Spirituality, Religious Wisdom, and the Care of the Patient

Fear in the Islamic Tradition by Akbar Muhammad, Ph.D.

Introduction

I will attempt to outline broadly some of the fundamental Islamic beliefs and salient aspects of Muslim views on
fear. I will present some of their ideas verbatim, with a view to giving the authors a direct voice in the
elucidation of this aspect of the Islamic tradition. Although most of them died centuries ago, their opinions are
still representative of millions of Muslims' attitudes towards fear.

Islam has its origins in the seventh-century predominantly polytheistic Arabian Peninsula. Its inhabitants
depended largely on healers, supplications to their deities, spirits, and the flora and fauna for physical and
mental cures. This general type of dependency was also typical of numerous peoples who converted to Islam
from the Middle Ages (according to Western periodization) well into the modern period. Apart from access to
modern health specialists and medicines, in the present context, perhaps the most important difference
between pre-modern and modern Muslims is the replacement of the deities with Allah. In the Muslim tradition,
Allah is Ash-Shafi, the Curer/Healer.

Many poor and rural Muslims, like other peoples in the developing world, have little access to modern medical
care; therefore millions still rely on old remedies for a wide range of ailments, emotional and otherwise. And in
view of the fact that numerous immigrants in the United States come from underprivileged backgrounds or
have had limited access to modern health care, one would expect to find a considerable number of them still
reliant on some form of traditional medicine, or, most likely, on a combination of Allah and modern medical
treatment. Of course the extent of one's dependence on either of the pair is probably not measurable.

The primary source of Islam is the sacred Qur'an (Koran), which Muslims believe is the literal and unaltered
word of Allah, as revealed to the Prophet Muhammad by the Angel Jibril (Gabriel) during the seventh century
CE. The second and much larger source of Islam is the Sunna, which is widely known as the Hadith. The latter
consists of various collections of sayings, deeds and decisions attributed to Muhammad. The Sunna/Hadith
exists in various compilations which differ to some extent in content and wording.

The Qur'an and the Hadith are replete with descriptions of the relationship between the believer and the
Creator, a brief mention of which will contribute to our understanding of fear in the Muslim tradition. Not only
is Allah the Creator, He is also the source of life and indirectly of sickness. There is a covenant (‛ahd), a kind of
binding agreement, so to speak, between Allah and Adam's descendants to the effect that they must obey
Him. Furthermore, by Allah's command, they must also obey the Prophet Muhammad. Allah orders Muslims to
accept Him as the final authority in worldly matters, and to depend on and trust in Him. A Muslim's lifespan is
a period in which Allah will test her or his 'loyalty' to Him in various ways, perhaps with such misfortunes as ill
health or the death of a loved one. The believer is commanded to meet adversity with steadfastness,
perseverance and patience, being faithful and diligent in the performance of prayer (salat) and supplication
(du‛a').

Prayer to Allah, Islam's fundamental institution, is performed by different bodily movements and
postures. Prayer is incumbent on the healthy and the sick, a humbling action involving Qur'anic recitation and
repetition of specific formulae. A person who is unable to pray in a normal fashion is permitted to do so in
almost any position that is comfortable, even sitting or lying on one's back. Supplication can also be made in
any posture. Allah commands both prayer and supplication; they symbolize submission to and dependence on
Him in all circumstances. Allah commands Muslims to remember Him in almost all of their activities.

Meanings of Fear

Perhaps the most frequently used (Arabic) terms for fear in Islamic texts are khawf and khashya, although
khashya has the additional meanings of apprehension and anxiety, especially about a person's expectation of
punishment for offenses or crimes.[i] Both terms are frequently used to mean fear of Allah, that is, His
displeasure and punishment. Among other terms related to fear are (1) huzn, grief and anxiety; (2) faza', fear
and consternation; and (3) hamm, anxiety, worry and distress. The first and second terms are used in various
contexts in the Qur'an, the third in the Sunna. Thus fear is thought to be a regulator of Muslim behaviour and
thoughts; it keeps the believer's behaviour in accord with the commands and recommendations of Allah and
the Prophet. Since Muslims believe in the afterlife, following the moral directives of the Qur'an and the Sunna is
accompanied by a sense of pleasing Allah, Whose pleasure Muslims hope to attain; therefore the way to
salvation is adherence to His and the Prophet's commands.

There are about 134 Qur'anic verses about khawf (fear) and its related terms, and about 48 verses on khashya
(fear, apprehension and anxiety).[ii]

Allow me to mention a few verses.[iii]

It is only1 Satan that suggests to you the fear of his votaries: Be not afraid of them, but fear Me, if you have faith
(3 [Âl ‛Imran]:175, where a derivative of khawf is used).

