Amid distress and disturbance, the cases of forgetfulness are rising in Kashmir.
By Zeenish Imroz
IN one frozen November day in Kashmir, a classic consultation scene—where doctor usually tries to break the sullen silence of patients—unfolded inside Institute of Mental Health and Neuro-Sciences (IMHANS).
On the doctor’s chair sat Kashmir’s prominent psychiatrist, Dr Arshid Hussain. And on the patient’s side, an unsound policeman flanked by an attendant wore a dead-panned face.
“What’s your name?” Dr Hussain asked.
The patient merely responded with blank eyes.
“What’s the time?”
Only silence came as a resounding reply from Wali Ahmad, a cop from Mattan in south Kashmir’s Anantnag district.
The doctor handed over prescription to Imtiyaz, Wali’s brother-in-law, and soon the dazed cop followed his attendant’s directions like a robot.
“Janaab, where were you?” Imtiyaz asked Wali, in order to demonstrate his mental state. The cop repeated his attendant’s words: “Janaab, where were you?”
Wali has been suffering from dementia for last three years now. Medics define dementia as a neurocognitive disorder leading to progressive memory impairment, difficulty in recognition, way finding difficulties and eventually to complete dependence on caregivers.
Symptoms like forgetting were first noticed after the 50-year-old cop was traumatized by the death of his colleague.
In 2017, the cop was on a routine sentry duty in Charar-e-Shrief town when a sudden militant attack rattled him. Wali escaped unhurt in Nund Reshi’s shrine premises, but was left traumatized by seeing his colleague bleeding to death.
“He wasn’t the same person after that,” Imtiyaz said. “He started acting strange. His uncertain behavior was a complete undoing of his lively personality.”
One such behavior was demonstrated during a friendly visit to Wali’s senior. “That’s when I first noticed his abnormal behavior,” Wali’s brother-in-law said.
At the officer’s house, Wali who would invariably abstain from local bakery products had eaten ‘them insatiably. After tea, the cop devoured a big apple akin to a starving man.
While Imtiyaz was wondering about Wali’s sudden ‘wild’ behavior, the cop soon walked away—without bidding a goodbye to his officer and waiting for Imtiyaz—and drove home in haste.
“Is everything alright at his home?” Imtiyaz recalled the officer’s concern over Wali’s rash behavior.
“I believe he’s a little distressed these days,” Imtiyaz replied.
Knowing that Wali was economically and emotionally secure at home, Imtiyaz realized that it was killing of his colleague which altered Wali’s mind and method in life.
Soon after the violent episode at Chrar-e-Sharief, Wali, a father of four girls and a 3-year-old boy, had started fearing for his life.
In his quarter, Imtiyaz would later learn, the cop would imagine his fallen colleague’s fate and fretted. His distressed mental state would escalate to a level where it reared an obsessive head.
“He would call his senior repeatedly for transfer — sometimes even more than 200 times a day,” Imtiyaz said.
By the time his transfer order came, Wali’s neuro-degenerative disorder had already deteriorated.
Wali would behave oddly — forgetting names of people, remaining heedless of important daily activities and trying to run away at night through the main-gate.
From aggression to calmness, his trauma had taken a severe form of dementia.
Trial of Trauma
As someone well-versed with the cop-like traumatic cases in Kashmir, Dr. Insha Rouf, a psychiatrist in the valley, said that dementia is fast becoming an end result of the rampant and pervasive trauma in Kashmir.
“The old memories remain intact initially,” Dr Insha said. “It’s the recent memories that get affected. Patients cannot form memories.”
At least 20 dementia patients visit IMHANS and Drug De-addiction center of SMHS hospital daily, she said, while many others prefer to opt for private clinics or neurologists.
“The dementia patients we see are the tip of the iceberg,” Dr. Rouf, who detailed dementia’s link with trauma in her 2014-16 study, told Kashmir Observer.
“Much of this has to do with our mindset which considers forgetfulness as a part of normal aging. Mostly patients from the affluent class of the society come forward for the treatment.”
But by the time most of these patients show up for treatment, she said, dementia already takes a mental toll on them.
“Most patients are usually in a severe to profound stage of dementia where they’re usually brought with complaints of diminished self-care, agitation and aggression,” the medico said. “Mostly, they carry a lot of caregiver burden.”
Unfortunately, she said, there’s no cure for dementia. The available treatments can only mask the symptoms of the disease and help the person to live as normal of a life as possible.
Wali’s Lonely Tribe
In Srinagar Psychiatrist Hospital, a 50-year-old woman calmly lying on her bed was asked about her health. In her dazed state, she asked her young attendant, “Mea kath chu doad” (What is my illness?)
The lines engraved in her face defined the agonizing pain inflicted upon her. Her heart was pounding, the blood pressure monitor showed the reading 156/100.
Syeda was shivering, and was restless.
A resident of Anantnag, Syeda has been suffering from dementia for the past 8 months.
A divorcee, she would mostly seek emotional refuge in her sister. Her departure, however, affected her mind.
She recognizes her family members and is closely bonded to her grandchildren, but she tends to forget names after every 10 minutes and obsessively gets her blood pressure checked.
“Once an active lady who used to keep everyone in the family on toes now needs support for movement,” said her attendant.
Battling Alzeheimer’s disease, which is one of the most common types of dementia, Syeda’s memory issues started with her inability to comprehend or produce speech.
“Dementia robs you of everything that makes you who you are,” Dr. Sama Beg, a certified trainer on Alzheimer’s and related disorders, argues in her article.
“It steals your memories, your intelligence, your independence, your ability to think, to make decisions, to communicate, and to do the simplest of tasks. As humans, we pride ourselves on our intelligence – that God created us as the most gifted of living beings. The tragic irony is that the same intelligence we take pride in can be taken away with little warning in the form of this debilitating condition.”
After facing trauma, cop Wali is able to see but unable to make sense. He only follows his attendant like a robot and repeats his words.
“Due to memory impairment and difficulty in recognition, dementia patients might feel that they are not at home and may wander away without informing anybody,” Dr. Tajamul Hussain notes in his write-up.
This assertion perhaps explains why the cop leaves home in the midnight before being dragged in by his alert attendants.
“People with dementia might sometimes become aggressive towards caregivers,” Dr. Tajamul, Assistant Professor of Psychiatry at GMC Baramulla, further reveals.
“It might seem unprovoked to the caregivers but usually has some underlying cause like fear, pain, confusion etc. As people with dementia might have difficulty in communicating it often leads to caregivers doing things contrary to what the patient wants.”
As someone who has managed dementia care facilities in the US and India, Dr Sama said, she has found one form of therapy to be the most effective.
“And that’s love, patience and kindness,” she said.
“We must remember that a person living with dementia is still a human being with emotions. They deserve to be treated with dignity and respect because they are trying to do their best despite having been tragically robbed of their identity.”
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