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SRINAGAR, Kashmir — On a cold evening last December, Sajad limped home and sat in his living room under a dim tungsten bulb. He pulled a cigarette packet out from his black woolen cloak.
Within fifteen minutes Sajad, 20, had impatiently smoked two, letting ash fall to the floor. He had just finished a day of work at the Grand Mosque market of Srinagar in the Indian-controlled region of Kashmir, where he sells used clothes off a cart.
That neighborhood carries strong associations. Last August, about a mile away from where he now works, Sajad was shot in the leg by a solider during a protest. The Grand Mosque area is known for anti-India activity, and thousands, including Sajad, have been part of rallies that have at times become violent.
That wasn’t Sajad’s first clash with law enforcement agencies. Since 2009, police have filed four cases against him for “war against the state and rioting.” In February 2013, he was held for 45 days at Kotbalwal prison, 350 kilometers from Srinagar, before a court order released him.
After he spent a month in police custody, his family realized something was different about him. “He was beaten up and may have been hit in the head,” says Ghulam, his elder brother. “Later we noticed, he would laugh unnecessarily, look puzzled, be in tense moods and complain of headaches. He stopped working.”
The changes prompted Sajad's family to take him first to the Government Psychiatric Diseases Hospital in Srinagar and then to the Institute of Mental Health and Neurosciences. There, doctors diagnosed severe mental illness and prescribed him drugs that caused insomnia, anxiety, nausea and vomiting.
Sajad belongs to the generation of Kashmiris born between the late 1980s and early 1990s, when armed rebellion against the Indian administration of Kashmir first began. That generation’s political conscience was shaped during the 2008 and 2010 civil uprisings, as Kashmiris carried out mass rallies and protest marches demanding independence. During the last uprisings, government forces killed around 200 civilians, most of whom were teenagers. In addition, thousands of young boys were imprisoned, mutilated or maimed — acts that often affected their mental health, and the well-being of their families.
Shabir, 22, is another young man who has been permanently affected by the conflict. He suffered brain damage after being hit in head by a tear gas shell during the 2010 uprising. He was in a coma for 27 days, and underwent six operations for injuries to his skull. He lost the ability to speak as a result, and his right hand was disabled. According to his family, Shabir’s personality also changed after the incident. “He is a chain-smoker now and wonders what happened to his life,” his father said. “We can’t understand most of what he says due to his disability. Anger in him has increased.”
Rise in post-traumatic stress
Dr. Arshad Hussain sees up to a 100 patients a day at the Srinagar psychiatry hospital, where he has worked for over 16 years. He says mental health in Kashmir is declining at an alarming pace, and has treated many young patients who developed depression after the uprisings.
“Young men have a continuous fear of getting arrested again,” he said, adding that long-term incarceration has been linked to post-traumatic stress disorder. “We have younger people coming to seek help. We have an epidemic of mental health problems, particularly depression.” Hussain then compared the way cholera used to hit Kashmir every year to the way depression now affects the region.
In 2009 a study on the relationship between conflict and depression in Kashmir found that the prevalence of depression in the region is over 55 percent.
The decline in psychological health has led to an increase in substance use and suicide in Kashmir. Over the years, the number of patients seeking help at the Srinagar facility, the only psychiatric hospital in the region, has increased rapidly. According to doctors, around 1,700 patients visited the hospital in 1989, compared to more than 100,000 last year. Private clinics and district hospital centers have also opened to accommodate patients.
In 2009, a study on the relationship between conflict and depression in Kashmir commissioned by the Sher-e-Kashmir Institute of Medical Sciences in Srinagar found that the prevalence of depression in the region is over 55 percent. Moreover, it found that people in rural areas, women and young people were particularly affected.
There are many causes of mental illness, Hussain says, but ongoing political conflict is a major one. “It was thought to be an illness of middle-aged people but now large numbers of people are between 18 and 35 years old.”
Fighting social stigma
Mental illness carries a social stigma in Kashmir, and researchers say it has not been easy for young people to see psychiatrists. According to Hussain, there are many people in Kashmir in need of mental health services who have never been treated. “In our society, people don’t talk about depression. They don’t detect depression. People never go to psychiatrists.”
The lack of awareness has likely resulted in fewer medical consultations, though government and community organizations, such as Action Aid India in Kashmir, have held campaigns to promote mental health treatment. Since 2003, Action Aid India has worked in roughly 100 villages a year, distributing pamphlets, conducting workshops and organizing medical camps.
To reduce stigma around mental health problems, Action Aid India also started a campaign in which they write descriptions of the symptoms of the depression on public walls. In the village of Lelhar 19 miles south of Srinagar, a painter was at work on a large banner that would read, “Symptoms of depression include sadness, anger, excessive sweating, sleeplessness, nightmares, loss of interest and low appetite.”
Beyond awareness, there are other problems. Project manager Tanveer Ahmad Dar says mental health issues are often chronic and require continuous follow-ups. This, he says, can be expensive: “Costs incurred in treatment are very high.”
Zeba lives in Lelhar in a mall mud-brick house. Last August, her 22-year-old son, Lateef was shot several times in the lower back during a protest. One bullet was removed and another is still lodged in his spine. He is now unable to work, and his mother has also suffered as a result of his injury.
“I have depression and can’t sleep,” says Zeba, who describes her typical mood as agitated, restless, hyperconscious and worried. Each day she smokes around four and a half pounds of dry tobacco for relief. A few weeks ago, she burned all her medical prescriptions.
Since the uprisings, Hussain, the psychiatrist in Srinagar, has treated many families like Zeba’s. “Families are drifting because of mental illness,” he said, adding that rising anger has been an “indirect effect” of these dynamics.
As the political conflict continues, the need for mental health services will as well. In Kashmir, Dar says, recurring traumatic events keep people trapped in a cycle. Until the environment changes, he says, the “mental health situation in Kashmir will not improve. With one person, the whole family is affected.”