J Relig Health DOI 10.1007/s10943-014-9992-2 PSYCHOLOGICAL EXPLORATION

Understanding Mind/Body Medicine from Muslim Religious Practices of Salat and Dhikr Arthur Saniotis

Ó Springer Science+Business Media New York 2015

Abstract There has been an increasing medical interest in Muslim religious practices in promoting well-being. Central to Muslim religious practices are salat (prayer) and dhikr (chanting). These two religious forms may be argued as comprising elements of mind/body medicine due to their positive effect on the psychoneuroimmunological response. The aim of this article was to further understand the mind/body aspects of Muslim salat and dhikr. Keywords

Al-tibb al-jismani
Al-Tibb al-Ruhani
BDNF
Psycho-physical well-being

Introduction There has been increasing medical interest in mind/body medicine over the last 30 years. Such attention has been expedited by improved understandings of the brain/mind and medical technology such as brain imaging. Furthermore, this interest has been spurred by many medical anthropological studies which focus on the efficacy of traditional healing systems due to their ability to include emotional states in their therapy (Helman 2008). Considerable mind/body research has been conducted on the correlation between mental states and neuroendocrinological function (Newberg et al. 2002, 2003; Ernst et al. 2007; Wahbeh et al. 2008, 2009). Various mind/body techniques are currently being investigated for the treatment and management of various maladies and diseases such as cardiovascular disease, cancer, psychiatric disorders, and multiple sclerosis (Berntson et al. 2008; Penn and Bakken 2007; Gordon 2008; Mason and Hargreaves 2001; Mills and Allen 2000). A key idea of mind/body medicine is that human mental states can inform psychophysical well-being. (Wahbeh et al. 2009). In Western medicine, the link between affectivity and predisposition to diseases was known in the early twentieth century, but became dominated by the mechanistic paradigm of medicine. Furthermore, there has been

A. Saniotis (&) School of Medical Sciences, University of Adelaide, Adelaide, Australia e-mail: [email protected]

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considerable research conducted in examining the efficacy of religious-/spiritual-based techniques in enhancing well-being. These studies have included an increase in brainderived neurotrophic factor and reduction in cortisol secretion in prolonged Buddhist meditation, (Pace et al. 2009), improved neuro-plasticity and increase in cerebral blood flow in the practice of transcendental meditation (Jevning et al. 1996), and enhanced brain connectivity in long-term meditators (Luders et al. 2011). Furthermore, recent brain imaging studies have discovered changes in brain anatomy in long-term meditators (i.e. increase in cortical thickness in brain areas associated with attention and sensory processing) (Lazar 2011; Jha et al. 2007), and boost in density grey matter (GM), in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum (Ho¨lzel et al. 2011), and the brain stem (Vestergaard-Poulsen et al. 2009). In one study, it was found that even short term (11 h of Integrative Mind–Body Training (IBMT) promoted white matter integrity of the corpus callosum and the superior and anterior corona radiate Tang et al. 2010). Current medical research into religious-derived mindfulness practices indicates their positive effect on psycho-physical well-being and in the treatment of chronic stress-related disorders (Kabat-Zinn et al. 1992; Miller et al. 1995; Goldberg et al. 1998; Grossman et al. 2004). While Hindu- and Buddhist-based mindfulness meditation has been researched as a potential clinical intervention (Rani et al. 2012; Streeter et al. 2012; Baer 2003), there have been few studies conducted on Muslim-based religious practices and their stress reduction and life-enhancing qualities. (Chishti 1985) was one of the first studies which focussed on Sufi practices and their therapeutic efficacy. His study discusses both the spiritual and physical enhancing aspects of Muslim ritual prayer (salat) and meditation (dhikr). A more recent study recognises salat and dhikr for their therapeutic qualities, but does not discuss how such techniques can be implemented by modern Muslim clinicians (Al-Rawi and Fetters 2012). While salat and dhikr may be viewed as incorporating elements of mind/ body medicine, there needs to be more research into this area. Consequently, this article will examine the mind/body aspects of salat and dhikr in order to further understand their therapeutic use in clinical practice.

