Monday, July 28, 2008

Islamic Psychotherapy Online
(Revised version)
Volume 11, November 2009
St. Louis, Missouri

Editor: Mohamed Ziauddin

In the Name of Allah, the Most Beneficial and the Most Merciful


Suicide is a major problem in the United States impacting individuals of different age groups. In terms of the elderly (age 65 and older), although they comprise about 13 percent of the U.S. population, they account for over 18 percent of all suicides. As indicated in the past, our Muslim Ummah is not immune from the contemporary problems facing our society in the U.S. today.

A significant percentage of American Muslims are immigrants who have been born overseas. Many of the immigrants, once they are settled down, consider it only but natural to sponsor their parents and bring them to live with them in the U.S.

On the positive side, both the parents and the children are generally happy to be living together again. The children have a feeling of personal contentment that for all the sacrifices made by the parents, the least they could do is to bring their parents to the U.S. and not only live with them but if possible show them around various local and out of town tourist places within the United States et.c.

However given the economic realities in the US where both husband and wife had to work to support the family, in many cases it leads to increased loneliness of the parents during the the hours of work of their children and in-laws. Many of the elderly lack fluency in English and this makes it difficult to communicate with the new social circle that they may have made in their local neighborhood. In communities where there is large Muslim population, it makes it easier for them to initiate and maintain contacts with other elderly persons who share their same language, culture, nation of birth and or religion.

As far as the socialization is concerned for the elderly immigrants, it is possible mostly during weekends, when in most cases the elderly persons would have the company of their children with them and have greater opportunities to leave the house either to visit their local Mosque, or to host or be a guest at parties, functions and anniversaries.

One of the realities for the elderly is that many of them have not just one or two but multiple medical problems and they have to deal with it on a day to day basis. It becomes more hard during the work week when they have no physical or emotional support during most of the day. In many cases, the children may call from work to see how the parent is doing, but it makes a difference when the same child is at home to assist the parent(s) with his /her multiple medical problems.

The extent and frequency to which the elderly parent may need the assistance from the children varies widely depending upon the severity of their medical condition. Many times the child may take off from work to take the parent on Dr's appointments or to hospital as needed.

At times the parent feels guilty of taking away the time of their child from work and worry if frequent such time offs from work may adversely affect the child's ability to maintain his or her employment in good standing. The elderly parent's guilt may be significantly impacting him or her but they may not verbalize it. This coupled with other ongoing stressors on the elderly may be taking a silent toll. It is always important to KEEP THE COMMUNICATION LINES OPEN not only between the elderly parent and the child but also encourage the elderly parent to reach out and contact other socially supportive resources in the area whatever they may be.

Too frequently the major stressor for the Muslim elderly parent may be the multiple medical problems. Besides the above, there may be other problems such as financial problems in the family that they are currently living and their own feelings of guilt of becoming a financial liability to their children, problems with not having insurance or having only partial insurance or difficulty making the huge co-payments for their medical expenses while being hospitalized or for getting their medications et.c.

It could also be relationship problems with the child or child's spouse (in-laws). Or to complicate matters, their medical condition may be worse to the point that they need to be supervised 24/7 which involves their transfer to a nursing facility Not knowing fluent English and feeling lonely and/or abandoned at a nursing home could further increase their sense of alienation from their traditional support system and also increase their stress level.
If the multiple stressors continue with no resolution, very likely it may lead to depression and if left untreated it may end in suicide.

Not surprisingly, the most common cause for elderly suicide is depression that has not been treated. It is to be noted that about one third of the elderly experience depression. Before assuming the depression purely from a psychiatric view point, it is important for the elderly to receive a physical examination from a medical doctor to rule out physical basis for depression.

Some physical conditions may cause symptoms of depression. For example, thyroid disorders, diabetes, Parkinsons disease, multiple sclerosis, strokes, tumors and some viral infections may cause symptoms that mimic depression.

Similarly, some medications may cause symptoms of depression such as blood pressure medication, arthritis medicaton, hormones and steroids.

It is important that an elderly person who has gone through a recent and major stressor must be closely monitored. Some elderly persons may be in denial of their depression or hide their depresson for various reasons. Therefore it is all the more critical to watch closely for any hint of a suicide warning sign or depressive symptom. Elderly persons must be encouraged to seek help.

As Islamic Psychotherapists we call upon all Islamic Centers to ensure that they not only have a SOCIAL SERVICE COMMITTEE but also have a sub-committee that aims to assist the elderly Muslims by taking the following steps:

1) Identify the number of elderly Muslims in the Islamic Center's catchement area that are in need and willing to receive supplemental help from the Islamic Center. We use the word "supplemental" because there is already an assumption that the Federal, State, Local Govt and other private social service organizations are already providing the PRIMARY help to the elderly.

2) Assign a Voluntary Ansar (Case Worker) to the elderly Muslim who need intensive case management. We mean intensive in those cases where the elderly Muslim has very minimal support from family if any. The case worker can monitor the elderly Muslim by frequent and regular phone contact, provide ongoing referrals and links to other social service agencies in the community including (if needed) home health care et.c, Meals on Wheels services et.c. Last but not the least be of immense emotional support to the elderly Muslim.

It was sad to note during one of my earlier visits to a elderly Muslim in a nursing home who told me that that for the past several years, there was not a single Muslim that visited him. All of his relatives were oversees and his primary social support initially came when he was living in an apartment in the community and visiting the local Mosque. As his medical condition worsened to the point that he could not physically take care of himself and his medical needs, there was no option but to be permanently placed in a nursing home. WHEN WE TALK ABOUT THE UMMAH, it is here that we need to REALLY CARE FOR THE MOST VULNERABLE AND HELPLESS GROUPS OF PEOPLE WITHIN OUR COMMUNITY.

Anyone needing help to start above Social Service Commitee and subcommitee for the elderly at their local Islamic Center are welcome to e-mail us at below e-mail address and we will be glad to assist them.

As usual, feel free to e-mail your valuable opinion and comments to