10th October is celebrated annually as the World Mental Health Day aims to increase public awareness on mental health. Malaysian Mental Health Association in 2018 reported that mental health is essential for every person because it is not only related to mental illness.
National Health and Morbidity Survey 2017 in Malaysia shows that suicidal tendency in teenagers aged 13 to 17 years old is 10 per cent higher compared to 7.9 percent in 2012. According to the reports of the World Health Organization (WHO), for every 40 seconds, a death is reported due to suicide. 
The issue of mental health is still a taboo in the Malaysian community and this does not help with the stigma of mental illness. The stigma associated with people suffering from mental illness makes them feel left out and helpless. This will then prevent them from getting professional help which would affect their healing process as well as their quality of life.
When we analyze the numbers and percentage in Malaysian Mental Healthcare Performance: Technical Report 2016, all sorts of worry and concern came to our mind. In our experience of visiting Hospital Bahagia, Tanjung Rambutan to meet the patients there has opened up new horizons in our mind to look at the issue of mental health in a wider and more rahmah (compassionate) framework. The same goes for a friendly visit from the Mental Illness Awareness & Support Association and Befrienders which greatly help us in deeply understanding this issue.
Answering the call of World Mental Health Day 2019 which focuses on the theme of “Suicide Prevention”, we entitle this series of Bayan Linnas as “Islam, Joker and Stigma on Mental Illness”. Hopefully this will benefit the Muslim nation and all Malaysians in general.
According to the Malaysian Mental Health Policy, mental health is defined as the ability of an individual, group and environment to interact between one another to promote subjective harmony as well as optimal effective function and the usage of cognitive ability and interaction towards achieving the individual and group objectives in line with fairness.
Mental illness is not a single type of illness. They include various categories of illnesses. Generally, mental illness can be divided as 3 main groups:
- Neurosis: Those categorized under this group usually experience changes and disturbances in their mind, feelings and behaviour without having effects towards their sanity. Individuals with neurosis are normally aware of their own well-being. Their daily functions may be disrupted a bit. Among the examples of neurosis are as follow:
- Depression: Depression is a sense of extreme and prolonged sadness. Sadness is a common feeling but if it is too much to bear and persisted for more than 2 weeks, disrupting daily function, then this is not normal sadness but rather a depression.
- Anxiety: The symptoms are feelings of worry, uneasiness and agitation. One may experience stress, tension, sweatiness, heart palpitations and extreme fear for danger or harm which they don’t even the cause of it.
- Psychosis: Those with psychosis may experience major changes in their thoughts, feelings and behaviour. Their sanity is also affected. Sufferers will feel confused with invisible voices communicating with them. It is called hallucination. They also have weird belief that is not shared by others which then cause an extreme reaction from them (the patients). This is called a delusion. An example of a delusion is that there are people who want to do something bad upon them that makes them turned violent towards those they suspect are a danger to them.
They may say unreasonable / ridiculous things, acting weird like talking alone, laugh or get angry without reason. The examples of common psychosis are:
- Schizophrenia: Among the main symptoms are: hallucination, delusion, thought, speech and behavioural disorders. Their work performance will deteriorate greatly.
- Manic-depressive Disorder (Bipolar): This disorder makes them experience major changes emotionally. They usually lose control and will become too happy (manic phase) or too sad (depressive phase)
- Personality Disorder: Basically, this type of disorder makes a person to have a personality or character defect. It may affect the person’s interpersonal relationship with others around them.
Joker and Reflection on the Reality of Society
Undeniably, this film has violent parts and that is why it is classified as 18 (years and above). However, the main theme on mental health is successfully portrayed by Todd Philips. Our primary opinion is it is a film that depicts the true reality of a society whose ethics and moral values are so corrupt that it leads to oppression abuse for some of the people in the society.