Mind/Body Medicine in Islam: Historical Roots In order to locate the mind/body elements of salat and dhikr, an overview of the Muslim psychological model is necessary. Since the early period (eighth–thirteenth centuries), psychiatric health has been an important element in Islamic medicine. Al-Balkhi (d. 322/ 934) emphasised the need for physicians during his time not to ignore psychological aspects behind physical illnesses, believing that most physical ailments had a psychological basis (Deuraseh and Talib 2005). Muhammad ibn Zakariya¯ Ra¯zı¯ (865–925) and Abu¯ ‘Alı¯ al-H
usayn ibn ‘Abd Alla¯h ibn Sina (980–1037) incorporated psychological methods in their clinical practice. With the completion of his medical canon Al-Mansuri, Al-Razi wrote a treatise on spiritual medicine (at-Tibb ar-Ruhani), where he explicated his ideas on psychotherapy (Al-Ghazal 2003). Ibn Sina developed an associative system for reading pulse and ascribing it to the psychological state of the patient (Syed 2002). Ibn Sina’s psychology was grounded in physiology, with perception connected to intellection (aql); this correspondence between the outward and inward senses creating a unified and seamless consciousness (Avicenna 1952). Psychotherapy was also endorsed by Ali Ibn Sahl Rabban At-Tabari (838–870); he noticed that sickness was also contributed to ‘‘delusive imagination’’ (Haque 2004). Other noted scholars including Abul Hasan Ali

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Abbas Al-Majusi (d. 995), Abu Ali Ahmad B. Muhammad B. Ya’kub Ibn Miskawayh (941–1030), and Abu Hamid Muhammad Al-Ghazali (1058–1111) wrote treatises on human nature and disease. Islam divides medicine according to two types: physical medicine (Al-tibb al-jismani) and spiritual/psychological medicine (Al-Tibb al-Ruhani). Unlike the bio-medical model, these two medical categories are symbiotically related since in Islam humankind is composed of body (jism) and spirit (ruh) (Deuraseh and Talib 2005). In addition, Islam recognises human mental health as being constituted by psyche (nafs), mind (aql), and heart (qalb). In western terminology, the nafs is cognate with the ego and is often referred to by Muslims as the ‘‘baser self’’ which needs vigilant control. Medieval Islamic physicians and philosophers compared the naı¨fs with ether, which was believed to be ‘‘emitted from the heart’’ and transported via the blood throughout the body ‘‘giving it life’’ (Phillips 1989:17). Schimmel (1976), cites three types of nafs found in the Quran, and their mystical meanings. Firstly, there is the nafs which incites humans to commit sin (an-nafs al-amma˜ra bi’-su’); ‘‘the soul commanding to evil’’ (Quran 12:53) (1976:112).1 Traditional Sufi thought recommends the use of certain mystical practices in both taming the nafs and for attaining higher spiritual states, and finally, to a ‘‘passing away’’ or dissolution of a Sufi’s self (fana) into the Divine Reality (Nicholson 1976; Stoddart 1994; Bakhtiar 1991; Hoffman 1995). In traditional Islamic thought, the heart is recognised as the seat of compassion and spiritual discernment. According to Saniotis (2012a), Indian Sufis describe the qalb as a seat of spiritual power (qudrat-I-qalb; literally, ‘‘heart’s power.’’ qudrat means ‘‘power’’ and qalb translates to ‘‘heart’’). The self same also note that a function of the qalb is in distributing the ruh via the circulatory system. In this way, nafs and ruh are mutually connected. On this note, the pre-eminence of the qalb was highlighted by Al-Ghazali who stated that it regulates human instinctual drives and intellect (Haque 2004). Al-Balkhi described two kinds of sadness/depression (al-huzn); in the first case, huzn was triggered by an external event/circumstance and is cognate with exogenous depression. The second kind of huzn could be triggered by a sudden trauma or distress, causing ahedonia and fatigue—analogous to endogenous depression. In both kinds of huzn, traditional therapy included talk therapy providing guidance in order to develop a balanced mental condition which would reduce the depressed condition while creating mental power for preserving psycho-physical well-being (Deuraseh and Talib 2005). The physician ‘Ali b. al-‘Abbas alMajusi (d. 383/994) highlighted in his treatise, Kamil al-Sina‘ah al-Tibiyyah, that the physiological and mental changes caused by huzn necessistated immediate medical attention since they could worsen health problems (Deuraseh and Talib 2005).

