Every year, over a billion Muslims mark Ramadan by fasting from dawn to sunset. For people with mental health conditions, deciding whether to fast can be complicated, with lots of things to consider.
Young people with eating disorders, for example, need to take part in Ramadan in safe, healthy ways that support their recovery. Young people with conditions like depression or anxiety need to consider how fasting might affect their symptoms, and people on certain medications might need to check in with their treatment team too.
We spoke to two Muslim experts to find out more about how people with mental health conditions might take part in Ramadan.
Dr Omara Naseem is a Counselling Psychologist who specialises in treating eating disorders (though she also works with people with a range of other mental health conditions).
Fareeha Jay is a Dietitian who’s especially passionate about supporting people from South Asian backgrounds with nutrition.
Know that if you’re unwell, you’re exempt from fasting
‘Fasting during Ramadan is only meant for people who are physically and mentally well enough,’ says Dr Naseem. ‘If someone’s who’s unwell tries to fast, it might actually exacerbate their issues and make them worse – and that’s not the purpose of observing Ramadan at all.’
This might seem most obvious for people with eating disorders, as the link between their condition and fasting is clear. But Dr Naseem continues: ‘The same goes for any mental health condition. If someone is self-harming or in a bad way with depression and anxiety and having panic attacks, they need to pause to get well.’
When it comes to eating disorders, Fareeha emphasises that it depends on which phase of recovery someone is in: ‘With eating disorders and other mental illnesses with physical symptoms, physical and mental wellness don’t necessarily follow the same timeline,’ she says. ‘Someone might start feeling well physically before they’re well mentally.’ In these cases, it’s important to make sure your mind and body are in recovery before you decide to fast.
‘If you’re not well enough, you have permission not to fast,’ says Dr Naseem. ‘Your body is a blessing – and it’s your job to take care of it. You would not be taking care of it properly if you forced yourself to fast when you’re unwell. Fasting in Ramadan in not supposed to be difficult in this way – obviously you get hungry, it’s a bit hard in that way, but it shouldn’t put you at at risk of harm.’
Both Dr Naseem and Fareeha agree that people people who aren’t fasting can still participate in Ramadan in other ways.
Consider the intention behind your fast
Part of considering whether you’re well enough to fast involves thinking through whether you’re well enough to manage the effects that fasting can have on your physical and mental health.
But it’s also important to consider your intentions when it comes to fasting.
‘Your intention should be spiritual,’ says Dr Naseem. ‘It should be in line with the values of the religion. If your motivation to fast is anything related to eating disorder values like restricting food, losing weight, changing your shape – those aren’t the right reasons.’
Fareeha agrees. She suggests young people could ask themselves: ‘Am I fasting for myself? Am I fasting for the eating disorder? Or am I fasting for Allah?’
Take part in Ramadan in other ways
‘I totally get it that Ramadan is about fasting from dawn to dusk,’ says Fareeha. ‘But very often, what we tend to do is ignore all the other things around Ramadan.’
Embracing other ways to participate in Ramadan can be valuable whether you choose to fast or not. If you’re not able to fast, you can still engage spiritually with the month – and if you choose to fast, it can be helpful to have these things as regular reminders of what Ramadan is about.
‘People just think of Ramadan as fasting,’ says Fareeha. ‘But these “other” things are things which everyone anywhere should be doing!’
‘I always say to my clients that the intention is important,’ she continues. ‘If you intend to fast, even if you’re not fasting, then according to the religion you’re still getting the “Brownie points”. Intention matters in the religion.’
Dr Naseem agrees. ‘You can observe Ramadan in lots of other ways,’ she says. ‘You’re not at a disadvantage if you choose not to fast for your wellbeing.’
One alternative way to participate in Ramadan is Fidya – paying for someone else to be fed when you’re not able to fast.
Fareeha says you can also recite Quran, read it with translation, and focus on bringing it into practice. ‘In reality,’ she says, ‘Quran is sort of a script for how to lead a good life. Spiritual reflection is a way of participating in Ramadan.’
