• The Perilous State of Mental Health in Kashmir

    Excerpt from “Will Peace Return? Trauma and Health Related Work in Kashmir”

    Sahba Husain

    March 5, 2018

     

    I had always wished to return to Kashmir, which I was able to in the year 2000, as a consultant with Oxfam, as part of its Violence Mitigation and Amelioration Project (VMAP). I was returning to Kashmir after 20 years. Much had changed in these years, particularly the heavy military presence against the unarmed civilians. My brief was to examine, empirically, the psychological impact of violence on people’s daily lives; and to attempt to understand the various ways in which people, both at an individual and collective level, coped with the immediacy and the aftermath of violence — loss, prolonged grief and stress, unforeseen hardships, suffering, and the intense trauma that it entailed.

    Until I returned there, I was deeply concerned, as most of us have been, about the situation in Kashmir. But, I must confess that I was not prepared to be confronted with such a colossal human tragedy. The challenge I faced, as an activist, a researcher, and a field-worker, was not so much in terms of collecting data and securing testimonies as much as in being able to question my own ignorance regarding the scale of this tragedy, and to be able to begin to absorb and understand this calamitous change that I was witnessing. At the same time, I had to try and come to terms with my shifting, fast eroding, crumbling beliefs and perceptions which I had, so far, held of the Indian State and its treatment of the Kashmir conflict, one of which was the belief that Kashmir was an integral part of India.

    […]

    Women and children, rendered more vulnerable in this situation, had to slowly learn to cope with the trauma of sudden loss, death, and destruction on such a large scale. Women had to adjust to their new roles, as breadwinners, to support and sustain their families in the absence of their men who were either killed or “missing.” Are they, are any of us, equipped to deal with such a calamity? To live with this deep sense of loss, insecurity, fear, and in the constant shadow of death, and, within this, to search for new sources of livelihood, comfort, and trust that were being eroded in a hostile environment; this concern remained with me wherever I went to meet people.

    According to a district chief medical officer, “One of the most negative and critical outcomes of this prevailing atmosphere of violence has been the loss of trust and confidence in oneself and others… I say this with a sense of pain because this basic ability to trust has been integral to our character, our personality, and our very existence as Kashmiris, but this has been destroyed over the years. Suspicion stalks everywhere. Young men are picked up on suspicion of being militants, parents often suspect their sons to be militants. As for me, I have been picked up on suspicion of nurturing links with militants simply because, as a doctor, I have treated many young men who came to me with bullet injuries. I was kept in a cell for three months and tortured. If this can happen to a government employee, imagine the plight of ordinary people on the streets, in the villages. To be made to suffer such inhumanity and indignity can easily lead to a loss of self esteem, confidence, trust, and one’s ability to live without fear… ”

    When I first heard someone say to me that, when he left home every morning, he was not at all certain whether he would return alive in the evening, I took it as a stray comment; his individual anguish. But it soon became a refrain, irrespective of gender, age, class or profession — a collective anguish of a people learning to live as “normally” as possible in the midst of the most abnormal and trying situation.

    […]

