Integrated Medical Education Resources: 250517P - RESEARCH ON FAMILY SOCIAL PROBLEMS WITH UNDERLYING MENTAL HEALTH ISSUES

Presented at a Research workshop in Integration of Knowledge at Harare Zimbabwe on 17^th May 2025 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), DrPH (Harvard), DrPH (Harvard).

1.0 PROBLEMS AND STRESSES OF LIFE

The relation between social stress and mental health is reciprocal and complex.
Problems are pre-ordained.

مَا أَصَابَ مِنْ مُصِيبَةٍ فِي الأَرْضِ وَلا فِي أَنْفُسِكُمْ إِلَّا فِي كِتَابٍ. [الحديد:22[

Problems are a reason for the forgiveness of sins.

فعن عائشة قالت: سمعت رسول الله صلى الله عليه وسلم يقول: ما من شيء يصيب المؤمن حتى الشوكة تصيبه إلا كتب الله له بها حسنة أو حطت عنه بها خطيئة. متفق علي.

Causes of stress: anger and envy.

لا تباغضوا ولا تحاسدوا وكونوا عباد الله إخوان. رواه البخاري ومسلم
"وَلَقَدْ نَعْلَمُ أَنَّكَ يَضِيقُ صَدْرُكَ بِمَا يَقُولُونَ. سورة الحجر، الآية 97

2.0 FACING STRESSES OF LIFE

Waswaas treated by istighfar.

متفق عليه: "فَإِذَا بَلَغَهُ فَلْيَسْتَعِذْ باللَّهِ وَلْيَنْتَهِ".

Taqwa and the stresses of life.

وَمَنْ يَتَّقِ اللَّهَ يَجْعَلْ لَهُ مَخْرَجًا .سورة الطلاق.

Dhikr and solving problems.

ومَنْ أَعْرَضَ عَن ذِكْرِي فَإِنَّ لَهُ مَعِيشَةً ضَنكًا

Patience in front of difficulties is the key to success.

وَلَنَبْلُوَنَّكُمْ بِشَيْءٍ مِنَ الْخَوْفِ وَالْجُوعِ وَنَقْصٍ مِنَ الْأَمْوَالِ وَالْأَنْفُسِ وَالثَّمَرَاتِ وَبَشِّرِ الصَّابِرِينَ * الَّذِينَ إِذَا أَصَابَتْهُمْ مُصِيبَةٌ قَالُوا إِنَّا لِلَّهِ وَإِنَّا إِلَيْهِ رَاجِعُونَ * أُولَئِكَ عَلَيْهِمْ صَلَوَاتٌ مِنْ رَبِّهِمْ وَرَحْمَةٌ وَأُولَئِكَ.

Iman or its deficiency is the underlying factor in dealing with social stresses.

قول رَسُولُ الله ﷺ: “عَجَباً لأمْرِ الْمُؤْمِنِ إِنَّ أَمْرَهُ كُلَّهُ لَهُ خَيْرٌ، وَلَيْسَ ذَلِكَ لأِحَدٍ إِلاَّ للْمُؤْمِن: إِنْ أَصَابَتْهُ سَرَّاءُ شَكَرَ فَكَانَ خَيْراً لَهُ، وَإِنْ أَصَابَتْهُ ضَرَّاءُ صَبَرَ فَكَانَ خيْراً لَهُ.” رواه مسلم.
وَلَئِنْ أَذَقْنَا الْإِنْسَانَ مِنَّا رَحْمَةً ثُمَّ نَزَعْنَاهَا مِنْهُ إِنَّهُ لَيَئُوسٌ كَفُور﴾ هود: 9
وَإِذَا أَنْعَمْنَا عَلَى الْإِنْسَانِ أَعْرَضَ وَنَأَى بِجَانِبِهِ وَإِذَا مَسَّهُ الشَّرُّ كَانَ يَئُوسًا. الإسراء: 83

Calmness of the heart.

الَّذِينَ آمَنُوا وَتَطْمَئِنُّ قُلُوبُهُم بِذِكْرِ اللَّهِ ۗ أَلَا بِذِكْرِ اللَّهِ تَطْمَئِنُّ الْقُلُوبُ. سورة الرعد ٢٨.
لَقَدْ رَضِيَ اللَّهُ عَنِ الْمُؤْمِنِينَ إِذْ يُبَايِعُونَكَ تَحْتَ الشَّجَرَةِ فَعَلِمَ مَا فِي قُلُوبِهِمْ فَأَنزَلَ السَّكِينَةَ عَلَيْهِمْ وَأَثَابَهُمْ فَتْحًا قَرِيبًا. [الفتح:18].

