Mind Medicine Matrix 

Many years after a top intelligence officer served in Kashmir, his anthropologist daughter went to the US and wrote a book about the system that attempts to heal Kashmir’s minds and souls, it landed into a controversy, writes Khalid Bashir Gura

Saiba Varma’s book on psychiatry and strife became controversial because the scholar’s father has served a major security agency in Kashmir when she was a minor.

Saiba Varma’s book explores the psychological, ontological, and political entanglements between medicine and violence in Kashmir. Published by Duke University in the US and Yoda Press in India, The Occupied Clinic: Militarism and Care in Kashmir is about the carrot and stick approach in Kashmir. Varma is an Indian anthropologist at the University of California, whose father has served Kashmir as a senior officer in India’s external intelligence agency, RAW. Her research, however, is a recent phenomenon.

The book delves into the bruised psyche of Kashmiris and assesses the impacts of militarization on it. It decodes and unmasks the language of care laced with institutionalized violence of power and its impact and interactions with public health and infrastructure. It sheds light on how the collective personality of Kashmir is shaped by centuries of non-local rule.

While telling stories of the people who suffered during counter-insurgency, the book also focused on the institution of psychological care and psychological morbidity. The institution of psychiatry is symbolized as the epicentre of the conflict.

Governance Model

The book at length has insights on how militarized care and humanitarian intervention laced with violence is a mode and model of governance in Kashmir. Also, the language of care is used as a justification for militarization.

The medical anthropologist’s riveting and rigorously ethnographic researched book lifts the fog of façade from dominant narratives in disguised democratic settings in Kashmir. It helps understand how demonization and emergency laws lead to immunity, impunity and violence. It explains how the supposedly tentative draconian emergency laws become a permanent feature in the disturbed area with no accountability.

Trauma

The book essentially deals with the trauma and manifestations of institutionalized violence imbued deep into the psyche of victims and the population. It listens to the life shaped by militarization and “imposed normalcy” and the certainty of uncertainty. It shows how a language of peace, normalcy, and sanity is turned topsy-turvy in a disturbed area.

Focusing primarily on the ailing public health sector infrastructure of one of the notoriously corrupt states in India, Varma remains confined to a psychiatry hospital and (Shri Maharaja Hari Singh) SMHS.

The author has explained how the prevailing situation creates worlds of disrupted meaning in which clinical life is connected to political disorder, undermining biomedical neutrality, ethics, and processes of care.

With care and health as the nucleus of her research, Varma delves into the policies and narratives crafted to ‘demonize, and stereotype’ a population to justify official actions and decisions. It documents how immunity leads to impunity and ensuing human rights violations. Further, it analyses how the demands are glossed over and muzzled through carefully crafted state language working in the ambit of national interests.

While explaining all this, the book unfolds the layers of militarized thoughts, bruised bodies and resilient souls of residents. It uncovers how violence has seeped deep into sleep and dreams.

Taking a wider, historical angle, the book sees the reshaping of life and death in the context of centuries of subjugation and natural disasters and how it has impacted the people mentally as well as physically. It explains the voluntary and induced divide within.

Resilience

On the flip side of it, the book tells tales of how repeated traumas made people resilient. This, it insists fostered collective strength and support for each other and created a cohesive community. The book sees the government’s crisis management as “callous” envisaging the abandonment of people during disasters thus inducing alienation.

Sabia Varma

The language of the book is sprinkled with literary devices, poems and letters. Its lingo breaches the language of security and national interest. The narration of stories through non-fictional characters makes it lucid and riveting to read.

Seemingly, the author has put the ear to the ground, strictly as her role as an anthropologist demand: listen, observe astutely and with an unbiased and curious eye. This has enabled her to travel deep to the heart of insurrection and learn what historical care and humanitarian interventions between the ruler and the ruled and how the saga of violence led to an epidemic of trauma. More than sixty per cent of the civilian population suffers from depression, anxiety, PTSD, or acute stress, the book documents.

The August Start

The book starts by recalling the post-August 5, 2019 siege and communication blackout. It describes suddenness as a characteristic of life in Kashmir and its powers to alter life. It also reveals the state’s “gas-lighting” statements. After Article 370 was read down, the author analyses how the decision was sold to the Indian public as necessary to facilitate Kashmiris greater integration with India, end terrorism, ensure economic development and invigorate the tourism industry. The decision according to the author was articulated in the language of care and development without consulting the stakeholders.

For “garrisoned” Kashmir, however, the unilateral decision did the opposite of what it claimed. Besides people struggling for livelihood, the book has documented the economic slump with a struggle to access health care, education amidst siege.

The author dissects the slow state violence in the form of demographic change, detention and criminalization of young people, prohibition and expression of dissent besides weaponizing all aspects of civilian life.  However, she observes people’s passive aggression and refusal to comply with newly imposed normalcy.

In the introductory chapter, she starts ethnographic work from the place of past imperial debris in the old city and soon lands in Kashmiris lone psychiatric hospital for her research journey. Now, the Institute of Mental Health and Neurosciences (IMHANS), and then Government Psychiatric Diseases, the hospital according to the author was an index of brewing cost of conflict and simmering mental morbidity.  The still stigmatized hospital despite name change and up-gradation is critiqued as another construction to mint money.

Boondoggle projects boom in the militarized zone as every disaster is an economic opportunity for some people, she argues.

