CAIRO, Egypt — Like many of her fellow activists, Zeinab el-Mahdi had faced a difficult few years.
The young Egyptian dodged birdshot and tear gas during the January 2011 revolution that removed Hosni Mubarak from power, saw people killed in front of her during the violent years that followed and faced the threat of arrest and imprisonment throughout.
Then on Nov. 14, she hanged herself at her family home in Cairo.
The Arab Spring began with a suicide — a young Tunisian, Mohamed Bouazizi, lit himself on fire in 2010 after a police officer confiscated his wares, sparking off uprisings across the region.
Now, a number of highly publicized suicides in Egypt have raised public awareness that the turmoil of the four years since has taken its toll on the mental well-being of the country.
There were others before El-Mahdi. In September a man hanged himself from a billboard in central Cairo, reportedly because he was no longer able to feed his family. Two months later another man hanged himself out of the window of his home, also reportedly for economic reasons, prompting an outcry across social media.
The deaths received widespread attention, but they are only part of the story. Since the 2011 revolution, psychiatrists in Egypt report seeing increased instances of trauma, depression, anxiety and PTSD.
“We are starting to see problems that before we only saw in refugees fleeing war,” says Farah Shash, a psychologist at the el-Nadeem Center for the Rehabilitation of Victims of Violence.
These issues are particularly prevalent in those who have been on the frontline of the country’s turmoil over the past four years — activists and protesters.
“There is no one who has lived all of that who would not have thought about suicide,” says 22-year-old Sara Mohamed, a friend of El-Mahdi's and fellow activist.
“Actually, most of us [have] thought of suicide after what happened in Rabaa and Mohamed Mahmoud, all of those things,” she says, referring to two of the worst post-revolution massacres of civilians by security forces. “It was like, I need this to end. It’s too much for us to accept what’s happening.”
Mohamed started to see a psychiatrist after witnessing particularly violent clashes in 2011, but later stopped.
“After Zeinab I was thinking seriously of going to see a psychiatrist again” she says. Her work involves documenting the stories of women and children detained by the government, most of them held just for protesting.
“I don’t want to know anything anymore. I’ve started to be aggressive. I’m being aggressive and I feel nothing.”
The upheaval seen in Egypt over the past few years has meant that there are few who have not witnessed violence in some shape or form.
Afnan Ahmed, another young student, says she has friends who can’t step into Rabaa Square, the site of the massacre of more than 800 protesters. “I know a few people who went and they started screaming once they entered the place,” she says.
Obstacles to care
But recognizing the problem is only the beginning of the battle. In Egypt, there are many obstacles in the way of people receiving help.
For example many Islamists, who have been a particular target of security forces since a crackdown by the government of current president Abdel Fattah el-Sisi, are fearful that if they seek psychological help they might be detained for having participated in protests.
“They are not sure about the privacy of the data they give. They are wary about the attitude or background of the healer [psychologist],” says Dr. Abdalla, a psychologist at Zagazig University.
“They are suspicious of us,” says Dr Suzan Fayad, another psychologist at the Nadeem Center.
However, she adds that there is a young generation of female activists, who come from more Islamist-leaning backgrounds, including Mohamed, who are beginning to recognize the importance of psychological care.
On the whole, though, mental health in Egypt remains a social and cultural taboo. Seeking professional support is often seen as a form of weakness.
“People say you’re crazy. You’re going to a psychiatrist? You have a psychological problem? Are you sick? Are you crazy?” says Mohamed.
Many in Egypt say people should seek solace in a mosque rather than on a psychiatrist's couch, seeing the difficulties they face as a kind of test of faith rather than a health issue.
“They would tell me before anything that you have to go to God,” Ahmed, who comes from an Islamist family, says of people in her community. “Seek your relationship with him and everything will automatically be alright.”
But even for those who want it, mental health care is expensive and few have the means to afford it.
Targeted by the state
Although it appears that the worst of the violence has passed, many Egyptians live in fear of detention or harassment by the state, a condition that adds to their psychological stress.
"The authorities or people in power… use fear so people will feel paralyzed,” says Dr Abdalla, “we eat fear, we breathe fear all the time.”
There are tens of thousands of political prisoners in Egypt. Many, particularly Islamists, are subjected to torture in prison and rates of PTSD and trauma among those who have been released are high.
“When the state is the perpetrator it’s worse because who is supposed to protect you actually is the one violating your rights and torturing you,” says Dr Sally Toma, another Cairo-based psychologist.
While the obstacles to proper care remain, Mohamed and her friends see talking about them as an important first step.
“We should start asking people more [about how they are] and raise awareness about [how to] take care of each other after what we all faced during these days,” she says.
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