Lone Psychiatric Hospital Battles with Chaos in Srinagar City

Abstract: This project will study the functioning of lone psychiatric hospital of Srinagar in the strife-torn Valley of Kashmir where thousands of people are suffering from post traumatic stress disorders (PSTD). The 16 years of turmoil in the state has resulted in a sharp increase in stress related disorders especially the PSTD. The armed conflict in the state has affected the society at large. The continued violence has made vast population psychiatric patients. The research will seek to detail the strains and pressures in the conflict ridden society leading to the psychiatric problems among the population. It will also look into the needs and remedies required to provide solace to the battered population.

Bio: Peerzada Arshad Hamid, is a Srinagar based freelance journalist. He has written for the Tehelka, Midday, and other papers. In depth research based human interest stories are a priority for Peerzada. He holds an M. A. in Mass communication and Journalism.

Website: www.kashmirnewz.com

Email: peerzadaarshad @ gmail.com

24/1/06

Hi all,

I am Peerzada Arshad Hamid, a Srinagar based freelance journalist. Reporting violence and human sufferings from one of the known conflict zones inspired me to pursue the research project at Sarai.

Having done post graduation in Mass communication and Journalism from University of Kashmir, I have been in the field for around five years now. Apart from reporting day to day events and news, in depth human interest stories has always been a priority for me. Although some of my favourite stories were never published.

The turmoil that Kashmir is going through has given birth to many serious problems. To find a way out, these problems mostly concerning the humanity need an empirical approach to study.

My research project titled “Lone Psychiatric Hospital Battles with Chaos in Srinagar City” is a step forward in this regard to study the psychiatric problems and the functioning of hospital.

My postings to Sarai during my fellowship period will explore:

1. the root cause behind sharp increase in the number of psychiatric patients particularly Post Traumatic Stress Disorders (PTSD).

2. how much the continual violent episodes like Killings, arrests, bloody scenes, are telling upon the mental health and psyche of patients.

3. case study of some patients will be evaluated and detailed interviews with the patients and their family members will be carried out to get a feel of the problem.

Ironically prior to the diagnosis of psychiatric diseases, the majority of the patients were treated for heart ailments or anxiety and the process is still going on.

In this backdrop, focus of the study will remain the functioning of Psychiatric hospital. How the doctors employed there treat their patients and whether the hospital is fully equipped to tackle the burgeoning number of patients?

Cheers,

Peerzada



27/2/06

Kashmir, a society haunted

By Peerzada Arshad Hamid Srinagar, February 27, 2006

Incessant violence since 1989 has devastated the Kashmiri psyche and stress related disorders are rapidly growing up.

People continue to be under tremendous pressure. They have been witnessing encounter killings, torture, death and destruction due to bomb blasts, disappearances and rape. Besides this the daily humiliation which the inhabitants here have to endure, with gun totting men dominating the civic landscape , makes survival of the people even more depressing. In such scenario mental disorder is an expected outcome.

If increasing figures of the patients visiting Srinagar’s lone psychiatric hospital since 1989 (the year armed conflict started) is any indication, Kashmir can not be considered a normal society. The post traumatic stress disorder prevalent among large sections of Kashmiris has been even highlighted by Humra Qureshi in her book Kashmir: The Untold Story (Penguin).

“The number of patients at the out patient department (OPD) of the lone government hospital for psychiatric diseases in the valley jumped from six per day in 1990 to 250-300 in 2000 per day. The total number of patients rose from 1,760 in 1990 to 18,000 in 1994 to over 38,000 in 2001,” the book reads.

Most of the people living in Kashmir have fallen prey to mental disorders like depression or anxiety. The root cause being the continuous threat to life and mere presence of troops and gun wielding men has led to the feeling of insecurity among the masses. Prolonged violence for the past 17 years in the valley has even brought to light the cases of psychosomatic disorders.

