Atlas›Domain XIII · Contemplative & religious disciplines›Guide 249
Guide XIII-249

Qadiri vocal dhikr

Abd al-Qadir al-JilaniBaghdad
A 35 · L 54 · M 1112 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: vigorous, collective vocal dhikr (dhikr jahri or jali, "remembrance aloud") of the Qadiriyya Sufi order. It is described from the order's reference accounts (Britannica; Banglapedia), the Chechen Qadiri circle zikr as historians report it (Brightwell, drawing on Gammer, Bullough, Gall and de Waal), and the loud-dhikr teaching of the Tarekat Qadiriyyah Naqsyabandiyyah (TQN) at Pondok Pesantren Suryalaya, Indonesia, as described by Hayat (2023). The standing hadra of the related Rifa'iyya order in Aleppo (Poche's notes) is used only where it shows the general shape of an accelerating standing dhikr. Silent dhikr and individual loud dhikr after prayer are outside the scope of this guide. [source: Britannica; Banglapedia; Brightwell; Hayat 2023; Poche]

What it is. The Qadiriyya takes its name from 'Abd al-Qadir al-Jilani (1078–1166), a Hanbali theologian in Baghdad. Britannica calls it probably the oldest Sufi order. Al-Jilani's sons organised it and spread it to North Africa, Central Asia and India. The order is loosely organised, so each regional community develops its own ritual prayers. Banglapedia describes Qadiri followers' dhikr as "pious recital in loud voice". In many regions the collective form is a gathering in which members, led by a shaykh or his deputy, chant the declaration of divine unity (la ilaha illa Allah) and divine names aloud together. In some communities the chanting is done standing or moving in a circle, often with rising intensity. In Chechnya the Qadiri zikr, brought by Kunta-Haji in the 1850s–60s, is a circular, chanted and moving ritual. Historians describe it as a "loud" prayer, unlike the silent dhikr of the Naqshbandiyya. [source: Britannica; Banglapedia; Brightwell]

How change happens, in the tradition's terms. Practitioners describe dhikr as remembrance that clears the heart of heedlessness (ghaflah) and keeps awareness of God's presence (hudhur). TQN Suryalaya teachers frame it as purification of the self and a form of inner healing. These are religious claims. They are attributed to the tradition here, neither affirmed nor dismissed. [source: Hayat 2023] For the psychotherapist, the practice matters as a source of meaning, belonging, identity and coping. It also carries specific physical and psychological risks: dizziness, fainting, hyperventilation, exhaustion and intense altered states. The therapist does not teach or lead dhikr. The therapist's job is client-led integration, safety and collaboration with the client's own teacher. [synthesis]

Health claims. At Suryalaya, loud dhikr is part of the Inabah programme for people who use drugs and for troubled youth, alongside a repentance bath, voluntary prayers and group recitation. In the article this guide relies on, its effects are described in the tradition's own terms. The article gives no controlled clinical evidence, and dhikr is not presented here as a treatment for any physical or mental disorder. [source: Hayat 2023]

2. Framework

A. The gathering as the tradition describes it. Forms vary by country and lineage, and the stages below are a composite. No source gives one fixed liturgy for all Qadiri branches. [uncertain: composite]

  • Permission and initiation. In TQN Suryalaya, a person receives the dhikr formula through talqin, an instruction given by the shaykh or his authorised deputy. Teachers stress that it should be learned this way, not from reading or listening alone. Anything an order treats as an initiatory secret is not reproduced here. [source: Hayat 2023]
  • Opening. Seated recitation: Qur'an, blessings on the Prophet, litanies (wird) and hymns. This is documented for the Aleppo hadra of the related Rifa'iyya. [source: Poche]
  • Vocal dhikr. Participants chant the declaration of unity, then the divine Name, and sometimes shorter divine names such as Hayy ("the Living") and Hu ("He"). They are led by the shaykh, with a hymn-singer (munshid) setting the pace. Tempo and intensity rise, and whole-body movement goes with the chant. Drums may be used in some communities (Rifa'i Aleppo; Chechen accounts). [source: Poche; Brightwell]
  • Climax and close. The ending may be abrupt. A closing supplication and quiet recitation follow. [source: Poche]
  • Who leads. The shaykh or his deputy leads and authorises. In Baghdad the main body of the order is governed by a descendant of al-Jilani. [source: Britannica]

