May 31, 2018

Kashmir Pen

Due to continuing conflict in Kashmir during the last 18 years there has been a phenomenal increase in psychiatric morbidity. The prevalence of depression is 55.72%. The ongoing conflict-related events cause substantial suffering in the Kashmiri population. Once Kashmir was referred to as ‘Paradise on Earth’. Now it has become rather a nightmare of constant fear that affects all areas of life. The impact on the physical and mental health and socio-economic functioning is alarming. There is a level of despair and lack of future perspectives that potentially endangers the long-term well being of many. People suffer from serious psychological distress. Physical and mental coping mechanisms are exhausted, and the health system needs further strengthening. The substantial needs for psychological and psychiatric support can only be addressed through a strong community-based mental health system. This type of service is advocated in the Indian Mental Health Policy, but in Kashmir, community psychosocial services are absent and psychiatric services outside Srinagar remain non-existent. The failure of the Ministry of Health to implement its own Mental Health Policy in Kashmir and many other parts of India contributes to increased and unnecessary suffering. Due to lack of services and/or medication, severely disturbed and ill people must travel long distances to seek care. Psychosocial support (including counseling) in the villages is needed, with basic psychiatric support, including medication, at health post level. The mental health condition of the people must be given much greater attention.

Mental, physical and social health, are vital strands of life that are closely interwoven and deeply interdependent. Depression is more likely following particular classes of experience – those involving conflict, disruption, losses and experiences of humiliation. World Health Organization has ranked depression as the fourth among the list of the most urgent health problems worldwide and has predicted it to become number two in terms of disease burden by 2020 overriding diabetes, cancer, arthritis etc.

Despite growing evidence over the past two decades of the terror – both of the physical and mental dimensions of war upon civilians – much of post-conflict activity tends to concentrate on physical reconstruction – roads, bridges and buildings. Moreover, even though psychological and psychic injuries can have more damaging, long-term consequences as other injuries from a situation of conflict, they remain undetected and distanced from any plans for rehabilitation. Kashmir has been regarded by many as heaven on earth. Its splendid beauty and hospitable population is legendary. Over the past 18 years Kashmir became associated with violence. Violence here may either take implicit forms in the manner of institutionalized oppression and inequality, or a more explicit form of state oppression through the use of state sanctioned institutions, such as the police, the military and courts. Civilians are increasingly being targeted in these episodes of contemporary violence. Most civilians witness war-related traumatic events such as shooting, killing, rape and loss of family members. The extent of psychosocial problems that results from this mass exposure to traumatic events can ultimately threaten the prospects for long-term stability in society.

The situation in Kashmir can best be described as a “low-intensity conflict”. What predominates in such conflicts is the use of terror to exert social control. Kashmir is not merely a law and order problem but there are social, emotional, political and psychological aspects involved.

The increase of depressive disorders is primarily due to continuing conflict. Violence is seen as the root of all evil. It does not only dislocate the life of many individuals, also social and community life is affected for many rituals and events are banned for security reasons. A lingering generation conflict seems to be triggered by the violence. Family structure changes, habits disappear and respect for tradition is diminishing. The protective belt usually formed by family is eroded. Especially in the rural areas all expressions of psychological suffering are summarized by the expression of having ‘tension’. The people of Kashmir must be assisted in achieving peace and safety in their own homeland. Counselors and psychologists can play a role in bringing about peace using worldview research.

There is a need for collective response from the members of all walks of life to evolve multipronged strategy with provision for immediate, short-term and long-term objectives for addressing these problems. Mental illnesses do not have only materialistic but also more powerful divine and spiritual solutions. Spiritual leaders (priest, learned scholar, etc.) should communicate with masses about the ground realities and approach to tackle issues such as social problems, drug addiction, suicide, unemployment, etc. by quoting the perfect models of prevention and control. Cultural and religious beliefs which discourage substance misuse or suicide and support self-prevention measures that enhance protective factors can play a key role in prevention of several mental disorders. Spiritual approach can be combined with evidence-based scientific methods of management of most mental illnesses. Health education in educational institutions regarding mental illnesses is essential. Programmes that support and sustain protection need to be in place. Investing in mental health today can generate enormous returns in terms of reducing disability and preventing premature death.

Jeelani Saima Habeeb can be mailed at saimahabeeb786@gmail.com