Some Afghans prefer ancient treatment for mental ailments

AFGHAN MENTAL: A Kandahari man stays in cell No. 5 of the Mia Ali Sahib shrine in Jalalabad, Afghanistan. No one at the shrine knows his name. Photo for The Washington Post by Mikhail Galustov (Photo for The Washington Post by Mikhail Galustov)

No one here knows the man whose left leg is shackled to the wall of cell No. 5. Last week, he finished tearing his mattress to shreds and then moved on to his clothes, ripping his shirt and pants off before falling asleep naked.

"He's insane," say the villagers who have come to gawk at him. "He doesn't know whether he's in this world or another."

"He's getting better!" said Mia Shafiq, the man responsible for his recovery and the one who shackled him to the wall of a shrine in this eastern Afghan city.

The man's brothers drove him here from southern Kandahar province two weeks ago, drawn by the same belief that has attracted families from across Afghanistan for more than two centuries. Legend has it that those with mental disorders will be healed after spending 40 days in one of the shrine's 16 tiny concrete cells. They live on a subsistence diet of bread, water and black pepper near the grave of a famous pir, or spiritual leader, named Mia Ali Sahib.

Every year, hundreds of Afghans bring mentally ill relatives here rather than to hospitals, rejecting a clinical approach to what many here see as a spiritual deficiency. The treatment meted out at the shrine and a handful of others like it nationwide might be archaic, but the symptoms are often a response to 21st-century warfare: 11 years of nighttime raids, assassinations and suicide bombings.

For more than a decade, Western donors have helped train Afghan psychiatrists, who diagnose many of their patients as having an ailment with a distinctly modern acronym: PTSD, or post-traumatic stress disorder. Mental health departments in Afghanistan are plastered with posters detailing the disorder's symptoms. Pharmacies are stocked with antipsychotic drugs.

But many of those suffering from the disorder never see doctors or pharmacists. Instead, they are taken on the long, unmarked dirt road, through a village of mud huts, that leads to an L-shaped agglomeration of cells.

The brothers of the man in cell No. 5 drove back to Kandahar, more than 400 miles away, once the shackles were in place. They left an indecipherable phone number on a scrap of paper. They paid $20 for the treatment, as all patients must. If they told anyone the name of the man, no one remembers.

"What will I do with this man?" asked Shafiq, the shrine's director and a descendant of Sahib. "Who is this man?"

Shafiq wondered: Was the man's mental state a product of war? Was he a former soldier? A civilian who had seen too much horror? Shafiq had helped check men like that into the shrine. He'd watched them writhe and scream and, eventually, he said, recover.

"For a lot of these people, faith is a key part of the healing process, and they have faith in the shrine," said Humayun Zahir, a doctor and the director of Nangahar Hospital, which is funded by the European Commission.

In his office 10 miles from the shrine, Zahir, too, has treated soldiers and civilians affected by the shock of war. Some came to the hospital after 40 long days shackled to Mia Shafiq's wall. Often, Zahir said, the shrine did more damage than good.

"They need medical treatment," he said. "A prophet cannot heal their disease."

In recent years, two of the shrine's patients have died — both from causes unrelated to the asceticism of life here, Shafiq said.

The deaths have prompted criticism, and so have the successes. Where Shafiq sees a healed patient — a violent man turned calm, his anger fading into passivity — his critics see quackery. The shrine's patients are being weakened by a lack of food, they say, not rehabilitated. Shafiq's ancestor was seen as a prophet and a healer in the days before modern medicine came to Afghanistan. Shafiq is seen by many as a crazy person.

To this, Shafiq merely shrugs.

"There are many who will never believe," he said.

The man from Kandahar had "anxiety and depression" — the product of an unknown trauma that had driven him to lose control, according to Shafiq.

The diagnosis is as unclear as the man's identity. He looks like a teenager, but clumps of his hair are missing. He spends his days singing and groaning and sleeping. When visitors with cameras come, the man often turns his back or throws a sheet over his head.

In the cell to his right is a man who says he was driven into depression by his brother-in-law's death in a U.S. night raid. To his left is a recovering drug addict with a wispy white beard who claims to be 20 years old.

Shafiq has deep-set gray eyes and a thick black beard. He walks slowly around the shrine, peering into the cells, checking on his patients. He carries a thick chain around his neck "in case any of them get out of control."

His enterprise could be written off as ridiculous or inhumane — it has been labeled both — but even mental health professionals have been forced to acknowledge its attraction in some of Afghanistan's most traditional communities.

"These shrines have been around for four centuries," said Ahmed Zahir, the head of the mental health department at Nangahar Hospital. "Many are totally inhuman, without even proper sanitation. . . . But there is certainly a strong belief in them among the people."

Several years ago, doctors from the hospital visited patients at the shrine, offering drugs to those willing to receive diagnoses. But that relationship faded quickly. The shrine and the hospital once again feel as if they belong to different centuries.

"The doctors cannot help us," Shafiq said.

Not all of the men and women shackled to the shrine's wall are forgotten like the man from Kandahar. In the corner cell, 27-year-old Mohammed Sadiq sleeps while his brother stands outside. He's there to keep away bothersome visitors and ensure that the recovery process goes as planned.

Sadiq went into a spiral of depression after his brother-in-law was killed in a U.S. airstrike three years ago, he said. He tried to deal with it himself but continued to unravel. He traveled to Saudi Arabia to work in construction, but the condition worsened, and he was forced to return to eastern Afghanistan.

Two weeks ago, his brother, Ahmed, decided it was time to intervene. He drove Mohammed 100 miles to the shrine and handed him over to its three employees.

When Mohammed Sadiq stirred from a deep sleep this week, he smiled wide and stretched his arms.

"I'm feeling much better," he said. "I am healing."

Shafiq looked on proudly. Another of his patients had acknowledged what so many doctors had denied: Shafiq's treatment worked. The miracle of the shrine was timeless.

The man from Kandahar still can't, or won't, articulate his progress or distress. When he awakes, his eyes are wide and empty. Flies are always buzzing around him.

He has about three weeks of treatment left.

"My Kandahari boy!" Shafiq exclaims when he gets close to the cell.

"You're feeling much better, aren't you?"