B. The therapist's work alongside the practice [synthesis; no source gives phases, session counts or formats for this work]:

  1. Engagement and assessment. Learn the practice's meaning, the lineage, the teacher relationship, and how often and how intensely the client takes part. Screen for physical and psychiatric risk. Move on once you understand the client's practice in their own words, consent to discuss it is clear, and any medical questions have been routed to the doctor.
  2. Safety and integration planning. Agree a client-owned plan for gatherings, including when to step back and how to recover afterwards, made with the teacher's guidance where the client wishes. Move on once the plan exists and any medical clearance is in hand.
  3. Working with experiences. Process ecstatic, frightening or confusing experiences. Tell spiritual experience apart from psychiatric illness. Use dhikr as a resource if the client chooses. Move on once experiences are integrated, or a referral is in place.
  4. Consolidation and collaboration. Check in with the teacher or imam if the client wishes. Plan for relapse or for intensive events such as retreats, anniversaries or Ramadan nights.

The sources consulted give no session counts.

3. Guiding principles

  • Client-led and consented. Dhikr enters therapy only at the client's initiative and with explicit consent. Practically, ask before you explore, and record consent. [source: APA Ethics Code 3.10; synthesis]
  • The tradition defines the practice. Use the client's terms (dhikr, hadra, halqa, wird, talqin, shaykh, murid), and let the client or the teacher correct you. Practically, never instruct, correct or redesign the dhikr itself. [source: Hayat 2023; synthesis]
  • Not the teacher. The therapist is not a shaykh, spiritual director or religious authority. Practically, refer questions about the formula, permission or method to the client's shaykh or imam. [source: APA Ethics Code 2.01(b); synthesis]
  • Concepts attributed, not adjudicated. God's presence, the nafs (lower self), unveiling, states (hal) and annihilation (fana) are described as the tradition holds them. Practically, ask "What does this mean in your path?" rather than interpreting. [synthesis]
  • Respect and competence. Ethics codes name religion among the differences psychologists must respect. They require training, consultation or referral where religious understanding is essential to the work. Practically, consult or seek training before deep work. [source: APA Ethics Code Principle E, 2.01(b); Vieten et al. 2013; Abrams 2023]
  • Body safety comes first, described qualitatively. Vigorous chanting with movement can bring on dizziness, tingling, chest discomfort, palpitations, fainting and panic. Practically, route all medical questions to the doctor, and never give breathing patterns, counts or tempo targets. [source: Terveyskylä; synthesis]
  • Altered states are neither pathologised nor romanticised. Ecstasy, weeping, laughter and trance are expected in some gatherings. Distress and impairment still need clinical attention. Practically, assess function, distress and duration, not content alone. [source: Poche; Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica]
  • Trauma-informed choice. Crowds, loud sound, darkness, touch, gendered arrangements and authority figures can trigger trauma responses. Practically, build in choice and exits that stay within the tradition. [synthesis; Treleaven 2018 [uncertain: not verified]]
  • Identity and history. For some communities, such as Chechens, the zikr carries a history of resistance, prohibition and deportation. Practically, ask what the practice means for identity and family, not only for spirituality. [source: Brightwell]
  • Boundaries and self-disclosure. Avoid multiple relationships that impair objectivity, such as attending the client's circle or taking a role in their order. Disclose your own faith briefly, and only when it helps the client. [source: APA Ethics Code 3.05; Abrams 2023]

4. Intervention inventory

The vocal dhikr belongs to the tradition and is taught by its shaykhs, so these are the therapist's interventions alongside it. Most of them are the guide's own clinical synthesis; the sources for each are tagged. Cross-references: Domain VII (spiritually integrated psychotherapy), Domain II (mindfulness-based programmes, as secular adaptations only), Domain IV (trauma-sensitive body practices), entry 239 (dhikr, the wider practice of remembrance in this family), entry 247 (Mevlevi sema, a different Sufi movement practice), and the pointer to XI 049 (ruqya) for clients who see their distress in terms of spiritual affliction. No published secular clinical adaptation of Qadiri collective dhikr appears in the sources consulted.

