Kashmir's Psychic Toll

Zohur Ahmed Dar had no reason to fear when he went to his neighborhood mosque one night late last year. But after an evening of prayer and ritual to celebrate the day the prophet Mohammed received revelations from God, Dar never made it back home.

Riding his motor scooter through the dark streets of Srinagar--the summer capital of the disputed, Indian-ruled region of Kashmir--Dar was attacked by "unidentified gunmen" wearing masks. They shot Dar in the back and left him for dead. Taken to hospital, he survived for two days, then succumbed to his wounds.

The psychological shock from that single event--one of some 60,000 killings in 13 years of conflict in Kashmir--continues to eat away at Dar's family and friends. His 30-year-old wife, Salima Bano, was probably hurt most. For two months after the killing, the mother of three couldn't stand to be in a well-lit place, or to hear people's voices. Now she's recovering, but slowly. Sitting on a stool in the Government Hospital for Psychiatric Diseases in Srinagar, Bano explains that she came to get more Sertaline, a Prozac-like drug she can't really afford but desperately needs. As she explains why--the bad dreams, the sense of dread--she breaks into sobs, and wipes away tears with the edge of her black head scarf. "If I stop the medicine, I feel it again," she says.

The Valley of Kashmir, nestled beneath the white-topped Himalayan mountains, was once regarded as a thin-aired Eden, far from the troubles of the world. But the current conflict--pitting ruthless Islamic militants, many of them foreign jihadists, against Indian security forces--has made a shambles of Kashmiri society. Islamic terrorists kidnap and kill people they regard as enemies, sometimes chopping off their heads. The Indian security forces, which operate largely above the law, have a long record of torture and extrajudicial killings against people they suspect of being militants. In addition to massacres and murders, hundreds and perhaps thousands of people have simply "disappeared." Yet along with the dead, the wounded and the missing are countless others who have lost their peace of mind, or their sanity.

Case loads at the Government Hospital for Psychiatric Diseases are soaring. In the late 1980s, psychiatrists treated 1,700 to 2,000 cases a year at the facility, which has room for 100 inpatients. (Doctors reserve beds only for people who might do harm to themselves or others.) Already this year, they have treated 48,000. Some of the increase can be attributed to factors unrelated to the conflict, but pervasive violence in Kashmir has had both direct and indirect effects. "I've seen many patients who have not actually had anything happen to them," says Dr. Arshad Hussain, 28, a psychiatrist at the hospital. "But if they hear a sudden knock at night, they will become very frightened. They suffer from panic attacks, night tremors and insomnia."

Attackers are often classified as "unidentified." Dar's wife, for instance, has no idea if his killing was political or criminal. (The killers took some money Dar was carrying.) "There are so many people who are just walking somewhere and get killed--in a shooting, or a grenade attack or abducted by 'unidentified persons'," says Shazia Kawos, 27, a social worker and counselor who has been working on a project for widows and orphans since 1998.

The creaky door of Hussain's office swings open and closed throughout the day. Patients sit on one of four chairs, one missing a back and others missing armrests, in a cement room lit by a bare bulb. When he wants some privacy, Hussain asks someone to twist a bent nail that serves as a lock on the door. "One woman I treated, whose brother was killed by 'unidentified gunmen,' was OK after two or three sessions," he recalls. "Then there are others who never get better. One elderly man of 60 years lost his son in a crossfire incident. Eventually, we lost him."

The elderly man kept re-experiencing his son's death in his thoughts and his dreams, and lost interest in life. "He was a government employee who was very religious before the event happened," Hussain recalls. "But his faith in God was shaken." After more than two years of treatment, including counseling and various drug regimens, the man stopped coming and was never heard from again. "I don't know what happened," Hussain says, ignoring the screams of a violent patient erupting in anger in the hallway outside his office.

Hussain doesn't discuss politics with his patients or anyone else. It's safer that way, and he doesn't really care to know the source of violence in any particular case; it doesn't help to cure the survivors, who often don't know who the killers were anyway. The general absence of knowledge and justice, however, may add to a pervasive sense in Kashmir that life is tenuous and unpredictable and that much of what happens is senseless.

Drug abuse is also rising. Young men and women can buy opiates and anti-anxiety drugs without prescriptions from licensed and unlicensed medical shops. Other people ingest wood polish to get high. "Friends of mine are codeine addicts," says Hussain. He learned of his friends' addictions after one of his old schoolmates--"the gentlest boy of my class"--became hooked on codeine and sedatives and sought help. The addict then gave the names of other friends who had also become hooked.

"One was from a family that was involved in the tourist business," Hussain explains. The young man had planned to take over the business when he was old enough, but now tourist houseboats stand empty, and none but the most intrepid visitors come to the fabled Kashmir Valley. The young man has no future, or at least not the one for which he planned. "For every person who comes in, we usually find a whole family that is suffering," says Hussain. "That person becomes an index case for us." Many of those cases begin, says Hussain, with "a traumatic event that they don't have the human capacity to comprehend."