Mind/Body Medicine Salat Salat is the second pillar of Islam. As an obligatory requirement of ritual worship salat combines the essential tenets of Islam—worship of one God, remembrance of Allah, submission to the Allah’s will, supplication, as well as, a symbol of unity of the Muslim 1

According to Schimmel this ‘‘forms the starting point for the Sufi way of purification’’ (1976). Secondly, there is the nafs as the ‘‘blaming soul’’—an-nafs al-lawwa˜ma (Quran 75:2), which corresponds to the human conscience; and thirdly, the nafs after having been purified (mutma’inna) (Quran 89:27). In this state, the nafs is purged of any incendarianistic qualities, and is ‘‘at peace’’ with Allah.

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community (ummah). Salat is performed at five appointed times during the day and is preceded by ritual ablution (wuduˆ’). Salat includes various postures (raq’aas) which involve standing, raising and lowering of arms, bowing, sitting on shins, prostration and head rotation. The movements of salat are co-ordinated with ?prayer, with the ritual movements being repeated. In all, the five obligatory salat consist no \17 raq’aas (Al-Barzinjy et al. 2009). Al-Tharshi (1992), has pointed out that the five daily salat consist of 280 movements, 72 prostrations and 36 bowings. Various authors have examined the therapeutic aspects of salat in relation to what extent it promotes psycho-physical well-being. For example, Reza et al. (2002), and Al-Barzinjy et al. (2009) focus on the musculoskeletal benefits of salat. According to these authors, salat uses many joints and muscles. Further reported benefits of salat include: Providing muscle tone, maintenance of postural equilibrium, improving circulation, and has a protective role in reducing osteoarthritis (OA) of the weight bearing joints. Additionally, salat improves cerebral circulation due to its mild to moderate amount of physical activity (Reza et al. 2002). It could be suggested that an outcome of salat’s physical activity level (PAL) may also contribute to an increase in brain-derived neurotrophic factor (BDNF), which provides neuroprotective, neurotrophic benefits and enhances brain plasticity/neurogenesis (Cotman and Berchtold 2002; Cotman et al. 2007; Alberini 2009; Noakes and Spedding 2012; Mattson 2012a, b). Additionally, BDNF contributes to the therapeutic action of antidepressant treatment (Shirayama et al. 2002; Editorial 2012). Following from Yu¨cel (2010) highlights the correspondence between salat and Indian yoga, in that both require a unification of body/mind. Anthropological studies note on the relationship between ritualised body movement in eliciting affective states (Turner 1967, 1969; Lewis 1971; Obeyeskere 1981; Kapferer 1983, 1997; Desjarlias 1994; Dissanayake 1992; Saniotis 2001; Winkelman 2000). Yu¨cel’s quantitative study on Islamic prayer [salat and dua (supplicative prayer)] amongst sixty adult participants 18–85 found that both prayer types reduced stress and depression while providing comfort. The study also indicated that 75 % of study participants indicated that Islam was an important factor in their lives (Yu¨cel 2010). The mind/body relationship Muslim prayer provides a basis for overcoming life’s exigencies, decreasing anxiety/depression while relying on Divine assistance and guidance (Yu¨cel 2010). Dhikr: Modern Social Elements Dhikr, meaning ‘‘remembrance of Allah’’ is a meditative-based practice which can be performed either individually or collectively. The Qur’an (18:24; 2:152; 33:40) commands Muslims to remember Allah throughout the day and night. While salat is an integral part of dhikr, as well as, leading a pious life, the practice of dhikr has tended to be organised according to a structured practice involving the repeating of one of Allah’s Divine Names/ Attributes (Al-Asma Al-Husna). For many centuries, Sufism, the mystical branch of Islam, has created many kinds of dhikr techniques which Sufis perform. Traditionally, Sufism has categorised dhikr according to the verbal dhikr (dhikr jali) and dhikr of the heart (dhikr kafi) (Geels 1996). Although dhikr is highly encouraged amongst Muslims in general it is not in the same category as salat, since it does not incorporate a single, standardised form. Rather, dhikr comprises many performative features, some of which have been borrowed from older religious traditions. For example, Goldziher (1917:176–177) argues dhikr practices in Sufi orders which included ecstasy and kenosis can be traced back to India. The use of the rosary used during dhikr is a case in point. The rosary becomes widespread amongst