. fear not men, but fear Me (5 [Al-Ma'ida]:44, where a derivative of khashya is used).

Be sure we shall test you with something of fear and hunger, some loss in goods or lives or the fruits (of your
toil), but give glad tidings to those who patiently persevere-who say when afflicted with calamity: 'To Allah we
belong, and to Him is our return'-they are those on whom (descend) blessings from their Lord, and mercy, and
they are the ones that receive guidance (2 [Al-Baqara]:155-7, where a derivative of khawf is used).

Allah sets forth a parable: A city enjoying security and quiet, abundantly supplied with sustenance from every
place; yet it was ungrateful for the favours of Allah; so Allah made it taste hunger and fear ([khawf,] closing in
on it) like a garment, because of the (evil) which (its people) wrought (16 [An-Nahl]:112).

Say: 'I would, if I disobeyed my Lord, indeed have fear of the Penalty of a Mighty Day. On that Day, if the Penalty
is averted from any, it is due to Allah's Mercy; and that would be salvation, the obvious fulfilment of all desire (6
[Al-An‛am]:15-6, where a derivative of khawf is used).

The related concepts of fear and hope are expressed in innumerable Islamic texts, perhaps none more
succinctly than in the slim volume Al-Khawf wa'r-raja' (Fear and Hope), written by one of Islam's most
influential philosophers, Sufis and theologians, Abu-Hamid al-Ghazali (d. 1111).[iv]Muslim scholars have
mentioned repeatedly that the believer lives between hope for salvation and fear of Allah's punishment. Al-
Ghazali and other Muslim thinkers hold that fear is caused by anxiety (hamm), and that hope, the twin of fear,
so to speak, should accompany or decrease the intensity of fear.[v] Al-Ghazali describes fear (khawf) as an
expression for the suffering of the heart and its conflagration by means of the anticipation of what is abhorred
as a future contingency. . And whoever is intimate with God, whose heart is ruled by truth and who lives in the
present through his seeing the majesty of truth perpetually no longer turns to the future and is possessed of
neither fear nor hope. More, his state has become higher than fear or hope, for both of these are reins which
preclude the soul from its excursions into laxness. [A]l-Wasiti[vi] has pointed to this in saying: Fear is a veil
between God and the creature. Again he said: When the truth makes plain the things which are secret, there
remains in them no residue for hope and fear. ... Fear may ... issue in sickness ... weakness ... depression ...
bewilderment ... intellectual atrophy ... [and] disease; it may even issue in death.

The aim of fear is the same as the aim of the whip which is to incite to action. If it is otherwise, fear is imperfect,
because it is deficient in its essence, since its product is ignorance and impotence. Ignorance, because one does
not know the sequel of his affair; and, if he 'knew' he would not be afraid, since the thing which is feared is that
about which there is doubt. Impotence, because he is exposed to a forbidden thing which he is unable to
repel. Therefore it (fear) is commendable in connection with human deficiencies ... The profit of fear is caution
... abstinence ... piety ... spiritual combat ... worship ... reflection ... recollection, and all the means that bring
about union with God. And all of that requires life along with health of body and wholeness of intellect and
whatever impairs these means is reprehensible. . [T]he most valued of blessings is prolongation of life in
obedience to God, and everything which annuls life or mind or health ... is a loss and deprivation ...[vii]

Remedies for Fear, and Death

Muslims belong to a text-based, faith-healing or spiritual medicine tradition.[viii] There are numerous texts
containing supplications which are said to have healing qualities. The sick, the apprehensive and the troubled
are encouraged to repeat certain Qur'anic verses, Hadiths and other sanctioned "magical" formulae (ruqya)
once or several times in order to regain health and well-being, or to remove or alleviate fear. Many of the most
widely recognized Muslim philosophical, medical and theological works contain such healing texts.

Reading or recitation of the Qur'an is widely believed to cure numerous illnesses, especially when the sick
person is pious and combines Qur'anic verses with other formulae.[ix] Chapter (surah) 17 [Al-Isra'], verse 82
reads in part: "We send down in the Qur'an that which is a healing and a mercy to those who believe." The
Opening Chapter of the Qur'an, "Al-Fatihah", which is the most frequently recited part of the book, is believed to
have healing qualities:

Praise be to Allah, the Merciful, the Compassionate, the Master of the Day of Judgement. It is You whom we
worship, and from You we seek aid. Show us the right way, the way of those whom you have blessed, those
whose portion is not wrath, and who go not astray.