4.1 Respectful religious and spiritual assessment

  • Purpose and when. At intake, or when the client mentions dhikr, find out what the practice is in this client's life: lineage, teacher, setting, frequency, intensity, meaning, and community ties. [source: Abrams 2023]
  • Steps. (1) Ask about religious background and current practice alongside family and work questions. (2) Invite the client to describe a typical gathering in their own words: who leads, seated or standing, how long they usually stay, and what they feel. (3) Ask what dhikr gives them and what, if anything, troubles them about it. (4) Use the DSM-5-TR Cultural Formulation Interview, and its supplementary module on spirituality, religion and moral traditions, if your setting uses it [uncertain: not verified]. (5) Note strengths, such as community, discipline and comfort, alongside strains. [source: Abrams 2023; synthesis]
  • Example language (illustrative). "You mentioned the Thursday gathering. Would you be willing to tell me what happens there and what it means to you?" / "What words do you use for this, so I can use them too?"
  • Watch for. Whether the client looks guarded, which may reflect past dismissal by clinicians or, for Chechen clients, a history of persecution. It is working when the client corrects your terms and volunteers detail. [source: Brightwell; synthesis]

4.2 Clarifying authority, permission and the teacher relationship

  • Purpose and when. Early, and whenever practice questions come up. Locate who authorises the client's practice: shaykh, deputy, or local mosque. Do this so that method questions go to that person and the therapist stays out of the teacher's role. [source: Hayat 2023; APA Ethics Code 2.01(b)]
  • Steps. (1) Ask whether the client received the dhikr through talqin or another form of permission, and from whom. (2) Ask how questions about the practice are normally raised in their circle. (3) Agree that you will not teach, alter or evaluate the formula. (4) Map the relationship: closeness, the obedience expected, the freedom to say no, and the cost of stepping back. [source: Hayat 2023; synthesis]
  • Example language (illustrative). "Questions about how the dhikr itself should be done sound like ones for your shaykh. I'm happy to help you think through how you'd raise them."
  • Watch for. Whether the client relies on the teacher with no room for dissent, is pressured to stay in gatherings while unwell, or describes isolation from family. These may be signs of coercive control; see 4.10. [synthesis]

4.3 Physical risk screening before vigorous collective dhikr

  • Purpose and when. Before the client returns to or intensifies standing, moving or accelerating dhikr. Also after any episode of dizziness, collapse, chest pain or panic during a gathering.
  • What the risk is (qualitative). Breathing faster than the body needs blows off carbon dioxide. This can cause dizziness, tingling or numbness in the hands, tremor, chest pain, palpitations, a feeling of suffocation, fainting, and intense fear like a panic attack. New or unusual episodes call for medical assessment, because heart or lung conditions can sometimes be the cause. Sustained loud chanting, rhythmic whole-body movement, rising tempo, heat, crowding, standing for long periods and fatigue may add to the risk. A fall during a faint carries its own risk of injury. [source: Terveyskylä for the physiology and symptoms; Poche and Brightwell for exertion and exhaustion in gatherings; synthesis for the combined risk]
  • Steps. (1) Ask whether the client has felt light-headed, had tingling, chest tightness, palpitations, near-fainting or fainting, or been unable to stop during or after dhikr. (2) Ask about heart or lung conditions, past fainting, seizures, pregnancy, low blood sugar, dehydration (for example on fasting days) and panic disorder. (3) Ask the client to discuss any positive answer with their doctor before vigorous participation. Do not give medical advice yourself, and do not advise on medicines. (4) Record the referral and follow it up. [source: Terveyskylä; synthesis]
  • Example language (illustrative). "Some people feel dizzy or tingly, or even faint, during very energetic chanting. Has anything like that happened to you? If it has, I'd like you to talk it over with your doctor so you can take part safely."
  • Watch for. Whether the client minimises symptoms as "just the state". It is working when the client has seen the doctor, knows their own warning signs, and has a plan agreed with the teacher (4.4).
  • Not given here. No breathing patterns, counts, rhythms or tempo targets, whether to increase or to limit practice. Pacing within the gathering is a matter for the client's shaykh and doctor.

