Making its Mark: Art Therapy in the Arabian Peninsula

By Powell Sara

Art therapy is rapidly expanding across the Arabian Peninsula. This book showcases the works of pioneering art therapists in the region who integrate and adapt Western psychotherapeutic models whilst adhering to culturally responsive practice, capturing innovative treatment protocols reflective of differentiated psychological and cultural needs. More importantly, it provides a voice to a cross section of a community from a region that is often misunderstood and muted on the global stage. This book is surprisingly the first of its kind for the region and provides a window to art therapy within this cultural context, its challenges and its strengths. It is informative and benefits mental health professionals, educators, students, and anyone with an interest in expressive therapy.

• Language: English
• Publisher: Hamad Bin Khalifa University Press
• Release date: Apr 14, 2024
• ISBN: 9789927164460

Book preview

Acknowledgements

It has been a long journey, but this book is the result of the collective efforts by all the contributors as well as the publishing team, who have patiently helped in the narration and completion of the book.

This is my first attempt as editor to piece together the narrative and experience of my fellow professionals and co-contributors in painting an authentic picture reflecting the diversity of art therapy in the Arabian Peninsula.

I would like to, first, extend my deepest appreciation and gratitude to the State of Qatar, and to Hamad Bin Khalifa University Press, who, without hesitation supported this project from the outset and provided a platform and a voice for art therapists in the region.

Second, I would like to thank my family who have been a guiding inspiration, a force who show me, on a daily basis, cross cultural understanding and love can and does exist. This again was a source of inspiration to showcase the splendor of the Middle East and its people and to offset, at times, an ill-informed, skewed and sadly negative perception of this part of the world.

To the contributors and authors of this book, who continue to advocate and pioneer this profession throughout the region and who have patiently awaited the publication of this book, sincere thanks and gratitude for your contributions and perseverance. To my colleagues at ATIC Psychological and Counselling Center, Dubai, Natalia Gomez-Carlier and Mariam El Halawani, who have a shared vision of advancing art therapy in the region, grounded in best practice and cultural understanding, I extend a heartfelt thanks and appreciation for all your continuous support and enthusiasm. Also, thanks to Andrew Wright who at the earlier stages of this project supported its editorial process.

Last but not least, thanks to all our clients whose stories and willingness to share their experiences enable therapists to serve our communities with better understanding and cultural sensitivity.

Introduction

Western Origins of Art Therapy

In brief, Art Therapy interchangeably known as art psychotherapy may be viewed as a recent profession, however, its historical influences, using the visual arts as a form of ritual and healing, symbolic imagery, has been connected globally, throughout history, evidently with multiple examples (Spivey, 2005). Art therapy has a strong rehabilitative lineage tracing to the mid-twentieth century, however, art therapy has its origins, at least, in the 1840s (El-Mallakh, 2021, p. 205). Physician Philippe Pinel was possibly the first to document art made by patients (El-Mallakh, 2021).

Art therapy has been influenced by the field of medicine and psychiatry (Edwards, 2014), influenced famously by the likes of Sigmund Freud, Carl G. Jung and psychoanalysis. The unconscious, dreams and expressive symbolism arguably, are the main components in providing the profession with an initial conceptual framework. A starting point from which the profession has since evolved (Junge, 2010). Many more prominent psychoanalysts such as, Melanie Klein, Donald Winnicott, Marion Milner and Alice Miller incorporated painting and the arts within a predominantly verbal clinical practice (Edwards, 2014). It also provides effective support to non-verbal members of society through the incorporation of artistic mediums for expression and communication (Piliere, 2018). Art therapy has been shaped by its ability to reach non-verbal populations and naturally is a beneficial treatment for trauma as far back as WWII. Art Education has also been a contributing field, with the likes of Viktor Lowenfeld, art educator and psychoanalyst, who focused on the psychological underpinnings of children’s art, highlighting the connection between creative and intellectual development (Junge, 2010).

