She seemed to have it all - which is why the murder-suicide was even more shocking.

When Noera Ayaz died by suicide after killing her two children on September 5, 2018, Muslims in her Herndon, Virginia community, as well as across the country, struggled to understand the tragedy.

She was a doting mother, and an award-winning, Ivy League-educated attorney who helped domestic violence victims on a pro bono basis. She also regularly worshipped at the ADAMS Center, one of the nation’s most dynamic and well-established Masjids.

But the news did not surprise Nadia*, a Muslim mother of two young children in Chicago. She had attempted to kill herself two months before this incident.

“You’re feeling depressed and worthless,” she explained in an interview with Sound Vision. “You can’t help yourself and you’re sad. You get to a point where you can’t even take care of yourself. You decide to help everyone else and put this fake smile on your face because when you’re known as the smiler, you feel good about yourself, you’re not worthless.

“We just want people to think we’re normal. We go through so much on the inside, we need to make ourselves look normal on the outside.”

Statistics on the Muslim suicide rate

To date, no Muslim suicide rate has been determined.

Dr. Rania Awaad is Clinical Director of the Bay Area branches of the Khalil Center, the largest clinic nationwide for Muslim mental health issues, including crisis work. She said there is very little research on suicide among Muslims because Muslim countries don’t report deaths by suicide to the World Health Organization (WHO).

As well, neither the United States, nor Canada report suicides based on the religion of the deceased.

Generally, in America, according to the U.S. Centers for Disease Control (CDC), suicide rates have been rising in nearly every state. In 2016, nearly 45,000 Americans aged 10 or older died by suicide. Suicide is the tenth leading cause of death. It is also one of the three leading causes that are on the rise.

The same is true of Canada, where suicide is the ninth leading cause of death.

Anecdotal information offers some clues about the crisis of suicide in the Muslim community. In 2017, Sound Vision established a partnership with Crisis Text Line to offer a free, confidential, text-based hotline service for Muslims. By texting “SALAM” to the number 741741 at any day or time, callers can reach out to a counselor trained to handle all kinds of crises. Suicide was the fifth most common reason people texted or called.

Another clue is the training Awaad, who is also Clinical Assistant Professor at Stanford University’s Department of Psychiatry, gives to leaders in the aftermath of a suicide in a Muslim community.

In 2018, she offered at least six of these trainings across four different states. The program works with the local team of mental health professionals, as well as the Imam or religious leaders to help Muslims handle the pain, grief, and shock when a loved one or community member dies by suicide.

The Islamic view of suicide: Balancing prohibition with compassion

In the Quran, suicide is defined as a sin.

“O you who have believed, do not consume one another's wealth unjustly but only business by mutual consent. And do not kill yourselves. Indeed, God is to you ever Merciful. And whoever does that in aggression and injustice - then We will drive him into a Fire. And that, for God, is easy” (4:29-30).

“One of the things that happens, and this comes from Muslims being very conscious of their faith, is that when something comes up they want to say ‘What does our religion say about this matter?’” said Shaykh Rami Nsour, Director of the Tayba Foundation, in Union City, California, and a Senior Instructor at SeekersHub Global.

He noted that while Muslims have asked questions like whether the deceased should be buried as a Muslim, and if one can attend the Janaza (funeral prayer) of someone who died this way, this is not the right response.

“Although I’m able to answer those questions, I tell people that in the aftermath of a tragedy like this, it’s a time to get through the process and to help the survivors, the family and friends,” he said.

“This person is to be buried as a Muslim and to be offered the rites of a Janaza,” he emphasized.

Awaad, who is also a professor of Islamic law at Zaytuna College in Berkeley, California, added that while this one verse of the Quran prohibits taking one’s life, there are also rules and varying interpretations in Islamic jurisprudence about what to do when someone dies by suicide.

Nsour emphasized the need for Imams and community leaders in the aftermath of a suicide to “really understand the matter properly, the theological and legal issues surrounding the status of this act. They should understand the Tafsir (explanation) of the verses of the Quran related to this, and the commentary of the Hadith that are related to this.”

”Suicide is a more complicated construct in Islam,” explained Dr. Farah Islam, a mental health educator and scriptwriter of the Muslim children’s program Adam’s World in Toronto, Canada. She said many see the issue as black and white “but our religion is more nuanced than that.”

This is especially in cases where an individual has mental illness, something that is common in the majority of suicide cases.

The key role of mental illness

Mental illness is considered a primary cause in many suicides, although experts agree that other factors and stressors play a role as well.

“Over 90 percent of suicides are actually mental health related, whether the mental illness was diagnosed or undiagnosed,” said Awaad. “Sometimes it is undiagnosed or sometimes it’s not fully treated.”

