Saturday 8 April 2017

Kashmir Floods-Then and Now

Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake through this landscape, lakes which are homes in themselves and the lush green floating paddy fields.  Kashmir is also equally known for its disasters, both natural and man-made.  From the perpetual conflict situation to earthquakes, snowstorms and floods, there are hardly any disasters left, it has not seen.  In the September of 2014 Kashmir valley witnessed the worst ever floods of last 100 years.  The floods were so sudden and severe that for a few days there was no government in power, as everyone including the then Chief Minister of the state was trapped.  All means of communication including the mobile networks went dead.  Even the emergency numbers and wireless system of the security machinery could not stand the assault.  The sudden drowning of the capital city led to the total collapse of the state administration.  It was not that there were not enough warning signs- the incessant rains in upper reaches for days, the hiccups of the meteorological department to offer any proper forecast and advice and finally the failure of the Irrigation and Flood control department to manage the situation, lead to utter devastation.  Even on the day when the Srinagar city lost its defences to the rising waters and the banks of river Jhelum breached, the administration kept reassuring the inhabitants that there was nothing to worry about.  By this time, the south of the valley was already under water for days and it did not take long for north Kashmir to submerge.  The worst hit areas included Srinagar, Anantnag, Kulgam, Pulwama, Shopian and Bandipore in the Kashmir province.  Some areas of the Jammu province were also hit by heavy rains and consequent floods especially Poonch and Rajouri.
Millions of people were trapped, displaced, unsafe, and worst of all at the mercy of the missing administration.  People volunteered, innovated and used whatever means they could, to help and save each other.  Srinagar, a city of million people slipped under water and even those high up in the corridors of power, were not able to get any help.  Many people were rescued by their distant relatives, coming down from far off villages, days after they found themselves trapped under the  rooftops, living on dry rice and whatever they were able to stock, in that moment of  chaos.  Panic gripped the inhabitants of the valley and their relatives and loved ones living outside Kashmir. The situation was made worse by the lack of communication and the abundance of rumours, as there were hardly any credible sources of information.  The water reached up to 18 feet in some areas, flooding the 2nd floors of the houses and drowning and washing away essentials, valuables, cherished memories – anything that stood in its path.
There was social media frenzy, rumours, and a severe criticism of both the state and the central government, for not doing enough to save and help the people in time.  Kashmir being a conflict zone, the outcry was worse.  Even though the Army and National Disaster Rescue Force (NDRF) claimed to be helping people, there was a severe disquiet from various quarters. Allegations of favouritism and selective rescue and relief were hard to ignore.  There was a total lack of coordination between agencies claiming to be working in the rescue operations.  Even the Chief Minister went on record in the Supreme Court that the situation was under control and no further help was required in terms of boats and other essentials.  Obviously, that was a far-fetched claim and people remained trapped for weeks.  The media especially the tabloid news channels went to great lengths making heroes and villains depending on their loyalties, ignoring the actual victims and their suffering.  Sometimes they didn’t even spare people who had just been rescued after days of entrapment and trauma.  Some had lost their loved ones in the flood, but one could see the microphones being thrust into their faces, followed by insensitive questions like ‘How do you feel now?’   
The state government announced estimated loss of Rs1 trillion due to the floods, with housing sector losses of Rs30 000 crore and business losses of Rs70 000 crore.  The death toll after the floods was 280, more than 2500 villages submerged and around 2.53 lakh houses damaged1.  More than 550 000 people were displaced.  People lost everything from businesses, crops, livestock, vehicles, houses and other infrastructures.  The city remained submerged under water for more than 10 days due to the lack of necessary machinery to pump the water out, leading to severe damage to houses and buildings. 
Like other essential services, the health infrastructure totally collapsed with most hospitals remaining submerged under water.  Some hospitals were able to continue minimal services but they were left with no means to transport the sick and the injured.  The inpatients, most of whom were very unwell and some in critical condition were at the mercy of nature had it not been for the local volunteers who along with the on duty medical staff helped the patients to safety.  There was a looming risk of diseases worsened by the lack of clean drinking water, food, essential medicines and cold weather.  The situation became even grimmer when the bodies of dead animals started decomposing in the open and in the water bodies.  Even human bodies surfaced at many places.  The threat of water borne and contagious diseases loomed over the valley, just as the dark clouds continued to do so.  Death, decay and disaster were the only things clearly visible.
A lot has been written about the devastation, failure to manage the disaster and lack of appropriate response once the calamity was over.  Was this tragedy preventable by a proper forecast and warning system?  Was the state’s response and preparedness anywhere near adequate?  What caused such floods and devastation? Many people suggested that the floods were a manmade disaster for various reasons. Had the climate change even taken this picturesque valley into its grips? There are so many questions but hardly any answers.  Even after a year or more since the great flood, there hardly seems any change, reflection or preparedness for future disasters.  People are still living in constant fear and even a day’s rain reminds them that they may have to flee without any official warning.  Finally, the relief and rehabilitation of those worst affected, is still a mystery. When the physical rehabilitation is distant and people are still longing for the safety of their homes, it would be pointless to talk about psychological rehabilitation of the traumatised population.
