Ramadan is a wonderful time of year, but it doesn’t come without difficulties. It’s the purpose of the spiritual revival associated with the month. As many scholars put it, “We starve our bodies to feed our souls.” How beautiful, fulfilling, and rewarding this month can be is dependent on the efforts put forth day in and day out despite wondering how we’ll make it through the day without the things we’re used to: sleep, coffee, food, and yes, non-Muslim friends and coworkers, “not even water.” Many of us spend our days wondering if we’re going to keep all of our #RamadanResolutions and what’s on the menu for iftar while others struggle with the decision to work towards strengthening their relationship with Allah (swt) by fasting without undermining or disrupting the progress they’ve made in regulating their mental illness(es).
It shouldn’t come as a surprise to anyone that these long periods of abstaining from food and drink have a significant impact on people who are otherwise relatively healthy. Increased irritability, sensitivity to light and sound, struggles concentrating during working hours, and lack of sleep are just some of the symptoms people experience. For those who live with illnesses, that struggle can sometimes be multiplied depending on the severity of the toll it takes on their overall health and well being. Most of us have come across someone who does not fast due to medication or dietary requirements that would be negatively impacted by fasting, especially in places with 12+ hour fasts. For people with mental illnesses, being of sound mind and body can often be dependent on a consistent medication regimen which, for some medicines, cannot be taken on an empty stomach. Even for those who do not take medications to regulate their mental illness, a consistent schedule for sleep and meal intake is part of what helps regulate their disorder(s) in order to minimize their symptoms and the impact they have on their everyday lives. However, because of the stigma around mental illnesses in general, it can be difficult for individuals to know whether or not they fall in the group of people who are exempt from fasting, so they do so out of fear of being ostracized by their family and the community.
We’re often told that during Ramadan, the gates of hell are closed and the devils are chained. Unfortunately, statements like these, while not made with ill-intentions, can make it that much harder for those with mental illnesses to reconcile their inner demons – which find an empty playground in the minds of those who have a hard enough time fighting them off when they are well fed, rested, and medicated (if need be). Some effects people experience as a result of fasting are intensified for those with living with mental illnesses. Symptoms such as lethargy, restlessness, inability to focus, negative and overwhelming thoughts, and irritability, for example, already pose roadblocks to upholding their everyday expectations. The struggle of a mental illness is an ever present one. It doesn’t disappear along with the “devil’s whisper” when Ramadan arrives to provide us with a month of devotion to the Quran and worship of Allah (swt). One might argue that it could be easier to regulate an illness without the devil playing tricks on the mind and capitalizing on those symptoms to steer a person away from following the guidance of Allah (swt), but the exhaustion, sleep deprivation, and limited food intake does play a role in compounding the symptoms listed above, among many others.
…they do so out of fear of being ostracized by their family and the community
According to the National Alliance on Mental Illness (NAMI), approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences some form of mental illness in a given year. Approximately 1 in 25 adults in the U.S.—9.8 million, or 4.0%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities. So, if 1 in 25 people have a mental illness that can impact or interfere completely with major life activities, it’s safe to assume that includes fasting during Ramadan. However, since there is such a wide range of mental illnesses, and individuals have their own set of experiences and struggles, it can be challenging to understand what that means for the person with the illness.
Listed below are a few categories of major mental illnesses which run a risk of having symptoms impacted or exacerbated by Ramadan rituals. This provides a broad scope of understanding for the benefit of supporting people we know who endure this added level of struggle during this blessed month.
Anxiety disorders cause people to experience distress that comes from a place of fear and apprehension. Symptoms of anxiety disorders include panic attacks, nightmares, obsessive, racing, or compulsive thoughts, and/or physical symptoms such as dizziness, sweating, upset stomach, headaches/migraines.
Commonly diagnosed anxiety disorders include:
- Panic disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Social phobia (social anxiety disorder)
- Generalized anxiety disorder (GAD)
Symptoms of anxiety can increase during fasts, making it stressful to perform acts of worship such as focusing while reading and reciting Quran and during prayers. It can also be difficult to attend prayers in congregation at local places of worship due to social anxiety. And not being able to do these things as continuously advised during Ramadan can cause feelings of low self-image and worthlessness to increase.
Mood disorders include illnesses that are marked by serious changes in mood such as sustained and severe symptoms of sadness, irritability, inescapable low mood, loss of interest in previously enjoyed activities, and/or extreme highs and lows when it comes to mood and energy levels, to name a few.
Most common mood disorders:
- Major Depression
- Bipolar Disorder
Depression can make it hard to find the motivation to perform extra acts of worship during Ramadan for those who already find it difficult to perform general daily tasks and obligations. Physical and emotional exhaustion are also symptoms of depression, so sleeping a lot could be caused by a combination of the illness and fasting and not because one is attempting to “sleep away the fast.”
Eating disorders involve obsessive and distressing thought and behavior patterns in regards to food intake and consumption. The goal of eating disorders is not always to lose weight, though that is a commonly held belief due to symptoms including reduction of food intake, overeating, feelings of depression or distress, obsessive thoughts about food, abnormal eating patterns, and/or concern of weight, body shape, poor self-image.
Common types of eating disorders:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
With eating disorders, the risk of fasting during Ramadan could increase the behaviors that an individual may be engaging in to support the disordered thought patterns. For those recovering from eating disorders, participation in Ramadan can cause a relapse or setbacks to the progress made to treat the illness.
With only about half of the people who have identified themselves as living with a mental illness seeking treatment, along with the taboo and shame associated with them in general, the struggle of Ramadan for them is beyond real. Part of Ramadan is deepening the bond of togetherness within the Muslim community. Remember to include those living with mental illnesses in your duaas and reach out to anyone you are able to lend a helping hand during Ramadan and beyond. Having a positive and strong support system can provide opportunities for individuals who are otherwise struggling to participate in Ramadan altogether. Invite others to your iftar gatherings, have a masjid carpool for Taraweeh, go out for a late night snack after Taraweeh, or do all of the above. And then maintain those relationships after Ramadan. After all, one of the goals of the month is to implement all of the good deeds we carry out and the positive qualities we develop in the days and months to follow.