When a mentally ill Muslim dies by suicide, “Allah does not hold that person responsible,” said Imam Abdul Malik Mujahid, President of Sound Vision.

“In Islam, being ‘sane’ or what we would today call ‘in stable mental health’ is a condition to fulfill Islamic obligations. This includes all five pillars of Islam and every other act of worship. A person who is not in that state is not held accountable for these obligations, nor are they punished for sins the way a person of sound mind would be.”

Mental illness played a direct role in Nadia’s suicide attempt. She fell into depression six years prior to it, after the death of her young daughter. She said most of her family and the Muslim community were unhelpful.

“Whenever I had a hard time, I was told I wasn’t praying enough, it’s the Shaytan, and it’s a problem with my faith,” she said. “For a while it started pushing me away from my faith. I felt like I couldn’t even be sad without feeling guilt about it.

“It would have also been really nice if my spouse understood my pain. If I had Muslim friends who had been supportive,” said Nadia.

Her sole source of support was her mother-in-law, who helped and consoled her, even as everyone else failed to understand the level of her pain and grief.

But that ended when she died in early 2018. It was a blow that hit Nadia hard.

“When I tried to commit suicide it was two months after she had passed,” she said. “Nobody was understanding. Nobody would reach out and help me. I was labeled as ‘crazy’ and I would just start keeping my feelings to myself and put a fake smile on.”

She and her family were on vacation when she attempted suicide. As her husband and children slept, she tried to hang herself, remembering fashion designer Kate Spade, who had died by suicide this way just weeks before. While the attempt caused Nadia pain, it didn’t kill her. That was when she decided she had to stop.

“When it failed I was staring at the mirror and I could see the red ring around my neck, and I thought, ‘I need help’, because my kids almost became motherless,” she said. “I think that’s when I realized what this could do to my children.”

The need for more awareness of mental health struggles, better services, as well as mental health literacy, are key. But many in the Muslim community still shy away from seeing a psychiatrist or counselor when mental illness becomes overwhelming. And few will recommend family members and friends to a professional when it is clearly needed.

“We’re allowing our community members and our loved ones to inadvertently slip through the cracks by not referring to higher level help,” said Awaad.

“When someone has cancer, we don’t say that person didn’t pray enough,” said Nadia. “We don’t say their cancer is because they have a lack of faith. But if you’re depressed or you have some kind of mental illness, you’re made to feel that way.”

“Mental illness doesn’t discriminate,” Awaad stressed. “It’s not about class, education level, race, ethnic group, or even about religiosity.”

Islam noted that for women, an additional challenge is that there may be untreated mental illness that began as postpartum depression or psychosis. In one study she conducted of South Asian youth in the Toronto area, “a lot of them were seeking mental health services, and many of them had moms who most likely had some kind of postpartum depression and they hadn’t sought help”. She said this affected their parenting.

“We have to be proactive in taking care of our own mental health before taking care of our children’s,” she advised.

However, not all mental illness results in suicide. Many struggle with it but are able to manage it.

“It’s important to remember that people live with mental illness, and they may even be suicidal, but they get over it, take medications, or see a therapist,” said Islam.

This was the case for Nadia. Since her suicide attempt, she has found a supportive group of Muslims to help her, as well as a psychiatrist and a therapist.

“I just care about raising my children the right way and being there for the people going through this,” she said. “I want to speak. I almost lost my life that night.”

While mental health often provides a critical clue in figuring out why a Muslim dies by suicide, causes can be more complex.

“Suicide can to be linked to poor mental health, but a person doesn’t have to be suffering from a mental illness to die by suicide,” said Sakinah Kaiser, author of “No One Taught Me The Human Side of Islam: The Muslim Hippie’s Story of Living with Bipolar Disorder”. “You can be living with the effects of abuse, trauma, drug or substance use issues, abandonment or neglect issues, and so forth, which all contribute to suicidal ideation.”

The role of isolation

As was the case for Nadia, isolation exacerbates suicidal thoughts and tendencies.

“Isolation is a key factor in any type of suicide,” said Islam. “The feeling that nobody understands your pain.”

Awaad said even the physical presence of someone being there for a person considering suicide helps. In particular, listening to them, not turning away from them or shaming them for how they feel are important. Referral to a mental health professional can also help stop the suicide from happening.

“We have to open our lines of communication and actually be willing to listen,” said Islam. “When someone says ‘How are you?’, are you willing to hear something else? Do you know how to be an empathetic ear? We need to educate ourselves in emotional intelligence and read it in others. We should be able to see that pain in their eyes.”

The possible role of Islamophobia

Islamophobia and hate crimes against Muslims are rising in the U.S., Canada, and in other parts of the world.

