Mired Minds

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The situation that emerged on August 5 has started taking a toll on the population’s mind-space. Sharing information reluctantly, psychiatrists believe the real load of the crisis will reach hospitals later this year, reports Saima Bhat

Art Work by Malik Yasir

Art Work by Malik Yasir

Adil, a man in his late twenties, was scheduled to revisit his psychiatrist after four weeks in mid-August but missed the meeting because he was in police custody since August 5, 2019, when New Delhi unilaterally stripped Jammu and Kashmir of its statehood and special status.

A resident of Shopian, Adil is under treatment for severe seizures and was released only when he had a severe episode after spending two months in police custody.

“I was arrested by the army during a midnight raid on August 5,” he said. “My father got me medicines the next day because I cannot afford to miss them but my health was affected badly. How long can a severely ill patient like me tolerate being tortured?” Adil was highly uncomfortable talking about his situation in police custody.

“Adil was initially in a bad condition. Last time I saw him, he was actually improving,” his doctor, Dr Majid Shafi, a consultant psychiatrist at the state-run District Hospital (DH) Pulwama informed. “His family members said that he had a severe seizure inside police lockup and was hence released on medical grounds.”

The situation after August 5 has increased the patient inflow. At DH Pulwama, doctors said, the footfalls have increased. Apart from regular follow-ups of patients, new admissions have also increased. Apart from Pulwama, patients from Shopian, Budgam and even Ganderbal come for consultations to the DH Pulwama.

At the Institute of Mental Health and Neuro-Sciences (IMHANS), Rainawari and its extension at the SMHS Hospital, senior doctors said they did not receive many patients in their OPDs due to restrictions so they preferred to go to district hospitals.

Table: An analysis of the Psychiatry OPD for Pulwama district hospital

Table: An analysis of the Psychiatry OPD for Pulwama district hospital

“Due to lack of accessibility in this situation, only follow-up patients are able to visit the main hospital,” a senior psychiatrist at SMHS hospital says. “All new patients are visiting peripheral hospitals. The true impact of this situation will only surface after a few years. The average lag between people facing mental health issues and seeking treatment is about 3 to 5 years. Although this gap is reducing, it still takes people a few months to ask for psychiatric help.”

The district hospitals chain are getting a peculiar patient load. DH Pulwama received 1453 patients in July of which 403 were new. In August, when Kashmir was under lockdown, 673 patients of which 118 were new ones, managed to reach the hospital despite there being virtually no means of transport on the roads. In September, the patient flow increased to 1361 with 344 new patients and in October 1158 patients visited the hospital, of which 340 patients were new. During  November,  272 new patients came in a total of 986 patients who reached OPD. The numbers have once again increased in December when public transport started plying on the roads.

The hospital records show the new patients needed consultancy regarding what appeared to be symptoms of depression, anxiety and headaches. (See box)

DrMajid expects the patient inflow to keep increasing as people are released from custody and start moving out of their homes. The condition of some of his patients might have worsened because of the unavailability of medicines and the stress caused by the situation. Since the help was not available, the problems relapsed. Some of his patients dealing with depression or anxiety were off the medicines and doing well, until the situation began acting as a stressor, rendering years and months of progress useless.

“The abrogation was just as much of a stressor as the situation that followed,” the doctor said. “They were concerned about their future and the future of their children. These thoughts made their mental state worse than before.” According to him, the younger generation have taken the intervention more seriously. “They saw it as an attack on their identity and integrity. This precipitated anxiety, depression, and adjustment issues in them.” So far he has not more than ten follow-up patients who were arrested after August 5 and later released.

Barbiturates

Initially, patients with depression, anxiety, somatic disorder, OCD, PTSD, and bipolar disorder started coming up. Dr Majid admitted that the situation was a collective trauma for the average Kashmiri. “Most of us are resilient and can endure traumatic situations well. Torture and arrests are the new normal in this district.” He provides consultation to around 200 patients a day in his four-room, congested OPD.

