Ramadan and the impact on those with mental illnesses.
For many of us, Ramadan is a month of peace, solitude and reflection. However, for those who are unable to fast during this month it can feel very isolating and shame triggering. In Islam fasting is prescribed upon all Muslims around the time they hit puberty. Those who are pregnant, nursing, on their periods or elderly are exempt from fasting. Being too unwell, where it is detrimental for a person to fast, is also an exemption. As are those embarking on a journey, as "Allah does not burden a soul beyond that it can bear ", Surah Baqarah Verse 286. Muslims who are exempt from fasting do not make the decision in haste. They are encouraged to seek advice from their Doctor and local Imams. Many of us know of someone who is unable to observe Ramadan and feel 'sorry' for them, as Muslims believe that Ramadan is the month of blessings, mercy and forgiveness. Those who are unable to fast miss out on its virtues. People tend to hold a lot more acceptance, compassion and empathy for those who present a physical illness or obstacle preventing them from fasting. Comforting advice such as "Allah has given you an exemption because you are carrying a child. A healthy pregnancy is important", can be heard being offered to those carrying children. For those who are physically ill, "you have to listen to your body" and "Allah doesn't want fasting to be detrimental to you" are often said. These reassurances are offered to the person who is unable to fast, to help them feel better about not taking part. What about those of us who live with mental health illnesses? Often we are so willing to accept a person with physical, noticeable illnesses whom are exempt from fasting, that we discount the challenges of Muslims struggling during this month, with their mental health. Muslims with eating disorders particularly find Ramadan difficult. Mental health illnesses being stigmatised, means that often families and friends may not be aware of the person suffering with such disorders. Therefore, feeling completely alone and isolated with their challenges. The person suffering from an eating disorder may be left feeling conflicted with the desire to fast and the fears of their eating disorder being triggered. They are torn between taking part and also the anxieties around a relapse of their eating disorder. Along with eating disorders, many Muslims find it difficult to also manage other mental health illnesses during Ramadan. Those who suffer from Bipolar disorder are particularly at risk of experiencing a manic or depressive episode whilst fasting. A staggering 45% reported this in a study conducted by The Journal of World Psychiatry in 2014. The onset of such episodes can be caused by the change in times that medication is consumed, as well as changes to sleep patterns. In Ramadan Muslims are requires to wake before sunrise for their suhoor (breakfast to nourish the body before fasting for the day) and returning to sleep after fajr (prayer at sunrise). Although this sets up the body with fuel for the day, it poses challenges for those who are unable to function well without a certain amount of sleep. Sleep disturbance is a big factor in the triggering of a manic or depressive episode. Another contributing factor to increasing symptoms in Bipolar disorder during Ramadan, is falling into the trap of feasting on unhealthy foods for iftaar (meal to break one's fast). Many of us become caught up in lavish meals consisting of fried foods and high calorific desserts. These are all guilty of increasing the symptoms of Bipolar.
There are many reasons why a Muslims may not be able to fast during Ramadan but one of the reasons that is the most difficult for others to understand is Mental Health. Those who suffer from disorders which make it difficult for them to fast feel so much shame and guilt due to not being able to partake. They feel worse when 1) someone asks them if they are fasting and 2) when someone asks them why they are not fasting. Please be mindful of such questions as they often do more harm than good and work in adding further shame to the way a person feels when they are not able to partake. Ramadan is a month of spiritual detox. This means that as well as refraining from food and water during fasting hours, we must also refrain from sinning in general as it counteracts the rewards of the fasting. Muslims are encouraged to speak less and dedicate their tongues to reciting the Quran, pondering upon its meaning and engaging in dhikr (praising God). There is absolutely no need for us to ask others if they are fasting or not. I have said this before in regards to fertility and other triggering issues, mind your damn business folks. For those brothers and sisters who are unable to fast during the month here are a few suggestions of how to reap the rewards of this month and embrace the unity; 1) Give charity- The best charity is that given in Ramadan"- Tirmidhi. 2) Read Quran in Arabic and the language in which you feel you can best understand it. Ponder upon its meanings. Reflect on its lessons. Ramadan was the month Allah sent the first revelation of the Quran, what better month is there to strengthen our relationship with it? 3) Increase the voluntary prayers. Along with the night prayers that come with fasting (Taraweeh), it is also a great month to get into the habit of practicing the sunnah and nafl prayers that perhaps we abandon during the rest of the year. 4) This year we are unable, but usually I would suggest to break your fast with family and friends. There is a great amount of love and joy in being able to do this and spending time with family is a blessing in itself. 5) Make food for a non-Muslim neighbour or friend so that they too can feel the unity of the special month, also. 6) Keep a Ramadan journal- This will help to track your spiritual development and enable you to express any feelings surrounding not being able to fast. 7) Check in on others who are also unable to fast. If you are feeling lonely or isolated, chance are they may be too! 8) Talk to Allah. Nobody will truly understand your struggle except him. Nobody will see your intentions except him. Nobody will ease you of your struggles except him. Ask him to relieve you of your condition, grant you shifa (wellness, recovery) and grant you the ability to become healthy enough to fast (Ameen). Please remember that your Mental Health is not a reflection of your faith and you do not have to compromise your mental health to reap the rewards of fasting. Allah is Ar- Rahman (The Beneficent) and Ar-Raheem (The most Merciful). The same Lord that gifted us a month of mercy, also has mercy on you and your struggles. As "…Allah intends for you ease and does not intend for you hardship…" Surah Al- Baqarah (2:185).
اَللّهُمَّ بَلِّغْنَا رَمَضَان
Allahumma ballighna Ramadan
Oh Allah, let us reach the month of Ramadan!