Contrary to it prior to the militancy period certain mental disorders, which were unknown to Kashmir have shown phenomenal presence after the conflict. One such disorder is the Post Traumatic Stress Disorder (PTSD). Psychiatrists affirm that no such case was reported before 1989 in the valley. “PTSD was completely unrecognized in Kashmiri society till 1989 because the situation was peaceful,” says Dr. Arshad Hussain, Psychiatrist and Neuro-Psychiatrist.

Nowadays about 15-20 per cent patients visiting the hospital’s OPD are suffering from PTSD followed by Major Depressive Disorder (MDD). However the doctors consider this number quite small and misleading. “15-20% of the patients suffering from PTSD, MDD pouring in the hospital is just the tip of iceberg. The percentage of such patients would be higher less owing to the incessant violence,” said Dr. Arshad Hussain.

Visiting Psychiatric hospital for treatment of diseases has a social taboo attached to it. Reason? A common notion here is that anyone visiting a Psychiatrist is insane. This is the biggest obstacle for the people to come to Psychiatric hospital for medical consultation.
A study conducted by the doctors in the department of Psychiatry at Government hospital has shown that after the commencement of any mental disorder; it takes 5-6 years for a patient to reach the psychiatrist for consultation of his/her diseases.

Till then they (patients) visit different doctors for treatment as they are not aware and above all not ready to accept that they are suffering from mental disorders. Even doctors (other than psychiatrists) too treat them either for anxiety or cardiac ailments.
The study further revealed that substance use disorder or drug addiction and suicidal tendencies are other repercussions of the conflict. And in such conditions these disorders are assuming epidemic proportions in the community and the patients who come to seek help are in the productive age group (s) of 20-35.

Caught up in the growing complexities of adolescence, youth are usually vulnerable to depression. Mere exposure to the additional conflict related problems, makes them feel over burdened.

Other mental disorders too have shown four fold increase due to the conflict in Kashmir although they don’t have any direct bearing to these diseases. These include bipolar disorder, panic, phobia, generalized anxiety and sleep disorders.

As Kashmiri people are living under stressful conditions, the fear of constant insecurity and uncertainty always occupy their mindset. Watching helplessly their dear ones being killed, injured and above all themselves fearing the same has simply wornessed their mental health. Such circumstances carry every potential of rendering the masses vulnerable to mental disorders.

The year wise breakup available at Psychiatric Diseases hospital, Srinagar showing the flow of patients is as:

Year 1985 775 people visited the Psychiatric hospital.

Year 1989 approx 1,700 people visited the Psychiatric hospital.

Year 1994 approx 18,000 people visited the Psychiatric hospital.

Year 1996 approx 20,000 people visited the Psychiatric hospital.

Year 1999 approx 35,000 people visited the Psychiatric hospital.

Year 2001 approx 38,000 people visited the Psychiatric hospital.

Year 2002 approx 45,000 people visited the Psychiatric hospital.

Year 2005 approx 60,000people visited the Psychiatric hospital.

Coping with stress

Peerzada Arshad Hamid

Mar 28, 2006

In my previous posting I pointed out that root cause behind the sharp increase in the number of Post Traumatic Stress Disorders (PTSD) in valley are the stressful prevailing conditions here. Exposure to violent incidents and feeling of insecurity, besides the daily humiliation experienced by inhabitants in the name of frisking also contributes to mental disorders.

The current posting deals with the case studies of some of the patients I have interacted with, who have fallen prey to the conflict in Kashmir. The objective is to determine the impact of continual violent episodes like killings, bloody scenes, bomb explosions, etc. on the psyche of patients. The accounts of the patients have been duly cross-checked with their families.

CASE STUDY: 1

Shaheena (29) living in Bijbehara town of Anantnag district was studying in class XII when a tragedy fell on her family. Her younger brother, Bashir aged 16 years then, was the only male member in the family. On Octoiber 22, 1993, he fell prey to unprovoked firing by Border Security Force personnel (BSF). He along with other people of the township was marching in a peaceful procession demanding the lifting of siege from Hazratbal shrine in Srinagar.

