The Theologies Of The Mental Health Industry, Counsellors, And Psychotherapists

Authored by Sheikh A. Hasan & Dr Alizi Alias 

In the last decade, a surge of literature has been authored on ‘Islamic Psychology and Counselling.’ Despite the growth of the literature on aspects of Islamic psychology, counselling and psychotherapy in the English medium, there have been limited philosophical, conceptual, theoretical, and especially theological analyses of contemporary psychology and counselling. The contemporary secular ‘mental health’ industry promotes distinct ideologies, philosophies and theology which are incongruent with religious traditions, particularly the Islamic tradition. 

Since the earliest civilisations, individuals across societies have faced emotional and psychological distress. Within each culture, a community sought guidance, counselling, and therapies, including Muslim culture. In the time of the Prophet , he served as the “counsellor” for the community and continued by his leading companions, their students, and imams, scholars in subsequent eras. While imams and scholars still provide psychological support, there is a misleading campaign from certain factions to convince the public that religious scholars are ill-equipped to offer such assistance. In contrast, they argue that mental health professionals are the only parties competent. To be fair, their criticism might be an over-generalisation based on negative experiences with some religious scholars who may not be fully aware of the intellectual and academic specifics of Islamic psychology and, therefore, provide stigma-like and non-emphatic comments to those who are distressed and/or having problems in living.

The role of religious scholars necessitates an extensive discussion grounded in a fundamental understanding of ontology, epistemology, and how psychological problems are generally perceived, both within and outside the framework of Islam. Each aspect demands lengthy papers for comprehensive elucidation. We will endeavour to compile relevant discussions on these topics in an accessible and straightforward manner. 

The primary objective is to demonstrate that religious scholars should and already ontologically and epistemologically provide psychological therapies because, in general, they have undergone extensive study and immersion in Islamic discursive texts and the traditions of classical scholars. And to demonstrate, albeit briefly, the underlying ideologies, philosophy, and theology of the contemporary ‘mental health’ industry. 

To accomplish this, we must begin somewhere. Given that the concept of modern psychology and counselling originated in the West, and considering that the intended audience for this piece comprises Western Muslims, we will strive to highlight the main points from a contemporary Western perspective. It is worth noting that Muslims in other regions, including Muslim-majority countries, may also adopt Western conceptualisations of these issues. Therefore, the geographical limitation of the Western audience is not applicable here; the term “Western” is employed academically, referring to a Euro-American-centric worldview recognised by Muslim and non-Muslim writers.

It should be noted that each of the sections requires lengthy explanations. Hopefully, this cursory overview of the various secular psychological, philosophical, and intellectual dimensions will illustrate and highlight the theologies of the ‘mental health’ industry and psychological institutions that uphold them and encourage further contemplations. 

Historical Context

As mentioned, people in all societies experience emotional and psychological distress, and each culture and society has its own established systems of helping people with their difficulties. Before the industrial revolution and mass urbanisation, Europe was governed by Kings and Queens who adhered to a religious community. The social, political, economic, and spiritual authority was solely predicated on religious values (i.e. Christianity). And although dogma and rigidity took over in many places, the general society and its population adhered to moral and religious ethics that governed their public and private lives. Religious scholars provided ‘therapy’ and shepherded the souls of the people. Catholic confessionalism, in principle, was very similar to how counselling works.¹Mcleod, J. (2013) An Introduction to Counselling. Mc Graw Hill Education. Open University Press. ²McNeill, J.T. (1951) A History of the Cure of Souls. New York: Harper and Row

However, during the Renaissance discourse in European societies, it centred on man as the measure of all things (taken from Protagoras). Major economic, political, and scientific shifts took place. The shift from religious authority began as the Industrial Revolution took effect, capitalism began dominating economic and political life, and science replaced religion. 

PC: ActionVance (unsplash)

People began to move to large cities, increasingly worked in factories, and were influenced by materialism and science. Therapy began to become an institutionalised and professional endeavour slowly. Therapists began to be trained and emerge, in a way, as the carer of the souls.  So, whereas in the past, people would turn to learned religious scholars for solutions to life’s problems, now they would turn to themselves and science in contexts wherein religion and religious people were seen negatively and in a hostile manner.³Mcleod, J. (2013) An Introduction to Counselling. McGraw Hill Education. Open University Press.

Urbanisation and secularisation (the shift of authority away from the church) started to secularise and demarcate practitioners’ societal roles. This resulted in a significant paradigm shift in psychology, counselling, and psychotherapy. In reality, psychology had replaced religion, and counselling and psychotherapy had replaced the roles of religious learned people. Many people continue to find religious alternatives in secular counselling and psychotherapy. Conversely, the number of so-called ‘mental illnesses’ keep increasing, and with the hundreds of billions of pounds spent on ‘mental health’ products, services, and research, we are not witnessing any significant improvements to people’s lives and how they see problems.⁴Mcleod, J. (2013) An Introduction to Counselling. McGraw Hill Education. Open University Press.

The Secularisation of Society 

Many connections exist between religions and the historical advancement of counselling and psychotherapy. There was a decline in clerical personnel and a simultaneous increase in psychotherapists. As stated above, religious faith gradually gave way to a set of beliefs and values, as some writers term the ‘faith of the counsellors’. Secular counselling and psychotherapy assumed the role of religion in various aspects of life, including offering explanations for perplexing events, addressing the existential query of life’s purpose, establishing social values, and providing ritualistic means of interaction. In many instances, counselling and psychotherapy approaches were disseminated as a form of pastoral care. In order to position itself within the twentieth-century market and develop a ‘mental health industry,’ psychotherapy deliberately tried to distinguish itself from religion. Mainstream theories of counselling and psychotherapy, by and large, resemble a form of ‘faith’, as argued by Halmos.⁵Halmos, P. (1965) The faith of the Counsellors. London: Constable

The language used by therapists and counsellors often uses medicalised language without realising its impact. Terms like “symptom,” “condition,” “treatment,” and “relapse,” along with diagnostic labels, are incorrect and sometimes harmful ways of expressing psychological problems. This further compounds the problems and convolutes our understanding of psychological problems. 

