The Hindu Business Line : No bomb shelters for the mind

In terrorist-hit Jammu and Kashmir, doctors continue to grapple with the alarming increase in psychological disorders among the people, particularly women.

The psychological health of people — particularly women — affected by violence in the Kashmir Valley has been a side issue of the otherwise high-profile conflict. Since 1989, the alarming rise in the number of people with psychological disorders has been cited often in the media — local, national as well as international. However, the fact remains that the medical community in the conflict zone is always hard pressed in its attempt to develop new coping strategies.

According to the data of the Government Psychiatric Hospital (GPH), Srinagar, the number of registered patients here in 2002 were nearly 50,000; the corresponding figure for 1989 is 1,700. A majority of the patients are women and many suffer from post-trauma stress disorders (PTSD). Such disorders are defined as a protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature, likely to cause pervasive distress in almost anyone.

Local psychiatrists point out that if the psychological health of the valley's people is divided into pre and post-militancy phases, the identifying features are anxiety and depressive disorders respectively. In comparison to men, a larger number of women patients show symptoms of depressive disorders. And it is clear that women have the added burden of living with the knowledge that some members of the family, usually male, have either been tortured or killed. Then there are those who have disappeared — waiting for them or for news related to them can be extremely stressful.

Dr Mushtaq Margoob, a leading psychiatrist in the valley, and his team of young doctors at GPH have done extensive research for the last 10-15 years. This has thrown up some significant patterns.

One such pattern relates to the rural-urban divide. As the years of militancy rolled on, the scene of violence shifted mostly to the rural areas. Dr Zaid Wani of GPH says that as much as 70 per cent of the patients are from rural areas. But this could be due to the fact that well-to-do patients (mostly in cities) prefer private practitioners, who have also seen a dramatic increase in the number of patients in the last 15 years.

With rural women forming the largest group of patients at GPH, there is a real danger that their medical needs may not be met, as most of the psychiatrists at the hospital are men. According to Dr Margoob, some of the stereotypical notions men harbour about women are that they are uneducated, believe more in the supernatural, and tend to go to faith healers.

The media also reinforces some of these notions. Dr Margoob recalls an incident during the first parliamentary elections (1996) after the start of militancy in Kashmir, when the media reported that some villagers near Tangmarg believed that students of the local girls' school were possessed. After investigating, Dr Margoob found that the signs of psychological trouble among the adolescent girls were the result of a combination of factors.

First, election time was generally stressful for everyone. Then, the presence of security forces in the school premises along with the rumour that the forces would not leave for a long time added to the stress.

Local residents had, after a long struggle, persuaded the administration to set up a separate school for girls as they were not comfortable studying in the village's co-educational school. So there was an added fear in the minds of the girls that they may have to go back to the co-ed school. Also significant was the fact that these were adolescent girls, who were more vulnerable to anxiety and stress. Fortunately, Dr Margoob was able to convince both the media and the villagers that the girls were not possessed, and that they needed psychological counselling.

This example highlights the rural-urban and male-female divide among even children and adolescents. GPH data for that period confirms that rural girls were more prone to PTSD, schizophrenia and attempted suicide.

Over the years, the medical community and government departments have realised the need for non-pharmacological (drugs-free) counselling. Several NGOs also stepped in to wean patients away from non-scientific healers and counsellors. The health department of the Jammu and Kashmir Government allowed Médecins Sans Frontières (MSF) to work in the State in 2001. MSF has a counselling centre at GPH, and its workers fan out to various parts of the State, including border areas.

With NGOs stepping in, the number of women doctors and counsellors has increased. Interestingly, at the University of Kashmir, women account for about 70 per cent of the students enrolled for the M.A. psychology course, which was started last year. In 1998, Dr Margoob's team launched the `Defeat Depression Programme' to spread awareness about psychological disorders in the valley and the need for scientific treatment. Apart from working closely with NGOs like MSF, the programme aims to bring more doctors into its fold.

During the summer, for instance, Dr Margoob and other psychiatrists visit remote areas in GPH vans, which function as mobile clinics. Apart from examining patients in the villages, the team trains local general physicians in diagnosing and treating patients. Later (during the winter months, especially), local physicians keep in touch with GPH psychiatrists over phone for advice and treatment.

That doctors and counsellors seek patients, rather than the other way round is a fact of particular significance in a conflict-affected State.

Women's Feature Service

Picture by Nissar Ahmad

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