In 2015, an international NGO, Médecins Sans Frontières (MSF), Doctors Without Borders, conducted a study in Kashmir suggesting that nearly 1.8 million people or 45 per cent of  Kashmir’s adult population is suffering from some form of mental distress, and 93 per cent of them have experienced conflict-related trauma. An average adult witnessed around eight traumatic events during his or her lifetime, and more than 70 per cent of adults experienced or witnessed the sudden or violent death of someone they knew.

According to the MSF report, 50 per cent of women and 37 per cent of men are likely to suffer from depression; 36 per cent of women and 21 per cent of men have a probable anxiety disorder, and 22 per cent of women and 18 per cent of men suffer from post-traumatic stress disorder (PTSD).

After the publication of this report, the NGO refused to interact with media as insiders alleged that the organization was under the “radar of security grid”.

Abdul Khaliq, a hawker by profession, is a man in his late sixties. Silent while waiting in line for his appointment, his face was pale and devoid of expression. His unmarried daughter said Khaliq was arrested and kept in jail for two weeks.

“Somewhere around early September, my father and his friends were discussing the situation sitting on a shop front,” she said. “They might have expressed their contempt for the people who aided the abrogation of the special status of Jammu and Kashmir. The same night, a police party came and arrested him for ‘incitement of violence in the area’.” She alleged that her father was beaten and tortured.

Institute of Mental Health and Neuro Sciences Kashmir (IMHANS)

The arrest had a deep impact on Khaliq’s psyche, who already suffered from depression and acute mania. He was recovering and put off medication, but it seems that his health is deteriorating once again. His doctors have their fingers crossed, waiting for Khaliq to respond to his medication.

Ahmad, a teenager with severe OCD, reached out to his psychiatrist at the DH Pulwama to inform him about his intention of leaving Kashmir to study abroad. He told his doctor that an encounter took place in his area, following which the army picked up a few youngsters including him under the accusation of sheltering militants.

“I was detained and tortured for two months,” he told his doctor. He was repeatedly summoned to the army camps and police stations afterwards. “I can’t even change my phone number. If I do, they get my new number and start calling again. They beat me up for changing my SIM.”

DH Pulwama’s OPD is visited by a good number of female patients as well. DrMajid says the females suffer from direct and indirect trauma.

As soon as teenager Shaheen saw her psychiatrist sitting in the OPD she broke down. Around half a dozen patients in a queue behind her started pushing the line so that they could listen to her, so she was shifted to a separate room. She had been suffering from anxiety a few years ago but had improved remarkably and did not need any medicinal help.

Shaheen told her doctor that she has to appear for her annual board exams but cannot focus on her studies.

Community General Hospital, IMHANS- Kashmir, Srinagar.

“Almost a month ago some armed forces barged into our house during midnight to arrest my brother,” Shaheen told the doctor. “When they realized that my brother was not at home, they got angry and threatened me if he didn’t cooperate. This was more dangerous to me than the arrest of my brother.” She gave her doctor a detailed description of the raid, crying and sobbing.

In the last three months, this OPD was visited by at least five mothers from the same area in Pulwama who were already receiving treatment for depression. One consultant doctor says that there has been an increase of at least 5 to 10 per cent of new patients which is huge for a district hospital.

In Anantnag, Mugli’s son was arrested post-August 5 situation. She managed to meet him one last time in a local police station before he was shifted to a jail outside Kashmir.

“I saw bruises all over his face. He had bruises on his back and legs as well. He told me he is fine but I could feel that he was not. His wounds were still giving him a lot of pain and he was not able to sit properly,”,” she told her doctor. “I’ve been getting flashbacks of our meeting ever since. They kept me awake at nights and the thought of my son in pain has left me restless. I don’t know about his current state or how he’s holding up, and it has been over three months already.” Her doctor has put Mugli on anti-depressants again.

Mughli’s neighbour, Mehtaab Bano, had another precursor for depression. Actually a resident of Sopore, she moved to Anantnag after her marriage some 12 years back.