That year some militants had entered the shrine, which Indian paramilitary forces had cordoned off following the information about their presence inside the shrine. Entire valley was observing strike and shutdown against the siege and sacrilege to the holy shrine, which was in jeopardy.

Bashir’s bullet pierced body was brought to his house in a hand driven cart and everywhere there was a pall of gloom in the town. That day some 43 persons were killed and about 150 people received injuries.

“The tragedy is unforgettable. It was a complete blood bath. Those who died passed away, those who survived could not forget the roar, which at times still makes me restless. I survived harmlessly but the rattling of guns and wailing and chest beating episodes make an echo within me,” says Shaheena.

Sight of Bashir’s body huddled along other bodies in the cart took Shaheena by awe and she was left shocked. Initially Shaheena’s problem was not taken differently owing to the melancholic ambience in the house. However, when Shaheena could not bring herself back on rails, her family was forced to take her to a general physician. She took medicines for anxiety and sleeplessness as prescribed by the doctor but her conditions worsened day by day.

“The death episode of my brother always occupied my subconscious. I used to think why my brother got killed, what would happen to us, why he got killed in such a way, etc.

Images of Bashir’s bullet pierced body huddled with other bodies were reverberating in my mind and giving me restlessness. First I would weep, then getting violent and many a times I thought of ending my life,” Shaheena recalls.

Shaheena was brought to psychiatric hospital in the year 2000, exactly seven years after the incident. Today she is in a good condition and showing improvement. For Shaheena, doctors at Psychiatric hospital Srinagar are the only hope.

“Before coming to Psychiatric hospital, the doctors whom I approached used to pressure me to give up the worries, when the fact is that I was not worried at all. They were not empathizing with my situation as if I was pretending the illness,” Shaheena said.

Doctors at Psychiatric Hoispital Srinagar has declared Shaheena as PTSD patient and put her on medical advice and counseling.

CASE STUDY: 2

Meet Ghulam Qadir Bhat (42). His son Javid Ahmad Bhat (15) was picked up by the soldiers of Rashtriya Rifles on May 7, 2005, along with four other men after militants exploded an improvised explosive device outside his native village Doonipora in South Kashmir. Late in the evening when all the persons were released, Ghulam Qadir was told that his son escaped from the police custody.

Refusing to accept the police version, for ten days the family continued to visit the local police station and army camp but could not get the right information. However the released villagers informed Ghulam Qadir that his son was beaten savagely by the troops and was detained in a separate vehicle. They also told him that he was not able to talk or move, leave aside running away.

Unable to get the whereabouts of his son, Javid’s family approached a local newspaper with their woeful tale about enforced disappearance of their ward. Late in the evening Javid’s bullet-ridden body was fished from river Jehlum and brought to the village. Next day alongside the disappearance story, information about fishing of javid’s body appeared on the front page. Javid though a chap was working as a labourer and thus contributing towards helping his father to make two ends of the family meet.

Javid’s demise brought miseries to the family and Ghulam Qadir fall prey to trauma. With Javid all the happiness vanished.

“After my son’s death, Ghulam Qadir got shattered. He used to remain lying on the bed, often weeping. In solitude, he was murmuring, What can I do now? He was totally innocent.they will kill me also. Now I too will die, etc. etc.,” says Ghulam Qadir’s wife Zaina Begium.

“I have shown my Husband to many doctors and priests, then one day someone in a private doctor’s clinic suggested me to take him to Psychiatric hospital, Srinagar.

Ghulam Qadir too has been brought to the Psychiatric hospital for treatment. His complaints include that he is not able to come out of the panic and fear that he too may get arrested and killed in custody.

CASE STUDY: 3

Abdul Majeed Bhat (65) is a retired government employee. Hailing from Gureewat, a village in district Budgam, Bhat’s home was blown by mortar shelling and explosive devices and reduced to rubble in the year 1999. The incident happened when para-military forces zeroed Bhat’s house, where militants had taken shelter. In the ensuing gunbattle that continued for serveral hours, Bhat witnessed motar shelling aimed at his newly constructed house and watching the destruction helplessly.

