Kashmiri: Mind on Edge

Kashmir faces a deepening psychological crisis where conflict trauma, drug addiction, stigma, screen overexposure, joblessness and anger intertwine. Psychiatry battles neglect, faith, and silence, struggling to heal minds scarred across generations, writes Masood Hussain

In one Kashmir home, parents sit in silence, unable to comprehend how their son, sent to the coaching hub of Kota to fulfil their dream of seeing him as a doctor, never returned alive. His rebellion was not by words but by silence, and finally, by surrender. He took his own life, overwhelmed by a career path forced upon him, by expectations he could neither meet nor escape.

This tragedy is not an aberration. It is part of a swelling tide that psychiatrists, counsellors, and public health experts say has turned Kashmir into a valley of silenced cries. Forced career choices, deep-seated trauma, and the crushing weight of expectations are increasingly driving young people towards the edge. “Career choices are being enforced, and it is pushing youngsters towards suicide or into developing suicidal tendencies,” Dr Abdul Majid, a senior psychiatrist who heads the Psychiatry Department at SKIMS Hospital Bemina, told his peers at a recent medical gathering in Srinagar.

The numbers confirm what families whisper in fear. Majid said Kashmir has seen suicides soar from 0.5 per lakh before militancy to 7 per lakh in 2007 and an alarming 13 per lakh in 2020. By 2022, 600 suicides were officially reported, 570 from Kashmir and 30 from Jammu, but psychiatrists insist that these figures are underestimates. Stigma and denial often ensure that suicides are disguised as accidents, heart attacks, or illnesses. The true toll, experts say, is far higher.

Globally, the picture is no less grim. “India has overtaken China as the world’s suicide capital, reporting 1.7 lakh cases in 2022,” said Prof Lakshmi Vijayakumar, founder of SNEHA and a leading voice in suicide prevention worldwide. She explained that suicide patterns vary across geography and culture: the south of India records the highest rates, the north the lowest. But what sets Kashmir apart, she suggested, is the collision of cultural, political, and psychological stressors. “There is no single factor; it changes with time and geography,” she said.

Her research reveals sobering truths: women suffer higher rates of depression, but men take their lives more often. Low-income groups are disproportionately vulnerable, with poverty amplifying feelings of hopelessness. Yet religion appears to provide a buffer: suicide rates are lower among Muslims, where it is religiously forbidden. “Suicide is not an instinct in the human race; it is a learned behaviour,” Vijayakumar stressed. “But it can be unlearned if the signals are picked up in time.”

For Kashmir, however, those signals are often drowned out. The scars of conflict, the weight of social pressures, and the absence of open conversations at home mean that warning signs, isolation, anger, and mood swings go unnoticed or are brushed aside, and when families do notice, shame often silences them.

The result is a grim paradox: Kashmiris are caught between acknowledging a crisis and refusing to name it. Behind closed doors, mothers whisper of sons lost, fathers struggle with guilt, and siblings learn to carry secrets. Yet in public, silence prevails. For psychiatrists, this is the greatest hurdle. Suicide, they argue, is not inevitable. But it requires recognition, not just of the act, but of the despair that precedes it.

In this silence lies the true crisis: an epidemic of unspoken pain, festering in a society reluctant to confront it. And if Kashmir does not find a way to speak, more futures risk being extinguished before they can even unfold.

In 2024 alone, the Institute of Mental Health and Neurosciences (IMHANS), the major psychiatric treatment facility in Kashmir, had a footfall of 203231 patients; more than double that of the AIIMS. It has 1996 IPDs as well. Numbers have been surging with every passing year: 1015192 in 2018; 113452 in 2019; 75814 in 2020, when Covid-19 dominated the scene; 108419 in 2021; 155279 in 2022 and 175053 in 2023.

