بسم الله الرحمان الرحيم
I am sharing this story because firstly, I know how lonely it is for those suffering from mental illness and how comforting it is for us to hear from others who have had similar experiences. Secondly, I’ve learned a lot from the past 4 years that I think will be useful for those who have just started experiencing symptoms. Thirdly, understanding mental illness from a theoretical perspective doesn’t do justice to what people suffering from it feel, especially when we consider how the suffering is invisible on the outside. The list of symptoms for these illnesses can often sound generic or trivial, but the person suffering from it distinctively knows that something is tangibly wrong with them. Lastly, I want to emphasize how much we Muslims need to take mental illness seriously, not just in confronting the stigma, but in approaching diagnosis, treatment, management and prevention as seriously as we would do any other health issue we encounter in our own lives.
Like most people in the 90s & early 2000s, while growing up I had little to no knowledge or understanding of mental health or illness apart from the more severe cases you would see on TV and movies. In university, I began to take an interest in psychology and observing human behavior beyond the few courses I had taken in my first year. I began to understand that I was introverted, a little eccentric and probably had some mild ADHD, although as I would later realize, the reason why I couldn’t focus on studying in university was most likely because I wasn’t that interested in the program and subjects I was studying, and that like most people I would let stress and perfectionism prevent me from figuring out how to do well in school. I never knew what my passion was or what I was good at until I was in my mid-20s. Either way, I never bothered to learn much about stress and mental health, or think that I would ever be someone who could suffer from a mental illness myself.
In January 2014, I was in the middle of working a full-time teaching job (If you’ve taught at the high school level, you know how stressful it can be) while also studying up to 30 hours a week. My workplace – which had a stressful and illogical employee management system – had just made our schedules needlessly more hectic, and my wife and I had just had our first child. Instead of backing off on my studies outside of work (which weren’t at a university, rather I was driving dozens of kilometers to my teachers’ houses every day before work, during work and spending 12-16 hours every weekend in class), I buckled down. I believed that I needed to be tougher, that regardless of what life threw at me, I needed to accomplish the goals I had set for myself in life and in my studies. I neglected my health and even sleep for the sake of fitting in excellence in work and study, making time at home with my family (which often involved me having to take out my family because at this time women still couldn’t drive in Saudi Arabia) and even reading/research on the side. To fit in all these tasks, I would drive like a race car driver, which had the added advantage of giving me a fun adrenalin-filled activity in between tasks, which although dangerous is not as bad as it sounds, because this was in Riyadh and I fit right in driving like that. To add onto this, I was drinking a lot of coffee, and at this moment in my classes I was studying some heavy texts in fiqh, usul, poetry and balaghah (Arabic rhetoric). My only time to relax would be in the summer. Even in March break I would attend day-long intensive readings of study texts. During this time, I also started strongly disliking Saudi Arabia for its politics, religious polemic and oppressive treatment of expats. I myself felt the immense pressure to achieve my knowledge-related goals before I was suddenly fired and forced to leave the country.
For the next year and a half, I started noticing something different about myself, but I wasn’t too troubled about it. I became addicted to the adrenalin and started to enjoy driving like a maniac, I would have random chest pains that would freak me out, and I began to pride myself on being ‘productive’ and felt like Jason Bourne doing one thing after another with clockwork. I would also very brief dizzy spells at work, lasting for no longer than a second. I also started to gain more weight and anger very quickly (and very loudly). When I came home at 6-7 pm in the evening, I found myself unable to mentally and emotionally wind down and relax. I didn’t know it at the time, but I was experiencing severe symptoms of chronic stress. My wife (may Allah bless her and reward her) suffered during this time because of my behavior, and may Allah forgive her for her patience. In general, I hope Allah forgives and blesses both my wife and my parents for being patient with me during my studies abroad.
