principles are designed to further solidify this already solid friendship:

1) ENHANCE YOUR LOVE MAPS

Get to know your partner—their preferences and their dislikes. Emotionally intelligent couples are intimately familiar with each other’s world. They know each other’s goals, each other’s worries, each other’s hopes and expectations.

She knows what kind of salad dressing he likes, and he knows how she feels about her boss at work. She knows what deadlines he is working towards and he knows how she feels about his sister-in-law. These are the nuts and bolts of communication.

2) NURTURE FONDNESS AND ADMIRATION

Gottman states: “Although happily married couples may be driven to distraction at times by their partner’s personality flaws, they still feel that the person they married is worthy of honor and respect. When this sense is completely missing from a relationship (i.e. contempt has taken over) the relationship cannot be revived.”

My own take on this is that there is a gender distinction here. Men need to feel admired (for their achievements) and women need to feel loved (for themselves). In either case the need for positive regard is fundamental.

Gottman continues: “Fondness and admiration can be fragile unless you remain aware of how crucial they are to the friendship that is at the core of any good marriage. By simply reminding yourself of your spouse’s positive qualities— even as you grapple with each other’s flaws—you can prevent a happy marriage from deteriorating.”

3) TURN TOWARDS EACH OTHER,NOT AWAY

This involves taking each other’s side, even if you believe his or her perspective is unreasonable. Don’t side with the opposition as this will make the spouse resentful or dejected.

This means that if the spouse comes home and complains about the harshness of his employer, don’t even attempt to justify the employer’s behavior at the expense of your partner. The truth in this situation can wait for later.

4) LET YOUR PARTNER INFLUENCE YOU

This can be especially hard for males. As Muslims, we have been encouraged to consult. And after all the best of consultants is often right next to us. So we have to get around the trap of always wanting to be right and always knowing everything.

For example, one of the natural areas of conflict occurs in household organization. Men seem to be more aware of the functional aspects of things (How strong is the water pressure? How many amps of electricity are in the electrical boxes? How many beams are supporting the floors?) while women tend to be more aware of the aesthetics (the wall-paper is old and dingy, the lighting is dim, and none of the windows have curtains). There is an obvious complementarity here, but it can easily break down into conflict—especially if the budget is tight and priorities have to be set.

Once again, communication and compromise are de rigueur. Any attempt to tyrannically impose one’s will is likely to be met with resentment and bitterness even if acquiescence is the initial reaction.

5) SOLVE YOUR SOLVABLE PROBLEMS

These include relations with in-laws, dealing with money matters, distributing housework, and conflicts about raising children. Each of these subjects are potential minefields. Although each of these dimensions operates according to their own laws, the basic approach has to be the same:

a) Soften the startup, i.e. don’t begin with hostility and attack. Instead of “I hate it when your mother comes over” try “The next time your mother comes over, could you tell her that it really hurts me when she criticizes my child-rearing practices.”

b) Learn to back off and make repair attempts. Don’t keep pushing the point if you are at loggerheads. Avoid emotional flooding.

c) Soothe yourself and each other. Again, avoid emotional flooding. Take a break. “Chill out” as they say in modern lingo.

d) Look for compromise and common ground. Dr. Phil, the TV psychology guru likes to repeat in his shows “A couple is negotiation.” In order for this to occur, one must return to principle four—allowing yourself to be influenced.

e) Be tolerant of each other’s faults.

6) OVERCOME GRIDLOCK

There are inevitably some unsolvable problems in couples. Here Dr. Gottman has an interesting insight. He claims that one of the major sources of unsolvable problems is not including each person’s dreams in the couple’s contract.

I have seen this in my practice on numerous occasions. For example, if the woman has always dreamed of having children and the male partner objects for whatever reason (maybe this is his second marriage and he feels he has no energy left for other children), this will sabotage the marriage. Another example is the male who has always dreamed of having his own business. If his female partner is too insecure and pushes him to take a stable job at a large firm this too will weigh heavily against the success of their union.

Actually there is a spiritual dimension to this particular dilemma. The deep-seated dreams we carry in our hearts are reflections of our destiny, given to us by our Creator. If we resist and oppose them, we are actually resisting Divine Will and no good can come from this.

7) CREATE SHARED MEANING

This may involve family rituals, the evening meal together or common goals (building a house , preparing together for a world tour or developing a charitable project).

In this vein Gottman leaves us with a series of practical suggestions as to time management. He calls this the magic five hours:

a) Say goodbye in the morning and find out one item in the day’s agenda of the spouse. ( 5 minutes each workday)

b) Debrief together at the end of each work day to unstress. (20 minutes each workday)

c) Communicate some genuine affection and appreciation every day. (5 minutes each day)

d) Express affection physically once a day, Could be a kiss or a hug or back rub. (5 minutes each day)

e) A weekly date (away from the pressures of home and work). This can take many forms—a visit to the coffee shop, a meal at a restaurant or a long walk in nature. (2 hours per week)

Now do the math. It’s 5 hours per week—a very worthwhile investment.

CONCLUSION

I hope I have been able in this brief essay to give some of the more important principles of the psychology of couple relationships. There is, of course, much more to say including numerous other illustrative case histories that I was unable to include in such a short essay.

Suffice it to say that our marital and family life is a vital and precious part of our existence. It is the cauldron in which our characters are formed and it is a wonderful context in which to work on our character (akhlaq). No other situation gives us a better mirror within which to see our faults and shortcomings and to try to correct them.

Between our parents, our spouses and our children there is no excuse for any of us not to be aware of our personal limitations. Then we must turn to our beliefs and teachings and to our Lord to help us to correct ourselves.

May God help us in this greatest of struggles (Jihad al- Akbar) as the nafs we struggle with is nowhere more apparent than in our family interactions.

Note: The details of the case histories have been altered to protect the identities of the persons involved. Any resemblance to persons alive or deceased is thus only very partial. The identities of actual persons should not be inferred. This notice applies as well to the previous and forthcoming articles by Dr. Kreps.


Dr. Ibrahim Kreps is a psychiatrist in private practice in Pointe-Claire, Montreal. He has 30 years of psychiatric practice with particular interest in integrative psychotherapy and he was a former teacher in the Department of Medicine at McGill University.

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