4.4 Client-owned participation and recovery plan

  • Purpose and when. After screening (4.3), or after an adverse episode. The plan helps the client take part in a way they and their teacher accept, without the therapist redesigning the ritual. [synthesis]
  • Steps. (1) Ask what the tradition already allows. For example, can someone sit down, step to the edge of the circle, join only the seated recitation, or leave quietly? The client may need to ask the shaykh. (2) Help the client name early personal warning signs, such as light-headedness, tingling, a racing heart, or fear rising beyond the usual intensity. (3) Agree in advance what they will do: step back, sit, drink water, or let a trusted companion know. (4) Plan a period of rest and grounding after intense gatherings, with time to re-orient before driving or being alone. (5) Review after the next gathering. [synthesis]
  • Example language (illustrative). "In your circle, what does someone normally do if they need to sit down? Would you feel comfortable asking your shaykh how he'd like you to handle that?"
  • Watch for. Shame about stepping back, and fear that it means spiritual failure. It is working when the client uses the plan without distress, and episodes become rarer or stop.

4.5 Processing ecstatic and intense experiences

  • Purpose and when. When the client brings states from gatherings: weeping, laughter, trembling, a sense of dissolving, insensitivity to pain, visions or presence experiences. Such states appear in ethnographic accounts of standing dhikr. [source: Poche]
  • Steps. (1) Invite a description in the client's own words. (2) Ask how their tradition and teacher understand it, for example as a hal (passing state) or as a test. (3) Ask about its after-effects on sleep, mood, work and relationships. (4) Separate meaning, which belongs to the client and the tradition, from function and distress, which are clinical concerns. (5) Help them integrate it through narrative, values, and continuity with daily life and prayer. [synthesis; source: Lindahl et al. 2017, PLOS ONE, on the range of valence and impairment]
  • Example language (illustrative). "How did your shaykh speak about what happened to you? And how have you been sleeping and coping since?"
  • Watch for. Experiences that persist outside gatherings, intrude, or impair functioning. Move to 4.6 if they do.

4.6 Responding to challenging or adverse experiences

  • Purpose and when. When a client reports distress linked to practice. Research on contemplative practices, mainly meditation, describes challenging experiences across cognitive, perceptual, affective, somatic, conative, sense-of-self and social domains, from transient to severe and enduring. A systematic review found adverse events reported in about two-thirds of studies, with a pooled prevalence of about 8%. Anxiety, depression and cognitive anomalies were the most common, and events occurred in people without prior mental health history. Neither source studied Qadiri dhikr specifically, so applying them here is an inference. [source: Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica; uncertain: extrapolated]
  • Steps. (1) Assess safety: suicidality, psychosis, mania, dissociation, panic, and medical causes (route to the doctor). (2) Normalise without dismissing: challenging experiences are documented in contemplative practice. (3) With the client's agreement, consider reducing intensity, for example joining only seated or quieter parts, or attending less often, decided with the teacher. (4) Use grounding: orientation to the room, feet on the floor, naming objects, ordinary activity. (5) Coordinate with the shaykh if the client wishes. (6) Refer to specialists if needed. Cheetah House offers consultations and training on meditation-related difficulties. [source: Cheetah House; Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica; synthesis]
  • Example language (illustrative). "Difficult experiences can happen in intense practice, and they're taken seriously both by researchers and by many teachers. Let's look at what would help you feel steadier, and whether you'd like to talk with your shaykh about the pace for now."
  • Watch for. Escalating insomnia, loss of reality-testing, mood elevation, or dissociation between gatherings. These call for urgent psychiatric assessment.

4.7 Telling spiritual experience apart from psychiatric illness

  • Purpose and when. When intense experiences raise the question of psychosis, mania, depression or dissociation, or when the client or their family fears they are "losing their mind" or being spiritually afflicted. [synthesis]
  • Steps. (1) Check fit with the culture: do co-religionists and the teacher recognise the experience as part of the path? (2) Check whether it stays within the gathering or spreads into daily life. (3) Check function: sleep, self-care, work, relationships, risk. (4) Look for features of illness: persistent fixed false beliefs beyond the shared framework, disorganisation, sustained mood elevation with reduced need for sleep, prolonged derealisation or amnesia. (5) Where the main issue is a religious or spiritual problem without disorder, DSM-5-TR lists a religious or spiritual problem as a focus of clinical attention, code Z65.8. (6) Where illness is present, treat it or refer, while keeping respect for the practice. [synthesis]
  • Example language (illustrative). "I'm not here to judge whether this was a spiritual state. I do want to make sure your sleep and mood are okay, because that's something I can help with."
  • Watch for. Two errors: pathologising normative ecstatic states, and missing early psychosis or mania because it looks religious.