    During my visits to the only government hospital for psychiatric diseases in Srinagar, I interviewed doctors and also spent time observing/meeting patients who had come with complaints of acute depression, frequent palpitations, heart ache, lack of concentration, loss of appetite, sleep disorders, and intense anxiety. The rooms in which the doctors sat were small compared to the large number of patients who had to jostle for the doctors’ attention. I soon learnt that, for the past 25 years, while the number of doctors (psychiatrists) had remained stagnant at 5, the number of patients had increased dramatically. From 1,700 patients in 1971, their number had gone up to 32,000 in 1999. According to one doctor, at least 80–100 patients visited the OPD daily, compared to 10–15 of them in 1993. “Medication alone is not the solution, as majority of the patients are highly traumatised and require sustained counselling.” The few doctors on duty are unable to provide this due to paucity of time, space, and the fact that the state health authorities do not consider this to be an essential service, despite the fact that more than two-thirds of the population today suffers from chronic psychological disorders. According to them, “What majority of people are coping with, today, is not ordinary stress, but catastrophic stress,” which is induced when they are witness to sudden killings, disappearances, and torture of their close relatives or loved ones, oftne in their presence. Since this has been a common occurrence in the last decade, patients come with psychotic symptoms such as delusions and severe hallucinations. “The quality of life among such people is close to schizophrenia. Even remote reminders of the actual event can trigger extreme fear among them, leading, sometimes, to their refusal to go out or meet people. One individual’s psychotic state can often lead to family illnesses where all members, particularly women, begin to suffer similar symptoms.”  Some officials in the health department admitted that it was beyond their capacity to address (or redress) this magnitude of tragedy and trauma among people, many of whom have no other option but to consume a variety of psychotropic drugs on a daily basis, including anti-depressants and tranquilisers,  in order to survive. This was corroborated by a leading chemist, according to whom, there has been a 100% increase in the sale of such drugs.

    Men visit the hospital more often than women, said the doctors, even though women and children are more prone to depression and anxiety. Out of 10 cases of acute depression, 7–8 are reported to be those of women patients as they struggle to keep the family together, often neglecting their own health. What keeps many women away from the mental hospital is also the fear of social ostracisation, particularly young women, whose marriage prospects, the parents fear, would get jeopardised. Added to this was the problem of the long distance that they had to cover to reach the hospital, where, due to a severe shortage of staff, doctors had limited time to give to each patient, which often resulted in many of them returning unattended. It was mentioned that if the fear of social ostracisation and retaliation had not been a real constraint, not only would more women visit the hospital, but many cases of rape would also be reported and treated. Suppression of this brutal reality has caused women to suffer in isolation. The problem is further compounded for women, as the village level health workers are now conspicuous by their absence. Their fear of the ever present Security Forces preying upon them is matched by the repeated threats that they receive from the militants to stay away from duty or face the bullet, as any work related to  family planning or abortion is, as a decree, “forbidden” by them.

    Doctors report an increase in the number of cases of attempted suicides, particularly among young girls. According to a study on  the rate of suicides in the Valley (Department of Sociology, Kashmir University), more than  2000 persons  have committed suicide in the last decade, and the trend, particularly among women and the youth, has become more prevalent in the last few years. “Although, as per unofficial estimate, only 40% of the suicide cases are reported, an average of 15 persons kill themselves each month, making it one case of suicide every alternate day.” The most active suicidal age group, according to the study, belonged to the 16–25 years (76.92%), followed by 26–40 years age group (20%). The report cites women as the most vulnerable group, accounting for 77.41% of all the cases of reported suicides.

    Today, in Kashmir, all age groups are exposed to symptoms of PTSD. Prior to 1990, only those above the age of forty complained of high blood pressure, hypertension, and heart ailments; but, now, such patients’ age group is 18–35 years. In a situation like this, children become susceptible to high emotional stress, often leading to various behavioural disorders. They suffer from fearfulness, irritability, instability, refusal to be left alone, and a general lack of concentration. “Children born in 1985 are now 15 years old. They have grown up in this hostile and violent environment. They have not seen normalcy or known what it means to lead a normal life. They perceive this abnormal situation as normal, until they can go out of Kashmir and see the difference. Most children of this age have not seen life outside the Valley or life as it was before this toofan, this storm, began,” said a middle-aged father who is also anxious about the well-being of his own children.

    Children constitute nearly 38% of the state’s population, but there are no official figures regarding the number of orphans. The unofficial estimate is of 40,000 orphans. There are only three government orphanages, housing 58 boys in one and 25 girls in another. One orphanage is meant only for the Gujjar Bakerwal community and has 100 girl orphans. While hundreds of orphans are reported to have taken shelter in their relatives’ homes, majority of them remain uncared for. Some fortunate ones have found a home in private orphanages run by local NGO’s where, despite their efforts, the capacity is limited, mainly due to shortage of resources. This, along with an escalation of poverty and deprivation, has led to an increase in child labour involving petty jobs as well as the traditional carpet weaving industry that provides many children a source of livelihood. There have been reports of children suffering from malnutrition and mental degradation with no recourse to social, legal, and emotional protection. Disruption in normal life, which includes an uninterrupted access to education and health, has exposed majority of the children to unforeseen risks and hardships.

