Peace and Justice Post

Mental Health Cases Swell in Two Decades

By Emily Wax
Washington Post Foreign Service
Monday, September 1, 2008; A09

SRINAGAR, India

Suraya Qadeem’s brother was one of the Kashmir Valley’s brightest students. Handsome and disciplined, he had been accepted into a prestigious medical school in Mumbai. But just weeks before Tahir Hussain was to pack his bags, the 20-year-old was shot dead by Indian forces as he participated in a peaceful demonstration calling for Kashmir’s independence.

At his funeral, Suraya Qadeem, also a medical student, wept so hard she thought she might stop breathing. Seventeen years later, she spends her days counseling patients in Indian-controlled Kashmir who have painfully similar stories.

In the sunny therapy rooms of a private mental hospital here in Kashmir’s summer capital, Qadeem listens to young patients, nearly all of them children scarred by the region’s two-decade-old conflict. Most suffer from depression, chronic post-traumatic stress disorder, drug addiction and suicidal tendencies in numbers that are shockingly high, especially compared with Western countries.

Srinagar, a scenic lakeside city nestled in the foothills of the Himalayas, once had among the lowest mental illness rates in the world. But in 1989, leaders of the region’s Muslim majority launched an armed separatist movement, one of several said to have been backed by predominantly Muslim Pakistan, which has fought two wars with Hindu-majority India over Kashmir since India’s partition in 1947. Srinagar became a battleground as hundreds of thousands of Indian troops quelled the uprising. The fighting has left a powerful psychological legacy.

The number of patients seeking mental health services surged at the state psychiatric hospital, from 1,700 when the unrest began to more than 100,000 now. Last year, they were treated at the hospital or the recently opened Advanced Institute of Stress and Life Style Problems, where Qadeem works.

“Every home in Kashmir has a heartbreaking history,” said Qadeem, who admits she sometimes becomes emotional during sessions. “There is terrible ache when you lose a sibling. Pills can’t help. I share that agony of loss with my clients. In Kashmiri society, this pain is everywhere.”

India’s push to keep Kashmir is taking a toll on Kashmiris as well as Indian soldiers, in ways that are harder to measure than deaths or injuries. Experts say that mental health is an invisible casualty of war and that generations will bear the scars, imperiling Kashmir’s prospects for a bright future with or without India.

The patients have insomnia, learning disabilities, anxiety disorders and what Kashmiri therapists call the “midnight-knock syndrome,” a fear stemming from the many pre-dawn raids by Indian security forces aimed at rooting out suspected insurgents.

Mental health groups estimate that 60,000 Kashmiris committed suicide last year, a record number, said Mushtaq Margoob, head of the Government Psychiatric Diseases Hospital in Srinagar.

More than 15 percent of Kashmiris are afflicted with post-traumatic stress disorder, according to a recent study by Margoob. Indian troops also are suffering, undertaking long tours without their families in a place where residents are often hostile. In January, the Indian army recruited 400 psychiatrists after more than 100 soldiers, including officers, killed themselves.

Among Kashmiris, the sufferers who reach the hospital are a fraction of those who need help. Remote villages have borne the brunt of the violence, and many who live there do not have the money for the long trip.

“It’s really an epidemic in Kashmiri society,” said Margoob, who opened Qadeem’s hospital to deal with the overflow of cases. “Over decades, Kashmiri society has been stretched beyond its natural capacity to cope. Depression and anxiety can also be passed down from generation to generation.”

Part of the problem is that there is little justice, Margoob said, something that in psychological terms would be called “closure.” Human rights groups estimate that the conflict has left 77,000 people dead and as many as 10,000 missing. Women whose husbands have gone missing during the conflict are known here as “half-widows.”

Under Indian law, security forces have wide powers when operating in “disturbed” regions, including the right to shoot on sight any insurgency suspect. A Human Rights Watch‘s report last month, “Getting Away With Murder: 50 years of the Armed Forces Special Powers Act,” alleges that the law has become a tool of state abuse and discrimination.

The 500,000-member Indian force is posted in bunkers in Kashmir’s apple orchards, saffron farms and hospitals. Signs dotting villages, towns and cities read “Our ultimate aim is your well-being.”

Tensions had eased in recent years. But a crisis began in June when Muslims demonstrated over a government decision to transfer land to a Hindu shrine. They said it was a settlement plan meant to alter the region’s religious balance. After the plan was rescinded, Hindus took to the streets of Jammu city, in the predominantly Hindu part of the state of Kashmir and Jammu, demanding that it be restored.

About 40 unarmed protesters have been killed by Indian forces during the self-rule demonstrations, the largest since early 1990. The land deal reinvigorated a nonviolent movement for Kashmir’s independence, especially among the so-called children of the conflict, those younger than 35, who make up nearly 70 percent of the population.

But with an Indian-issued curfew in place, many say the tough times are back, and so are the memories. Depression often flourishes under curfew, Margoob said, with children unable to play outdoors and parents worried about their stocks of food.

Qadeem has more than 100 patients, but she is a doctor who specializes in the care of women and children, not a mental health expert. She started working at the Advanced Institute of Stress and Life Style Problems because there were only 14 practicing psychiatrists in Kashmir, a region with more than 5.7 million people. Margoob helped train her.

Among Qadeem’s typical cases is a 30-year-old widow with four children. The widow’s 13-year-old daughter is suicidal. The mother has been depressed for three years and complains of headaches and insomnia. Her husband was a teacher who got caught in crossfire. His wife and daughter saw his bloodied body lying limp on their neighborhood street.

Before the conflict, Kashmir was often featured in fairy-tale-like Hindi movies, with couples falling in love amid the saffron fields. Across from Qadeem’s clinic is where Beatles guitarist George Harrison learned to play the sitar and, it is said, where Buddha used to meditate.

But the region’s natural beauty masks a community in pain. Qadeem, a petite, energetic woman, said she sometimes feels as anxious as her patients. During the curfew last week, she was unable to see her patients.

Qadeem said her 3-year-old daughter recently asked to pet some puppies she had noticed.

“It hurt. I had to tell her it was a curfew,” Qadeem said, as the child screamed in her arms. “Before that, she asked me to take her to the nearby gardens. I also had to tell her no, because there was lots of Indian army there. Suddenly I realized that from childhood, she knows that there is danger. That is Kashmir. That is our reality.”