Friday, 15 July 2011

Day 4: Thursday = Saturday

The day started on a sad note – a member of staff here was a close friend of a local man whose brother’s family have all just been murdered. Everybody around them feels very traumatised and upset. A few of us talked about it first thing this morning, and we were all affected by the horror of it – especially for those who are closest to the family.

Today is weekend – although it is a Thursday, today and tomorrow are on all the calendars and computers as the two days of rest.  Thursday is traditionally just a half day and Friday is the day for prayers – as in all Islamic countries, of course. Modernisers recently are trying to pass a parliamentary bill to change the weekend to Friday and Saturday, so it would be at least aligned with the western world of commerce and business for four and not three days of the week. The government is trying to support it - but it is a very sensitive and complex matter, and will need a great more discussion before it is agreed. So Saturday remains the first day of the week and Sunday the second: while we are feeling Monday Morning Blues, people here are already nearly half way through their working week. However, like home, many shops and businesses are open at weekends (including the psychiatrists seeing their private patients – see day 2). I wonder if there has ever been a Friday equivalent of the British ‘Keep Sunday Special’ campaign here – I suppose it is an inevitable consequence of global commercialisation that such sentiments do not have the same priority as economic ones.

But in a quirky way, the shifted weekend is an extra ‘disorientator’ that keep humans aware that different places in the world are actually different – however hard we try to homogenise our lifestyles in the name of progress. So alongside the daily and annual astronomical ones (time zones and seasons), we have the cultural one of religious beliefs: the weekly one of weekends, and the annual one of festivals and holidays. So – and perhaps this is getting a little far-fetched – we have the astronomical or cosmic anchors to the land (day and night, winter and summer) and the cultural or spiritual anchors to our fellow humans (weekends and festivals). And anchors like these, I would propose, provide an internal experience of containment through ‘knowing what’s when’ – and keeping the terrors of uncertainty safely at bay. Which is, of course, just what we do with our time boundaries in psychotherapy and therapeutic communities…

But for me, the experience here is definitely of a Saturday – ignoring the alarm clock, getting up for a leisurely breakfast, and not worrying exactly what needed doing today. And the extra bonus of having interesting conversations with my housemates about many things as we just chill out and hang loose, as they say.
And indeed, on that theme, one was language and idioms.  Yousuf’s first language is Persian (also known as, or nearly the same as, Farsi or Dari), and Raymond’s is Swahili. But like most under-educated Brits, my only language is English, so our chewing of the fat had to be in English. Though I did notice that we used quite a lot of hand-gestures to describe nuances and subtle grades of meaning, especially when the English wasn’t quite good enough to express something.

Another aspect of language which is more directly relevant to our mental health work is analysis of the qualitative data on our teaching evaluation forms. The numerical data is simpler – one can either cheat with the analysis, or do it correctly; and we all trust our staff to not cheat when entering the quantitative data into spreadsheets. However, in mental health, it is often the qualitative data that gives more information about meanings and relationships: and here, even the process of translation may introduce bias. For example, the evaluation forms have comments on them which are written in Persian, but need analysing in English. Our interpreter is a member of the team, but also a local young woman, and both English and Persian are second languages to her. To help with some of the trickier written responses, she discusses them with one of the psychiatrists who has good English. At least three sources of bias come in here: (i) she goes to ask different people, who all tell her slightly different things; (ii) the psychiatrist is senior to her, so she is culturally unable to disagree with any of his or her opinions; (iii) both of them may, probably unconsciously, choose wording which does not offend local or national sensitivities. This is a life and death problem in the war – as deliberately distorted interpretations are known to have caused fatalities. To prevent the danger of this, the British forces now train their own interpreters and translators – and recruit, for example, Afghanis resident in the UK to translate between the local languages (Persian, Pashto and Uzbecki, mostly). I heard that the British forces run a ‘training village’ in the UK to replicate many of the cultural and religious factors, to help accuracy of understanding for translators who are learning the subtleties and nuances of the three main local languages.

We had quite a scare after lunch today, when we were at the NGO offices: Yousuf received a phone call from his wife in England telling him that there had been a suicide bombing in Kandahar Red Mosque, where the President’s brother’s memorial service was happening – and one of Yousuf’s close family members was with the Presidential party. Although President Karzai was known to have left and flown back to Kabul after the funeral and before the memorial service, there was confusion as to whether the family member was still in Kandahar, or had also come back to Kabul. The fact he could not be reached by mobile phone made it more worrying and reassurances from officials on the phone were not convincing, and only when Yousuf had directly spoken to him on the phone an hour or so later (the phone also kept getting jammed by the ‘blockers’ – see day 1) did he feel able to relax. We later learned that four people died and he was indeed in the mosque at the time – but at the other side from the entrance. Also, most Afghans normally wear turbans – which are never searched, and it was the turban in which the bomb was hidden, which we thought was a new thing – so this will probably lead to routine searching of turbans from now on. Like the shoe bomber being responsible for us having to take our shoes off at airport security nowadays.