4.8 Trauma-sensitive adaptation

  • Purpose and when. For clients with trauma histories, including war, deportation and persecution in some communities (see the Chechen history in Brightwell), or abuse in religious settings. Loud collective chanting, darkness, drums, crowding, physical contact and a powerful leader can trigger trauma responses. [source: Brightwell; synthesis]
  • Steps. (1) Identify triggers in the setting. (2) Plan choices that stay within what the tradition allows: where to stand or sit, near an exit, alongside a trusted person, joining quieter parts first. (3) Teach grounding to use if the client feels overwhelmed. (4) Respect the client's choice to step away for a period without treating it as giving up their faith. Trauma-sensitive mindfulness principles, such as choice, titration and attention to arousal, apply by analogy (Treleaven 2018 [uncertain: not verified]). [synthesis]
  • Example language (illustrative). "You've said the drums sometimes bring back that night. What would help you feel more in control: where you stand, who's beside you, or joining a bit later?"
  • Watch for. Flashbacks, numbing or dissociation during or after gatherings. It is working when the client feels in charge of their participation.

4.9 Dhikr as a client-chosen resource in spiritually integrated therapy

  • Purpose and when. When the client wants to draw on dhikr and community for coping, recovery or meaning. Clinicians are encouraged to centre the client's existing beliefs and supportive faith communities. In some Qadiri settings, such as TQN Suryalaya's Inabah programme, dhikr is itself framed as healing. That framing belongs to the tradition. [source: Abrams 2023; Hayat 2023]
  • Steps. (1) Explore how the gathering and community support the client, for example in sobriety, grief or loneliness. (2) Link therapy goals to the client's values as they state them. (3) Encourage contact with the community, while keeping the practice under the teacher's guidance. (4) Do not prescribe dhikr as a technique or set its form, intensity or frequency. [synthesis]
  • Example language (illustrative). "You said you feel most like yourself after the gathering. How could we build on that during the week?"
  • Watch for. Dhikr used to avoid other needed treatment, or overused to escape painful feelings. Both are worth exploring gently.

4.10 Teacher power, coercive control, leaving and religious trauma

  • Purpose and when. When the client describes pressure, exploitation, isolation or fear around the teacher or circle, or is leaving the order. Independent investigations of misconduct specific to a Qadiri teacher: none found in the sources consulted. [synthesis]
  • Steps. (1) Explore what the relationship involves: obedience, money, time, sexual boundaries, punishment for questioning, and control of contact with outsiders. (2) Name concerning patterns descriptively, without labelling the group. (3) Support the client's autonomy and their safety planning. (4) If the client is leaving, attend to grief, loss of community and identity, and religious trauma. Help the client keep the parts of their faith they want to keep. (5) Follow safeguarding and reporting duties where there is abuse or risk to children. [synthesis]
  • Example language (illustrative). "It sounds like questioning feels dangerous there. What happens when someone says no?"
  • Watch for. Fear of spiritual punishment for speaking, and ambivalence. Go at the client's pace.

4.11 Scrupulosity around recitation and practice

  • Purpose and when. When the client repeats formulas out of fear they were said wrongly, doubts the validity of their intention or purity, or feels compelled to keep doing dhikr to relieve anxiety. OCD can drive rituals that mimic religious behaviour, such as excessive prayer. In the IOCDF's account, healthy practice fits the person's beliefs and OCD runs against them. [source: IOCDF]
  • Steps. (1) Assess for OCD, including intrusive doubts, compulsive repetition and reassurance seeking. (2) Explain that OCD is a clinical problem, not a spiritual failing. (3) Use ERP adapted to faith: exposure targets are chosen so they do not require the client to oppose their faith. (4) With consent, consult a religious authority the client trusts about the actual requirements of practice. The IOCDF notes that some clinicians work with clergy. [source: IOCDF]
  • Example language (illustrative). "It sounds like the worry about saying it wrong is pushing you to repeat it again and again. Would it help to ask your shaykh or imam what is actually required, so we can tell your faith apart from the OCD?"
  • Watch for. Reassurance-seeking from the therapist or the teacher becoming a compulsion in itself.