At the SKIMS Hospital at Bemina, in Srinagar’s periphery, the psychiatry department had an OPD footfall of 16339 in 2015-16, and 238 patients who required hospital stay. In 2024-25, the footfall was 86004 for OPD and 1210 for IPD, a fivefold increase in a decade. The department recorded 314992 OPD registrations in 10 years. “Almost 15 to 20 per cent of the footfall is the new patient and the rest are follow-ups,” Dr Majid said.

Anger of a Generation

In Kashmir, trauma is a lived experience. Witness to cycles of violence for more than three decades, its psychological consequences are now deeply embedded in its collective consciousness. Unlike disasters that strike suddenly and pass, the conflict here has been relentless, producing what psychiatrists describe as “perpetual trauma.”

“Nearly 90 per cent of Kashmir’s population carries anger linked to political instability,” said Prof Zaid Ahmad Wani of IMHANS, told a CME. His words carry the weight of years spent listening to patients of every age group. “Forty-five per cent of children have witnessed severe traumatic events. It is a generation gone astray.” The childhood of a Kashmir generation was marked not by playgrounds and laughter but by curfews, crackdowns, gunfire, and loss.

What alarms psychiatrists is how trauma has altered its very presentation. Traditionally, psychiatric disorders like depression or PTSD were diagnosed in adults, usually after the age of 18. In Kashmir, these disorders are now surfacing in adolescence and even in children. “There has been a 180-degree shift between what psychiatry teaches and what the field now demands,” Wani remarked. Children as young as 12 are presenting with symptoms once confined to adulthood: panic attacks, intrusive memories, personality disorders, and even suicidal thoughts.

The Science of Trauma

Prof Mushtaq Ahmad Margoob, Kashmir’s foremost psychiatrist and founder of SAWAB, has spent decades trying to decode this. “For the first 15 years, I studied why trauma affects people,” he said. “In the next 15, I studied how resilience develops.” His research shows that Kashmiris process trauma differently from populations studied elsewhere. For example, when American soldiers returned from Vietnam, their PTSD often improved with time and treatment. But in Kashmir, neuro-imaging revealed a troubling difference: the hypothalamus, a brain region impacted by PTSD, did not show improvement even after treatment. “Our perpetual trauma scene is different. It explains why the hypothalamus does not recover here,” Margoob explained. “Our trauma is not one event. It is daily, layered, and without closure. That is why our brains respond differently.”

This has fetched Kashmir a niche of its own, putting it on the global psychiatric map. When Margoob presented his findings in Washington DC, fellow scientists recognised the Valley as a unique trauma laboratory, tragic but invaluable for understanding human resilience and vulnerability. Kashmir was not just another case study; it was rewriting the science of PTSD.

The research went beyond neurobiology. Genetic studies suggested that trauma might leave chemical imprints on DNA, altering how stress is processed in future generations. This phenomenon, known as epigenetic inheritance, means that the children of those traumatised in the 1990s may carry heightened vulnerability to stress, anxiety, or depression, even if they themselves never directly experienced violence. “Trauma can be passed on like an heirloom,” explained Dr Yasir Ahmad Rather. “It lowers the threshold for bearing stress in subsequent generations.”

At the clinical level, Kashmir also experimented with tools adapted to its own realities. Electroconvulsive Therapy (ECT), often stigmatised elsewhere, became a lifeline here. “Contrary to myths, ECT is one of the most effective treatments for severe depression and trauma-related conditions when medication fails,” Margoob argued. By refining its application, Kashmiri psychiatrists reduced risks and demonstrated outcomes that brought patients back from the brink of suicide.

The science, however, always intersected with culture. For instance, patients often presented with somatic symptoms, chest pain, headaches, palpitations, and masking underlying trauma. In Kashmir’s conservative society, especially among women, direct admission of psychological pain was rare. Doctors had to learn to interpret the body’s signals as coded cries of the mind.

This blending of neuroscience, genetics, and cultural psychiatry makes Kashmir an outlier in global research. It is not merely a site of suffering but also of knowledge. “We have produced data here that the world could not ignore,” Margoob said. “But sadly, while the West values it, our own policymakers do not.”

