Kabul, Afghanistan: Soheila Hashemi has hardly slept since a suicide bomber targeted a rally in the Afghan capital last month, killing more than 80 people and wounding scores in the deadliest attack in Kabul since the war with the Taliban began 15 years ago.
She is tormented by feelings of guilt for surviving the carnage and for encouraging fellow Hazaras to come to the protest that called for an end to discrimination against their community, Afghanistan's poorest ethnic and religious minority. Hashemi says she needs "professional help" but with the dearth of psychologists in the war-ravaged country, she feels there really isn't anyone she can turn to.
"I encouraged people to attend the demonstration and yet I wasn't there when the explosions happened," said the 23-year-old university student. Many of her close friends were killed or wounded in the July 23 bombing.
Hashemi had already left the rally when the bomber struck. As the explosion shook Kabul, she ran back to Demazang Square, only to faint at the horrific scene of dead bodies, scattered body parts and pools of blood.
For days afterward, she was quick to lose her temper and felt herself becoming aggressive for no reason. Even if she found a psychologist, Hashemi believes she'd be branded as "crazy" for admitting to psychological and emotional problems after the attack.
After almost 40 years of conflict and crisis, experts say the vast majority of the Afghan population suffers from some form of post-traumatic stress disorder, yet arcane societal attitudes on mental health are holding back many from seeking help. Hundreds of psychologists have been trained over the past decade to work at clinics across the country, many funded by foreign donors - but the stigma associated with "being crazy" remains a barrier.
Hashemi says she has been able to use social media to express some of her feelings. She said others who went through similar experiences wrote back, encouraging her to "talk it out." It's the simplest solution, she said, in a country where "if you ask a person to visit a psychiatrist, they will get angry and tell you they are not crazy."
With all the wars, violence has become embedded in the fabric of Afghan society.
The Soviet invasion of 1979 lasted for 10 years, followed by three years of war against the installed communist authorities. Then came a civil war in which warlords destroyed much of Kabul. An estimated 80,000 people were killed in the city between 1992 and 1996.
The Taliban ruled for five years - a time when women were stoned to death for disobeying their strict version of Islamic law, or Shariah, and severed hands of alleged criminals were hung up in bazaars. The 2001 U.S.-led invasion ousted their brutal regime but also marked the start of a 15-year Taliban insurgency.
Now, new players have emerged, such as Afghanistan's branch of the Islamic State group, which claimed responsibility for the July attack on the Hazara protest. Unlike most Afghans who are Sunni, the Hazaras are Shiites and IS regards them as apostates.
The U.N. mission in Afghanistan, which began tracking Afghan civilian casualty figures in 2009, says almost 23,000 civilians have been killed by the war and another 41,000 have been wounded. In a population of around 30 million, that means very few have been unaffected by the violence in one way or another.
Khalil Rahman Sarwary, who teaches psychology at Kabul University, says war "has the most destructive effect on human behavior, conduct and life." His research, he says, has found that up to 75 percent of Afghan people suffer "from stress and other psychological pressures because of the war and insecurity."
"Around 25 to 30 percent of Afghans have very high stress, anxiety and other psychological issues - the toll is getting higher day by day," Sarwary said.
Also, ancient superstitions prevail, with many across Afghanistan still attributing mental illnesses to being possessed by demons. An afflicted person can be locked up in a cage or left chained at a shrine for days on end.
Families often call in mullahs when they think a loved one has become "possessed by a djinn" - a mythical spirit in Islam, similar to an angel, which can take human or animal form and influence behavior for either good or bad. Many of the hundreds of counsellors who were trained by a variety of organizations - with the aim to have at least two to each of Afghanistan's 34 provinces - have left the profession to return to their hometowns, said Fareshta Qudees, managing director of the International Psychological Organization in Afghanistan.
Qudees says there are plans to train 250 more in the coming months. Around 200 clinics nationwide provide counselling - though most treat drug addicts, whose numbers are rising in the country responsible for producing most of the world's heroin.
"The Afghan society is still very traditional and mental health problems are a taboo subject," said Khetab Kakar, director of the Mental Health and Drug Addicts' Hospital in Kabul's western suburb of Kart-e-Sei. "Psychology is new to Afghanistan," Kakar said. "If a person becomes sick, they will be advised against going to a doctor, rather than to a shrine or a mullah." But there are signs modern psychology is making inroads, especially among women, who are among the hardest hit by the fallout of war in this male-dominated society, their suffering compounded by discrimination, widespread restrictions on their movement and domestic violence.
Zia Jan, 45, says she has benefited from counselling she received at Medica Afghanistan, a non-profit, non-governmental organization helping traumatized women across Afghanistan. After the Taliban killed her son, wounded her husband and burned her uncle alive, Zia Jan sank into a deep depression. Her family decided she had been possessed by a djinn.
"People started saying I had a djinn, my family took me to the mullah a few times, and he said I had a djinn," she said. The mullah even performed an exorcism, but she only got worse. After years of torment, she finally found her way to Medica Afghanistan.
Psychologist Yalda Ahmad said Jan was unable to talk when her treatment began: "She could only cry." Now, after eight years of regular sessions, Jan says she feels she is finally able to cope with the memories, though they will "always burn" in her mind.
