There seems to be a lot of assumptions when it comes to certain mental illnesses like depression.
One such assumption is that depression is a purely physical phenomena like getting a cold or diabetes. This leads to other assumptions like the solution is found within purely mechanistic terms. For example we know diabetics cannot turn glucose in the body into glycogen due to insufficient amounts of insulin. Therefore the solution is to replace this chemical with either synthetic alternatives or drug treatments that help sensitive bodies reaction to insulin etc.
So the assumption follows that let's identify the chemical agent or structural feature that results in depression. Provide chemicals to mimic or stimulate these and one can solve depression.
This means Muslims start to see depression as isolated from the environment people live in, the choices they make and the concepts they hold.
From a medical point of view depression is unlike other physical illnesses.
Firstly the precise mechanism that relates to elevation of mood or depression is not fully understood. Yes we can explain something about dopamine levels in the brain particularly in the mesolimbic system but it's not at all clearly understood. Although it's considered that low levels of dopamine results in depression new studies actually state that prolonged exposure to dopamine can result in depressive episodes too.
Let's take one example depression is associated with poor sleeping patterns. But does depression cause sleeping problems like insomnia or is insomnia that causes depression? The point is aspects of the brain are so highly complex and science is still trying to understand the basics of what causes depression. It's just not understood.
Secondly the current treatments like ssri's (selective serotonin reuptake inhibitors) are not fully understood in the role it plays with depression. For instance one may think that once you take ssri's you'd have more happy chemicals like serotonin floating around the synaptic cleft (between neurones in the brain) and feel an instant effect on mood. However the effect may take between two to four weeks of taking the medicine every day. The assumption is that some changes are taking place within the Neurones and it's not simply the increased amount of serotonin.
Thirdly the most popular drugs to treat depression like ssri's have almost no effect on mild to moderate depression above a placebo. Even in severe cases their effect is moderate at best. Although some other studies may suggest better results it's not conclusive.
Fourthly one of the more effective treatments for depression isn't actually drug treatment but speaking therapies. Either through counselling to understand the underlying reasons for feeling depressed or cbt (cognitive behavioural therapy) which seeks to reshape our thoughts particularly to situations and feelings and thus breaking cycles and habits that perpetuate depression.
Why do I mention all this? It's because we have to be very careful we don't go into extremes firstly denying there's something called depression and secondly overly assuming it's so physical biological problem that needs to be fixed by some mechanistic approach to the brain thus rendering the individual without agency to deal with their problems or make rational choices.
The vast majority of people with depression will suffer from mild to moderate forms that are reactive to the environment. Eg death, disease, loss of job or home which results in a prolonged period of feeling low or depressed and thus may start to effect motivation and being able to function normally.
Some of the factors that affect this are thus conceptual, with these concepts resulting from the society one lives in.
For instance in Professor Layard's book on happiness discussing certain key factors that result in "unhappiness" and in extreme cases depression. He and other academics mention some of these causes:
Increase in the number of broken families
Declining levels of trust in society. The Harvard academic Robert Putman described this phenomena in his book "Bowling Alone", which sought to understand why people were increasingly "going it alone" and living lonely lives disconnected from family and community.
The role television and advertising has played in normalising sex and violence and unrealistic expectations around health and beauty as the cause of particular anxiety.
Economic and Social Rivalry. Trying to keep up with the Joneses. Ie not being satisfied with what one has due to competition with other people.
The wealth "treadmill". A person may feel happiness at the acquisition of some wealth, but the feeling soon wears off. This urges man to acquire new wealth to regain the sense of happiness, then again and again. Observations found possessions had to be better each time to provide the same level of happiness
Lack of a sense of purpose in ones life.
Unable to contextualise problems one faces in life or problems that don't accord to what he thinks is his only chance for ultimate happiness.
Personally I meet and deal with lots of people with depression, antidepressants are afterall probably the most popular class of medications given to patients.
In the vast majority of cases of my personal experience those suffering from depression do so because of conceptual problems and poor life choices.
Eg one patient I see and speak to on a daily basis is a recovering drug addict, has no friends, doesn't see any family, lives alone, no job or hobbies, feels like he has no purpose and thus little worth. He's on the strongest form of anti depressants yet he's of sane mind relatively intelligent and he ultimately understands his depression is less about an internal medical condition as opposed to the choices he made and the situation he finds himself in.
There are loads of similar examples, young single mother struggling with rent and raising a child, no job, little prospects for getting ahead in life, poor diet, doesn't feel respected etc... who is on citalopram 20mg daily and has been on this for depression for the last three years.
Here then the problem in both these examples are a combination of social and conceptual factors that create unhappy and depressed people.
It's therefore wrong to see depression as simply a physical problem where individuals have no agency or that society doesn't play a significant role with the problems they face and the acquisition of concepts that doesn't provide them with the ability to cope and contextualise these problems.
So although I'm not adverse to drug treatment in special cases and although it's not as simple as just telling a person to pull themselves together we need to look at more holistic approach to this condition.
This is where I believe Islam plays such a significant role. Not the read more Qur'an or pray more approach. Issue isn't about rituals done without awareness as to why one does them but rather reading and comprehending the Qur'an provides individuals with conceptual frameworks to understand problems, their purpose and perspective on life. Similarly Islam as a holistic system creates environments conducive to human fitrah and not against them. Like social and family environments where individuals understand their identity as humans and not economic machines trying to maximise sensual gratification.
Furthermore speaking to islamically literate counsellors will help mentor people back to being able to cope with depression and retuning them to normal life. And together with rituals like salah and fasting provide them with habits that help to reinforce a particular viewpoint and perspective on life.
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