The tragedy, he noted, was that while Kashmir contributed cutting-edge insights to psychiatry, its own people remained underserved. “Science recognised us, but society still stigmatises us,” he lamented.

Kashmir’s unique findings reveal an unsettling truth: conflict reshapes not just lives but the body itself. Trauma becomes embedded in the brain, the blood, and even the genes, a legacy that outlives the event. For Kashmiris, healing is thus not only about surviving the present but also about breaking cycles that could otherwise echo into generations yet unborn.

The daily experience of fear and uncertainty compounds this. Families live with the constant possibility of violence, sudden death, or disappearance. Unlike other conflicts where trauma may be tied to a single event, Kashmir’s is ongoing, making healing extraordinarily difficult. Recently, when 26 tourists were massacred in Pahalgam, psychiatrists claimed they got a massive load of patients, most of them who had healed earlier.

The result is anger -raw, unfocused, and often destructive. Psychiatrists say that anger here is both a symptom and a coping mechanism. It surfaces in road rage, domestic violence, and neighbourhood quarrels, and even in children lashing out at teachers. “People here don’t understand what trauma is,” Margoob observed. “They think it is normal life. But anger, impulsivity, and poor decision-making are its behavioural manifestations.”

The cost of this trauma is borne not only by individuals but by families and communities. When fathers struggle with mood swings rooted in PTSD, the family environment becomes fragile. When mothers suppress grief, children absorb it as silence. And when children carry these burdens, they pass them down. Psychiatrists are now exploring what they call trans-generational trauma transmission, the idea that trauma imprints itself onto DNA and is inherited by subsequent generations.

This means that Kashmiri teenagers may be carrying not only their own trauma but the imprints of their parents’ and grandparents’ experiences. It explains why young people are so vulnerable to impulsivity, despair, and self-harm.

The Drug Epidemic

If trauma is the silent epidemic in Kashmir, drugs are its corrosive shadow. Over the past decade, substance abuse has spiralled into one of the most alarming public health crises Kashmir has ever faced. What was once whispered about in hushed tones has now become undeniable: Kashmir is in the grip of heroin.

“Around 90 per cent of cases seeking treatment in our hospital are related to heroin,” said Dr Yasir, Associate Professor at IMHANS. “The situation is alarming. There has been a surge over the past few years, and deaths due to overdose are happening every day. But families don’t report them as overdoses. They attribute them to heart attacks or illnesses, because acknowledging drug abuse carries stigma.”

That stigma allows the epidemic to fester in the dark. Parents who discover a syringe in their son’s room often hide it, hoping it was a one-time lapse. Families grieving an overdose often choose silence, fearing the shame that would follow an honest admission. As a result, accurate data on drug-related deaths in Kashmir remains elusive. “Illnesses don’t heal with criticism or advice,” Dr Rather emphasised. “They need treatment. But because addiction is seen as a moral failing, not an illness, patients are denied empathy.”

The health consequences are staggering. Needle sharing has triggered outbreaks of hepatitis B, hepatitis C, and HIV. Young men in their twenties, many still in college, now present with end-stage liver disease or collapsed veins. Cardiologist Dr Wasim Ahmad has documented cases where hidden substance abuse led to sudden heart failure. “Every practitioner must physically examine patients carefully,” he cautioned. “Drug abuse is being concealed, wasting both time and lives.”

The fallout extends beyond the body. Addiction devastates families, frays neighbourhoods, and destabilises communities. Crimes once unthinkable in Kashmir, broad daylight thefts, violent robberies, even murders, are increasingly linked to drug dependence. Since 2018, the Jammu and Kashmir Police have arrested more than 10,000 people for drug consumption or peddling under the NDPS Act.

The geography of addiction also tells a story. Studies reveal Anantnag has some of the highest rates of opioid abuse, while Kupwara is hit hardest by benzodiazepine misuse and alcohol. Across the Valley, however, the profile of addiction has shifted: no longer confined to unemployed men or broken families, heroin use now cuts across classes. Students, professionals, and even young women are part of the epidemic.