Institute of Mental Health and Neuro Sciences Kashmir (IMHANS)

In the prelude to chapters, the author narrates the emergence of militancy in Kashmir and Delhi’s ruthless crushing of it through soft and hard power. It also assesses, though superficially, the sanctions many nations got after the United States “war on terror,” which allowed racial profiling and policing of Muslim communities worldwide. But by September 2001, the violence and militancy in Kashmir had slowed down to trickle in Kashmir.

Even though the violence had ebbed, Kashmiri continued to pay an extraordinary high social, political and psychological cost.

Feminist Framework

The author in her ethnographic research has focused on both genders and how conflict takes a toll on them. She assesses women’s issues through a feminist framework in a patriarchal and conservative society. The limitations they face in getting treatment are due to gender disparity. The author has studied some cases that have been at the receiving end of the violence and analysed their psychological distress.

It also speaks of people cloaking psychological pain as bodily weakness due to stigmatization and culture. Besides, the study also reveals the gender disparities in society and psychiatry fields and how it alleviates mental health crises, especially in females. The psychiatric care dominated by men, at that time, lacked the heart to understand women’s pain, the author has assessed. As the body is suffused with medications, the distressed soul remains unaddressed. Hence redress is sought and suggested in spirituality.

Varma further sketches the life in Kashmir dictated by the infrastructure of militarization; the ubiquitous armed forces, guns and bunkers. She realizes how her non-Kashmiri identity makes her more secure at a place where locals battle identity crises and their identity becomes their cause of vulnerability.

The author has assessed how miscommunications in medical encounters are symptomatic of the uncertainties and instabilities unleashed by counterinsurgency. Besides, the author assesses how militarism and medicine dissolved. Curfews and strikes disrupted the flow of drugs, equipment and professional opportunities.  Despite emergency services, the professionals and ambulances were attacked. The culture of impunity and immunity has fostered corruption, mistrust and malpractice even in medicine, the book says.

Use of Aid

Meanwhile, the author has detailed the use of aid to Kashmir to produce psychic, social, and political-economic dependence on the government. Through years of investment in fencing borders and securing them, the militancy has become indigenous. The book also traces that counselling and care combined with force could not get the desired results.

As all forms of protests have been delegitimized and met with brute force, the book says the space to speak and think have been further closed down. She observes that people collectively console by remembering history.

A Stalemate

As two nuclear powers are in a political stalemate, the turn to nonviolent resistance has not improved the lives of Kashmiris. Rather, militarization and systematic human rights violations continue. Castigating two powers for silencing Kashmir while claiming to own and speaking for them, she considers BJP as xenophobic, anti-Muslim, and Hindu nationalist.

Further, political agitations are labelled as externally influenced framed as desires for aid. The state violence is followed by gestures of caring words and packages doled out to further delegitimize the needs and demands. The author has also analysed the role of NGO’s acting as a buffer between the public and government.

Challenging the benign image of the siege as a form of militarised care, she has documented the lived history of people during the height of the conflict. The village clinics were transformed into torture chambers and how mistrust and fear run deep into every aspect of life and institutions. Hospitals have become an extension of the battlefield, rather than places of refuge, she explores.

The ‘Weakness’

As worrying has become a perpetual part of life, the author finds the ubiquity of physical, psychological, moral and collective Kamzori (an Urdu word for weakness) in people. Since the centuries-long siege, she in her conversation with people and unfolding of events learns manifestation of the different forms of Kamzori. She learnt it is a ubiquitous complaint and how it has been used to cloak the mental health crisis, especially by women. She also assesses the impacts of the gendering of space during a siege.

Verma observes that mental health experts and humanitarian organizations were drawn to certain mental health crises like Post Traumatic Stress Disorder, as it was morally exculpatory. And how human rights activists used epidemiological reports on PTSD to counter state discourses on Kashmiri Muslims. PTSD, she believes became the language of suffering in Kashmir. Further, the author explored how some aspects of life were relegated to the background as people were busy worrying about life and death. The people’s mistrust and paranoid feelings in the state were reinforced when the news of spurious drugs as a form of slow genocide came in news. This, she argues, reinforced people’s mistrust in the state and loss of faith in public institutions. Further, the protests kindled by the scam were met with militarized treatment and surveillance. And medicine became collateral damage. During agitations, hospitals became a zone of surveillance and patients criminals and seditious people.

The book demystifies the narrative of militants as vectors of disturbance.

ECT Reluctance

In her third chapter, shock, she explores reasons why patients are reluctant to accept electroconvulsive therapy ECT as part of the cure. She considers its unmodified use as torture in the form of care.  Further, through her case studies, she reveals how clinical priorities, families role in community-based care over institutions take over and why hospitals (psychiatric) are invoked as a sign of punishment. The limitations and inefficacy in health care in turn brew anger towards clinical care. Besides families abandoning the mentally ill patients, she also scrutinized how clinical failures become embodied as kinship failures.

At the same time, the book reveals the limitations of psychiatric care in the form of counselling. Talk therapy, she argues was unrecognizable as care as it lacked material transactions. She also assesses the NGO’s priorities clashing with the recipient’s needs; the failure of organizations to quantify lived experience or psychological distress into the language of the survey. She examines militaristic and humanitarian organizations debriefing.

Conclusion

The book is a deeply moving work from a committed medical anthropologist. It will be of great help to anyone who wants to understand the cost of living in a highly and densely militarized zone of the world.

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