What I learned from a Muslim psychiatrist

There is something deeply deceptive about despair. We usually do not see it that way. We call it pain, grief, and darkness. We call it the feeling that the world has collapsed in front of our eyes. And all of these descriptions may be true. The suffering is real. The weight is real, the tears are not fake, the person who is hurting is not pretending.

But beneath the pain, if we listen carefully, there is often a claim being made — that nothing will ever get better.

This is not simply saying, things are unbearable right now. It is not simply saying, I cannot see a way forward. It is making a far greater claim. It is saying that the future has already been examined and found to contain no mercy, no opening, no relief, no change, no unexpected gift from Allah.

If you are reading this from a place of pain, I acknowledge that what you are carrying is real, but no human being has the authority to say that the future is complete darkness. At the same time, the feeling that things will not change is not a character flaw. It is what happens when a person has been under unbearable pressure for long enough.

You are not weak for feeling this way. You are not a failure of faith. The most honoured people in the history of this religion were broken at points in their lives. The Companions cried out asking when relief would come. The Prophet ﷺ experienced grief so acute that Allah revealed verses to address his state. Being in pain is not evidence that Allah has abandoned you. In many cases, it is the opposite.

So before anything else, let that be said. You are seen. What you are carrying is real.

What is the specific claim that despair is making to you?

I ask this question, not concerning the pain itself, but the story the pain is telling about the future. That this will never improve. That no door will open. That you have already seen enough to know how the rest of the story ends.

Sit with that claim for a moment, because this is where something important can begin. Because that claim, however loud it feels, however convincing it has become, is the thing that Dr. Zeyn Green-Thompson, consultant psychiatrist with two decades of experience in emergency- and neuro-psychiatry, asks his patients to examine carefully. He trained in South Africa and Cambridge and has sat with people in some of the most difficult rooms medicine has to offer. Rooms where people arrive after they have decided, or almost decided, that life is no longer worth continuing.

He does not speak to them with shallow optimism. He does not say “just cheer up”. He does not dismiss their suffering. He tells them something far more serious:

Hopelessness is always a lie

It’s not a lie because the person is dishonest or because their pain is exaggerated. It is a lie because it makes a claim that no human being can prove. It requires the person to know, with certainty, that no solution will ever come, no relief will ever arrive, and no future moment will ever be different from the present one. But you do not know that. You cannot know that.

As Dr. Green-Thompson explains, you cannot have perfect knowledge that things will not get better. It is entirely possible that a solution could appear from a direction you do not see. This is not merely religious language. It is rationally true. The one who says there is no hope is not describing the future. They are describing how the present feels. And the present, however painful, is not the whole of reality.

I understand why a person in that place stops being able to imagine otherwise. Suicidal thoughts, in their most dangerous form, are not merely feelings. They often arrive with a conclusion attached: there is no solution, there will never be a solution, therefore there is no reason to remain.

What makes the situation more dangerous is not the pain itself, but when pain becomes certainty. When suffering is no longer experienced as present but as permanent. When the mind begins to speak about tomorrow as if tomorrow has already been fully known.

This is where the psychiatrist’s framing carries such weight. He is not asking anyone to pretend they are fine. He is not blaming the person in crisis. He is pointing to something precise: the central claim of hopelessness does not stand. It has no evidence strong enough to justify the conclusion it reaches.

Hope, by contrast, is more honest. Hope does not say, I know everything will happen exactly as I want. Hope says, I do not know what Allah has written. I do not know what may open. I do not know what help may come. So I will not close a door that Allah has not closed.

That is humility. Despair speaks as if it has seen the Unseen. Hope admits that it has not. And for the Muslim, the matter goes deeper still. We believe in the Lord who parted the sea for Mūsā (ʿalayhi al-Salām); Who saved Yusuf (ʿalayhi al-Salām) from the well and from the prison; Who protected Ibrāhīm (ʿalayhi al-Salām) when the fire was made cool; Who brought victory to His Messenger ﷺ after years of rejection, grief and hardship.

When the heart whispers that nothing can change, īmān answers: you do not know what Allah may do next!

The model that is missing a dimension

Modern psychiatry often works with what is called the biopsychosocial model. It looks at three dimensions:

1. the biological — what is happening in the body, the brain, and the nervous system;
2. the psychological — what wounds, thoughts, coping patterns, and traumas shape the inner life;
3. and the social — what relationships, community, responsibilities, and support systems surround the person.

This model is useful. It matters. We should not dismiss it. But Dr. Green-Thompson argues that, as Muslims, we must not stop there.

