Haider: Opening our eyes to mental illness in the Kashmir valley

Haider is a movie replete with characters struggling to maintain mental balance, in times of violence and distress in Kashmir.


A man standing and staring the front gate of his house not responding to repeated asks of his mother to get in, until a person who deciphered the reason and asked for his id, frisked him and asked him to go in. And it worked, he went in. He remarked, they are so used to frisking that they don’t even go inside their homes without showing ids.

Image Source: indianexpress.com

Image Source: indianexpress.com

And everyone laughed in the theatre. The people of valley have become numb, all their daily routine is to track the curfew timings and be under stress and uncertainty of their survival.  But the question is have we also become numb? That all we can do is laugh and enjoy the humor? Is this our taste of humor?

What is shown in Haider is the grim situation of the valley. It portrays the life of a common man in Kashmir showing their struggle to maintain their mental balance in presence of violence and hatred. The ‘heaven’ of India is in real distress. This bollywood movie has an underlying message of prevalence of mental health issues in the valley. Almost all the characters are shown dealing with problems like PTSD (Post traumatic stress disorder), depression, and suicide to name a few.

Image Source: indiatoday.intoday.in

Image Source: indiatoday.intoday.in

Root of the problem is same; the history of consistent violence, but it has resulted into different consequences for different genders and age group. Medecins Sans Frontiers (MSF) reports that there has been ten times rise in trauma cases in the last ten years. (Jarundi, 2002) Mental disorders in both men and women have shown an alarming increase when compared to pre conflict days in 1989.( Hasan and Shafi 2013)

Women

According to studies 70- 80% of all cases of acute depression are women.  Records reveal that 15% of women are suffering from prolonged trauma and stress(Syed 2014). It’s a serious problem in the valley, which makes women lives miserable, leading to post traumatic stress disorders, depression, phobias along with social stigma for them. As also shown in the movie in the characters of Ghazala and Arshi. Ghazala gets the status of half –widow after involuntary disappearance of her husband. Over 90 % of these women do not consider remarriage and continue living life of uncertainty. A study done by University of Kashmir reveals that 80 % of widows are aged between 25 and 32.(Mustafa 2014)

Image Source: www.livemint.com

Image Source: www.livemint.com

Many young women also become victims of suicide. Research from the Psychiatric Diseases Hospital says Kashmir’s suicide rate has increased 40-fold since the militant insurgency against the Indian army began.

Before 1989, Kashmir’s suicide rate was 0.5 per 100,000 people. Still high, by the standards of the Muslim world (which, typically, has a very low suicide rate of between 0.1 and 0.2), but the lowest in all of India. By 2007, the suicide rate in Kashmir was estimated at up to 20 per 100,000, double the all-India average. Women suffer most, Dr Margoob says, often because they are the ones left alive when and if the violence subsides(Margoob 2011). This exactly is portrayed by Arshi in the movie, who is a young independent women a journalist by profession but she also gets entangled in the worsening dynamics of their families and became victim of violence and bloodsheds losing her father, so she loses her mental balance and commits suicide.

 

Men

Image Source: brightlightsfilm.com

Image Source: brightlightsfilm.com

According to facts, in Kashmir prevalence of depression is highest in the age group of 15-25 years.  Just over 40% of all orphans aged between five and 12 years suffer from PTSD, followed by major depressive disorder (MDD), which has been diagnosed in 25% of all orphans.
Conversion disorder is present in 12.5% of orphaned children, panic disorder in 9.38%, attention deficit hyperkinetic disorder (ADHD) in 6.25% and seizure disorder in 6.2%. (Margoob,2006) Haider is mirroring the youth of Kashmir, who is fighting everyday to make sense of changing relationships, statuses amidst all the violence and bloodshed and conflicts, and ends up burning in the fire of revenge. Many young males end up misguided and get involved in terrorist activities.

Inadequate Mental Health Support System 

Lack of Infrastructure and manpower

Over more than 25 years of bloodshed and consistent life threats on the Kashmiri soil, problem of mental illnesses like PTSD, depression etc is humongous. Health care is supported by government hospital, private sector hospitals, clinic, faith healers etc.  The mental health services in Kashmir continue to remain segregated and are confined to Government Psychiatric Disease hospital, Srinagar which was a mental asylum before, as the main centre for a population of 7 million.