Given this pattern of behavior, its obvious that I would eventually hit a wall. In the weeks preceding my first panic attacks, I began to feel anxious during my once exhilarating morning drive. I would suddenly jump if a car appeared from a blind spot. I realized it was not normal, and began to fear for my health, immediately cutting out all my carbohydrates and going on a near-Keto diet that had helped me lose a lot of weight in university. Unknown to me at the time, this probably accelerated my emerging mental illness, as consuming carbohydrates lowers your cortisol (stress hormone) levels. Making everything worse was a really bad accident I had on the highway in September 2015, right after returning from summer vacation. The traffic on the highway suddenly came to a halt, and the driver behind me who wasn’t paying attention barreled into me at top speed. I felt my entire body lift towards the roof as my car leapt forward a whole meter or two, although Alhamdulillah I wasn’t injured. The usual stress of getting my car repaired after followed.
In November 2015 while teaching at work and attempting to discipline a student for talking, I suddenly found myself unable to breathe. I stopped speaking suddenly, and even my students noticed and started asking me if I was alright. I felt a huge wave of nausea sweep over me. I felt like I was going to collapse. I thought that’s it. I’m dying. I’ve having a heart attack and its all over. I was just waiting for some intense pain to radiate from my heart so I could say the shahadah. What happened was the opposite of what I was expecting: a wave of cold, almost like a shiver, radiated from my stomach to my head and legs. Weird, I thought. I’m pretty sure that’s not what a heart attack feels like. I left my classroom, called my supervisor and asked them to send a cover teacher, and asked my partner teacher (in the room next to me) to cover my class. He asked me if I was okay, and instinctively, although I knew nothing about them I replied, “I think I’ve having a panic attack.”
The next month was one of confusion. I felt like I had just experienced an explosion and was suffering from acute PTSD. I called my wife and went straight to the hospital after work. My EKG and blood tests came back normal. What the hell, I thought. What’s wrong with me? I drove back to work, but the entire drive was a struggle. I realized that I couldn’t drive anymore. It would just make my panic worse. I started taking a taxi to work and back. I started going through a battery of different tests with a cardiologist in the best private hospital in Riyadh. I tried to attend my classes for a day or two but excused myself. One of my teachers gave me a list of dhikr and duas to do Ruqya with, and I tried it for a week or two but it didn’t do anything. I tried to pray and lengthen my sujud (which always used to work for me and bring tranquility to my soul) but frighteningly it did nothing. I tried to start exercising and going to the gym, but every time I lifted weights I had a panic attack the following night (unknown to me at the time, lactic acid can induce a panic attack). Every panic attack involved a 2am visit to the Emergency room, where I would eventually calm down and then be told after an EKG and blood test that I was fine. I was suddenly unable to sleep as well. I couldn’t teach anymore either, continually asking my supervisor to cover my classes. The tests with my cardiologist came back negative for any serious issues, and he told me to take time off work. I went to my workplace and asked them for an unpaid month off in December so I could go back to Canada and relax. In Canada I did more tests with my doctor, and still everything came back negative.
I realized that this most probably was not the evil eye or black magic. Until the day of my panic attacks I was still praying almost all my prayers in the mosque and seeking Islamic knowledge. The ruqya didn’t work, and neither did any spiritual activity. It didn’t make sense. My many EKGs, blood tests, stress tests, echocardiograms and God knows what else had all come back negative for any serious issues.
Something else was going on. I started buying and reading books on anxiety, panic disorder and hypochondria. I visited a psychiatrist in Saudi Arabia (literally one of 3 in the entire city of Riyadh), and he listened to me for only 5 minutes before prescribing me medication. I’m not taking that, I thought. I did some research on mineral precursors for serotonin and started taking large doses of magnesium to help me sleep. Eventually I switched to taking ZMA and melatonin, which helped me sleep for the next few years. I started to watch TV and play video games again, realizing that I needed a way to de-stress and relax. Although I kept reading and studying online with teachers, I knew that I had to become more realistic about what I achieved in life.
One thing I almost immediately started doing was being open about what I was going through. Some family members chided me on this first, telling me to keep it to myself, but I thought that was a mistake. It turned out to be a great decision, as I suddenly found out how many of my friends and acquaintances (especially the ones you never expect) had have mental health issues. Mental illness can make you feel extremely lonely, as no one knows what you feel like except yourself, so finding someone who you can discuss your symptoms and share experienced with can be liberating and comforting.