“Initially, there were stereotypes that only the unemployed or those from lower classes used drugs,” Dr Rather explained. “But now addiction has no bar. Employed or unemployed, upper class or lower, rural or urban — it is everywhere.”

The social fabric is fraying under the weight. Domestic violence, road rage, and fights over trivial issues are increasingly tied to lowered frustration thresholds. “As a society, we have become so used to pain, trauma, and violence that we have forgotten how to live a healthy life,” Dr Rather said. “The target is survival, not growth. And in this environment, drugs provide an easy escape.”

The government has unveiled a comprehensive drug de-addiction policy, and new de-addiction centres have opened across districts. At 16 Addiction Treatment Facilities (ATF), a staggering 12635 registrations have been recorded. “At least 11 new cases come to these centres daily,” a senior doctor said. SKIMS Bemina Hospital has more than 3000 registrations, of whom 2523 were screened for various diseases, and the revelation came that 834 were Hepatitis-C positive, 12 were carrying Hepatitis-B, and 74 were infected by both.

Yet the gap remains vast. Community awareness is low, stigma is high, and resources are thin. For every young man who finds his way to a clinic, dozens more remain in the shadows, hidden by families, silenced by shame, or simply lost to overdose.

Struggle for Care

In Kashmir, to walk into a psychiatric clinic is often to walk into a cloud of suspicion. Patients, their families, and even doctors themselves know the weight of being seen near the doors of what many still call pagalkhaanas. Stigma has built walls around the very institutions meant to offer healing.

A 2015 survey by MSF found nearly 1.8 million adults in Kashmir showed symptoms of mental distress, but only a small fraction accessed professional treatment. One reason is the cultural lens through which mental illness is viewed. “Mental illness is seen as taboo, a weakness, not a medical condition,” explained Wasim Kakroo, Consultant Clinical Psychologist. “Institutions are labelled pagalhaspataal, professionals as pagaleunhund dactar. People hide their struggles to avoid being ostracised.”

The reliance on faith healers compounds the problem. Research shows that in 1996, 73 per cent of psychiatric patients visited a faith healer before seeking medical help. By 2005, the figure was still 68.5 per cent, higher in rural areas. While some healers provide comfort, others delay treatment or subject patients to harmful practices. And yet, stigma ensures many Kashmiris turn to them before stepping into a clinic.

Breaking this silence requires more than doctors, professionals assert. It requires communities to unlearn inherited prejudices, for schools to normalise conversations about mental health, and for the media to portray patients as people, not caricatures. “We need a collective effort,” Kakroo insisted. “Education, community outreach, personal testimonies, only then will the walls around psychiatry begin to crack.”

Until then, stigma will remain a silent co-patient, shadowing every diagnosis, every consultation, every attempt at healing. In Kashmir, it is not just the illness but also the shame of the illness that breaks people down.

New Age of Anxiety

In Kashmir’s crowded classrooms, children are often judged less by their curiosity and more by their rank. The pressure to succeed academically is immense, and for many families, medicine or engineering remains the only acceptable path. That obsession, psychiatrists warn, is leaving scars as deep as the conflict outside.

The tragic story of the boy sent to Kota, who died by suicide after being forced into medical coaching, is one among many. “We are seeing a disturbing pattern where parents impose career choices on children,” said Dr Abdul Majid. “It is pushing youngsters into despair, even suicide. They cannot see a way out because their identity is tied to fulfilling someone else’s dream.”

At home, the silence of such struggles is filled with another modern intruder: the screen. Mobile phones, tablets, and endless internet access have created a new psychological battlefield. Social media platforms that promise connection often deliver alienation, while gaming addictions erode sleep, discipline, and concentration. For Kashmir’s children, already navigating trauma and pressure, the glow of the screen can be both refuge and trap.

