The widely reported suicide of Aisha Oyebode, a 300 Level Library Science student of Ahmadu Bello University Zaria, allegedly from Depression, has generated robust public interest around Depression, Mental Illness, Suicide and the concept of ‘Insanity’ privileges in Islam. The fact that Islam has exempted certain category of people from judgement and responsibility based on their mental state is settled and incontrovertible among nearly all Muslims. The contentious bit is whether the late Aisha, who despite her depression, looked and lived like every regular girl next door, with active social media presence, appropriate attention to grooming and appearance, and acceptable behaviour and socialization was ‘insane’ enough to escape responsibility for her suicide.
Everyday sadness or ordinary depression isn’t necessarily clinical depression. There is a whole lot of difference between everyday feelings of misery, depression or sadness and clinical depression. Just like there exist between mere fever, body weakness or headache and malaria. Someone may have some headache and weakness that could get cured after a rest for example. But if that headache were from malaria for instance, no measure of rest may be enough. One may have to use antimalarials! So is the case with depression. One may feel miserable, depressed and sad and snap out of it without much elaborate treatment but not when it is clinical depression.
Clinical Depression is a psychological state of sustained and extreme weakness of the body and or loss of interest in the context of a depressed mood for most of the days of at least 2 consecutive weeks. This mental state must also be associated with a specific count or all of; poor sleep, weight loss, poor appetite, loss of libido, crying spells, forgetfulness, anxiety, irritability, cognitive distortion (hopelessness, helplessness and worthlessness), suicidal ideations, obsessive behaviours/ruminations etc etc.
The symptom of cognitive distortion may need a special clarification as it relates to suicide. It is a pattern of over generalised negative thinking and abstraction. One negatively analyses the present and feels totally ‘helpless’ (helplessness). He also negatively analyses the future and feels completely ‘hopeless’ (hopelessness). And then negatively analyses the self and feels utterly ‘worthless’ (worthlessness). This severe cognitive state of self damnation is the major enabler of suicidal ideas in clinically depressed subjects. Suicidality ranges from it’s mildest form where one just wishes and hopes they were never born through feeling as if one is better off dead to thinking of how to actually end ones life and in severe cases attempted and completed suicide.
Clinicians have difficulty grasping what ‘insanity’ specifically entails. Concepts like that of a generic ‘insanity’ are alien to them. What they know instead are specific psychological diagnoses and syndromes. It is only this clinical process that can determine those who may have lost touch with reality and therefore Islamically not responsible for their actions and otherwise. Cognitive distortion in clinical depression is a classical instance of one ‘loosing touch with reality’ and accordingly meets the criteria of diminished responsibility in lslam.
Like Aisha, if indeed she were depressed, everyday regular ‘normal’ people who would suffer clinical depression could loose substantial touch with reality without necessarily coming up as ‘insane’ in their appearance and behaviour (because they are not insane).
Islam has established spiritual code for promoting good psychological health and even early interventions in some afflictions. Significantly, science too has sanctioned spirituality generally and certain specific rituals like praying and meditations as established treatment pròtocols and good outcome determinants in most mental illnesses. In fact, the more religious (any religion) a group is, the less the incidence of suicide among it’s members. However, much as spirituality is promoted as a part of broader management objective, that is never to suggest that all those who eventually complete their suicide as a component of Severe Clinical Depression are spiritually weak
A Clinically Depressed person, just like anyone with Hypertension, Diabetes or HIV, may have specific brain changes, biochemical disruptions and physical symptoms that can benefit from hospital visits and drug prescriptions. What they need most is understanding, care and empathy, not our convenient judgements of their spirituality, and eternal condemnations.
Dr Muhammad is a Consultant Psychiatrist @Melville HR