The ongoing conflict in Kashmir has had multiple consequences for the Kashmiri society. One of the ignored and hidden consequence remains the deep impact conflict has had on the minds of Kashmiri people. This short essay by two doctors Khawar Khan Achakzai and Iqra Shah looks at the multiple effects conflict has borne on the psychological health of Kashmiri people.
The Kashmir conflict, spanning over 70 years, has had its consequences on the social, cultural and political framework of the Kashmiri people. Aside from these consequences, many authors have often stressed upon other aspects of conflict which include varied scholarly interests of geography, topography and demography. However, one of the very stark realities of the conflict has been its effects on the subjects of the land in form of the personal and property losses or exposure to such grotesque events that have physically and mentally crippled locals for a lifetime. The physical aspects have varied from rendering the victims handicapped, maimed or blinded with torture, indiscriminate fire and pellet and teargas shells. The psychic/psychological consequences, however, of such violence remain largely oblivious even though psychological and psychic injuries can have more damaging, long-term consequences as other injuries, but from a situation of Kashmir conflict, they remain undetected and distanced from any plans for rehabilitation. Partly this is because these injuries are difficult to fathom in terms of the enormity of scale and the delayed manifestation of symptoms which can sometimes take years to surface. Many psychiatric ailments may have very vague symptoms that may be overlooked, and additionally, the taboo associated with such conditions makes it unlikely in many cases for the victim to seek medical advice and hence their treatment may be impeded. Physical violence and disability, on the other hand, maybe easier to identify, name and quantify than psychic or symbolic violence.
The following compilation tries to bring out and debate various mental implications of the political commotion and militarisation in Kashmir in view of various internationally published research works. The multitude of the psychological and psychiatric manifestations is unsettling, to say the least, and carry a massive burden in terms of disability and costs for individuals, families and societies are staggering.
A study conducted by Syed Amin et. al and published in the International Journal of Health Sciences Qassim University revealed that the prevalence of depression in Kashmir was 55.72%. The prevalence was highest in the 15-25 years’ age group. The prevalence was 60% in females while it was 51.34 % in men. Depression was much higher in rural areas (84.73%) as compared to the urban areas (15.26%). The reason for such difference in urban and rural areas in addition to the worsening political conditions in villages could be unemployment, lack of recreation and lower socio-economic conditions. Women in Kashmir conflict have been synonyms to suffering and suppression and continue to be direct and passive victims of violence at every level: state, system and society. In tirades between various stakeholders, the women stand silenced out.
In 2015 Housen T, et al writing for the British medical journal found that more than half (64%) of its survey respondents reported feeling low in energy and worrying too much (61%) in four weeks prior to the survey. A large proportion also indicated that in the previous four weeks they had sleep difficulties, loss of interest in things and feeling of sadness and hopelessness.
Research by Kaz de Jong named ‘Conflict in the Indian Kashmir Valley: Psychological Impact’ found out that over 33% of the study population (total participants were 510 mostly from Budgam and Kupwara) had symptoms of psychological distress, women scoring significantly higher. The risk factors for men included ‘violation of modesty’, forced displacement and physical disability related to violence. The risk factors for woman included witnessing killings apart from a general sense of insecurity. In this study confrontation with the violence was reported both in the past and more recently. The participants recalled crossfires, there were people who were exposed to round up raids and cordons and almost three-quarters of the participants had witnessed physical and mental mistreatment, some at multiple occasions. There was a significant number of people who were subjected to molestation, torture, forced labour or had witnessed rape.
