Mental Illness and Ramadan

“Yahya, I can see the angels.”

Hearing that, on the fifth night of Taraweeh, by a prominent member of my community, was astonishing. The brother was a gentle soul, always helpful, studious and had taught himself to read with Tajweed and always volunteered around the Masjid. He had a wife and a couple of beautiful children, whom he loved and adored. His voice, however, that night, was a bit louder, laughter more intense and moments of quietude unsettling. By the tenth night, the brother was no longer attending the Tarweeh. It then dawned on me that something preventable, not spiritually supernatural, had occurred.

Although mental health care has improved significantly over the last decades, many Muslims still choose not to seek treatment or quit prematurely. Stigma is perhaps the most significant cause of this. Simply, a person is made to feel that they are disqualified from full social acceptance.

Public stigma, in particular within ones’ community, is the prejudice and discrimination that blocks individuals’ access to spiritual fulfillment, avenues to employment, enriching educational opportunities, health care, and secure housing. Public stigma occurs when members of the public endorse stereotypes about mental illness and act on the basis of these stereotypes.

Anas ibn Malik narrates that: A woman, who had a defect in her brain, said: Allah’s Messenger ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him), I want to talk to you. He ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him) said: Mother of so and so, choose on which side of the road you would like to stand and talk, so that I may fulfill your need. He stood with her on the sidewalk until she spoke to her heart’s content. Muslim 1081

To me, one of the greatest injustice is that a person living with manageable mental illness begins to have a self-induced stigma. Self-stigma occurs when individuals belonging to a stigmatized group internalize public prejudice and direct it toward themselves. Suffering in silence, many of those needing our support, isolate themselves and find little to no help from the broader community. This self-stigma occurs when they think that everyone around them knows of their condition and will not treat them, as “normal” people should.

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The Challenge of Ramadan

With the arrival of Ramadan a sharp increase of public cases of imbalance within our community begin to emerge, whereby, previously manageable psychiatric symptoms become exacerbation.

During Ramadan, even persons without mental disorders have reported irritability, decreased sleep, difficulty concentrating, and anxiety.[1] In patients with bipolar disorder, one study described a high rate (45%) of breakthrough manic or depressive episodes during Ramadan, despite stable lithium levels.[2] Fasting-related changes in circadian rhythms and insomnia are thought to contribute to psychiatric symptom exacerbation.

For many, Ramadan poses the challenge of the inability to take medications during the day, dehydration and other somatic changes that necessitate dosing modification changes. Doctors must be consulted and informed of the commencement date of Ramadan and they are best placed in deciding whether one is capable of the fast or not. This is particularly important in localities where the fast will exceed twelve hours.

Making a unilateral decision to fast, without doctor approval is irresponsible and religiously unacceptable. Medicine and healing are Islamic functions. There is no shame or sin in not fasting due to medical prohibition. Allah, the Al-Mighty, Knows His creation best and it is He who said:

“Ramadan is the (month) in which was sent down the Qur’an, as a guide to mankind, also clear (Signs) for guidance and judgment (Between right and wrong). So every one of you who is present (at his home) during that month should spend it in fasting, but if any one is ill, or on a journey, the prescribed period (Should be made up) by days later. Allah intends every facility for you; He does not want to put to difficulties. (He wants you) to complete the prescribed period, and to glorify Him in that He has guided you; and perchance ye shall be grateful.” Al-Baqarah 2:185

Commentators explain that Allah simply refers to illness in its broadest sense. It

Many Ahadith (traditions of Prophet Muhammad ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him)) encourage the Muslims to seek medical treatment and as a prevention of ailment.

Abu Hurayrah narrates that the Prophet ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him) said:

“There is no disease that Allah has created, except that He also has created its remedy.”

Bukhari 7.582

Usamah ibn Shuraik narrated:

“… ‘O Allah’s Messenger! Should we seek medical treatment for our illnesses?’ He replied: ‘Yes, you should seek medical treatment, because Allah, the Exalted, has let no disease exist without providing for its cure, except for one ailment, namely, old age.’” Tirmidhi, Accepted

In fact, taking proper care of one’s health is considered by the Prophet Muhammad ṣallallāhu 'alayhi wa sallam (peace and blessings of Allāh be upon him) to be the right of the body. Bukhari as-Sawm 55, an-Nikah 89, Muslim as-siyyam 183, 193, Nisai

The Prophet not only instructed sick people to take medicine, but he himself invited expert physicians for this purpose, as Imam As-Suyuti and Ibnul Qayyim both relay in their, Medicine of the Prophet.

