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Abstract
This paper discusses Health problems of adolescents (13-19 years) from the perspective of the five purposes of the Law, maqasid al shari’at. The purpose of protection of diin, maqsad hifdh al ddiin, relates to adolescent identity crises, role ambiguity, and marginalizing spirituality. The purpose of protection of life, maqsad hifdh al nafs, relates to protecting and promoting physical health of adolescents. This purpose also relates to the limited competence of adolescents in medical decisions due to an immature brain. The purpose of protecting progeny, maqsad hifdh al nasl, relates to sexual and reproductive health education for adolescents. The purpose of protecting the mind, maqsad hifdh al ‘aql, relates to adolescent problems of depression, suicide, para-suicide, addictions (nicotine, alcohol, and drugs), and juvenile delinquency. The paper suggests social engineering practical measures to deal with adolescent problems consisting of cognitive approaches, faith (iman) therapy, early marriage with contraception, living in extended family for psychological support and enhancing youth esteem.
Introduction to adolescence
The stages of the human life span
are childhood, tufuulat; youth, shabaab; middle age, sinn al
shudd;,[1] and
old age, shaykhuukha[2].
Youth is divided into 2 stages: adolescence 13-19 years, and young adulthood
20-40 years. Adolescence starting at puberty is a rapid, complex, and difficult
adaptive and adjustive changes in physically (height, weight, primary and
secondary sexual characteristics) and behaviorally (emotions, thoughts,
behavior, psychological, social, and moral). In the past the transition from
childhood to adulthood was rapid and painless so that by about 15 years
children became adults with puberty being a mark of adulthood. Today we have
prolonged childhood up to the age of 20 and more with a long transition full of
psychosocial problems.
Methods
Adolescent health problems and
associated factors were classified and discussed under the 5 purposes of the
Law, maqasid al shari’at[3],
to provide an intellectual context for their further analysis and solution. The
5 purposes are: protection of diin, hifdh al ddiin; protection of life, hifdh
al nafs; protection of progeny, hifdh al nasl; protection of the
mind, hifdh al ‘aql; and protection of wealth, hifdh al maal.
The purpose of protecting diin, maqsad hifdh al ddiin
The identity and role ambiguity
with associated tensions and imbalances in adolescents are due to imperfect internalization
of ddiin. The solution to these problems is by a cognitive approach and
an iman restoration therapy approach[4].
The cognitive approach consists of equipping the adolescents with a world view
based on the Qur’an, ru’uyat kawniyyat qur’aniyyat[5]
that consists of six elements. The first element is to understand the
integration, takaamul, of the cosmos that everything relates to
everything else and that we cannot deal with a problem in isolation. The
adolescent cannot handle his or her affairs without reference to other
considerations in society. The second element is to appreciate that
approaches to problems must be comprehensive, shumuuli. We cannot
successfully solve a problem without taking into consideration all related
factors thus adolescent problems have to be approached in a multi-disciplinary
way. The third element is to seek the golden mean and avoid extremes in dealing
with any adolescent problem. This involves balance, mizan, and equilibrium,
e’itidaal. The fourth element is to understand the action-reaction
phenomenon, tadafu’u, so that the adolescent considers the potential
reaction to his or her actions before taking any action. Many adolescent
problems arise from precipitate actions based on emotions and drives without
clarity of vision. The fifth element is to build the adolescent’s self-esteem as
that will strengthen the will to resist negative temptations through an
understanding of human responsibility and accountability of vicegerancy, khilafat.
The adolescent will maintain the highest standards of conduct appropriate to
the role of khilafat. The sixth element is to understand the
adolescent’s civilizational responsibility that starts with all creation being
placed at the service of the human, taskhiir, so that he can build a
physical civilization, ‘imarat al ardh.
Strengthening and / or restoring the faith (iman) of the
adolescent is necessary at all times to ensure that he/she can stand up again
whenever moral weaknesses overpowers him or her.
