By Aaliyah Gohir (MWN Hub Editorial and Communications Manager)

The month of Ramadan is a special time for many – it’s a time of spirituality and unity as the Muslim community comes together to fast, however some who are not mentally fit to fast may feel pressured and obliged to do so. While it is openly addressed that those who are not physically fit, should not fast, Muslims with poor mental health are often overlooked. They do not seem to be considered unwell enough to meet the criteria that exempts them doing the fasts. This can result in them fasting and making their mental health worse, causing more harm.

The vast majority of Islamic scholars agree pregnant women, the elderly or the sick do not have to fast but seem to have little understanding of mental health...

Individuals and families with loved ones who are experiencing mental health difficulties will look to Islamic scholars for guidance. The vast majority of Islamic scholars agree pregnant women, the elderly or the sick do not have to fast (and can compensate this by feeding the poor through a charitable donation) but seem to have little understanding of mental health, thus providing the wrong advice and sometimes stating those with mental illness are not sick enough to not fast. Due to these attitudes even those who do not fast end up feeling guilty for not fasting, which can cause further anxiety and doubt as to whether they should be fasting. The change in routine, such as altered eating and sleeping patterns, can already be difficult for the average healthy person, so for those with mental health difficulties, it can possibly exacerbate any psychological symptoms.

The change in timing of meals, a change in sleep patterns and daytime fatigue during Ramadan is likely to disrupt the body’s natural circadian system. Circadian rhythms are a part of the body's internal clock running in the background to carry out essential functions and processes. One of the most important and well-known circadian rhythms is the sleep-wake cycle. The impact of fasting on the internal body clock will depend on the season in which Ramadan falls and location in the world as this determines the lengths of fasts which can last between 10 to 20 hours daily. Fasting for much longer hours and sleeping for shorter periods is likely to impact moods. Sufficient sleep, as we know, is essential for good mental health. Fasting could therefore increase the risk of mental health worsening for those already suffering from mental health conditions, especially for those who may have to also take medication at certain times because not taking medication at the prescribed intervals and going without medication for up to 18 hours at a time can affect symptoms. More information regarding medicine and fasting can be found here.

Nabila felt she was committing a sin for not fasting and felt guilty. She then sought advice from a local imam who advised her that she should be fasting. However, during the first few fasts her anxiety got worse and she started having more panic attacks.

More awareness is therefore needed of the impact of Ramadan on mental health within Muslim communities and the faith leaders that advise them. We have experienced cases on the helpline where individuals have experienced worsening of their mental health because of the or in some instances ordered to still fast, including advice that it will help improve symptoms. For example Nabila suffered from anxiety and would get panic attacks. When she contacted her GP, she was advised not to fast. However, Nabila felt she was committing a sin for not fasting and felt guilty. She then sought advice from a local imam who advised her that she should be fasting. However, during the first few fasts her anxiety got worse and she started having more panic attacks. She then sought additional opinions on the issue and was advised that she should not fast until she was well enough to do so because poor mental health is also an illness just as physical illness.

In other cases, instead of feeling pressured to fast some may use it as a way of concealing mental health issues – for example, some individuals who suffer from anorexia nervosa use Ramadan to hide their eating disorder as they are expected to go through long periods of not eating, which can be their health in serious danger. Family and friends should look out for this. Others who have been diagnosed with the condition and have since been treated for it and have managed it are often expected to be fit enough to fast. However, fasting during Ramadan can act as a trigger for the illness to creep back. So careful consideration should be given to whether fasting is appropriate. Some may choose to do shortened fast to participate with family and friends. No one has the right to judge another person’s practice of his or her faith.

It is important to seek help or if you know someone who is having mental Health difficulties, to speak to them to find out whether they are fit enough to undertake such long fasts. Mental scars and illnesses are just as important as physical ones, just because they may not be visible to the eye it doesn’t mean they should be ignored, so please take careful consideration when participating in fasting and how it can impact mental health issues.

Extracts of this article have been taken from the ‘Mental Health in Muslim Communities’ information booklet produced by Muslim Women’s Network UK