4.12 Collaboration with the shaykh, imam or chaplain, and ethical boundaries

  • Purpose and when. When the client wishes, for example for safety planning, to clarify requirements, or during a crisis. [source: Abrams 2023; APA Ethics Code]
  • Steps. (1) Get written consent specifying what will be shared. (2) Explain your role and limits. (3) Ask what the tradition permits, for example sitting out for health reasons. (4) Avoid multiple relationships: don't attend the client's gatherings, join the order or accept a religious role. (5) Disclose your own faith or non-faith briefly, and only when it helps the client. (6) Seek consultation or training where your competence is limited (Standard 2.01(b); Vieten et al. 2013 competencies). [source: APA Ethics Code 2.01(b), 3.05, 3.10; Vieten et al. 2013; Abrams 2023]
  • Example language (illustrative). "With your permission, I could speak with your shaykh about what you've agreed for the gatherings. Which parts would you be comfortable with me sharing?"
  • Watch for. Conflicting guidance between teacher and clinician. Resolve it with the client at the centre.

5. Handling problems

All guidance in this section is the guide's own synthesis, except where a source is tagged.

  • Client collapses or nearly faints at gatherings but insists it is a spiritual state. Respect the meaning, and separate it from safety: "Both can be true, and your body still needs checking." Arrange medical review (new or unusual episodes warrant it [source: Terveyskylä]). Ask the client to raise sitting out with their shaykh. Never set breathing or tempo rules yourself. [synthesis]
  • Panic attacks that began in dhikr and now occur elsewhere. Get a medical review first. Then use standard panic treatment, explaining that bodily sensations from vigorous chanting can trigger fear cycles. Agree any return to gatherings with the client and teacher. Interoceptive exposure involving overbreathing is a clinical procedure; do it only within an established protocol and with medical clearance, never as part of the dhikr. [synthesis]
  • Fear of spiritual consequences if they reduce participation. Explore the fear without arguing theology. Suggest the client asks their teacher what the tradition permits during illness. [synthesis]
  • Stuck: experiences keep recurring and the client wants to stop but feels unable to. Assess for compulsion (4.11), dependence on the group for regulation, or coercion (4.10). Widen sources of support. [synthesis]
  • Rupture: the client feels the therapist pathologised their faith. Acknowledge it directly, repair, and restate that the client defines their faith. Ask what felt dismissive. [synthesis; the harm of dismissing religion is noted by Abrams 2023]
  • Therapist and client share the faith, or clash over it. Monitor countertransference, consult a colleague, and keep self-disclosure brief and client-focused. [source: Abrams 2023]
  • Family or community conflict, for example a family that opposes Sufi practice, a family that insists on it, or community politics around the zikr. Explore the client's own position. In some communities the zikr is tied to national identity and political history, so pressure may be social as well as religious. [source: Brightwell; synthesis]
  • Non-adherence to the safety plan or medical referral. Explore the obstacles: shame, cost, distrust of doctors. Problem-solve, and if the risk is serious, say so plainly. [synthesis]
  • Minors. If a child or adolescent takes part in vigorous gatherings, involve parents or guardians. Attend to the young person's own assent and any medical issues, and follow local safeguarding procedures if there is pressure, harm or exhaustion. [synthesis]
  • Possession or affliction frames. If the client or family reads symptoms as spiritual affliction, see the pointer to XI 049 (ruqya). Assess for illness respectfully, and collaborate with religious authorities the family trusts. [synthesis]
  • Gaps in the sources. No clinical study of adverse effects specific to Qadiri vocal dhikr appears in the sources consulted. The guidance on dizziness, fainting and hyperventilation applies general physiology to this setting and is marked as inference. [uncertain]

Sources

Web sources:

Also cited:

  • Treleaven, D. (2018). Trauma-Sensitive Mindfulness. [uncertain: not verified]
  • American Psychiatric Association. DSM-5-TR: the Cultural Formulation Interview and the code for a religious or spiritual problem, Z65.8
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