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ORIGINAL PAPER

Salat and Dhikr to Dispel Voices: The Experience of Indonesian Muslim with Chronic Mental Illness

Suryani

Faculty of Nursing, Padjajaran University, Indonesia

Abstract

Objective: The aim of this study was to explore the experience of dispelling voices as articulated by Indonesian Muslim with chronic mental illness. Methods: Descriptive phenomenological approach was applied in explicating the phenomenon of dispelling voices in this study. In-depth audio-taped interviews were conducted with 24 participants. Analysis of participant transcripts was undertaken using Colaizzi’s (1973) approach. Findings: The finding of this study confirm that the participants found a personal path to living with hearing voices by doing salat or dhikr every time they heard the voices. Three theme explicated from this study: The voices are related to evil and Satan, Salat and dhikr to dispel voices and the strength of faith had an important influence over the voices. Conclusion: This study challenges the existing conceptualization of dispelling voices to consider the religion or cultural background of the individuals.

Keywords: Dispelling Voices, Chronic Mental Illness, Salat, Dhikr

Introduction experience persistent hearing voices despite psychopharmacological treatment.4,5 Hearing voices are potentially dangerous not only for people who experience them but Hearing voices affect the whole live of also for other.1 Approximately 28% of people who experience them.6 People who people living with hearing voices consider experience hearing voices reported that they suicide at least once per year.2 Hearing cannot do daily activity and cannot relate to voices have been identified as the cause of other. They felt anger, irritation and self-harming behaviours.3 A study by agitation, especially when they hear the McNiel et al, 2000 found that 30.1 % of voices frequently.7 The unconfortable and patients with hearing voices reported disturbed presence of voices has led experiencing voices telling them to hurt individuals to develop ways of coping to others and approximately 22.3 % of these live with the voices.2,8 people said they had complied with the voices instructing them to hurt others.1 Yet, The literature demonstrated that listening to a significant number of people with chronic radio headphone is effective for dispelling mental illness such as schizophrenia voices.9 Similar findings were demonstrated MJP Online Early MJP-02-03-13 by a single case study by Collins et al., 1989 In addition, a cross-cultural study by in the UK that reported that listening to Wahass and Kent, 1997 in UK found that music and interesting conversations in a individuals’ strategies in dispelling voices radio reduced the frequency of voices.10 were influenced by their cultural While listening to uninteresting monologues background. The finding indicated that or conversations and a blank tape had no people from UK who experienced hearing effect eliminating the presence of the voices tended to use distraction and voices.10 Another single case study was physiological techniques while people from carried out by Johnston et al., 2002 in the Saudi Arabia were more likely to cope with UK.11 The participant was treated using a the voices using religious approaches.14 personal stereo over a three week period. However, the finding of Wahas and Ken’s The three weeks involved one week with no study did not explore in dept what religious treatment, one week with treatment and one approach were used by their respondent in week with control treatment. The findings of dispelling the voices. This study aim to the study indicated that the use of a personal explore in depth the experience of stereo could dispel the voices.11 However, as Indonesian muslim with chronic mental indicated in Johnston et al’s study the use of illness in dispeling voices as most such devices or being exposed to sounds had Indonesian (approximately 88 %) practice no effect on individuals’ self-esteem and the Islamic faith.15 belief about the voices. Research design Unlike Johnston et al, 2002, a study in Japanese by Hayashi et al, 2007 of 144 Focus of the Study people found that talking to someone and The research problem to be addressed in this participating in hobbies such as playing study concerns the experience of dispelling games were the most effective coping voices. The research question which informs strategies in dispelling voices, while this study is: What is the experience of retorting and reading aloud had minimal dispelling voices as articulated by effect.12 Listening to appropriate and Indonesian Muslim people with chronic relaxing music was identified as being more mental illness? effective than watching TV.12 Furthermore, Nayani and David,1996 found that watching Participant Selection and Access TV triggered hearing voices because the Purposeful sampling was used for the voices commented on the television recruitment of participants. To achieve the programs.13 Another study by Tsai and goal of this research, the inclusion criteria Chen, 2005 concerning self-management in for participation were Indonesian Muslim people who experienced hearing voices who experience chronic mental illness, using 144 people with chronic mental illness attending the outpatient department of a in Taiwan