Often overlooked among the innumerable consequences of conflict in Afghanistan is the impact on mental health, especially among youth. Though there is a shortage of data showing the plight of mental health in Afghanistan, a study conducted by Gallup indicated that approximately nine in every 10 Afghans described their living condition as “suffering.”
Many Afghans of all generations express experiencing depression and anxiety. While both men and women are faced with these serious health issues, women tend to talk about it more openly and are more likely to seek help. Men, on the other hand, are expected by social norms to show strength and are discouraged from seeking professional help as doing so would undermine their masculinity.
The World Health Organization defines depression as a “mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.” Depression can be caused by traumatic experiences, in the case of Afghanistan as a result of living and experiencing war and witnessing decades of violence.
Afghan youth in particular carry the heavy burden of intergenerational trauma from decades of war. Studies indicate that untreated trauma can get passed down to next generations through epigenetics. Afghans born to parents living in war and under severe circumstances are likely to carry heavy burdens of their parents’ untreated trauma. Even though there has not been a study conducted on Afghans, 2015 research showed that children of Holocaust survivors had epigenetic alterations which demonstrated linkages to the levels of cortisol — a primary stress hormone. This study suggests that trauma does not die with us; if left unaddressed, trauma has the ability to alter our DNA and be transferred through our genes.
Afghans continue to live with varying levels of fear, stress, anxiety and trauma, which further complicate their psychological wellbeing. In the absence of mental health providers, many Afghans struggling with these issues often turn to religious leaders or mullahs for help. Some find it therapeutic to tell their problems and issues to a mullah; however, mullahs don’t have training or advanced knowledge of mental health diagnoses and treatment. Remedies often prescribed to women for depression, anxiety and post-trauma disorders include partial or total isolation from family and friends for a certain period, extended fasting, strict dieting, and using different methods for inflicting physical pain to forget the trauma. These and other methods do not necessarily improve mental health but contribute to exacerbation of the underlying psychiatric illnesses. In return, women may pay the mullahs a fee ranging from $5 to $50, sometimes more.
Men may turn to mullahs for assistance, but face gender norms that discourage seeking help. Instead, in urban areas they often turn to physical, recreational and social activities, which they have greater access to than women, to help them cope. However, unaddressed mental health issues may contribute to abuse of narcotics, alcohol (if available) or other controlled substances or physical abuse of intimate partners.
During a January visit to Kabul, I spoke informally with a number of Afghans and asked them about their experiences.
One of the interviewees was an experienced lawyer whose 23-year-old son was killed two years ago. She said, “my emotions are all mixed up. Every day, I mourn the death of my son. I feel profound sadness and emptiness in my heart. It feels as if I am watching a horror movie day and night, but at the same time I am overwhelmed with fear and anxiety imagining something horrible would happen to the rest of my family.” A couple of months later, she lost her husband to COVID.
Another, a middle-aged man, said, “It has been five years now that I stopped watching television. I can’t cope with the violent stories and images of this ugly war. I was a total wreck five years ago. Every night, I would cry my heart out feeling a heavy weight on my chest [watching the news of suicide attacks]. I couldn’t take it. I did not need to see with my eyes and hear with my ears the sufferings of my people reported by the media. I live it every day.”
When asked if he sought professional help, his reply was, “there is no professional help for this type of health problem here.”
Another woman in her early 40s recounted, “Every morning when I leave home for work, I have this feeling that today is the day I would be killed. I keep imagining my own death, some days in a suicide attack and other days by a gun shot or a magnetic bomb. I have trouble sleeping. I have taken all types of sleeping aid available here. Nothing seems to work. I am far from healing. I worry about my future and the future of my daughter and my family. I worry about life after peace with the Taliban. Are they [the Taliban] going to rob my daughter of her identities because of her gender? I don’t want my daughter to go through what I suffered under the Taliban regime.”
Young Afghans in particular are vulnerable to different types of violence and traumatic events. About 46 percent of Afghanistan’s population is below the age of 15, and majority of this group has either witnessed or experienced traumatic incidents. Research shows that trauma and chronic stress can hinder learning abilities and prevent children and youth from building the executive function skills needed in a learning environment. Executive function skills rely on three types of brain functions: working memory, mental flexibility and self-control. Children develop these skills as they grow. Trauma, if left untreated, could impede the development of these skills and cause other behavioral changes in adulthood.
Having witnessed conflict for their entire lives, young Afghans have experienced lasting impacts on their psychological wellbeing. For their future and the future of Afghanistan — particularly if a peace agreement is reached — these traumas must be addressed so they can better lead the country forward.
During the last 42 years, the international community has played multiple roles in the Afghan war in one way or another. As peace talks between the Afghan government and the Taliban progress, it is vital to have an immediate and long term reconciliation plan that does not only address the visible, but also the invisible and enduring consequences of decades of war. It has never been more important and timely for the international community to start playing their part in helping Afghans heal from the conflict’s unseen impacts.
Belquis Ahmadi is a Senior Program Officer for Afghanistan and Central Asia at the U.S. Institute for Peace (USIP). Asma Ebadi is a Program Assistant for Afghanistan at USIP.