Amin A. Muhammad Gadit  ( Discipline of Psychiatry, Memorial University of Newfoundland, 300-Prince Philip Dr, St. John's, NL A1B 3V6, Canada. )

The present era is surrounded by unrest, catastrophes, upheavals and overall global disequilibria. Under these circumstances, the mental health has become a challenge and reports are full of description about growing mental illnesses. Sometimes, the available biological therapies are unable to control or alleviate the mental health problems. Psychotherapies have their role to some extent but the modern day therapists are in favour of a holistic approach towards addressing mental health issues. ICD-10 which is a W.H.O. classification has already added a 'spiritual dimension' for mental well-being which is worth exploring.¹ The human brain is complex and it is said that during life-time about 15% of it comes in use, which otherwise would manifest powers and solve mysteries that could come as a great surprise for the human beings.² Brain has remarkable power despite the fact that it does not have regenerative property. Human beings experience phenomena which are at times beyond comprehension. The spiritual concept helps us to understand that this component has a tremendous capacity to help individuals in emotional traumas and crises. Faith has been discussed in some scientific and lay literature that plays a great role in religion as human being no matter how thick skinned or hard core he/she has would need a shoulder to cry and share misery with an entity with which a direct communication can be established. The concept of God and faith in 'His' powers can help an individual in times of mental upheaval. The power of religious words and recitations have psychotherapeutic value no matter whichever religion is being followed. Spirituality, though beneficial to mental health does not necessitate holding religious beliefs, or engage in religious practices or belong to an established faith group.³ On the other hand, evidence is also available indicating benefits for mental health of belonging to a faith community, holding religious or spiritual beliefs and engaging in associated practices.⁴ It is identified with experiencing a deep sense of meaning and purpose in life, together with a sense of belonging. According to one definition "the spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite, and comes especially into focus in times of emotional stress, physical and mental illness, loss, bereavement and death-it deals with healing of the whole person". The potential benefits of spiritual dimension are: improved self control, self esteem and confidence, speedier and easier recovery, achieved through both promoting and healthy grieving of loss and maximizing the personal potential, improved relationships and a new sense of meaning resulting in reawakening of hope and peace of mind, enabling people to accept and live with problems not yet resolved.⁴ Spiritual practices foster an awareness that serves to identify and promote values such as creativity, patience, perseverance, honesty, kindness, compassion, wisdom, hope and joy which are all good for sound mental health. The Royal College of Psychiatrists, UK has a special interest group instrumental in developing insight into this important dimension of mental health. According to this group, making a spiritual assessment is as important as all other aspects of medical history taking and examination. It is also emphasized that when making a diagnosis, a psychiatrist should be competent in distinguishing between spiritual crisis and mental illness, and able to explore areas of overlap and difference between the two.⁴ In practice, it has been observed that some medical practitioners have greater healing powers than others which are independent of the quality of communication skills, qualifications, years of experience and other personal attributes. Is this healing power innate or a result of some spiritual connection?⁵ We can perhaps explain this on the basis of 'mysticism' that is a phenomenon experienced by senses but not explainable by intellect and involves "faith". The shamans, dervishes and tantriks have been observed to bring miraculous cure by virtue of mystical/spiritual powers, which shows that human beings do possess such powers. In the holistic approach, physical as well as mental exercises, religious practices, meditation, yoga and other therapies are included which are tailored according to the individual patient needs. Owing to its effectivity and its acceptance in the classification system, its role in mental health has been established beyond doubt. The mystical or the spiritual powers are difficult to explain on scientific grounds but many things are not understandable in this way, the exploration of such phenomena will go a long way in unraveling some mysteries. The 'Sufi' saints who are described as having tremendous healing powers by virtue of their direct communication with the spiritual world and the way they confer benefits long after their deaths is a fascinating area worth exploring as studies^6,7  have shown benefits in mental health conditions like: depression, prolonged grief, psychosomatic conditions and some physical ailments with psychological connotations. Even the spiritual practices like prolonged meditation, avoiding worldly gains, simple eating, fasting and recitations of holy verses, yoga, Tai Chin, sacred music, pilgrimage have been associated with general mental well being. It is said that general tranquility, calm, proximity to oceans, moon light and natural environment provide strength to the brain and as a result, coping ability is strengthened along with the development of resistance to disturbing emotional sensations. A study⁸  has shown benefits of including a shaman in a multidisciplinary mental health team as well as the role of shamans in mental health system conferring therapeutic benefit in some conditions. Similar studies^6,7   elsewhere have found the same situation in terms of its importance in mental health and illness. How much is the knowledge of spirituality and mysticism essential for the mental health professionals dealing with patients? In view of existing information and addition of this dimension in classification systems, it is obviously very important to have an adequate insight into this aspect. In US, provision has been made for psychiatric residents to do elective postings in religious places, UK is working on this issue and the Royal College of Psychiatrists has already established a working group and has accepted the absolute importance of this dimension. What is being in Pakistan where we have a culture rich in such belief systems and literature full of mystical accounts? Are we pursuing a course of instruction in spirituality during undergraduate medical studies and postgraduate psychiatry training programs? Is there a provision for psychiatric residents to undergo an elective rotation in this area? Are we ready to formally include the dimension of spirituality and mysticism in our curriculum?
Are we ready to take off from this moment in time? Let's begin our journey.

1. International Statistical Classification of Diseases and Health Related Problems ICD-10. 2nd Edition, Geneva, Switzerland. WHO 2005.
2. Guinevere D. Spirituality, mental health - time to develop insight. [online] 2006 [cited 2006 Feb 1]. Available from: URL: http://www.nation.com.pk/daily/jan-2006/3/nationalnews10.php  "Spirituality, mental health-time to develop insight" Guinevere David; date accessed: 1/2/2006.
3. Stanford Encyclopedia of Philosophy. Mysticism, 2005; p: 1-21. Stanford, USA.
4. The Royal College of Psychiatrist. Spirituality and mental health. [online] [cited 2007 Apr 16]. Available from: URL: http://www. rcpsych.ac.uk/mentalhealthinformation/therapies/spiritualityandmentalhealth.aspx. "Spirituality and Mental Health" The Royal College of Psychiatrists. Date accessed: 16/4/2007.
5. Gadit AM. Healing powers among doctors: Is there a role for mysticism? J Coll Physicians Surg Pak 2006; 16: 313.
6. Gadit AAM. Health care service delivery by Shamans. Int J Mental Health, 2003; 32: 63-83.
7. Jilek W, Jilek-Aall L. The psychiatrist and the shaman colleague, cross-cultural collaboration traditional Ameri-Indian therapists. J Open Psychiatry, 1978; 9, 32-38.
8. Gadit AAM. Role of Shamans in a Multidisciplinary Mental Health Team. J Coll Physicians Surg Pak, 2007; 17:183.