    Even though the state government has instituted a few compensation/rehabilitation schemes for orphans and widows, these fall far short of the actual needs and requirements of those who have suffered and borne heavy losses due to the continuing violence of the last twelve years. In fact, as one travels through the Valley, there is a sense of a loss of governance everywhere. There are visible signs of a near complete structural collapse of social services, particularly in rural areas.

    That the state only recognises “victims” of militancy as beneficiaries of its rehabilitation schemes, that too after fulfilling time consuming and cumbersome procedures, is evident from the fact that all the others who have been, and continue to be, victims of the excesses committed by the security forces, have nowhere to turn for their grievances. Left to fend for themselves and their families, many of them, women and men, have been protesting against these injustices and many more are engaged in long-drawn legal battles against severe human rights violations, of which almost every single family is a victim today.

    On any given day, a large number of people — old men and women, young women with small children — can be seen in the premises of the High Court, where they come to either file or pursue the abeus corpus petitions regarding the whereabouts of their missing relatives. The phenomenon of “enforced” disappearances in Kashmir is as old as the armed conflict there. The heavily deployed security forces (more than six hundred thousand, the highest number… during “peacetime” anywhere in the world) has resorted to this brutal method of unwarranted arrests and disappearance as part of its campaign against armed militants. However, as every Kashmiri, particularly young men, are suspects in the eyes of the security forces, a large number of innocent persons have become victims of enforced disappearances. According to unofficial sources, more than 3000 men have disappeared since 1989, after their arrests by the “law enforcing” agencies, a majority of whom are socially and economically underprivileged. Among the families of the disappeared, there is large-scale ignorance regarding their legal rights, leading to loss of time, energy, and their meagre resources, in their search for the missing person. Along with the deep social and economic instability that a disappearance entails for a family, close relatives also suffer constant agony as the disappeared person is neither declared dead nor alive. Women whose husbands are missing are known as “half-widows,” not able to claim any compensation which a widow is entitled to. Many such women are left with no earning member anymore and have had to go out in search of, not only their husbands, but also for a means of livelihood.

    I met scores of such families where the sudden hardships, prolonged grief,  and sorrow seem to have touched, shaded, and altered  all other aspects of their lives. Poignantly vacant eyes implore that justice be done, that their long wait bear fruit, and their loved ones returned to them…. if  not alive, then, at least,  their dead bodies be  handed over to them so that they are able to bury their grief along with the bodies. “Yeh aisa dard hai ki rath ko neend nahin aati aur din ko aaram nahin milta. Jab bhi darwaze par aahat hothi hai tho lagta hai ki mera beta wapas aa gaya hai. Bolo phir neend kaise aayegi?” This is how an aging mother expressed her grief as she continues to search for her missing son even after ten years. He was 16 years old then, and she is waiting to see how he must look as a young man now, refusing to even consider the possibility that he may not be alive anymore. Busy within its four walls, she had earlier never had to go out of the house. The outside world was taken care of, she said. But all this changed for her as she began to traverse different corners of the state, visiting jails, law courts, government offices, demanding that she be allowed to meet her missing son or at least be told of his whereabouts.Ladke ke saath  saath mera darr bhi kho gaya”, she said. Today, she heads the Association of Parents of Disappeared Persons (APDP), and mobilises similarly affected families for a collective struggle, redefining and transcending boundaries and lending a new meaning to “victimhood.”

    Having crossed the threshold of their homes, their patience and endurance, women are now negotiating at  different levels in pursuit of justice, and for an end to mindless violence, which has not only claimed thousands of lives but has also unleashed, for them, unprecedented  challenges and transitions. 


     

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