Year : 2018 | Volume
: 16 | Issue : 3 | Page : 202--206
Addressing the mental health needs of many people with few resources: An interview with Dr. Rohullah Amin
Bezhan Ayubi1, Hikmatullah Noori2,
1 Assistant Professor and Mental Health Counsellor, Faculty of Psychology and Educational, Science of Kabul University, Kabul, Afghanistan
2 Senior Finance Advisor, Hunter College, City University of New York, Kabul, Afghanistan
Assistant Professor and Mental Health Counsellor, Faculty of Psychology and Educational Science of Kabul University, Kabul
It is assumed that mental health problems are prevalent among Afghans and that the number professional mental health services are less than is required. An interview with one of the pioneers of the contemporary mental health sector Dr. Rohullah Amin is here presented. Psychological interventions are a relatively new approach for addressing emotional and behavioural problems in Afghanistan. However, providing mental health services for many people with few professionals remains a challenge and requires high levels of knowledge, skills and creativity. Mental health professionals may use different available approaches for addressing mental health issues but incorporating cultural strengths into their service makes their efforts acceptable and may lead to more desired outcomes. Use of television and other media may be one way to destigmatise seeking mental health services, as well as educating people about psychological health. Furthermore, mental health and psychosocial support could be used as tool for enhancing the quality of Afghan lives.
|How to cite this article:|
Ayubi B, Noori H. Addressing the mental health needs of many people with few resources: An interview with Dr. Rohullah Amin.Intervention 2018;16:202-206
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Ayubi B, Noori H. Addressing the mental health needs of many people with few resources: An interview with Dr. Rohullah Amin. Intervention [serial online] 2018 [cited 2019 Jun 17 ];16:202-206
Available from: http://www.interventionjournal.org/text.asp?2018/16/3/202/246439
After decades of war, the Afghan psyche has been wrought with consistent conflict to the extent that the masses have, for years, been normalising and undermining the mental health impacts of war. However, amidst this grim mental health epidemic, a steadily growing community of psychologists, psychiatrists and mental health experts are recognising and addressing the need for reform and capacity building in the field, while also organically developing practices suited to the Afghan people and culture. Among the pioneers of the contemporary mental health sector is Dr. Rohullah Amin, who is known not only for his efforts to increase awareness of the need for psychological counselling among Afghans, but also for his extensive knowledge on the impacts of violence on mental health within the Afghan context.
A postgraduate in psychology at New York University in 2013, Dr. Rohullah Amin is a psychologist by profession and has conducted independent social psychological research on the psychology of peace within the context of Afghanistan, as well as on the impact of violent conflict on public mental health. He has developed theories on organisational development and organisational behavioural changes in the workforce under conditions of psychological stress. Prior to this, Dr. Amin had studied curative medicine at Kabul Medical University. Over the last few years, Dr. Amin has conducted research on the psychology of peacebuilding and the rehabilitation of war mentality.
Dr. Amin serves as commissioner and head of the Appeals Board of the Independent Administrative Reform and Civil Service Commission. He also contributes his services as a director and senior research fellow at the American Institute of Afghanistan Studies. In addition, he has taught at the American University of Afghanistan, Kabul University and the Institute of Diplomacy of the Afghan Ministry of Foreign Affairs and has also served as head of the Fulbright Association in Afghanistan.
As well as providing mental health services, he is also considered an influential advocate for human rights and mental health. He frequents many television shows speaking about mental health and provides psychoeducation to different age groups, especially youth. For this very reason, we met with Dr. Amin on 12 July 2018 in Kabul to discuss his views, ideas and experiences of using the medium of television, extremely popular in Afghanistan, to address increasing awareness of mental health issues. Through his experiences, insights and effectiveness of such programmes, we hope to encourage other professionals to develop similar (or more creative) programmes to deal with mental health and wellness issues.
Television programme on mental health
Dr. Amin appears on the morning programmes of a variety of Afghan channels. These programmes are focused on providing general psychoeducational information to the public. It helps sharing simplified psychoeducational information to help people learning the different aspects of mental health in their lives and how they can take measures for their own psychological wellbeing. Several television channels have shown interest in running such programmes, and there are several programming slots dedicated to similar formats.