A clear world-view will enable
the adolescent to navigate many problems such as identity, self-knowledge,
tension due to change, and compensation for the biological immaturity of the
brain. The concept of takamul enables the adolescent avoid the
child-adult dichotomy by understanding that it is one integrated continuum with
roles and responsibilities changing in a smooth and gradual transition from
childhood to adulthood. The same concept will also enable the adolescent to understand
that the changing roles and responsibilities of dependence and independence as
he changes from a child to an adult are all part of an integrated social
system. The same concept will also enable the adolescent to avoid the crisis of
balancing between identifying with peers and identifying with parents or
society at large. The adolescent, the peers, the family, and the society at
large are part of an integrated holistic system whose components can work
together with no tensions. The concepts of balance and equilibrium will enable
the adolescent to navigate tensions experienced during rapid growth: the
tension between high intellect capacity in the adolescent balanced by wisdom
acquired through experience, the tension between the abstract / idealistic
adolescent thinking and the cruel realities of practical life, and the tension
between biological sexual maturity and constraint on sexual expression because
of delay of marriage until full maturity.
Besides a cognitive approach based on a
world-view, an approach based on strengthening / restoring iman is needed for
adolescents. A strong iman gives the adolescent strength to face the
challenges of life through the knowledge that his faith is a direct connection
to a higher power that he can rely on. This strength can also help overcome
cognitive and behavioral defects due to an immature brain because the inner
strength of the ruh can overcome weaknesses of the physical body. This
fits well with the Islamic understanding of the human duality consisting of the
physical body and the ruh or nafs.
The purpose of protecting
life, hifdh al nafs
The purpose of protection of life
motivates many medical interventions in adolescents. Growth anomalies such as
early puberty, delayed puberty, and congenital anomalies are treated to protect
good health. Programs that prevent adolescent injury, violence, crime, and
delinquency serve the purpose of the protecting the life of the adolescent and
the community at large. These programs should in the first instance be directed
against the underlying socio-demographic risk factors such as the attention
deficit and hyperactivity disorder (ADHD), low school connectedness, low scholastic
achievement, high peer delinquency, alcohol, risky sex behavior, hopelessness,
parental divorce, and weak parental authority.
Patient autonomy is fundamental
in protecting life because of all the persons involved with the illness
including healthcare workers and family members, it is the patient who has the
purest of intentions and therefore should be the ultimate decision maker. This
raises the issue of the competence of adolescents in consenting to, assenting
to, and refusing medical decisions. Since their brain and therefore cognitive
functioning are still developing, they may not be relied on to make the best
decisions on their care. Research showing brain immaturity will require review of
international and national statutes about adolescent competence in medical
decisions. Review will also be needed for other issues that involve assertion
of adolescent rights, ahliyyat al wujuub, and adolescent
responsibilities as well as accountability, ahliyyat al ada.
Protection of progeny, hifdh
al nasl
Sexual and reproductive behavior
falls under the purpose of protecting the progeny. Many adolescent problems
relate to sexual behavior that is part of reproduction. Mass media and
entertainment outlets give a lot of sexual messages that impact adolescent
sexual behavior. This is embedded in the economic system because commercial
advertisement cannot operate without exploiting the sex theme. The problem
arises when sexually mature adolescents, bombarded by sexual messages from the
media and entertainment industries, cannot find legitimate sexual expression
through marriage because they are not ready to run a home. They end up engaging
in risky sexual behavior that results in teenage pregnancy and sexually
transmitted infection (STI). The Prophet taught youth to control their sexual
urges by fasting, saum, if they are not able to marry[6]. Additional
approaches to preventing risky sexual behavior is sexual and reproductive
health (SRH) education at school and other social outlets. SRH can be a
double-edged sword: it can help
adolescents learn to control themselves but can also act as a stimulant to
sexual experience among those who knew nothing. The parental role in SRH education
cannot be over-emphasized. They have to talk to teenagers about marriage,
courtship, pre-marital sex, STI, etc. A dangerous approach of some SRH
education programs is the promotion of the concept of safe sex by use of
condoms. This reduces teenage pregnancy and STI but increases promiscuity that
is eventually detrimental to society by undermining the family institution
based on marriage.
