Women rest in an inpatient ward of the main hospital in Herat, Afghanistan. (Elise Blanchard for The Washington Post )
KABUL - Psychiatrist Shafi Azim spent much of his career attending to the trauma caused by two decades of fighting, which ripped apart buildings and families.
But over the past months, his hospital - Afghanistan's primary mental health facility in Kabul - has filled with patients who say they are experiencing a different kind of suffering, he said. With the Taliban leadership severely restricting female education and work, there are mounting concerns about the mental health of girls and women. The restrictions and "sudden changes," said Azim, appear to be at the root of the trauma suffered by most women and girls now seeking help at this hospital.
"They fear they will never be able to go back to work or school," said Azim, 60. "They are isolated and become depressed."
Mental health professionals at five Afghan hospitals and health centers shared similar accounts of a rising challenge. They said many women are receiving outpatient therapy and medication. Some have been encouraged by doctors to seek an escape in the shrinking number of activities that are still tolerated.
"As the circle of limitations and restrictions widens," said a female mental health worker, "even women who were so far not directly impacted by the bans are now being dragged into it."
The Taliban says that women's lives have improved under its two-year rule. Supreme leader Haibatullah Akhundzada issued a ban on forced marriages shortly after taking power, and he vowed in a recent audio message that he wants women to live "comfortable" lives.
But many women tell a different story. A 29-year old participating in an art workshop for girls and young women in Kabul said she is afraid of the moments when her fellow students say they are starting to feel better. "These days, it actually just means they have given up hoping for a better life," said the woman, who like others interviewed spoke on the condition of anonymity for fear of reprisals.
Resistance and resignation
Even before the Taliban came to power, a study published in the journal BMC Psychiatry found that about half of Afghan women suffered from high psychological distress.
Viviane Kovess-Masfety, one of the study's authors, said no comparable study has been released since the Taliban takeover. It may be too soon to tell if psychological conditions blamed on the restrictions reflect mounting nationwide distress, she said, adding that the end of the war also may have prompted positive changes.
A woman speaks with a doctor while waiting for counseling at the hospital in Herat. (Elise Blanchard for The Washington Post )
But particularly in urban areas, the Taliban's view of what women's lives should look like has often been met with resistance, criticism and - increasingly - resignation, as the government has banned secondary and university education for women, prohibited them from working for nongovernmental organizations or U.N. agencies in many roles and restricted their access to public spaces. This week, the Taliban ordered beauty salons to close within a month, eliminating one of the last opportunities for women to work and socialize.
Representatives of Afghanistan's health ministry, which granted The Washington Post access to visit several hospitals, did not respond to questions. The ministry has not released public data on mental illness among women.
In the main hospital of Herat in western Afghanistan, mental health department head Shafiq Umair said he had seen no cases of girls "shaken because they can't go to school." The world "thinks our women are weak, but they are very strong," he said, adding that "our women aren't interested in getting education."
But a few yards down the crowded corridor, his colleagues were attending to a hospitalized 16-year-old whose mother recalled how her daughter's mental health had deteriorated after the girl's 80-year-old fiancé prohibited her from going to school. When she decided instead to teach younger students at a madrassa, a religious school, her fiancé banned that, too.
When her daughter is depressed, the mother said, she tells her that one day she will get back to teaching. "It's the only way to motivate her these days," she said.
Similar accounts are more widespread than the hospital's management admits, according to one doctor, speaking on the condition of anonymity because he was not authorized to talk with journalists. He estimated that women who struggle to cope with Taliban-imposed restrictions and the more repressive climate account for about 80 percent of non-hospitalized patients in this facility.
"We prescribe them medication or therapy," the doctor said hurriedly, while his supervisor was elsewhere. "And then we send them away."
Vanishing opportunities
Eighteen-year-old Sayed has tried to help his sisters persevere, once they were barred from furthering their formal education.
He said he teaches his younger sister at their Kabul home. She usually stays in her room all day, he said, going through books and trying to keep up with the lessons she would have been able to take, had schools not been closed. "But at least she still has hope," said Sayed.
A young woman attends a counseling session at the hospital in Herat. (Elise Blanchard for The Washington Post )
His older sister is struggling. She was about to attend a university when women were banned last year. She signed up for English classes, only for those to be shut down as well. "Every time she tries to hold on to something, it disappears," said Sayed.
As her life spiraled downward, he said, his sister sought help at a mental health facility multiple times in recent months.
Afghan psychologists said they must reconcile a growing gap between reality and the optimism they were taught to convey. When young patients come to her these days, "I no longer believe what I tell them," said a female mental health counselor in Herat.
Another counselor in Herat said the best approach is urging women to forget about the opportunities of the past and to focus on what is still possible. With women banned from gyms and many parks, some psychologists are encouraging girls to turn to art workshops.
In a Kabul business center, more than a dozen girls and young women met on a recent morning to talk, paint and learn. In this neighborhood, which during its worst days before the Taliban takeover was shaken by daily terrorist attacks, dozens of art galleries have in recent months become a refuge.
Some of the girls here used to be on cycling teams or performed spinning kicks at Korean martial arts gyms. Now, their bikes are sold and many of their friends have fled.
The paintings on the walls show fall leaves tumbling from trees, crying children, and the face of a woman covered in blood after a terrorist attack on a nearby mixed-gender educational center.
A 29-year old woman recalled how she was signed up for the workshop by her husband after suffering from depression in recent months. Afraid of hospitals, she had hesitated to seek treatment, but found painting to be an effective therapy, she said. Her favorite drawing shows a child curling up in the cold and staring at a hot mug. It shows depression but also strength, she said, tightly gripping her pencil.
"The Taliban thinks they can destroy us - and they can. But they can't change our minds," said Sahar, 16, speaking in flawless English.
"We want to change the world," her friend agreed.
Their teachers worry that this enthusiasm might not last. Months ago, the gallery was closed by authorities for several weeks, and recently the students' participation in an upcoming art competition was canceled because their paintings showed faces, which the Taliban has told them is no longer allowed.
"We haven't told our students yet," the gallery owner said in a lowered voice.
