"Should we sacrifice another goat?" Afghan shrink finds the Taliban to be chronically depressed.greenspun.com : LUSENET : Unk's Troll-free Private Saloon : One Thread
LA Times Mar 11, 2002
Taliban Had the Blues, Says an Afghan Doctor
By JEFFREY GETTLEMAN, Times Staff Writer
MAZAR-I-SHARIF, Afghanistan -- They strutted around in black turbans, they drove big pickups, they looked tough. But on the inside, the Taliban were actually a bunch of pretty depressed guys.
At least that's what their shrink says.
"I remember one Taliban commander telling me he hadn't seen a sunny day his whole life," said Dr. Nader Alemi, director of mental health at Mazar-i-Sharif's General Hospital.
Another commander, Alemi recalled, wanted to commit suicide but couldn't because of Islamic strictures. "Every time he went to battle--and this was a big general--he hoped someone would shoot him.
"I don't think the Taliban needed more guns," the doctor added with a grin. "But more Prozac."
When the hard-line Islamic Taliban invaded this northern Afghan city 3½ years ago, Alemi was stuck in the unenviable position of dispensing mental health care to a group of people who, with their appetite for war and medieval punishments, would seem certifiably insane almost anywhere else.
His Taliban patients are gone now. But Alemi, who deposits a soft touch and a gigantic "Ho-bas!" (Good!) on each person he meets, is still very, very busy. Every day, there's a line 50 patients long outside his office: children traumatized by bomb blasts, soldiers who were tortured, schizophrenic shopkeepers, sleepless farmers worried about drought, sleepless girls worried about marriage.
Post-Taliban life is a little freer, a little brighter, though still unsettled. Alemi's practice offers a glimpse, however random or rushed, of how Afghan society is adjusting.
"Doctor, I can't remember any verses from the Koran, and my mullah says I'm crazy," began Mohammed Tahir, a distressed student, during a recent office visit.
"You seem as wise as the prophet," Alemi said, patting the young man on the head. "Don't worry so much. You'll remember everything."
Despite Alemi's soothing optimism, mental health care here is in a sorry state. For a population of 25 million, Afghanistan has perhaps two dozen psychiatrists. The only psychiatric hospital is a 50-bed facility in the capital, Kabul, and it is shut down half the time. In Mazar, Alemi works from a corner of the hopelessly crowded General Hospital and in a small private clinic above a vegetable shop.
Afghanistan has no practicing psychologists, social workers or counselors, said Dr. Azizullah Baig, one of Alemi's few colleagues. Most aid agencies are still in emergency mode, focusing on first aid, child immunizations and nutrition.
Modernity vs. Tradition
"We feed people first," said Dr. Abdul Wahid Wahidi, a Mazar-based program officer for the World Health Organization. "Then we worry if they are happy."
Extended families and mosques provide some support for the mentally ill. But they can also muddy things up.
The other day, Alemi's redcarpeted office, with its bare white walls and empty light sockets, became a boxing ring where modernity and tradition duked it out.
In one corner was a desk cluttered with price lists for modern psychotropic medications--Zoloft, Paxil, Lithonate, Prozac--or, more specifically, the Iranian-made generic equivalents available here.
In another corner lay a 25-year-old woman convinced that her in-laws had cursed her with a supernatural intruder--a jinni.
"All of a sudden, life does not interest me," said the woman, named Feriba. "I don't even wash my husband's clothes anymore."
Her mother had already taken her to see a mullah.
"Should we sacrifice another goat?" Feriba asked.
"Ney. Ney," Alemi said. No. No. "Allah has given these pills great power. It's like swallowing a little piece of god."
After she shuffled off, he said, "They usually trust the doctor."
A Practical Approach
Alemi's work is no Freudian analysis. With five to six patients an hour, many of whom have journeyed for days to see him, there's no time to sit alongside a couch and download an entire life story.
Often, he dispenses practical health advice.
To a farmer with insomnia and high blood pressure: "Eat less fat and nuts."
To a nibbled-fingered woman depressed about miscarriages: "Your baby will come, God willing. But you must rest more."
During the Taliban days, Alemi, 46, was careful to refer to many ailments as "nervous problems," not as mental or emotional ones.
"These guys were warriors," he said. "They couldn't be marked as mad."
Because Alemi grew up in the northeastern city of Jalalabad and is the only psychiatrist in northern Afghanistan to speak Pashto, the language of most Talibs, he became their doctor after they captured Mazar in August 1998.
Taliban forces used the city of 200,000 as a base for military operations across the north, and Alemi, an ethnic Tajik, estimates he treated at least 1,000 soldiers and commanders of the regime.
"Sometimes when they'd cry, I'd cry, and when they'd feel down, I'd feel down," he remembered. "One soldier once told me: 'This is great. Finally I meet a doctor who suffers from the same thing I do.' "
Alemi has a simple diagnosis for the Taliban: They were sick of war. Most wanted to go home and see their families, except a few leaders who really were quite ill.
One night, a few weeks before Mazar fell last November, Alemi was whisked from his house to see Aktar Osmani, the most powerful Taliban commander in Mazar and a confidant of Mullah Mohammed Omar, the group's spiritual leader.
"The commander was hearing voices," Alemi said. "He was schizo."
Alemi scribbled out a prescription for haloperidol, an antipsychotic medication that the man would be able to obtain, and left.
"I would treat anybody who was sick," Alemi said. "But I was not neutral. These people caused a lot of pain in our society."
Nowadays, there are many jokes about the Taliban, which Alemi encourages.
Outside his office, a young man nudged through the crowd, saying, "Excuse me, excuse me, I must see Mullah Omar," which means "go to the bathroom."
Things in Afghanistan are easing up, and once again Alemi has time to go cake shopping in his rusty Nissan, grow roses on his front lawn and research the next topic for his weekly 15-minute "Health for All" radio show.
He has a great reputation.
"There is so much empathy in that man's blood," said Rafat Fugaha, a psychiatrist visiting from Jordan. Alemi got his M.D. from the Kabul Faculty of Medicine, completed a three-month fellowship in Poland and learned English from Mr. Chris, a Peace Corps volunteer. It's come in handy because he keeps his notes of psychiatric sessions in English, which protects patient confidentiality since nobody in his office can decipher them.
He and his wife, Perween, illegally ran a girls school during the Taliban era. But the Taliban left him alone, because so many of its members were his patients.
He makes $30 a month. Short and thick, he suffers from diabetes. Sometimes all the gunmen on the street frighten him.
But at the end of a recent workday, with the last bits of sun glinting off his gold-rimmed glasses, Alemi's cheerfulness hadn't slackened.
"I would love to see the world and have many nice things," he said. "But Allah put me here in Afghanistan to work. And I am satisfied."
Then he caught himself with a laugh: "Or maybe I'm just--how do you say in your language?--rationalizing."
-- (Roland@hatemail.com), March 11, 2002
They're coming to take me away, ha-haaa!!
They're coming to take me away, ho-ho, hee-hee, ha-haaa
To the funny farm. Where life is beautiful all the time and I'll be
happy to see those nice young men in their clean white coats and
they're coming to take me away, ha-haaa!!!!!
-- (firstname.lastname@example.org), March 11, 2002.