Doctors providing mental health services in Jammu and Kashmir Image Source: www.msfindia.in

Doctors providing mental health services in Jammu and Kashmir
Image Source: www.msfindia.in

Recently another department of psychiatry was started in a general hospital affiliated to SKIMS medical college at Srinagar. Both the facilities lack man power in terms of specialized experts. Also there are no extensions or mobile clinics present.(Khan & Dutta) . Doctors without Borders/ Medecins Sans Frontieres (MSF), provides emergency aid in catastrophes all over the world. MSF’s mental health program in Kashmir carried out around 6,000 consultations in 2009. The organization encourages people to take part in community activities which can help in patient’s reintegration in the society. (Doctors without border, 2010) There is only one Institution for psychiatric care with just 100 beds. The two general hospitals are can only handle outpatient department. All the needy people have to travel to Srinagar for treatment as there are absolutely no facilities in rural area.

A doctor writing prescriptions for a patient. Image source: www.doctorswithoutborders.org

A doctor writing prescriptions for a patient.
Image source: www.doctorswithoutborders.org

To add to this gloomy and worried scenario there is also no facility for child psychiatry.  The two general hospitals are over burdened with the patient influx and they are so time pressed that all they are doing is writing off prescriptions unscrupulously without giving enough desired time to patients and suggesting them with alternative medicine or therapies. There is no support available to deal with such growing numbers. The hospital’s finite resources are being stretched by an increasing number of patients requiring acute care, Dr Margoob says. By 1994, the number per year was 20,000, now it is one lakh, (100,000) people a year, about 270 people per day.” Another challenge with lack of infrastructure is lack of staff.  The state has only eight psychiatrists and no clinical psychologist. It’s a huge challenge for the present staff that is responsible for over a million depressed people and another 1, 00,000 vulnerable for committing suicide.

A team from Healing Kashmir. Image Source: healingkashmir.org

A team from Healing Kashmir.
Image Source: healingkashmir.org

Healing Kashmir, a UK based charitable organization, is providing free mental health care and education, noticed that Psychiatrists have not time to breathe and are therefore unable to pay attention to the side effects of excessive medications. So, healing Kashmir though is treating patients with combination of conventional and alternative therapies and treatment, the minimum appointment time is 40 minutes so they can only see 15 patients in a day.

Stigma & Faith healers

The general belief mostly in the rural communities is that possession by evil spirits is the cause of mental disorder. (Khan and Hasanah, 1996) So people go to traditional healers and do not seek professional help or comply with medications. Due to heavy influence of religious beliefs, going to faith healers is preferred despite advances in medical care. Another reason is due to the stigma attached to the mental illness. Families do not seek medical help for treatment due to stigma around mental illness. Especially in the rural areas they go to faith healers and others in the family unless situation gets worse and the person is brought to the hospital. The community does not take it as any other illness but something a person is doing either voluntarily or is possessed by some evil spirit. Though stigma is lessening in urban areas but the problem is still intense in the rural communities. There is not enough awareness among the community about mental illness and its causes and that it can be treated.

Image Source: dartcenter.org

Image Source: dartcenter.org

Dr. Arshad Hussain, an associate professor of psychiatry at the Government Medical College in Srinagar says, “In Jammu and Kashmir state, mental illness is stigmatized, especially among girls and women”.  Women who are known to have struggled with mental illness often are not accepted as mentally healthy even if they’ve been successfully treated. There are serious societal repercussions for unmarried women even mentally ill married women are rejected by their husbands. So, married and single women alike are inclined to hide their mental illnesses to avoid shame and rejection.(Hussain, 2014)There has been little progress over the years and people have stepped up to seek professional help and are recovering from their illness. Many experts believe that medical treatment and faith healing can be complimentary.

Conclusion

Haider is an awakening call for us to understand what comes with the package. There is so much violence going on, innocent people dying and suffering, small children losing their parents and families and living in an atmosphere of uncertainly and frustration. The government should take the steps to create a sustainable system to deal with the side effects of war. Just writing prescriptions is not helping. Those people need full care and assurance.

