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Mental illness often stems from early-life trauma. It’s happening in Kashmir

We remember youth as the one period in which we were inspired by hope for our own future, and for our community. As a miasma of fear descends upon Kashmir, imagine the impact this would have on the minds of children and young people already damaged by two decades of conflict.

Written by Vikram Patel | Updated: August 7, 2019 9:11:58 am
A boy rides a bicycle past a barbed wire erected as part of security restrictions in Jammu, Tuesday, Aug.6, 2019. (AP Photo: Channi Anand)

When we think of childhood adversity, we imagine the kind of truly horrible stuff which happened to the character of Bobby in the film Judgementall Hai Kya. While I found the film somewhat cringe-worthy, I thought there was at least one figment of a fact which was credible. The protagonist’s mental illness was seeded by the trauma she had experienced in her childhood, her violent father and his extreme jealousy, her parents’ marital strife and, ultimately, their tragic death. Indeed, adversities in childhood are the most important predictor of our mental health, not only in childhood but throughout our lives.

The most memorable line in William Wordsworth’s The Rainbow, that the “child is the father of man”, is a prescient reminder that each of us is the product of our childhood experiences. This was also the inference that Sigmund Freud made when he claimed, based on his assessments of patients with mental health problems, that the experiences in our childhood profoundly influenced our adult well-being. This scientific observation is — at par with Isaac Newton inferring gravity when the apple bounced on his head — amongst the most important in history. But Freud was wrong about actually how childhood adversity leads to mental health problems. This association is not, as he surmised, because of the monsters lurking in our unconscious but, as neuroscience is now showing us, because the brain is immensely malleable in response to the social environment in the first two decades of life.

But childhood adversity isn’t only about the kind of awful and terrifying experiences that marked Bobby’s descent into mental illness. Unremitting fear is the most damaging of all emotional experiences. A vast body of science provides compelling proof of how fear seeps into the deepest recesses of the human brain and leads to profound disturbances in our mental health and, ultimately, in the way we respond to our environments. Its poisonous influence is greatest during childhood; indeed, scientists use the term “toxic stress” to describe the experience of strong, frequent, or prolonged fear on children’s emotional development. What makes such stress particularly toxic is that its effects show up not only in the form of disturbed mental health in childhood but also through the full gamut of disturbed mental health in adulthood, including paranoia, self-harm, depression, addiction and aggression.

Perhaps we might take a moment, then, to consider how this science might apply to our fellow citizens who live in the beautiful, if benighted, region of Kashmir. Amidst the growing fear and uncertainty in Kashmir in recent days leading to an exodus of tourists and pilgrims and an influx of paramilitary forces, one particular group of the residents of the region deserve our special attention. A paper by Mohammad Altaf Paul and Waheeda Khan, published in the current issue of the journal Community Mental Health should alert us to their needs. They describe the results of a survey assessing the mental health of a thousand children from 12 schools in Shopian district. They report an astonishing finding: One out of every three of these children had a clinically diagnosable mental disorder, most commonly in the form of mood, anxiety or behavioural disorders. And this study was conducted before the current troubles. Even as all those who have homes somewhere else flee Kashmir, spare a thought for the children who are trapped there, with nowhere to go.

Now, try a thought experiment to illustrate how being caught in a never-ending grindingly oppressive situation might make you feel. Imagine you are 10 years old. You are living in an environment suffused with constant fear of being hurt or humiliated, where the very guardians of your security are threatening and dangerous, and where your parents, who you always looked up to protect you from the worst, are despondent and hopeless. There is no escaping this pressure-cooker, day after day, month after month, year upon year. Imagine what this enduring fear, uncertainty and despair would do to you. Science teaches us that these are exactly the right ingredients to ferment a potent brew of hate, anger and violence in our minds.

Those of us who believe that the youth of Kashmir who line the streets pelting stones or who pursue martyrdom through terror attacks are simply misguided and falling prey to the propaganda of the enemies of India should pause to think about the impact of the toxic environment in Kashmir on the mental health of her children. This mental health crisis, spawned by unrelenting fear of something terrible about to happen, stirred up with the daily stress of being humiliated, trapped and isolated by stringent security policies, will haunt the region for years. Security is, of course, of paramount importance, not least to the people of Kashmir. But security which suffocates minds through fear and uncertainty is worse than a horror, or just plain horrible, movie. At least you know the latter is fiction, one which will end at a definite time and, moreover, one you can walk out of.

We remember youth as the one period in which we were inspired by hope for our own future, and for our community. As a miasma of fear descends upon Kashmir, imagine the impact this would have on the minds of children and young people already damaged by two decades of conflict. This is no Bollywood film screening. The impact should already be plainly visible to the billion plus viewers in the rest of the country, but its pain and suffering will continue to fester, hidden until it ultimately explodes one day, in the minds of Kashmir’s children. It will surely continue to breed more anger and violence. And, in the end, it will make any chance of winning their hearts and minds even more remote.

This article first appeared in the print edition on August 7, 2019 under the title ‘Judgement day’. Patel is Pershing Square Professor of Global Health at Harvard Medical School.

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