In a 2017 report , the Council on American-Islamic Relations (CAIR) said it recorded over 2,200 “anti-Muslim bias incidents” for 2016. That was a 57 percent increase from the year before. Hate crimes rose 44 percent. This was even more than the stunning 374 percent increase between 2015 and 2016.

In Canada, the number of police-reported hate crimes against Muslims more than tripled between 2012 and 2015, despite the overall number of such crimes decreasing over the same period, according to Statistics Canada.

All of this leads to fear, stress, and anxiety that can result in mental illness or struggles. A number of studies since the 9/11 attacks published in the Journal of Muslim Mental Health have established the detrimental role Islamophobia has had on the mental health state of the Muslim community.

Perfectionism in the community

While isolation, mental illness, and Islamophobia may play a more direct role in suicides in the Muslim community, perfectionism is a hidden cause that few discuss.

“We often come from cultures of perfectionism,” said Islam. “You have to give this veneer of success in everything. The standards we set for ourselves and our community members are unbelievable and unattainable.”

Nadia felt the same way in dealing with her community as she struggled with depression which led her to attempt suicide.

“If you try to reach out to someone, if you are struggling as a parent, they’ll have this perfect story to follow up about their kids. Nobody wants to talk about their kids failing. Instead of coming together, they’re too scared to reach out and admit they’re not perfect for the fear of failure because everyone else in the community has to be pretend to be that way.”

Stigma

When it comes to the death of a loved one by suicide, Muslim families often hide the reality of how their loved one died.

“Because of the social stigma around suicide, they will give another reason for the sudden death. Saying it was an ‘accident’ is very common,” noted Awaad.

There have also been incidents of Muslim cemeteries not allowing those who have died by suicide to be buried there. This poses a challenge when those struggling with suicidal thoughts try to talk about it.

“It’s like the stigma of drug use,” said NSour. “(For) someone struggling with addiction issues, it may be so stigmatized that they don’t want to bring it up with someone within their faith. Nobody will argue that drug use is not Haram (forbidden). But if we stigmatize it and ignore it, then we don’t have a space for those struggling with those issues to start thinking of treatment.

“So in the same way, if we’re not recognizing that suicide is a struggle that some people deal with and we’re not having the conversation in our spaces, and educating our community, then where are these conversations going to be had?”

He stressed the need to have more open discussions about suicide and issues that may lead to it in mosques and Islamic centers.

“Many churches have AA (Alcoholics Anonymous) meetings in the church,” he said. “You would be hard pressed to find a Masjid that has an AA meeting. And that speaks to the stigmatizing of addiction and substance abuse in our communities.”

Solution: Better suicide awareness and mental health literacy

Nsour suggested ways that the silence and stigma around suicide can be challenged.

“The discussion around it needs to be normalized,” he said. “We need to have this discussion in our Islamic schools, Sunday schools, youth groups. The Imams, youth directors, Halaqa leaders need to be trained to know what to do, how to speak about it.”

He also suggested that the community should be made aware of suicide hotline numbers like Crisis Text Line , even posting them “in our bathrooms at the Masajid,” and to “dedicate one Khutba (Friday sermon) a year addressing this topic.”

Another solution is educating Imams and community leaders, who are on the frontline of the crisis. Islam recommends that they receive mental health first aid training, which is widely offered in Canada in mainstream social service settings.

Some of these initiatives are already happening. Awaad, who is also Director of the Stanford Muslim Mental Health Lab, said this institution is working on developing a manual for Muslim communities in the aftermath of a suicide.

As mentioned above, she has already been offering such trainings across the country.

In addition, the Stanford Muslim Mental Health Lab is working on a white paper that will gather the Islamic rulings on suicide to give religious leaders suggestions on what to say and how to say it post-suicide.

“Some people need the Imam to say it’s okay to grieve and not judge. Others need counselors to say ‘this is how you handle it’. We need both resources”

She is hopeful for the future.

“In most cases, with proper intervention, suicide is preventable,” she said. “Especially with the younger generation, across the board, they tend to be much more willing to talk about this.”

In terms of the general community, Nadia emphasized the need to develop the skill of listening without judgment, and offering empathy.

“Just let them talk and let them say what they need to say,” she advised. “Talk to them on a regular basis. You just want someone willing to listen and not judge. You can suggest some help. But let them know you’re still there. You’re not going to disappear. Then that makes us feel very isolated. We need to remember that it is our responsibility to make sure our community is healthy.”

Islam said Muslims can also help on an individual basis by reaching out to someone in crisis, and sharing incidents of personal hardship they were able to get through successfully.

She advised people to ask themselves “how can you be that hope for someone else (and pay) it forward?”

* Name changed for privacy purposes