Today, art therapists administer support in areas of humanitarian, rehabilitative, medical, educational, and private settings, providing assessment and treatment from early childhood to children, adolescents, adults, seniors, couples, families, and groups. Presently, art therapists are much more eclectic in their therapeutic approach, and are grounded by evidence-based practice.

For the past 50 plus years, art therapists have been predominantly professionally licensed and regulated by the United Kingdom (UK) and the United States (US). The British Association of Art Therapists (BAAT) was the pioneering body established in 1964. Leading up to this many art therapists in the UK had roots in the arts and in art education (Edwards, 2014). Edward Adamson was the first artist hired by the National Health Service (NHS) and was the founding chairman of BAAT in 1964 helping to significantly develop the field of art therapy (Seftel, 1987).

To be an art therapist in the UK, it is also mandatory to be licensed by the Health and Care Professions Council (HCPC), underlining the importance and the significance of this profession and its standing in the social care sector. Similarly, The American Art Therapy Association (AATA) is one of the leading professional organizations for art therapy. Founded in 1969, it formulated a standard of practice by the mid-1970s for requisite qualification and training criteria for registration and designation as art therapists. Pioneering influencers from the USA are Margaret Naumberg, who rested on psychodynamic theory and the unconscious, and Edith Kramer, who proposed an alternative model of art therapy art as therapy, with a focus on the importance of the creative process and its ability to provide healing and relief (Potash, 2005).

According to the British Association of Art Therapists:

Art therapy is a form of psychotherapy that uses art media as its primary mode of expression and communication. Within this context, art is not used as a diagnostic tool but as a medium to address emotional issues which may be confusing and distressing. Art therapists work with children, young people, adults and the elderly. Clients may have a wide range of difficulties, disabilities or diagnoses. These include emotional, behavioral or mental health problems, learning or physical disabilities, life-limiting conditions, neurological conditions, and physical illnesses. Art therapy is provided in groups or individually, depending on clients’ needs. It is not a recreational activity or an art lesson, although the sessions can be enjoyable. Clients do not need to have any previous experience or expertise in art. Although influenced by psychoanalysis, art therapists have been inspired by theories such as attachment-based psychotherapy and have developed a broad range of client-centered approaches such as psycho-educational mindfulness and mentalization-based treatments, compassion-focused and cognitive analytic therapies, and socially engaged practice. Exploring the links between neuro-science and art therapy has also been at the forefront of some of BAAT’s conferences. Importantly, art therapy practice has evolved to reflect the cultural and social diversity of the people who engage in it.

Art therapy is well integrated into the healthcare sectors in the West and has shown to be making great progress with its integration across Asia (Kalmanowitz & Chan, 2012). Its integration in the Arabian Gulf in particular is still in its infancy, a shortcoming that has not gone unnoticed by the authorities, but it is still a work in progress. With successful frameworks already in place in the West and Asia, art therapy and art therapy practitioners need to adapt to the cultural realities, dos and don’ts and evolve the profession to incorporate cultural sensitivity in order to provide the best care possible, commensurate with the cultural norms, and refine overall standard procedures and practices for art therapy in the Middle East.

Middle East: Origins of Art Therapy in the Arabian Peninsula

The Middle East can be described as the cradle of civilization, spanning two continents and giving birth to the three major monotheistic religions (Judaism, Christianity and Islam). The region blends a great diversity of tribal practices, ethnic populations, cultural norms, and religious views. It is a land of great wealth, but with that wealth has come the watchful gaze of others.

Notwithstanding modern-day differences within the region, it is uniquely interwoven by many common factors. A common thread runs throughout its geography, with language at its center, depicted historically within its arts and traditional crafts; weaving, embroidery, poetry, pottery, music, dance. In modern times there is also an embrace of paintings and literature (UAE’s Government Portal, 2022), archaeological site symbols, historical rock art (Bednarik, 2017) and its architecture to name but a few; all things that can be seen, translated, and carried over to its present day as a historical source of communication. This link and anchor, as a form of communication, can be used as a foundation for greater understanding and a fertile platform to utilize the principle of art therapy to give visual voice to diverse populations within the region.