There was also a ‘minor scare’ from the security staff in the HQ office, who said that they had just had a report that our way back to the house was blocked by a large demonstration – and we wondered if we were marooned in the office, just as everybody was due to go home. However, a conversation with a native man on the security staff soon established that it was a group of female university students who were objecting to sexist remarks made by their male passers-by. Their slogan was 'This is my street too' - so they could walk along the street without being harassed or abused. We would have gone and joined them if we were allowed!

But this illustrates how the ‘being in a war zone’ is more dangerous to mental well-being than it is to physical health. With the protection and regulation imposed on us, it takes no great statistical analysis to say ‘I am more likely to get killed as a cyclist on the Euston Road to Paddington station (which I do most weeks) than I am to be murdered as an expatriot in Kabul’: several cyclists get killed in London each month, and nobody here can remember when an NGO expatriot was last murdered. But what does happen nearly every day are these ‘anxiety bombs’ – which transmit their shock waves like electricity through all the personnel here: often with personal worries about loved ones, or colleagues. And they are used very effectively by the security staff to keep us in line – and obeying the rules of where we can go (our NGO's premises and projects, and the places on the safe list) and where we can’t (everywhere else). At least one of those anxiety bombs, of different severity, has gone off each day I have been here. And it’s OK for me – because I’m going home on Sunday: but what effect must it be having on the mental health of all the permanent staff, people like Yousuf who know so many people here, and even more on the residents of Kabul, who know no other home –and surely can never feel safe from this anxiety and dread?

There is a real, and I think insoluble, muddle about ‘us and them’ in discussion of ethnicity over here. At first, I kept hearing words like Tajik, Hazara, Dari, Uzbeck and even Sunni and Shia without understanding whether they were religious, tribal or linguistic. So I asked a few questions and concocted the following ‘idiot’s guide’ to help me through conversations without putting my metaphorical foot in it (and feet are another sensitive matter – my iPhone etiquette app told me that it is extremely insulting to use them for anything except walking - but Yousuf tells me he has never heard of such rubbish! Or is it that comes from a different Afghani group, or is somebody trying to start a silly urban myth, or just make me paranoid?). But then we had a long and complicated discussion about what you can and cannot do with your feet, and decided it meant sitting on the floor with your legs out (they should be crossed) or touching other people with your feet - both of which are very rude.


Facial appearance
Varies, but is quite distinct from Uzbecks and Hazaras
Iranian or Tajikstanian
Area of Afghanistan
S and SE
S and SE
N & W
Geographical origin
Southern Asia
Southern Asia
Central Asia
Pashto & Persian
Persian (mainly)
Persian (mainly)
Type of Islam
Others (including non-Islam)
(all figures are seriously disputed)
Less than 40%
Includes most  of the Taliban (but most are NOT Taliban)
About 25%
About 10%
Less than 10%
About 5%

Families are extended and huge, and often the line between who is family and who is tribe becomes indistinct – especially in matters like job application and recruitment. In our Western ‘we can manage anything’ style, beloved of arrogant clinicians and authoritarian managers alike, Raymond and I soon had it sorted out. We said – ‘don’t you just need to agree an equal opportunities policy, so all the tribal factions and ethnicities are fairly represented? Surely it’s not beyond the wit of man to find something that is fair and agreed by everybody?’.  But no, said Yousuf, what we casually call ‘equal opportunities’ would be seen here as encouraging racism at home – and certainly if it is written down or spoken on the public record. It would publicly question an Afghani's integruty that they are one people. The collective cultural sensitivities are seriously offended, and although it may happen ‘in private’ – any such behaviour would never tolerate public exposure. Publicly, all Afghanis will profess that “we are all brothers together in Afghanistan” – but in private, and out of media or ousiders’ gaze, they will gently joke with each other about their differences, poke fun at their different characteristics, and be friendly or less friendly rivals. There is a paradox here: that to respect everybody equally actually results in some others feeling disrespected, and that their collective cohesion is being disrespected.

Perhaps this very deeply ingrained process becomes entirely understandable when we think of it not as a matter of individual rights or conscious and rational decision-making, but more as a phenomenon of the collective unconscious – where decisions and actions necessarily come about through a complex and emergent process most of which is conducted at a level where words fail, and logic is largely that of the limbic system, or primary process. And this could then be framed as actually being more respectful , but of cultural, collective, emotional, social and relational values – rather than our own predominantly mechanistic, operationalised, materialialistic, reductionist and individualised ones. And who is in a position to say which of those two positions is more ethically, morally or philosophically right? I have only been in the country for a few days - and these are merely personal ruminations - I’m sure somebody will have done research and a great deal of thinking about this somewhere, but it is so far out of my own field of understanding that I wouldn’t know where to start looking. Has anybody any ideas?

[Photos today are random ones taken from the car while we were driving to and from the city centre. Through the windows of course!]

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