Protection of the mind, hifdh
al aql.
Adolescent addictive and
self-destructive behaviors can be considered aberrations of the mind. The most
significant adolescent health problem is addiction to nicotine, alcohol, and
drugs with their mental and physical consequences. Adolescents are susceptible
to addictions because of their cognitive immaturity, failure to control
emotions and drives, and peer or media pressures.
The adolescent social environment
affects behavior that will lead to addiction for example the socio-demographic
factors for adolescent smoking are environmental including living in a
household with one parent or no parent,[7]
parental or best friend smoking[8],
exposure to secondary smoking acting through nicotine addiction, [9],[10]
watching movies with smoking scenes.[11]
The socio-demographic risk
factors of alcohol addiction are: movies with alcohol themes[12],
friends[13], and
conflict with parents[14]. Alcohol,
named by the Prophet as the mother of all evils, umm al kabair[15],
leads to risky sexual behavior in adolescence[16]
and adulthood.[17] Binge
drinking is associated with structural[18]
and functional[19] changes
in the brain. Genes have been found to interact in multifactorial adolescent
alcohol pathways with such factors as parenting rule setting,[20]
peer influence,[21] the
psychosocial environment,[22]
stressful life events,[23]
and family malfunction or mistreatment.[24]
The socio-demographic risk
factors of substance abuse are similar to those of nicotine and alcohol addiction.
Structural defects found on MRI investigation indicate that growing adolescent
brains are susceptible to cannabis[25].
Both socio-demographic and biological risk factors of substance abuse can in my
opinion be overcome by good parenting and a healthy social ambiance. Religiosity
protects against substance abuse[26]
but research has shown that incongruence between internal religiosity and
external religious manifestations is a high risk for alcohol and drug use in
Mexican adolescents.[27] Anecdotal
evidences that I have collected over the years also seem to match this finding.
Further research will be needed to confirm the result as well as find an
explanation for it.
Suicide and para-suicide are
found among adolescents. Risk factors of suicide mediated through shaming are: parental
separation, parental unemployment and experiences of sexual abuse.[28]
Socio-demographic risk factors for suicide: low self-esteem,[29]
sleep problems,[30],[31]
conformity to social perfectionism[32]
as well as genetic and environmental factors[33]. In
addition to these, suicide has a biological basis. Frontal brain activity is a predictor
of depression.[34] MRI
differences in brain activation were found in the brains of teenagers before
and after treatment for depression.[35] A neurobiological basis for suicide was also
suggested by low levels of the brain derived neurotropic factor, which affects
serotonin neuronal development. This development is associated with suicide
risk independent of psychiatric diagnoses.[36]
There is no unanimous agreement
that behavioral problems may arise from the immature adolescent brain but there
is suggestive evidence. Brain abnormalities were associated with conduct
disorders[37]. MRI
studies found differences in activation in the brains of youth exposed to media
violence and those not exposed[38].
MRI image differences were also found among adolescents with eating disorders[39]. Structural
and functional brain defects were found in females with anorexia nervosa[40].
The way forward
I would suggest five approaches
to contemporary youth problems. First: an intellectual/cognitive
approach that will capitalize on the abstract thinking of adolescents to
present an integrated Islamic world view to resolve identity and imbalance
problems and to understand modern media and entertainment in their proper
perspective. Second: Iman restoration therapy to provide the spiritual
force needed to stand up to temptations. Third: Approach fiqh issues
from the maqasid perspective that starts with the higher purposes and
not the branches. Fourth: Early marriage with delayed parenthood to
prevent evils of extra marital sexual relations and their consequences. Fifth:
Social engineering to bring back life in the extended family. Sixth: Build
adolescent self-esteem by positive parenting and hope in the future of the
ummah.
REFERENCES
Available upon request