Depressed Dangerously

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Fast life, career rat race, destabilized families and the conflict have created such a mess of Kashmir’s mind that melancholy has become the new norm in staying normal. Even though the patient footfalls in Kashmir’s only psychiatric centre have surged eight times in three decades, Syed Asma reports that the real assessment of Kashmir’s state of mind needs a mindset shift at policymaking level

Institute-of-Mental-Health-&-Neuroscience-Kashmir---(Mental-Hospital-Srinagar)

Sana is an 18-year-old tall girl with fair complexion. She hails from a south Kashmir village and aspired to be a doctor. An above average student, her school teachers had high hopes from her. The only daughter of her father, a government employee, she would impress her teachers and peers by solving the complexities on blackboard.

But that was once upon a time. Fate challenged her very survival offsetting her goals in life. She was barely 13 when her father was diagnosed with cancer. Battling for his treatment for many months, the family flew him to Delhi, spent a lot of money on his treatment. He battled for his life for six months and finally succumbed to the malady.

Suddenly, the family shrunk to a grieving widow and a desperate daughter. Reconciling with the fate, she was coping with the loss of her father. Then another tragedy struck: her mother passed away of a sudden cardiac arrest. Sana was sixteen then.

“She was broken completely but she courageously recollected herself,” says Amina, her aunt and the guardian. For the last two years Sana is living with Amina, in another nearby village. “She surprised us all as she coped well with the loss.”

Sana started living to fulfil her parent’s dream of becoming a doctor, believes Amina. Barely a few months after her mother’s death she appeared in her matriculation examination and passed with flying colours, she secured a distinction, actually. But that proved the last milestone of her struggle to survive normally and fight back.

After migrating to Amina’s home, she mixed up with the family and became part of it. It was her cousin who would teach her and keep her inspired about her goal in life. She was attached to him. As she was preparing for the entrance examination, her cousin was killed in an incident of crossfire between troops and militants. Things fell apart. Since then Sana is under shock. It has been three years and she hardly talks, her doctor says. Sana discontinued her studies. She did not even appear in the entrance examination. She did not enrol herself in any college. Simply she stopped living.

Legacy-of-political-insecurity-in-Kashmir

“We mostly find her sitting in her room, either sleeping or sobbing,” Amina, who takes care of her and drives her to Srinagar for consultations with her doctors, said. Now on medication and counselling for last one year, the doctors are hopeful that she may show some improvement in a few months. Amina keeps her fingers crossed.

Sana is just one of the faces in the crowds that reach Srinagar’s Institute of Mental Health and Neuroscience (IMHANS), every morning. The rush of the patients keeps the corridors busy and it starts thinning by the evenings. There are hundreds of people who are suffering with more severe and serious mental ailments.

IMHANS remains inundated with the patient load. Doctors say the footfalls have increased manifolds. “We would get 100 patients a week in 1980s and it has now gone up to 850 per week in 2016,” says Dr Maqbool Dar, “Most of them are women.” Dar heads the Government Medical College’s Psychiatry department.

A recent study by the Médecins Sans Frontières (MSF, commonly known as Doctors Without Borders) only corroborated what Dr Maqbool said – massive mental morbidity. In collaboration with IMHANS and the University of Kashmir, its researchers randomly sampled 5600 households from 400 villages across Kashmir’s 10 districts. Focussing mainly on the most prevalent disorders like depression, anxiety disorders, and post-traumatic stress disorder (PSTD), the survey offers a peephole view of how adult minds in Kashmir survive with stress.

The outcome is shocking. Every Kashmir adult has witnessed or experienced 7.7 traumatic events during his life time: 94 per cent of the incidents experienced were natural disasters, 93 per cent were conflict related trauma, 76 per cent included life threatening accident or illness and 71 per cent were related to death of a loved one.

Weighted-prevalence-estimates-of-psychiatric-co-morbidity-in-adults-living-in-the-Kashmir-Valley,-KMHS-2015

By an average 73 per cent of men and 52 per cent of women had experienced or witnessed more than six traumatic events during their lifetime. But women are the most affected. “Women are comparatively more sensitive and emotionally weak, besides hormonal factors also play their part,” says Dr Maqbool.

The survey shows that 37 per cent of adult males and 50 per cent of females, which is 16 lakh individuals, are suffering from probable depression. Of these, 10 per cent (415,000 individuals) meet all the diagnostic criteria of severe depression. This state of mind explains the crowds that queue-up in the long lines outside IMHANS consultation rooms, desperate to seek cures for ‘tensions’ they are sometimes unable to explain.

Khateeja is another face. She must be in her 50s. Neatly dressed, displaying a typical Kashmiri henna designs of a duck on her hands, she talks uncontrollably at a high pitch voice: “What is wrong if I am dressed well?”

“Don’t look at me like this,” her voice echoes in the IMHANS corridors, the only psychiatric centre in Kashmir. “I will take out your eyeballs and throw them in Jhelum….don’t look at me like this.”

