Mental Health in Kashmir: Not a Copy-Paste Approach 

MENTAL health and psycho-social wellbeing is an issue confronting the world at large. Both in developing and developed countries, the issue of mental health has assumed newer and deeper dimensions. But a place like Kashmir, sandwiched as it is in the geopolitical rivalry between India and Pakistan has been a breeding ground for psychological and psychiatric disorders of all sorts. The political crisis that Kashmiris as people have witnessed has made them vulnerable to depression, anxiety, trauma and PTSD.

A 2016 survey published by Doctors Without Borders (MSF) recorded 45 percent of the Kashmiri population (nearly 1.8 million adults) experiencing some form of mental distress. According to MSF’s “Kashmir Mental Health Survey 2015,” 50 percent of women (compared to 37 percent of men) suffered from probable depression; 36 percent of women (compared to 21 percent of men) had a probable anxiety disorder; and 22 percent of women (compared to 18 percent of men) suffer from post-traumatic stress disorder (PTSD). “It is clear that a higher proportion of women were classified as having all three mental disorders,” read the survey findings. “This difference between the sexes was significant for all three disorders.” The survey also found that adults living in the Kashmir Valley either witnessed or experienced an average of 7.7 traumatic events during their lifetime; only 0.3 percent of the adult population surveyed had not experienced a traumatic event ever.

“Protracted conflict provides periods of peace interspersed with periods of political violence and insecurity. A recognized protective factor for improving mental health outcomes in populations affected by political conflict is the re-establishment of safety and security in the immediate environment. Likewise, persistent conditions of actual or perceived threat have been found to support the genesis and maintenance of psychological distress in affected populations. We conducted a qualitative study as part of ongoing activities to better understand the burden of psychological distress in the Kashmir Valley and specifically explore community perceptions of and reactions towards symptoms of psychological distress, document current health seeking behaviours and identify perceived mental health service needs,” note Tambri Housen, Shabnum Ara, and others in their 2019 Dua Ti Dawa Ti study.

“Protracted political insecurity was highlighted as a major perceived cause of psychological distress in communities. Mental health help-seeking included traditional/spiritual healers in combination with practitioners of western medicine, with access highlighted as the main barrier. Divergent views were expressed on the effectiveness of treatment received. Participants’ expressed the need for investment in mental health literacy to improve the community’s capacity to recognize and support those suffering from psychological distress,” the researchers reveal.

“Our findings demonstrate the universality of symptoms of psychological distress whilst simultaneously highlighting the importance of recognizing the cultural, spiritual and contextual framework within which psychological distress is understood and manifest. Co-constructed models of community based mental health services are needed.”

Decades of distress in Kashmir was only escalated by COVID. According to a study conducted by the National Center for Biotechnology Information, the change in the status of Jammu and Kashmir from a state to Union Territory after the abrogation of Article 370 in 2019, had an enduring psychological impact on the Kashmiri population. Just six months after that, the coronavirus struck India and the whole country went under a strict lockdown. As per the study, social distancing leads to increased loneliness and the feeling of being neglected, particularly among the elderly population, which precipitated mental health issues. The Indian Psychiatry Society found a 20 per cent increase in mental illness in India within a few weeks of lockdown starting March 25, 2020, and formulated national guidelines for telehealth services.

Doctors say that the situation has morphed into a severe psychological crisis. There has been an alarming rise in cases of depression, anxiety, and psychotic events in Kashmir. Besides, there has also been a surge in suicide cases in the Valley over the last six months, and particularly during the second wave of COVID. Some reports suggest that more than 100 people committed suicide in the region during the period. Officially, 500 suicide cases have been reported at SMHS hospital in the last one year. Data compiled by National Crime Records Bureau (NCRB) records around 6,000 cases of suicide in Kashmir between 1990 and 2019.

According to the 2011 census of India, Jammu Kashmir has a population of around 12.5 million, and there are about 41 psychiatrists, who are mostly affiliated at teaching hospitals in two cities of Jammu and Srinagar. Consequently, the mental health services are primarily limited to two hospitals in Srinagar (GMC Srinagar and SKIMS hospital), although the National Mental Health Plan and the District Mental Health Programme were started in many districts of Kashmir.

Besides these psychiatric disorders, the valley distinguishes itself by the fact that here people encounter psychological complications that sometimes even escape a specialist’s profiling and demand customised assessment and treatment modules. This aspect has been usually overlooked and professionals have started stretching generalizations beyond their legitimate limits. But the typology and peculiarity of the situation, the experts say, demand that instead of working with sweeping treatment methodologies, patient-specific and non-conventional methods be explored and employed.