It is important to note that numerous psychologies exist, each providing diverse explanations for human behaviour. Personality theories offer interpretive frameworks with categories, labels, and explanations. They propose various dynamics of desires, hopes, beliefs, and expectations within the psyche. These theories often consider the contributions of biology and social experiences. Norms and ideals establish benchmarks for human well-being, influencing diagnoses and guiding therapeutic aspirations. Counselling and psychotherapy conversations are steered toward an envisioned image of a flourishing individual. According to Robert Roberts, personality theories act as “alternative spiritualities,” presenting competing perspectives on human nature. They aim to influence our souls deeply, utilising powerful therapeutic methods to shape our growth accordingly. Just as there are multiple philosophies and religions, conflicting personality theories will always coexist.⁶Roberts, R. (1993). Taking the word to heart: self and other in an age of therapies. Grand Rapids, MI: Eerdmans.

Counselling and psychotherapy are neither value-neutral nor purely technical areas of knowledge and practice. Practices and tactics used in counselling and psychotherapy are intended to promote change in attitudes, behaviours, feelings, values, morals, ethics, and relationships. The observations and descriptions counsellors or psychotherapists make of what is happening around a client are influenced by their worldviews and values, which also direct the conversational interventions. Without some implicit but generally explicit ideal for how people should behave, one cannot seek to assist another in changing. Ideals advocate standards of right and wrong, truth and false, importance and irrelevance, even though counsellors and psychotherapists may be reluctant to acknowledge the moral dimension (‘theological’) of their interactions and the pervasive effect of “suggestion” conveyed in their queries, remark, and silence. The more reflective counsellors and psychotherapists may be aware that they are performing “pastoral” work and understand that moral principles and values must come into play with every human interaction.⁷Widiger, T.A. (2002). Values, politics, and science in the construction of the DSMs. In J.Z. Sadler (Ed), Descriptions and prescriptions: Values mental disorders and the DSMs. Baltimore: John Hopkins University Press.

Freud, for example, conceived of his work this way: “The words, ‘secular pastoral worker,’ might well serve as a general formula for describing the function which the analyst…has to perform in his relation to the public.” Freud saw himself doing “pastoral work in the best sense of the word.” But this was not from a God-centred perspective. Instead, when Freud conducted counselling and psychotherapy to someone, he would seek “to enrich him from his own internal resources.”⁸Freud, S. (1926 & 1927) “The Question of Lay Analysis” and “Postscript,” in The Standard Edition of the Complete Psychological Works of Sigmund Freud. Hogarth Press, volume 20, pp. 255f, 250

Carl Jung described a different aspect of the counselling and psychotherapy dynamic. “Patients force the psychotherapist into the role of a priest and expect and demand of him that he shall free them from their distress. That is why we psychotherapists must occupy ourselves with problems which, strictly speaking, belong to the theologians.”⁹Jung, C. (1933) Modern Man in Search of a Soul, trans by W. S. Dell and Cary F. Baynes. San Diego: Harcourt Brace Jovanovich, p. 241.

Mental health professionals such as counsellors and psychotherapists necessarily act as prophet-theologians (even though most will not readily accept or recognise it) who define human nature and the meaning of life while typically excising God and the divine messages and instructions for life. They necessarily act as priests-theologians, who typically shepherd the human soul to find refuge in other people and in psychoactive medication/drugs because they construct a universe barren of divine interventions.

Even in the micro approach to counselling and psychotherapy, Freud would intimate the process a Christian priest would typically follow in confession. The posture, sitting and facing the client in psychoanalysis is very similar to what a priest does with a confessor, for example. This is in the broader schema of replacing religion (God) with science and faith leaders with psychoanalysts. Science became the de facto din and therapists the messengers.

Mental Health Industry 

Psychologies’ and mental health’s social and cultural power is not sustained due to modern secular theories being more plausible or effective than religious practices or the less superior religious alternatives. Power is sustained through institutionalisation in social roles and locations. In the twentieth century, the role of counselling and psychotherapy evolved to include secular professions, reflecting the functional, disputable, and changeable nature of institutional structures. 

Currently, the “mental health system” is where most individuals go to understand and assist others. Western counselling and psychotherapy institutions are secular, with practitioners trained in disciplinary departments. Counselling and psychotherapy activities occur in clinics, hospitals, and offices. Boards legitimise education and practice while licensing laws and courts reinforce or destabilise professional practice. Clients link with counsellors and psychotherapists through referral systems. A distinct and culturally specific mass ethos is created with secular hegemony. 

For the past 40 years, there have been campaigns and policies to de-stigmatise mental health. In the West, this may have been inevitable (with the loss of religion). However, the pendulum has swung from extreme to extreme, and mental health efforts and propaganda have led us to the other end of the spectrum.

Modern definitions often associate it with “not feeling bad,” making it easy to label widespread poor mental health evidence of a mental health crisis. Mental health crisis organisations often grow, disempowering those they intend to help. People become angry and resentful, using injustice occasionally to avoid personal responsibility. Businesses often exploit and profit from mental health crises, leading to a lack of support and understanding among the affected population.

PC: Emily Underworld (unsplash)

Mental health discourse is ubiquitous in our schools, universities, movies, arts, pop music, popular culture and even how people express language. Athletes and famous personalities openly acknowledge their struggles, and sports teams often employ psychologists. Celebrities also promote psychotherapy and recognise its importance in their personal lives. The mental health industry and discourse are embedded politically, psychologically, economically, socially, and spiritually. Unfortunately, mental health awareness campaigns have become mental health crisis campaigns.¹⁰Davies, J. (2022) Sedated, How Capitalism created our mental health crisis. Atlantic Books, London.

The mental health crisis “prophets” need more people to take their cause seriously. They inflate their numbers by watering down mental health to be synonymous with “not feeling bad.” Regardless of their feelings, every person is a potential body contributing to their cause. Victims of the mental health crisis, who turn their bad feelings into evidence of poor ‘mental health’ and attribute it to a myriad of issues, further their narrative.

