Disease (al Maradh)
Prof. Dr. Omar Hassan Kasule Sr.
DEFINITION
Definition of disease: Health is a
condition in which all of the body functions are integrated and are being
maintained within the limits of optimal design (Bowman p. 4.2). Disease is
divergence from the normal (Gaussian mean) but not all deviation is
disease because of the reserve capacity and ability of the body to adjust.
In most cases, a deviation must also be related to other adverse changes
to be able to constitute disease. The demarcation between pathology and
normal physiological variation can be fine. Hunger and thirst for example
are psychological warning signs and are not pathological conditions. A
hungry person is not in immediate danger. When the situation of food
deprivation persists over a long time then physiological disturbances
within the compensatory range occur. Pathological changes appear if food
deprivation extends beyond that.
Relativity in Disease Definition
The definition of disease is very
relative. A high blood pressure in an elderly person does not have the
same implication as the same level in a younger person. Temperature levels
have different interpretations in neonatal and adult infections.
Adolescent behavior that may be normal would be considered illness in
adults. There are changes in the body that should be accepted as normal
processes of aging and not as diseases. There is a space-time variation in
definition and perception of disease depending on the culture, beliefs,
attitudes, and prevalence of diseases. In localities where the burden of
major diseases is high, some minor ailments may be ignored whereas in
other places they are taken as serious diseases. There are diseases that
may be associated with social status. Some diseases become reclassified
with changing public opinion for example homosexuality was considered a
mental disorder half a century ago but is now accepted as normal sexual
expression in Europe and America. New diseases continue to be defined due
to changes in the causative agents, host factors, or new scientific
knowledge.
Multi-dimensional definition of disease
Definition of disease considers several dimensions that may operate singly
or in combination: moral/spiritual, biological/pathological (khuruuj al
badan ‘an al i’itidaal), psycho-social, or normative/statistical. Loss
of spiritual equilibrium is a disease in itself and soon leads to physical
disease. Most diseases involve disturbances in the equilibrium of the
normal body physiology. These biological disturbances may be within the
range of normal physiological variation or may be clearly pathological.
The psycho-social dimension of disease is associated with loss of
equilibrium and may precede or follow physical disturbances. The normative
or statistical dimension is the most confusing. Sometimes people are
branded ill because they fall at the extreme end of the health-illness
spectrum. In the final analysis it is the perception of disease by the
victim, the family or the health care givers that defines disease. The
underlying pathology need not correspond with the victim’s disease
complaint; perception operates in between.
Disease in the Qur’an
The Qur’an has used several terms to
refer to disease. In the subject form the word maradh has been employed in
the context of spiritual diseases of the heart (2:10, 5:52, 8:49, 22:53,
24:50, 33:12, 33:60, 47:20, 74:31). In the adjective form the words maridh
(5:6, 24:61, 73:20, 2:196, 4:43, 9:91, 48:17, 2:184-185) and saqiim
(27:89, 37:145) have been used. The Qur'an discusses disease as a
disabling condition than can exempt a person from certain obligatory acts
of physical ibadat (p 1105 24:61, p 1105 9:91, 48:17, p 1106 2:184-5,
2:196, 4:43, 5:6, 73:20). Disease was also described as a harm, dharr
(83:21, 21:83). The Qur’an being primarily a book of moral guidance,
spends more time discussing the causes and treatments of moral diseases
and gives relatively little space to physical diseases. Humans are urged
to undertake the necessary research to understand the physical diseases
Superstitions and Disease
The growth of scientific knowledge
about the pathology of disease has contributed to a marked decrease in
superstitious beliefs that have plagued mankind for centuries.
Superstition is an attempt to understand and come to terms with
frightening and dangerous disease phenomena that afflict humans. In the
absence of true knowledge there is resort to superstitious beliefs and
explanations. Most superstitions have been passed down generations; some
even have a religious basis. Despite much progress in scientific medicine,
the majority of humans still suffer from the consequences of superstitious
beliefs. The Islamic position is to approach most diseases empirically and
to be guided by experimental science.