While she is taking rounds of the hospital teasing and abusing people, a young man comes chasing her. It is her son Abdur Rehman, who was just talking to one of the paramedics and pleading for an appointment with the doctor.

A desperate son, Rehman starts explaining to the paramedic: “For the last few days she is getting hyper. I had a lot of difficulty to convince her and get her here.” In the melancholy that rules IMHANS, the paramedic understands the crisis that helpless Rehman is handling. His mother is sick. A few minutes later, Khateeja and her son are called in by the doctor. She is admitted for a week, in the first go.

Symptoms-of-Depression-among-adults-in-Kashmir-report-by-MSF

Khateeja is a resident of a border Kupwara village. She lost her husband in a road accident some 25 years back. She had two sons, Rehman, the elder was of five years and the younger one was just toddler of three years of age. With the cushion gone, the homemaker took over as the bread winner till both her sons passed the tenth class examinations. Working hard to raise her children, she built a concrete home too.

But the load of being lonely was always on her subconscious. Khateeja got her first panic attack, Rehman said, when their uncle claimed his rights to their inheritance. “The shop belonged to my father and the house was built up by my mother, all alone,” explains Rehman. “We do not understand why he is claiming our property?” The case is already in the court but the Uncle’s act has already created a casualty.

It has been two years that Rehman is driving Khateeja to IMHANS. Doctors say she is a patient of severe depression and has a history of getting hyper and panic attacks as well.

Anxiety is the second highest mental disorder found in Kashmir adults. MSF report suggests that 21 per cent of males and 36 per cent of females – making a population of almost a million people, suffer from a probable anxiety related disorder. Again women are the most affected. Reason: being sensitive and the super-women role she is playing in the given situation.

“By choice or compulsion woman in Kashmir is playing every role one can imagine,” explains Dr Arshad Hussain, a psychiatrist. “She is a caretaker, a cook, a bread earner, a planner, and home-maker and does many things. We need to understand that every human body and brain needs rest, so does a woman.” He says women live busy, rest-less lives that trigger tensions and impacts normality of brain.

“Work place harassments and domestic violence also add to the trouble in a woman’s life,” adds Dr Yuman Kawoos, another practising psychiatrist.

Shahzada, 40, is a case representative of thousands. She was diagnosed with double depression and panic symptoms more than a decade ago. Presently on medication, she visits the hospital once in six months and believes her condition is improving at a much better pace that before.

Symptoms-of-Anxiety-among-adults-in-Kashmir-report-by-MSF

A burqa clad home maker, Shahzada married a labourer from Beerwah in early 1990s.  Living in abject poverty, the couple would engage in a tussle quite often. The squabbling would end up getting her thrashed. “I was used to it, “says Shahzada, talking meekly in measured words. She tried to be a submissive partner to an aggressive husband. It had its own costs. “One day he beat me ruthlessly and I suffered a miscarriage after six months of pregnancy. He did not even take me to the doctor.”

Beating was hurting her physically and she was not complaining. But the miscarriage coupled with his behaviours hurt Shahzada’s psyche. “After I lost my baby I was numb, almost unconscious, for a year,” she remembers. “Then my mother took me to a gynaecologist who suggested visiting a mental hospital.”

Initially Shahzada was reluctant to visit IMHANS for the stigma associated with it. But when her family noticed her deteriorating condition they finally drove her to Srinagar’s Pagal Khana, IMHANS’ basic name. Now after Shahzada is gradually improved, she is living with her husband and two sons.

The Pagal Khana tag is a huge limiting factor for many people to get their dear ones to the IMHANS. Even doctors admit the visible reluctance of a section of people in driving their patients to Rainawari. This was precisely the reason, Dr Maqbool said, they opened up a consultation wing in SMHS. “I suppose we get more patients in SMHS’s OPD than in our main hospital at Rainawari,” admits Dr Yuman.

Symptoms-of-PTSD-among-adults-in-Kashmir-report-by-MSF

One of those patients reluctant to visit Rainawari was Mehnaz. She is presently being treated in SMHS and she is happy with that.

Mehnaz is 25 and has completed her MBA from University of Kashmir. Post-studies, she decided against sitting at home. Instead of waiting for a suitable job, she thought of joining a consultancy, to stay busy, earn a bit and gain some experience. Donning Abhaya, Mehnaz is an introvert but an efficient girl. A good student all her life, she was used to the attention and praises from her teachers.  And the trend continued at her office as well. Her boss, a young man, was all praises for Mehnaz, her contributions to his consultancy and the way she conducted herself and the business.

“Initially I took it casually but eventually his behaviour started disturbing me,” shares Mehnaz while attending her counselling session in the SMHS. “He started talking less about my work and more about my appearance and dresses,” says Mehnaz, “It disturbed me a lot.”

Within a year of frequent praises of her person and attire and suggestive remarks, the ‘boss’ turned a total villain. His behaviour got dirty, remember Mehnaz. Not sharing with anyone, these circumstances started taking toll on her health and suddenly one mid-night she thought she got a heart attack. “I had difficulty while breathing, high palpitation and got unconscious,” shares Mehnaz. Her parents drove her to SMHS. After repeated medical examinations she was referred to the counselling cell of the hospital.