Psychiatrists say overexposure to screens is fuelling insomnia, anxiety, irritability, and depressive symptoms. The constant stream of curated lives on Instagram or shorts on YouTube breeds insecurity and restlessness. For adolescents, the gap between online fantasy and offline reality widens into a chasm of frustration. “We are now seeing children with behavioural patterns once reserved for adults,” observed Margoob. “Impulsivity, anger, personality disorders, these are emerging in teenagers, sometimes even younger.”

Cyberbullying has added another cruel layer. In schools and colleges, insults no longer end at the classroom door; they follow children into their homes through phones. For sensitive teenagers, ridicule online can escalate into self-harm offline. “We see suicidal behaviours and self-harm very commonly in teenagers and early adults,” said Rather. “Part of this is trauma, but part is also the added vulnerability from their social environment.”

What makes matters worse is the absence of open dialogue in most Kashmiri homes. Parents, often themselves burdened by trauma and economic stress, struggle to create an environment where children can share fears without judgment. “Family has an important role,” Dr Rather explained. “Children must be encouraged to speak openly about their routines, friends, and worries. Without such spaces, they bottle up stress until it erupts in harmful ways.”

The digital age has also blurred the lines between leisure and dependency. Many children now spend hours scrolling or gaming, not for entertainment but compulsion. Studies elsewhere link this to dopamine cycles similar to substance abuse, a chemical high from likes or victories, followed by withdrawal and craving. In Kashmir, where real-world opportunities are limited, the screen becomes both escape and addiction.

For young girls, the pressure is doubled. They are expected to excel academically while remaining “marriageable,” avoiding any hint of weakness. Counselling or psychiatric care is often denied for fear of social consequences.

Doctors term Kashmir’s new age anxiety as a toxic mix: parents forcing careers, schools amplifying competition, peers mocking vulnerability, and screens magnifying every insecurity. The result is a generation increasingly restless, impulsive, and disoriented. carrying both inherited trauma and self-inflicted stress.

IMHANS professor, Dr Arshid Hussain, said that Kashmir has witnessed a significant shift in the pattern of psychiatric illnesses over the past decade. What was once the ‘textbook picture of psychiatry’, dominated by middle-aged women and young men forming nearly ninety per cent of patients, has since 2016 given way to a new trend that is now at its peak. Those reporting new onset psychiatric problems are increasingly in the 12- 20 age group.

These patients, Arshid explained, do not fit into traditional psychiatric categories. Their symptoms are polymorphic. He recalled the violent incident in Ganderbal, where a sibling killed another, as a fringe neurodiversity pattern of high-loaded impulsivity becoming mainstream in Late Gen Z and Gen Alpha. The implications of this brain evolution, he warned, are myriad, from sociopathies to criminality to adverse mental health outcomes.

Arshid hypothesised that these changes are connected to ever-evolving brain patterns interacting with paradigm environmental and cultural shifts, compounded by climate changes, which are altering food chains and replacing them with neuro-disruptors. Younger brains are an evolution in progress, unfolding right in front of us.

“We enjoyed a 3 hr film, they enjoy 3-second reels. We never thought of extreme steps in a blink, but they do. But not everything about the brain is negative; they are digital fishes ready to navigate the new world order loaded with AI,” he said. “While we all love the old human ways and are nostalgic about the old order of society and culture, the only permanent thing, however, is change. Humans will evolve, and we do not have the power to stop it. What does evolution mean after all? It means evolution of the brain and the evolved brain will think differently, feel differently, behave differently and fall sick differently.”

The debate around Social Media, Internet use, AI is not about whether they are useful or harmful, but about a new reality dawning on us, an evolutionary model which will define the new human civilisation. Debating on digital media about the harmful effects of screens is an oxymoron we will live with, he asserted. “Books will be replaced by tablets in classrooms, and we cannot stop that. Will that harm our kids? Yes, in the same manner electricity became the first neuroendocrine disruptor, cars took away walking, refined foods disrupted our food chain, concrete houses stole our love for nature, and air got replaced with air-conditioning. I can keep writing and counting. But to stop evolution, everything else has to reverse,” Arshid explained. “Human distinctness, the language as we know it, will eventually go. I can grieve over it, I can write an obituary for it, but I cannot stop evolution, even if it is towards extinction.”