The label applied to mental health issues is crucial, as it can lead to false positives and instances of poor mental health. The belief in a crisis provides individuals with a refuge and explanation for their miseries, often turning them into victims of the mental health crisis. This can be enticing and can be a source of pride for those who have been affected.

Life is full of hardship, and human nature seeks explanations for it. The narrative of disempowering individuals can be analysed through multiple levels, including power dynamics, organisations seeking growth, and businesses exploiting profit opportunities. Powers may want to maintain their current position, while organisations may seek growth while presenting themselves as productive. Both factors contribute to the overall situation.

Profit-driven mental health applications are opportunistic and malicious at best, exploiting cultural trends to gain profit. They may trick themselves into believing their intentions are pure and heroic, but they take advantage of cultural trends intelligently. They are not true mental health champions or offer a true solution to mental health crises. Instead, they make themselves out to be the former to convince us of the legitimacy of their claim.

Explanatory Frameworks 

What is an illness in psychology or mental health? How society views human beings from this perspective is vital to the overall conceptualisation and our attitude to the difficulties in life. Throughout history, there have been three main theories of ‘mental illness’: supernatural, somatogenic, and psychogenic. In the literature, Supernatural theories attribute ‘mental illnesses’ to evil spirits, while somatogenic theories identify physical disturbances caused by illness, genetic inheritance, or brain damage. Psychogenic theories focus on traumatic experiences, maladaptive learned associations, and distorted perceptions. Etiological theories determine the care and ‘’treatment’’ for ‘mentally ill individuals, with individuals believed to be possessed by the devil receiving different treatments. These theories coexist and recycle over time, ensuring understanding and treatment for mental illness.

The classification of psychopathology has been viewed from various theoretical perspectives, influencing their corresponding approaches to theory and practical applications. Theodore Millon categorised these perspectives into four major groups: biophysical, intrapsychic, phenomenological, and behavioural theories. Biophysical theories emphasise the role of physiological processes as the primary determinants of psychopathology. Intrapsychic theories focus on psychological factors as the basis for abnormal psychological functioning. Phenomenological theories highlight individuals’ unique experiences and perceptions and how they manifest. Behavioural theories propose that pathology is shaped by the process of learning through reinforcement. These theoretical perspectives highlight the historical divisions in understanding psychopathology. Biophysical theories suggest abnormal psychological symptoms indicate a biological defect due to hereditary conditions or external factors that disrupt normal functioning. Intrapsychic theories argue that abnormal symptoms are compensatory efforts by individuals.

Phenomenological theories emphasise that each person has the potential for self-actualisation and view pathology as a result of hindrances to being true to oneself. They highlight the importance of an individual’s unique experience and perception of the world. The inability to fully embrace one’s inner potential and the consequent feelings of frustration and despair contribute to psychopathology.

On the other hand, behavioural theories reject the introspective aspects of intrapsychic and phenomenological theories. They focus on observable behaviour and the reinforcement of adaptive behaviour as indicators of healthy functioning. Psychopathology is seen as behaviour that has been reinforced in a maladaptive or socially unacceptable manner. According to Millon, psychopathology becomes a mechanical pattern of reactions when experience is reduced to abstract stimuli and responses.¹¹Butman, R.E., Yarhouse, M.A., & McRay, B.W. (2016) Modern Psychopthologies. IVP Acdemic, Illinois.

It is evident that the theoretical assumptions and biases held by those studying psychopathology significantly influence the factors they consider relevant to understanding the condition. Theoretical perspectives run the risk of limiting researchers and practitioners (i.e. counsellors and psychotherapists) to certain viewpoints, potentially overlooking other valid and valuable approaches to understanding psychopathology. However, without theoretical frameworks, as argued by the proponents, it would be challenging to comprehend and classify human functioning.¹²Millon, T. (1969) Modern Psychopathology. A biosocial approach to maladaptive learning and functioning. Philadelphia: W.B. Saunders.

The discussion on nosology and psychopathology is extensive. To simplify and make it more accessible, we can categorise the various explanatory frameworks into three models: 1) the diseased-centred pathologising model, 2) the non-diseased-centred model, and 3) the religious model.

1. The diseased-centred pathologising model: 

Before the mentioned paradigm shift, religious texts like the Bible were the primary guides for understanding human psychology and behaviour. However, as the shift from church to state occurred, secular thought and liberal ideology gained prominence. Practitioners aimed to establish a common language and universalise psychological classifications since different groups had their own subjective understandings and determinations. This effort led to the development of the DSM-1, which subsequently, rather aptly, became known as the Bible of psychiatry with its various iterations. DSM-1 and DSM-2 predicated their psychopathology understanding on a psychoanalytic dimensional perspective, i.e., the non-diseased-centred model. Over time, the number of ‘disorders’ increased, reaching approximately 300 mental disorders in the current DSM-5, published in 2013.

With the publication of DSM-3, another paradigm shift occurred, where practitioners (that include clinical psychologists, psychotherapists, and psychiatrists) explained and classified behaviour and mental processes from a diseased-centred medical model. This change was aimed at further universalising (to develop and articulate a common language) classifications and, more importantly, gaining credibility within the scientific and medical community. The involvement of pharmaceutical companies, marketing, and institutional formations contributed to establishing the DSM as one of the main frameworks and standards. However, this was not based on sound scientific investigations and studies. Compared from a secular and empirical point of view, it is a ‘theology’ – a faith rather than science. Some would probably be right in concluding it’s more fiction and, at best, speculations than even a hypothesis. The history and current work are marred with biases, ideology, politics, and many conflicts of interest with pharmaceutical companies.¹³Davies, J. (2013). Cracked, why psychiatry is doing more harm than good. Icons Books Ltd, London.