Pathology
Pathology is concerned with
abnormalities of structure and function, which result from disease or are
produced by disease (Bowman p. 4.3). It seeks to explain the why of a
disease, which includes etiology, pathogenesis, morphological changes, and
the functional impairment. Most of pathology is about the reactions of the
body and its adjustment to insults. As mentioned before, the line between
compensatory change in normal physiology and pathology can be very fine.
Manifestations of Disease
Disease manifests as symptoms or signs.
Symptoms are subjective patient complaints or description of disease.
Signs are objectively verifiable disorders. A syndrome is a combination of
symptoms and signs associated with a disease condition. Symptomatology is
perhaps a better indication of disease severity because it includes the
personality of the patient and reactions. Thus the same pathology does not
produce the same symptomatology in all patients. Those with strong iman
may complain less about pain than others. Fear of death also affects worry
and complaint about disease. Fever is the commonest non-specific symptom
of disease following pain. It was mentioned in many ahâdîth of the
prophet (KS p. 339).
Diagnosis
Diagnoses are measures including
history, physical examination, and logical deduction or induction that
lead to definition of a disease. There is a role for istikharah in the
diagnostic process. Allah can guide a believing and diligent physician to
the correct conclusion from available data more often than the
non-believing one. A definitive diagnosis need not be made before
treatment starts. Treatment is started using a tentative diagnosis. The
true diagnosis may be deduced from the response to treatment. One of the
strengths of empirical science is that a disease can be treated
successfully without fully understanding its pathogenesis or even how the
treatment works at the molecular level. This occurs for example in cases
when a new unknown chemical compound is tried on animals and then on
humans with good results. It is then adopted as a treatment. The mechanism
of action is established only later or may never be established
definitely. However this strength has a back-side to it. Using treatments
whose mechanisms of action are not well understood can lead to side
effects and adverse effects later.
Prognosis
Prognosis is an empirical estimate of the future course of the disease.
From the Islamic viewpoint, prognosis is part of the knowledge of the
unseen (‘ilm al ghaib). The physician does not have the privilege to say
anything definitive about the future prognosis. He or she can only
extrapolate based on available data and must always have the humility to
say ‘Allah Knows Best’ (Allah a’lam).
Relation between diseases of the heart (amradh
al qalb) and diseases of the body (amradh al badan):
There is a 2-way interaction between physical and spiritual maladies.
Disbelief (kufr) leads to a lot of human cruelty like genocide because of
lack of moral restraint. Diseases of the heart such as jealousy lead to
violence and even death. Lack of self-restraint in appetite leads to
obesity and attendant diseases. Addiction to alcohol leads too much
physical and mental derangement. Protein energy malnutrition of the poor
manifests social injustice in the community. Lack of spiritual equilibrium
leads to inability to handle the normal stresses of life such that the
victims become addicted to alcohol and psychoactive substances with
consequent physical illness. Addiction to power and sex leads to violence.
Physical diseases may cause so much depression and loss of hope that they
develop diseases of the heart. A hedonistic life-style is responsible for
family breakdown. Children grow in one-parent families. They do not get
the social and psychological balance needed for them to function well as
adults.
CLASSIFICATION OF DISEASE
Duration
Diseases may be classified by their duration as acute or chronic. Acute
disease is a temporary disturbance of homeostasis. Chronic disease may
establish a new level of homeostasis.
Moral Criteria
Diseases may also be classified by cause as diseases of the heart (amradh
al qalb p. 958 2:10, 5:52, 8:49, 22:53, 24:50, 33:12, 33:60, 47:20,
74:31). and diseases of the body (amradh al badan). These two categories
have been mentioned by the Qur’an.