In the meantime Bhat along with his cousin were brought and used as human shields by the army personnel, while proceeding towards the house. Suddenly a bullet hit the chest of Bhat’s cousin, who breathed his last on the spot. Bhat was watching that incident too. Thereafter army detonated the house to neutralize the hiding militants. After the encounter operation Bhat was taken in to custody by the army and interrogated for giving shelter to militants.

“In front of my eyes, everything got destroyed. My entire earning in the shape of house and belongings got damaged. Killing of my cousin and the physical torture at the army camp. How can I forget it? All this is a sort of burden on my mind,” says Bhat.

According to Bhat’s son when Bhat was released, his behaviour was abnormal. He was not speaking to anyone and was very much scared. He was not interested in the reconstruction of the house. He lost the desire to live and even today mere presence of troops or news about encounters, makes him to run away in panic.

Prior to coming to Psychiatric hospital Bhat’s family took him to several doctors and religious priests but his condition was deteriorating day by day. Bhat like many others too is struggling hard to cope up with the stress.

CASE STUDY: 4

Shiraz Ahmad Wani (20) hailing from Srinagar was normal till one day in 2001 while walking towards the market place, he witnessed a series of the bomb blasts carried out on State Assembly. He remembers the smoke fading the entire street and the deafening sound of the explosions followed by indiscriminate firing.

As he was about to run in panic, the sight of charred bodies and human flesh scattered all around left him unconscious.

After being brought home, Shiraz continued to weep and scream all the night, says his mother. Such was the intensity of the grief that he refused to go to school the next day. For months together he did not come out of his home and was indulged in self-conversation. His behaviour was source of inconvenience for his family. The focus of his self-conversation was centered on army raids, bomb blast, killings, firing, etc.

When someone in the family would try to persuade him, he resorting to fighting, a quite opposite behaviour, contrary to his earlier one.

“He was very submissive and gentle. Some evil spirit has cast shadow on my son, otherwise who would like to come to a hospital, where mental retarded persons are being treated,” says Shiraz’s mother swabing tears from her chubby face.

However Shiraz’s father is very much optimistic about the recovery of his son. He has brought Shiraz to Psychiatrist hospital on the recommendation of a general physician.

“I have been taking my son to all the leading physicians in the city. Then one day a doctor advised me to take him to Psychiatric hospital. Initially I refused because of the social taboo attached with it then I thought that life of my son is precious than caring for the social obstructions.

In the above cases Psychiatrists have helped them to overcome psychological problems. In all the cases the main problems were lack of sleep, undue aggression, abnormal heart beat, violent tendencies and self-conversation, etc. Talking to patients dawned upon the reasearcher that mere prescription of the medicine to psychiatrists is not the treatment. However empathizing with the patient that he/she is suffering from diseases, interaction and therafter lending them effective counseling resolve their intra-psyche conflicts to a large extent.

Regarding the inhibitions shown by people about psychiatric diseases, it is an assumed assertion that many people do not like to visit the Psychiatric hospital despite suffering from psychiatric diseases. The underlying reason is the social ostracism attached to visiting the hospital.

16/5/06

Voices Unheard I was supposed to submit my fourth posting between April 22 and April 28. The reason for the delay is the outright denial of most of the patients visiting Psychiatric hospital in Srinagar to share their grief and let the researcher know the reasons underlying their stress disorders.

Kashmir being a closed society, people have inhibitions disclosing their diseases particularly the psychiatric ones, for they fear disclosure of same may result in categorizing them as insane or lunatic.

Owing to this assertion of social ostracism, even doctors at Psychiatric hospital say that many people despite knowing that they have psychiatric problems avoid visiting the psychiatric hospital.

“We want to live and do not like intrusion in our lives. What bad we have experienced, we don’t like it to cast shadows on our future,” was the response from most of the patients, this researcher tried to caught up.

