Tough Cure for Mental Problems

Del Agha sat chained to a big tree by his wrists, and waited for his next meal of dry bread, salt and pepper. From time to time he tried to throw stones at the man chained to the next tree, who was singing.

It was his tenth day in chains, and he had 30 more to go. He begged to go home, saying, “I am well now. I’ll spend the rest of the days at home, following the diet. That would be good, because people bother me here.”

Del Agha is one of five men chained to trees at Afghanistan’s Mia Ali Baba shrine – but none has committed any crime. They are undergoing a course of treatment for mental illnesses.

The shrine, in the town of Samarkhel about 30 kilometres east of Jalalabad, has been in existence for more than 300 years, treating the mentally ill as well as people possessed by djinns, or spirits. Afghans bring their family members from as far away as northern Afghanistan, Pakistan and Iran because they believe the treatment will be effective, or because they have no alternative.

In addition to 40 days in chains and a restricted diet, the patients are not permitted to change their clothes or use soap. Their hair and nails must be left uncut. A personal attendant cleans up around them.

The treatment has a strong religious component – shrine caretakers recite verses of the Koran to the patients, and drape them with amulets containing quotations from the holy book.

The numbers of mentally ill people in Afghanistan have increased over the years of war, famine, and unemployment. At the hospital in Jalalabad, mentally ill patients are housed three or four to a room meant for a single person, while others are chained outside the rooms. Most receive little attention.

Kabul has the one hospital that offers modern forms of treatment, but with only 60 beds it cannot cope with the demand. Only a handful of doctors have been trained in psychiatry and therapy, and limited amounts of drugs are available.

At the Mia Ali Baba shrine, there are no drugs and no counselling. The basic approach is isolation, a strict diet, and prayer. The same formula is used in simpler forms at smaller shrines in other parts of Afghanistan.

The shrine was founded by Mia Sayed Ali Shah, known as Mia Ali Baba, who was born in 1625. He is venerated as a holy man, and the treatment he prescribed has been handed down from generation to generation. It follows the Chishti school of Sufism, the mystical strand within Islam. The shrine is still run by about 70 family members, who care for patients in shifts. It also attracts daily visitors who come for help with personal problems and illnesses.

Gholam Haidar Miakhel, 41, is the current caretaker. He said that while the Mia family still follows the original Chishti method, they don’t really know how Mia Ali Baba developed it, since no one has the same powers he had.

But it is his only job. “I don’t have land to support my family. I get income from my shifts at the shrine,” he told IWPR. Families of patients pay for the treatment with 35 kilogrammes of wheat and 50 Pakistani rupees, about 85 US cents, per day.

Another family member, 60-year-old Mia Afa Gul, is responsible for dispensing verses and amulets. He said the number of patients has been decreasing steadily, “No more than 60 people a day come to visit the shrine now.”

Dr Gul Habib Husseini, head of the health centre in the neighbouring village of Chardehi, thinks the number of people chained up is falling because medical facilities are improving in this part of Afghanistan. Last year, he said, the shrine had 18 patients tied up.

Husseini is concerned about conditions at the shrine, particularly the fact that no one is allowed to give medicine to the patients. He and other doctors say the treatment does not provide a cure, although it might seem to have a beneficial effect because they are weakened and quieted down.

But Gholam Haidar rejects the doctor’s claim that the treatment is ineffective, saying, “In the last 10 years, I have tied up 55 people for 40 days, and 45 of them were cured.” He said the treatment must be followed strictly in order for it to work.

Fazel Rahim Naseri, who teaches psychology at Nangarhar university’s medical faculty, suggests many of the people who appear to be cured were never really mentally ill in the first place, but were brought here because problems at home were making them angry and frustrated.

For those who really are ill, the “cure” is only a temporary respite. “Insane people who are very agitated and have high blood pressure are weakened by giving them pepper and dried food at the shrine. And when their level of agitation falls, people think they are cured,” said Naseri, adding that their mental problems return later.

IWPR reporters saw a woman who had just died at the shrine. Her husband had brought her there, thinking that she was mentally ill. The caretaker realised she needed medical treatment instead, but she died before she could be taken to a doctor.

For an outside view, IWPR spoke to Peter Ventevogel, who coordinates a mental health programme for Health Net International. He has been to the shrine several times as he surveys the mental health of Nangarhar province, and he sees it as important to work with local people in a way that acknowledges their culture and traditions. He thinks the shrine appears to help patients who are mildly depressed or who are said to be possessed by djinns.

“The patients don’t feel alone there, and they feel they are getting help from God,” he said. “In the shrine, it is quiet and calm and they are free from disturbance by other people, and they do not get angry. It’s an environment where people take care of the person and the conditions are the same every day.”

But Ventevogel expressed concern about the severely mentally ill, psychotic cases and epileptics who are sometimes treated at the shrine. These people need medicine, he said.

The veneration of popular “saints” like Mia Ali Baba and miracle-working shrines is an accepted part of Muslim practice across Afghanistan. But more orthodox clerics frown on such practices because they mix folk traditions, often predating the arrival of Islam, with conventional religious beliefs. The Taleban saw the shrines as anathema to their fundamentalist code, and discouraged people from going to them.

Maulavi Abdul Aziz Khairkhwa, the imam of the Torkham Hada mosque in Jalalabad, told IWPR that tying people up at the Mia Ali Baba shrine was a pagan practice. If one ascribed the cure to the shrine itself, that was tantamount to worshipping a place - something that Islam proscribes.

The imam suggested that Muslim visitors to Islam’s holy places in Saudi Arabia would not go there expecting a miracle cure. “If it was a good thing, people would be going to the shrine of the Prophet in Medina,” he said.

Danish Karokhel is an IWPR editor/reporter in Kabul. Ezatullah Zawab recently completed an IWPR basic journalism training course in Jalalabad.