Formation of the Diagnostic Manual of Mental Disorders (DSM)

As explained by many researchers, the history of DSM formulations is marred with pseudo-science, ideology, and politics. One would have thought that the basis of such formulations would be a sound scientific foundation. However, this was far from the truth. As researchers before, such as Thomas Szasz and currently James Davies, highlighted, essentially, it was a group of people who came together and voted on what is a disorder and illness. There was no scientific testing and investigations as one would do for medical conditions typically. The DSM-5 acknowledges that no incontrovertible etiologic or pathophysiological mechanisms have been identified for the diagnostic categories. These categories represent contextually (non-scientific) specific consensus of a specific group of researchers at a given time. If one were to provide an anecdotal example, it changes like the weather changes in the UK. Despite hundreds of billions of pounds that have been spent and continue to be spent on the mental health industry and research, there are no conclusive and convincing answers to the questions at hand. Conversely, the situation gets from bad to worse every year. 

It should be noted not all mental health providers embrace a single classification system. In a study conducted by the World Health Organisation in 2011 involving over 4,800 psychiatrists from 44 different countries, their attitudes and practices regarding mental health classification were explored. The findings revealed that 70% of psychiatrists who treated clients reported utilising the ICD system, 23% used the DSM system, and 5% employed a classification system specific to their context. Various examples of context-specific classification systems include the Chinese Classification of Mental Disorders (CCMD 3), the Latin American Guide for Psychiatric Diagnosis (GLDP), the French Classification of Child and Adolescent Mental Disorders (CFTMEA), and the Cuban Glossary of Psychiatry (GC 3).¹⁴Reed, G.M., Correa, J.M., Esparsa, P., Saxena, S., & Maj, M. (2011). The WPA WHO global survey of psychiatrists’ attitudes towards mental disorders classification. World Psychiatry, 10(2), 118-31.

Many high-profile establishment psychiatrists readily acknowledge the problems and invalidity of the DSM manual. A key figure, Allen Frances, Chair of DSM-4, stated that the DSM lacked reliability and validity and accepted no scientific definition of ‘mental disorders’: ‘’there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.’’

In 2013, while serving as the director of NIMH, Thomas Insel expressed that the diagnostic categories in the DSM lack validity and declared that NIMH will be re-orienting its research away from DSM categories.” Then, in his 2022 book Healing, Insel stated: “The DSM had created a common language, but much of that language had not been validated by science.”.” In his book Healing, published in 2022, Insel emphasised that “the DSM had established a shared language, but much of that language has not been scientifically validated.” 

Numerous other notable professionals expressed equally scathing criticisms regarding the DSM manual’s scientific validity, reliability, and correctness. Demonstrating that one’s worldview and epistemology are based on speculation and invalid assumptions should be, to an intelligent observer, sufficient to highlight the problems and harms the manual has caused. Unfortunately, even though the manual is readily acknowledged as invalid and unreliable, subsequent hypotheses and investigations have been based on that. This is like expressing that Harry Potter is a book of science and medicine and then basing one understanding of human behaviour on it! 

Critics rightly argue that the DSM (Diagnostic Manual of Mental Disorders) is a socially constructed reality. The DSM is considered a social artefact and operates differently from medical diagnoses. The process of diagnosing a patient with, for example, liver disease or treating someone with a fractured leg differs from the subjective and art-like nature of “mental health diagnosis.”

In a published response to Albert Ellis, Dr Guterman presented the following understanding of the DSM:

“The DSM consists of an elaborate system of if–then criteria that have been socially constructed to assign pathologising labels to clinical phenomena. Essentially, any given DSM category is tautological (i.e., circular and irrefutable) as long as its if–then propositions are upheld (Bateson, 1979). However, it is often forgotten that the community of stakeholders has created the if–then conditions in the first place. The legitimacy of any so-called truth regarding the existence of such categories is merely derived from the community of stakeholders’ inclination to describe clients accordingly.”¹⁵Ginter, E. J., Ellis, A., Guterman, J. T., Rigazio-DiGilio, S. A., Locke, D. C., & Ivey, A. E. (1996, April). Ethical issues in the postmodern era. Workshop at the American Counselling Association’s world conference, Pittsburgh, PA.

As mentioned above, it may be best described as speculation and guesswork. This has been shown to be the case in the replication crisis in which the results of most scientific studies are difficult or impossible to replicate. Critics argue that psychiatric diagnoses are fundamentally different because they are solely descriptive and never explanatory. The DSM diagnoses do not address or attempt to explain causes; their purpose is to describe effects. Most thoughtful psychiatrists adhere to a “biopsychosocial” model, which considers the causes of mental health problems biological, psychological, social, or some combination of these factors. 

The biopsychosocial model can be problematic if it argues that psychological problems have elements of bodily dysfunction (i.e., chemical imbalance in the brain) at their root. This is not to deny the presence of biology (it is present in some fashion, as biology is everywhere) in psychological problems, as it is undoubtedly a factor. However, this argument does not align with those who assert it is a mental illness. Some may be facing physical problems and may experience psychological problems. Conversely, some may be facing psychological problems and may experience certain physical and bodily problems. 

The ever-expanding list of entries in the DSM may sound like medical diseases due to the appended term “disorder,” but they are not. If we equate generalised anxiety disorder or major depressive disorder to pneumonia or diabetes, we commit a logical fallacy called a category error. A category error involves attributing a property to something that cannot possess it, such as assigning emotions to a rock. This is, again, not to say that psychological problems do not require support. Indeed, perceiving psychological problems as just “all in the mind” or just requiring “positive thinking” has, in some respects, created a negative stigma toward people living with problems in living. 

The focus is on over-medicalising psychological problems (medicalising normal human problems) and assuming they are chemical imbalances in the brain. Unlike conventional medical doctors who conduct physical examinations and perform measurable tests (such as blood work or scans) to identify the underlying cause, prescribing medication/drugs for psychological issues is different. It relies only on self-reporting by clients, without tangible tests or examinations, and there is no way to determine the true cause because, as previously stated, psychological problems are not medical conditions—they are not symptoms of an underlying brain condition. Further, it is very subjective. One group of professionals might consider certain clients to have, for example, depression, while others might not be for the same clients. It also differs culturally.

The Chemical Imbalance in the Brain and the Serotonin Deficiency ‘Theory.’