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Muslims as an item of religious devotion, spreading through Sufi orders. Furthermore, the religious pluralism found in India became fertile ground for the adoption on non-Muslim devotional practices by both Sufis and lay Muslims, influencing Indian Sufi orders such as the Chistiyyah. The Chistiyyah, particularly, became an ideological bridge between Islam and Hinduism, providing a point of vehicle for religious syncretism and social integration (Khizer 1991; Rizvi 1965; Nadwi 1977). The various forms of dhikr found in the Muslim world testify to the varieties of religious expression of Muslims in general, and how changing sociological milieu inform religious practices. For example, Werbner (1996) argues how modern day Sufis in the UK sacralise ‘‘domestic’’ space during collective rituals, and by doing so, root their identity in these new localities. Furthermore, the Naqshbandiyya in Rotterdam blend sober and ecstatic dhikr styles from both Naqshbandiyya and Mawlawiyyah orders (Widiyanto 2006). For the Dutch-based Naqshbandis, dhikr is viewed as a psycho-physical therapeutic practice par excellence, rendering the adherent in proximity with Divine healing (Widiyanto 2006). This is a poignant example of how dhikr is becoming accommodated in modern, non-Muslim environments. While attention on dhikr has mainly focussed on its spiritual merits, recent research points to dhikr as a marker of changing ‘‘Muslim’’ identity in the West. For example, Saniotis (2012b) notes that Sufi traditions are strongly placed in fostering inter-religious tolerance and liberalism in parts of the Islamic world. The fact that western Sufis (i.e. adherents from the Sufi movement of Inayat Khan, which is a branch of the Chistiyyah brotherhood) engage in modified forms of dhikr throughout the world is also a case in point in the globalisation of Muslim mysticism. The implications here include: 1. 2. 3.

How dhikr is being modified by adherents as a psycho-therapeutic method in nonMuslim societies. Increasing globalisation of dhikr has enabled western neuroscientists to investigate its features from a psychoneuroimmunological viewpoint. Further research into dhikr may further validate its neuro-behavioural benefits.

