Masood had never had it easy financially. As a musician in Tehran, his work was often interrupted by bans on events during religious occasions or the fallout from Iran’s years-long shadow conflict with Israel.
But in the past six months, during protests, open war and an economic crisis, difficulty has turned into near impossibility.
“Since January, I have been under a lot of pressure while dealing with stress, unemployment and empty pockets,” the pop rock musician told The National. Like others interviewed for this story, he used a pseudonym for fear of being punished by the authorities for speaking to foreign media.
He is one of the many Iranians trying to cope with the mental health toll of months of turmoil.
In January, the most brutal crackdown on anti-government protests in Iran’s modern history left at least 7,000 people dead, human rights monitors outside Iran said. Then came the war with the US and Israel, which killed thousands, displaced many from their homes and destroyed basic infrastructure. It also led to the rise of a more hardline leadership in Tehran, one more willing to continue military confrontation despite peace talks with Washington.
Masood is now out of work. The economic crisis and the inability to earn have eroded the incomes and savings of many other Iranians, too. Inflation of about 70 per cent has made daily essentials too expensive for many people, adding money worries to their already heavy mental load.
The scale of the problem is significant.
Majid Saffarinia, head of Iran’s Social Psychology Association, told the Didban news website in April that the country had seen a “significant increase" in mental illness in recent years, because of the “burden of economic, social and war tensions". About one in four of Iran's population of 90 million live with a mental health condition, most commonly depression and anxiety, he said. The war with the US and Israel will exacerbate these figures, he added.
‘Emotional collapse’
In interviews with The National, Iranians across the country described feelings of deep despair and hopelessness. Not only are they dealing with the trauma of death, violence and state repression of the past six months, but many see little opportunity to escape a toxic combination of strict social and political restrictions long imposed by Tehran, the need to find ways around them, economic misery and the spectre of more conflict.
The main reason for clients seeking help in recent months “has mostly revolved around hopelessness", Ali, a psychotherapist in Tehran, told The National. “There is this feeling of confusion, of constantly trying to predict the future but the news being contradictory, with personal lives being the same as well," he added. "This might be a global trend, but in Iran, due to the war and the protests, it is much more intense.”
The crackdown on January’s protests left many people angry at the state’s willingness and ability to use deadly violence against its own people. Human rights organisations reported protesters being shot in the head or back by state security forces.
“People are falling apart inside,” said Shayan, a resident of the city of Isfahan. He was injured and one of his friends was killed in the protests, which formed the largest popular challenge to the regime in its 47-year history.
War, repression and economic woes have caused profound shifts in Iranians’ outlooks on life, forcing them into short-term coping mechanisms and living for the moment over long-term planning for futures that they often cannot see, those interviewed told The National.
resident of Isfahan
For young Iranians such as Shayan, who is in his thirties, the idea of travelling or building a prosperous life seems so far off that they no longer allow themselves to imagine doing so.
“People say, 'Let me at least go and do some sport, or live my life in some way, just so I can be happy,’” he said. “A lot of things just don't matter that much to us any more.”
Others have seen their relationships with partners and family members deteriorate as they struggle with the mental burden of their surroundings and are displaying clear symptoms of anxiety, panic attacks and depression, mental health professionals said.
It has been a “strange, turbulent and bomb-filled period", Behrouz, a psychotherapist in Tehran, told The National. Given the circumstances, “one of the achievements of sessions was namely preventing [the patients’] mental collapse", he said.
Anger and trauma
The war, which began when the US and Israel launched strikes on Iran on February 28, lasted 40 days before a fragile ceasefire came into effect. In that time, Iranians lived through bombings of civilian areas, which, the US and Israel said, targeted figures from Iran’s security and military apparatus. With limited air defences and no warning systems, Iranians sheltered in their homes as warplanes flew overhead.
Nazanin, a resident of Tehran, said her mother started taking more of the antidepressants prescribed by a doctor after she was diagnosed with cancer. “During this period she used more of them. The fear made everything worse,” Nazanin said. “It wasn’t easy to find her medication.”
The war also revealed how different people coped in different ways. “A friend of mine would never leave the house,” said Mina, a business manager from the city of Isfahan. “She never slept and was much more stressed than I since she had children. Another friend, though, would have parties every day, drinking and dancing every day.”
But it was not just the violence of the war that affected Iranians’ mental health. Alongside the shock and fear of war, many felt anger at their own leaders for driving the country into its current state.
“I felt a lot of rage. I was angry because the people were not responsible for this war, that the one who was [Ayatollah Ali Khamenei] was dead and we were left with the pain of it,” Mina added, referring to Iran's former supreme leader who was killed in the conflict’s opening salvo. “Of course, there was a hope that positive things would happen after the war. But of course nothing happened – just an unending sense of confusion that keeps going.”