Weighted-proportion-of-problems-of-daily-life-identified-by-adults-in-the-KMHS,-2015

“Initially for about three weeks, she did not tell me anything,” says her doctor, “I had to gain a lot of her confidence and trust to let her share her exploitation tale with me.” Her doctor had to promise her that he will not share her crisis with anyone, not even her parents that she started opening up.

After knowing everything, the doctors asked her to resign from that consultancy. It took her six months to recover. Now Mehnaz, a daughter of a government employee, comes for a consultation once in two months. She now works at a different place and lives her life confidently.

Depression and anxiety apart, the most common disorder afflicting Kashmir is the Post Traumatic Disorder (PTSD). The study reveals that 18 per cent men and 22 per cent women are suffering from probable PTSD. Of them 6 per cent or nearly 248,000 individuals, meet the diagnostic criteria of the disease. High rates of co-morbidity of symptoms of depression, anxiety and PTSD were found in Kashmiri adults.

With 70,000 lives lost and 10,000 persons disappeared, PTSD is linked to the conflict in the region, the report reveals. “The political instability not only exposes a population to traumatic events but also has a negative impact on the social, economic and material fabric of society,” the report says. PTSD patients live on anti-depressants and have high suicidal tendencies. The report reveals that 11 per cent of Kashmiri adults were taking benzodiazepines (sleep inducing sedatives).

Noor Mohammed is a north Kashmir villager. Working as a daily wager, he is an orphan. He was barely seven years old, when in 1998, his parents were killed.

It was Ramzan, the Muslim month of fasting, he vividly remembers, when his father, a zameendar, came back from the Masjid and they were about to have dinner.

“It was the first fasting day of my life so we had celebrations at home. My mother had cooked all my favourite dishes,” remembers Noor Mohammad, with his eye moist and voice broken. In these celebrations and excitements a group of unidentified gunmen banged the door, barged in, isolated him from his parents. Noor Mohammad was kicked into a separate room and locked from outside. “After that I just heard the gunshots. I was banging the door for the entire night but no one heard my cries,” says a sobbing Mohammed. “Next morning when the door was opened, I found my parents in a pool of blood.”

“I have never forgotten that scene. I live with it. I could not sleep after that. I have never slept after that. Never!” says Mohammed, who is a regular visitor at the hospital since last three years now.

Noor Mohammed, the lone child of his parents lived with his uncles till he reached an age of 15. The circumstances did not allow him to be a regular student in the school, so he dropped-out before qualifying class tenth. After turning 15, he shifted back to the “haunted house” where his parents were killed. “I still live there,” he says.

Noor Mohammad is married now. He is proud father of a son. But he is living in his past when he was seven. His brain is stuck and refuses to move on unlike his body. “I am yet to come out of that incident,” he admits, politely.

Explains his doctor: “I see a lot of improvement in him but he still gets those blackouts and forgets everything.” Noor Mohammed complains that he suddenly forgets everything, his name, his address, family. Now his doctor has advised him to carry a notebook to remember his whereabouts. At times, it can get risky.

In rare cases, explains Dr Arshid, shock or trauma doesn’t destabilize humans and leaves a positive effect on an individual, instead. This energy becomes trigger for their success. But it requires individual strength and the capacity to handle the grief. But that capacity can be exhibited to extraordinary minds like that of Abrahim Linchon or Nelson Mendala.

Depression

Owais is neither of the two. Barely 16, he doesn’t talk much. Sitting isolated most of the times, his only question to his mother is: “Where is my father?

It was 2000, when he was six months old and his father, a labourer, did not return home from work. Haleema, Owais’s mother does not talk much about her husband’s disappearance. Instead, she complains about her son’s illness.

“I am on sedatives myself but I don’t care about that,” Haleema, a resident of central Kashmir, says. “All I want is my son to be fine.” Gradually, she said, Owais is becoming short-tempered, feels irritated all the time and remains isolated.

Owais has to appear in his class tenth examination this year and her mother, working as a domestic help, wants her son to be like other children, playing all the time.

Doctors say Haleema is unwell but she is coping up with the crisis for the sake of her son. She just needed a few counselling session and she was all right, her doctor says. Her son, however, would require more time to get normal.

Even increasing unemployment is worsening Kashmir’s mental health scenario. “At state level the unemployment has increased 190 per cent between 2008 and 2013,” MSF report says.

Doctors lack a way-out for all the tensions and stresses that plague Kashmir but they insist on more awareness. They suggest that routine medical officers posted in the periphery and the urban spaces of Kashmir must have a crash course in basic psychiatry. “It will help detect problems early and reduce drug use and abuse,” says Dr Maqbool.

State’s health set-up must go for an elaborate survey across Kashmir to offer a clear picture of the state of mind. It is crucial to individual contribution to overall growth and vital to understand the melancholy in paradise.

(Real names and addresses are not used in the story. The cover photo used is of Azi, a widow who lost her mental balance after her husband’s  death in Zakura massacre in March 1990.)

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