September 10, 2012
SRINAGAR, INDIAN-ADMINISTERED KASHMIR – Sana Mir, 21, is studying to be a doctor in Dhaka, Bangladesh. When she returned home for a month-long vacation this summer, she found her hometown of Srinagar in a state of chaos. Mir says she was confined to her home for the entire month thanks to violence, strikes and a strictly imposed government curfew.
“The only thing I had to do the entire day was eat, drink and sleep,” she says. “Every functioning system was paralyzed and the worst part was that no one seemed to know when normalcy would return.”
Kashmir’s summer of unrest left 111 people dead and hundreds more injured. But for Mir, the psychological impact of the violence and the home confinement took the largest toll.
“I fail to remember what date it is today. Each morning I [had] to ask what day it is. I feel I am turning mad,” says Mir, who was unable to meet with any friends or relatives during her school break.
Mir’s confusion is not unusual. “Being confined to my house is driving me mad. This forced confinement is frustrating for all. How long can one take it without any effect?” asks Shabeer Ahmad Khan, a local resident.
Local doctors and advocates say that post-traumatic stress syndrome, PTSD, and its related symptoms have taken a toll on as much as 80 percent of the population here.
“Each day there was a mixture of emotions going through me,” Mir says. “Frustration, anger, depression, helplessness. The only certain thing was uncertainty.”
Since August, residents of Kashmir have experienced near constant protests and violence. Residents say the spate of curfews and strikes has been endless and has led to long indoor confinements. For those who ventured out of their homes, many came in direct contact with violence. Yet, mental healthcare is not widely available or accepted here. Médecins sans Frontières, MSF, an international aid organization, has been working in Kashmir for nearly a decade and has set up one of the country’s only mental health facilities in more than a dozen key areas. Still, the reality of PTSD is not widely understood here.
Over the course of the last two decades, more than 70,000 people in Kashmir have died and another 10,000 have been disappeared. With 700,000 active troops here, it remains among the heaviest militarized zone in peace times. “Every public space — schools, stadiums, cinemas, markets, everything has been taken over by the security forces,” Sasha Matthews, Harding’s predecessor at MSF, said in September. “There‘s razor-blade barbed wire across the valley. Every day you see hundreds of military convoys and security forces patrolling the streets. For ordinary people, there is this constant visual reminder of their presence”
“The people of Kashmir are living in a conflict area. The past decades have left their impact on the minds of people. What they have been witnessed in the last few months is an acute situation. It compounds the earlier impact,” says Liz Harding, project coordinator of MSF, in Kashmir. Harding says the unpredictable nature of the current situation makes it difficult for people to go to work, earn a livelihood, and even acquire food and supplies on a regular basis. The inability to lead a normal life daily in combination with consistent violence and confinement, Harding says, has caused depression, anxiety and other mental illnesses in thousands of people here.
Last week the major English-language newspaper here reported that much of the population, like Mir, was experiencing confusion about the day and date thanks to something they called “disturbed biological clock syndrome,” which they defined as “a condition that can result from a continuous period of indoor confinements owing to curfews and strikes. People don’t remember what day or date it is.”
While many here agreed with the diagnosis, such a syndrome does not exist in modern psychological study.
“I have never heard about such a syndrome and there seems to be no study on it,” says Dr. Frank Neuner of Bielefeld University in Germany who has conducted a wide body of research on PTSD in conflict and post-conflict regions. Still, Neuner says this type of common confusion is a classic symptom of PTSD.
“I think a combination of the factors of disturbed circadian rhythm due to sleep disorder and cognitive impairments due to PTSD or depression increase the tendency to forget date or day,” he says.
Despite the fact that mental health awareness is low in Kashmir, MSF has been running a mental health program in the Kashmir valley since 2001. It provides psychosocial counseling to the conflict ridden people in and around its 16 centers that are based in the main hospital and sub district hospitals of the four districts of Anantnag, Budgam, Kupwara and Srinagar.
MSF has reported a sharp increase in the number of psychiatric patients seeking treatment, particularly those with PSTD in recent months. The number of patients seeking treatment at the lone government hospital for psychiatric diseases here was just 1,760 in 1990 and is more than 80,000 today.
“We’re dealing with a population already heavily traumatized by over two decades of violence,” says Maria Veerat, MSF’s mental health officer in Kashmir. “Today people are continuing to suffer psychologically.” Veerat says, “MSF is extremely concerned that the recent violence will only further increase mental health needs in the Kashmir valley.”
Harding and the other MSF counselors say those who came into direct or indirect contact with violence have had increased psychological needs. In response, MSF devised a program called “Mental Health First Aid” that offers “on-the spot psychological assistance” to the people who experience violence and their families. Mental Health First Aid gives patients the tools to use natural coping strategies after a traumatic event. Mental Health First Aid clinics have provided assistance to 1,000 people in the last four months.
“People need to cope with what they have seen and what they have been through. We help them to access their own coping mechanisms,” says Harding. She says local resistance to accept psychological treatment is a barrier, but MSF is working to help people see mental health as a part of normal health care.
“After being a witness to a violent incident or being a victim of one, a person is bound to have things like nightmares. What we try to do is try to make the patient understand it is the brain’s way of coping with what you have been through,” Harding says.
For Sana Mir, her spoiled vacation is over and she has since returned to school in Dhaka. For millions of other Kashmir residents, Harding says, escape may not be that easy.