found that most of the patients mental health facility, reported hearing developed their own distraction techniques voices, able to provide informed consent, such as ignoring the voices, engaging in and willing to be a participant in this study. activities, and accepting or arguing with the Exclusion criteria were, living with a co- voices.5 As this was a self-report study of morbid substance abuse disorder or organic Taiwanese people, the findings of this study impairment, a primary mood disorder, or are only representative for this group of having a severe cognitive deficit that would people. MJP Online Early MJP-02-03-13 prohibit the person from participation in meanings into clusters or themes. Before interviews. getting the fundamental structure/ definition of the phenomena, the researcher wrote an Participants were contacted in person by the exhaustive description of the phenomenon. researcher. The venue for contact was the The exhaustive description was validated Outpatient Unit of the West Java Psychiatric with each participant. Hospital. At the time the participants were informed that they needed to be assessed by Ethical consideration the attending psychiatrist in order to ensure In undertaking this project a number of they met the inclusion and exclusion criteria ethical issues were addressed including: for involvement in this project. letter of approval, informed consent, anonymity, confidentiality, storage of data, Information Gathering level of risk, and right to withdraw without Information was gathered through in-depth prejudice. focused interviews. Each participant was interviewed twice. The purpose of the first Results interview was to explore participants’ experiences of living with hearing voices Twenty four participants were involved in while the purpose of the second interview this study. The ages of the participants were was to provide the opportunity for the range from 19 to 56 years old. 10 participants to review the transcript of participants are men and fourteen of them interview and the findings of the study. The are women. sixteen of them are unemployed. length of the first interview with participants Most of them have been hospitalized for 2 to ranged from 45 to 60 minutes. The 3 times. interviews were conducted in the Out- patient Department of the West Java The voices are related to evil and Satan Psychiatric Hospital. With the consent of Most of the participants had experienced participants the first interview was audio- hearing voices for more than four years. taped in order to gain a contextual Almost all participants said that the voices understanding of the interview dialogue. All that they heard were related to evil and of the interviews were conducted by the Satan. For example a participant, said: I researcher. think… the voices are Satan’s voices… Yes… Satan’s voices, because they also Information Analysis prohibit me from praying and suggest me to Analysis of the participant transcripts sleep… and sleep. In a similar vein, another utilized Colaizzi’s (1973) seven step participant stated: she [the voice] was like approach.16 The narrative of participants Satan… I am scared of Satan… Only Satan from audio-taped interviews was interferes with man…I am sure Farida’s transcribed. Each participant’s description voice is Satan’s voice… I hear Farida’ was read and re-read in order to obtain an voices every ‘maghrib’ (evening time from overall sense of the participant’s experience, sunset to 7 pm). and then extracted significant statements. In The participants beleive that the voices are the next step, the researcher formulated satan’ voices because the voices often more general statements or meanings for disturb them and lead them to do bad things each significant statement, and then as stated by a participant: I think… the organised the aggregate formalized voices were Satan’s voices…. I am MJP Online Early MJP-02-03-13 sure….they were Satan’s voices. Satan is reading or saying the name of Allah): I just always disturb people, doing bad thing to did ‘dhikr’ by saying Allahu Akbar [Allah is people and lead people to go to hell. I am great] and Subhanallah [Glory to Allah]. I sure they were not people voices…. Yes…. just performed ‘dhikr’ … until the voices They were satan’ voices. The satans were stopped. disturbing and influencing my thoughts…… ‘Dhikr’ is usually performed by Moslems Salat and dhikr to dispel voices after doing salat. It can also be used in any The participants sought help from Allah to circumstance or situation such as when a dispel the voices. They seek releif from Moslem hopes for something or worries Allah by doing salat and dhikr. A about something. The participants participant stated: In my experience… if I performed dhikr to be free from the voices. hear her voice… I directly go to the bathroom to take an ablution and salat For a participant, dhikr by saying (ritual prayer which is performed five times astaghfirullah (Allah forgive me, please) each day: at dawn (al-fajr), midday (al- was effective in stopping the voice of his zuhr), afternoon (al-'asr), sunset (al- wife which began occurring after leaving maghrib) and evening (al-'isha). I am him to go to Saudi Arabia. He said: I just afraid… I do not want to hear her voice say astaghfirullah. Yes, I continue saying anymore. “astaghfirullah” until the voices stop.