When I came back to KSA in January, I met a friend who was also going through some mental health problems, except he was going through them for the second time. He referred me to an awesome website anxietycentre.com he had used the first time, which had probably the most important information I had ever learned about anxiety and panic attacks. I learned about the hormonal pathways, feedback loops and problematic behaviors and neglect of stress symptoms that lead to anxiety and panic disorder. I had basically trapped my body into a stress and adrenaline feedback look that would take years to die down. I also learned how important it is to distinguish between feeling anxious or depressed and have an anxiety or depressive disorder. Unfortunately, the website also stressed how important it was to avoid medication and instead opt for counseling and therapy. I began to think they were mutually exclusive, and it reinforced my anti-medication bias. I looked for psychotherapists in Riyadh and turns out there was only one female in the entire city.
I slowly came to terms with having a mental illness. I began exploring calming and breathing techniques and learned to identify my anxiety and panic symptoms and early warning signs. I still fell for it unfortunately. There were still late-night rushes to the Emergency room only to come back with a lack of sleep. More disturbingly, I began to realize that I didn’t recognize who I was from the inside anymore. I was in constant fear and worry, I felt like there was a layer of thought over my mind that was ‘fuzzing’ my mind up. I would see things from the corner of my eyes. Several times over the years, I would suddenly stumble backwards while walking outside, thinking I was about to walk into a pole, but there was nothing there. Strangely, in Ramadan my symptoms would disappear. Fasting seemed to have an effect on my symptoms, whether in Ramadan or a non-ritual fast outside of it.
Realizing that KSA was terrible for my mental health, we left in the summer of 2016. The whole time in between I was taking a taxi back and forth from work, although I started driving in the summer when the traffic died down. Although I miss the place, the memories and my teachers terribly (I also grew up in KSA), there is something about that place that does this to people, especially seekers of knowledge. There is a long casualty list of seekers of knowledge getting mental health issues in Saudi Arabia. I’ve even met fellow students from Madinah who told me how terrible it felt to realize that they felt more at peace in the USA than in Madinah. There have been students who jumped out of moving cars due to panic attacks. My mother also commented how she had mental health issues after moving to KSA in the first decade and a half of marriage.
I realized that I wasn’t Superman. But at the same time, I was convinced that I could not let my mental illness become an excuse for mediocrity. I wanted to complete my studies, especially in hadith as I had planned to keep that for later. We left for Cairo, Egypt, and we lived there on our savings for a good seven months. I dedicated myself to a good four hours a day of study and left it at that. I wasn’t able to do much more. The rest of the time I tried to relax and not push myself. I did have a frightening moment in Cairo where I was looking down from our balcony and some strange voice in my head told me to jump so I can end the suffering. But the blessings of Allah, Islam and being a student of knowledge made me recoil in horror at just having that thought.
In March 2017 I had to suddenly move back to Cairo to take care of my daughter while my wife awaited the birth of our twins while in bed rest at the hospital. I also had to start working again, and got a job as an Islamic studies teacher in a high school. With the stress of two new children (both had colic in their first year as well), as well as working with teens again in a high school I realized the stress was never going to go away. There was no way of running away from it. But now I realized I couldn’t afford a psychotherapist. They were way too expensive in Canada and Ontario public health insurance didn’t cover it.
But still I trudged on, determined that the only way to continue was to manage my anxiety and panic symptoms as best as possible and hope that one day it would eventually go away. I felt like I had aged considerably in my emotional state because of the constant fear of death and serious illness that my anxiety and panic issues kept reminding me of. I also felt that my mental illness issues were seriously affecting my ability to relax emotionally, as well as focus spiritually. I felt robbed but kept pushing on. I still could not go to sleep without taking my ZMA and melatonin. I was too afraid of medication and the horrible stories I had heard of side effects. I was also wary of the contemporary medical approach to psychiatry and thought that the pharmacology of psychotropic drugs was too reductionist to consider the complexity of our neurology and biochemistry, as well as our ignorance of the relationship between neurology and behavior. My sister, who had worked in the pharmaceutical sector for a couple of years, also had some stories to tell.
