Depression, anxiety and post-traumatic stress disorder (PTSD), are not new concepts in conflict-torn Himalayan Jammu and Kashmir region. While the militancy related incidents have ebbed, there has been steep increase in many other social and health related issues in the region. According a recent survey nearly 1.8 million or 45 per cent of the total adult population in the Kashmir valley, battered by 26-years of violent conflict, show symptoms of depression, anxiety and post-traumatic stress disorder (PTSD). The research by Médecins Sans Frontières (MSF) in collaboration with Kashmir University’s department of psychology and the state’s Institute of Mental Health and Neurosciences, covered 5,428 households in 399 villages across all the 10 districts of the valley between October and December 2015. PTSD occurs due to traumatic events. The last two decades have seen various traumatic events in Kashmiri population, which has led to psychological impact on all population, especially children. PTSD is one of the psychiatric disorders occurring after witnessing of traumatic events. The syndrome has been recognized for over 100 years; during the First World War it was known as Shell Shock, by the Second World War it had become Combat Fatigue, and in the Vietnam conflict it was referred to as post-Vietnam Syndrome. Typically, PTSD sufferers experience three distinct groups of symptoms – hyper-arousal, intrusions and avoidance. Features of hyper-arousal include persistent anxiety, irritability, inability to sleep and poor concentration. Intrusions include difficulty in recalling stressful events at will, intense imagery or flashbacks and recurrent distressing dreams. Avoidance involves inability to feel emotion, diminished interest in activities and detachment. Other possible complications include chronic pain and poor health such as circulatory and musculoskeletal disorders, and a greater number of medical conditions than people without PTSD. To cope, people may resort to addiction to various drugs, alcohol and nicotine, anger, harming themselves etc. Vulnerability to developing PTSD can be related to temperament, age (children and the elderly are more vulnerable), a previous psychiatric history, low self-esteem and traumatic experiences. Several treatments for PTSD exist, and can be divided into biological, psychological and social therapies. Their effectiveness is reliant on resource issues, especially in regions like Kashmir. Resources for mental health are scarce. Doctors work at a relatively high speed, constantly multi-tasking – each patient is reviewed in about three minutes with follow-up appointments. Psychotherapeutic treatment such as counselling and cognitive behavioural therapy requires time, resources and manpower. Fortunately, manpower is slowly increasing. While there is an increase in the number of psychiatrists across Kashmir, however researchers have witnessed an upward trend in the disease. The central government and the State government should join hands to work for the benevolence of the people as far as the highly stigmatised diseases are concerned.
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