Challenges Of Fasting For People With Mental Health Issues

However, not everyone finds it easy to fulfill the third pillar of Islam – fasting during the month of Ramadan – especially those struggling with depression, anxiety disorder and other mental health challenges.

Unlike others, individuals with mental health conditions must summon additional inner strength to fast throughout Ramadan due to the challenges they face.

Fasting requires abstaining from food, drink and anything that invalidates the fast from dawn until sunset, and it is obligatory for every Muslim who is mentally sound and has reached puberty.

 

 

Exploring the difficulties faced by Muslims with mental health conditions during the fasting month, Dr Alizi Alias, a freelance consultant in organisational psychology and a part-time lecturer at the Royal College of Medicine Perak, said among the challenges they face are waking up for the sahur (predawn meal), lack of focus during tarawih prayers and tendency to fast for more than 24 hours, depending on the type and level of mental illness.

“Some people with major depressive disorder or depression struggle to wake up for sahur, perform ablution and stand up to pray, eventually experiencing extreme guilt.

“For those with bipolar disorder, they may overspend or donate excessively. During the manic phase (when they are more active, energetic and agitated), they may not sleep for days because they stay awake all night praying, but eventually, they will experience severe depression,” he told Bernama.

Alizi said individuals with an anxiety disorder may struggle to maintain focus during congregational tarawih prayers or experience panic attacks while breaking fast at communal iftar (breaking of fast) gatherings.

He added those with anxiety disorder often worry excessively about swallowing saliva or airborne dust, or making mistakes while reciting the Quran, even if they are well-versed and fluent in it.

Alizi also said Ramadan poses challenges for persons with obsessive-compulsive disorder as they may repeatedly perform ablution at the mosque or struggle to complete the takbiratul ihram during the tarawih prayers, or constantly have doubts whether they have performed the niyyah or intention to fast before the time of Fajr (dawn) passes.

“As for those with eating disorders, they may skip sahur or iftar entirely, fast for more than 24 hours or intentionally induce vomiting during the day which they are aware of but cannot control.

“Meanwhile, individuals with attention-deficit/hyperactivity disorder may sometimes hyperfocus and at other times struggle to focus during worship. They may get bored easily with certain acts of worship as well as find it difficult to sit still while reading the Qur'an in a group, They may also experience sleep disturbances and eat unhealthy foods,” he said.

Alizi added some people with mental health conditions may not be able to perform both obligatory and voluntary acts of worship as perfectly as others.

However, he said mental health patients can still experience the joy and beauty of this blessed month in their pursuit of piety, as long as they do not compare their level of worship with others.

“While symptoms of mental health conditions (which come in various forms) are present throughout the year, they may become more apparent during Ramadan due to changes in meal and sleep schedules, increased religious activities, and physical and mental fatigue, as well as disruptions in psychiatric medication intake (sometimes even forgetting to take them),” he said.

 

According to Alizi, Muslims with mental health conditions can prepare for Ramadan by practising voluntary fasting before and after the holy month. This helps them identify difficulties, including symptoms they might experience while fasting.

“Report these to a psychiatrist or clinical psychologist for guidance on managing them and determining the best way to space out medication intake. Otherwise, bring a letter of support from a specialist and consult a knowledgeable religious scholar who can provide special concessions for the individual concerned,” he added.

He said although Ramadan is not a month of healing for mental health patients, it can contribute to the effectiveness of their recovery and treatment process.

“Ramadan cannot replace medication and psychotherapy,” he stressed, adding, “If a patient feels healed, it is not actually healing but rather a sense of ‘flourishing’ or well-being. It enhances mental health quality to the point where a patient feels their affairs are easier to manage and their symptoms are not as severe as before. However, their mental health condition has not completely disappeared or been cured. It can resurface if they stop taking medication or attending therapy sessions. 

“There is also the possibility that those who feel ‘healed’ during Ramadan may not actually have a mental illness but instead may be experiencing extreme stress or burnout, or non-clinical depression or anxiety, which are not classified as mental illnesses.” 

Stressing the role played by caregivers during Ramadan, Alizi said they must have accurate information about their patients’ specific mental conditions and their symptoms and severity.

“Caregivers play an important role in ensuring that individuals with mental illnesses don’t feel guilty for performing obligatory worship with great difficulty or for struggling to engage in voluntary worship. They should encourage them to pray according to their abilities and emphasise Allah’s generosity and compassion,” he said.

 

 

Meanwhile, clarifying doubts about fasting for people with mental health issues, senior lecturer at the Academy of Contemporary Islamic Studies, Universiti Teknologi MARA, Dr Khairul Azhar Meerangani said in principle, fasting remains obligatory even for people with mental problems.

However, he pointed out that certain specifics of the ruling can change depending on the patient’s current condition. For example, if their symptoms are mild and do not pose a threat to their health or impair their cognitive abilities, then they are required to fast.

“But those at risk of experiencing panic attacks or severe depression due to fasting are permitted to break their fast but must make up for the missed days after Ramadan.

“For individuals with chronic, long-term mental health conditions with no hope of recovery and who rely on continuous medication, they are also allowed to break their fast but must compensate by paying fidyah (fine) for each missed day,” he said.

However, those with severe mental disorders that completely impair their cognitive function and rational thinking are exempt from fasting, as having sound intellect is one of the fundamental conditions of the religious obligation of fasting.

“This reflects the flexibility of Islam in accommodating human capabilities in fulfilling religious obligations. If fasting would cause significant harm or excessive difficulty for individuals with mental health conditions, Islam permits them to take the necessary concessions provided,” he said.

 

 

Khairul Azhar added that acts of worship such as prayer, supplication and Quran recitation can help calm the mind and bring inner peace. Fasting also helps regulate emotions, promoting patience and acceptance of life’s trials.

“Ramadan teaches us to draw closer to Allah as a source of spiritual strength, especially for those being tested. The presence of family and friends in congregational worship activities can also help individuals cope with feelings of loneliness and depression.

“By embracing the wisdom, individuals, particularly those with mental health conditions, can find the deeper meaning of Ramadan from various dimensions, encouraging them to lead a more peaceful and fulfilling life in pursuit of Allah’s blessings,” he said.

In this respect, added Khairul Azhar, society plays a vital role in supporting individuals with mental challenges by fostering a compassionate and understanding environment.

“Avoid judging those who are unable to fast during Ramadan; instead, offer them encouragement and moral support. Many people with mental health conditions desire to fast like everyone else. So, don’t ridicule or mock them.

“Family members, for instance, can assist by helping manage their daily routines that may be disrupted during Ramadan, such as meal preparation, medication intake and prayer schedules. Setting realistic goals without external pressure is important… what matters most is the quality of worship, not the quantity,” he said.

He added people with mental health conditions are also encouraged to begin Ramadan with a positive mindset, praying for ease in their acts of worship.