PC: Robina Weermeijer (unsplash)

Professors of psychiatry such as Thomas Szasz, made the case that ‘mental disorders’ should not be considered illnesses or diseases since those labels pertain to bodily ailments, whereas ‘mental disorders’ are made up of human activity and behaviour patterns. According to this way of framing, a disease is a characteristic of the biological system known as the body in the broadest meaning. As a result, diseases can be conceptualised in physical terms and comprehended in terms of broad biological concepts unrelated to the persons they impact. According to their biological makeup, diseases progress in more or less predictable ways. Cancerous cells proliferate and spread, eventually negatively impacting healthy cells, and the organs become inoperable.¹⁶Szsas, T.S. (1974) The myth of mental illness. Harper & Row.

Coronary heart disease, known as artery narrowing, causes angina and heart attacks. By altering one’s body and environment, such as quitting smoking or receiving treatment, one may be able to affect the course of a disease, but one cannot wish an illness away. Like chemical and subatomic events, biological systems are governed by regularities independent of human preferences and goals. 

“The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,” a research review article, was published in the July 2022 journal Molecular Psychiatry. It was written by Joanna Moncrieff, co-chair of the Critical Psychiatry Network, and her research partners, who looked at hundreds of studies that attempted to find a connection between depression and serotonin. They came to the following conclusion: “We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”

This was not new. Others, even when the SSRIs were marketed back in the early 90s to the public, argued publicly that ‘depression’ is not caused by low serotonin levels in the brain. Consequently, proclaiming that serotonin is implicated in depression is a neurologising tautology. 

The online vitriol against the researchers and their findings was amusing, to say the least. Some establishment institutions said they knew this already and that the researchers’ findings of the umbrella study are not new. In discussions with some psychiatrists, it was the same. ‘’This is nothing new’’. ‘’We knew this already and adopted the biopsychosocial model anyway’’. Then subsequently, several establishment psychiatrists came to find faults in the supposed methodological problems of the paper – many of whom have ties with pharmaceutical companies! Then articles surfaced online with headings like ‘there may not be any connection with depression and serotonin, but psychiatric drugs work anyway! 

At best, the chemical imbalance in the brain is an unproven hypothesis, and at worst, it is merely speculation. The onus is on those who make the claim to substantiate it with sound scientific evidence. And despite billions of pounds having been spent on research, there is no clear and conclusive evidence that has been presented. It is highly unlikely that there will be any such findings. Unfortunately, however, the number of people in various countries in their millions who are prescribed SSRI drugs increases yearly! And the public is not fully aware of the potential harms of these drugs and the harmful side effects. 

Notwithstanding the comments by Insel above, the DSM framing is increasingly embedded in primary care systems. A further problem lies in that even if the DSM categorisations were to be abandoned, it is doubtful that these categorisations would disappear in society. It requires a complete paradigm shift and redefining of the ontological and epistemological frameworks. The classification of psychological problems is best described as ART than SCIENCE. 

Anti-Psychiatry 

An argument presented above is that the idea that psychiatry is a medical speciality is problematic in ‘mental health’ care. While psychiatry (incorrectly) is often considered a medical speciality, it is important to recognise that it is not a hard science like fields like biology or physics.

The primary issue with treating psychiatry as a medical speciality is that it relies heavily on subjective assessments and interpretations of clients’ behaviour. Unlike medicine, there is no clear way to diagnose mental health ‘conditions’ through objective measures like blood tests or imaging studies. Instead, psychiatric diagnoses are based on behavioural observations and self-reported ‘symptoms’.

For some time, using the term “anti-psychiatry” to silence and discredit critics has been a concern within the mental health field. The term is often used pejoratively by ‘mental health’ professionals and psychiatrists to de-legitimise those who criticise the field.

The term “anti-psychiatry” is used in different ways by different groups. Some use it as a badge of honour, while others believe non-drug interventions are more effective than traditional psychiatric ones. Yet, some use it to promote pseudo-psychology based on new age movements that do not meet scientific standards, and sometimes is even against Islamic standards involving ideas originated from the pagan era and Eastern religions.

However, how some mental health professionals and psychiatrists often use the term is pejorative and intended to discredit critics. Labelling someone as “anti-psychiatry” without their consent and knowing whether they identify with the term is a way of silencing and de-legitimising critical debate and dissent.

Furthermore, the term implies that psychiatry is a coherent and infallible system, immune to criticism and outside perspectives. This is not the case, and dismissing valid critiques as “anti-psychiatry” only reinforces this notion. It is often used as a way of avoiding meaningful dialogue, and the field of psychiatry should be open to constructive criticism.

Using the term “anti-psychiatry” to shut down debate and dismiss criticism is counterproductive and ultimately hinders progress in the mental health field. Rather than using pejorative labels, mental health professionals and psychiatrists should engage in open dialogue and welcome constructive criticism to improve the quality of care for clients. 

There are people who criticise the fields of counselling and psychotherapy, yet we do not typically see them being labelled as “anti-counselling” or “anti-psychotherapy.” When psychiatrists label valid criticism as “anti-psychiatry,” it gives the impression of insecurity, lack of humility, empathy, and, frankly, the mafia-like and dogmatic way some institutions and professionals operate. 

2) The non-disease-centred model 

The non-disease-centred model argues that psychological problems are not illnesses in the conventional medical sense. A way of approaching it would be not to determine the presence or absence of a disorder but rather to attempt to rate a person on a defined scale according to certain attributes of functioning – for example, personality traits, cognitions, emotions, behaviours, or levels of functioning. It views psychopathology on a continuum of health. They may be described as problems in living. Those who subscribe to this model typically do not agree with the defined biomedical approach.¹⁷Reeb, R.N. (2000). Classification and diagnosis of psychopthaology: Conceotual foundations. Journal of Psychological Practice, 6(1), 3-18.

This method argues that the DSM has a serious problem with its categorical (either present or missing) rather than dimensional (being on a spectrum where everyone falls someplace) classification of personality disorders.

From a psychoanalytic theory framing and a general understanding of human behaviour, it argues when referring to the idealisation or demonisation of things, loss of self-identity, and interpersonal difficulties as characteristics of borderline personality disorder, everywhere these qualities are present, including within ourselves. The sole distinction is that some people only sometimes or mildly feel them. Therefore, neither professional assistance nor hospitalisation is required. The same principle may be applied to other personality traits associated with these disorders.