Dhikr: Symbolic Elements The idea of the centre is ubiquitous in Muslim societies and is symbolised by the holy ka’ba located at Mecca, being the most sacred shrine in Islam. For Indo-Muslims, the ka’ba is considered as the ‘‘omphalos of the world, the navel of the earth’’ the sacral point of the world’s beginning, and the nexus between heaven and earth (Akkach 1995:93). Eliade’s notion of the pilgrimage shrine as an archetype of the sacred centre that constitutes a break from the ‘‘profane space surrounding it’’, has exerted a strong influence on the study of pilgrimage. Eliade discusses the way in which archetypal imagery is linked to sacred centres. These locations are believed by worshippers as the place where creation came into existence—at the symbolic centre of the universe, where the divine emanates itself into the world (Eliade 1957:37). As Eliade points out, ‘‘The centre is first and foremost, the point of ‘absolute beginning’ where the latent energies of the sacred first broke through; where the supernatural beings of myth, or the gods or God of religion, first created man and the world. Ultimately all creation takes place at this point’’ (Eliade 1957:37). Dhikr is important, recommended and practiced; however, it is not in the same category as is Salat. Hence, the various forms (for example, as mentioned by the authors a form chilla in the Indian subcontinent), and the different levels of current and potential practice of it by the followers. This requires some further discussion and implications in terms of research and practice.

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A common dhikr technique performed by Sufis is called wazifa, which involves either the verbal or silent chanting of one or more of the Divine Names/Attributes. In India, for example, wazifa may be practiced by Sufis over a period of days or weeks, in which a Divine Name/Attribute may be repeated hundred and thousands of times. Sufis generally believe that the practice of wazifa enables the participant to psychologically experience the unique quality of a Divine Name/Attribute. When performed silently and in coordination with the breath (fikr), wazifa may lead to psychological equilibrium and produce a state of calmness (Haas 1943, Chishti 1985). Laughlin (1996) postulates that intensive concentration on a ritual symbol may produce a transformative state of consciousness analogous to a mystical state of being. Moreover, prolonged and repetitive ritual body movements, as characterised by dhikr have the ability to elicit altered states of consciousness, thereby enabling the participant to intensify their state of communion with the sacred other (Myerhoff 1974; Winkelman 2000, 2002, 2004). The production of altered states of consciousness (ASC) through repetitive ritualised performance has been ascribed by Winkelman (2002) as being caused by the synchronising of the frontal cortex and the limbic system, in which the latter verges towards parasympathetic dominance. The parasympathetic system coordinates relaxation, with concomitant reduction in stress hormones (adrenaline, noradrenaline, cortisol) and activation of endogenous opioids. Additionally, the action of the parasympathetic system stimulates serotonergic function in order to heighten a sense of calmness and enhancement of immune response and neurogenesis (Veenstra-VanderWeele et al. 2000; Winkelman 2004; Mel’nikova et al. 2012).

Conclusion This article has provided an overview of salat and dhikr as mind/body medicine. These two ritual practices are embedded in the psychology of many Muslims. While the historical and religious aspects of salat and dhikr are well documented, there have been few studies conducted on their therapeutic aspects. In the author’s view, more quantitative and qualitative research is needed in further examining the mind/body aspects of salat and dhikr. Well-rounded research could combine anthropological, psychological, neuroscientific, and epidemiological approaches to understanding the multi-factorial nature of these two practices. Currently, there is need for physicians to incorporate more mind/body techniques due to the dramatic increase in chronic stress-related disorders throughout the world. This is a critical issue which needs short-term and long-term addressing. Loeppke (2008) refers to present levels of chronic illnesses as a modern onslaught. It is reasonable to suggest that mind/body medicine as offered in the practice of salat and dhikr may assist in the prevention of chronic illness, as well as, as alleviating the symptoms of chronic disease. Medical research into salat and dhikr should be conducted with sensitivity to Muslim beliefs and values. Moreover, such research should be conducted with a view of educating Muslim physicians on salat and dhikr as mind/body medicine. It is because Islam is concerned with the health and welfare of Muslims, that salat and dhikr can also be promoted by physicians as fostering psycho-physical well-being. This is not to reduce the spiritual intent or purpose of these practices, but rather, to also include them as possible therapies for practicing Muslim physicians. It is evident that for over 1,200 100 years Muslim physicians have possessed a keen understanding of the mind/body dynamic and its relationship with disease. Moreover, it is of clinical significance to increase our

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understanding into the possible causes of psycho-physical distress, and how these may be reduced via the performance of salat and dhikr.

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