Post Traumatic Stress Disorder (PTSD)
Exposure to the conflict has the potential to cause personal loss as well as the distress which is brought about by the loss of those we consider very close. The summation of these loses sometimes culminates into reactions which are out of proportion to the reality and cause a lot of emotional upset. Many of these individual’s witness nightmares that are as vivid and keep the memory and mental trauma of the injury or the insult alive. In a study by R.M Bhat et. al titled 'Exposure to Armed Conflict and Prevalence of Posttraumatic Stress Symptoms Among Young Adults in Kashmiris', which was published in Journal of Aggression, Maltreatment & Trauma, it was found that conflict exposure had a significant role in increasing the risk for PTSD symptoms. The study showed a high prevalence of PTSD symptoms (49.81%) among the respondents. The prevalence rate was comparable to the populations in other war-torn regions like Palestine etc. The various risk factors included the feeling of living in conflict, a family member being killed or missing due to the conflict, perceived risk to life, media coverage of violence and high levels of personal stress. Similarly, Dr Ali, Margoob and Hussain in their research in 2001 found that in PTSD victims in Kashmir illnesses tended to be ironic and severe. They stated that 20% of such patients were reported tortured, 35% witnessed close relatives killed violently, and 30% were injured in shootouts, explosions and so forth. Respondents who had watched or listened to or been exposed to media coverage of the armed conflict in Kashmir reported a significant level of PTSD symptoms.
Tambri Housen on basis of her research carried across 399 villages concluded that majority (99.2%) of the adult study population experienced or witnessed at least one traumatic event during their lifetime with an average of 7.7 events.
Usually, the patients who suffer from PTSD have overlap with other psychic disturbances like depression, anxiety and suicidal ideation.
A research conducted in 2013 at University of Kashmir concluded that 46% of the subjects (mostly from Srinagar) suffered from anxiety. Kashmir is the worlds most highly militarised zone. The subjects often have to face regular frisks, searches, cordons and parades. The day to day professional and personal affairs become highly uncertain owing to the precarious political situations on a daily basis. There is fear of living in close proximity of the army camps, feeling of vulnerability and injustice. All these factors make the subjects greatly predisposed to anxious behaviour. This manifests as losing calm over minor issues, decreased sleep and appetite and inability to cope up with different phases of life. A large proportion of the Kashmiri population suffers from anxiety.
It was stated in one paper that in recent decades, the number of individuals seeking mental help has soared in the valley. Mental wellbeing in Kashmir is declining at an alarming pace and youngsters suffer from anxiety especially after recent uprisings. According to the author, young fellows have a consistent dread of getting arrested again and imprisonment has been connected to a horrible anxiety issue. The author states that anxiety or depression influences the valley the way cholera did.
In a study by Kaz de Jong on 510 participants, it was found that a third of the respondents had contemplated suicide. A high prevalence of suicidal thoughts is more often reported among populations suffering from chronic violence, with a similar prevalence reported among Afghan refugee women in Pakistan during the Afghan war.
Drug and Substance Abuse
A large number of youth in Kashmir have a taken to drugs and narcotics. Conflict engineers high unemployment and total repression of opinion and will. The psychologically vulnerable youth, when subjected to such uncertainties of living and career resort to using illegal drugs. There are regular OPD visitations to hospitals by those who are hooked onto sleeping pills, cocaine, heroin and cannabis. The use of such drugs only worsens the situation for the abuser and has a direct impact on his surroundings and people close to him, resulting in abandonment.
A significant increase in somatoform disorders can also be seen in Kashmir. There was a drastic increase in the number of people suffering from the migraines, hypertension, cardiac problem, tutors increase in obesity and increased insulin levels etc. There is an increase in the number of miscarriages and spontaneous abortions.
Those subjected to the use of pellets, having suffered significant disfigurement or blindness are particularly vulnerable to develop mistrust and maladjustment with friends and family.
Hypomania, Bipolarity and Borderline Traits
Chronic exposure to critical situations can lead to varied behavioural disturbances apart from all those mentioned above.
The psychological effects of militarisation are colossal and hence can’t be overlooked. As such, there is an urgent need for rehabilitation of such individuals and the elimination of all the factors leading to disordered thought and behaviour.
A research titled ‘Psychiatric Morbidity in Pellet Injury Victims of Kashmir’ which was conducted by Dr Saleem Yousuf in IMHANS (Institute of Mental Health and Neurosciences) found that 92.92% of the patients with eye injuries were diagnosed with a psychiatric disorder, depression was the most common psychiatric disorder (25.79%) followed by Adjustment Disorder and PTSD, while hypomania was the least common psychiatric disorder. With the continued violence and new weapons and ways of controlling political antagonism, the prevalence of depression is certainly going to rise.♦