“My daughter had suicidal ideation in Ramadan. She was fasting. She came up to me at 11 at night to say that she needs to be taken to the hospital because she can't control her urges. I had no idea what was going on,” said Fatima* in an interview with Sound Vision.
“It was not like what they show in movies where the person is actively taking pills, or tying a noose etc. It was her calmly telling me this.”
But this was not the first time that her daughter, then 14, had approached her about her inner turmoil. Fatima said that in fifth grade, she wouldn’t brush her hair before going to school, which led her to initially joke about it, then get angry with her, and finally ignore the behavior “thinking it was just a phase” and that this was just an effort to look “cool”.
However, by the end of that school year, her daughter felt there was something wrong and she needed to see a professional. “Now, my kid was very self-aware, Alhamdu llillah, and I am open to therapy so I wanted to take her. Once she started, I found out that she was also cutting herself. This explained why she was wearing long-sleeved clothing - which I thought was part of her Islamic modesty. I also discovered she was battling with suicidal ideation. It was so bad in her mind that she had to be hospitalized for having strong impulses to commit suicide.”
According to a May 2017 study of American pediatric hospitals, admissions of patients ages five to 17 for suicidal thoughts and actions more than doubled between 2008 to 2015.
There are no exact numbers on how many Muslims, and specifically young Muslims, die by suicide. However, as is the case with other social ills in wider society, Muslim youth are no strangers to it.
Signs to watch out for
Dr. Farah Islam is a mental health educator in Toronto, Canada and the scriptwriter of Sound Vision’s Adam’s World. She said when young people have suicidal thoughts and ideas, the signs are often subtle and easy to miss. Some signals to look out for include:
- A change in sleep patterns (either staying up all night or always sleeping)
- A change in their eating habits? Are they eating more or less?
- How capable are they in dealing with emotions? Do they have sudden outbursts of crying and anger?
- Are they withdrawing from others?
In addition to these, the U.S. Centers for Disease Control and Prevention (CDC) also advises looking out for these warning signs:
- Feeling like a burden
- Being isolated
- Increased anxiety
- Feeling trapped or in unbearable pain
- Increased substance use
- Looking for a way to access lethal means
- Expressing hopelessness
- Talking or posting about wanting to die
- Making plans for suicide
“Just be a listening ear,” she advised parents when interacting with their children. “Our children are trying to tell us something but we often jump in and try to lecture them.”
The stigma of seeking professional help
Unlike Fatima, many Muslim parents would not consider taking their child to a therapist or counselor due to the social stigma attached to mental illness, even when the child specifically asks for it.
“Taking your kid to therapy is not the easiest thing to do in our community,” she said. “I had a husband who did not want me to take our child to therapy. He kept saying that going to therapy was admitting that we were not parenting properly. So not only was I watching my child going down a spiral, but I also was battling my husband on taking her to therapy.
“In our community, we do not talk about mental health. The whole time she was hospitalized, a week-and-a-half, I was told I couldn't tell anyone. Not my parents, my siblings, my friends. My husband didn't want to talk about it either, not because he was a bad person, but because he was just as broken as I was with the whole situation. So silence in our house.
“Along with that, when there were visiting hours, other kids' extended families would come visit the kids in the hospital, except for mine,” she said. “My daughter actually asked if she disappointed us and if we were ashamed of her and is that why we didn't tell her aunts and grandparents? And no matter how much we explained that it is just our culture, it didn't make her feel any better.”
A number of Muslim scholars, leaders, and mental health advocates, like Dr. Islam in Toronto, are trying to break that stigma. In the aftermath of a suicide by a young Muslim last year on the West Coast, Shaikh Rami Nsour of the Tayba Foundation in Union City, California joined with other Muslim leaders and professionals to discuss the tragedy with the community.
“The main thing we did was panel discussions to have a general discussion about the issue, and then breakout sessions for different groups - parents, dads, moms, youth by age, and then youth who directly knew the person,” he said.
These breakout sessions were held with licensed therapists.
“One of the things I did was I asked some of the parents how many had heard of the series ‘13 reasons why’,” he said. The program first aired on Netflix in the spring of 2017. The entire story is based on the suicide of a teenage girl, which is graphically depicted in one episode.
“I told the parents about suicide awareness in pop culture and in media,” he recalled. “I asked how many people knew Logic (an American rapper) and the song about the suicide hotline. And I asked kids. Many of them were able to rattle off the suicide hotline because of this popular song.
“The youth in our community are having these discussions, they are seeing these portrayals and if we don’t create a comfortable space to have these discussions then where are they going to turn to to have them?” he asked.
