PESHAWAR: Rifaat Ramzan lay in a hospital bed with a blank stare, still traumatised weeks after losing his best friend, Noman, to a suicide bomber.
"He had just told me how it is good to dream and we will achieve our dreams," said Ramzan, who began sleeping with a gun under his pillow, fearful he too will be killed in relentless violence.
"This man came and asked Noman if he could get a lift on his motorcycle to the police station. When they got there the man blew himself up. Noman and nine other people were killed."
In the conflict between Taliban insurgents and Pakistan's army, thousands have been killed in bombings of everything from military and police facilities to crowded street markets; even a volleyball match was attacked. Countless others have been wounded.
But the psychological toll often goes unnoticed, even though underfunded and understaffed hospitals are treating a sharply rising number of people who can't cope with bloodshed.
"This is alarming us," said psychologist Najam Younes.
Some people are too depressed to function. Others are gripped by anxiety attacks, paranoia and post traumatic stress disorder. Flashbacks are common.
It doesn't take much to destablise minds.
Even headlines of smaller attacks that flash across news channels are enough to send people to psychiatrists seeking pills to calm them or help them sleep at night.
Luckily for Pakistanis, the stigma attached to mental illness has eased, making it easier for them to seek psychiatric care, psychologists say.
But the problem is that people caught up in the violence -- mostly living in the epicentre of the conflict in the northwest -- have no access to psychological care facilities. So they must take long, expensive journeys to cities like Peshawar for treatment.
Those who can afford it often don't get the attention they need because there are too few doctors, who are often overworked and cannot provide therapy, only medicine.
Peshawar's Sarhad Psychiatric Hospital, located on the same complex of a prison where militants awaiting trial and other hard core criminals are held, is one example. It is the only proper mental health facility in the northwest.
In the hospital courtyard, patients dulled by medicine sit on a cement floor in rows, quietly staring at each other. Some look lost. Others are suspicious. "Long live Pakistan", is scribbled on a wall behind them beside a drawing of a flower.
In a grim, tiny kitchen nearby, a cook slops stew into a huge pot beside steel bowls.
Senior consultant Muhammad Tariq sometimes treats 100 patients a day. He is also the region's main forensic psychologist, so he must spend time in court. Scant funding at the state hospital means he has no computer to manage files.
"There is only so much I can do," he said.
Tariq says 10-15 new patients suffering mentally from the violence arrive every day. Many have lost their homes and livelihood.
Still, those are not the worst cases.
Handling people rattled by bloodshed who already have mental illnesses is far more challenging. They are the most vulnerable.
Muhammad Ikhtiar was lucky enough to have an Islamic charity pay for his schizophrenic son's medicines. Fighting distressed his son Muhammad's fragile mind.
"Sometimes he is scared of the Taliban and the army. Other times he is convinced he is the commander of the Taliban and the army," said Ikhtiar, a serious, elderly man with a white beard.
Ikhtiar's problems don't end there. Taliban militants would often hide in his maize fields, so government forces made him cut down the crop, he said. Now he has to find ways of making a living while caring for his son.
Doctors say the patients need family support. But because of the fighting, it's too dangerous for them to head home. Muhammad Iqbal, a sturdy man wearing a traditional flat wool chitrali hat, suffers from bipolar disorder. His moods often swing from depression to elation.
Doctors hope stabilisers will make him realise it's too risky to return to his four children in North Waziristan, which is infested with al Qaeda and Taliban militants.
"Right now he has no idea what is happening," said the hospital's Tariq. "He thinks he will return to a peaceful village with a nice forest."
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