Faith and Spirituality

In Kashmir, psychiatry has never existed in isolation. It has always had to contend with, and in some cases collaborate with, the powerful presence of faith and spirituality. For centuries, Kashmiris have sought solace at shrines, with imams, or in the counsel of peer babas before they ever considered a hospital. The challenge for psychiatrists has been not to replace faith but to find a way to work alongside it.

“Faith plays a therapeutic role here,” said Margoob, whose career has spanned more than three decades of mental health practice in Kashmir. “You cannot ask people to abandon what they believe in. Instead, psychiatry must adapt and acknowledge that spirituality can be an ally.”

The numbers underline that truth. In 1996, a survey found 73 per cent of psychiatric patients in Kashmir first went to faith healers before seeking medical help. Even in 2005, despite growing awareness, the figure was 68.5 per cent. In the Kashmir periphery, the reliance was even higher. For many families, going first to the shrine or the healer was not irrational, but tradition.

Some healers exploit that faith, offering false cures or delaying treatment with rituals that exacerbate suffering. But others provide comfort and community that modern medicine sometimes lacks. Recognising this, Margoob attempted something unusual: he invited imams and healers into the conversation. At SAWAB, the NGO he founded in the 1990s, religious leaders were trained to recognise symptoms of depression, PTSD, or psychosis, and to gently guide patients towards psychiatric care when necessary.

This blending of the bio-psycho-social model with a spiritual dimension is something Margoob has argued for internationally. In conferences from Srinagar to Washington, he has explained why Kashmir requires a different framework from Western psychiatry. “The perpetual trauma here means you cannot only rely on clinical tools,” he said. “Faith, community, and spirituality have to be part of the healing process. Otherwise, psychiatry will always remain a foreign implant, rejected by people who don’t trust it.”

For patients, faith can be both an anchor and a bridge. A mother who lost her son in violence may resist the idea of depression but accepts the imam’s reassurance that it is permissible to seek treatment. A young man battling addiction may refuse to see himself as “sick” but responds to the language of moral and spiritual recovery. By embedding psychiatry in familiar idioms, doctors reduce stigma and open pathways to care.

Still, psychiatrists acknowledge the limits. Belief alone cannot cure biochemical imbalances or trauma-induced neurological changes. “Illnesses don’t heal with advice or sermons,” Dr Yasir emphasised. “They need treatment. Stigma must be dismantled, but that does not mean medicine can be replaced by prayer.”

The reality, however, is that many patients will always move between both worlds. A visit to the psychiatrist one week, a night of vigil at a shrine the next. For some, this oscillation is confusing. For others, it is complementary. “It is not about either-or,” Margoob said. “It is about creating a space where both can coexist. That is the Kashmiri way.”

In a society where stigma is suffocating, faith often becomes the first safe entry point. By harnessing it rather than dismissing it, Kashmir’s psychiatrists are slowly reshaping how healing is imagined, less as a clash between science and belief, and more as a partnership between them.

Evolution of Kashmir Psychiatry

The story of psychiatry in Kashmir in itself is as turbulent as the Valley. It begins not with modern clinics but with an asylum, set up near Srinagar Central Jail during the Dogra rule, where those deemed “mad” were confined in deplorable conditions. Records suggest that treatment was rudimentary, often indistinguishable from punishment. Families brought relatives more out of helplessness than hope.

It was only in the mid-20th century that psychiatry assumed a professional form. Among its pioneers was Prof Erina Hoch, who arrived from Czechoslovakia in the 1970s. Her meticulous research on mental health laid early academic foundations, highlighting not just the prevalence of psychiatric disorders but also their unique social contexts. Local psychiatrists like Prof Beigh carried this forward, though with limited resources and little public support.