For weeks together, I kept on interacting with the patients and their families. If sometimes patients were ready to share their experiences and speak about the horrors, family sources showed reluctance. Their argument was that quoting examples from their families will make them ‘outcasts’ in the society. At times patients themselves were blunt.

At one point it appeared that I can not proceed further, then a detailed interview with a youth, Shabir Ahmad generated a fresh hope inside me. His positive approach and understanding of the problem made me to conduct further interviews.

Case Study 5:

Shabir Ahmad, hailing from Anantnag was brought to Government Hospital for Psychiatric Diseases, Srinagar in November 2005 after being diagnosed of post traumatic stress disorder (PSTD).Shabir’s family said they witnessed a dramatic change in his behaviour prior to the diagnosis.

He was a depressed lot, talking less, doing abnormal acts like pouring water in to rice, while taking the meals. Was complaining about sleeplessness and getting angry. At times he was getting totally unconscious. A stage reached, he was getting violent and trying to beat anyone who try to pacify him. His presence has become the source of inconvenience for the family.

His brother Manzoor, relates,
“One evening, when Shabir came back to home, he told us that he is not feeling well and complained of fever. We suggested him to lay in the bed. Around 10 pm, he felt unconscious and resorted to intra-personal communication .Everybody at home got puzzled. In the unconsciousness, he at once got up and ran towards the attic of the house raising alarm, save me, save me. . .

He whispered that army has zeroed the entire house and that encounter will start soon. We persuaded him that it is his nightmare and he need not to panic.

At the second moment, he complained that gunmen (militants) will shoot him. The drama continued for whole night till morning prayers were called form the local mosque,” recalls Manzoor. Next day Shabir was taken to the Psychiatric Hospital.

Initially Shabir’s family use to treat Shabir for evil spirits, for they were convinced that some evil spirits are causing harm to Shabir. Revered waters and clay blessed by the priests (locally know as peers) was given to Shabir as panacea.

Communication with Shabir dawned upon the researcher that Shabir had friendship in militant ranks as well as with police and army personnel deputed to tackle militants. His profile of job was such that he could not annoy anyone. Being a cable operator in the locality, keeping acquaintances both with militants and police/army personnel was Shabir’s compulsion.

Police station and army personnel in the locality were subscribing his service. Militants often used to summon him for according to Shabir, they many a times tried to close down the cable service. They were being told that cable service is likely to bring immorality in the society. “Having a sort of association with both, wild thoughts used to occupy my mind and sensing the prevailing situation, I thought I may become a target,” Shabir says.
Another reason for Shabir’s diseases is the broken love affair. Snapped ties with his fiancee forced him to take drugs in order to get relieved. For seven years Shabir relied on the drugs as an alternative to derive temporary solace. But continued usage of drugs that too with increased dosages each day found Shabir caught in the quagmire of drug addiction.
“I myself am responsible for the deterioration of my health but the prevailing conflict situation simply aggravated my stress,” Shabir says.

Nowadays Shabir is on the Medication under the supervision of Psychiatrist, who not only cured Shabir but ignited spark inside him for further living.

“The situation here is bad and needs a serious approach. Hundreds of the people are using drugs as an alternative to over come frustration and depression,” informs Shabir.

Case Study 6:

Sarwa Akther (50) is trying hard to forget the incident that made her daughter Yasmeena to breath her last in the courtyard of their house. The sound of bullets and screams of Yaseema are still resonating in her ears. Yasmeena was gunned down by militants in 2003. On the allegation that she was working as SPO (Special police officer) with the local police and providing them information about the movement of militants. The tragedy has left an indelible impressions on her memory. Unable to cope up with the separation of her daughter and the nature of Yaseema’s death, Sarwa became a psychiatric patient.
In April this year, she was referred to Psychiatric hospital by a doctor after Sarwa didn’t show desired results. She was being treated for depression and even double dozes of anti-depressants were not giving desired results.

