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Lecture given to 1st medical students at the Kulliyah of Medicine, International Islamic University, Kuantan 8th November 1997 by Prof Dr Omar Hasan Kasule, Deputy Dean for Research and Post=graduate Affairs
OUTLINE
1.0 CONCEPT OF GOOD HEALTH
2.0 GIFT OF GOOD HEALTH
3.0 IMAN AND GOOD HEALTH
4.0 HEALTH PROTECTION
5.0 HEALTH PROMOTION
6.0 DEFINITION OF DISEASE
7.0 CLASSIFICATION OF DISEASE
8.0 NATURE OF HUMAN DISEASE
9.0 CAUSES OF DISEASE
10.0 DISEASE AND QADAR
1.0 CONCEPT OF GOOD HEALTH
Definition of health: Health is a positive state of being and not just absence of disease. The components of good health: Spiritual (sihat ruhiyyat), biological (sihat al jasad, rahat jasadiyyat), psychological (sihat nafsiyyat, rahat nafsiyat), mental, and social. Islam looks at health in a holistic sense. If any part of the body is sick the whole body is sick. Similarly a person who is spiritually sick will sooner or later also become physically sick Health is relative and subjective. It varies by age, place, norms, gender, iman & tawakkul. A physical state that is healthy in an elderly person may not be so in a younger one. The conventions and norms (adat) of what is good health varies from place to place and even in the same place may vary from era to era . The subjective feeling of good health varies by gender, females generally being more worried about disease than males. Those with strong iman and trust in Allah (tawakkul) may feel subjectively healthier than those who do not have these attributes.
Measurement of health: Attempts have been made to measure health. Several indices of the quality of life have been defined and have been used. Statistical parameters have been used to measure health. They however are limited in that they indicate only the final state of health and do not take into account the intermediate stages. They also can not measure the intangible spiritual and mental components of good health. The best index would be one that includes both spiritual and physical parameters. Such an Islamic index has not yet been constructed to our knowledge. This index would also include criteria that reflect relations with Allah, with the self, with other humans, and with the environment.
Health as an amanat: Keeping body in good health is an amanat. The Muslim must keep his body physically fit to be able to undertake the functions of istikhlaf and isti’mar.
2.0 GIFT OF GOOD HEALTH
Good health is a gift from Allah. Humans tend to take Allah’s gifts for granted and are therefore not grateful. They only understand the gifts when they are taken away. An ordinary person may not understand or appreciate the value of good health when in good health. On falling sick, the value of good health is understood and is appreciated but most often for a limited time. Everything is forgotten as soon as the illness is over.
Humans must be grateful to Allah for the gift of good health. This gratitude is in the form of worshiping Him and doing good things.
3.0 IMAN & GOOD HEALTH:
There is a strong relation between iman, character, behavior and health. Iman cures diseases of the heart such as hasad and hiqd, that lead to violence in the person or those around him. These diseases may manifest physically as psycho-somatic illnesses or may manifest more dramatically such as murder of cause of bodily injury. Addiction to alcohol, or drugs is a reflection of weak iman. It leads to physical disease
4.0 HEALTH PROTECTION:
Islam encourages a human to take measures to protect the body from harm. Thus immunization, good sanitation, and disinfection are all acceptable measures for protecting health.
5.0 HEALTH PROMOTION:
There are activities that Islam encourages to promote health. They essentially put the body in the nest state to withstand disease and illness. These include diet, exercise, and recreation.
6.0 DEFINITION OF DISEASE
The Qur’an has used several terms to refer to disease. In the subject form the word maradh has been employed. In the adjective form the words maridh and saqim have been used (27:89, 37:145). The definition of disease is very relative. A high blood pressure in an elderly person does not have the same implication as the same level in a younger person. There are changes in the body that should be accepted as normal processes of ageing and not as diseases.
Definition of disease considers several dimensions that may operate singly or in combination: moral/spiritual, biological/pathological (khuruuj al badan ‘an al i’itidaal), psycho-social, or normative/statistical. Loss of spiritual equilibrium is a disease in itself and soon leads to physical disease. Most diseases involve disturbances in the equilibrium of the normal body physiology. These biological disturbances may be within the range of normal physiological variation or may be clearly pathological. The psycho-social dimension of disease is associated with loss of equilibrium and may precede or follow physical disturbances. The normative or statistical dimension is the most confusing. Sometimes people are branded ill because they fall at the extreme end of the health-illness spectrum. In the final analysis it is the perception of disease by the victim, the family or the health care givers that defines disease. The underlying pathology need not correspond with the victim’s disease complaint; perception operates in between.