The condition of Joker or Arthur Fleck acted by Joaquin Pheonix who is seen laughing uncontrollably in emotional situations is a form of neurological disorder termed as Pseudobulbar Affect (PBA). The main cause of PBA is complex, but it is said to be due to changes in neuronal pathways especially on the frontal lobe which controls the emotions. 
PBA normally occurs in patients of Parkinson Disease (PD), multiple sclerosis, amyotrophic lateral sclerosis or Alzheimer disease (AD) or those with traumatic brain injury, stroke and other neurological diseases which damages the main neurological system. 
Joker is also seen to be suffering from a chronic schizophrenia which is known as grandiose delusion. Throughout the film, Joker seems to have difficulty in differentiating between reality and fantasy. Joker fantasizes that he has special gifts and is the best compared to others and this builds a delusion that he firmly believes as the truth even when it is questioned or doubted by others.
What is the factor? We view that oppression of the low-class society by the capitalism system, physical and mental abuse, bully, abandonment, loneliness, craving for parental love and life hardships due to financial problems are among the realities that lead to mental illnesses such as despondency or worse, depression. This is portrayed through the character of Joker in this film which is actually the reality behind the scenes of today’s world.
Individualism “kills” the purity of souls and “gives birth” to new souls filled with negativity. Based on past dark experiences, ultimately, it shapes one’s character different and contrary from the true nature of humanity. Arthur Flex becomes Joker due to surroundings that forced him to be one. A “sick” society will produce “sick” souls psychologically. The Prophet PBUH told that everything is born in the state of fitrah:
كُلُّ مَوْلُودٍ يُولَدُ عَلَى الْفِطْرَةِ، فَأَبَوَاهُ يُهَوِّدَانِهِ أَوْ يُنَصِّرَانِهِ أَوْ يُمَجِّسَانِهِ
"Every child is born with a true faith of Islam (i.e. to worship none but Allah Alone) and his parents convert him to Judaism or Christianity or Magianism
Sahih al-Bukhari (1385)
This is the distinction in Islam that views humans as naturally good, different from Machiavelli, Thomas Hobbes and Sigmund Freud who view that humans are originally bad. For them, society exists to control their bad inclination.
What is then the true role of society? As narrated by Abu Hurairah RA, the Prophet PBUH said:
مَنْ نَفَّسَ عَنْ مُؤْمِنٍ كُرْبَةً مِنْ كُرَبِ الدُّنْيَا نَفَّسَ اللَّهُ عَنْهُ كُرْبَةً مِنْ كُرَبِ يَوْمِ الْقِيَامَةِ
“He who alleviates the suffering of a brother out of the sufferings of the world, Allah would alleviate his suffering from the sufferings of the Day of Resurrection,”
Sahih Muslim (2699)
Imam Ibnu Daqiq al-‘Id commented on this hadith in his book stating:
“There are numerous wisdoms and maxims in this hadith on the virtue of granting others’ wishes. It is also included in assisting the matters of gaining knowledge, property, advice and others” (Refer Syarah al-Arbain al-Nawawiyyah, 1/119)
Good manners in communication and interaction between humans and helping each other has almost disappear swallowed by individualism. Each person is too busy chasing materialistic things that they abandon and neglect people around them who are in need of moral and emotional support.
An Arab poet, Ahmad Syauqi said:
إنمـا الأمـم الأخلاق مـا بقيـت فإن هم ذهبت أخلاقـهم ذهبــواً
“Indeed, all nations will last as long as there are ethics. When they lose their ethics, then the nations vanish.”