At Psychiatric hospital Srinagar, she has been diagnosed a patient of PSTD, and after taking medicines her family sources say that now they feel a little difference in her attitude.
Sarwa’s reason for falling prey to Psychiatric diseases is that her daughter Yasmeena was killed by gunmen in cold-blood.

According to Sarwa,Yasmeena’s father was about to retire from service and to help the family. She choose to work as an SPO on 1500 rupees, which is a dangerous job to do in Kashmir. SPO’s are thought to be a cursed people with every apprehensions of facing the wrath of militants.

Sarwa argues that her daughter died as a martyr .The entire family is yet to come out of the shock that it suffered during an evening of September 2003 and Sarwa is worst affected.

“The two masked gunmen entered our house and asked for Yasmeena. Not feeling well, she was lying in the bed. When we pressed for knowing the reason, Yasmeen cried that they had come to kill her. No sooner the duo heard her cry from inside the room, they fired a volley of bullets killing her on the spot and critically injuring our seven-year-old cousin,” relates Tasleema, another daughter of Sarwa. The family abandoned their ancestral home in Bijbehara to help Sarwa recover from the diseases and tragedy. They have not visited their home and have almost snapped all their relationship with the relatives at Bijbehara. Nowadays the family lives in an exile in Anantnag town. Sarwa recalls the indifferent attitude of their neighbours in Bijbehara when Yasmeen was killed. “Nobody among our neighbours came out at the time of incident. Even a limited people joined us to carry her last rites. It was very painful, even more painful than her killing,” she says.

There is hardly a day when Sarwa does not weep in memory of her daughter. She compels her husband Ghulam Rasool to visit the grave of Yasmeena on every Friday to offer Fateh Khawani.

One thing that haunts Sarwa is that Yasmeena’s death has brought bad name to the family and that people will not marry any of her other daughters all of whom have attained the marriage age.

The daily news broadcast from radio makes Sarwa restless the moment violent incidents are reported.

Case Study 7:

Hajra (50) is a half-widow, meaning she has no whereabouts about her husband who has disappeared. Half-widow is a term coined by media in Kashmir, and refers to women whose husbands disappeared in the conflict. According to Muslim laws a woman whose husband has disappeared has to wait for seven years before she can remarry. Hajra is one of many half widows in Kashmir. Her worries simply increase with every passing day. Unable to trace her husband Mohammed Yosuf Malik, who she says was subjected to enforced disappearance in the custody, Hajra’s concern is the growing age of her three daughters.
Twelve years ago, to be exact on May 7, 1994, her husband was picked up by the army from her residence at around 2;30 am in the dead of night. The fearful entry of the men in uniform is still fresh in her memories.

“The men belonging to Para 9 Commandos broke open our doors and forcibly made their entry inside our bedroom, where we were sleeping along with our daughters. They dragged my husband and took him away,” recalls Hajra.

Right from that day, Hajra is suffering from abnormal heart beat that even make her unconscious. Relating the incident even today makes her feel uneasy and frightened. After her husband’s disappearance, she assumed the status of family head and used to manage everything from managing agricultural land to bear the expenses of daughters. She stood like a rock and is struggling hard for her family.

Doctors, whom Hajra approached for treatment of her diseases after seeing no let up in her condition, advised Hajra to go for psychiatric consultation after.

“I am not scared of my death but what will happen to my daughters, who will manage their marriage and other things. They have always seen sufferings,” says Hajra.

Mixing up with patients at psychiatrist hospital made Hajra feel that her worries are smaller compared to others visiting here. She has been put on medication and has been asked to report for counseling session twice in a week.

Almost all the people comprising of family members and patients whom this researcher interacted speak about their visits to shrines and consultation with priests in search of solace and end to their diseases. In the next posting, I will be bring the expert opinion on the burgeoning number of psychiatric patients.