Due to the diversity of the Middle East, this introduction primarily focuses on the Arabian Peninsula, an all too familiar geographical ground with a rich history and culture.

I studied art therapy at LASALLE College of the Arts in Singapore and witnessed the development and growth of art therapy in Singapore and the region. Its achievements, struggles, development and growth were also documented (Kalmanowitz & Chan, 2012). I spent close to six years there before returning to the Arabian Gulf (United Arab Emirates), with the intention of bringing art therapy to the community as part of a newly growing social care sector in the country.

The Arabian Peninsula represented within this book encompasses the Arabian Gulf, and parts of Levant and Egypt. The Arabian Peninsula itself is a diverse geo-political landscape which is deeply polarized. At one end of the spectrum, it is challenged by frequent political unrest, international pressures and influences, wars (past and present), fostering a collective trauma emanating from its instability (Neria et al., 2010) and humanitarian crises with displaced populations and refugees. On the other end, we have modernity, progressive reforms, globalization, and an interplay between holding traditional values on one hand and on the other welcoming Western influences, as deemed fit. Such polarization and diverse interests amongst constituents in the Arabian Peninsula have helped shape and mold the role of the art therapists in the communities they serve. Indeed, the role of an art therapist in some communities may be linked to humanitarian assistance, a necessity, in comparison to an art therapist supporting social challenges, similar to those in other developed countries, an intervention deemed as a luxury to many. Despite such polarization, this region in its entirety is proud of its progress and achievements, and strives for further improvement. Sadly, the achievements are often overlooked and largely unreported internationally. Nonetheless, as an art therapy community within the region, we recognize that more work needs to be done to promote and expand the art therapy footprint in the social health care sector in particular, with recognition and regulatory provision for licensing in line with other developed countries.

In 2014, ATIC gained licensure, and in 2015 opened its doors as a social impact company. Despite being the first center in the United Arab Emirates (UAE) offering art therapy, although largely unknown, both government entities as well as the community have embraced art therapy and welcomed the service and its wider use in the UAE. However, there are still the usual teething problems, chief amongst them is lack of regulatory oversight and unhindered use of art therapy by non-qualified members of the public. In addition, the notion of art being used in a clinical setting is perhaps perceived as less scientifically vigorous. Cultural considerations surrounding how the arts are viewed, and how mental health at large is viewed, may help understand the challenges we are beset with.

Education is the key (at the time of writing this chapter, there are four qualified and registered art therapists working at ATIC and in the UAE), so we set about familiarizing the community, both the public and private sector, teachers and surprisingly some mental health professionals, on the benefits of art therapy. The overall lack of understanding and value of art therapy in the public domain, was and, although there has been significant progress, still is problematic. Albeit to a lesser extent.

The emerging social care sector, like in any developed country, is typically the last sector to be developed. As a collectivist society which often places collective needs over individual needs (Al-Krenawi & Graham, 2000), shame is one of the limiting factors for individuals to emotionally express and/or seek mental health support in general (Abdullah & Brown, 2011). In addition, in parts of the Middle East, the privatization of psychological support and lack of insurance coverage have also compounded the problem. As art therapy is not regulated in the region, it has saddled the profession as well as the community with unintended consequences thereby limiting access to art therapy in comparison with other mental health professions, case in point, the extremely limited insurance coverage. Many mental health practitioners initially were also unaware and skeptical of the benefits of art therapy. The social care sector is embedded within a medical model, like many communities there is a tendency towards prescription medicine, which may not be the only solution in every case.

In short, without proper support and cohesion in regulating and licensing, from a wider perspective amongst Arab States, art therapy’s struggle and sluggish growth in the region will continue. However, it must be stressed that without government support and other local agencies, ATIC could not have provided art therapy programs to vulnerable populations and begin pilot programs, offering a solid footing for the integration of art therapy going forward. Due to the infancy of art therapy in the region, there is also a lack of culturally sensitive literature; research is therefore warranted to understand the manner in which to administer art therapy to the local population. ATIC’s pilot programs are at initial stages of developing trust within the community and evaluating the professional efficacy grounded in culturally informed evidence-based practice.

