After the Siege, The Trauma

  • Anees Amin
  • Publish Date: Jan 5 2017 9:02PM
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  • Updated Date: Jan 5 2017 9:02PM
After the Siege, The TraumaIllustration by Suhail Naqshband

Amid the prevalence of alarming levels of mental health disorders in Kashmir, the political crisis and the spate of violence inflicted on local population this year has only widened the fissures of mental trauma among the Kashmiris, experts say.

With over five months of complete disruption in life, mental health experts say the trauma suffered by people will have ‘disturbing impact’ on their psyche. Decades of political unrest, subsequent counter-insurgency in the 1990s, and the further protraction of the conflict in Kashmir has already had its impact on the mental health of people.

The unabated killings, grievous injuries and particularly the blinding of hundreds of youth due to pellet gun injuries has been a traumatic experience for people over the past five months.

A research based report – Mental Health Issues in Kashmir – by Action Aid India, compiled before the onset of the ongoing unrest, has confirmed the alarming levels of mental health disorders in Kashmir at 11.3 per cent among the adults. The study conducted by noted psychiatrist Dr Arshid Hussain of the Institute of Mental Health and Neurosciences Kashmir (IMHANS) has also found a staggering treatment gap of about 88 percent with only a little higher than 6 per cent suffering population having received treatment by a qualified mental health professional.

“The impact of conflict is one of the main reasons for the higher prevalence of mental illness in Kashmir,” the study conducted on over 4000 respondents concludes.

Dr Hussain, however, says he has not so far received any patients who have been directly affected by the ongoing crisis in the state but the reason for that mainly, according to him, is that there is still time for people to realize any ‘morbidity’. 

“People including especially the injured are still trying to cope up with their physical injuries. But it is evident from the past experiences with reported evidence that there will be an impact on people’s mental health due the violence and trauma caused this year,” he says. 

During the survey, Dr Arshad says, they found out nearly a dozen persons with mental disorders who had not sought a psychiatrist help yet. “We found out a schizophrenia patient, with a mental illness history of 20 years, in Sangrama area who had not visited any professional psychiatrist,” he says.

The National Mental Health Survey of India 2015-16 (NMHS 2015-16) results also point to the huge burden of nationwide mental health problems. Nearly 150 million Indians need mental health care services, while as only less than 30 million are seeking care which also points out an 80 percent treatment gap.

The state witnessed an unprecedented cycle of violence this year in which more than 100 civilians were killed, close to fifteen thousand people injured, with more than a thousand grievously injured in their eyes with pellets. Hundreds were arrested in nocturnal raids and crackdowns while a majority was confined to their households for months, registered as the longest spell of curfew and shutdown in Kashmir’s history. This experience, health experts believe, is a significant and compelling trauma a population can go through.

According to a Médecins Sans Frontières survey, mental disorder like depression is prevalent in almost half of the adult population in Kashmir. The study, also carried out by IMHANS in nearly 400 villages, stated that more than 90 per cent of the adult population has experienced conflict related trauma.

RESILIENCE HELPS

However, experts believe, experiences in the past have helped build remarkable ‘resilience’ among the Kashmiri population to counter the long lasting effects of violence or siege.  Dr Arshid says that it is the ‘coping’ and ‘resilience’ of Kashmiri population that this experience of people has not necessarily culminated into a mental disorder among the majority.

Resilience is a process which helps an individual to attain a positive adaptation following a significant threat, severe adversity, or trauma. “Resilience may be domain specific, as well as culture and context specific. For more than two decades despite raging violence and continued conflict, Kashmiris have shown massive resilience against several odds,” Dr Mushtaq Marghoob points out.

 Apart from resilience, Dr Marghoob, however, says there is a dire need to counter the impact of violence induced trauma through collective efforts and removing stigma attached with the mental health disorders. “Not just what is to come, but we as a society have to collectively address the mental health issues and we also have to take care of the costs around it in terms of survival and productivity of such individuals who have been effected in the past,” he says.

“There are individuals and their families who face numerous challenges in daily life, both for managing the condition as well as for making them productive due to prevailing attitudes, media portrayals, societal discrimination and deprived opportunities,” he adds.

Another psychiatrist, Dr Majid Shafi, who is posted in South Kashmir, says, "In first fortnight patients in psychiatry OPD dropped to 2 to 10 patients from usual of 60 to 90 patients per day," The numbers, he adds, increased gradually and first effects in OPD of turmoil were noted after one month.

According to official data, in the year 1985, prior to armed conflict, as many as 775 people visited the Psychiatric hospital. The number swelled to an overwhelming figure of approximately 82000 people in next two decades. Even as the stigma attached to psychiatric disorders, as per experts, has decreased to some extent, the treatment gap pointed out in the Action Aid report suggests there is still a lot to cover. Areas in South Kashmir were the worst affected during the ongoing crisis and inhabited most of the civilians killed, maimed or injured. However, the impact of traumatic experience is expected to develop mental health issues across Kashmir.

District Pulwama, where Dr Majid works, received more than 100 patients in one day recently, he points out. “Patients doing well from months and years were not able to buy medication and relapsed," he says, adding that the patients of known psychiatric disorders, who were in remission from years (off medication), relapsed due to precipitation by current turmoil.

Among the patients Dr Majid received, about 20 percent sought psychiatric help for the first time, he says, including a patient who couldn't talk for four to five days after being hit by a PAVA shell. This, Dr Majid says, is in an indirect, if not direct, reflection of the ongoing civil unrest in Kashmir.