Dr. Amin prefers the format which involves direct communication with his audience, so they can ask questions and he can interact with them. He also contributes to some televised debates on social issues, but he tries to stay outside of politics, because politics in Afghanistan means mainly to take sides and he wants to avoid that.
’I have been interested in elaborating psychological processes and to help people to make sense of their lives, their surroundings and all the phenomena around them, such as war, conflict and violence in general, as well as all the other issues they are dealing with on the daily basis. Because I notice that people are confused about everything. In that confused state, it is very difficult to make sense of their lives: think of experiences that people have in their own family, their relationships with their family and children, with their spouse, friends, colleagues and the larger community. Some interpersonal dynamics have their roots in the mental processes and mental conditions. The way our language is formed, the way our vocabulary changes and everything else has [have] a lot to do with making sense of our lives and surroundings. All I do in the television programme is to address those questions and share some of the answers that are good in my life, hoping that it may be good for others too. I join people in that search for the right answer, I don’t have the answers already prepared.
I have no possibility of measuring or studying the impact of my television show on mental health overall, but I receive many emails, Facebook messages, comments, likes and notes on Facebook. These messages give me an overall feedback of how it is received. They show respect for me as a teacher or doctor, which is part of the culture, but they also think or hope that I have the answers to everything that is important to them. I have to tell them that I don’t have any answers.
The comments show that the programme contributes to people’s attitude towards their lives, their marriage, their work and their life habits. I see it as achievement and that makes me happy and makes me continue and reinforce what I am doing. It seems that the programme triggers or encourages people to look to their personal lives. For example, in terms of choosing their soul mate or their future spouse. People have their own questions and look for their own answers. The programme helps some people, although I am sure it might also make [some] people more confused. This confusion creates new questions. People come back to me when they do not find an answer themselves. I notice that, due to the programme, people do question more in their personal situation and look for more resources and help, and search for more support in finding direction.’
Selection of topics
Often the programme team have selected topics that they picked up that week.
’Usually I work with their topics, but I fit that into my perspective. Because those who work on these programmes are mainly young women and men and they usually select topics based on their own daily experiences, needs and questions. I respect their lives and the questions that come up, I paraphrase in a way that I can share it. I try to keep it in a way that everybody can understand.’
’The programme watchers also give me a lot, it is two-way transaction. They ask questions that keep[s] me searching, reading, asking my supervisors, my friends and colleagues to find a way that can help a person to move on. As a young boy, I always craved for someone in my life that I could talk to, with whom I could feel safe, that I could feel like being with someone who would honestly accept me as I am and respond to the dilemmas I was dealing with.’
In psychology, we call that healing by healing. Healing others by healing yourself or healing yourself by healing others. This process gives me a lot. It is amazing that we can provide some psychoeducation for people, that they learn a little of how their psychology works. That they recognise experiences, how the environment influences them and how they − as a person − influence their environment. The Afghan society desperate [desperately] needs these general psychoeducation programmes. In particular the youth, a generation that is totally lost and doesn’t know where to go for answers. They don’t even know what to ask. Sometimes they are too confused. I think that helping them in that confusion, or even being confused with them, allows them to ask their own questions. I just jump into the water with them and, while swimming, they might be able to find their own way of surviving.
There are not specific programmes for children, but teenagers watch the programmes.
’I receive many messages from teenagers and adolescents. They are dealing with the transitional issues in their lives. Because they are on the edge of [moving from] one stage of their lives to another, they are searching for answers that convince them.’
Dr. Amin does work with children but not on the television. He works with a group of children in a very small, poor school.
’I work with the children by using storytelling. We sit together and tell stories about everything. I try to structure those stories and, by doing this, it turns to what we call narrative therapy. I help them to develop their own life narratives, making sense of their lives and helping them to restructure their narrative in a way that makes sense, and this more productive narrative helps them to create a life and future they want to create for themselves.’
Dr. Amin started this work because he was inspired by a woman who is a teacher and a community activist and who works with women and children to help them with their education. She started a local non-government organisation (NGO) and works with district offices of the municipality department, public schools and mosques. She finds women and children who are in need of support with their education and tries to find (financial) support by going to well-off public and private schools and asks for their support in accepting her students with discount. She connects the children to these schools.