Given my interest and concern about mental health, I was very interested in counseling my students in the high school I work in on not just religious issues, but mental health issues. I was careful to respect my limits and inform the office to get them specialized help when possible. But I started noticing something. Teenagers who had mental illness had a serious disadvantage. I had developed mental illness in my late 20s, and I had a degree in the Life Sciences and knew my way around research papers and journals. I already knew who I was and had mapped what I felt to be ‘normal’ before I started having symptoms. These teens would never know what that was. Mental illness would become who they were. How could they ever learn to manage their symptoms if they didn’t know where normal ended and their symptoms began? I became a lot more comfortable in advising students (and their parents) to see a psychiatrist and not just a psychologist if I felt their symptoms were bad enough. Kids that young simply cannot deal with their symptoms without pharmacological help. I realized that I should also see one but kept procrastinating on it. My family doctor kept recommending I take anti-depressants, but I didn’t trust her expertise enough on the issue to take them.
As school staff, we attended a local Muslim mental health conference and there I met a Muslim psychiatrist who knew an Islamic scholar/psychiatrist from the UK that I was acquainted with as well (Sh. Asim Yusuf, who came to present at the conference).
Speed up ahead to March 2019, and I took some students to our school Spain trip. It was an intensely relaxing and calming trip. I forgot I had mental illness. But on the flight back, it was excruciating. I hadn’t experienced such severe symptoms in a long time. It was a long flight (from Paris to Toronto), and the whole flight I felt like the plane was going to crash and I was going to die. I don’t know how I managed to keep it in, but it was during this flight that I read all of Michel Sugich’s ‘Hearts Turn’, which helped me to focus on a lot on tawakkul, although it didn’t take away the chaos in my mind completely.
When we landed, I realized that I had had enough. It was time to deal with this issue. I told my parents flatly that I was going to take medication for my mental health issues (they were quite against it). As I was figuring out what to do next, the next week a friend asked me to attend a theology class at a masjid and review the teacher and the content for him. There I met again the Muslim psychiatrist (I haven’t requested his permission to share his name here yet) I had previously encountered at the mental health conference. He gave me his phone number and told me to come visit his clinic. The next week I went to the clinic and the secretary commented loudly on how lucky I was to get an appointment the same day. People usually had to wait six months to see him. When I sat with him, I understood why.
Masha Allah the good doctor sat with me for a good two to three hours before giving me a diagnosis. He was a religious male Muslim, so it was even easier to tell him everything. For most of the time, I was just talking and telling him all my symptoms and experiences over the past few years. Right in the middle of our conversation he asks me: Samir, have you had any car accidents? The question took me by utter surprise. I had never thought that would be relevant. As I explained how I had a bad car accident almost every year in Saudi Arabia (Saudi Arabia has some of the worst driving in the world. I’ve seen some of the craziest car wreckages there. Imagine a brand-new Chevrolet Suburban cleaved in half), I realized that this psychiatrist might know what he was talking about. After all I had my worst car accident just 1-2 months before my first panic attack.
He explained the microtrauma to the brain (i.e. from whiplash, not a direct impact. It doesn’t show up on a CT scan) can result in parts of the brain becoming oversensitive as increased blood flow to repair the are results in greater nerve growth. I didn’t just have anxiety, I had a mood disorder (mild bipolar symptoms), and an overactive temporal lobe. He explained, this is why I had anxiety, hyper-philosophical moments where I would not be able to stop thinking for hours on end, why I would see things out of the corner of my eyes that weren’t there, and why I had insomnia.
He prescribed me two medications. Interestingly, he told me that an anti-depressant would likely have worsened my condition. One was for anxiety and sleep, the other was a drug to reduce the electrical activity in my brain. I made istikharah first before popping a single pill into my mouth.
I took the anxiety one first (a benzodiazepine), and right away I realized I didn’t need my ZMA or melatonin anymore (I started taking the ZMA again a month later after suspecting that my sudden halting of ZMA after years of taking it daily may have affected my immune system as I had 3 consecutive sinus infections in a month. Instead I’m trying to slowly reduce it over time). I haven’t needed any melatonin since, except for a day or two every month if I want to rest after a busy week and sleep restfully for a good 9 hours. Although I only need to take the medication on a by-need basis, I’m taking it daily, as I’d rather take a small pill daily instead of huge ZMA ones. Yes there is a risk of dependence, but I’m very firm on myself to not go over my dosage and sometimes swap it out for my ZMA once in a while.