This method argues that a multidimensional strategy fosters societal empathy and works to reduce stigma. It enables counsellors and psychotherapists to understand that those who struggle with more extreme variations of what we all experience are not strange, odd, or foreign. Instead, if we approach them with an open mind, they are entangled in profoundly human issues to which we can all connect.

This method holds that the categorical approach’s justifications are flawed. Arguments that we must avoid referring to aetiology (which a dimensional definition would require to discern psychological types and patterns) or that we need exact criteria to please insurance companies and offer scientific legitimacy are unpersuasive. These explanations are inadequate and faulty.

The PTMF (Power Threat Meaning Framework) and similar frameworks espouse the non-diseased-centred model. It, too, advocates for a distinct ‘theology’ and worldview espousing its own ‘religious’ commitments. A principal argument can be made on what ontological basis this model is predicated upon. They are not based on religious foundations and will inevitably be incongruent with religious ontology and epistemology. They may bring partial truths but not the whole truth.  

Is there such as thing as neutral scientific psychology?

How may we view scientific psychology? The much-celebrated philosopher, Alasdair Macintyre, has demonstrated the impossibility of neutral scientific psychology. His famous example is, “Is this a good hammer or not?” 

Now there is no way to answer the question unless you answer a prior question, “What is a hammer made for?” A person from Mars, who has no idea what a hammer is made for, cannot assess its goodness or badness without learning what it was designed to do—that is, its purpose. Hammers are very bad for doing surgery. But they are very good for pounding nails into wood. So you can find out many things about a hammer, such as its chemical constituents, weight, and length, but you can’t evaluate whether it is good or bad without knowing its purpose.

Now, turning to counselling and psychotherapy, there is no way to determine what a person “ought to do,” whether the behaviour is good or bad, unless we know for what purpose a person was created. Is the purpose of the human being to glorify God, pursue individual freedom, or promote honour within his or her family? Each of these examples presumes a distinctive worldview. Science cannot answer the question of human purpose; therefore, it cannot advise what people ought to do.

Consider this example. Secular psychology generally assumes that people should be individually free to choose for themselves the life they want to live. That assumes the secular view of the world: that we were not created, we just evolved; therefore, there is no purpose for which we were created. We are free to determine our purpose for ourselves. But can this psychology be proven by empirical science? Of course not; it is a faith assumption. Traditional cultures assume that our purpose in life is to honour our families and fulfil our roles within the family – many typically adhere to a divine faith tradition. 

Macintyre is right. There is no objective, scientific counselling and psychotherapy approach (in the secular tradition). The minute you say, “This way of thinking, feeling, behaving, and choosing is better than that one,” you are bringing a faith-held worldview to bear on the client’s or patient’s problem. Even the most non-directive counselling approaches, then, are quite directive. They assume the old humanistic belief that people have the inner resources to solve their own problems.

The Philosophy and Culture of Emotivism 

In After Virtue, philosopher Alasdair Macintyre argues that pursuing the questions humans have about their purposes and existence requires some coherent moral framework that has a sense of the telos or goal of human life as necessarily involving goodness. In his rendering, what we have now amounts to little more than fragments inherited from various past systems; we lack the basic capacity to communicate pressing concerns because we have no “moral language” or agreed-upon basis for “moral reasoning.” In Macintyre’s view, the closest thing we have is “emotivism,” our new default setting, which comes down to appealing to “expressions of personal preference” as the “only basis of evaluative judgments.¹⁸Macintyre, A (2007) After virtue, A study in moral theology. University of Notre Dame Press

In this framework, there is no basis for solving disagreements, as each party is entitled to his or her opinion, as the common phrasing goes. No individual can appeal to a foundation for judgement shared with others. Thus, instead of articulating reasons to attempt to persuade others, the sole recourse becomes manipulation of other people’s feelings. “What is the key to the social content of emotivism?” Macintyre asks, answering that “it is the fact that emotivism entails the obliteration of any genuine distinction between manipulative and non-manipulative social relations.”

PC: Pablo García Saldaña (unsplash)

He also argues that many people follow the logic of emotivism in their ontological conceptualisations, which holds that moral judgments are nothing more than personal preferences. According to emotivism, right and wrong have no true significance; ethical judgements are essentially attempts by people to encourage others to agree with them by cheering or showing disgust. The message is that rational disputes and judgements are meaningless and pointless. Instead, emotivist cultures tend to reduce ethical problems about what is right and just to utility—what makes something good is its “effectiveness” for this individual at this time.

Macintyre accused therapists of complicity in this ethical quandary: Because emotivism causes all ethical declarations and judgments to be seen as expressions of personal preference, the therapist’s role is to seek those objectives for the client regardless of how these goals and outcomes affect others. In this view, the only thing that matters in treatment is “effectiveness” and “feeling good”; participants are excused from moral and religious growth and communal responsibility.

Various Models for Understanding Human Psychology 

Approximately five major theoretical schools are rooted in a secular and materialistic worldview and philosophy. Each school holds a particular theory about human beings, such as cognition and behaviour.

Therapeutic models (interventions) are based on one of these psychology schools. There are over 300 models (which can be another topic of discussion), but approximately ten main ones are widely recognised, with the others being subsets of these ten in some way. The psychodynamic school, for example, is among these ten.¹⁹Neukrug, E. S. (Ed.). (2015). The SAGE Encyclopedia of Theory in Counseling and Psychotherapy. Thousand Oaks, CA: Sage Publications, Inc.

The psychodynamic school represents a contemporary version of Freudian psychoanalysis, albeit with different variations. Its theory and model are grounded in specific theological, philosophical, social ontological and epistemological foundations. For instance, it tends to be deterministic and pessimistic regarding human nature and behaviour.

Therapeutic interventions are constructed upon philosophical presuppositions about human beings. These presuppositions shape therapeutic dialogue, such as uncovering the subconscious.

