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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0004-MENTAL and NERVOUS CONDITIONS

Background reading material for medicine & fiqh panel discussion held on 8th April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.

OUTLINE

14.2.1 DISTURBANCE OF CONSCIOUSNESS

A. Ibadat:

B. Aadaat

C. Munakahat

D. Muamalat

E. Al Qadha

 

14.2.2 PSYCHIATRIC CONDITIONS

A. Personality Disorders

B. Neurotic And Psychotic Disorders

C. Sexual Disorders

D. Stress Disorders

E. Other Psychiatric Disorders

 

14.2.3 DEGENERATIVE CONDITIONS

A. Epilepsy

B. Parkinsonism

C. Dementia, Amnesia

D.

E.

 

14.4.4 NEUROLOGICAL CONDITIONS

A. Classification

B. Ibadat

C. Munakahaat 

D. Muamalaat

E. Qadha

 

14.2.5 OTHERS

A.

B.

C.

D.

E.

 

14.2.1 DISTURBANCE OF CONSCIOUSNESS

A. IBADAT:

DISTURBED STATE OF CONSCIOUSNESS:

COMA, SEMI-COMA

Causes of coma: Trauma, Infection, poison, psychiatric, shock, alcohol, epilepsy, increased intra-cranial pressure, opiates, uremic/metabolic

 

BRAIN DEATH & VEGETATIVE STATE - SALAT, HAJJ

SALAT

Forgetfulness in salat, al sahawu fi al salat (KS 321)

If salat is forgotten it is offered when remembered, idha nasiya al salat yuswaliha ‘insa ma yadhkurha (KS 315)

Doubts in salat, al shakk fi al salat (KS 321)

Salat in terminal illness, al salat fi maradh al mawt (KS 349)

Salat in coma or unconsciousness, salat al mughma ‘alayhi (KS 506)

Salat in semi-coma

Salat in syncope

Salat with stroke

Salat and dozing: if a person dozes he should stop salat, sleep and resume only when conscious of what he is reading (KS 315)

Salat while asleep, al salat naiman (KS 311: Nisai K20 B21; Ahmad 4:435, 442, 443; Ahmad 6:56, 202, 205, 259, 268; Tayalisi H2645)

Shortening salat when frightened, qasr al salat fi haalat al khawf

SAUM

Forgetting in saum, al nisyaan fi al saum (KS 333: Musnad Zaid H237 & 241)

Saum with syncope

Saum with stroke

 

B. AADAAT

Forced feeding of a semi-conscious person

 

C. MUNAKAHAT

Sexual relations with semi-conscious spouse

Psycho-social stress as a cause of divorce or khulu’u

Marriage/divorce of the semi-conscious

 

D. MUAMALAT

Transactions under duress, an nahyu ‘an bay’I al mudhtarr (KS 128)

Contracts by or on behalf of the semi-conscious

 

E. AL QADHA

Testimony by and on behalf of the semi-conscious

Legal liability for crimes under the influence of ordinary psychiatric medication

Legal liability for crimes committed under the influence of alcohol or drugs

 

14.2.2 PSYCHIATRIC CONDITIONS

A. PERSONALITY DISORDERS

DESCRIPTION

The common personality disorders are: paranoid, schizoid, compulsive, hysterical, narcissist, avoidant, and dependent, passive-aggressive, anti-social, borderline. Their underlying causes may be biological organic brain syndromes, genetic, developmental, social (psychodynamic, learned behavior, environment), and biochemical. The precipitating causes are: stress,  psychological disorders in medical/surgical disorders affecting both the patient and the family.

 

IBADAT

Personality disorders not accompanied by cognitive effects have no impact on ibadat.

Severe personality disorders may be reason for not performing hajj because the stress could precipitate a crisis

Saum and hunger could be a stressful condition precipitating a crisis

 

AADAAT

 

MUNAKAHAAT

Severe personality disorders as contra-indication for marriage

 

MUAMALAAT

Legality of contracts by persons with personality disorders that affect free will

 

QADHA

Crime due to underlying and perhaps genetically-determined personality disorder

 

B. NEUROTIC and PSYCHOTIC DISORDERS

Neurotic disorders are anxiety, fear, compulsive-obsessive behavior etc. Psychotic disorders: schizophrenia, paranoid, mood disorders( depression, suicide, mania, bipolar disease)

 

IBADAT

Salat in cases of anxiety

Lack of concentration in salat, ishtighaal al fikr fi al salat (KS 310: Bukhari K21 B18)

Compulsive-obsessive behavior and flatus

Compulsive-obsessive behavior and forgetfulness in salat

 

AADAAT

 

MUNAKAHAAT

Marriage of a spouse with madness, man tazawwaja imra at wa biha junuun (KS 550)

Marriage and divorce of a schizophrenic

 

MUAMALAAT

Contracts by a schizophrenic

Contracts in mood disorders clouding thinking

 

QADHA

Evidence by a schizophrenic

Assessment of evidence taking mood into account

 

C. SEXUAL DISORDERS

The common sex related disorders are: paraphilias (exhibitionism, transvetism, voyeurism, pedophilia), incest, bestiality, sadism, masochism, bondage, and necrophilia. Problems of gender identity could lead to trans-sexuality, bisexuality, and homosexuality. Psycho-sexual dysfunction includes:  impotence, ejaculation disorders, vaginismus, frigidity, and lack of libido.