Back in Sopore, Bano’s father had a heart attack and passed away on August 14. There were no means of communication due to the blockade and it became impossible for her brothers to contact her. Even going to Anantnag seemed inconceivable that day. “They decided to bury him without telling me,” Bano told her doctor. “I couldn’t meet my father for the last time. He was buried without me. I couldn’t even get one last glimpse. Since that day I feel like I am cursed.”

Mehtaab received the news of her father’s demise 15 days after his burial.

Unlike DH Pulwama, the DH at Anantnag, which is now a medical college hospital, the psychiatry section is getting a different class of patients. A psychiatrist at DH Anantnag who wishes not to be named said that most of their new cases were students from 10th and 12th standards. “There is a 300 per cent increase in the routine patient flow since students have started coming as patients,” the doctor said. “They initially thought that their examinations would be delayed but the government released their date sheet out of nowhere. The kids were plagued by the fear of night raids and anxiety. This caused sleeplessness, palpitations, and headaches.”

In the district’s drug de-addiction centre, one official confirmed that their influx comprised lesser cases of patients with withdrawal symptoms and more cases of a drug overdose.

In Srinagar, two days before the parliament downgraded the status of Jammu and Kashmir there was panic everywhere. Six paying guests living in Zahoor Ahmad’s accommodation returned to their homes in Shopian and Kupwara till the situation got better.

45-year-old Zahoor is a tailor who does not earn enough to support his wife, son and daughter. To help his wards continue their studies he has turned two floors of his three-storey home into rented accommodation for students who come from rural areas for coaching in Srinagar.

When his paying guests left along with their belongings, Zahoor turned pale and forgot to smile again. According to his wife Shazia, Zahoor was on anti-depressants for almost 10 years and had made substantial progress after which he was put off the medicines. “As our financial condition improved, it had a positive impact on his mental health,” Shazia said. After August 5, the situation deteriorated.

“The police raids to arrest youth in the area during nights frightened him,” Shazia said. “He became apprehensive that people of Kashmir will be killed and didn’t know how to manage the family without any work or paying guests.” His home was never raided but patients with psychiatric issues imagine situations that play havoc with their mind-space.

Shazia says it was impossible to reach out to her husband’s psychiatrist as her area was witness to stone-pelting incidents every day. Her husband was getting restless and sleepless so she requested one of her neighbours to shift her family to her parent’s home before dawn.

“My parents and the families of my brothers helped a lot in providing a comfortable atmosphere. I had taken his prescriptions along but I couldn’t contact his doctor so I restarted his medicines (from his earlier prescriptions) and it started to show an impact,” Shazia said. Doctors asked her to keep him on the same medication for some more time.

The doctor said the spending capacity of people has gone down and it is taking a toll on them. Every day I see at least three young male patients who suffer from anxiety and mood disorders,” one private doctor practising psychiatry in north Kashmir said on the condition of anonymity. “When I enquire about their jobs they say that they were working in the hospitality sector but are now jobless because everybody assumed the revocation of special status may lead to shut down for at least a year. This time we witnessed more despondency because we have seen more shutdowns.”

Teenager Naveed, a resident of Pattan, is a known stone pelter. When Kashmir was put under lockdown and arrests started during night raids, he was also one among them. “A few days later he had fits and lost consciousness,” the doctor said. “Police shifted him to the district hospital where they introduced him as a Personal Security Officer (PSO) thinking that Naveed may not survive. Luckily the treatment helped him regain consciousness. The police party left him in the hospital and ran away to avoid public outrage.”

District Hospital, Pulwama

Naveed informed his family about his condition and was taken home. A few days later, however, he started showing signs of fear. His family wanted to consult his psychiatrist but Naveed refused to visit him and visited a doctor in another district instead.

“I was surprised when I saw a patient from another district at my private clinic. The patient told me he was never afraid of what he was doing but this time he was frightened for his life,” the doctor said. “Unfortunately, he didn’t come for another consultation. Maybe he had not found this place secure either.”

(All names of the patients have been changed to protect their identities.)

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