Fareeha also speaks to clients about two concepts she’s nicknamed ‘the two Ts’ – Tahajjud and Tarawih.
‘Tahajjud is a prayer you perform in the middle of the night,’ she says. ‘This shows how much you are obedient to God. Tarawih is just extra prayer, usually done in the evenings.’
Finally, Fareeha suggests young people can engage in volunteering.
Make a plan if you’re not fasting
There are a few things you might want to consider if you’re exempt from fasting during Ramadan because of your mental health.
It’s a good idea to make sure that people close to you know about your decision so they can support you throughout the month, but you might not want to tell everyone about your mental health – and that’s OK.
‘If you just say “look, I can’t fast this year”, people tend not to interfere,’ Dr Naseem says. ‘But if they do ask why, it can be intrusive,’ she adds. She says there are some ‘easy outs’ if you don’t want to get into an in-depth discussion about your mental health: ‘You could just say you’re not well enough to fast or on medication.’
And while she wouldn’t want anyone to pretend to be fasting when they’re not, she says it might be helpful to think about finding a discreet place to eat where people will feel safe. This might be especially relevant at school, for example.
When it comes to Iftar, the meal eaten at sunset to break the fast, it’s a good idea to plan how you’ll get involved so you know what to expect.
‘If you’re comfortable making meals,’ says Dr Naseem ‘you could get involved in that way because there’s value in that for us too. In preparing food and giving it to others, you’re participating in Ramadan.’
She continues: ‘Young people could sit with the evening meal, having a snack or some of their meal if they’re not eating the same as their family members, working out the practical details with their treatment team if they need to.’
Fareeha agrees: ‘Make someone part of the meal,’ she suggests, ‘because if you’re isolated it can have a major impact.’
The morning meal, Suhoor, is early, with the sun rising before 6am in London at the start of Ramadan in 2023. ‘If the person’s not waking up at that time to eat,’ says Dr Naseem, ‘they might wake up at that time to pray.’
And, of course, it’s important to build a support network you can rely on throughout Ramadan too.
Make a plan if you choose to fast
If you’re physically and mentally well enough to fast (and are confident your intentions are healthy) it’s a good idea to make a plan with the people who support you in your recovery.
Dr Naseem suggests you could try ‘practice fasts’ in the run up to Ramadan – especially in winter where the days are shorter. She says you can then see how things go: ‘What thoughts or feelings come up? Are there potential triggers? What’s it like to eat in this way? Review and reflect on what went well and what might you need to refine or have more support around.’
Fareeha suggests it’s sensible to recognise that the Iftar (evening meal) and Suhoor (morning meal) are celebratory: ‘You could call them feasts,’ she says, ‘so they can be challenging for people in eating disorder recovery.’
First and foremost, Fareeha says: ‘If you fast, it’s crucial that you don’t miss Iftar or Suhoor – even as the days progress, and you start to want to be lazy and skip Suhoor.’
She tells young people: ‘Remember that after the Iftar, you will feel full! Anyone will feel full – so be mentally prepared for that. Chat to someone you trust about how you can manage this feeling if you think you might find it challenging.’
While people in eating disorder recovery should talk to their treatment team to make a plan that works for them, Fareeha also shares some practical tips to make Iftar more manageable.
In general, she suggests dividing the Iftar into two courses: ‘The first course is light – as soon as you break the fast with a date, have some water, a smoothie, soup, fruit, or yoghurt. Then take a break before you go with the second course.
‘The reason for this gap is that it gives your body time to digest. It will understand that you’ve broken the fast and that food is slowly coming in. Then the second course can just be the meal, with regular foods that give you energy: starchy carbohydrates, protein, healthy fats, vegetables.’
You can find more practical dietetic advice from Fareeha in Dr Naseem’s downloadable guide to help people to learn about Ramadan and participating if you have experience of an eating disorder.
And, of course, it’s important to build a support network you can rely on throughout Ramadan too.