Should I fast Ramadan, or Not?

Illness, of course, is a relative term. In the Shari’ah there are two scenarios:

(i)               The illness or the circumstances it causes, is one from which there is hope of recovery from. The fast should be suspended until a different period in time, when the illness has subside or the essential medical treatment has been altered. The individual is required to make up the missed days, or entire month, if need be when they are cleared medically to do so.

(ii)             The illness is one from which there is no prognosis of gainful recovery wherein fasting could be sustained without harm. In this case, one is not obliged to make up the fast; rather they should feed one poor person for each day of Ramadan.

The decision as to which one of the two scenarios one finds themselves in is to be made with the direct advice of the treating medical doctor and a frank discussion with a trusted Imam familiar with the patient.

I pray that Allah gives strength to all who are suffering and that their ailment is cause for their admission to Allah’s Mercy and Eternal Jannah.

I pray for those supporting those suffering with illness. I ask the Al-Mighty to strengthen them, honor them and grant them patience and wisdom.

 

 

 

[1] Toda M, Morimoto K. Ramadan fasting—effect on healthy Muslims. Soc Beh Pers 2004;32:13-18.

[2] Kadri N, Mouchtaq N, Hakkou F, Moussaoui D. Relapses in bipolar patients: changes in social rhythm? Int J Neuropsychopharmacol 2000;3:45-9.

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29 responses to “Mental Illness and Ramadan”

  1. OJ says:

    Where is that hadith in Sahih Muslim? I looked up 1081, but it’s not there. Could you clarify which book it is in? Just curious, I have never seen it before and would like to read the arabic

  2. […] mental disorders have reported irritability, decreased sleep, difficulty concentrating, and anxiety.[1] In patients with bipolar disorder, one study described a high rate (45%) of breakthrough manic or […]

  3. R says:

    Assalamu alaikum,

    Jazakallahu khair. Thank you for mentioning this. I am trying to help someone to overcome this stigma about mental health so they seek medical treatment. The family has lived in the Middle East their entire lives, and the stigma is a very strong one. Sadly, i just don’t know if he will ever see a doctor. The symptoms have only increased over time and his family is extremely unsupportive. Please make du’a for him and all of our brothers and sisters facing this.
    May Allah reward you for your article.

  4. Maya Salam says:

    I like to thank you for raising this issue for the Muslim community. I work with mental health patients and witnessed Muslims suffering in silence without recognition by the family or community. Some even say there are no such thing as mental illness if you a true Muslim. This kind of ignorance very unhelpful to the patients and their family. There needs to be more awareness within our community to be able to support those who are in need of support. JazackAllahu khairan.
    Psychotherapy with Islamic values.

  5. Salmaan says:

    Fantastic article. Stigma is alive and well. Not just the mental health stigma but also the religious stigma aka not being pious enough. Thank you for writing this article.

    Salmaan Toor
    clincial psychologist

  6. Aswrwb, Jzkk for writing about this Ustadh. Sadly the stigma and self stigma is a huge problem within our communities. More needs to be done at a grassroots level to educate our mothers and fathers, brothers and sisters, uni and school students about mental illness and how it can be easily prevented. This article is an excellent starting point. Jzkk
    Sabrina Begum
    Mental Health First Aid Instructor

  7. As salaamu alaikum
    Jazakallah Khair akhi Yahya for shedding light on this topic.

    Wr are conducting research in our Toronto-based Hijamah clinic, to see if hijamah can assist the body in reaching homeostasis of the neurochemicals and hormones that contribute to mental illnesses.

    We alhumdulillah have seen improvements in patients who experience social anxiety, attention deficit, and mild depression.