Furthermore, the absence of a local governing association and/or university training program also hinder art therapy development in the region, though these are secondary considerations, and absence of regulatory and licensing framework by and large restrains and diminishes art therapy’s contribution to the community. In order to increase both awareness and provide a snapshot to those in pursuit of a career in art therapy with reputable universities, ATIC, in collaboration with the British Association of Art Therapists (BAAT), has developed a foundation in art therapy course which is culturally adapted to familiarize the community at an introductory level on the importance and benefits of the profession. We also have recently had the privilege to further provide training in the State of Qatar, in conjunction with Virginia Commonwealth University, offering a level 6 diploma in Creative Therapeutic Practice for Children and Young People accredited by the Counselling and Psychotherapy Central Awarding Body (CPCAB) UK. It is also worth mentioning that the first art therapy conference in the United Arab Emirates was held at the University of Sharjah in February, 2016. Despite numerous challenges, art therapy is nonetheless making its mark in a changing social care landscape in the region.

Aim of the Book

The aim is to attempt to capture the pioneering work of art therapy in the region, progress and positive impact that art therapy continues to make within the Arabian Peninsula, helping to move past a typically distorted international perception of the region, which is often purportedly grappling with extremism and conflicts. As a British national, third culture kid, who has spent many years in the Gulf, and having children and extended family from the region, I have developed a deep connection to this land. I have been saddened on many occasions when attending international conferences, seeing first-hand there still exists a real lack of understanding of the region and with that, ensuing misconceptions. Regrettably, some media outlets have perpetuated the distorted image, knowingly or unknowingly, and in so doing have promoted the notion that the region lags in many fields while also berating many of its achievements. Yes, there is a lack of art therapy representation or recognition across the region and arguably to a lesser extent at international level. The lack of regional representation spurred me on to join hands with my professional colleagues (albeit a small group) to showcase the noteworthy preliminary work undertaken in the region, with a purpose to become inclusive and widen the diversity of the international art therapy community. This book attempts to document the practices of art therapists bound by cultural and traditional values and influences while also embracing modern-day norms and societal challenges in presenting art therapy in the Arabian Peninsula. This book is intended as a resource for healthcare practitioners, educators, and individuals who are interested in learning more about art therapy that is culturally specific to the region.

Structure of the Book

This book is a celebration of the first recordings of work that art therapists in the Arabian Peninsula have provided and pioneered. The Middle East is continually changing and the chapters encapsulate an earlier point in time establishing art therapy with a variety of populations across the region. Admittedly, it has been a struggle to find a wide pool of practitioners in the region and that is perhaps understandable given the absence of formal educational programs and regulatory framework. Therefore, anyone interested in art therapy, for example to study, research or as a career, needs to move abroad for education and training. It is important to stress that the authors do not represent the countries or communities they are writing about; they, however, share their professional views and this should not be taken as a generalization of the respective country. Unfortunately, due to the absence of suitable contributors, Kuwait, Syria, Palestine and Iraq are not represented. However, it is hoped that these countries can be included in the subsequent edition.

The first chapter of the book is presented by Alan S. Weber. Based in the State of Qatar, he provides an overview of the historical and theological development of arts for health and art therapy in the Islamic world, with a focus on the Arabian Gulf.

The Kingdom of Saudi Arabia can be considered the starting point of art therapy development at large within the Arabian Gulf. Accordingly, a large segment of the book is dedicated to the development and status of art therapy in the Kingdom. Alia Al Shaer explores her perspective of being a Saudi art therapist in Saudi Arabia, with case examples of dyadic work in support of siblings with trauma; Emily A. Fiddy reflects on expressive arts therapy in the Kingdom from a cross cultural perspective, providing an enriching narrative, outlining in addition her adaptive role as a mentor and expressive arts therapist. Fahad S. Al Fahed discusses his perspective as a Saudi national art therapist providing an interesting viewpoint on culture and spirituality and his group work with people with visual impairments.