We should follow the example of the love of Allah towards His slaves even if they commit sins. We are astonished by a beautiful saying:
تَخَلَّقُوْا بِأَخْلَاقِ اللهِ
“Adopt ethics like the ethics of Allah”
This saying is not a hadith as taught by some people. Imam Ibn Qayyim al-Jauziyyah in his book states that this athar (narration) is batil (not sahih). (Refer Madarij al-Salikin, 227/3)
However, it is stated in the books that promote ethics like the ethics of Allah, but they state that the meaning of ethics of Allah is following mahmudah attributes (acclaimed) as well as avoiding mazmumah attributes (bad). In addition, among those who state that this narration is not linked to the Prophet PBUH is Imam al-Ghazali in al-Ihya’. (Refer Ihya’ Ulum al-Din, 306/4)
Also, Imam al-Ghazali named one of the chapters in his writing al-Maqsad al-Asna by a chapter of being a devoted servant and achieving his happiness through adopting the ethics of Allah SWT. (Refer al-Maqsad al-Asna, 45). Syeikh al-Mubarakfuri in Tuhfah al-Ahwazi [Refer Tuhfah al-Ahwazi, 29/6] and Syeikh al-Abadi in ‘Aun al-Ma’bud also states the encouragement to adopt the ethics of Allah SWT. (Refer ‘Aun al-Ma’abud, 36/1).
These advices are none other than for people of all generations to not be affected by the stigma on the issues of mental health. Patients with mental illness should not be generalized as “insane” and are abandoned and isolated. They are also human beings like us who are facing a test of mental affliction. They are in need of support and encouragement especially from individuals around them. They may be among those around us but they are unidentified for this illness do not have a “face”.
Religion and Mental Health
Some are inclined to view the issue of mental health without any relation to religion. Others are inclined to view the issue to be entirely handled through religion. In handling this issue, balance in giving an opinion is essential. We certainly think that religion has its role in the recovery process, even if it is a small part of it. At the same time, patients with mental illness such as neurosis, psychosis or personality disorder should undergo therapies set by the professionals which would surely include counsellor, psychiatrist or psychologist.
The jurists (both fuqaha’ and usuliyyun) define insanity and mental illness as: “Mind distortion that disrupts the function of action or speech from its normal form.” (Refer Mausu’ah al-Fiqhiyah al-Kuwaityyah, 16/99)
According to Muslim scholars of Psychology, they divide mental illness into two types:
- Prolonged mental illness (mutbiq).
- Temporary mental illness (‘aridh/ghair mutbiq) which can be treated by medicines and therapies. (Refer Mausu’ah al-Fiqhiyah al-Kuwaitiyyah, 16/101).
In Fiqh, an insane man who commits murder will not be sentenced with the same punishment in return (qisas). This is the agreed opinion of the majority of scholars. It is also agreed by Sheikh Abdul Qadir al-Audah. He states that it is impermissible to sentence criminal punishment upon those afflicted with hallucination or schizophrenia. (Refer Tasyri’ al-Jinai al-Islami, 1/504)
The same goes for mental illness patient; whatever happens during that period of time – if it is verified by a specialist as being out of his control – whether through actions, words or confessions, then it is not counted as sinful according to syarak.
This is in accordance with the saying of the Prophet PBUH narrated by Aisha R.Anha:
رُفِعَ الْقَلَمُ عَنْ ثَلاَثٍ عَنِ النَّائِمِ حَتَّى يَسْتَيْقِظَ وَعَنِ الصَّغِيرِ حَتَّى يَكْبُرَ وَعَنِ الْمَجْنُونِ حَتَّى يَعْقِلَ أَوْ يَفِيقَ
"The pen has been lifted from three: From the sleeper until he wakes up, from the minor until he grows up, and from the insane until he comes back to his senses or recovers."
Sunan an-Nasa'i (3432)
Imam al-San’ani commented, what is meant by the Prophet PBUH’s saying, “and from the insane until he comes back to his senses or recovers” is punishment is not imposed upon him. (Refer Subul al-Salam Syarh Bulugh al-Maram, 16/20). Syeikh Abdullah al-Tayyar states: “What is meant by the hadith is sins are not written upon him. This is because, during that particular time, he is not recognized as mukallaf.” (Refer Wabal al-Ghumamah Syarh Umdah al-Fiqh Li Ibn al-Qudamah, 9/9).