Diseases of the heart include: lahw (21:3),
ghaflat (18:28), ghill (7:43, 15:47, 59:10), ghaidh (3:118-119), kibr
(40:35, 40:56), nifaq (2:8-10, 2:2-4, 3:167, 5:41, 9:8, 9:64, 9:75-77,
48:11). These diseases of the heart lead directly or indirectly to somatic
diseases. Diseases of the body mentioned in the Qur’an include:
blindness, ama (p 851 2:17-18, 2:171, 5:71, 6:50, 6:104, 7:64, 10:43,
11:24, 11;28, 12:84, 17:72, 19:9, 20:102, 20:124-125, 22:46, 24:61, 25:73,
27:66, 27:81, 28:66, 30:53, 35:19, 36:66, 40:58, 41:17, 41:44, 43:40,
47:23, 48:17, 54:37, 80:2), akma (congenital blindness 4:49), deafness(sum)
(2:18, 2:171, 6:39, 8:22, 10:42, 21:45, 27:80, 30:52, 43:40), lameness (araj)
(p 807 24:11, 24:61, 48 :17), leprosy (baras) (p 189 3:49, 5:110),
dumbness (bukm) (p 204 2:18, 2:171, 6:39, 8:22, 16:76, 17:97).
Physical cause
Disease can also be classified by physical cause: infectious (viral,
bacterial, fungal, protozoal, or helminthic), neoplastic, allergic,
genetic, congenital, nutritional, environmental, mental, degenerative,
metabolic, circulatory, or hormonal. The inflammatory process is a
reaction to the original disease pathology in both its acute and chronic
forms and is essentially a defensive measure. It is sometimes also harmful
to the body on its own. Most disease processes are actually attempts by
the body to repair damage.
Site
Disease can also be classified as local or systemic. Fever is a systemic
condition whereas a local wound is a local condition. However local
conditions become systemic with time and systemic conditions may have
particular effects on some local tissues.
Mental cause
Disease can be classified as physical
or mental. This classification is not valid all the time because in many
instances mental conditions have a physical or biochemical basis. Mental
disorders are either neuroses (anxiety, phobia, hysteria,
obsessive-compulsive disorders, or depression) or psychoses. Psychoses are
more serious than neuroses. Psychoses normally require drug treatment
whereas the preferred management for neuroses is psychotherapy. Psychoses
can be organic (types of epilepsy) or functional. The functional psychoses
are either affective disorders (manic-depressive disorders, endogenous
depression, reactive depression) or schizophrenia. Schizophrenia involves
disorders of thought, emotions, will, body movements, delusions, and
hallucinations. It is noteworthy that schizophrenia has the same
prevalence all over the world. The Qur’an uses the term madness (junuun)
to refer to the major disorders like psychoses. The Qur’an also explains
how the label of madness is used to refer to righteous people like
prophets who are abused because they differ from the general public that
is bent on evil (p 297 15:6, 26:27, 37:36, 44:14, 51:29, 51:52, 52:29,
54:9, 68:2, 68:51, 81:22).
Among neuroses described in the Qur'an are
sadness, worry and anxiety. Sadness, huzn was described in general (p.
332-333 3:139, 3:153, 9:40, 9:92, 19:24, 28:8, 29:3, 33:51, 58:10).
Separation from loved ones is a cause of sadness, huzn al firaaq (p 333
12:13, 12:84, 12:86, 20:40, 28:7, 28;13). Sadness is an earthly problem
since it does not exist in jannat (p 333 2:38, 2:62, 2:112, 2:262, 2:27,
2:277, 6:48, 7:35, 7:49, 10:62, 3:34, 35:34, 39:67, 41:30, 46:13). Worry
and anxiety (hamm and ghamm) were also described by the Qur'an (p 1293
3:154, 12:84, 16:58, 40:18, 43:17, 68:48).
NATURE OF DISEASE
Reaction and Adjustment
A pathophysiological disturbance is normally a response to a biological,
physical, or chemical insult or injury to the body. Thus most disease
manifestations including their symptoms and signs are a reaction to the
injury and an attempt to re-adjust. Most disease processes operate at the
cellular level. The causes of cell injury are: hypoxia, physical agents,
chemical agents, infectious agents, immunological anomalies, genetic, and
nutritional disorders. Cells respond to injury in two ways: (a)
adaptation: atrophy, hypertrophy, and hyperplasia. (b) Acute injury which
could terminate in death or could be reversed.
