May 03, 2012

Decades of war, widespread poverty, and societal restrictions can take a toll on the mind, making Afghanistan uniquely suited as an incubator for mental illness.

 

But while the factors are numerous, the path to treatment is fraught with obstacles ranging from the shame felt by family members, to age-old traditions that compete with modern methods, and a deficiency of professionals and facilities equipped to deal with the situation.

 

Among the mental illnesses affecting Afghans most are depression, anxiety, and posttraumatic stress disorder, but precise statistics are difficult to pin down.

 

One frequently mentioned figure estimates that 60 percent of the population is affected by some form of mental illness. Other estimates range from around the 15 percent range to as high as 98 percent.

 

Even one of the leading authorities in the field of mental health in Afghanistan, the World Health Organization, expresses skepticism at attempts to quantify the problem.

 

Ahmad Azadi, communication and advocacy officer for the WHO in Afghanistan, cites a lack of recorded data and mental-health professionals to properly diagnose patients. In an e-mail he simply says that "Afghans are in great need" when it comes to mental-health treatment.

 

That conclusion is difficult to dispute. With some 30 million inhabitants, Afghanistan has only a handful of mental-health treatment facilities nationwide.

 

In Kabul, the state's main facility has a capacity to treat just 60 patients at a time. There are specialized hospital wards in Jalalabad, in eastern Afghanistan, and Herat, in the west. In the northern city of Mazar-i Sharif a gleaming, private hospital helps fill the void.

 

Other than that there are no other medical facilities to treat mental patients throughout Afghanistan's 34 provinces.

 

Azizuddin Hemat, head of the government-run Society of Mental Health Specialists, says the situation is dire, especially in the country's regions, but that there are positive developments.

 

He singles out the private Alemi Neuro Psychiatric Hospital in Mazar-i Sharif -- the administrative center of Balkh Province -- as a particular source of pride when it comes to treating patients with mental health-problems.

 

Unlike the dilapidated state hospital in Kabul's crowded Alauddin area, the four-story Alemi facility is gleaming and equipped with modern equipment.

 

'Just A Drop In The Ocean'

 

Dr. Nader Alemi, the owner of the hospital, claims patients come from all over Afghanistan.

 

"In the past 12 months, 964 patients from different provinces have sought treatment here," Alemi says. "But it's just a drop in the ocean. We have millions of people suffering from depression in villages and cities who desperately need treatment."

 

Dr. Nader Alemi, the founder of Alemi Neuro Psychiatric Hospital in Mazar-i Sharif

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Public awareness of the problem is seen as key to treating it in a country where mental illnesses are seldom recognized as a medical issue, and are often covered up by family members out of shame.

 

Traditional treatments, according to Alemi, involve employing mullahs to "cure" people by means of exorcisms or the reading of verses.

 

Sufferers often turn to holy shrines known as "ziyarats" for treatment. Prominent "ziyarats" such as Niali Saheb in Nangarhar, Shams Saheb in Ghazni province, and Shpole Baba in the eastern Mahipar town have become a popular destination for tens of thousands of people suffering from depression.

 

Only when patients' distress and suffering becomes unbearable for the patients and their families do they find their way to the country's few specialized facilities.

 

Alemi says that when it comes to proper treatment, psychological counseling "goes a long way."

 

He maintains that sufferers of mental illness are eager to share what they have been going through.

 

'Suffering In Silence'

 

Time and money are a hindrance, according to Alemi.

 

While treatment for depression, for example, usually takes many months, the majority of his patients come from remote rural areas and cannot afford extended hospital stays.

 

"So we have found the best possible solution under our circumstances." he says. "We hospitalize patients for a few days, during which they undergo psychological counseling, and we prescribe medications before they leave.

 

"We stay in touch over the phone; patients can call our doctors for any advice they need. And then they return for another check-up in two-three months."

 

"It's not ideal but it helps," Alemi says.

 

Meanwhile, in Kabul, the Society of Mental Health Specialists works to convince the government to allocate money to train experts and open mental heath facilities in all provinces.

 

"People are suffering in silence, it's affecting their families and entire society," says Hemat.

 

"If they had access to treatment, perhaps we would have less domestic violence, self-immolation and drug addictions, and even a lot less suicide bombings. You can't make a happy and healthy young man wear a suicide belt to blow himself and others up."

 

Written and reported by Farangis Najibullah, with additional reporting by Radio Free Afghanistan correspondent Omid Marzban.