If you or someone you know is having serious thoughts of suicide, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
This column is part of an ongoing series by USA TODAY Opinion exploring the mental health crisis facing Americans.
Sana was gripped with fear. Her mind raced as she debated whether Allah would forgive her for being so ungrateful. She became certain that her newborn and toddler would be better off without her, a mother who couldn’t bond with her children. The thoughts surprised her. Sana considered herself religious and was aware that suicide is forbidden in Islam. But it seemed like the only solution.
Her characteristically joyful personality had given way to uncontrollable feelings of guilt, despair and hypocrisy. Here she was, a lawyer and teacher of the Islamic sciences, considering suicide.
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Seeking help from friends was futile, as they told her what she already felt – she was suffering from weak iman (faith). They encouraged her to read more of the Quran and pray to restore her faith and gratitude.
On the day Sana had planned to die by suicide, a concerned friend called to check in. She had just completed a suicide response training developed by the Stanford Muslim Mental Health & Islamic Psychology (MMHIP) Lab and offered by Maristan, a community partner with the lab.
Sana’s friend recognized red flags that she had learned about, explained to Sana that her symptoms were the result of postpartum depression, and insisted that she take her to an emergency room for a psychiatric evaluation.
Learning about her symptoms and that they were unrelated to her level of education or religiosity helped to comfort Sana and ultimately saved her life.
Mental illness is still highly stigmatized around the world, but its stigma in Muslim communities is especially strong. Instead of seeing mental health challenges as medical problems requiring (in part) medical solutions, many Muslims view such challenges as purely spiritual ones that can be prayed away or addressed with similar spiritual solutions.
Suicide, in particular, is a taboo within a taboo not only because of its connection to a mental health vocabulary, but also because it is morally forbidden in Islam.
A combination of Quranic verses and Hadith (narrations of the Prophet Muhammad, peace be upon him) underscores God’s explicit prohibition of killing oneself, emphasizing the special status that He has given to each human life and reminding Muslims about the nature of trials in this life and the need and goodness of patiently enduring them.
But moral prohibitions alone do not afford Muslims blanket immunity from suffering suicidal thoughts or dying by suicide. Research shows that a significant number of Muslims attempt and die by suicide each year, despite the fact that reported rates of Muslim deaths by suicide are low.
There also might be a good reason to believe that the rates are actually much higher than reported. In addition to its social stigma, suicide is criminalized in many Muslim-majority countries, which may yield underreporting or misclassification of deaths by suicide as “accidental deaths.”
American Muslims at higher risk
In the United States, our recent study published in JAMA Psychiatry – through a partnership among our Stanford MMHIP Lab, the Institute for Social Policy and Understanding, and the Institute for Muslim Mental Health – showed that American Muslims are twice as likely as any other religious group to report previous suicide attempts.
As noted in The Economist, it is hard to imagine that this is not linked to the high rates of Islamophobia and anti-Muslim sentiment that defined post-9/11 experiences for most American Muslims. But there’s more, too.
Mental health is not only stigmatized, and culturally and religiously congruent resources not easily accessible, but American Muslims also suffer from unique stressors in their daily lives that hurt their mental well-being. For example, our study showed that experiencing discrimination – especially the combination of Islamophobic and gender-based discrimination – increased suicide attempts by 180%. And gay and bisexual Muslims were eight times as likely to report attempting suicide.
Cultural assimilation also plays a major role. U.S.-born Muslims were much more likely to attempt suicide than their immigrant-born predecessors.
Ultimately, the study underscores that there is a growing suicide crisis afflicting the American Muslim community.
Over the past several years, our Stanford MMHIP Lab has been contacted by numerous Muslim communities in the United States and abroad following deaths by suicide. It became clear to us that we needed to develop custom-tailored resources for Muslim communities to help them navigate the impact of suicide on their communities.
By April, when two brothers killed themselves and their family members in a murder suicide in the Muslim community in Allen, Texas, we had completed the first draft of a suicide prevention, intervention and post-intervention manual that integrates the latest evidence-based scientific research on suicide along with Islamic ethics and moral teachings.
Within 24 hours of the Allen tragedy, our team had hosted multiple virtual training sessions for Muslim leaders in the Dallas area, including training specific to imams, other religious leaders and mental health professionals.
We also published a widely circulated article on the do’s and don’ts of suicide response for Muslims who were reeling after the brothers’ graphic suicide note had gone viral. Our goal was to prevent a suicide contagion in U.S. Muslim communities.
Addressing suicide has been a major gap in Muslim communities worldwide, but we are finally beginning to take meaningful steps to combat the troubling anecdotal, clinical and research findings that show an increase in suicidal ideation and deaths by suicide. The Stanford MMHIP Lab recently received a John Templeton Foundation grant to study Islamic-inspired character virtues that may serve as unique resiliency and protective factors against suicide, representing a significant stride in Muslim mental health research.
Suicide prevention training is available
Several recent tragedies were the catalyst for Maristan to launch its 500 Imam Campaign with a goal to train at least 500 Muslim leaders across the country in 2022 in suicide prevention, intervention and post-intervention. Maristan’s five-year goal is to train leaders in all 3,000 mosques across the USA.
Muslim communities seem finally to be waking up to the reality of mental illness and the acute need to address it through collaborations among mental health professionals and community and religious leaders. But there is still much work to do.
Effective suicide prevention in Muslim communities requires more information, more commitment and more communication. It requires the entire community to engage. It requires a solution that is medical and spiritual, and one that meets each community where it is at and uses tools from varying traditions to engage the problem effectively.
We need more research to document the extent of the problem, more resources to provide care based in the Islamic tradition, more communication about the importance of mental health care, more recognition of unique stressors, and more leadership to responsibly guide communities to a healthier future.
Yet, there is reason for hope. At Maristan’s first in-person suicide prevention training in September, an imam was the first person to arrive. And he sat in the front row. A few years ago, he had brushed off the need to talk about mental health, despite our efforts to seek his support.
Dr. Rania Awaad is an associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. Taimur Kouser is a Masters in Bioethics & Science Policy student at Duke University.