Tips for talking about suicide
For many parents, even if a child is not battling suicidal thoughts or tendencies, a death by suicide in the community leaves them in shock and reluctant to discuss it. But this is the ideal time to take a direct approach and do the opposite.
Dr. Islam advised watching the news piece, if it has been covered by the news media, with them and asking what they think about it. Ask why do they think someone would feel so lost and in despair.
Then she advised bridging into a question asking if the child knew people who talked about suicide or suicidal thoughts at school.
Finally, asking the child is s/he has had hard moments in their life and how they got through that hardship. This is critical not just in a general sense, but from a faith-based perspective too.
“We emphasize the rules and regulations of our faith, like how to do Wudu, but we forget to teach them the emotional aspect,” she said.
Dr. Islam also advised putting up hotline numbers for mental health services or Crisis Text Line on the fridge at home. This serves to not only offer help when needed, but would serve to normalize the discussion about mental illness and suicide.
Building community support
While parents are on the front lines of suicide prevention, they cannot do this alone. The entire community needs to offer support, especially for those like Fatima.
“If I knew someone else who had gone through this, I could have talked to them and would have been able to make decisions faster than I did,” she said.
“When parents are dealing with a child who might be experiencing ups and downs, suicidal thoughts, it is important to seek support for the child and yourself as a parent,” advised Amber Rehman, a youth leadership development instructor at Horizon Academy Institute in Calgary, Canada. “Often, we feel alone in our struggles as parents and seeking help from Imams, counselors, and trained professionals is valuable for parents too.”
Rehman also said sometimes community support means just providing youth a space to talk and learn about mental health.
“Every Ramadan on Fridays, I invite all the teens I work with for Iftar,” she said. “I try to invite a fun guest speaker who is young and knowledgeable about Islam but is also capable of answering their questions about mental health and well-being. This creates a bond between me and the teens and their parents for the rest of the year.”
This, she notes, can lead to building one-on-one mentorships for youth who are struggling.
“I think there is too much emphasis on hotlines,” she said. “Though those are available and they are good, there is nothing quite like one-on-one mentor ship.
“It’s also very important to monitor kids and their ability to cope with social situations from a young age,” she added. “Parents need to get their kids involved in volunteerism and community organizations from a young age, so they have the ability to turn to a community that is different from their school or (when dealing with) other-stress inducing situations.”
Healing and hope
Fatima was able to find the right help in time for her daughter. But the process was time-intensive and sometimes difficult, as she navigated the maze of mental health requirements and options for treatment.
“After hospitalization, I learnt that therapists are good for behavioral therapy but we need psychiatrists for prescribing medication, so the doctor search started again,” she said. “However, this time, her therapist was a great resource and hooked us up with a great psychiatrist.
“Also after hospitalization, there are different levels of care, so she needed a couple of weeks on intensive outpatient care, that meant going to a program from 8 am to 5 pm every day. This was a little easier because she was at home with us. However, now she is missing so much school. And that becomes another fighting point at home.
“Having to learn all of this and go to group sessions is so time-consuming but so necessary. I learnt that this is a chronic disease. My child will live this forever and I have to make sure she has the tools to deal with it. But the hardest thing is to be supportive and not feel sorry for her. And I don't know if I managed to do that because there are good times and bad times. That changes day to day and I just have to deal with it.”
In response, Shaykh Nsour said that when it comes to suicide, “We need to have this discussion in our Islamic schools, Sunday schools, youth groups. “The Imams, youth directors, Halaqa leaders need to be trained to know what to do, how to speak about it.”
He also suggested that the community should be made aware of suicide hotline numbers even posting them “in our bathrooms at the Masajid,” and to “ dedicate one Khutba (Friday sermon) a year addressing this topic.”
Another solution is educating Imams and community leaders, who are the frontlines of the crisis. Islam recommends receiving mental health first aid training, which is widely offered in Canada in mainstream social service settings.
Some of these initiatives are already happening. Dr. Rania Awaad is Clinical Assistant Professor at the Department of Psychiatry at Stanford University, and Director of the Stanford Muslim Mental Health Lab, which is developing a manual for Muslims communities in the aftermath of a suicide. It will be available in 2019.
Experts at the Lab are also working on a white paper that will gather the Islamic rulings on suicide to give religious leaders suggestions on what to say and how to say it post-suicide.
Awaad is hopeful that the stigma and silence around suicide in the Muslim community is receding.
“In most cases, with proper intervention, suicide is preventable,” she said. “Especially with the younger generation, across the board, they tend to be much more willing to talk about this.”
* Name changed for privacy reasons