18/5/06

Dear Arshad Thank you for choosing an extremely interesting topic for research, and also for visibilising the mental health status in Kashmir. It is likely to be extremely beneficial for many people who are concerned about mental health services (both mainstream and otherwise) and their impact in dealing with mental illness. There are a few questions about your study that I MUST ask though: 1) What role does confidentiality play in your study? are the names you provide, real names ? if they are real names, do the subjects know you will be providing these names on a public list ? 2) Is there a way by which you could veil the identities of those you interview? Especially in the context of a society that fiercely guards its mental health and mental illness status, perhaps methods to obtain data and yet assure confidentiality will help you 3) I am curious also about whether volunteering at a hospital could help you. You might learn a lot through observation too, also people might get the chance to trust you because they have seen you around. 4) What do the subjects get from you for telling you their stories? I often wonder, when I do research as well, why anyone must tell me their story unless they have something to gain — be it catharsis or some other goal such as ‘better treatment’, anything. Have you had a chance to think about it? 5) How do you go about finding subjects as of now? What method do you follow? I mean how do you decide who to interview and how do you convince people to sit for an interview. In case you have mentioned methodology before, please could you paste just that part again.

Hope to hear from you soon,

All the best for your project!

Warmest Regards,

Gitika Talwar

Programme Associate

Bapu Trust – Center for Mental Health Advocacy and Research http://www.camhindia.org

***

Thank you Gitika for your interest in my research. Being a reporter i have tried my level best to do the research objectively. i have not used the real names as it would have a negative impact on the future of subjects. i have mentioned the incidents when few people were reluctant.

But some people (read psychiatric patients) were eager to share their experiences. They were of the view that it would help others to come forward to seek medical advice. i have spend my five years in the field of reporting. In the conflict zone , one gets enough time to report sufferings and tragedies, so that way it was esay for me to identify the cases. i follow the method of interviewing and that is the only effective tool when one has to work on ground. for further queries mail me.



12/8/06

Is there a remedy to unending stress in Kashmir?

Peerzada Arshad Hamid

Srinagar

Seventeen years of conflict in Jammu and Kashmir has had a direct bearing on Society in the form of increasing number of Post Traumatic Stress Disorders in state. Frequent violence in the shape of grenade explosions, improvised explosive device (IED) blasts, killings, encounters culminating in damage of residential structures and brutal killings are worsening the situation. In such an aura mental disorder in shape of stress and panic is a natural outcome.

On the prevailing stressful conditions in Kashmiri society, veteran sociologist Dr. Abdul Gani Madhosh says, “The overall situation in Kashmir is not all that pleasant so stress and depression can’t be taken out simply.”

As a way out, Madhosh suggests, “Counselling of bruised souls is a first step and rest things have to follow. You have to create an atmosphere where people no longer feel scared.”

Dr. S Khurshid-ul-Islam is Assistant Professor in the Department of Communication and Behaviour Sciences at Jammu and Kashmir Institute of Management, Public Administration and Rural Development. He says that situation prevailing in the state has snatched leisure from the people and their minds always remain preoccupied with fear.

“We are humans and there are varied things that one has to think of in order to run family affairs and routine business. In doing so a sort of stress always remains on us though unintentionally. Now add to it the unusual fear and insecurity that anything unusual can happen the next moment. So where from can you bring the desired change,” he says.

Khurshid believes that fear and insecurity are the basic reasons for increasing psychiatric disorders. “Unless and until sense of insecurity is not taken out from the minds of people, you won’t be able to put a check on increasing number of such patients instead the numbers will escalate as they have since 1989,” he suggests.

Laying emphasis on more and more social interactions rather than focus on individualism, Khurshid foresees way out within society and holds the view that as a society, Kashmiris can definitely contribute towards lowering the number of psychiatric diseases.

“What people need to do is, they have to increase their social interactions within their families and neighbourhood. By this people will manage to share their grief and possibility of stress on a particular person gets minimal to a large extent. Then religion too has a role, it helps the people to cope up and endure the worst kind of happenings in one’s life,” Says Khurshid.

Shazia Manzoor is a lecturer in the Department of Master in Social Work at the University of Kashmir. She teaches students the art of social work and techniques of counselling and rehabilitation of the patients, whom she describes victims.