Benefits
In an Islamic context, disease does not
always connote a negative or bad event. There are indeed many situations
when what is a disease situation is actually beneficial. Falling ill may
be Allah’s way of forcing the person to take a desired rest or care for
the body before it can deteriorate further. Death from some diseases was
said by the Prophet to be martyrdom (shahadat). Patience in the face of
severe illness is a reason for entering paradise (jannat). The pain due to
disease is a reminder of the punishment and suffering that the evildoers
will suffer from in hell. Disease can be an opportunity for personal
redemption by expiation/atonement for previous sins (KS p. 503-504,
MB#1949). The trials that one goes through and the eventual patience can
be rewarded by Allah’s forgiveness (MB#1948). Patience with chronic
disease/disability is associated with high reward for example epilepsy
(MB#1954) and loss of sight (MB#1955). Disease may enable a person return
to the due equilibrium in life. Falling sick may at times be Allah’s
blessing in disguise that a person is incapacitated and thus is prevented
from pursuits that could prove more dangerous for him. While a person is
sick and is not busy with the routines of life he may have time to reflect
and remember Allah.
Punishment
Some diseases are due to disobedience.
Acts of disobedience may be followed by epidemic disease or by disease in
an individual. The disease may be directly related to the sin such as
liver cirrhosis due to chronic alcohol consumption or there may be no
direct relationship.
Disease as an Exemption from Obligations
Allah in recognition of the burden of
disease and the need to give the body a chance to recuperate excused the
sick from some physical religious obligations (2:10, 48:17, 2:184, 2:185,
2:196, 4:43, 4:102, 5:6, 9:9, 73:20).
CAUSES OF DISEASE
Sufficient Cause of Disease
When all the factors that produce a
certain pathological condition are existing, we say that there is a
sufficient cause of disease. However humans can never know for sure that
there is a sufficient cause because Allah’s divine will (qadar) is
involved. There are many cases when all the humanly known factors of a
disease exist but the disease does not occur. This is because of the
unknown factor attributable to Allah alone.
Necessary Cause
There are empirical factors that must
operate for a certain pathological condition to occur. These are referred
to as necessary causes. For example the tubercle bacillus is a necessary
cause for the disease of tuberculosis. Humans must know the necessary
causes of diseases. Denying their existence is denying the cardinal
principle of sunan Allah fi al kawn and is akin to superstitious belief.
Multifactorial Causation of Disease
Human diseases, like the human organism, are complicated and usually
several factors are involved in their causation. Humans may know some of
the factors and ignore others. It is not necessary to know all the factors
in order to treat a disease. Since the factors usually act in sequence,
knowledge of only one may be sufficient to interrupt the causal pathway.
Endogenous and Exogenous Causes of Disease
Endogenous diseases are caused by factors from within the human body or
the internal environment. Exogenous diseases are caused by factors in the
external environment.
Intrinsic and Extrinsic Diseases
Intrinsic diseases are genetic or in-born. Extrinsic diseases are those
acquired after birth. Some diseases are in infancy and may be an extension
of intra-uterine problems or are acquired early in life. These include:
intra-uterine growth retardation, prematurity, congenital birth injuries,
and inborn errors of metabolism.
Environmental Causes of Disease
Heat, cold, radiation, water, smokes, and high altitude can lead to patho-physiological
disturbances and disease. Extreme heat can cause heat stroke and
dehydration. Water kills drowning people, gharaq (2:50, 7:64, 7:136, 8:54,
10:73, 10:90, 11:35, 11:43, 17:6, 17:103, 21:77, 23:27, 25:37, 26:66,
26:120, 29:40, 37:82, 43:55, 44:24, 71:25). Humans on the average inhale
many liters of air a day that bring in smoke and other air-pollutants.
