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Background material by Professor Omar Hasan Kasule Sr. for year 3 Semester 1 Med PPSD session on 20th October 2008
DISTURBANCE OF CONSCIOUSNESS
Forgetfulness in salat is remedied by the prostration of forgetting. A forgotten salat is offered when remembered. In complete loss of consciousness, there is no obligation to pray. In semi-coma, syncope, or stroke the patient tries to pray as much as they can. Stroke patients must be careful not to fall down during salat due to the limb paralysis or paresis. A dozing person stops salat, sleeps, and resumes when conscious of what he is reading. In fright or inability to concentrate, salat is shortened.
A person who forgets and eats in Ramadhan just resumes fasting and completes the day. The obligation of fasting is dropped if the patient is in coma or is fully unconscious. Hajj is delayed if consciousness is impaired. Hajj rites are delayed in case of syncope following postural hypotension
Semi-conscious patients or those in coma are fed without their consent under the purpose of preserving life. Pronouncements of divorce or khulu’u, marriage, or contracts under psychosocial stress or impaired consciousness have no legal effect because of legal incompetence. However a guardian, wali, on behalf of the unconscious, can conclude valid contracts. Court testimony by a semi-conscious person is not allowed. There is reduced legal or civil liability for crimes and contracts under the influence of ordinary psychiatric medication. Liability is not reduced for crimes and contracts committed under the influence of alcohol or illegal drugs.
PERSONALITY DISORDERS
Personality disorders not accompanied by cognitive effects have no impact on ‘ibadat. Severe personality disorders exempt from hajj for fear of crises. Preventive measures are needed to protect the public from psychopaths. Severe personality disorders are a contra indication for marriage. Personality disorder may be considered as legal incompetence in contracts and criminal prosecution.
NEUROTIC and PSYCHOTIC DISORDERS
Neurotic and psychotic disorders: Obligatory salat is anxiety due to inability to concentrate. Compulsive-obsession about passing flatus in salat should be ignored. It may also cause forgetfulness in salat. Psychiatric disease does not affect the obligation of paying zakat because zakat is related to the wealth and the not the individual. Psychiatric illness that affects legal competence exempts from salat and hajj. Attempts are made to treat psychiatric illness before resort to divorce. A marriage contract is deemed void or irregular because of mental incompetence. Divorce pronouncements by an insane person have no immediate legal effect unless confirmed by a competent court. Contracts by a schizophrenic or a patient with mood disorders clouding clear thinking are void. Evidence by a psychiatric patient is evaluated in view of the type of cognitive or personality defects because some may be acceptable. The evidence of patients with mood disorders must be considered in the light of their clinical conditions.
SEXUAL DISORDERS
Sexual disorders: Sexual disorders usually have no direct impact in ‘ibadat, aadaat, or mu’amalaat; they however are intimately related with marriage and divorce. Divorce or khuluu can be considered for lack of libido, sexual deviation (e.g. sadism or masochism), transsexual behavior, male impotence, and female vaginismus/frigidity. Fasting may help control sexual desire.
STRESS DISORDERS
Stress can be controlled internally salat, dhikr, and i’tikaf. It may lead to wrong unintended decisions in transactions, produce adverse effects on marriage leading to divorce, affect appetite, and impair concentration in salat. Hajj and saum may increase the stress level. Salat generally decreases stress levels.