3.0 FAMILY HEALTH AND CHILD HEALTH: HEN and EGG RELATIONSHIP

Good mental and physical health requires that children grow up in a healthy family so that they can be balanced adults who will set up successful families.
There is no alternative to the family for child upbringing.
The family teaches attributes needed for balanced psychological health: trust, loyalty, a sense of belonging, and rights and responsibilities.
The family is a basic social unit that operates as an economic and a primary health care unit.
A dysfunctional family leads to several dysfunctional families 2-3 decades later, and the vicious circle continues.

4.0 FAMILY HEALTH AND COMMUNITY HEALTH: HEN AND EGG ARGUMENT

The concept of community health was not widely recognized until the last quarter-century. It is, however, a very old concept found in the Qur'an.
The Qur'an has told us about many communities in the past as lessons for us.
Good, al balad al taib. Surat Araf:58.

وَالْبَلَدُ الطَّيِّبُ يَخْرُجُ نَبَاتُهُ بِإِذْنِ رَبِّهِ ۖ وَالَّذِي خَبُثَ لَا يَخْرُجُ إِلَّا نَكِدًا ۚ كَذَٰلِكَ نُصَرِّفُ الْآيَاتِ لِقَوْمٍ يَشْكُرُونَ.

Safe, al balad al amiin. Surat Tiin:3. وَهَٰذَا الْبَلَدِ الْأَمِينِ
The Qur'an also told of communities that were victims of collapse, khiraab, those that were punished by famine, or were destroyed by Allah, ihlaak. The physical destruction was due to moral deviations like batar, transgression, dhulm, and corruption, fasaad.
No community is destroyed or is punished until it receives a warning from Allah. Surat Isra:15.

مَّنِ اهْتَدَىٰ فَإِنَّمَا يَهْتَدِي لِنَفْسِهِ ۖ وَمَن ضَلَّ فَإِنَّمَا يَضِلُّ عَلَيْهَا ۚ وَلَا تَزِرُ وَازِرَةٌ وِزْرَ أُخْرَىٰ ۗ وَمَا كُنَّا مُعَذِّبِينَ حَتَّىٰ نَبْعَثَ رَسُولًا.

A healthy community is the basis for a healthy family.

5.0 PSYCHOLOGICAL WELL-BEING IS A BASIS FOR FAMILY HEALTH-1

My proposition is that there is a lot of unrecognised mental ill-health in the community and that this is a major cause of family break-up.
Many bad husbands and wives are actually sick, and their mental illness manifests as neglect and abuse of the family.
Early diagnosis and treatment of mental disorders would prevent family dysfunction and breakdown. Simple medications or psychotherapy can save the family.
In the old days, grandparents and other relatives would be marriage counselors, and they saved many families.

6.0 PSYCHOLOGICAL WELL-BEING IS A BASIS FOR FAMILY HEALTH-2

In our sophisticated society, they no longer play that role. We need marriage counselors with psychological training.
Undiagnosed psychiatric disease is an underlying cause of many social problems such as marital discord, nushuuz, violence, homicide, social incompetence, and neglect of self and others.
Common mental issues can be neuroses, psychoses, or personality disorders. These are complicated by addictions (drugs, alcohol, etc.) and perverse lifestyles.
We need to develop general community awareness that family problems may be due to mental health and to solve these and not let the family collapse.

7.0 NEUROSES

Neuroses are simpler mental disorders such as anxiety, phobias, hysteria, obsessive-compulsive disorders, or depression. They are treatable by dua, acts of ibadah, and psychotherapy.
Among neuroses described in the Qur'an are sadness, worry, and anxiety.
Sadness, huzn was described in general (Al Imran:139). Separation from loved ones is a cause of sadness, huzn al firaaq (Surat Yusuf:13).

.وَلَا تَهِنُوا۟ وَلَا تَحْزَنُوا۟ وَأَنتُمُ ٱلْأَعْلَوْنَ إِن كُنتُم مُّؤْمِنِينَ
قَالَ إِنِّى لَيَحْزُنُنِىٓ أَن تَذْهَبُوا۟ بِهِۦ وَأَخَافُ أَن يَأْكُلَهُ ٱلذِّئْبُ وَأَنتُمْ عَنْهُ غَـٰفِلُونَ

Worry and anxiety, hamm and ghamm, were also described by the Qur'an[1]. Surat Al Imran:154.