 

IBADAT

 

AADAAT

 

MUNAKAHAAT

Divorce on basis of sexual disorder such as sadism, masochism

Divorce on basis of transsexual behavior

Divorce on basis of male impotence or female vaginismus/frigidity

Marriage contract in established lack of libido

Divorce/khuluu on basis of lack of libido

 

MUAMALAAT

 

QADHA

 

 

D. STRESS DISORDERS

Stress and its control: causes, reactions, manifestations, external control, internal control (solat, dhikr, itikaaf)

Salat while under stress

Hajj while under stress

Saum while under stress

 

E. OTHER PSYCHIARIC DISORDERS

SLEEP DISORDERS

Dreams:  process, significance, interpretation, good and bad dreams

 

14.2.3 DEGENERATIVE CONDITIONS

A. EPILEPSY

Salat of the epileptic

Hajj of the epileptic

 

B. PARKINSONISM

Salat

Hajj

Unintentional injury

 

C. DEMENTIA, AMNESIA

Salat: validity of imaamat

Hajj: obligation

Court evidence: evaluation of court testimony by the elderly in view of incipient dementia

leadership

 

14.4.4 NEUROLOGICAL CONDITIONS

A. CLASSIFICATION

NMJ DISEASE:

Myasthenia gravis and salat

 

NEUROPATHIES

Types: mono-neuropathy and polyneuropathy. Peripheral nerves can be injured by (a) entrapment neuropathy like the carpal tunnel syndrome and the ulnar entrapment (b) peripheral nerve tumors. Neuropathies may be due to disease, metabolic disorders, or toxins.

 

HEAD INJURY

Open or closed. Focal or diffuse. Focal can be hematoma (epidural, subdural, intra-cerebral). Post concussion syndrome

 

VESTIBULAR DISTURBANCES

Standing up in salat may be difficult

Tawaaf in hajj may be difficult without support

 

BRAIN TUMORS

Both benign and malignant tumors have pressure effects. They are gliomas, meningiomas, pituitary adenomas, cranipharyngiomas, neurinomas. Intra-cranial vascular tumors are: aneurysms, A-V malformations, intra-cerebral hemorrhage, sub-arachnoid hemorrhage. Symptoms of increased intra-cranial pressure are: headache, nausea, vomiting, personality changes, loss of consciousness

 

B. IBADAT

Vestibular disturbances and salat or hajj

 

C. MUNAKAHAAT 

 

D. MUAMALAAT

 

E. QADHA

 

14.2.5 OTHERS

APHASIA, DYSPHASIA: marriage, witnessing, public duty

 

INFECTIONS: brain abscess, cysticercosis, AIDS

 

CRANIAL STENOSIS

 

CRANIAL NEURALGIA

 

SPINAL CORD INJURIES.

Cervical injuries lead to quadriplegia

Thoracic injuries

Lumbar injuries lead to paraplegia

 

DISCUSSION

DISTURBANCE OF CONSCIOUSNESS

The concept of dhimmat for the brain-dead

Legal liabilities and obligations for the brain dead

Forgetfulness or absent-mindedness in salat

Salat in a semi-conscious state

Ruling on dozing in salat

Salat and stroke

Forgetfulness in saum

Forced feeding of a semi-conscious or unconscious person

Sexual relations with a semi-conscious spouse

Marriage or divorce of the semi-conscious

Contracts by and on behalf of the semi-conscious person

Court testimony by a semi-conscious person

Legal liability for crimes and contracts under the influence of ordinary psycho-active medications

Legal liability for crimes and contracts  under the influence of alcohol and non-medicinal drugs

 

PSYCHIATRIC CONDITIONS

Obligation of hajj on person with borderline personality who could break down under stress

Saum for a borderline person as a stressor that could precipitate a crisis

Refusal of marriage for person with severe personality disorders

Legality of contracts or court testimony by person with personality disorders that affect free will

Liability for crimes in a person with underlying personality disorders that are genetically-determined

Salat in a state of fear or anxiety

Absent-mindedness in salat

Compulsive-obsessive disorder and doubt about nullification of wudhu by flatus

Compulsive-obsessive disorder and forgetfulness in salat

Discovery of severe psychiatric condition in a spouse after marriage

Marriage and divorce of a schizophrenic

Contracts by a schizophrenic

Contracts in mood disorders that affect free will and clear thinking

Court testimony by a schizophrenic

Assessment of evidence taking mood into consideration

Divorce of the basis of a sexual disorder such as sadism, masochism

Divorce on the basis of trans-sexual behavior

Divorce on the basis of male impotence or female vaginismus/fridigity

Validity of marriage contract concluded with knowledge of established lack of libido

Divorce/khulu on the basis of lack of libido

Salat while under stress

 

DEGENERATIVE DISORDERS

Obligation of congregational salat for an epileptic at risk of epileptic attacks

Obligation of  hajj for an epileptic at risk of attacks

Legal liability of injury caused by a patient with Parkinson's disease

Validity of imaamat for a person with dementia and amnesia

Evaluation of court testimony by the elderly in view of incipient dementia leading to amnesia

 

NEUROLOGICAL DISORDERS

Vestibular disturbances and salat/hajj

Marriage contracts in cases of dysphasia and aphasia

Salat for the quadriplegicx

Hajj for the quadriplegic

Professor Omar Hasan Kasule Sr April 2000