Most training involves secular ‘tarbiya’ (education), aiming to shape the psyche and behaviour based on these presuppositions. Therefore, whether it is psychodynamic or humanistic, many aspects of it are highly problematic and, in many respects, potentially harmful. This does not mean everything about them is problematic, but the fundamental framework serves as the cornerstone that guides all other aspects.

To provide a simple example of the approach certain models adopt:

Consider the core therapeutic questions promoted by some schools of psychology. These questions are based on specific presuppositions rooted in a particular understanding of “healing,” ‘’diagnosis’’, ‘’well-being’’, ‘’flourishing’’, and ‘’prognosis’’ of problems.

It should be noted that all psychological and counselling schools emerged within a specific cultural, socio-economic, and political context. To provide one example of Carl Rogers, who developed the Humanistic school of psychotherapy. His early upbringing, family upbringing, and social context critically informed his (subjective) epistemology and worldview, how he views psychological problems, and the subsequent interventions he suggested and practised. In his work and as a clinician, he immersed himself in the values of American culture, and his theory is informed by the many elements of that culture and time. His work underlines distrust of experts and authority figures, emphasis on method rather than theory, emphasis on individuals’ needs rather than shared social goals, lack of interest in the past and valuing of independence and autonomy. There are also similarities between Roger’s approach and the philosophy of the ‘New Deal’ political movement in the USA in the 1930s.²⁰Mcleod, J. (2013) An Introduction to Counselling. Mc Graw Hill Education. Open University Press.

Many of these counselling and psychotherapeutic schools and models’ widespread recognition and propagation is due to the secular institutions, systems, and mechanisms upholding them and the millions of pounds spent to facilitate, train and educate professionals. And it is important to appreciate that even practical counselling interventions are not value-neutral and purely technical. 

3) Religious frameworks 

As explained above, the religious leaders and the established church governed various aspects of people’s lives, including social, economic, moral, and spiritual aspects. Texts like the Bible served as guides for understanding the general purpose and the general human psychology and behaviour. For instance, priests provided what was referred to as ‘the cure of souls.’ However, the responsibility of helping individuals with their psychological and ‘problems in living’ shifted from religious priests to psychologists and therapists.

Those who professed a belief in God and the truthfulness and reliability of religious texts generally shared a common understanding of certain fundamental aspects, such as the notion that human beings are created as servants of God and possess a divine purpose, free will, and the concepts of heaven and hell. Additionally, they recognised the concepts of disobedience, community and family values, and humanity’s inherent inclination to acknowledge God. These distinct religious concepts and shared common language influenced the theoretical understanding of psychopathology and the usage and framing of nosology.

While the Abrahamic religious traditions share many similarities, there are also areas where their teachings differ. Individuals with a deep awareness and knowledge of Islamic discursive texts and mainstream interpretive traditions can observe notable differences in how the person is perceived, and human psychology is understood compared to other faiths.

The objective and scope of this presentation are not to outline the Islamic ontology and epistemology of human psychology. This task requires many elements to be in place. It is evident that Islamic theology and the psychology of human behaviour are generally framed with a unique and distinct understanding. For diligent researchers, it is important to establish Islam’s ontological and epistemological foundations before attempting to integrate specific secular theories and practices within the Islamic explanatory framework. One could argue that integrating two distinct frameworks and worldviews may be unnecessary and fruitless. However, this does not necessarily mean that the Islamic framework does not accommodate cultural (urf) and practical elements, as it seeks to harmonise the sacred and the ‘secular’ (dunyawi & ukhrawi). 

Yet, if the practical aspects, in this case, the psychological dimensions, are based on a specific theological and philosophical ontology and epistemology, it is essential to consider what the tradition prescribes in relation to current secular psychological ontologies, rather than simply superficially incorporating and plastering certain Islamic teachings into the realm of secular psychology, the ‘mental health’ industry, and the mass ethos that is prevalent at present. Although renovating an existing building may seem promising, erecting and building anew, with all the schematics and plans, is much more realistic and fruitful (and a necessity), especially as things stand institutionally (with the hegemony and psychologisation of people and society) and the qualification capacity (ahliyat) of many seeking to build with the many limitations and restrictions. 

The late Prof Malik Badri, regarded by some as the pioneer of modern ‘Islamic psychology’, expressed his concern in his work “The Dilemma of Muslim Psychologists” about the widespread tendency among Muslims to imitate and blindly follow secular psychologies. He warned that if Muslims are not vigilant, they will unknowingly tread the same misguided path as their predecessors. In accordance with an authentic tradition of the Prophet Muhammad ﷺ, he quoted the Prophet’s words: “You would tread the same path as was trodden by those before you inch by inch and step by step, so much so that if they had entered into the hole of the lizard, you would follow them in this also…” [Muslim].²¹Badri, M. (1979) The dilemma of Muslim psychologists. Islamic Book Trust, Kaula Lumpur.

Regrettably, although this warning was rightly put forth several decades ago, the future that the late Prof warned against and made tremendous efforts to avert has largely become a reality in the ‘Islamisation of Psychology’ realm. Even in our observations, some individuals who claim to heed his advice and purport to carry on his legacy have, unfortunately, fallen into the very trap he cautioned against.

Seeing the Past with the Present 

The term ‘presentism‘ refers to the questionable practice of interpreting past experiences solely through the lens of contemporary concepts to distort history to validate current biases. An illustrative example is the assertion that “Religious mystics were actually schizophrenics.”

In this case, linking a term’s early usage to its current usage poses the genuine risk of presuming that the phrases are referring to the same phenomenon. The behaviours of free-falling bodies in a gravitational field and the nature of the attraction force between them are the same issue that was addressed by Newton in the 17th century and Einstein in the 20th. Despite their obvious differences, these two approaches to gravity deal with the same phenomenon. However, we need to proceed cautiously while discussing psychology. Since the soul (the terms psychology literally means the study of the soul, and the term psychotherapy literally means the cure of the soul) is a non-material assumed thing, it is clear from the word’s early usage (and their Islamic ontological formulations) that very few, if any, psychologists, or psychotherapists in the secular spaces, in the twenty-first century, would agree to its existence and what they might imply in theory formulations and practical applications.²²Roberts, R. (2015). Psychology and Capitalism, the manipulation of the mind. Zero Books, Winchester, UK.