.ثُمَّ أَنزَلَ عَلَيْكُم مِّنۢ بَعْدِ ٱلْغَمِّ أَمَنَةًۭ.

8.0 PSYCHOSES

Psychoses are more serious than neuroses and include schizophrenia. The Qur’an uses the term madness, junuun, to refer to the major disorders like psychoses.
Psychoses can be organic (types of epilepsy) or functional such as affective such as manic-depressive disorders, endogenous depression, reactive depression) or schizophrenia.
Schizophrenia involves disorders of thought, emotions, will, body movements, delusions, and hallucinations. It is noteworthy that schizophrenia has the same prevalence all over the world.

9.0 MANIFESTATIONS OF MENTAL DISORDERS THAT STRESS THE FAMILY-1

A delusion seems real and important to the patient despite its logical absurdity and contradiction of empirical reality.
Hallucinations are sensations that do not exist in reality.
Paranoid people believe without justification that others are plotting to harm them.
Affective disorders such as bipolar disorder affect mood being either depression or elation. Major depression may be a single episode or may be recurrent. It may be precipitated by stressors.
Melancholia is a severe form of depression characterized by early morning waking, depression most severe in the morning, loss of appetite, constipation, loss of interest in love and sex.
Anxiety is fear that has no basis in reality or an exaggerated response to a real threat.

10.0 MANIFESTATIONS OF MENTAL DISORDERS THAT STRESS THE FAMILY-2

Obsessions are recurrent thoughts that cannot be suppressed. Compulsions are movements that the victim cannot stop voluntarily
Somatoform disorders (hysteria) are involuntary physical symptoms observed in the absence of organic disease.
Schizophrenia has a lifetime risk is 7-9 per 1000. It is characterized by thought and emotional disorders.
Personality disorders: paranoid, schizoid, compulsive, hysterical, narcissistic, behavior, Schizophrenia, avoidant, and dependent, passive-aggressive, anti-social, and borderline disorders.
Homosexuality
Trans-sexualism
Stress disorder: is a physical and emotional state manifesting as failure to cope. It can be controlled internally through salat, dhikr, and antisocial, and externally by removing the stressor.

11.0 TREATMENT OF MENTAL DISORDER

The beginning is to realize that they are diseases like any other organic disease, and most have an organic basis that can be treated by drugs.
We should avoid stigmatization.
Dua and other acts of ibadat are the first lines of treatment.
Psychotherapy, including cognitive therapy.
Behavioral approaches.
Drugs and surgery as last resorts

12.0 MENTAL DISORDERS AND MARRIAGE

Consider mental health as a criterion in marriage. It does not prevent marriage, but knowing how to handle it is important, so it should be disclosed before marriage.
If mental illness appears after marriage the husband should be kind with her like with any other disease, but he has permission to divorce if he wishes.

وَعَاشِرُوهُنَّ بِالْمَعْرُوفِ فَإِنْ كَرِهْتُمُوهُنَّ فَعَسَى أَنْ تَكْرَهُوا شَيْئًا وَيَجْعَلَ اللَّهُ فِيهِ خَيْرًا كَثِيرًا) النساء /19

Mental disorders should be considered as an underlying cause of family dysfunction and should be diagnosed and treated to save the family.
No divorce should be allowed before ruling out treatable mental disease.
Divorce pronouncements or requests for divorce of people with mental disorders have no legal effect they are treated as طلاق .المجنون

قال ابنُ قدامة: (من لا يَصِحُّ طلاقُه لا يَصِحُّ ظِهارُه؛ كالطِّفل، والزَّائِلِ العَقلِ بجنونٍ، أو إغماءٍ، أو نومٍ، أو غيرِه

13.0 MENTAL DISORDERS IN CHILDREN

Children suffer from a wide range of mental disorders; some are specific to children, but others are like those of adults.
Many childhood mental disorders are from disorders/diseases in the intra-uterine or postnatal periods.
Many childhood mental disorders are a direct result of a dysfunctional family and have long-lasting effects in adulthood, resulting in a vicious circle.
The social environment may also contribute to childhood disorders because of its negative influence. Bukhari 1385.

كلُّ مولودٍ يولَدُ على الفطرةِ فأبواه يُهوِّدانِه أو يُنصِّرانِه أو يُمجِّسانِه.

Efforts should be made to discover childhood disorders early to start early treatment.

[1] p1293 3:154, 12:84, 16:58, 40:18, 43:17, 68:48)