    Dear reader: If you are in or know someone in the Toronto area suffering bipolar or related challenges, we would be humbled if you could provide our reference and assist in gatgering case studies in this area. JazakumAllah khair – info hijamahworks.com

  8. Shamsun says:

    Wonderful article

  9. Kulsoom says:

    Really good article. There is a definite need to raise awareness in the Muslim community about mental illness. Espcially appreciate the link with Ramadan. It’s something so obvious I haven’t considered.

  10. Sr Jenni says:

    As salaam alaikom. The link I want to share is a point in a lecture about layat’l qadr (forgive me for misspellings, I am a new muslima), when it mentions about the number of angels coming down is almost unimaginable. Yes, there is such a thing as mental illness – but also we mustn’t rule out someone else’s reality might just be a blessing we don’t understand. See link: https://youtu.be/38dgobJ_IhE?t=37m45s

    • Thank you for your comment Sr Jenni.

      The angels are from the world of the unseen. They do not appear to us in their angelic form.

      The Quran mentions in Chapter 19 the visit of Jibreel to Mary in the form of a man. Also to Abraham & Lot they appeared,but were NOT known to be angels by those pious souls until informed.
      So it is not correct to accept someone claiming that they see or hear angels.
      That claim is either delusion or dishonesty.

  11. Sister says:

    Asalamu Alaykum,

    I suffer from chronic anxiety issues, OCD, and depression, and I sincerely appreciate that you took the time to write this article in order to shed light on such a pertinent issue which impacts all humans, be they Muslim or non-Muslim. It took me years and years of suffering, denial, and failed experiences before I became open to taking medication to help treat my symptoms.

    Many Muslims attribute a lack of piety, black magic, evil eye, or jinn as the causes of our mental maladies. However, the truth is that mental ailments are just as real as physical ones, and they too, have viable treatment options like their physical counterparts.

    Articles like these and people like yourself are doing a great service to our community by shedding light on the importance of seeking medicinal treatment for our mental illnesses.

    May Allah reward you with a place in Jannah for taking the time to write this, and I pray that it reaches those who are in dire need of a proper Islamic view.

    Barak Allahu Feekum.

  12. Nur says:

    Assalamualaikum,
    This article is timely.. i am on my 2nd week of antidepressant for my depression, obsessive disorder and anxiety disorder. It has been very trying time for me and my husband as we struggle with my illness and other issues..
    However, even when I had to take medication, I see this as Allah’s way of testing me, especially in Ramadhan.. I am much more aware of myself in terms of getting close to Him.. alhamdulillah… tho I am still afraid what my family would think of me.. I find comfort in my prayer to Him..
    I know I am not broken…

  13. nimra says:

    Thank you very much, there was a dire need to discuss such a thing. JazakaAllah!

  14. Brother says:

    Salaam, thank you for sharing and writing this. My experience is that there are many Muslims suffering from common and treatable mental illnesses like depression, anxiety, OCD, etc. There is no need to suffer in silence; there are plenty of therapists and treatment options out there, including both cognitive therapy as well as medication. Please, if you think you may be suffering from mental illness, do not hesitate to visit a trusted psychologist or psychiatrist in your area (but do your research before deciding on one to work with – finding the right therapist is a big part of the recovery process, as this person will work with you and get to know you very intimately). You want to find someone you are comfortable with.

  15. aneesa says:

    I cannot express how grateful i am for this article!

  16. Nora says:

    As someone who’s mother had a mental illness, I find this article informative and helpful in letting others no that these people are not alone. My family comes from a culture that frowns upon mental illness and tries to keep it a secret from the world because ‘what will people say?’ It was very difficult and scary for a young child to see a mother go through such ordeals and at the same time having to keep a secret because it was shameful. I wish there was an accepting community of such illnesses and cases just like any other disease. I hated dealing with these circumstances and I always would wonder why can’t I have a normal mom? Anyhow, coming from first hand experience, it’s painful for the loved ones of the ill, I can only wonder how the ill persons themselves feel

  17. Sister says:

    Jazakumullahu khairun sheikh for bringing light to this very important topic that is often neglected in islamic circles. Another point that I wanted to add was that Ramadan in and of itself can also often serve as a trigger for many Muslims that have mental health issues (even in those individuals that may not be fasting). This is a commonly known occurrence for nonMuslims during nonMuslims holidays, example Christmas etc.

