We have closely covered damaging effects of post-traumatic stress disorder facing U.S. soldiers returning from the battlefield. Inadequate mental care has failed many of these veterans, and has done serious damage to their lives and their families as they have tried to reintegrate into civilian life. No doubt, this is a tragic situation, but it is only half the story of war. In the countries where these soldiers battled, there are millions of civilians who suffered the disintegration of their society, and with that have taken on a tremendous mental health burden.
Afghanistan was rid of Taliban oppression by the end of 2001, but it is easier to destroy than to rebuild, and the U.S. soon turned its attention to Iraq and left much of the country to heal on its own. Today, some of the physical infrastructure has been rebuilt, but there are still many psychic wounds. Psychiatric News ran an article last week about the country's struggle to provide adequate mental health care. While the title of the article decries the fact that Afghanistan only has two qualified psychiatrists in the entire country, it actually presents some encouraging news about the progress being made with limited resources.
In 2002, even the most diligent reporters would be hard-pressed to find any signs of progress in Afghanistan. C.J. Chivers came back from Jalalabad Psychiatric Hospital to tell the New York Times about the patients who were chained to trees and forced to dance for the amusement of the overworked staff. A nurse summed up their prospects: "Mostly this is where the patients will just stay until they die." That year, a nationwide survey found that in addition to anxiety disorders and drug addictions, 60% of men and 70% of women were depressed.
The magnitude of this depression became clear enough to galvanize Dr. Faizullah Kakar when he heard that a wave of youth suicide was sweeping through major cities. Dr. Kakar, the Deputy Minister of Public Health, realized then that mental health had to be a priority. In 2006, the United States Substance Abuse and Mental Health Services Administration reported that Dr. Kakar was working with them to create an ambitious mental health plan. In addition to drumming up support from U.S. NGOs, he visited a psychiatric hospital in Virginia where he saw what was possible with enough effort and the right medical culture.
Dr. Kakar returned home to share his vision, and he inspired other doctors to make the same journey. The Psychiatric News reported that three Afghan doctors toured hospitals last month to bring back useful techniques. The mental health system is still not adequate, but significant steps have been made. It is true that there are only a handful of specialized psychiatrists in the country, but other doctors are being given supplemental training to fill the gap. There are only 40 of these "junior psychiatrists" now, but their numbers are growing.
It is debatable whether Afghanistan should focus on training psychiatrists instead of trying to work with existing medical practitioners, but compromise may be necessary with so many citizens in desperate need of immediate care. One example of tricky compromise is the government's cooperation with traditional healers. These healers often use very crude methods, such as chaining the mentally-ill to the shrines of fallen heroes, but the government sees the respect they have from the community as a valuable asset. Instead of trying to directly replace these healers with psychiatrists, something that traditional culture would strongly resist because it has no respect for psychiatry, the government has negotiated deals so that doctors can visit the constrained patients and give them antipsychotic medication a couple of times a month. This may not be ideal, but it is certainly progress from the hopeless stagnation immediately following the war.
|