Depending on the individual’s type and level of mental illness, challenges could include difficulty waking up for sahur; lack of focus during tarawih prayers; and a tendency to fast for more than 24 hours.
“Some people with major depressive disorder struggle to wake up for sahur, perform ablution, or even stand up to pray. As a result, they often experience extreme guilt, which exacerbates their condition,” said Dr Alizi Alias, a freelance consultant in organisational psychology.
“Those with bipolar disorder, meanwhile, may overspend or donate excessively. During the manic phase, they might not sleep for days because they stay awake all night praying. Eventually, this will lead to 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 gatherings. They might, for instance, worry excessively about swallowing airborne dust, or making mistakes while reciting the Quran even if they are well-versed and fluent in it.
Ramadan also poses challenges for those with obsessive-compulsive disorder as they might repeatedly perform ablution at the mosque, or constantly have doubts over whether they have performed the niyyah, or intention to fast, before dawn.
“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,” Alizi said.
“Meanwhile, individuals with attention-deficit hyperactivity disorder may at times be hyperfocused and, at others, struggle to focus during worship. They may get bored easily with certain acts of worship, or find it difficult to sit still while reading the Quran in a group.”
Alizi highlighted that while symptoms of mental health conditions are present throughout the year, they may become more apparent during Ramadan owing to changes in meal and sleep schedules, increased religious activities, and physical and mental fatigue.
There could also be disruptions in consumption of psychiatric medication, with some even forgetting to take them.
On the flipside, the expert noted that the holy month can contribute to the effectiveness of recovery and treatment processes. But “Ramadan cannot replace medication and psychotherapy”, he stressed. “If a patient feels healed, it is not actually ‘healing’ but rather a sense of ‘flourishing’ or wellbeing.
“Ramadan can enhance 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 condition has not completely disappeared or been cured; it can resurface if they stop taking medication or attending therapy sessions.”
Emphasising the role played by caregivers during the holy month, Alizi said they must have accurate information about their patients’ specific mental conditions and their symptoms and severity.
“Caregivers must ensure that individuals with mental illnesses don’t feel guilty if they find it difficult to carry out obligatory tasks and worship, or struggle to engage in voluntary worship,” he said. “They should encourage them to pray according to their abilities, and emphasise Allah’s generosity and compassion.”
Alizi concluded that those with mental health conditions 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 and devotion with others.