Prophet Muhammad is credited with the saying, "For every illness there is a cure." According some authorities,
this Hadith encourages the sick to seek medical treatment,[x] and the physician to treat the sick. This, of
course, is in accord with the so-called Hippocratic Oath, which Muslims have known since the ninth century.[xi]

Natural and spiritual cures for various illnesses, including fear, are attributed to Muhammad in well-known
collections, some of which are called "Prophetic medicine";[xii] internal evidence, however, indicates that many
alleged cures are from the post-Muhammad era. Glorification of Allah (tasbih) by exclaiming subhana'l-lah,
"Glory to Allah", a number of times is said to be have been used by the prophets in times of grief and
distress. Glorification of Allah frequently involves repetition of some or all of His "Beautiful Names" or
attributes (20 [Tâhâ]:8, commonly reckoned as 99), often using a rosary consisting of 33 or 99
beads. Muhammad reportedly said that repetition of the well-known expression la-hawla wa-la quwwata illa
bi'l-lah al-'aliyy al-'azim, "There is no power and strength except in Allah, the Exalted, the Majestic", cures 99
ailments, "anxiety (hamm) being the easiest to cure" in this manner.[xiii]

The modern scholar Hassan as-Saffar suggests that intense fear must be fought with determination. However,
he admits the possibility that supplications and remembrances (adhkar) may strengthen a person's
determination, as they are a kind of autosuggestion. It is commendable to repeat several times, " 'This is the
condition (maqam) of the one who seeks refuge in You against the fire of hell', and to repeat seventy times, 'I
ask my Lord Allah's forgiveness, and I repent to Him'." Also the supplications of well-known and esteemed
Muslim persons may be used by the fearful. [xiv]

An instructive verse about death reads, "Say: 'The death from which you flee will truly overtake you: then you
will be sent back to the Knower of things secret and open, and He will tell you (the truth of) the things that you
did' " (62 [Al-Jumu‛ah]:8). Apart from its obvious meaning that death is inescapable, this verse, taken together
with others, urges the believer to live such a moral life that when death arrives, there will be hope for his or her
entrance into the Garden (al-Jannah), that is, Paradise. Yet another verse reads, "But to no soul will Allah grant
respite when the time appointed (for it) has come; and Allah is well acquainted with (all) that you do" (63 [Al-
Munafiqun]:11). After mentioning this verse, as-Saffar relates the following poem anonymously: "The
physician has medicine and knowledge/As long as there is some time left in the person's [divinely
predetermined] lifespan/When the patient's days come to an end/The physician is helpless, his drugs having
failed him."[xv]

How does a Muslim prepare to die? Preparation for death begins in life with, as the Imam and Caliph ‛Ali ibn-al-
Khattab (d. 660) reportedly said, "Performance of the Islamic obligations, avoidance of the forbidden, and being
virtuous. Then the person does not care whether death falls upon him or he falls upon death."[xvi]

The celebrated ethicist Miskawayh (d. ca. 1030) lists various persons who fear death and offers remedies.

Fear of death befalls only the person who does not know what death really is; ... or who thinks that death
involves a great pain; or who is puzzled, not knowing what he will face after he dies ... .

... To the one who is ignorant about death and does not know what it really is, we explain that death is nothing
more than the soul's abandonment of the use of one's tools, namely the organs ..., just as an artisan abandons
the use of his own tools. .

As for the one who believes that death involves a great pain other than the pain of the diseases which may have
preceded and caused it, the remedy is to demonstrate to him that this is a false belief since pain belongs to the
living being only, and a living being is one that is subject to the effect of the soul. A body which is not subject to
this effect does not suffer or feel. .

To the one who is afraid of death because of the punishment with which he feels threatened after it, we must
explain that he is not, in fact, afraid of death but of the punishment [for his transgressions]. If one fears
punishments for an offense, his duty is to guard against it and to avoid it. .

[Finally,] he who claims that he does not fear death but is grieved because of the relatives, descendants, wealth,
and property which he will leave behind, and who regrets the delights and desires of this world which he will
miss-such a person must be told clearly by us that grief is the anticipation of a pain or an evil and that such grief
brings no benefit whatsoever. .

Death is not an evil, as the mass of the people suppose, but the evil, indeed, is the fear of death and whoever is
afraid of death is ignorant of it and of his own self.

Miskawayh ends his discourse with the following supplication: "We solicit God's good help in what will bring
us nigh unto Him. Generous is He indeed, munificent, compassionate, and merciful!"[xvii]

In summary, although the Islamic tradition views fear as inherent in human nature, fear of anything other than
Allah's displeasure is discouraged on religious and moral grounds. Upon reaching puberty-at which time a
person becomes legally and morally responsible in Islam-a Muslim must be cautious about what is Islamically
forbidden, and to a large extent about what is reprehensible. Since accountability for one's acts and thoughts
on the Day of Judgment is certain, fear regulates a Muslim's behaviour, and in that context, it is a positive
instinct or impulse. And because life and health are 'gifts' from Allah, a Muslim must be mindful to preserve
them. Similarly, since death is preordained for every living creature, and knowing that some illnesses are
incurable, death must be faced without fear of it.