“My focus is to teach students the methods by way of which they can tackle the patients and them effective counselling. So far as I have been able to get the feel of patients visiting the Psychiatric hospital, underlying reason for majority of the cases is conflict going on in Jammu and Kashmir. There are cases of Schizophrenia, Bipolar Disorder, PTSD, Drug addiction, Anxiety, Neurosis, etc.,” says Shazia.

Shazia feels that awareness regarding psychiatric diseases in Kashmir is not done effectively. She argues that people in Kashmir are still having inhibitions in visiting psychiatric hospital or psychiatrist.

“Your figure about visits of people at psychiatric hospital will say patients are coming and number is increasing but my experience says people come to psychiatric hospital, when it becomes unavoidable for them to seek help of psychiatrists. Prior to that they try their best to seek refuge in the prescriptions of doctors other than psychiatrists,” says she.

Regarding awareness among the people, Shazia says help from opinion leaders and religious heads at grass root level can make difference and bring desirable change.

A private international Medical and Humanitarian organisation, Medecins Sans Frontiers (MSF) or Doctors without Borders has set up its office in Srinagar with the aim to bring down the levels of stress related psychosocial problems of people here. In Kashmir, MSF started its functioning in 2001 by assisting in the rehabilitation of Government hospital for psychiatric diseases.

The brochure of MSF in Kashmir mentions that apart from serving victims of natural and man made disasters, MSF provides medical assistance to victims of armed conflict. The valley of Kashmir has been engulfed by instability since 1989. The armed conflict going on here gave rise to stressful situations. Violence has touched each family living in Kashmir one way or other. People here are in need of help.

With the agenda to serve affected people of Kashmir, MSF reconstructed wards of psychiatric hospital and in the year 2003 started counselling services in the hospital for psychiatric patients.

Farhat Mantoo is a team leader with MSF in Srinagar. “In counselling our aim remains to infuse fresh hope in the psychiatric patients. This is achieved by reinforcing the positives (healthy things) in patients and eliminating the negatives by providing alternatives,” explains Farhat.

Terming patients as clients, Farhat says counselling is a brief therapy where clients (individually or in groups) talk to a counsellor who in turn provides help to client by offering emotional support, psycho education , and sometimes practical advice. Furthermore the client learns to strengthen his/her ways of coping with problems.

“In counselling the foremost thing is acknowledgement. You as a counsellor have to acknowledge that the client has a problem and show concern about it,” she says.

Haroon Mirani is Research Head at Kashmir Newz , Srinagar. Mirani says that situation in Kashmir has not changed as portrayed by certain sections of media. “Violence is still going on but we can say the society has adapted to the deteriorating situation to some extent. That is why we don’t see entire town tense after a grenade blast or cross firing between militants and troops in the Srinagar or any other place. Contrary to the initial phase the impact is felt within a limited area for a short span of time,” Mirani explains.

Deliberating on the human relations, he says at times they surpass the limits of adaptability and one fails to control him or herself.

“You can’t stop yourselves when someone close to you falls prey to bullets or gets killed accidentally in violence. You experience the flow of psyche and fail to cope up, you develop stress and if it prolongs, you become a patient,” Mirani says.

Dr. Arshad Hussain is a practising psychiatrist at the lone psychiatric hospital in Srinagar. He advocates the amalgamation of mental health in general health.

“Kashmir is closed society. People still have inhibitions in visiting this hospital. The fault does not lie with them. Actually the word went across that anyone visiting the hospital of psychiatric diseases for treatment has mental problems, which actually is not true.

So in order to relieve them of this burden the government should keep services of psychiatrists available at premier health institutes of state like SKIMS and SMHS in Srinagar and other allied hospitals. Then people won’t feel inhibitions,” opines Arshad.

Cautioning about the fallout of stress on people, Dr Arshad points out that if suffering of stress and trauma among people (mostly of younger generation) goes unattended, it results in genetic disorder.

“It can become a genetic disorder and there is possibility that it can transmit from one generation to another,” says he.

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