Afghan Physician (right) Confers with a Patient at Kabul's Mental Health Hospital, November 2001.

If the world has changed since September 11, it has changed more for North America's Muslims than for the rest of us. A local story will indicate just what I mean.

My daughter returned from her fine suburban school after that day to tell of a seven-year-old Muslim boy—the only one in the school—who was cornered in the playground by the older and "wiser" 10- and 11-year-old boys, who taunted him with "Whose side are you on, ours or bin Laden's?" Pushed and shoved until rescued by a playground supervisor, the lad was traumatized by his experience, and was ill for several days. There must be hundreds of thousands of such stories below the surface of this attack, and he may well stand as a symbol for a minority group within North America that suddenly is far more visible than it wants to be. Moreover, the dislocation this is causing may have direct implications for health care.

Of even worse provenance, white supremacist groups have sprung up in September 11's wake, creating pressure on everything from immigration quotas to policy on neo-Nazis. The rapidity with which this has occurred has frightened both Muslims and Jews, and has prompted minority comments, including that of Mazen Chouaib, executive director of the National Council on Canada-Arab Relations, as quoted in Maclean's: "These groups are trying to undermine multiculturalism and have a vested interest in seeing some sort of clash of civilizations taking place." It is startling to see Samuel Huntington's polarization thesis, described in 1993 in Foreign Affairs, being acted out in a schoolyard. Indeed, seldom has polarization taken such a quick and surly direction. Memory fails to identify a similar precedent within the U.S. and Canada when a religious group has been singled out and traumatized by something that almost none of them had any idea about. The repercussions for social and mental health are significant.

It might be helpful to remind those who deal with such spiritual problems that early Islamic medicine developed an aspect of health care relevant here. We could even call it the Muslim version of "chicken soup for the soul," but one far more central to medicine than the famous books. Begun in the work of the scientist and physician al-Kindi (801–873), it was conceptualized by Muhammad al-Razi (865–924), the well-known physician, as Tibb al-Ruhani, literally "medicine of the spirit." He regarded it as an important strand within the whole field of medical activity. The philosopher Ibn Miskawayh (932–1030) carried on this tradition by identifying Tibb al-Rufus (soul medicine) as an important part of the Islamic corpus. It was extended through such greats as Ibn Sina and al-Ghazzali.

Central to soul medicine was the integral nature of the human, by which physical, mental, and spiritual dimensions had a common interface within the human. The consequence was that health was not just subject to physical systems and causalities, but to the whole range of human and spiritual experience. Thus ethical, intellectual, and legal matters could affect well-being just as much as physical trauma. Depression, so often identified today as the result of stress and anxiety, that is, given quasi-physical descriptors, is multifactored in Muslim soul medicine. It is seen to arise out of several possible spiritual and ethical environments. Thus Ibn Miskawayh, in his Tahdhib al-Akhlaq, says "for we can observe [that] the man who is ill in his soul, whether with anger, grief, passionate love, or agitated desires, undergoes a change in the form of his body whereby he shakes, trembles, turns pale or red, becomes emaciated or fat, and the form of his body is affected by the various (other) changes which can be perceived by the senses." The good doctor argued that there were various principles to be applied to address such situations, but for him, when the "cause" of the illness is deemed to be in the psyche, then the clinician should work to offset it by its opposite. That is, if one is in a state of depression, then the antidote is to provide a situation of joy, happiness, and celebration. Ibn Miskawayh believes that a key factor in Tibb al-Ruhani is the sense of balance within the whole person, and illness therein is an expression of imbalance within the emotional and psychological domains. A sidelight to his interpretation of illnesses in soul medicine is his notion of moral precepts. He clearly holds that Islamic well-being comes about from the certitude of moral legitimacy. Once one is convinced of the ethical validity of one's actions, that certitude brings calmness and tranquility.

We can summarize some of the more important principles in Ibn Miskawayh's analysis this way:

• Set up a good physical exercise program because it is essential for the proper balance of mind and body.
• Watch whom you spend your time with; associate only with those of recognized high moral conduct, since interpersonal environments have a significant impact on well-being, and one's mind should be engaged in uplifting matters rather than common or vulgar ones.
• Take care not to invest completely in physical pleasures and bodily activities, and don't let yourself be bogged down in coveting "things."
• Your mind can do you in; keep it busy with the pursuit of knowledge, and make it work hard. That way it can't be used in counterproductive ways. Remember you are the master of your mind.
• Find a way to do mental exercises; take courses in sciences that balance each other out, such as mathematics and music, geology and astronomy.
• Don't stir up your soul with all of those problems of the past, and refrain from dwelling on those negative aspects that drag you down.

In short, there are many valuable resources within Islamic medical tradition to aid Muslims through this difficult time. For Muslims here, the principle of balance would seem to be invaluable. While centering on the resources of Islam as a bulwark, meeting other Americans face-to-face and discussing the unfortunate impact on both communities would seem to be good advice. Moreover, maintaining an emphasis on Islam's rich moral and ethical traditions will assist in building bridges to other Americans, and will undermine the sense of isolation. Learning just what fellow countrymen think will go a long way to alleviate the constant pressure to prove their loyalties, since the engagement in ideas and concepts, according to Ibn Miskawayh, is a good way to offset soul malaise. Nor does one have to be a scholar to be successful in this activity. Finally, soul medicine stresses the importance of keeping engaged, either physically or psychically, and the aftermath of September 11 should be the perfect moment for Muslims to engage in both self-criticism and building bridges to the future. And clearly it would be most helpful if the rest of us could provide our Muslim fellow citizens the "high moral conduct" that would help them beyond this traumatic time in our collective history.