This article originally appeared in Tonic.
"Being a policeman in Kabul is more challenging than being a policeman in another country," says 35-year-old Amruddin solemnly, sitting in an office in downtown Kabul. He is restless, and his hands shake as he picks up his glass of green tea, a consistent traditional Afghan offering to guests and foe alike.
Amruddin, who like many Afghans has only one name, had one of his many frequent visits to the psychiatry department today. He has been diagnosed with a case of Post Traumatic Stress Disorder (PTSD), believed to have been caused during his time in battle with the Taliban in the northern province of Badakhshan. He was dismissed by his supervisors, who pointed to his mental health as the reason why they lost the battle with the Taliban. That was six years ago.
Afghanistan was liberated from Taliban rule 15 years ago, but for Amruddin the last decade and a half has been filled with death and gore. His family home in Badakhshan was hit by a rocket sometime in 2001; it killed one of his wives, his brother, and his uncle. Amruddin survived but was severely injured and was sent to Iran for treatment. "In Iran, I saw how their police kept order in their country," he says. "I was very impressed and I decided to join the Afghan police force to bring order to my country, and joined soon after I returned."
"But being a policeman in Afghanistan is nothing like what I would have expected," he adds with a weary sadness in his voice. "I defended the Kishim police station, its command post and the weaponry, with six other people. It was us against 200 Taliban," he says. "I watched my friends and colleagues die. I've been injured several times in war, but instead of [being rewarded], I have been labeled as crazy," he adds. "If I wasn't crazy then, I will go crazy now."
Amruddin's story is not an isolated case, but a persistent trend observed over and over among Afghans serving in the police forces. Former Afghan minister of public health Suraya Dalil once surmised that over 60 percent of Afghans suffer from some form of psychiatric problems. This figure is likely much larger among security forces: A majority of the 150,000 members are believed to have a mental health problem.
"They experience direct trauma from battle and are exposed to so much death that it is bound to have a lasting affect," says Ahmad Elham, a psychiatrist who didn't want to use his real name for fear of reprisal from authorities. Elham has worked closely with several police officers, including Amruddin. "Another police officer I treated suffered from nightmares where he was carrying the body of his friend whose death he witnessed," he says.
Still another of his patients, also a police officer, was diagnosed with schizophrenia and suffered from hallucinations. "He was suspended from the force, his family abandoned him; his wife left him, and he was on the brink of losing his job. We eventually sent him to India for treatment, where he showed signs of improvement and has since been on a positive recovery path," Elham adds, saying that it is likely they will be able to reinstate him into the service if he so wishes.
For every happy ending, though, there is a devastation. Take the police officer currently in treatment at a government facility, who believes that he is the notorious Afghan politician and warlord Gulbuddin Hekmatyar. He barks orders at his "commanders"—the hospital staff—to execute his enemies. There is little hope of reintegrating him into society, let alone into the forces.
For the police in Afghanistan, the challenges are multifold. Their duties often go far beyond just maintaining law and order. It is not uncommon to find them in battle with insurgents alongside the army—with far less training and a fraction of resources at their disposal. This also makes them an easy target for insurgents, who at times are better-equipped than they, leading to high casualties. In fact, the Afghan National Police suffer greater casualties than the Afghan Army, the Ministry of Interiors has noted.
A major force that keeps police from seeking help: cultural stigma. "[The] majority of the Afghan police forces are male," points out Afghan psychologist Rohullah Amin, who has worked with several police and security personnel. "There is a lot of stigma attached to mental conditions for this identity of a male figure in defense—gun-toting, strong, undefeatable, undisputed—it's hard for them to complain or validate how they feel," he explains.
"A lot of times even those in the defense authority stigmatize mental conditions rather than validating them," Amin says. "Officers are often teased or told off for crying, or complaining or for expressing fear. 'You're not a woman, don't cry. You're a man—be brave.'" And so these men in service sometimes ignore their fears and traumas, afraid of the stigma or of losing their jobs and credibility as a soldier.
Amruddin was accused of deserting his colleagues on the battle field. He spent six months in prison for a crime he doesn't believe he committed. "After they blamed me for losing a battle with Taliban, they transferred me, but never assigned me to a new post," he says. "So I went back home to see my family, since I hadn't seen them in months. When I returned, I was arrested on charges of deserting my post. It didn't matter that I had defended the Kishim police station. I was sent to jail and my salary was stopped." Amruddin often feels like the system is working against him. He has restlessness and insomnia and on the occasions that he does sleep, it's filled with nightmares and flashbacks.
Yet it took years for him to get a diagnosis. "While new recruits to the police department go through a routine psychological evaluation, there is no system to periodically re-evaluate their mental health once they are in the field," Elham says. In fact, Amin adds, cases of mental health problems often don't get identified at all unless there's an extreme manifestation symptoms, like a psychotic break.
Another serious issue that stems from lack of mental health support is addiction to prescription drugs. "When Afghan patients hear that I have "Dr." prefix in my name, they often immediately ask for a prescription to a common drug. That's a disturbing trend among Afghans," says Elham. But even without prescription, a lot of "nerve medicines" are easily available over the counter in Afghanistan. "Service men who are dealing with addiction often tell me how they started taking certain drugs because it helped them stay alert during operations and in battles." However, a lot of them find themselves addicted to these drugs unable to function without them.
The police hospital in Kabul is a calm, vast compound amidst lush greenery. It has a modest 50-bed unit for psychiatric patients that is almost always completely occupied. In 2016 alone, they've received approximately 300 patients, a majority of them diagnosed with PTSD. But there are so many more who are keeping their pain to themselves.
Amruddin is speaking to me about his situation in hopes of bringing more attention to the issue. He says that if the government educated the Army and police about mental health problems, it would mitigate the stigma. But there's a limited amount of funding, which means prioritizing food and first aid. International allies and organizations working in Afghanistan have yet to invest in the cause. All the people I spoke to nonetheless see it as an imperative for the success of coalition war against terrorism—a war that relies largely on the physical and mental capacity of the security forces.
Amruddin is among the lucky few who have received medical attention for his mental health. As he prepares to leave our meeting, he acknowledges this, but adds, "What we experience in the field is not healthy or normal. And for a lot of us, there is no going back to a normal life after having fought in the war."
"At the very least," he adds, "[the government] could make it easier for us to seek help, before we all go completely crazy."