Projecting modern psychological concepts into the past and making assumptions about historical individuals’ worldviews and the usefulness of modern psychological constructs in interpreting their actions provide an even higher risk.

Classifying ‘mental health’ in the present time is neither neutral nor value-neutral or non-political undertaking. The very notion of a ‘mental disorder’ assumes that society collectively assigns value to the concept of “normal” or “healthy” psychological functioning, as diagnosing a mental disorder implies a judgement regarding functioning that is deemed “abnormal” or “unhealthy.” Furthermore, as noted by writers, the precise “boundary” between normal and abnormal functioning is open to debate and influenced by personal and societal values. 

The various determinations of ‘’well-being’’, ‘flourishing’’, ‘’how to thrive’’, ‘’healing’’, and similar psychological terms have several implied interpretations and meanings depending on the psychological theoreticians. In our estimation, the notion that therapists uniquely know and are in a better position to help people than religiously trained scholars display a basic understanding of the Islamic tradition and implies a form of secularising of Muslims. In this case, the bifurcation of knowledge, understanding and conceptualisation of psychology is problematic and harmful. It ignores fundamental aspects of how the psychologisation of people and society work in relation to understanding human behaviour and functioning, how the ‘mental health’ industry operates, how the psychological systems and institutions have been formed (the secular ‘church’), and the impact of the mass ethos on our current understanding.²³Widiger, T.A. (2002). Values, politics and science in the construction of the DSMs. In J.Z. Sadler (Ed), Descriptions and prescriptions: Values mental disorders and the DSMs. Baltimore: John Hopkins University Press.

A few years before his passing, Prof Malik Badri made an outstanding statement:

“In my experience, religious and spiritual scholars are often superior as psychologists and therapists (referred to as ‘mental health professionals’) compared to the majority of psychologists I have encountered.”²⁴Personal communication, 2018, Istanbul, Turkey.

This will undoubtedly raise questions such as what does that precisely mean? How can religiously trained scholars, including imams, be more effective as lay counsellors and psychotherapists or even professional counsellors and psychotherapists? What about the perceived allegations that the so-called religious are often judgemental in labelling people as having a lack of faith, sinners, or even the dwellers of the Hellfire? What about religious scholars willing and sincere to play the role of counsellors and psychotherapists but choose to study and practice pseudopsychology instead?

We may need to explore these questions when time permits. However, the main message of this piece is to understand that the ‘mental health’ industry, psychiatry, psychology, psychotherapy, and counselling base their ontological and epistemological understandings of human behaviour and psychopathology on distinct secular ‘theology’, which directly impacts how society is viewed (which creates a unique mass ethos) and how human functioning is formulated, and equally importantly, how psychotherapy is practised in society. 

This often conflicts with the religious ontological and epistemological foundations, particularly Islamic ontology and epistemology. Muslims need to be extra mindful and cautious not to fall into the lizard hole as the late Prof Malik Badri predicted.  

Further reading and viewing:

1. The Myth of Mental Illness 
2. The Myth of Psychotherapy 
3. Cracked 
4. Sedated 
5. Manufacturing depression 
6. Abolishing the concept of mental illness 
7. The Cure Within 
8. Medicine, Mind, & the Double Brain
9. Deadly Medicine and organised Crime 
10. Formulation in Psychology and Psychotherapy
11. Psychologisation under Scrutiny
12. Anatomy of an epidemic 
13. Mad in America 
14. De-medicalising misery II
15. The manufacture of madness 
16. A Straight talking introduction to the causes of mental health problems 
17. Insane Medicine 
18. The bitterest Pills: the troubling story of antipsychotic drugs 
19. The myth of chemical cure
20. Mind Fixers: psychiatry’s troubled search for biology of mental illness 
21. Trauma and Mental Health – Dr Lucy Johnstone
22. Ethical Matters: Mental Health, Capitalism & the Sedation of a Nation with Dr James Davies
23. Dr Peter Gøtzsche | Critical Conversation about Psychiatry
24. Dr Joanna Moncrieff – The Myth of the Chemical Cure: The Politics of Psychiatric Drug Treatment. 
25. Psychiatry & Big Pharma: Exposed – Dr James Davies, PhD
26. Why Psychiatric Drugs Are Killing Your Brain And How To Get Out Of The Bind With Dr. Peter Breggin
27. An interview with Dr Joanna Moncrieff, senior lecturer, Department of Mental Health Sciences, UCL, and Honorary Consultant Psychiatrist, North East London Mental Health Trust.
28. Psychiatric Drugs are Neurotoxins. Why and How to Avoid Taking Them? by Peter R. Breggin , M.D.
29. Bruce Levine | The Rise and Fall of Psychiatry 
30. Sami Timimi | Insane Psychiatry 
31. Prof Sami Timimi. No More Psychiatric Labels: Working Beyond Diagnosis.
32. Beyond Psychiatric Diagnosis | Full Talk | Dr Lucy Johnstone
33. Debunking the Serotonin-Depression Theory (with Dr. Joanna Moncrieff)
34. The great psychiatry fraud | Robert Whitaker
35. Antidepressants and Mass Shootings/Murder Suicide: An interview with Dr. David Healy
36. DEPRESSION: disease of the brain or a state of mind? Conversation with Dr Joanna Moncrieff
37. Dr. Jason Fung: Financial Conflicts of Interests and the End of Evidence-Based Medicine
38. The PTMF (Power Threat Meaning Framework Dr Lucy Johnson 
39. Robert Whitaker: our psychiatric drug epidemic 
40. Peter Gotzsche: why few patients benefit and many are harmed 

Related:

– Our Struggles – Mental Health And Muslim Communities | The Family and Youth Institute – MuslimMatters.org

– Cultivating Mental Well-Being in the Muslim Community [Part I]: Debunking Myths, Steps Toward Seeking Support – MuslimMatters.org