Narrated by Ali bin Abi Talib RA, the Prophet PBUH said:
رُفِعَ القَلَمُ عَنْ ثَلَاثَةٍ: عَنِ النَّائِمِ حَتَّى يَسْتَيْقِظَ، وَعَنِ الصَّبِيِّ حَتَّى يَشِبَّ، وَعَنِ المَعْتُوهِ حَتَّى يَعْقِلَ
"The pen has been lifted from three; for the sleeping person until he awakens, for the boy until he becomes a young man and for the mentally insane until he regains sanity."
Jami` at-Tirmidhi (1423) and Sunan Ahmad (956)
Pertaining the status of this hadith, it is also narrated by other companions like Aisha R.Anha and Abu Qatadah. Imam al-Tirmidhi views this hadith as hassan gharib in his Sunan. Also, Imam al-Hakim evaluates this hadith as sahih, but it is not recorded by al-Bukhari and Muslim. While Syeikh Syu’aib al-Arna’outh evaluates this hadith as hassan li ghairihi and its narrators are trustworthy (thiqah) because they are the narrators of al-Bukhari and Muslim.
Syeikh al-Mubarakfuri views the meaning of “المَعْتُوهِ” as insane or its equivalent. (Refer Tuhfah al-Ahwazi, 570/4). Ibn Abidin said in his hasyiah that scholars of usul had explained that the ruling for the “المَعْتُوهِ” is the same as baby who is mumayyiz and aware of his actions, but free from the obligations (free from being obliged by). (Refer Hasyiah Ibn Abidin, 426/2).
However, if the patient is conscious or is still able to control himself and he commits suicide, we are inclined to stick with the original ruling which is haram and of major sins. This is in accordance with the Prophet PBUH’s saying:
مَنْ قَتَلَ نَفْسَهُ بِشَىْءٍ عُذِّبَ بِهِ يَوْمَ الْقِيَامَةِ
“He who killed himself with a thing would be tormented on the Day of Resurrection with that very thing,”
Sahih al-Bukhari (6047) and Sahih Muslim (110)
This is where parents, close family and friends should play their role and always be around them and provide them with any support needed to reduce the dejection in their hearts.
Among other things that are forgiven are blasphemous thoughts and utterances like questioning the existence of Allah SWT, His role as well as questioning His Shari’ah. If the questioning comes from thoughts or troubling whispers of Shaytan (or scientifically said as schizophrenia), then it does not make someone a disbeliever as long as it is not related to one’s faith. The Prophet PBUH once said:
إِنَّ اللَّهَ تَجَاوَزَ لِي عَنْ أُمَّتِي مَا وَسْوَسَتْ بِهِ صُدُورُهَا، مَا لَمْ تَعْمَلْ أَوْ تَكَلَّمْ
"Allah has accepted my invocation to forgive what whispers in the hearts of my followers, unless they put it to action or utter it."
Sahih al-Bukhari (2528)
Imam al-Nawawi states that thoughts and intentions in one’s heart, if it is not permanent and continuous in one’s heart, then the person is forgiven by Allah SWT according to the consensus of the scholars. This is because, he has no choice when it happens and has no way to avoid it. Imam al-Nawawi also stresses out that as long as the thoughts are not permanent like kufr (disbelief) and others which exist out-of-control and he avoids it, then he will not become a disbeliever and nothing will be imposed upon him. (Refer al-Azkar, 273).
This is in accordance with the statement of Allah SWT in the Quran:
وَلَيْسَ عَلَيْكُمْ جُنَاحٌ فِيمَا أَخْطَأْتُم بِهِ وَلَـٰكِن مَّا تَعَمَّدَتْ قُلُوبُكُمْ ۚ وَكَانَ اللَّـهُ غَفُورًا رَّحِيمًا
And there is no blame upon you for that in which you have erred but [only for] what your hearts intended. And ever is Allah Forgiving and Merciful.
