Dr Ahmed Rashid: “Diseases of the heart: Where theology meets cardiology”

Associations between religion and health have been debated for many years. This interest has been paralleled in the medical literature and has led to the inclusion of religious, cultural and sociological topics into medical school curricula, encouraging future clinicians to adopt a more holistic approach to understanding patients and their behaviours.

Much of the research focus has been into church-going populations in North America although the cosmopolitan nature of the modern world means that most clinicians are likely to encounter patients from any world religion. Islam is the second largest religion in the world after Christianity, but consideration about the potential impact it may have on health behaviours has rarely been considered.

He [will prosper] who brings to God a heart protected and pure.” (Quran, 26:89)

This verse from the Quran holds particular relevance in the science of Tasawwuf, or Islamic spirituality and is one of many references that the scripture makes about the heart. For Muslims, just as there exist laws concerning outward religious practice such as prayer, fasting and giving to charity, there also exist inward spiritual laws, which must equally be observed. These laws seek to shape good character and reach a state of Ihsan, an Arabic term which can be translated as ‘excellence’. Thus, outward religious observance in Islam is empty, unless it is coupled with striving on a path towards spiritual excellence.

Countless theologians throughout Islamic history have discussed the importance of purifying one’s heart in order to reach a higher spiritual state, perhaps most notably Imam Al-Ghazali, widely considered to be the most influential classic Islamic scholar. In ‘Wonders of the Heart’, Al-Ghazali describes the differences between the heart of flesh that sits in the chest and the ethereal heart that is described as a “subtle, tenuous substance”, whilst acknowledging the important connection between the two1.

The means to purify one’s heart is by expelling from it any greed for worldly wealth, regularly self-accounting for all good and bad deeds and engaging in meditation and remembrance of God. Indeed, at any moment of time, the heart should be in a particular state, with vices such as anger, jealousy and vanity being shunned and lofty virtues such as patience and tolerance being sought to replace them.

The ultimate aspiration is therefore to rid oneself of diseases of the heart. Naturally, many of the uses of the term ‘heart’ discussed here are metaphorical and can be taken to mean soul or spirit. However, the centrality of the metaphysical heart in Islamic thinking parallels the centrality of the heart physiologically in the cardiovascular system. Additionally, both the spiritual and physical hearts are concealed from the world, lying hidden within the depths of an individual whilst more outwardly apparent manifestations rely on their function.

There is also a notable relationship between the Islamic paradigm of heart disease and that which we are used to in clinical practice. Although many Muslim virtues are civic in nature, such as selflessness and universal love for humanity, others are intensely personal. The term nafs denotes the ego or lower self, which must be overcome in order to reach a higher spiritual state. The nafs is associated with desire and greed and left unchecked, leads to overeating, laziness and addiction. The clinical use of the term heart disease, meanwhile, is synonymous with coronary artery disease, which has comprehensively been linked to risk factors such as obesity, physical inactivity and cigarette smoking2.

The restraining of the nafs for spiritual purification of the heart may also, therefore, ameliorate the physical purification of the heart by modifying these key risk factors. This message is particularly pertinent to Muslims from the Indian subcontinent, whose risk of coronary artery disease remains alarmingly high.

By considering a discipline apparently far removed from clinical practice, clinicians may be reminded of the variety of meanings of anatomical words and challenged to consider the context in which it is being used and understood in consultation rooms. Furthermore, in a climate where any talk of religion or spirituality can be considered socially awkward, it is a reminder that that it may, in fact, motivate positive healthy behaviours for many individuals.

References:

  1. Al Ghazali. Wonders of The Heart. Trans Skellie WJ. Petaling Jaya: Islamic Book trust, 2007
  2. Yusuf S, Hawken S, Ôunpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364:937–952

Edited by Dr Ayesha Ahmad

Author: Dr Ahmed Rashid

NIHR Academic Clinical Fellow

Department of Public Health and Primary Care

University of Cambridge

Strangeways Research Laboratory

Worts Causeway

Cambridge, CB1 8RN

Tel: 0044 7763 611198

Email: mar74@medschl.cam.ac.uk