The 1990s, however, proved catastrophic. As militancy erupted and violence engulfed the Valley, psychiatric needs surged. Yet just when Kashmir required its institutions the most, they faltered. In 1996, the sole psychiatric hospital in Srinagar caught fire, destroying infrastructure and records. Patients were left scrambling, care was disrupted, and psychiatry in Kashmir was literally reduced to ashes.

It was in this vacuum that SAWAB (Society for a Better World), began to play a pivotal role. With little more than conviction and a few colleagues, SAWAB filed a Public Interest Litigation (PIL) in the High Court, forcing the government to invest in rebuilding psychiatric care. The PIL cited not only the local crisis but also the Erwadi tragedy in Tamil Nadu (2001), where mentally ill patients chained in a faith-healing home were burned alive. SAWAB argued that unless Kashmir upgraded its facilities, it risked similar disasters.

Gradually, institutions began to take shape again. The IMHANS in Srinagar became the flagship, though it struggled with overwhelming demand and meagre resources. De-addiction centres followed, often in partnership with NGOs. International organisations such as Médecins Sans Frontières (MSF) and Action Aid also stepped in, offering counselling services and community outreach at a time when stigma still choked local responses.

Despite these efforts, the gap remained vast. A 2015 MSF report estimated that only 6–7 per cent of patients ever accessed treatment. Still, progress did happen. Psychiatrists like Arshid Hussain, Zaid Wani and Yasir Rather expanded services, introduced research-driven models, and trained new generations of mental health professionals. SAWAB experimented with blending psychiatry and spirituality, while MSF’s community-based interventions normalised the idea of counselling.

Today, IMHANS is a recognised institution, but the struggle continues. With only a handful of specialists for a population of over 12 million, Kashmir’s mental health system is still under siege. “We fought for psychiatry to be visible,” Margoob reflected once. “But visibility is not enough. We need acceptance, resources, and dignity for patients.”

The long arc of psychiatry in Kashmir is thus one of survival, from colonial asylums to burned hospitals, from legal battles to fragile recovery. It mirrors the Valley’s own resilience: battered, scarred, but refusing to disappear.

Fractured Social Fabric

If there is one emotion that psychiatrists agree defines Kashmir today, it is anger. Not the sharp, purposeful anger of protest, but a restless, simmering rage that spills into the smallest corners of daily life. Anger has become both a symptom and an expression of the Valley’s psychological wounds.

“Nearly 90 per cent of Kashmiris carry anger linked to instability,” said Prof Zaid Ahmad Wani of IMHANS. “It is visible in the way people drive, the way they talk to each other; even the way they raise their children.” What worries psychiatrists is not just the prevalence of anger but its intensity and direction: it is unfocused, often turning inward on families and communities rather than outward towards solutions.

On Kashmir’s roads, this takes the form of road rage, a horn too long, a brake too sharp, and tempers flare into physical fights. In neighbourhoods, petty disputes over parking spaces or water taps escalate into violent quarrels. At home, unresolved trauma often erupts as domestic violence, leaving women and children as the quiet casualties of psychological instability.

Psychiatrists trace this to lowered frustration tolerance, the inability to absorb stress without exploding. “Conflict, uncertainty, unemployment, and trauma have lowered the threshold of patience,” explained Dr Rather. “People want instant gratification. When that doesn’t come, the default response is anger.”

The family, once a stabilising unit, has become a flashpoint. Fathers suffering from PTSD lash out unpredictably; mothers, themselves burdened by grief, withdraw into silence; children grow up internalising both. The cycle repeats as those children become adults who struggle with emotional regulation. “Trauma is contagious within households,” Wani said. “It seeps into relationships, disciplining styles, and even the way parents dream for their children.”

The anger has also warped Kashmir’s public sphere. Online spaces are rife with trolling and cyber-abuse, where anonymity becomes a shield for aggression. Political debates, once framed in terms of ideology, often collapse into personal attacks. Even the act of disagreement, psychiatrists warn, is now loaded with hostility.