’She often asks them; would you pay for this kid’s school? Would you pay for this kid’s course, or class or something like that? So, I was introduced to her and saw that she was providing such a valuable service, I started to support her. Not only financial support, but by having meetings with about 28 children we selected, all orphans. They lack either their father, or their mother, or both. Some are living with close or distant relatives. They have some food and clothes, but many are abused. A few went to school, very few, I think about seven of them. The rest work for their uncles, their brothers, or their brother-in-law; in shops, stores and other places. Their ages are between five and thirteen. The older girls are not able to work outside. They have to do the housekeeping. Their movements are restricted and their social roles are dictated by the cultural norms. I met a five-year-old child who was working with an uncle who was selling potato chips. This child had to peel about 20 kilograms of potatoes every morning, in the cold mornings of Kabul − frozen water, frozen potatoes, but he had to sit on the side of the road and peel all those potatoes for his uncle to come and fry and sell them. Five-years-old … those were the kind of children I came across in the last three years. Two other friends of mine and I tried to contribute with our time, money and/presence to pay for five teachers and to help these children. We rented a house, where the teachers could teach these kids outside school times. They helped the children with math, reading and writing and teaching the Quran and other subjects, such as arts.
I came every week and was training these teachers how to tell stories, and I was telling stories with these kids myself. I did that for about three years, almost every other day, and then only once a week until we had trained three people who could do that. Now those three teachers are doing it and I am receiving all the transcripts of those stories. We shape those stories and then we tell them to the kids and allow them to continue making those stories, so they reflect on their personal lives via these stories, which is fascinating.’
The strength of the Afghan culture
We would like to know how he considers our Afghan culture. It is often addressed on its negative and problematic elements, but what is the strength of our culture and society?
’I would say a strong sense of religiosity. One big mistake is that many NGO’s and progressive moves made in Afghanistan is that they would take over the role of religion. Denying something that is very deeply rooted in the country is not a very smart move. You can shape and reshape it, you can modify it, you can help people to improve their perspectives, improve their own connection to religion and culture in the society, but you cannot ask them to start believing in something new. It is like asking them to betray their own culture, betray their own self, betray their blood, their ancestors, betray everything that they are about to be. You cannot ask someone not to be religious, not to be a Muslim. That was a big mistake. I think religion is a great asset. We need to work with religious leaders, but also with religious people. Also, allowing them to develop inner understanding and a new understanding of subjects they have been living with for a long time. I see that as an asset, that can be utilised to improve quality of life and quality of health and mental health and individuals and families.
The other element I want to mention is the very hierarchical society. This is not only an obstacle, but creates opportunities. Hierarchy will not just disappear. It is better to work with that system of hierarchy. It is better to shape those in power to what we believe is helpful for the country. We have to express our ideas and intentions for youth, women, girls and children in our society. That is exactly what this amazing teacher has done to the head of municipality district officer. Just telling them what we [would] love these children to have, can you help, and they said, ‘of course’. It is otherwise very difficult to mobilise fifty people.
Once, we went with our families to this village to celebrate Iftar. We sat with those kids and ate with them and the villagers accepted us, not because they had to, but because they wanted to. I think that is what we need to do to break the hierarchical patriarchal system in Afghanistan, reach out and build bridges. With the support of the locals, you can penetrate all layers of the Afghan society, allowing you to have a larger, lasting impact.’
Gender issues and cultural behaviour
’I think this man centred, masculinity praising, patriarchal system is possibly one of the negative aspects of Afghan culture that we can work on. The same for extremism. I don’t mean particularly religious extremism. We are extreme in what we eat and how we eat, like eating rice all the time. It’s as if there is nothing else in the market that we can afford. Our diet is extreme and if we are religious, then we are fasting for three months, like my mother does, which is it is not good for her. That is extreme behaviour. Another example of extreme behaviour is of a friend who is studying engineering. He doesn’t sleep for four nights. Studying four days and nights and then after that sleeps for three days. We go totally for something as if there is nothing else except that one particular thing. Or we totally follow our parents’ values or are totally rebellious against them. But most things are not totally great, or totally bad, and we should find the middle ground. I think extreme thinking and extreme tendencies are negative aspects. We see the world as black and white and tend to omit the grey areas and ignore seeing many other colours. So that is probably one of the things that we can think about as aspects that are not very helpful in creating human society.