[i] 'Ali ibn-Muhammad al-Jurjani, At-Ta'rifat (Cairo: Dar al-Kitab al-Misri; Beirut: Dar al-Kitab al-Lubnani,
1411/1991), 111, 114; Ahmad Muhammad Kan'an, Al-Mawsu'at at-tibbiyya al-fiqhiyya (Beirut: Dar an-Nafa'is,
1420 AH/2000 CE), 451.

[ii] Hasan as-Saffar, Kayfa naqhar al-khawf (Beirut: Mu'assasat al-Wafa', 1404/1984), 18-9.
[iii] Translations of Qur'anic verses are based on, but may differ slightly from, 'Abdullah Yusuf 'Ali's The
Meaning of the Holy Qur'an (Brentwood, Maryland: Amana Corporation, 1411/1991).

[iv] Al-Khawf wa'r-raja', ed. Zuhayr Shafiq al-Kalbi (Beirut: Dar al-Fikr al-‛Arabi, Silsilat Ihya' ‛Ulum ad-Din 7,
1991); for an English translation, see William McKane below, note 6.

[v] See, for example, al-Azraq, Tashil al-manafi‛ fi't-tibb wa'l-hikma (Cairo: Maktabat wa-Matba‛at al-Mashhad
al-Husayni, n.d.), 76.

[vi] He is probably Abu-Bakr Muhammad al-Wasiti, the Sufi scholar, who died in 930 or later. See Annemarie
Schimmel, Mystical Dimensions of Islam (Chapel Hill: University of North Carolina Press, 1975, reprint 1978),
490; Encyclopaedia of Islam, New Edition (Leiden: Brill, 2000), X, 314, col. b, 377, col. b. The end of al-Ghazali's
quoting of al-Wasiti is unclear in the Arabic and English editions of al-Ghazali's book.

[vii] William McKane, Al-Ghazali's Book of Fear and Hope (Leiden: E.J. Brill, 1965), 25, 30, 31; Arabic edition, 33-
4, 38, 39.

[viii] On spiritual medicine and Islamic spirituality, see Fazlur Rahman, Health and Medicine in the Islamic
Tradition: Change and Identity (New York: The Crossroad Publishing Company, 1987), 84-90; Abu-Bakr ar-
Razi (d. ca. 925), At-Tibb ar-Ruhani, ed. 'Abdul-Latif Muhammad al-'Abd (Cairo: Maktabat an-Nahda al-
Misriyya, 1978), English translation by A.J. Arberry, The Spiritual Physick of Rhazes (London: John Murray,
1950, in the Wisdom of the East series); Majdi Muhammad ash-Shahawi, Al-'Ilaj ar-rabbani li's-sihr wa'l-mass
ash-shaytani (Beirut: 'Âlam al-Kutub, 1417/1997); Brian M. du Toit and Ismail H. Abdalla, eds., African Healing
Strategies (Owerri [Nigeria], New York and London: Trado-Medic Books, 1985), especially chapters 1-4;
Seyyed Hossein Nasr, ed., Islamic Spirituality. Volume I: Foundations; Volume II: Manifestations (New
York: The Crossroad Publishing Company, 1987 and 1991 respectively, in World Spirituality: An Encyclopedic
History of the Religious Quest series, volumes 19 and 20).

[ix] See ash-Shahawi, passim.

[x] See Adh-Dhahabi, At-Tibb an-nabawi (Riyadh: Maktabat Nizar Mustafa al-Baz, 1417/1996), 227.

[xi] Franz Rosenthal, Science and Medicine in Islam (Aldershot: Variorum, 1991), III, 52-87, V, 226-45.

[xii] The most famous collections are Shams ad-Din adh-Dhahabi's At-Tibb an-nabawi (see note 10 above) and
Ibn-Qayyim al-Jawziyya's work of the same title (Cairo: Dar at-Turath, 1398/1978).

[xiii] Al-Azraq, 76.

[xiv] As-Saffar, 146-7, 151-2, 170.

[xv] As-Saffar, 128.

[xvi] Quoted in as-Saffar, 133.

[xvii] The Refinement of Character: A translation from the Arabic of Ahmad ibn-Muhammad Miskawayh's
Tahdhib al-Akhlaq, by Constantine K. Zurayk (Beirut: The American University of Beirut, 1968), 185, 188-89,
190, 191,192; Ar. Tahdhib al-akhlaq (Beirut: Dar Maktabat al-Hayat, 1961), 183, 186, 187, 189.

Published: September 17, 2004