Dalal Al Sindi, reflects on her work establishing art therapy in Bahrain, outlining a unique cultural comparison and reflection from her perspective working as an art therapist between the Kingdoms of Saudi Arabia and Bahrain. Dalal is the first trained Bahraini art therapist.

Two expatriate art therapists reflect on their initial work in Qatar — Siobhan Bareen, setting up art therapy addiction and rehabilitative services, and Tara DeLuca who reflects on the initial challenges of art therapy integration within the country, leading to the development and introduction of an art therapy and music therapy school program.

I, Sara Powell, reflect on my work in private practice and in the realm of medical art therapy in the UAE, with a cultural focus on pediatrics with genetic disease. Mariam El Halawani also reflects on her work in the UAE documenting art therapy support for migrant workers.

Natalia Gomez-Carlier explores a cross cultural perspective on art therapy intervention in support of grief in The Sultanate of Oman.

We then cross the planes to the Levant where Myra Saad and Julia Byers jointly depict their work in a Palestinian refugee camp in Lebanon, with a trauma-informed perspective. Myra helped establish art therapy in Lebanon and is the first trained art therapist in the country.

Next, Emily A. Fiddy reflects on her experience as an expressive therapist with the displaced people of Syria in a refugee camp in Jordan.

In the final chapters, Egypt is dually represented by Carol Hammal and KiKi Haddad Zaynoun. Carol reflects on her work establishing art therapy in Egypt as the first trained Egyptian art therapist, showcasing her work with addiction, in-patient and in private practice. Kiki Haddad Zaynoun reflects on the developments of art therapy in Egypt with a focus on community interventions. She provides cross-cultural considerations between community settings in Egypt and the Dominican Republic.

References

Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review, 31(6), 934–948. https://doi.org/10.1016/j.cpr.2011.05.003

Al-Krenawi, A., & Graham, J. R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 25(1), 9–22.

Bednarik, R. G. (2017). Scientific investigations into Saudi Arabian rock art: A review. Mediterranean Archaeology & Archaeometry, 17(4).

Edwards, D. (2014). Art therapy. Sage.

El-Mallakh. (2021). William A. F. Browne: Earliest Documented Use of Rehabilitative Art in Great Britain. Art Therapy, 38(4), 205–210.

Junge, M. B. (2010). The modern history of art therapy in the United States. Charles C Thomas Publisher.

Kalmanowitz, D., & Chan, S. M. (2012). Art therapy in Asia: To the bone or wrapped in silk. Jessica Kingsley Publishers.

Mazen Maarouf. (2012, September 2). The poetry of revolution. Al-Jazeera English. Retrieved July 12, 2015, from http://www.aljazeera.com/indepth/opinion/2012/08/201283014193414611.html

Neria, Y., Bravova, M., & Halper, J. M. (2010). Trauma and PTSD among civilians in the Middle East. PTSD Research Quarterly, 21(4), 1–8.

Piliere, R. (2018). Art therapy interventions that facilitate non-verbal expressions and how art therapy can improve communication for children with autism.

Potash, Jordan S. (2005) Rekindling the multicultural history of the American Art Therapy Association, Inc. Art Therapy, 22(4),184–188.

Spivey, N. (2005). How art made the world. BBC Book.

United Arab Emirates’ Government Portal. (2022). Art. https://u.ae/en/about-the-uae/culture/art

Chapter One:

An Overview of the Historical and Theological Development of Arts for Health and Art Therapy in the Islamic World and the Gulf

By Alan S. Weber

Weill Cornell Medicine in Qatar

Alan S. Weber, PhD, is professor of English at Weill Cornell Medicine-Qatar. He teaches the Medical and Health Humanities and his research includes the intersection of health and the arts. His article, Expressive Arts Therapy in the Arabian Gulf: History and Future, (2011) was the first published overview of this topic.

