- Afghans are traumatized and depressed, and experts say the mental health system is ill-equipped to help them.
- Sources described how desperate Afghans are self-medicating with antidepressants and anti-anxiety medication.
- Afghanistan's former health minister told Insider that the country is also facing a looming suicide crisis.
- See more stories on Insider's business page.
"My education is ruined, my dreams, everything," Ghulam* said. "There is nothing for us here now, no future."
In conversations with Insider over the past month, Ghulam, a 21-year-old Afghan man, has described his increasingly deteriorating mental health ever since the Taliban took control of the country in a sweeping offensive.
Ghulam said that he has self-harmed and considered suicide as he contemplated his future under Taliban rule and its strict adherence to Islamic Sharia law.
"I self-medicate with Pregabalin. I take three pills at once because one won't do anything. It just helps me calm down and forget about all of my problems," Ghulam said.
Pregabalin is a medication typically used to treat generalized anxiety disorder.
Sources told Insider that it is increasingly common for people suffering from mental health issues to seek solace by self-medicating with antidepressants and anti-anxiety medication in Afghanistan.
"In Afghanistan, you can get any kind of medicine from the pharmacy without a prescription, or there are black markets where you can get anything," Ghulam said. He added that in Kabul, there are street children who sell cheap prescription medications, often counterfeit.
"Many of my friends are overdosing," Ghulam said. "They take one medicine, and it doesn't work properly because it's fake, so they're taking two, three, four different medications at one time just to try and improve their moods."
He said that his friends commonly take the antidepressants fluoxetine or escitalopram, as well as Pregabalin. Often, they will experiment with different combinations and recommend them to each other.
"People are buying medications without the advice of the doctor, even though they know that they are not 100% original or the quality is not good, just to try and improve their mood," Ghulam added.
Dr. Wais Aria, an Afghan psychiatrist who heads up mental health non-profit Tabish, said that a cascade of societal problems, including a collapsing economy, cataclysmic social changes, and the threat of violence, is straining Afghanistan's already under-resourced mental health infrastructure.
"Demand is very high and the services are very limited," he said. "And because there's no real psychosocial support for people to deal with their stress or mental health problems, people are looking for antidepressant pills or sedatives."
A deeply traumatized nation
People are increasingly turning to counterfeit medication to try and "numb the reality," said Lyla Schwartz, the managing director of the psychological support consultancy Peace of Mind Afghanistan, during a phone call with Insider.
Afghanistan's population was already deeply traumatized by decades of poverty and conflict, she said.
A 2018 European Union survey found that an overwhelming majority (85 percent) of Afghanistan's population had experienced or witnessed at least one traumatic event. And a 2019 study by the International Psychosocial Organisation (IPSO) estimated that 70 percent of the 40 million population was then in need of mental health support.
Afghanistan's former public health minister Dr. Wahid Majrooh told Insider that access to mental health professionals in the country has always been limited.
According to the most recent data from the World Health Organisation, there are only 0.3 psychologists per 100,000 people in Afghanistan. Comparatively, in the US, there are 30 per 100,000 - equating to 100 times more.
Large swathes of the country, particularly rural areas, have relied solely on counselors with minimal training who "don't fulfill the expectations of the system," Majrooh said.
The situation over the past month, however, is "worse" and "exacerbated," he said.
Psychologists are needed more than ever, but they're fleeing the country
Aria, who worked as a psychiatrist in Kabul until last month, said that the political turmoil had decimated the paltry supply of medical professionals in Afghanistan. "We have a lot of therapists and doctors who left the country because they do not feel safe there," he said.
Aria himself fled Afghanistan on August 25 for the US because, he said, he feared that his psychiatric work with NGOs could make him a target for the Taliban.
His friend, Judy Kuriansky, a psychology professor at Columbia University Teachers College and a United Nations NGO representative, is helping other psychiatrists escape. "They are needed more than ever, sure, but they cannot operate," she told Insider. "Their lives are at risk."
One of the nation's most prominent psychiatrists, who received death threats, was abducted from his work last week, The Guardian reported.
Kuriansky, who said that it's unfortunate but necessary that these mental health professionals need to be evacuated, fears that the consequence is that "the entire mental health system in Afghanistan is going to collapse."
And, according to experts, it's women who are the most vulnerable.
'If it were not for my family, I would end my life'
Women, whose lives have already been heavily restricted since the Taliban came to power, are no longer permitted to work alongside men and are also not allowed to leave the house without a male guardian.
Zahra*, 25, a doctor in a maternity ward in Kabul, told Insider that while most women are currently unable to work, the Taliban have allowed her to because of the shortage of doctors in Afghanistan.
She said that she is hassled at Taliban checkpoints for going to work without a male chaperone. Taliban fighters who guard the hospital often speak to women derogatory.
Zahra said that the new restrictions on her life have negatively affected her mental health.
"I was not like this in the past," she told Insider. "But since the Taliban took over, the future is unknown. I'm really depressed. I wonder what will happen to me, what will my future be?"
Zahra said she went to a psychologist who prescribed her the antidepressant fluoxetine and helped her get it at a discounted price as a favor. Zahra said she fears she will not be able to afford more once she runs out.
But the pills can only help so much, Zahra said. She said she is worried about her safety but has no choice but to work as she is the sole breadwinner for her family since her father passed away.
"If it were not for my family, I would end my life because I don't know what the Taliban will do with me," Zahra said.
Afghanistan's looming suicide crisis
She is not alone in having suicidal thoughts. Multiple interviewees in Afghanistan independently told Insider that they had been considering ending their lives because they felt hopeless about their future.
Zahra said that she recently witnessed one of her neighbors die by suicide after they jumped from the top floor of their house.
"Living under this kind of trauma, no one has hope for the future. People feel helpless and are thinking of ending their life. People are saying I wish we weren't even born," she said.
Majrooh, the former health minister, told Insider that he fears Afghanistan faces an imminent suicide crisis. "I can tell you that a few months from now, the levels of suicide, especially among the elite and educated, those who enjoyed their positions in the past, will be just shocking," he said.
Ayesha Ahmad, senior lecturer in Global Health at St Georges' University of London whose work focuses on Afghan trauma, said that women in Afghanistan were already at an alarmingly high risk of suicide, even before the Taliban takeover.
According to data from the Afghan Independent Human Rights Commission (AIHRC), around 3,000 Afghans attempt to take their own lives every year, the BBC reported. Out of these, an estimated 80% were women.
"Afghanistan is quite an exception to some of the global trends in the sense that there are more female suicides than males," Ahmad said.
Ahmad said that gender-based violence was a primary motivator for women to take their own lives, which is likely only to worsen.
As Afghans look to an uncertain future under the repressive Taliban regime, some see self-medication, or even suicide, as the only options.
With the mental health system crumbling around them, few have been able to get access to professional help. But those who have, like Zahra, the support has provided little solace.
She remains unmoved by her psychologist's advice to "stay strong and try to not overthink much."
(*We have given pseudonyms to some of the interviewees in Afghanistan to protect their identity.)