From an Islamic point of view, salat is an Invoking the saying astaghfirullah is a way activity that should be performed by all a Moslem seeks Allah’s forgiveness. It is Moslems five times a day. Through salat, a usually performed after ‘salat wajib’ (the Moslem is able to commune with Allah. obligatory prayers) which are performed Salat has several advantages for the person. each day. It is also performed every time Psychologically, the person performing the Moslems realize that they have committed a salat finds relief from the daily troubles of sin. In the participant’s case, he invoked the life including anxiety, fear, and pain as all of word astaghfirullah when hearing his wife’s life’s difficulties are placed in the hands of voice because he felt that he had sinned for Allah. not being able to perform his role as head of the household. Another participant also performed salat to stop the voices and to prevent relapse. In Another participant discovered that dhikr by sharing her experiences she said: I always saying Allaahu Akbar was an effectively salat and read ‘Al Qur’an’ when hearing the means of stopping the hearing voices. She voices…I simply pray… [and] hope I can said: In my experience in order to stop the recover and never have a relapse. She also voice just say ‘Allaahu akbar’, By saying turned to doing dhikr when the voices were ‘Allahu akbar’ for several times, present. Such a practice is encouraged by alhamdulillah (thanks God) I can stop the Islam as a means of finding relief and peace voices. She stated further: No one taught me. in being in communion with Allah. I just tried it and it worked. Sharon shared her wisdom by suggesting: For patients who In a similar vein, another participant have similar experience to me they must described how he experienced relief by always remember God by doing dhikr and doing ‘dhikr’ (remembering Allah by MJP Online Early MJP-02-03-13 salat, because dhikr and salat can enhance merciful, only by seeking help from him and strengthen one’s faith. people can be protected from evil spirit. At times of seeking relief in Allah, participants The strength of faith had an important turned to do salat and dhikr as a means of influence over the voices invoking Allah’s help. For a number of the Some participants believed the strength of participants the very act of engaging in their faith had an important influence over doing salat was a potent means of stopping the voices. They believed that if their faith the voices. This finding is consistent with was strong no voices would be heard. A this researcher’s previous study where 22.5 participant described her experience by % of respondents used praying to expel the stating: I mean…it depends on how strong presence of the voices.19 This finding is also my faith is. If my faith was not strong supported by the findings of Lee et al’s enough, I would die ... yes ... it depends on study in which 25% of participants used how strong my faith is... If my faith was not praying to cope with the experience of strong enough, I would be finished off by hearing voices.20 This finding is also her. In similar vein, another participant said consistent with a study by Sylvia et al, 2006 In my experience if my faith was strong... I in Geneva who interviewed 115 people often do dhikr and salat... and so I can diagnosed with schizophrenia using semi dispell the voices. But, when my faith was structured interviews. The findings of their weak, I find it difficult to dispell the voices. study indicated that 71 % of participants used religious practices as a mean of coping Discussion with voices.17