1.1. Introduction

The recent introduction of art therapy interventions in the Islamic world and the Arabian Gulf, in particular, raises a number of theological, cultural and practical questions. For example, the psychological, psychoanalytical and psychiatric theories which underpin most modern art therapy approaches are controversial in Muslim-majority countries and originated from medical and aesthetic philosophies developed in Western cultures. Although Islam has a documented tradition of expressive art therapy such as music therapy (Weber, 2011a), conservative theologians have expressed throughout history negative attitudes towards all forms of art, specifically the making of images of humans and animals as well as any depiction of a religious subject. Sunni Muslims almost unanimously agree that depicting the Prophet Muhammad (PBUH) visually is haram, and except for some Persian miniatures from the 13th to 17th centuries and in modern Shia Iran, only a small number of portraits of the Prophet (PBUH) exist (Bloom & Blair, 2009, pp. 192–94).

The relationship between visual art and Islam is complex, and pre-Islamic Iranian and Israelite religions as well as 8th century Byzantine Christian culture and 16th century Calvinism additionally entered into analogous debates about the lawfulness of images, depicting divinities, or imagining deities as animals (zoomorphism) (Mettinger, 1995; Shenkar, 2008, pp. 239–40). In the modern period, Muslim attitudes towards art were additionally influenced by rejection of Western colonialism and orientalist thought, Western views of fine art, and reactions against image- and media-driven consumerist and secular societies (Naef, 2004, 2007). Whatever the ultimate causes of some Muslims’ uncomfortableness with art, non-representational ornamental arts such as calligraphy, mosque decoration, and geometrical patterns are much more common and more highly developed in the Muslim world: All of these traditions avoid representations of religious subjects, humans, animals, or plants with the exception of Spanish Uammyaad period art or the Persian and Mughal miniature traditions (partially non-Islamic in origin).

Understanding the historical and theological development of art therapies in both Islam and Western countries is essential for art therapy to be accepted by healthcare practitioners, government licensing bodies and the general public in the Gulf region, where art therapy is now not widely available. Thus, a complete understanding of the potential for art therapy interventions to gain acceptance in the Islamic world requires a full elucidation of the Muslim Ummah’s complex relationships with both artistic expression and psychology.

1.2. Psychology and Psychotherapy in the Islamic World

Modern Western psychology grew out of the early Greek classical speculation on the soul (psukhē), such as Aristotle’s De anima, because in classical Greek philosophy and religion, this entity was believed to be the locus of behavior, emotion, memory, cognition, and rationality. Aristotle proposed a comprehensive and hierarchical series of three souls — vegetable, animal and intellective (human) — to explain both the physiological and mental phenomena of all living (animate) beings, including nutrition, reproduction, sense perception, imagination, and rationality. Like Christianity, Islamic religious texts contain very little explanation of the exact nature of the soul, only vaguely alluding to in the Qur’an a principle of personhood (nafs) or lower self and a spirit (ruh); attempts to formulate a modern conception of soul in Islam have additionally included concepts such as qalb (heart) and aql (intellect or rationality) (Rothman & Coyle, 2018, p. 1732; Haque, 2016). Early Islamic physicians including Ibn Sina (980–1037) and Al-Razi (854–925) recognized and discussed delusional, psychotic, mood, personality, and dissociative disorders. Ibn Rushd (1126–98), who was both a physician and theologian, similarly drew on translations of Aristotle’s De anima in his psychological writings. Ali ibn al’Abbas al-Majusi in the Kitab al-Maliki described many diseases such as hemiplegia, amnesia, and epilepsy, which we now know to be neurological in nature. Al-Majusi’s book was widely reprinted in a Latin version by Constantinus Africanus called the Liber pantegni; thus, the Greek psychological heritage was expanded by the clinical observational work of Islamic physicians who helped to form the basis of early psychological theory in Europe. Both Western and Islamic psychological theories therefore share some common philosophical roots.

