By Suheir Kafri

May/June 2023

When I first started my job at the ADAMS (All-Dulles Area Muslim Society) mosque, I was very elated that I would be working with my own beloved community in Islam.

I had recently graduated with a degree in social work. However, in between graduating and getting a job, I went through an immense bout of depression, anxiety and grief. In May 2013, I sat among my fellow George Mason University graduates, waiting for my moment to walk across the stage and receive my diploma. Although I had waited for this pivotal and important moment for six years, another parallel moment held even more significance in my heart — my mother and children were in the stands, cheering me on as I started walking. She proudly held up a sign that said, “That’s my daughter!” 

I had married young and had my children. After my youngest got on the school bus, I enrolled in college. By the time I was a senior, my eldest daughter was freshman at the same college. It was a time of joy and such accomplishment. My support system included my mother, my biggest cheerleader. I would call her before every exam and ask her to pray for me.

A dialysis patient for 13 years, my mother went to her treatment center four times a week. I watched her endure her own depression after realizing what the future held for her as she waited for a kidney donor to match. Unfortunately, she never received a transplant. The doctors initially told us that without a donated kidney, she would live only another year because of other preexisting conditions. By the grace of God, she survived for longer than that.

The summer after graduation, I traveled. I made umra and visited my home country to see family and three months later, in August 2013, came back to the U.S. to begin job hunting. Six days after arriving, my mother went into cardiac arrest and returned to her Creator. I’ll never forget the grief that overtook me and the collapse of everything that was light in life. It felt as if someone had turned the lights off and I was in bleak darkness, unable to see forward or to process and function. If I didn’t have my children to care for, I think I would’ve been in a state of nonexistence and trying to hide from the world, for grief and depression had set in.

After six months, I woke up and prayed that God would remove me from this darkness. I looked for a job. The first one I saw was for a social worker at a mosque. After a few interviews, I was hired and told myself that day, “This will be my turning point! I’ll begin to utilize my skills to empower and enhance the lives of others.”

On my first day, I was instructed that some people would be asking for zakat assistance. But to my surprise, my first phone call was from a woman seeking help in reaching out to the community to get a donated kidney for her father, who had gone into kidney failure. I was immediately triggered and taken aback, because now I would have to re-enter the despair I had just recovered from. I took it as a sign that I was where God intended me to be. I promised to hold this community close to my heart, as my own pain was speaking to me through this woman. 

Determined to look deeper into my community’s issues, I greeted each client and listened to their stories. I helped them complete their applications for assistance and reveal how their hardships had begun. Knowing that I’d have to advocate for them, I began writing down my assessments of what resources they would need. 

Some of them were caretakers of their family, so earning a living and having a regular job everyday was nearly impossible. Others said they were taking care of family members with various mental health illnesses — schizophrenia, bipolar disorder and suicidal ideation — and that leaving their loved ones without daily supervision posed a safety risk. I’d hear them clients say, “If I leave my loved one alone for the day, I’m afraid of what will happen to them while I’m working.” 

Many said they had tried to work; however, they’d lose their jobs because they had to take so much time off. This scenario was very present in the community. I’d listen to the families and caregivers saying that they felt so helpless that they’d started developing anxiety and depression. After expressing my concern about their own well-being and suggesting therapy so they’d have a safe space to process what they were experiencing, I was often surprised by their replies.

After suggesting therapy as part of a holistic wellness approach, they’d reply, “No, I’m not sick, I don’t need a therapist” or “No, I can’t see a therapist because people will say that I’m crazy.” One of the most heartbreaking comments came from a woman who’d endured depression for an extended period of time. When I suggested therapy, she said, “No, I cannot go see a therapist, although I want to, because my husband will divorce me and tell his family. They’ll think I’m crazy.”

I had to think of other ways to convince them to get the help they needed. I advised them to share the symptoms — all mental health related — they were experiencing with their primary care doctor. I thought perhaps this would lead them to seek help. But many refused this option as well.

I felt helpless. How could I help my community beat the stigma associated with mental health?

I began thinking about how I could convince them to see mental health care in a new light. One evening as I reviewed the events of my workday, it came to me. I would bring the needed care to them. I’d enable them to seek help within a familiar sanctuary: their mosque. I created a Mosque Mental Health Model and, together with the imams, collaborated on ensuring that it would incorporate spirituality and the clinical aspect of care. 