Surah al-Ahzab (5)
The same goes for the saying of the Prophet PBUH:
إِنَّ اللَّهَ تَجَاوَزَ عَنْ أُمَّتِي الْخَطَأَ وَالنِّسْيَانَ وَمَا اسْتُكْرِهُوا عَلَيْهِ
Allah has forgiven for me my nation their mistakes and forgetfulness, and what they are forced to do
Sunan Ibn Majah (2043)
Still, our advice is for those experiencing this to ask for forgiveness from Allah SWT through istighfar and renew their syahadah when their sanity is restored. This is in accordance with a hadith that commands us to always renew our faith. The Prophet PBUH said:
جَدِّدُوا إِيمَانَكُمْ “، قِيلَ: يَا رَسُولَ اللهِ، وَكَيْفَ نُجَدِّدُ إِيمَانَنَا؟ قَالَ: ” أَكْثِرُوا مِنْ قَوْلِ لَا إِلَهَ إِلَّا اللهُ
"Renew your faith. Then, one asked: 'How do we renew our faith?' The Prophet PBUH answered: 'Repeatedly utter la ilaaha illallah'"
Sunan Ahmad (8710)
Serious attention is needed from parents and close family in providing support for mental illness patients. Among things to be done is gaining more knowledge related to mental health, giving full attention and care towards them, never abandon them as well as trying to make them feel as part of the family while performing daily activities especially during worship and social activities.
To those afflicted with mental illness, we pray that you find strength and patience in undergoing this test. Trust in Him and His words:
فَإِنَّ مَعَ الْعُسْرِ يُسْرًا ﴿٥﴾ إِنَّ مَعَ الْعُسْرِ يُسْرًا ﴿٦﴾
For indeed, with hardship [will be] ease. (5) Indeed, with hardship [will be] ease. (6)
Surah al-Syarh (5-6)
According to Imam al-Syaukani, the phrase (الْعُسْرِ) or “hardship” which is repeated in this surah means only one single hardship because both are using isim ma’rifah. This is because, if isim ma’rifah is repeated, the second usage is the same as the first either it is isim ma’rifah using alif lam jinsi or alif lam ‘ahdiyyah. While the phrase (يُسْرًا) means two because it is a repetitive isim nakirah; the context for the first first is different from the second. (Refer Fath al-Qadir, 5/564)
In short, in one hardship, there comes several ease, solutions and way out. This is the beauty of Arabic language through Allah SWT’s promise upon His slaves.
Ibn Rajab al-Hanbali leaves us with a heart-touching advice on the importance of patience in facing life’s hardships. According to him: “When hardships become heavier and harder, a slave will become weary. It is the normal condition of a creation who is incapable of getting out of his hardship himself. Then, he hangs his heart merely unto Allah SWT and this is the essence of tawakkal (total trust and reliance on Allah). It may be the major reason of why his wishes are granted. This is because, Allah SWT will provide sustenance to those who put his tawakkal upon Him. Allah SWT state in the Quran: And whoever relies upon Allah - then He is sufficient for him.” (Refer Jami’ al-‘Ulum wa al-Hikam, 1/493)
Furthermore, there are other suggestions:
- Form a serious collaboration with various authorities in government agencies. Ministry of Health will continue playing their main role in assisting this collaboration from different sectors through programs and mental health activities needed by them to mingle in a more meaningful way with others.
- The society should take part in planning, managing and evaluation of the activities which is based on the community to decide on the rights, pride and acceptance of these activities.
- Planning and development of human resource in mental health to fulfil the needs of the government should be the main investment in the health sector.
- Mental health service should provide high-quality care and guidelines by implementing existing internal quality assessment programs. It should also follow standards included in the United Nations resolutions relating to Protection of Rights for those with mental illness.
- Research and development pertaining mental health should continue and should be funded by both government and private sectors.
- Rights and freedom of those with mental disorder and mental illness should be guaranteed and protected by law.
Sahibus Samahah Dato’ Seri Dr. Zulkifli Mohamad al-Bakri
Mufti of Federal Territories
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