Inhalation of smoke and other atmospheric pollutants causes respiratory
diseases including lung cancer. The low levels of oxygen at high altitudes
can cause hypoxia. Extreme cold causes frostbite or death from endothermia.
Irradiation causes neoplasia and chromosomal damage. Humans on their own
free will ingest chemicals as drugs that have many adverse reactions.
Natural and man-made toxins are ingested with food. The Qur’an
anticipated space travel (55:323). Prolonged life under zero gravity may
have long-term effects on the human organism that are not yet known.
Genetic
Genetic diseases could be a single gene disorder or they may be
multi-factorial involving more than one gene even other non-genetic
environmental factors. Single-gene disorders could be autosomal or
X-linked. As part of the parity principle of human creation, each gene is
in pairs one from each parent with the possibility of a dominant or
recessive combination. Mutations and chromosomal damage can alter the
body’s growth or metabolic processes resulting in disease. These operate
through disturbances of protein and enzyme synthesis or function.
Molecular diagnosis and gene therapy are growing fields and will give rise
to a different understanding of pathology. Islamically speaking we can not
say that there was a genetic or chromosomal mistake. It is all part of
Allah’s grand design.
Immunological
Disease arises from disorders of cells of the immune system: T and B
cells, macrophages, dendritic cells, Langhan’s cells, and natural killer
cells. Disease could arise in all three conditions of immunological
disturbance: a hypo-active immune system cannot protect the body against
invading organisms, a hyperactive immune system may destroy parts of the
body such as occurs in auto-immune diseases, and some immune reactions are
abnormal or paradoxical causing tissue damage.
Malnutrition
Under-nutrition causes disease by depriving the body of essential
nutrients. Protein energy malnutrition of children in poor countries is
due to lack of protein and calories. Vitamin and mineral deficiencies
disturb normal metabolism. Extreme nutritional deprivation, qaht, leads to
death. Over-nutrition results in obesity , diseases such as heart disease
and various types of cancer. Excessive intake of necessary nutrients like
vitamins causes various hypervitaminosis syndromes.
Infection
(al ad’wah)
Infection of the human body by other organisms is part of Allah’s plan
especially in fulfilling the food chain. It is part of the balance of the
eco-system. This does not however mean that such diseases should be left
alone. There has been some confusion about hadiths of the prophet dealing
with infection and contiguousness of disease. There is actually no
contradiction between hadiths that indicate that disease is contagious (KS
p. 504) and those that indicate the opposite (KS p. 504). The Prophet was
speaking about different diseases on different occasions. Even with one
disease like leprosy there are contagious and non-contagious forms (Ibn al
Qayim p. 154).
Neoplasms
Loss of control over cell multiplication results in cancer. This is
violation of a basic law in biology that equilibrium and homeostatsis will
be maintained.The molecular basis of cancer has been elucidated in detail
recently. Oncogenes are thought to be the basis for neoplastic growth.
Carcinogens as initiators or promoters interact with the oncogenes to lead
to neoplastic proliferation. Age and heredity play a role in cancer
etiology. Malignant neoplasm differs from the benign one in being less
differentiated, being anaplastic, high growth rate, invasion of local
tissues, and distant metastases. Normally the immune system is able to
detect the neoplastic cells and eliminate them. In situation of relative
immune deficiency it is not possible to eliminate the neoplastic cells.
Degeneration
In old age phenomena of growth and decay are more that repair and growth
and degenerative diseases could result. These are strictly speaking part
of Allah’s design and not an anomaly.
DISEASE AND QADAR
Occurrence of Disease as Qadar:
It is Allah’s pre-destination that a person falls sick.
Treatment/prevention of disease is not against qadar. Medical treatment is
subsumed under the principle that qadar can reverse another qadar (radd al
qadar bi al qadar). In the end all cure is from Allah and not the human
(26:80).
Source:
http://www.iiu.edu.my/medic/islmed/Lecmed/
e-mail:
kasule@iiu.edu.my |
