By Altaf Hussain
BBC news, Srinagar
Although cases of PTSD are declining, tensions remain
Psychiatrists in Indian-administered Kashmir say there has been a sharp decline in the number of post-traumatic stress disorder (PTSD) cases, thanks to an improvement in the security situation.
The Kashmir valley witnessed an epidemic of stress-related disorders after the outbreak of armed conflict two decades ago.
A survey conducted six years ago showed that 17% of the population in the valley suffered from PTSD.
But the number has steadily gone down since. India and Pakistan, which both claim divided Kashmir in its entirety, declared a ceasefire in 2004.
Renowned psychiatrist, Dr Arshid Hussain, says he used to see on average 25 to 40 cases of PTSD at the Psychiatric Diseases Hospital in Srinagar daily.
"Today we see hardly one fresh case of PTSD a day."
Dr Hussain says this fall is commensurate with a reduction in the level of violence in the state.
According to official statistics, the annual number of violent incidents in the state went up to nearly 6,000 during the peak of insurgency. It is down to a mere 400 this year.
"Traumatic incidents are on the decline and so is the incidence of PTSD," Dr Hussain says.
At the Psychiatric Diseases Hospital, however, doctors say the number of patients coming for treatment is still rising.
MSF has been working with mental health issues in Kashmir since 2002
Hospital superintendent Dr Hamidullah Shah says a majority of the patients now come with problems other than PTSD.
He says this is largely due to greater awareness among people that conditions like palpitations, backache and restlessness might be psychosomatic and thus require psychiatric treatment.
"Earlier people who had such problems would first go to a faith healer, then consult a general physician and then the neurologist. The psychiatrist came last of all, if at all."
Dr Hussain says despite a huge decline in the number of PTSD cases, the state of mental health in Kashmir "remains precarious".
This, he says, is because there has been an alarming increase in substance abuse and suicides.
"We are seeing deaths due to substance abuse; it has become an epidemic."
Prominent sociologist Dr Bashir Ahmed Dabla says one-third of people in the region between 15 and 40 years are addicted to drugs.
"We have lost one generation to violence and now we are losing another generation to drugs," he says.
Last year, many Kashmiris were incensed by the land transfer plans
Some sociologists and psychiatrists, however, say that mental health problems are on the rise globally.
"Kashmir is no different from New York [in that sense]," says Dr Hussain.
Among the contributing factors are a break-up of the family system, urbanisation and "secularisation" or weakening of religious faith.
"Resigning to God's will acted as a shield for many people against PTSD and other mental health problems during the two decades of the conflict," says Dr Hussain.
"If a similar conflict were to break out now, there would be a huge PTSD problem."
When the armed conflict broke out two decades ago, Kashmir was ill-equipped to deal with PTSD and other disorders.
But the situation has improved considerably - the number of psychiatrists has since grown to 20 and the faculty is still expanding.
Experts say although militancy is on the wane, the region still lacks stability.
The valley saw massive protests last year over the state government's decision to allot a plot of land to the management of a Hindu shrine.
Many children painted their worries
Days of violent protests and the curfew-like situation in Srinagar and many other towns led to immense anxiety among the residents, especially children.
Medicins Sans Frontieres (MSF), or Doctors Without Borders, has been working with mental health issues in Kashmir for the past seven years.
The organisation runs 16 counselling centres in five districts of the valley and offers counselling to nearly 6,000 people.
MSF broadcasts on the local station of All India Radio to generate awareness about mental health issues. Many Kashmiris tune in.
MSF recently held a mental health week in which nearly 300 students participated.
Counsellors say a drawing competition held as part of the week was an eye-opener.
Many of the children did not draw hands, says counsellor Munazza.
"Not drawing hands means they do not have freedom, that otherwise they want to do so many things."
She points to the use of dull colours by the children.
"They have depicted their stress so well. They have drawn barren land, naked trees without leaves and flowers. This is how they see their own lives."