As he puts it, we should not just look at those three aspects. We should be looking at the spiritual. And it should not merely be one of four dimensions. It should inform our view of all of the dimensions.

This changes the entire picture. The spiritual is not another box to tick. It is the lens through which everything else is properly understood. Our deepest beliefs shape how we suffer. They shape how we interpret loss and shape whether we see hardship as meaningless punishment or as a test, purification, warning, elevation, or invitation back to Allah.

A person who knows that their duty is to act well, to make sincere effort, to seek help, to take the means, and then to leave the outcome to Allah, is protected from a crushing illusion: that everything depends entirely on them.

As Dr. Green-Thompson tells his patients, Muslim and non-Muslim alike: your duty is to be a good person, to have good intentions, and to do the best you reasonably can. Performing your duty does not guarantee the outcome you desire. But it was still your duty to do those things.

This is a powerful reframe. It disconnects worth from outcome. It separates effort from result. It teaches the soul that failure is not proof of worthlessness, and success is not proof of self-sufficiency. If Allah gives a good outcome, there is shukr (gratitude). If Allah tests with a painful outcome, there is sabr (patience and perseverance). In both cases, we belong to Him.

The Prophet ﷺ said,

Amazing is the affair of the believer. All of it is good for him, and this is for no one except the believer. If good comes to him, he is grateful, and that is good for him. If harm comes to him, he is patient, and that is good for him.” [1]

So there is no outcome in which the believer is left with nothing.

The certainty nobody has

There is a subtle danger inside hopelessness. It is not arrogance in the ordinary sense. It is not pride, boasting, or self-admiration. A person in despair usually feels the opposite. They feel weak, broken, ashamed, or exhausted. But hopelessness carries a hidden assumption: that one already knows the end of the story.

I know this will never improve. I know there is no way out. I know nothing can help me.”

But to know these things, to truly know them, one would need complete knowledge of the future. One would need to see every path Allah may open, every person Allah may send, every treatment Allah may make effective, every change Allah may create in the heart, every mercy Allah may place in the days ahead. No human being has that knowledge. No human being has ever had that knowledge.

So the invitation is not to pretend you are fine. The invitation is this: stay, because you do not know what Allah may show you next. Stay, because the story is not finished. Stay, because the door you cannot see may already be on its way to opening.

Prophet Mūsā under the tree

There is a Qur’ānic scene that Dr. Green-Thompson returns to, when speaking about despair.

Musa (ʿalayhi al-Salām) had fled Egypt. He had lost his position, his security, his home, and the future he once knew. He arrived in Madyan exhausted, hungry, and alone. He sat under a tree and made one of the most beautiful supplications in the Qur’ān:

My Lord, I am truly in need of whatever good You send down to me.” [2]

A du’ā of need. No performance, pretence, or grand speech. Just a servant, broken before his Lord.

But then something remarkable happens. Before the provision arrives, before his circumstances change, before he receives shelter, marriage, work, and a new chapter of life, Mūsā sees two women in need. They are unable to water their flock. So he gets up and helps them.

He is exhausted, but he gets up. He is in need, but he serves. He is broken, but he acts. And through that one act, Allah opens a new future for him.

This does not mean that every person in pain must suddenly become strong. It means that sometimes the smallest sincere action can become the means by which Allah opens something vast. One prayer, phone call, or appointment. One honest conversation, a walk to the masjid, or an act of service. One refusal to let the lie of hopelessness make the final decision.

Shukr is the practice that restructures the soul

There is a concept that runs through this entire discussion like a spine: shukr (gratitude).

Not gratitude as a mood or gratitude as pretending everything is fine. Not gratitude as denying trauma, grief, or depression. Shukr is seeing reality more accurately.

Dr. Green-Thompson reflects on the verse in Surah Ibrāhīm, in which Allah tells us that if we were to count the blessings of Allah, we could never enumerate them. The wording is profound. It is not merely that we cannot count all blessings. It is that even one blessing from Allah contains more than we can fully account for.

Consider the heartbeat. Your heart is beating now. It began before you were born and was working in the womb before you knew how to ask for anything. It beats while you sleep, when you forget Allah, when you are angry, distracted, heedless, or broken. It asks for no applause.

If you were told you had only a thousand heartbeats left, and that you could buy more with all your wealth, you would give everything. Yet the heart has been beating for years. How many times have we said “alhamdulillāh” for it?