Yet anger in Kashmir is not merely an individual failing; it is a collective inheritance. Decades of violence and loss have conditioned people to live on edge. “We often mistake trauma for normal life,” Margoob observed. “But behaviours like impulsivity, irritability, and aggression are not normal; they are psychological scars.”

The tragedy is that while anger is visible everywhere, it is rarely recognised as a mental health concern. Few families seek counselling for “anger issues,” dismissing them as temperament or personality. In reality, psychiatrists argue, chronic anger is as debilitating as depression or anxiety. Left untreated, it corrodes relationships, undermines community trust, and fuels cycles of violence.

Policy Gaps

For all its suffering and sacrifice, Kashmir’s mental health sector remains trapped in neglect. Decades of conflict created a population uniquely vulnerable to psychological distress, yet the infrastructure to respond has lagged at every stage.

The scale of need dwarfs the available resources. By conservative estimates, Kashmir requires at least 300 psychiatrists to cater to its population. Yet fewer than 60 specialists are currently in practice, most concentrated in Srinagar. Counsellors, clinical psychologists, and psychiatric social workers are even scarcer, leaving district hospitals to rely on overburdened general practitioners who lack training in mental health. “There is no balance between demand and availability,” admitted Dr Rather. “The gap is not just wide, it is dangerous.”

Policies exist on paper. In 2018, the government announced a Mental Healthcare Policy, promising to integrate psychiatry into primary health centres, expand de-addiction services, and create awareness campaigns. A comprehensive drug de-addiction policy was also unveiled, calling for coordinated efforts across law enforcement, education, and healthcare. Yet implementation has remained sluggish. Funds are scarce, bureaucratic will is inconsistent, and stigma continues to undermine even the best-designed interventions.

Part of the problem is perception. Mental health has long been seen as secondary to “real” healthcare. “Governments are ready to invest in cardiac care, orthopaedics, or dialysis,” said Margoob. “But psychiatry is dismissed as marginal, even though it directly affects productivity, social cohesion, and public health.” This marginalisation means hospitals run out of medicines, de-addiction centres lack rehabilitation facilities, and awareness campaigns barely scratch the surface.

NGOs have offered counselling, outreach, and advocacy. School-based awareness programmes and peer-support models have shown promising results. But without institutional support, these efforts remain fragmented. “We cannot fight a crisis of this scale with piecemeal approaches,” warned Rather. “It needs systemic change.”

Tele-Psychiatry

Despite all this, Jammu and Kashmir has emerged as India’s top performer in responding to distress calls under Tele MANAS, the Centre-backed digital mental health support initiative launched as part of the National Tele Mental Health Programme in October 2022. The 19-Counsellor IMHANS centre has received 1,03,504 calls (till July), of which 87,450 were user-initiated and 15,731 were follow-up or outreach calls, making it one of the busiest in the country with nearly 150 calls daily. It also has 400 video consultations to its credit.

Virtual psychiatry, experts suggest a multi-tiered strategy. At the base level, primary health centres must be equipped with trained counsellors who can provide first-line care and referrals. At the secondary level, district hospitals should have fully functional psychiatric units, not just visiting specialists. At the tertiary level, IMHANS and medical colleges must be expanded into research hubs, generating local solutions for local problems.

Equally vital is community engagement. Faith leaders, teachers, and media personalities can play a transformative role in normalising conversations about mental health. The stigma that silences families must be tackled head-on.“If children are taught that mental illness is like any other illness, they will grow up without shame,” said Wasim Kakroo, clinical psychologist.

But at the heart of every recommendation lies a simple truth: Kashmir cannot afford silence any longer. Suicide rates are climbing, addiction is tightening its grip, trauma is embedding itself into genes, and anger is fraying the social fabric. Without urgent investment, the Valley risks losing not just individuals but entire generations to a preventable crisis.

“Psychiatry is not a luxury,” Margoob reminded once. “It is survival. And in Kashmir, survival is already fragile.”