Once the model was satisfactory, I asked the local Muslim mental health professionals to contract with the mosque and take the referrals I would send. I was so humbled by all of the therapists, professional counselors, social workers, psychiatrists and psychologists who agreed to help me destigmatize mental illness and treat the community, many of whom had been struggling alone for years.

As this model went into effect in 2015, the community slowly became more comfortable with this arrangement. I watched as client after client said “Yes.” Not only did mental health professionals treat them for depression and other mental health issues, but they also treated victims of domestic violence and various traumas.

As the number of professionals grew, our work continued with specialists who could shed light on those adverse childhood experiences that lead to mental health illnesses. We continued to educate the community through seminars and workshops on such topics as depression and PTSD, especially in terms of refugees, addiction and domestic violence. Our imams played a most supportive role by speaking about mental health in their Friday sermons and expressing the importance of seeking treatment for all such ailments while utilizing spirituality and the help of mental health clinicians.

Seeking to improve our model even more, in 2018 our mosque opened its first counseling office utilizing the living room model, an approach that makes clients feel like they’re sitting in their own living room. We have coffee, tea and snacks, and they can come to the mosque and see an onsite therapist.

By 2020, as Covid took a toll on the world, our dedicated team of mental health professionals addressed the rise in depression and isolation by switching over to a telehealth model of therapy via face-to-face Zoom meetings or phone calls. Many clients told me that this continuation of service was lifesaving, as the initial pre-therapy problem was their inability to seek support within their homes.

Although the effects of Covid linger on and many families have lost loved ones, their ensuing grief and depression would have become unbearable without the mosque’s mental health professionals who reached out and kept their clients on the path to healing.

Combining spirituality and mental health treatment provides hope, and this invaluable resource should be available for every Muslim struggling with mental illness. When you enter the mosque to speak with your imam about your troubles, you should be able to walk into the next office and receive mental health care. I would say that we, as Muslims, are getting stronger in this cause. We will continue striving to destigmatize mental illness and create a better quality of life for those who reach out.

In my mosque, mental health is as important as physical and spiritual health. There is no wellness without mental wellness. “Verily, with hardship comes ease” (94:5).

Suheir Kafri, BSW, QMHP-T, is social worker at the All-Dulles Area Muslim Society, Sterling, Va. bio

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By Khalid Iqbal

May/June 2023

A few weeks ago, I woke up in a daze realizing that I had just fainted. According to my doctors, my neck muscles were too stiff to protect my head and neck. I couldn’t move, turn or rest. 

During my first night home, I realized that I’d have to sleep while sitting in a chair. As this was a recipe for sleeplessness, I soon became lost in my thoughts and allowed depression to take control of my mind — thinking negatively about my past and my future, lost opportunities, my health and life after death. 

Time passed very slowly. I was anxiously waiting for fajr and then sunrise. But it was only 2:15 a.m. — more than three hours until fajr. The night crawled by so slowly, and the sound of the clock’s second hand grew louder as everyone else fell asleep. 

Sometimes I dosed off, but as my neck tilted sideways I woke up crying with pain. The neck brace didn’t help, for the pain was so severe. The doctors gave me strong pain relievers and muscle relaxants, but it seemed that every medication had more adverse side effects. Thinking that it has to be divine punishment for my sins, I tried to remember them and ask for His mercy and blessings.

I noticed that as time passed, I began to be changing. For example, I didn’t have the energy to do anything and was always thinking negatively about myself, the future, life and others. I didn’t enjoy anything anymore, even when my wife made my favorite dishes — I took a few bites and then stopped eating. I felt tired all the time, took a long time to decide what to wear or make simple decisions. I felt worthless and guilty for my non-participation at home and and the masjid, angry and agitated. Every night I thought about death, despite my fear of it, and how my being gone would affect my family. 

Only after I told my doctor did I learn that these are signs of depression and that I needed to see a specialist. By this time, my family had realized what was happening to me. They would listen to me non-judgmentally, even for long periods of time so I could get all my thoughts and concerns off my chest, trying to reassure me and get me to have a positive outlook. This was when my wife pushed me to find a mental health professional and get proper treatment. I’m lucky that my family was always there, engaging me in positive activities. 