Iranians who had hoped that the conflict with the US and Israel would cause the regime to collapse have been left bitterly disappointed. They have seen a new set of leaders within the same system claim victory and influence power in negotiations with the US.
“People had hope that the government would change, that we would arrive at good times, times of plenty, that the clerics would finally go and everything would be OK,” said Shayan. “But in reality, when that didn’t happen, and when they killed so many people [in the January protests], when they made peace [with the US], that injected a huge sense of hopelessness in all Iranians.”
Iranian society is “in turmoil now", Nazanin said. “Everyone is in a state of shock. They cannot believe what has happened.”
The culmination of events has had a profound impact on Iranians’ sense of self and how they relate to their country. While they had lived for years trying to find ways around the many social and political restrictions in their country and adapting to sanctions and hostility from Israel and the US, the past year has marked an even deeper shift.
Ali, the psychotherapist, said the past six months prompted many of his clients to wonder what home – their vatan, their homeland, Iran – means to them.
Isfahan resident
Some people have come to think of where they are from as a threat, Others regard it with fondness and others are uninterested, he said. “To some, it has been a discovery, as in just realising how deep the connection is.”
Sara, a family counsellor and therapist from the western province of Kermanshah, said the war forced families to interact with each other, exacerbating tensions. Symptoms of anxiety, panic attacks and feelings of insecurity were “very observable” in her patients, she said.
Differing views between older generations and younger Iranians who oppose regime-imposed restrictions have also created friction. That also happens between couples, Sara added. “The one who has not changed has problems with the one who has, in terms of ideology, politics or personal freedoms,” she said.
Coping mechanisms
Mental health professionals described a surge in the use of medication over the past six months as Iranians looked for ways to cope with stress and trauma. There has been a “meaningful increase” in the consumption of psychiatric medication, Behrouz said. Such treatments include antidepressants, mood stabilisers and antipsychotic drugs, medication that is generally only available on prescription in Iran.
Masood began to take citalopram, an antidepressant, in 10mg doses, which he credited with helping him to “retake control of my life, mentally speaking". He is still taking the medication, as is his wife.
Others have found themselves uncomfortable with their own reactions to medication. Shayan had been taking medicine that was “stronger than Prozac”, but decided to stop last week and started taking part in sports again. Exercise is widely accepted as a natural antidepressant and is recommended by doctors around the world, alongside medication and counselling.
“I took so many of them. I was going for them at really odd times and I felt really guilty about it,” he said. “So I threw myself back into working out and running so I could get through things.”
Others have found different ways to get by. Roya, another resident of Tehran, described how the events of the past six months have had a “significant impact” on her mental health. Economic uncertainty, security concerns and constant stress have led her to feel “emotionally exhausted", she said.
“To cope with these feelings, I try to focus on small daily routines, listen to music, spend time in nature when I can, limit my exposure to distressing news and remind myself that these difficult circumstances are temporary,” she added.
Some turned to therapy. Mina said she was continuing sessions that she began before the war. But others are put off by the cost or concerns that it will not help them, especially in the short term.
Mental health professionals also raised concerns about a surge in demand for counselling, exposing gaps in oversight and quality. “Due to social media, anyone can be one [a psychologist] even without having a supervisor or working professionally,” said Ali. “Due to the business aspect of it, they feel justified. This is the danger of it all.”
Others have also used illegal means to get by. Alcohol, recreational drugs and extramarital sex are prohibited in Iran, but many have turned to them as coping methods, professionals said.
“I met a friend a few days ago who had quit marijuana and they said, ‘Well yeah, after the war, we’re back on it,’” Ali added.
Government response
Government officials acknowledge that people with mental health conditions in Iran need treatment. The state welfare organisation in May launched a national mental health assessment programme that aimed “to identify people at risk of mental trauma caused by war and crisis and provide them with specialised services", state news agency Irna reported.
But many Iranians, so disillusioned with the government, are sceptical. “It seems more like showing off to me,” Nazanin said.
Professionals are also critical of what they see as the state's lack of interest in providing effective mental health care. Given years of security tensions, sanctions and economic crisis “one would expect some planning for people’s mental health", said therapist Sara. “But it has never been a priority.”
Ali said officials responsible for mental health services were not always appointed on the basis of skill but rather because of their government ties. They are "not particularly concerned with psychology", he said. “Also, due to the circumstances, they are either religious or are forced to act religious or something like that.”
While officials have acknowledged the effects of the war, some have also referred to factors that experts dismiss as causes of mental health conditions.
Last October, Deputy Health Minister Alireza Raisi blamed depictions of smoking and alcohol in series produced by local streaming services and non-state TV for Iranians’ poor mental health. “We can simply say that the opinion of these officials is wrong,” Behrouz said.
While taking medication has helped him to get through, Masood does not believe that his career as a musician will ever take off in Iran. He struggles with the idea of working in entertainment while so many people around him experience physical and mental trauma. “Something always hurt deep down, and still does,” he said.
