By Sudabah Ehrari
The razor scars on 18-year-old Leila’s hands and neck bear witness to her past attempts at suicide. The Herat teenager told IWPR that she had become deeply depressed after her marriage to a 45-year-old man.
“I married a much older man because of my parents,” she said. “Later, I realised that this was not what I wanted. I was controlled and banned from going anywhere, and his interference in every little detail of my life became unbearable. I was so aggravated that I decided to end my life by taking poison, but survived. Later, I tried again to commit suicide with a razor, but again I was rescued.”
Leila subsequently sought treatment for her mental health problems.
“Now, I feel better following medication and a long series of consultations,” she said.
Mental health issues are rampant across Afghanistan, fed by the legacy of more than three decades of conflict. Psychologists note that women bear the brunt of the problem.
Experts in the northern province of Herat say that rates of depression are rising among women, fuelled by factors including gender violence, poverty and associated social problems.
Local mental health practitioners estimate that they have dealt with 20 per cent more referrals this year than last year.
Abd Al Rahman Hamraz, an official with the Herat department of public health, told IWPR, “Our statistics show that rates of depression have risen, with more referrals to mental health services.”
Wahid Nourzad, head of mental health services in Herat Regional Hospital, said that this reflected a growing awareness of the problem among women.
“I estimate that this same high rate of depression was also true in the past, except it wasn’t reflect by statistics due to a lack of awareness and fewer mental health clinics.”
Herat psychologist Mahdi Hossaini said that the condition could be categorised as minor, mild, and major depression.
He said that symptoms included “aches and pains, feelings of sadness, reduced energy, fatigue, helplessness and crying, guilt, anger, and [social] withdrawal”.
Treatment involved a combination of counseling and medication, he added.
Nourzad said that the treatment offered in state-run clinics was tailored to the severity of the individual’s symptoms.
“Those presenting with mild depression are treated with four to five consultation,, whereas patients with symptoms of major depression are hospitalised for a six-month period where they receive medication as well as counseling,” he said.
Mohammad Asef Kabir, head of Herat’s public health department, said that psychotherapy and medication were available at all the province’s health centres.
In addition, he continued, “There are ten clinics dedicated to patients suffering minor [mental health issues] and one, located in the Herat Regional Hospital, for severely ill individuals.”
Kabir added that these clinics also raised public awareness of mental disorders and how to prevent them.
Zahra, 38, who has a long history of depression, spoke to IWPR while an in-patient at Herat Regional Hospital.
“I’ve been suffering from this illness for 15 years, trying different medications in several places like Iran and Pakistan; however, all treatment ultimately failed although sometimes I feel better. Recently, losing my sister intensified my depression. I frequently struggle with headaches, I always quarrel about nothing with my family. This is my third day of hospitalisation.”
IMPACT OF GENDER VIOLENCE
Public health minister Firoozuddin Firooz announced on World Mental Health Day last year that 72 per cent of Afghan women had experienced depression.
He said that war, poverty and displacement and lack of resources were the main causes of mental health issues in Afghanistan. Psychological services were available at some 1,500 health centres around the country, he continued, with 300 dedicated mental health clinics. The government planned to create another 200 specialist centres, he said.
But others say that the impact of Afghanistan’s conservative traditions and associated gender inequality are central to the issue of women’s mental health. Little progress was possible with a fundamental change in attitudes.
Fatemah Bagheri, director of women’s affairs at the Afghanistan Independent Human Rights Commission (AIHRC), said, “Almost all women’s rights organisations as well as [the AIHRC] are concerned about the large number of women experiencing mental health problems.”
Madinah, who was diagnosed with depression more than a year ago, attributes her illness to the effects of poverty and her father’s drug addiction.
“My only wish was to go to school, but I was beaten and deprived of education because of my father’s addiction,” she said. “I was in a constant state of distress, so I went to a psychologist and was told that I was suffering from depression.”
Mahboobeh Jamshidi, head of the department of women’s affairs in Herat, noted that the overwhelming majority of women who experienced domestic violence developed mental illness.
She said that her department had recently established a psychological consulting centre for women, but lamented the lack of a wider strategic plan to address mental health issues among women.
“The initial treatment for a depressed woman is counseling, which is inefficient because medication, which is usually tried last, is more effective,” she said.
Hossniyah Nikzad, dirrector of the Afghan Women’s Network, agreed that discrimination both at home and in the wider society was the major cause of depression among women.
“The state must create a system under the auspices of the department of education, the department of information and culture and the department of haj [and religious affairs], to closely cooperate to reduce violence, since women’s depression is associated with increased violence,” she said. “If people are more are aware of the rules and regulations [governing gender discrimination], then violence and depression will be reduced.”
But with the proper treatment, some women say that they have been given new hope for the future. Leila, the 18 year-old with a history of suicide attempts, now works at a mental health centre which she said has helped her address her own trauma.
“I asked to work here since I understand what happened to these women and the pain that they went through,” she said. “I intend to help these women recover.”