The World Health Organization defines mental health as a state of well-being in which the individual realizes his/her ability to cope with stress, can work productively and contribute positively to his/her community

I went to a Virginia senior home to do some political campaigning for a candidate. I met two female residents. The first one, an Indian in her 80s who sews clothes for others to make some extra money, was extremely happy to see me. She asked me to stay a bit longer so we could converse in Punjabi. She told me that she was waiting for her son and grandchildren to visit. When I asked when they had last visited her, she couldn’t remember. She showed the date in her diary — they had visited two years ago.

Although Muslims get a lot of solace from praying and connecting with God to seek His guidance and mercy, our community isn’t immune to mental health issues. Family and marriage issues top the list, along with the death of a loved one, financial difficulties, loneliness, old age and materialism. Our youth are subjected to pressure through social media, Islamophobia, peer pressure, parental divorce, social pressure to excel in their studies, wear fashion and designer clothing and so on. 

Unfortunately, most curable mental health cases go undetected because of certain ill-formed myths and misconceptions, such as people with real mental health issues are violent. Research, however, shows that these people are no more violent than the general public. Another myth is that mental health disorders are signs of weakness and personality flaws 

Labeling people with a mental health issue only causes them to hide it and allow it to worsen. I remember a 15-year-old boy with severe undetected — and therefore unaddressed — depression. His parents only realized its severity after he committed suicide. 

The second lady wanted me to take some money she had saved and put it in the mosque’s zakat box. She had put the money in a pile of plastic shopping bags, along with other stuff, so no one could break in and take it while she was sleeping or when she was out. Being over 80, it took her 5 to 15 minutes to open each bag, most of which only had $5 inside; the rest was trash. 

My wife and I visited these ladies several times. They are getting frail and losing their vision and memory. Now they no longer recognize me. One of them passed away recently. I saw her son and grandchildren at the funeral. I hope they had visited her during her lifetime. 

I related my struggle and recovery to a friend, who referred me to a course on “Mental Health First Aid” offered by Loudoun County. While attending it, I recalled my emotional struggle and negative thoughts. Every bit was true — severe anxiety and depression while struggling to sleep sitting on that chair night after night.

My family, although not trained in mental health first aid, helped me every step of the way. My wife, especially, spent so much time talking with me about positive things, giving me hope and encouraging me to talk to my primary physician. We met, and right away he referred me to a specialist. 

My recovery taught me that dealing with a mental health issue is a deeply personal process of regaining physical, spiritual, mental and emotional balance. My brother and his wife came from Pakistan to visit me. Their presence had a very positive effect on my health, especially my thinking. Our ensuing discussions inspired me to learn how to cope with my situation. We would exercise together or talk about family or other matters. They were supportive and gave me hope, recognized and highlighted my strengths, encouraged me to use them to think positively from a strength-based perspective and helped me develop my self-esteem and coping skills.

The peer support they provided was the best aspect of my recovery. Instead of thinking negatively each night, I started to sleep most of the night and began thinking about positive things. I’d look forward to getting up for tahajjud and ask God for His blessing and mercy. My wife, my brother and his wife would get up and pray together with me. That was such a serene and beautiful environment. 

After the mental health first aid course, I realized that it’s important to become familiar with and how to cope with the various aspects of mental health. We need to learn how to recognize if someone has an issue and talk with them about it in a non-judgmental way, to encourage them to seek professional help and to be there for them throughout their ordeal. This is especially important for parents of young children who sometimes have mood swings, anxiety or depression. Parents must be there for them, to talk with them nicely with love and mercy, to understand their mood(s). 

Just like knowing first aid, mental health first aid will also help support and save lives, especially of those who are depressed and commit suicide or hurt themselves. Our centers and mosques should begin conducting this type of training. 

Khalid Iqbal is founder of Rahmaa Institute, which focuses on issues related to marriage, conflict resolution, divorce, domestic violence and anger prevention. He is an author (“Anger and Domestic Violence Prevention Guide for the Muslim Community”) and speaker who has developed and teaches a comprehensive eight-hour premarital counseling course. He has been married for 50 years and has three wonderful children and ten grandchildren.

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