"A Safe Place"-Rehabilitation for the Chronically Mentally Ill

Today we start our rehabilitation program with eight women from the "Deawana Khana Zan" which loosely translates to "The Women's Crazy House". The understanding of mental illness has a ways to go here for a more politically correct name. We like to call it "The Safe Place".

Below is a bit of writing I did about it last year:Marnie Gustavson June 2007
PARSA moved into our newly renovated building about four weeks ago, and my staff greeted the residents as if they were old friends. In fact, when Mary MacMakin, the founder of PARSA, started her work in Kabul PARSA worked at Maristoon also. Yasin, our national director, is a physiotherapist and he found some of his old patients still residing at Maristoon. There hasn’t been much of a turnover here in this, last place of safety for the disabled in Kabul. I stood at the door of one of the many buildings that make up the Maristoon and realized it was a house that makes few Afghans want to come into Maristoon. It has many names but the most common is the “crazy women’s” house. Fatima Gailani, president of ARCS, told me that one of the reasons that she took the job of being president of this agency was to somehow make a difference for these women. During the wars, soldiers would come to this house and commit unimaginable violations. Fatima told me that she has been able to keep them safe but no more. For four weeks I worked with my husband, a clinical psychologist, and director of American Friends Service Committee, my staff and the ARCS doctors and medical staff to assess the women inside and come up with medical therapy that could do more than merely sedate them. For years the illiterate attendants had been giving them a sedating anti-convulsent simply to control their behavior. As a result of our new plans these medications had been taken away so that they could be started on medication more likely to help them.

My staff member, Salia had been chosen by our ARCS/PARSA team to dispense medications for the next month while the medical team “titrated” the medication so that it worked for the patients. Salia and I faced a thin, angry female attendant; arms crossed who was refusing us entry. She was throwing time honored Afghan curses on our heads, and telling us that Allah would punish us for us for distressing her-a widow. Behind her I could hear shrieks, wailing and the breaking of glass. We had had a tough few days removing all previous medications from the attendants and it was imperative that Salia and I begin the new medication therapy so that the attendants could control the inmates. I called the supervisor, the supervisor’s supervisor and finally Fatima to gain entry as the attendant was simply doing what she had been trained to-protect her women. Any change in routine was highly suspect especially by a foreign agency. Three hours later, we finally walked through the doors, and as inured as I am to suffering I realized I had been avoiding visiting this house with its chaos of human minds gone awry. Salia, very comfortable with these women professionally set about medicating them. The attendants were affectionate also but had various tough methods of restraining the agitated ones. A number of the women were naked, talking to themselves in a language that only they can understand. But the images from this first visit there still haunt me. Salia and I and the attendant walked out to the courtyard to the far back corner where the attendant took out a key and unlocked a door. Into the doorway stepped a beautiful, unclothed young woman, with startling blue eyes and long black hair. She stared at us, took her medication and juice and the retreated back into the dark hole that was her room and the attendant closed and locked the door after her. Two months ago, she had bitten off another inmates lip and now this dark room is her life.

My husband says that we may experience some “miracles” with our new therapy because they have never been treated. Salia and the ARCS attendants are beginning to add “activities”. Salia has designed a pretty uniform with Velcro fastening for the inmates that feel compelled to rip off their clothing from time to time. We collect small gifts for the attendants and try to make their work easier. This has to be one of the darkest most unconfrontable corners of Afghanistan. We hope that if we can change something in the quality of these women’s lives, it will provide inspiration for other changes, giving hope to the Maristoon residents, and the Maristoon staff-so many who have worked for so long during the impossible conditions of the wars. We hope to support Fatima Gailani’s vision of a compassionate social protection program- Afghans caring for Afghans.