This is not said to shame the one who is suffering. It is said to gently correct the scale by which despair measures life. Despair often counts what has been taken and forgets what is still being given. The marriage ended, the job was lost, the illness came, the humiliation happened, and grief remains. These things may be real. Islam does not ask us to lie about pain. But those losses take place inside a life that is still being sustained by Allah. If the heart is still beating, if the lungs are still breathing, if the mind can still turn even faintly toward Allah, then the account has not been closed. The story is still open.

Shukr does not remove pain instantly. It reorients the soul and reminds us that despair has not been doing honest accounting. It has been counting wounds while ignoring gifts. And sometimes the first act of shukr is very small. A breath. Alhamdulillāh. A glass of water. Alhamdulillāh. A heartbeat you did not command. Alhamdulillāh. A morning you did not create. Alhamdulillāh.

You do not need to feel grateful in a dramatic way. You only need to turn in the direction of gratitude, even from the floor.

Shukr goes hand in hand with istighfār

Dr. Green-Thompson also reminds us that gratitude must be joined with istighfār.

The Prophet ﷺ repeatedly sought forgiveness throughout the day, even though he was the most beloved of creation to Allah. This teaches us that gratitude and repentance are not occasional emotions; they are daily disciplines of return.

• Shukr says: my Lord, everything I have is from You.
• Istighfār says: my Lord, I have not responded to Your gifts as I should.

Together, they protect the heart. They do not create a cycle of shame. They create a path of return.

For someone in depression, the words “be grateful” can sometimes feel like an accusation. As if the person is being told they are failing again. That is not the Islamic meaning of shukr. Shukr is not a grade. It is a direction. Face Allah, even weakly. Say “alhamdulillāh”, even quietly. Return, imperfectly.

Allah is not asking you to arrive with a polished heart. He is inviting you to turn with the heart you have.

Freedom from the tyranny of outcomes

You want to be free? Dr. Green-Thompson asks his patients. Stop being enslaved by outcomes. Free yourself from the tyranny of results. You had a duty to act and you acted. The rest belongs to Allah.

This is not passivity. It is not doing nothing. It is the freedom of knowing what belongs to you and what belongs to Allah. You are responsible for effort, not control. You are responsible for sincerity, not guarantees. You are responsible for taking the means, not owning the Unseen.

This matters deeply for mental health. Many people are crushed not only by what happened, but by the belief that they should have been able to control it. They blame themselves for outcomes that were never fully in their hands. Islam liberates us from this. Act. Seek help. Take the medicine if needed. Speak to the therapist. Call the friend. Make the du’ā. Pray on time. Show up to what you can. And then know: the outcome belongs to Allah.

The community must not look away

There is a silence that surrounds suicide in many communities. Sometimes it comes from stigma. People fear that speaking about suicidal thoughts will make things worse. They fear saying the wrong thing. They fear bringing shame onto the family. So they say nothing. But silence can make the person who is struggling feel even more alone. They may think: there is no place for my pain here.

Among younger generations, the problem can be different. Mental health language is everywhere. It is shared, posted, and sometimes turned into an identity. The danger here is not always silence, but normalisation without seriousness. Words that should carry weight become casual. Pain becomes content. Diagnosis becomes social currency.

Both responses fail people.

The elderly man who has never had language for depression and the teenager who has too much language but not enough guidance do not need the same conversation. They need care that understands their world. But both need a community that does not look away.

If someone says they want to die, or gives signs that they may be moving in that direction, the response cannot be silence. We do not need perfect words, we need sincere words. We need presence. We need to say: I am here. I am listening. You are not a burden. We need to get help. Let us speak to someone now.

This is not weakness. This is responsibility.

Hope is always true

There is a final inversion in Dr. Green-Thompson’s argument.

Hopelessness is always a lie. But hope is always true, not because everything will happen exactly as we want, not because every du’ā is answered in the form we imagined, not because pain disappears immediately.

Hope is true because it speaks within the limits of human knowledge. Hope says: I do not know what is coming. I do not know what Allah may open. I do not know what mercy may arrive. I do not know what strength may be placed in me. So I will not pretend that the future is closed.

This is īmān refusing to let pain become prophecy. It is the servant saying: my Lord, I cannot see the way, but You can. And Allah, who says Be and it is, can bring relief from a direction you do not see.

Patience and perseverance (sabr) is not passive waiting. It is the active refusal to let despair have the final word. Gratitude (shukr) is not denial of pain. It is the restoration of truthful vision. And hopelessness, however loud it becomes, however convincing it feels, however real the pain beneath it may be, is still making a claim it cannot prove.

It is always, in the end, a lie.

---

Source: Hold On / Islam21c

Notes

[1] Sahīh Muslim, 2,699; https://sunnah.com/muslim:2999

[2] al-Qur’ān, 28:24