The other medication is important, and I want to talk about it. I was prescribed Lamotrigine for two years. The first week and a half I took it, I felt ‘normal’ again for the first time in 4 years. However, I misread the label, botched the titration of the dose and went up too fast. I developed a rash that can be fatal, and immediately stopped the drug. Although the rash went away, I was convinced that this was the medication that I needed. A lot of people get scared at this stage and stop taking their drugs, but I was convinced of its importance, and that I was the one who made the mistake. I looked in a lot of research papers on the drug and discovered that I could take it again after a few months if I went up in the dosage very slowly. I spoke to my psychiatrist and we agreed to restart it after Ramadan. Since after Ramadan in 2019, I have been taking the drug, and am taking the full dose Alhamdulillah and have been feeling ‘normal’ ever since.
I still have the odd ‘anxious’ feeling nowadays (although this is usually the result of too little sleep, too much coffee, or eating too much and junk food), but its nowhere near what it was before. The mental haze is gone, the feeling of impending doom is gone, my anger is more restrained and much easier to control, and I feel like I know who I am again. But perhaps most importantly for me as student of knowledge, I can focus exceedingly well on research, writing and reading without losing control of my mind and not being able to fall asleep at night. The most pleasant effect is that I feel that I can focus on spirituality again. The tranquility of prayer, dua, dhikr and sujud has returned in abundance, and it feels like a refuge again that I can come back to in times of seeking forgiveness or difficulty.
I’m no longer as skeptical of modern psychiatry as I used to be. Yes I would rather have lived my life without taking these medications but I had been bearing it and suffering for a long time and needed help. People have a lot of negative attitudes towards modern medication, but it makes sense when you realize that anything you put in your body will have secondary and tertiary effects, and that even ‘natural’ medicine can have side effects. Some plants can kill you if you consume them. In the end, our biology will always be impossible to fully understand, and evidence and research-based medicine is just our best attempt to understand it. It doesn’t mean its perfect. But it’s not wise to dismiss it entirely, although it is important to ensure you see an experienced, well-read and intelligent specialist for your health issues. A family doctor is a generalist and not always the best for understanding specialist medical issues.
I will update this article with any new developments in my journey, and inshaAllah they will be positive.
To summarize some of the main points of advice implicitly or explicitly mentioned in this article:
- We need to end the stigma on mental illness, and move beyond that into normalizing diagnosis, treatment and prevention of it among Muslims. This means addressing a lot of religious, political & social ills we have.
- Students of knowledge can get serious mental illness too. You faith and spirituality are helpful, but they do not render you bulletproof from physical, mental and emotional trauma that penetrates into your neurology and endocrinology.
- Stress management: Deal with it before it destroys you. Don’t be Superman. You’re human.
- Sleep aids: try ZMA or melatonin if you don’t have medication yet. I’ve known people who suffer from insomnia for months before they see a doctor and become suicidal because of it.
- Don’t mistake ‘feelings’ for disorders. They are two different things.
- Make sure your doctor is not just a specialist, that they are intelligent and an expert in their craft. I’ve seen the difference between medical specialists who just work and go home, and those for whom medicine is a passion and they are either professors and researchers on the side or take the intellectual side of medicine seriously when dealing with their patients. Having friends who are doctors helped me with this a lot. Not all of them are the same.
- Don’t be afraid of medication. It is probably better to avoid it if you can, but don’t be afraid to go down that route if you need it. It has a job to do, and until you can handle it yourself and improve your lifestyle, environment or social circumstances, it can be critical for your health.
- Don’t freak out with side effects. Talk to your doctor (again, a good one) and discuss options accordingly.
- Get help. Don’t do it alone.
There are many other things that can be said. Please don’t hesitate to send me feedback, tips or advice on this article. It could be very helpful to me, or to others.