Learning to Deal With Stress

The nation’s mental health appears to be improving two years after a survey suggested a large majority of Afghans suffer from psychological problems.

The study, conducted in 2002, but only published last month in the Journal of the American Medical Association, revealed that almost 68 per cent of the population are affected by depression, while 72 per cent showed symptoms of anxiety. The percentages were even higher among women and the disabled.

The study, conducted in 2002 by the US Centres for Disease Control and Prevention and collaborating partners, concluded, "In this nationally representative survey of Afghans, prevalence rates of the symptoms of depression, anxiety, and Post Traumatic Stress Disorder were high."

But now, two years since that study was conducted, although specialist facilities and modern equipment remain in critical short supply, there appears to be signs that the nation’s mental health is improving, according to two psychologists who work in the capital.

Khitab Kaker, director of the Afghanistan’s only mental health hospital, said he believed that currently between 20 to 30 per cent of the population is mentally ill including people that are clinically depressed, while between 40 to 50 per cent suffer from anxiety. He based his conclusions on figures drawn from his own hospital in Kabul, as well as medical NGOs, health clinics and general hospitals throughout the country.

Dr Emal Aziz Jabbarkhail, who works in the psychiatric ward of Kabul’s Ali Abad Hospital, said the number of patients he treats for mental health problems has sharply declined over the past two years.

Jabbarkhail, who also lectures at the Kabul Medical University, credited the improved economic and political situation in the country for the apparent decline.

“In the past people didn’t have peace, and they were in a bad mental situation because of the fighting,” explained Jabbarkhail.

Dr Mohammed Fahim Pazhman, a psychologist at the Army Medical Academy Hospital in Kabul, agreed.

“During the Taleban government, the economic situation of people was bad. And also the security situation was bad,” he said. “People always felt that they were in jail, not in Afghanistan.”

Dr Pazhman said that under the Taleban, many young people suffered from anxiety because they feared they might be accosted by the Amr-e-bil-Maraof, a group of religious police who enforced the Taleban’s strict dress and social codes, which included not allowing them to listen to music.

In the country’s sole mental hospital, conditions are clean but sparse. There are no fans to circulate the stifling air. The walls are painted steel grey and white. The hospital’s 60 beds are crowded into nine rooms

Dr Najibullah Bekzad said the hospital, which was founded one year ago, is too small to handle the number of cases that are referred to it by other health facilities. He also complained that the electrical supply was unreliable.

He spoke of the night he tried to rush to one patient’s room, oil lamp in hand, after hearing the sound of glass breaking. A 25-year-old hashish-addicted patient had broken a window and then cut himself. Because it took so long to get the lamp going, Bekzad felt he arrived at the scene too late. He said the hospital only runs its electric generator for two to three hours at the beginning of the night. City power is not functioning for most of the rest of the night.

Kaker, the hospital director, refused to elaborate on conditions at the hospital, only saying, “We have problems.”

In a tent to the right of the hospital building, doctors consult with patients suffering from drug addiction. The doctors see more than 100 addicts on an outpatient basis each day. About one third of those admitted to the hospital are suffering from drug addiction.

Dr Taimur Shah, a psychologist there, told IWPR that 70 per cent of drug addicts treated at the hospital first became addicted in the refugee camps in Iran.

Over the course of three days of observations, an IWPR reporter met patients being treated at the mental health hospital for drug addiction, manic depression, depression, and suicide attempts. Other patients included people who hear voices and other sounds, and one man who suffered hallucinations.

Shah said that many pregnant women, who are weary of their lives, depressed and suicidal, are also admitted to the mental health hospital.

People suffering from mental illness rarely treated in hospital. Instead, they may seek help at marastoons, shelters set up in Afghan cities that were originally intended to help destitute families, but also now provide care for the elderly and the mentally ill.

“It’s not our job to keep these people (the mentally ill) in the marastoon. The health ministry should decide to take these people from here to other hospitals,” said Safiullah Saadat, deputy head of the Kabul marastoon. He said it has been providing shelter for several mentally ill patients for years.

Others seek religious help to deal with mental illness. Many travel to the popular Mya Ali Ba Ba shrine in eastern province of Nangarhar, where patients are given only salt and pepper to eat and can sometimes be found chained to trees.

Allah Yar, a psychologist who works at a marastoon in Jalalabad that houses its own mental health clinic, doesn’t accept that kind of treatment. “In the shrine patients are not given enough food and the patient is dying,” he said. “But here the patients are given suitable food and are cured very well.”

Yar, who had 26 patients in his clinic, said many of his patients’ mental illnesses stem from joblessness, poverty and family and personal troubles.

Dr Pazhman fears the problem of mental illness in the country is being neglected.

“We have a lot of money here (from donors) in Afghanistan, but nothing is being done about mental health,” he said.

Both Pazhman and Dr Nadir Aksir, chief of the Ali Abad hospital, believe a bigger, better-equipped medical facility that meets international standards should be built.

“We have doctors and we have training, but we don’t have buildings to use for mental patients,” said Pazhman.

Mohammed Jawad Sharifzada is an IWPR reporter based in Kabul. Hayatullah Gahiz, a freelance reporter based in Jalalabad, also contributed to this report.