With political conflict and societal norms adding to stress, taboo around mental health is stopping people in Kashmir from seeking professional help.
The last time Azra was close to a mental breakdown, she could not seek psychiatric or professional help on time. She is 20 and is already worried about her career which is uncertain in a conflict zone where public health, education, and the market have broken down.
Her relatives constantly asking about her pimples is an add-on to her anxiety, and has led to self-esteem issues. This has made her question her self-worth, thus, causing anxiety and lack of self-confidence.
Azra is fed up and feels that such insensitivity is widely prevalent in the Kashmiri society as people ‘usually crack jokes’ based on bodies and individuals who do not conform to the normative culture.
“Struggle begins within one’s own being, creating a stressful relationship with one’s imperfections,” she says.
What worsens her anxiety is that she is not able to seek professional help because of the taboo around mental health in society.
“There’s no education or counseling in schools about mental health. Bottled up emotions either end up in our diaries or tears seem to be a refuge,” she says.
Doctor Aaliya Khanam who’s currently pursuing MD in psychiatry from the Institute of Mental Health and Neurosciences, Kashmir, talking about the stigma associated with mental health says that a major chunk of people does not seek help on time because of the stigma attached to it.
The stigma, she says, is worse for women.
“People are scared of what other people will say when they get to know that they were admitted, or even seen at a mental hospital,” she says.
Further, she says that people don’t recognize the psychiatric issues due to lack of awareness and they end up consulting cardiologists or general physicians.
“Even people who are aware, and recognize the behavioural abnormality, shy away from seeking professional help. As the illness progresses, they minimize the symptoms forcibly, and therefore, it worsens,” she adds.
The disturbingly casual attitude towards one’s mental wellbeing and the deeply internalized stigma attached to the mental illnesses/disorders have further complicated the problem in the valley. “This results in their friends being the therapists which is not always healthy,” Doctor Aaliya says.
Years of conflict in Jammu and Kashmir have taken a toll on people’s mental health in the state. According to a survey conducted by MSF, nearly 1.8 million adults (45% of the adult population) in the Kashmir Valley show symptoms of significant mental distress. This is compounded by the stigma associated with mental illness.
The MSF survey was conducted in 2015. Experts say that since then, the graphs have drastically gone on an upward spike, making the number more alarming than they already were.
Another young woman, Abeer, in her twenties, has not had the privilege of seeking therapy till now.
She has been frequently going through phases of anxiety and stress after witnessing cases of domestic violence around her. This prevalent practice in our society not only disturbs her but triggers a kind of fear which she has not been able to pour out in front of a therapist or psychiatrist because “what will people say.”
The widely prevalent practice of domestic violence, physical and mental, particularly after marriage, triggers Abeer’s anxiety for her future and worsens the fears and insecurities she undergoes as a woman. With inflexible cultural norms, the constant body shaming, and demand for a community with homogenous individuals and identities, she feels that the stress is an add-on to those who are already struggling with personal issues, ranging from building a career in a politically-disputed zone to composing themselves within these struggles.
Stressing on the importance of awareness about mental wellbeing and psychiatric help, Doctor Aaliya says that people need to be made aware of the symptoms and of the help that is offered by psychiatrists and therapists.
“When someone gets a physical illness, we don’t ask them to cool down or cheer up. We need to understand that same is the case with someone going through a mental illness. Moods change because of chemical changes taking place in the brain, thus, the individual needs medical help,” she says.
As per psychiatrists, substance abuse has been on a steep rise, amongst the youth in particular. Youth from all age groups; school-going, college-going, and even as young as 13, are taking refuge in drugs including heroin and opioids.
As per Doctor Aaliya, the OPD of the hospital receives about 60-70% of patients with substance use disorder.
The disorder is predominantly found in males as compared to females because, in the Kashmiri social construct, men are found to be more outgoing than women and therefore, have more chances to succumb to peer pressure and get exposed to these practices.
As per the Doctor, in a case, where the confidentiality of the patient has to be maintained, a woman in her 40s had a history of consuming, rather chasing heroin for two years as she was suffering from Post-Traumatic Stress Disorder (PTSD) after witnessing the killing of her brother by the armed forces, in front of her eyes.
Due to the conflict, three of her close family members were killed, leading to her depression and PTSD.
Experts say that living in a conflict zone has triggered major stress amongst people in Kashmir. Uncertainty of the future, and the availability of drugs, contribute to its widespread abuse.
There is a dire need to de-stigmatize and mental illnesses so that care can be sought and given, says Doctor Aaliya.
“Mental illness is a part of life, and as a society, we need to not only normalize taking care of our mental state but also do away with unhealthy norms that trigger mental upheaval; especially because of the ever-present political turmoil which has already taken a heavy toll over the mental health of people,” Doctor Khanam says.
But as of now, the situation seems to be going from bad to worse.
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