There is no prevention and no effective care. Everything is being compromised. Nobody is talking about them, everyone is celebrating how hard answers we are giving to Pakistan and how brave are our soldiers. Agreed, but the real questions is will someone talk about the innocent depressed lives who have seen traumas and nothing else in the past 26 years? There should be aggressive efforts to build infrastructure and employee mental health workers to bridge the gap. Don’t ask them whether they want to be in India or Pakistan, just ask them for once do you or your family need help? And not just ask help them by taking steps like encourage non-profit organizations to work in the valley, bring policies to fund patient care.  Take people from the community and train them in basic mental health care.

Image Source: www.vocativ.com

Image Source: www.vocativ.com

The education surrounding mental health is a critical component that needs to be addressed in order to diminish the stigma surrounding it (The MINDS Foundation 2014). There should be extensive awareness programs on mental health education and stigma around mental illness. Campaigns should be run to educate the community to identify symptoms of depression, insomnia, bi polar etc. The area is underserved; we need more and more professionals to tackle increased number of patients. We cannot change the environment but focus should be on how to make the best of the stressful environment to ensure mental health balance. More and more community core group activities should be organized where people can share their worries and come up with solutions.   Let’s just work together to give medical and moral support to the people who are supposed to be dwellers of ‘heaven’.

 

 

Reference

  1. Jarundi, I (2002) The people of Kashmir, features, vol 2002,murj 21
  2. Hassan, A & Shafi A (2013) Impact of conflict situation on mental health in Srinagar, Kashmir, Bangladesh e- Journal of Sociology  Volume 10, November 10 January 2013.
  3. Syed, A “Kashmir: The Mental price of conflict”, Kashmir Global available at http://www.kashmirglobal.com/2012/02/14/kashmir-the-mental-price-of-conflict.html viwed on October 8, 2014
  4. Mustafa, A (2014) “Mental Health Matters” Greater Kashmir available on  http://www.greaterkashmir.com/news/2014/Aug/18/mental-health-matters-41.asp viewed on 10/15/2014.
  5. Margoob, M as quoted in Doherty Ben, “Suicide rates spirals in traumatized Kashmir” The Sydney morning Herald, available at http://www.smh.com.au/world/suicide-rate-spirals-in-traumatised-kashmir-20111120-1np85.html viewed on October 8, 2014.
  6. Margoob, M ,etal (2006) “Psychiatric disorders among children living in orphanages- An experience from Kasmir” JK Practicioner, Volume 13(Suppl1)
  7. Khan and Dutta  “Mental health in Kashmir, available at http://medind.nic.in/haa/t02/i1/haat02i1p10g.pdf  viewed on 10/15/2014
  8. Doctors without Borders (2010) , “ Mental health care in Kashmir, DRC, and Iraq available at  (http://www.doctorswithoutborders.org/news-stories/field-news/mental-healthcare-kashmir-drc-and-iraq viewed on       10/15/2014
  9. Amin & Khan, (2009), “Life in conflict : Characterstics of depression in Kashmir”, International Journal of Health sciences 3(2) 213-223
  10. Khan & Hasanah (1996)  “ Belief in supernatural causes of mental illness among Malay patients : Impact on treatment . Acta psychiatric Scandinavica 94, 229-233
  11. Hussain , A quoted in Bashir (2014) , A “ Kashmiri women explores spiritual , Psychiatric Treatment for Mental illness” The Kashmir Monitor available at http://www.kashmirmonitor.in/news-kashmiri-women-explore-spiritual-psychiatric-treatment-for-mental-illness-72246.aspx viewed on     10/15/2014
  12. The MINDS Foundation , “ Our Model “ available at http://www.mindsfoundation.org/our-model/ viewed on 10/15/2014

 

 

 

 

 


  ABOUT THE AUTHOR
Niharika Bajpai is Chief Operating Officer at The MINDS Foundation, an international non-profit committed to providing high quality and cost effective mental health services to rural areas in India. She lives in Boston, USA. more

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  ABOUT THE AUTHOR
Niharika Bajpai is Chief Operating Officer at The MINDS Foundation, an international non-profit committed to providing high quality and cost effective mental health services to rural areas in India. She lives in Boston, USA. more

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