In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. Falling ill may be Allah’s way of forcing the person to take a desired rest or care for the body before it can deteriorate further.
7.0 CLASSIFICATION OF DISEASE
Diseases may be classified by their duration as acute or chronic. Acute disease is a temporary disturbance of homeostasis. Chronic disease may establish a new level of homeostasis
Diseases may also be classified by cause as diseases of the heart and diseases of the body. These two categories have been mentioned by the Qur’an. Diseases of the heart (amradh al qalb) include shakk, shahwat, and ghil (2:10, 5:52, 8:49, 9:125, 22:53, 24:50, 33:12, 33:32, 33:60, 47:20, 47:29, 74:31, 2:16). Diseases of the body (amradh al badan) mentioned in the Qur’an include: blindness (ama) (p 851 2:2:17-18 … 80:2, 3:49 … 12:96), …(akma) (6:104, 5:71, 28:66, 22:46, 47:23, 27:60, 6:50), deafness(sum) (2:18, 2:171, 6:39, 8:22, 10:42, 21:45, 27:80, 30:52, 43:40), lameness (araj) (p 807 24:11 … 48:17), ……. (baras) (p 189 3:49, 5:110), ……. (bukm) (p 204 2:18 …17:97).
Disease can also be classified by physical cause: infectious (viral, bacterial, fungal, protozoal), neoplastic, allergic, genetic, congenital, nutritional, environmental, mental, degenerative, metabolic, circulatory, hormonal.
8.0 NATURE OF HUMAN DISEASE
Reaction and adjustment: a patho-physiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust.
Punishment: Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship.
Expiation/atonement for previous sins: disease can be an opportunity for personal. The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness.
Blessing: Disease may enable a person return to the due equilibrium in life. Falling sick after over-working and spending some time in bed resting is a good example. Falling sick may at times be Allah’s blessing in disguise that a person is incapacitated and thus is prevented from pursuits that could prove more dangerous for him.
Benefits: While a person is sick and is not busy with the routines of life he may have time to reflect and remember Allah
Disease as an excuse from obligations: Allah in recognition of the burden of disease and the need to give the body a chance to recuperate excused the sick from some physical religious obligations (2:10, 48:17, 2:184, 2:185, 2:196, 4:43, 4:102, 5:6, 9:9, 73:20).
9.0 CAUSES OF DISEASE
Environmental: heat, cold, radiation, water drowning, smoke, and high altitude can lead to patho-physiological disturbances and disease.
Genetic: mutations and chromosomal damage can alter the body’s growth metabolic processes resulting in disease. Islamically speaking we can not say that there was a genetic or chromosomal mistake. It is all part of Allah’s grand design.
Immunological: disease could arise in all three conditions of immunological disturbance: a hypo-active immune system cannot protect the body against invading organisms. A hyperactive immune system may destroy parts of the body such as occurs in auto-immune diseases. Some immune reactions are abnormal or paradoxical causing tissue damage.
Malnutrition: under-nutrition causes disease by depriving the body of essential nutrients. Over-nutrition results in diseases such as heart disease.
Infection (al ad’wah): Infection of the human body by other organisms is part of Allah’s plan especially in fulfilling the food chain. It is part of the balance of the eco-system. This does not however mean that such diseases should be left alone.
Neoplasms: loss of control over cell multiplication results in cancer. This is violation of a basic law in biology that equilibrium and homeostasis will be maintained.
Degeneration: in old age phenomena of growth and decay are more that repair and growth and degenerative diseases could result. These are strictly speaking part of Alah’s design and not an anomaly.
10.0 DISEASE AND QADAR
Occurrence of disease as qadar: It is Allah’s pre-destination that a person falls sick. Treatment/prevention of disease not against qadar. Medical treatment is subsumed under the principle that qadar can reverse another qadar (radd al qadar bi al qadar). In the end all cure is from Allah and not the human (26:80).
11.0 DISCUSSION
Explain in your own words the WHO definition of health
Describe disease prevention such as immunization in the context of qadar
What do you understand by the term psycho-somatic disease
Describe the local ordinary man’s classification of disease
What is the attitude to disease in your community
What are the common beliefs in your community about causes of disease
Explain how disease of the heart could lead to physical diseases