These Islamic theories and the practice of psychological medicine were a mixture of empirical observations made by Aristotle, Hippocrates and Galen (Greek humoral medicine), Indian Ayurvedic medicine, Chinese medicine traded via the Silk Road in addition to insights originating in Islamic physicians’ practices mixed with Qur’anic learning and the ahadith on health. Islamic theories of healing generally recognized: (a) somatization or the impact of emotion and feeling on physiological health and vice versa; (b) the importance of balance in diet, exercise and spiritual life as therapeutic doctrines; (c) the natural healing power of the body; d) external metaphysical forces as causes of disease, such as djinn and the evil eye; and (e) the obligation to care for the mentally ill humanely, instead of incarceration or punishment, which was common practice in medieval and early modern Europe. As with religious approaches and Ibn Qayyim’s compilation of religious medicine discussed below, classical Islamic medical approaches often did not invoke a strict mind/body dualism, which has become common in Western philosophies of being and medical philosophy since Descartes. The man as machine (‘L’homme machine’) metaphor has been very productive in advancing modern mechanical and biochemical means of fixing the ‘broken body,’ such as surgery, but has left many questions about general well-being and emotional and psychological states unanswered. In Al-Majusi’s conceptualization of emotional distress and trauma, on the contrary, the emotions were explained physiologically. For example, anger is the boiling of the blood in the heart and the movement of the natural heat, which is sent outward to the rest of the body; it can be seen by redness in the eyes and a flushed face. The heat dries the body and strengthens the bile until it becomes a daily fever (Dols, 1992, p. 64).

These historical Islamic approaches to spiritual healing thus share a similar outlook with modern holistic healing and Traditional Medicine/Complementary and Alternative Medicine (TM/CAM). Folk medical practices are still widespread throughout the Islamic world, especially beliefs and therapies surrounding mental illness. Somatization, for example, among Arab Bedouin women of the Negev was investigated by Huss and Cwikel in a study involving art therapy sessions with women drawing and sculpting their self-perceptions of their own bodies. Many participants chose symbolic representations such as trees, and the self-chosen subjects revealed that they spontaneously employed culturally neutral and universally understood symbols of their inner mental states, for example, depicting depression as blackness, and a woman who sculpted a cow to express abandonment: A woman is like a cow. If the woman gives milk, it’s looked after, but after it doesn’t give milk, it’s discarded (Huss & Cwikel, 2008, p. 144; Bürgel, 1973).

Another healing tradition that is still influential today is called Prophetic medicine or tibb al-nabawi. Prophetic medicine is based on medical information found in the Qur’an and the practices (sunnah) and sayings (ahadith) of the Prophet Muhammad (PBUH) on medicine, reported in collections compiled by Al-Bukhari, Muslim, Abu Dawood and others. The collection of Sahih Al-Bukhari contains more than 100 medically-related ahadith. One of the most quoted and influential anthologies of Prophetic medicine was compiled by Ibn Qayyim Al-Jawziyya (1292–1350), a Hanbali scholar from Damascus. In his Prophetic Medicine, Al-Jawziyya proposed two types of diseases: those of the heart (qalb) and the body (badn) (Al-Jawziyya, p. 3). Diseases of the heart include anxiety, worry, sorrow, grief, terror and insomnia. Al-Jawziyya explained that treatment for these calamities can include 15 religious-based cures, such as recognition of the oneness (tawhid) and omnipotence of Allah (SWT), seeking help from Allah (SWT), repentance, and striving and seeking forgiveness through prayer and supplication, etc. (Al-Jawziyya, 1998, pp. 149–150).

In addition to drugs, herbs and written talismans and amulets (not universally accepted by all Muslims), which had been used by the Prophet (PBUH) and the companions (as-sahaba), Al-Jawziyya viewed one key component of healing as ijtihad or struggle and effort, a very common conception of all illness in Islam. Other common views of disease among Muslims are that illness is a test of faith and that affliction is a purifying process to purge sin, with rewards in the afterlife (Dif, 2003, pp. 20–21). These views may hinder individual Muslims from seeking either pharmacological, cognitive-behavioral or expressive art therapies