Afghanistan tackles hidden mental health epidemic

September 3, 2015, by Sune Engel Rasmussen, Sept. 2, 2015, original
Dr Fareshta Quedees, project manager at the International Psychosocial Organisation in Kabul, at a training session for counsellors. Photograph: Sune Engel Rasmussen

Mohammad Qassem had been chained to a wall for 13 days. Locked in a tiny concrete cell with his hands and feet shackled, he had 27 days left before he would be declared healthy.

During that period, the keeper of the holy shrine where Qassem was held would feed him only tea, bread and black pepper, ostensibly to rid him of what his family said was insanity. Qassem, a former soldier who spoke hoarsely, with bursts of laughter, said he just had a hashish addiction. “When I don’t smoke hashish I want to kill all foreigners,” he roared, to giggles from a crowd of onlookers from the nearby village who had gathered at the cell entrance.

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For generations, the Mia Ali Baba Shrine, in a rural part of Nangarhar province, has been renowned for allegedly curing mental illnesses with forced asceticism and spiritual cleansing. “We leave everything to God,” said the shrine keeper, Mia Saheb. “The Earth and the sky have been made by God. God takes care of the patients.”

Qassem, meanwhile, showed off wounds where the chains had gnawed into his wrists. “They need to take me to the doctor instead of putting me in prison here,” he said. “They made me crazier by bringing me here.”

Fourteen years of violence have created a hidden epidemic inAfghanistan of post-traumatic stress disorder (PTSD) and other war-induced illnesses. It is one of the most enduring damages wrought by the war – one few people understand, and fewer can treat. But a small army of therapists now seeks to change that. And they are led by a woman.

“We are in a vicious cycle of violence and trauma,” said Dr Fareshta Quedees, project manager at the International Psychosocial Organisation (Ipso) in Kabul and the driving force behind training 280 psychosocial counsellors who work across the country.

Half of the counsellors are women, a rare ratio for any profession in Afghanistan, and an acknowledgment that wives and families also suffer from trauma, despite often being removed from the frontline. Domestic violence, for instance, is rampant in Afghanistan, and is often unleashed by trauma.

“Women don’t necessarily face trauma directly but traumatised men are more violent, and that increases family conflicts,” said Fariba Amin from the provincial hospital in Zabul, who, along with dozens of fellow counsellors, had come to Kabul for a five-day training course.

A man chained beneath a tree, as treatment for his mental illness, on the compounds of Mia Ali Baba Shrine in Nangarhar province, Afghanistan. Photograph: Rahmat Gul/AP

For women, she said, counselling is a rare chance to confide in someone. Afghan women are rarely asked about their hopes and dreams, let alone what burdens them. “That someone sits down and listens to the woman is a treatment in itself,” said Amin.

A UN-sponsored survey found that in 2005, 16.5% of Afghans suffered from mental disorders. The problem is likely to have grown since then.

The Afghan government has made tackling mental illness a priority and developed a national mental health strategy. All provincial hospitals now offer counselling. Counselling is free, and even available online.

Quedees, 35, discovered psychosocial counselling in 2004, while in medical school, during a stint as a translator for a foreign NGO. She found the therapy resonating with ideas she had harboured herself but never articulated. “I was the sort of person who always talked a lot about my feelings, and I remember my friends made fun of me,” she said with a smile.

But Quedees’s counsellors are working against long-held traditions and a culture of stigmatisation of the mentally ill. Faced with mental disorder, many resort to drugs or superstitious practices that often cause more harm than good.

Critics claim the treatment at shrines like Mia Ali Baba is a hoax, which sedates patients suffering from hunger and maltreatment rather than curing them. Still, locals maintain a strong belief in their healing powers. One of them, Nasibullah Subara, said the treatment had helped his nephew.

“Before, he didn’t sleep. He had a short temper and bothered his family. But now he doesn’t have those problems,” Subara said. The $20 cost of the treatment at the shrine is cheaper than medicine or a trip to the nearest hospital. As a result, the shrine’s 16 cells are often full.

Modern therapy is also at odds with the sense of privacy so paramount in Afghan culture. “Many people don’t like the concept of counselling. It is not appropriate in our culture to share intimate matters and family secrets,” said Fatma Dauladzai, a counsellor from Paktia province.

But while the idea of counselling has yet to take firm root, women, especially, are growing more receptive.

Wahid Nurzad, a male counsellor from Herat, recalled a group session for people who had experienced domestic violence, where one 35-year-old woman suddenly started crying: “When these tears of mine are falling, I feel lighter,” she had said. “I forget the suffering I have gone through.”

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