Kashmir’s Unprecedented Mental Health Crisis

“What happens when an entire society is suffering from PTSD?” asked Beyond the Breaking Point, published in 2009 by the Dart Center for Journalism and Trauma when addressing the mental health situation in Kashmir.

Sandwiched between India, Pakistan, and China, India-administered Kashmir suffers from violent political instability with conflict between government forces and militants always simmering just below the surface, if not actively boiling over. In the last two decades, mental health experts in the capital city of Srinagar reported a massive increase — nearly tenfold, by some reports — in the prevalence of psychological problems among residents. This has also given rise to physical health maladies such as hypertension, cardiac issues, and diabetes.

“For some, the hopelessness and helplessness associated with persistent insecurity, statelessness and poverty will trigger ephemeral reactions such as those mentioned above. For others, conflict experiences may lead to Post-Traumatic Stress Disorder (PTSD) and chronic depression,” reports Impact of Conflict Situations on Mental Health in Srinagar, Kashmir by Asima Hassan and Aneesa Shafi. “These conditions, in turn, can lead to suicide ideation and attempts, chronic alcohol and drug abuse, interpersonal violence, and other signs of social dysfunction, which can last up to five years after the conflict. This persistent dysfunction is linked to decreased productivity, poor nutritional health and educational outcomes, and decreased ability to participate in development efforts. The effects of mental health and psychosocial disorders in conflict-affected populations can be an important constraint in reconstruction and development efforts.”

Among the general population in India, researchers estimate that about seven percent of the population has some form of psychiatric disorder. Affected populations in prolonged conflict situations are much more vulnerable to mental illness, staring down killings and physical violence, disappearances, amputations, gender-based violence, and forced displacement.

PTSD was practically unheard of in the Kashmiri consciousness before 1990. Only thirty years later, the sole psychiatric hospital in Kashmir is inundated with an overwhelming number of patients without adequate resources to deal with the influx. When healing from PTSD, the patient needs to have a peaceful environment, which is hard to come by in Kashmir. Citizens can’t escape news of bombings in their region or hearing about the killing or disappearance of neighbors, friends, or relatives.

One 2009 study, Life in conflict: Characteristics of Depression in Kashmir, published in the International Journal of Health Sciences, looked at the non-combatant civilian population in Kashmir. The study found the prevalence of depression to be as high as 55 percent. The highest rates of depression were in the age group from 15 to 25, at a shocking 66 percent. The study found that rates of depression were much higher in rural areas compared to urban areas. The psychological damage from decades of low-intensity conflict and frequent trauma from war-related violence is widespread in Kashmir. There is a mass exposure among the civilian population to torture, rape and sexual torture, executions, shootings, death of family members, destruction of property, disappearances, loss of limbs, and poverty.

Some of the common psychosocial consequences of conflict, as listed in Impact of Conflict on Mental Health with Special Reference to Kashmir Valley, are “sleeplessness, fear, nervousness, anger, aggressiveness, depression, flashbacks, alcohol and substance abuse, suicide, and domestic and sexual violence.”

Decades of seemingly endless conflict and political violence have long been a part of life in Kashmir, including allegations of widespread human rights abuses by the Indian security forces deployed to the region. A 2015 report published by Amnesty International entitled “‘Denied’: Failures in accountability for human rights violations by security force personnel in Jammu and Kashmir” gives a scale to the community damage committed by Indian security forces deployed in the region.

“Shocking as the government statistics are, human rights activists and lawyers say that the figure of civilian deaths caused by the security forces fails to reflect the true scale of violations by security forces. Activists estimate that up to half of all human rights violations by security force personnel may have gone unreported in the 1990s and early 2000s. Amnesty International reports in the early to mid-1990s documented a large number of instances of torture and deaths in custody of security forces. This organization alone recorded more than 800 cases of torture and deaths in the custody of army and other security forces in the 1990s, and hundreds of other cases of extrajudicial executions and enforced disappearances from 1989 to 2013.”

A shocking 2005 survey conducted by Doctors Without Borders found that civilians were often caught up in the violence that plagues the region. 86 percent of those surveyed had been exposed to crossfire and 83 percent to round-up raids. 44 percent had been subjected to maltreatment, 33 percent to forced labor, 17 percent to legal or illegal detainment, 13 percent to torture, and 12 percent to sexual violence.

Like many parts of the world, there is a strong stigma in Kashmir against mental health treatment, with sufferers often being afraid to look for psychiatric care in fear of being labeled as crazy. Some doctors and NGOs in Kashmir estimate that only about 10 percent of those with mental health issues get treatment.

Oftentimes, Kashmiri people rely on faith healers and religious institutions for their mental health needs. One of the region’s leading psychiatrists, Dr. Mushtaq Margoob, said in Impact of Conflict Situation on Mental Health in Srinagar, Kashmir, “the people have absolute faith that whatever tragedy strikes them is the Will of God, so they don’t give up.”

Women are particularly susceptible to mental illness in Kashmir, in large part due to the role that Kashmiri women play in their society. The largely Muslim region looks down on the concept of widows remarrying, so often women whose husbands have died or disappeared are unable to remarry. A study by the University of Kashmir found that 91 percent of widows in the valley included in the survey have not considered remarrying.

Women are often thrust into being the sole provider in an unequivocally patriarchal society, often having to care for both their children as well as elderly relatives. Illiteracy is high, especially among rural women. Even for married women, domestic bliss can be elusive, with high levels of poverty and domestic violence paired with low levels of education for women. While education levels and literacy rates for women are improving, there is still a long way to go. There is an epidemic of sexual violence as well as sexual torture in the valley, with Kashmiri women’s sexuality used as nothing more than a political pawn in the ongoing conflict between the Indian security forces and militants.

The Kashmir Valley is already gripped in poverty and many residents have little access to medical care. Mental health is an essential element when determining well-being and the Kashmiri people suffer from sky-high rates of mental illness. Studies show that vulnerable civilians in combat zones don’t adapt to constant violence, but it rather exacerbates mental illness and the breakdown of a society already on its edge.