As presented in the finding, most The finding of this study is also consistent participants believed that the voices was with an empirical phenomenological study satan voices. The finding of this present by Yip, 2003 in Hong Kong in which four study is consistent with a study by Sylvia et participants from a Psychiatric Halfway al, 2006 in Switzerland in which one of House and an Outpatient Clinic were participants in their study believe that her interviewed about their experiences of hallucinations and delusions are due to bad hearing voices and delusions. The findings spirits.17 The findings of Wahass and Kent’s of their study revealed that religious beliefs study, 1997 in the UK were also similar to and superstitions impacted on the meaning the finding of this present study in respect of attributed to the participants’ hearing voices the belief that hearing voices are caused by and the way they cope with the voices.21 Satan.14 The findings of this present study This has significant implication for work were also in line with the finding of a study with cross-cultural population. For example, by Kurihara et al, 2006 in Bali, Indonesia in the use of salat and dhikr in dispelling which the majority of the participants in voices was not only about seeking Allah’s their study reported that schizophrenia or assistance to be free from such intrusions, chronic mental illness were caused by but also because they harboured a belief that witchcraft.18 the voices came from evil spirits such as Satan. According to Vandenbroeck, 2008, The majority of the participants performed the majority of Indonesian people are salat and dhikr whenever they heard voices. Moslem and therefore, they believe that They seek relief form Allah because they people who suffer from mental illness have believe that Allah is the most powerful and a weak faith or lack the ability to believe in MJP Online Early MJP-02-03-13

Allah.22 This alleged spiritual weakness at the moment of remembrance Allah, provides fertile ground for Satan’s evil chemicals (endorphins) come out influences. automatically in the human brain. These substances resulting in a sense of calm and An ethnographic study by Horikoshi-Roe, peace in the human mind because its 1979 in West Java reported that Muslim function is similar to morphine.27 people view mental illness as a result of inadequate religious faith.23 Similarly, Limitations of the Study another ethnographic study by Saptandari, 2001 in Java found that the developing of As this study was conducted by applying a mental illness could be caused by lack of phenomenological approach to inquiry in attention to daily religious practice and weak which deep and rich descriptions of the faith. If people are strong in their faith, they participants’ experiences of the participants are less likely to become mentally ill. The were sought, only a small number of faithful individual is protected by God from participants were involved in this study. any form of disturbance that may lead to Therefore the results of this study cannot be hearing voices or behaving in strange ways generalized to the broader population. such as talking to oneself as a consequence However, the findings of this study have the of hearing voices.24 potential to fill a ‘blind spot’ in knowledge about auditory hallucinations from an Furthermore, participants in this study Indonesian perspective. believed that their strength of faith has a significant impact on the presence of hearing Conclusion voices. This finding is supported by a previous study by Lindgren and Coursey, This study explored the experience of 1995 in Maryland that was conducted in Indonesian muslim with chronic mental psychosocial rehabilitation. The study illness in dispeling voices. The finding of explored the influence of spirituality on the this study articulated that Indonesian lives people with serious mental illness. Muslim performed salat and dhikr to dispel Thirty participants took part in the study. voices. From the discussion above it can be The findings of the study revealed that argued that hearing voices have significant spiritual belief had a positive correlation meaning for the individuals.28 The ways with patients’ recovery from their illness. they dispel voices were influenced by their Lindgren and Coursey,1995, suggested that religious background. The findings of this people who have a strong spiritual belief research contribute to the literature on the feel a sense of comfort and being cared for, way people dispel voices. This current study resulting in better outcomes.25 Harahap and adds new understandings about the Dalimunthe, 2008 in their book experience of dispeling voices from a “Dahsyatnya doa dan zikir: agar diberi different socio-cultural perspective to those kesehatan, kekayaan dan kebahagiaan” of other studies. (Enormity of prayer and dhikr: for given health, wealth and happiness) stated that Acknowledgements dhikr can be reassuring because when we rely remembrance all matter to God, we will I would like to thank the Indonesia have sense of calm and peace in the hearts Directorate General of Higher Education and minds.26 According to medical science, that provided scholarship for my PhD study. MJP Online Early MJP-02-03-13

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Corresponding Author Dr. Suryani Faculty of Nursing Padjajaran University, Indonesia Jalan raya Jatinangor KM 21, Sumedang, West java, Indonesia Phone: 61 22 7795596 Fax: 61 22 7795596

Email: [email protected]