Build a support network
If you decide to fast this year, it’s important to have people you can trust to help you throughout the month.
‘Before Ramadan starts,’ says Fareeha, ‘You must have at least one trustworthy person – a friend or family member – who’s there with you to support you during and after meal times.
‘And if you decide not to fast, you shouldn’t feel shameful about it, or that you can’t discuss it,’ she continues. ‘Reach out for help. Having someone you can trust is important.’
Dr Naseem adds: ‘Beyond that, it’s about letting everyone know what’s happening. You can talk to people about how you want to handle things during Ramadan and let them know what will and won’t be helpful.’
Be aware that some people don’t understand
It can be difficult if the people who are supporting your mental health recovery don’t understand Ramadan.
To best support Muslim young people who are struggling with their mental health, people need to understand the religious and cultural significance of fasting, and what life is like during Ramadan,
At the same time, some people come across challenges when others in the Muslim community don’t understand that some people participate in Ramadan without fasting because of mental ill-health.
‘The thing is,’ says Fareeha ‘Ramadan is a religious obligation – but we’ve turned it into a cultural pressure. Religion is something between you and God, but when culture comes in between it puts extra stress on a person.’
‘It’s difficult for the Muslim community to get their head around,’ says Fareeha. ‘Sometimes, people think that it’s only an illness if you can see it.’
But Dr Naseem is optimistic that understanding is growing. ‘I think the new generation understand about mental health,’ she says. ‘We have the language and we talk about it.’
Help people to understand mental health and Ramadan
Together, Dr Naseem and Fareeha are doing all they can to support increased understanding between everyone involved in supporting Muslims with mental health conditions.
‘Education is key,’ says Dr Naseem. ‘We give people the tools to support one another and have these conversations with respect.’
Fareeha is passionate about the role of Imams in helping mental health professionals and families to understand one another as they support young people during Ramadan. ‘An Imam with an understanding of the condition can make a big difference. I always give the example of Diabetes UK – they have Imams involved with guidance, so why can’t it happen in eating disorder and mental health services?’
In fact, emails from people around the world who were struggling to help their treatment teams understand Ramadan prompted Dr Naseem to create a downloadable guide to help people to learn about Ramadan and participating if you have experience of an eating disorder. Fareeha also contributed her expertise to the guide.
‘I made the guide on the back of feeling like there aren’t resources out there made by a minority who has that understanding,’ Dr Naseem says. The guide is a fantastic resource for Muslim young people who might want to start a conversation with their family, treatment team, or Imam – as well as for people who want to learn more about celebrating Ramadan while supporting recovery.
You could also show this blog to people supporting your recovery.
Check in throughout the month if you’re fasting
If you’ve decided to fast, it’s especially important to check in throughout the month to review how things are going.
Dr Naseem says she would set up ‘reviews’ with a young person in eating disorder recovery – including checking in with their family.
‘We need to observe the level of risk,’ she says. ‘Things like, have any thoughts about the eating disorder come back? Have you had urges to restrict or binge? Are any of the eating disorder values coming back in?
‘We’d also monitor weight, because actually you’re not supposed to lose weight in Ramadan. You find that your weight stays quite stable because your body adapts and it’s clever. So keeping an eye on them clinically too.’
If you start to fast during Ramadan and find that it isn’t healthy (whether you have experience of disordered eating or another mental health condition), it’s OK to change what you’re doing.
‘It’s OK to say “we tried, and it’s not for you this year”,’ says Dr Naseem. ‘It’s your job to take care of your body. You can still participate in Ramadan in other ways.’
Have hope for recovery
If you’re not able to fast this year, it can be challenging – but you might find it helpful to remember that recovery is possible.
Dr Naseem recognises that fasting during Ramadan is meaningful – but says that means ‘it can be a motivation to get well when you’re not well.’
‘You can do the work of recovery with the intention that, in the future, you would love to be healthy enough to fast,’ she says. ‘The work of recovery is like an investment.’