  18. umair says:

    I did not fast as i am recovering from anoerxia.
    not only is it a mental challenge, my body cannot, NOT eat for long
    may Allah forgive me

  19. Mujahidah says:

    Assalamualaikum wrh. Very helpful article for me. I just had panic attacks last two months but alhamdulillah I took no time to seek a psychiatrist for help. These attacks lead to anxiety disorder and agarophobia. Although my doctor told me it’s just a mild one, I still find it distracting especially when I am in public. I am still on medication and will only stop after 6 months. Ramadan is coming soon, please make dua that I can survive during fasting and have strong patience with this sickness. I pray that Allah will cure this sickness and I’ll pray the same duas for everyone. Stay strong and I know we will gain a lot of benefits from this test at the end of the day. Smile always and stay positive insyaAllah.

    P/s: if anyone knows any remedies for this kind of sickness, please drop a comment, I’d love to try. My Allah reward you. Jzk.

    • Fatimah says:

      Sister I have schizophrenia, and I am being treated with hijama. I used to hear voices both inside of my head and outside my body. I had anxiety attacks, depression, visual and auditory hallucinations. But alhamdulilah, I feel so much better now. I take my medicines and I do hijama (cupping therapy). Give hijama a chance. The prophet Muhammad peace be upon him instructed us to eat honey and to get treated with hijama. The virtues of hijama are so many, google it. May Allah heal us all and may He reward us for our patience.

      • Fatimah says:

        Chiquita is right. Pharmaceutical drugs have awful side effects. I started shaking, and half of my face got paralyzed. Hijama on the other hand does not have side effects. In sha Allah soon I will just use hijama and quit psychiatric drugs completely!

  20. Chiquita says:

    Bismillah…as someone who spent 11 years wading through the mental health industry and who has successfully made a full recovery by the grace of Allah SWT, I can tell you that mental health professionals are not equipped or trained to work with Muslims who have mental illness. Not even the Muslim therapists. They not only re-victimize and further stigmatize Muslim patients but they coerce them into taking expensive pharmaceutical products that are very harsh on the body. These products do little to reduce symptoms and are not even tested for long-term use before being approved by the FDA. I suffered reproductive and neurological damage from psychotropic drugs. I spent three years running hospital based support groups for the mentally ill and can say with confidence that the current system does not work. There is a dire need for culturally competent, community-driven solutions. Imams need to be trained to appropriately intervene in the lives of mentally ill Muslims. Every masjid should have a support group for members with mental health challenges. Families and friends need greater assistance in dealing with their loved ones and navigating complex health systems. Community members need to pool their resources to give charity to those struggling to pay for mental health treatment. And consumers need to be empowered. Contrary to popular belief, a person doesn’t have to experience a mental illness for forever. With patience, perseverance and reliance on Allah, one can recover just like I did alhamdullilah.

    • Repenting Muslima says:

      I agree with you Chiquita so much. I am a sufferer who has jumped from one psychiatrist to another. They either make me feel like I should be ashamed and never mention my illnesses to anyone or they give me such heavy medication for years that I forget myself sometimes and all these chemicals alter behavior and motor skills. It is very scary. I was diagnosed at 17 and now 20 years later, due to poorly educated doctors I have become worse. I even travele overseas for treatment where I did gain some insight into my illnesses but I hit a plateau and stopped improving. I can’t stay in the same job for long because I fall so sick from being stressed out at work that most jobs land me in the ER. Every day I fear God’s wrath to an obsessive extent because I take so many pills throughout the day hence I cannot fast. The medications have rendered me diabetic. And severe panic attacks leave me paralyzed for days where I miss my prayers. And to top this off, I have sinned through words as well as action and the remorse I feel directly afterwards is almost too awful to bear. All I do is feel guilty and pray for God’s forgiveness day and night. Thank you for your time in reading my comment. Salam.

      • Fatimah says:

        May Allah forgive us all and heal us. May Allah bless us, protect us and guide us all. May Allah provide for us and help us every second of our lives. Oh Allah, have mercy upon us. Ameen!

  21. Muhammad Siddique says:

    JazakAllah Khair for this article. I pray it reaches many and may Allah (swt) help them and guide them. I was most eagerly looking for something written on this topic that made sense and this article sure does.

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