But we do have negative aspects regarding gender. Unfortunately, Afghanistan is a man centred society and a lot of emphasis is put on manhood and masculinity. We attach positive values to masculinity values and connect them with other characteristics like bravery, richness, leadership, control and so on, but we can challenge these values together. We can help men to be human first and in the second place man, but then we have be able to meet as man and woman, as human beings and respect each other and allow our daughters to flourish as we help our boys to flourish.’
Fortunately, Dr. Amin also sees positive resources in the Afghan culture, also related to gender. Something that is considered as problematic.
’As long as they are young, people will call them names, bother and harass them. That happens a lot, but actually, we are trained to respect women. This respect that we have learned could be better utilised and better understood, and we could train our children to develop a better understanding of that respect and operationalise it in a way that it improves our social relations. Also, religion has many resources, like the prophet saying that one should respect the women and children. If everyone of us takes care of one child that has no parents, no family no support system, there would be no children without support in this country. So, let’s work together, let’s talk together, let’s work on mechanisms that we can utilise all these resources.
The biggest start is within our families by respecting our daughters as much as we do our sons, that is a great beginning as brothers and as fathers. Men should be fighting this fight before everyone else. We should be empowering our girls not through NGO’s, but through our own family values. We should let our girls know that they can and that they should never give up and they will have our support. We should let them know that we will stand by them, no matter what choices they make, and that we will never leave them. We should assure our daughters that they are as valuable as our sons, our brothers and anybody else in our families, and they can make their lives the way they want, and we will do anything we can to help them to get where they want to be. So that is the start. The second thing is that we should probably challenge our thinking, all the things we believe in, all the norms that we have so deeply absorbed and is now in our blood. We should be able to freely challenge everything that we treat as inevitable, as unquestionable. We should question the unquestionable and I think that is the way to move on to change all these negative effects.’
Mental health and psychosocial support and peacebuilding?
We are interested in his vision on mental health and psychosocial support (MHPSS) and how we can use this knowledge to improve the lives of Afghan children.
’MHPSS is a great tool that we can adopt that would help us integrate our services, our policy making strategies, our ways of determining of what should be done, how it should be done and where. If we have decided that we allow institutions to work together and define their strategies on how to get to that shared vision, that we have to define together. So, these are the priorities that MHPSS looks forward to for a mentally healthy world and I think there are a lot lessons that we can learn from this amazing tool that we can use in institutional culture and policy making level to improve equality of lives and the quality of the social values that we want to create.
Leaders in Afghanistan come with many visions, and try to define those visions and develop some strategies to get there. But institutions are the machines to operationalise those strategies and institutions in Afghanistan are working in silos and don’t communicate with each other. They create systems that don’t interact. For example, the challenges of the health system and the education system are enormous and there is much overlap, thus those systems should work together for a mentally healthy society instead of patronising each other. There is a lot that our educational system can learn from MHPSS to improve the quality of education for mentally healthy children. There is a lot that our health system can learn, there is a lot that our Ministry of Labour, Social Affairs, Martyrs and Disabled (MOLSAMD) can learn from MHPSS to improve the quality of our social affairs, our professional designations for institutions for these areas of expertise that can improve the quality of lives, but also implement those visions. We can really benefit from MHPSS, such as better institutional culture, information sharing and integration of systems of implementation, monitoring and evaluation. That will allow the educational system to utilise resources and create what they thought was good for those societies.’
There are different pathways that psychologists can take to help people to enhance their quality of life. For a mental health professional, working on individual level is not always enough. For presentation and support, using mass media can be an appropriate manner to convey the message. Furthermore, working on a community level seems to be a more applicable approach to addressing shared concerns and improving mental health. This could be true, especially in countries where almost all of peoples’ experience is of different forms of discomfort. It is also essential to consider the cultural strengths of a community while working on different levels. Moreover, working for improvement of mental health is, in reality, a big step towards peacebuilding. Once people have inner peace and positive attitudes towards each other, they can work on other issues more effectively.
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Conflicts of interest
There are no conflicts of interest.