The unrivalled social transformation coupled with the unleashing of technological potential has plunged mankind as a whole into the abyss of wholesale existential crisis and psychological pandemonium. Never before in the known history of mankind have changes bombarded the human species so frequently and with such agonising consequences. With the invasion of technology and then more technology in our lives, human miseries at the deepest level have just multiplied in number and deepened in their ramifications. Having overcome the threats and obstacles outside themselves, human beings are now more scared by what lies within – an era of psychological and existential crisis has permeated the very existence of mankind. Urbanisation, industrialization and modernization have just culminated in man’s alienation – from the self and the world. Happiness and meaningfulness are two indispensable denominations of human existence and the world we have landed in seems to be bereft of both these essentials. Both globally and locally, mankind seems to have compromised with mental health, exchanging it against restlessness for petty material gratifications and in so doing we have just made the deteriorating mental health an inevitable catastrophe. We are all at discomfort with our existence at deepest levels and despite this deep lurking danger sending repeated warnings, it just goes unnoticed and suffers gross ignorance at our hands – only to recur in much devastating and damaging manifestations.

Not just man’s misplaced efforts and endeavours result in disorders of psychological and psychiatric order, but the direction in which the modern world has set itself rolling adds to these anomalies and abnormalities in unforeseen manner and magnitude. The phenomenon that needs unearthing and attention is to see the extent to which mental health providers – psychologists, psychiatrists and counsellors have kept pace with these mutations of mental health disorders and the degree to which they have responded to the same. The fact remains that most of us haven’t been prompt enough in our response to these mental health issues and the subtleties they are accompanied by. The accelerated proliferation and diversification of mental health issues has equally baffled the patients and doctors alike. The situation has been deplored by the negligence towards and at times ignorance of these mental health issues by the patients. The situation is further convoluted by the issues particular to our valley and the failure and incapacity to address these diverse and nuanced issues have only catalysed the worsening of the overall scenario.

Psychiatry and psychology are in the process of assuming critical roles in defining and guaranteeing the wellness of our overall health. Just that people have not fully awakened to the importance of the psychological dimension of health, the fields of psychiatry and psychology are yet to enter the domain of critical importance that legitimately belongs to them. “Mental Health in an unequal World”, as the theme for this years’, World Mental Health Day stands,  appropriately captures the uniqueness and diversity of Mental Health issues faced by people in conflict torn and economically underprivileged zones.

It so happens in these regions, like ours, that people are so busy fighting the battle of life and seeking their sustenance and sustainability that they end up being indifferent to their Mental Health issues. This naivety and gross negligence multiplies the responsibilities of Mental Health providers,who, in such cases not only diagnose and treat the patients but also raise the level of consciousness vis a vis Mental Health and its importance among masses.This places an incumbent responsibility upon the institutions and specialists to come out of their daily cyclic schedule and to reach masses in whatever form they can so as to mitigate the inadvertent Mental Health crisis that looms over the horizons.There is an urgent need to sensitize people to the intricacies of Mental Health and make them proactive in responding to any anomaly. This awareness has to flow in a top to bottom approach and psychiatrists have a heightened role to play in disseminating the prior knowledge and awakening masses,irrespective of their mental health status,to the effects of the same.

In a fragile zone like Kashmir early psychological and psychiatric intervention can be very helpful; both in mitigating the problem and dispensing information.But this process of early intervention builds upon the premise of positive and cordial patient doctor relationship.The scenario demands from doctors to leap out of their predesigned treatment, frameworks and modules and to adopt a holistic, sympathetic and integrative approach towards the patients. This early intervention and improved doctor patient relationship can account for systematic information within the overreaching reaching superstructuree of the  Mental Health care system.

A further descriptive and emancipatory role is supposed to be played by Mental Health workers in spreading awareness and thereby profiling mental health disorders like any other health disorder. The tragic fate of psychiatric patients is that they are subjected to marginalization, otherisation and unacceptance at social and familial levels consequent to their psychiatric /psychological disorders. This has played a ruinous character in preventing people from seeking early and timely psychiatric intervention, till they end up in situations beyond medical reach. An emancipatory awareness to this end can only flow from the experts of the field and unless this phenomenon of emancipation permeates the society we cannot expect any improvement in the mental health of the people, for most of the cases,s will go unnoticed as ever. This must awaken the psychiatrists and Mental Health providers to the task at hand and in so doing they must discover for themselves the roles beyond clinical evaluation and routine medicine prescription.

Views expressed in the article are the author’s own and do not necessarily represent the editorial stance of Kashmir Observer 

• The author is a Srinagar based writer and columnist

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