Despite being prone to extreme weather, rains, floods and earthquakes, Jammu and Kashmir does not have any flood forecasting system or capacity for flood preparedness.  And the facts have not changed since the devastation of 2014.  Although, there was a nominal disaster management cell in the office of divisional commissioner Kashmir, once the floods took over, the cell went underground and has not since made any fresh claims.  The head of the meteorological department was the only source of news and somehow achieved celebrity status but was hardly able to address the worries and anxieties of people.  At times, he was used by the state administration to cover up its failures.
An analysis by the Centre for Science and Environment (CSE) suggests that the climate change and increased carbon emissions are responsible for heavy rainfall in the Himalayan region2.  The situation is worsened in Kashmir due to lack of appropriate drainage system.  If we talk about Srinagar only, the city has expanded beyond reason without any proper planning.  Most of the unplanned construction has taken place around river banks and encroachments are at its peak.  Huge buildings have come up in many flood-prone areas. Even many government offices like the Board of School education, State Hajj House, Police and Hospitals have been constructed in Bemina area of the city.  The area is actually meant to be the flood channel, which is supposed to divert the water in case of flooding in the Jhelum River.  One cannot help but wonder what were the clever city planners thinking, when they approved this land for the construction?   The corruption within the local administration means planning permission is hardly ever a problem and the alleged masterplan for the city has been dumped before it could have taken any practical shape.
As per the CSE ‘In the last 100 years, more than 50 percent of the lakes, ponds and wetlands of Srinagar have been encroached upon for constructing buildings and roads.  The banks of the Jhelum River have been taken over in a similar manner, vastly reducing the river's drainage capacity’.   Another research study undertaken by Directorate of Environment, Ecology and Remote Sensing concluded that, ‘During the past century, deforestation in the Jhelum basin led to excessive siltation in most of the lakes and water bodies of Srinagar and subsequent human greed brought about sustainable reclamation and land-use change in these assets of high ecological value’.  More than 9,119 hectares of open water surface and wetland have disappeared between 1911 and 2014 while only 6,873 hectares were preserved’3.  The encroachments and landfilling is an open secret.
The lakes like Dal, Nagin, Manasbal and Wular stand shrunk, invaded, and turned into a landfill by dumping the rubbish and excreta from the city and adjoining areas.  Mighty buildings, hotels and houses around the officially off-limits land have become part of the city’s identity.  The size of Dal Lake has shrunk from 22 square kilometres (8.5 sq mi) to the present area of 18 square kilometres (6.9 sq mi), and there is a concerning rate of sediment deposition due to catchment area degradation4.   Dal Lake has lost half of its water surface area in last forty years. The adjoining lakes like Gilsar, Khushalsar and Aanchar have all disappeared.  The feeding channels to these small water bodies have turned into landmass through heavy siltation.  Experts like Dr Shakil Romshoo of Kashmir University’s Earth Sciences department had recommended long ago that construction should be totally banned in this ecologically fragile area.  He had also suggested that measures like de-siltation of water bodies and afforestation programmes in catchment areas of the Jhelum should start on a war-footing.  "If the indifference of successive governments and the greed of the society at large has led to the degradation of our water bodies, we, at least, have to think of measures to save them from further degradation before it is too late,"5 But as usual, there are hardly any takers for such advice as the administration is working hand in hand with the land mafia turning the water bodies into a concrete jungle.
The Jhelum River with its origins from the Verinag spring in the Anantnag district passes through various parts of the valley before flowing into Pakistan.  With an increasing population and illegal construction boom encroaching on its banks, the capacity of the Jhelum River to carry usual amounts of water has significantly diminished.  This has meant even one day’s rainfall leads to water logging and potential risk of floods.  The other small rivers, streams and water bodies have suffered a similar fate. Some are at the risk of extinction and many have completely disappeared. 
It is no exaggeration to say that with the global climate change, increased risk of rainfall, lack of adequate drainage channels due to man-made encroachments, disappearing of wetlands and reduced capacity of lakes, Kashmir is at increased risk of flooding again, if necessary steps are not taken sooner.  There is a total lack of planning on the ground and buildings are popping up on any kind of land, from agricultural to forest. Who is responsible? Is it the civil society or the government? Why after so many disasters, nothing seems to change the public attitude or the State’s preparedness? Is the ongoing political conflict shadowing everything else in the state?
With the fragile political situation and the often mistrustful state-centre relationship, nothing much has been achieved as for the prevention and management of such disasters is concerned. Elections were called within few months of the devastating floods which led to regime change in the state.  That did not help matters either, as the administration got drawn into the conducting elections and poor flood victims were left at the mercy of no one.  The state government after preliminary estimates implied lacking enough resources to provide relief and rehabilitation of such enormous scale.  As the winter was approaching there was hardly any plan to house those living in makeshift camps.
There was a flood of non-governmental organisations (NGOs) during the deluge, both local and national. Many Kashmiris living outside India travelled back to help.  People worked hard all over the country to collect money and goods for the flood victims.  Here again, the effort was not organised and many people cried foul for various reasons.  Overall the NGO's were able to support, be it with clothes, medicine, money and other essentials. Many airlines agreed to carry the load free from Delhi and other major cities to Srinagar.  On the other hand, there were complaints that the administration is creating hassles in the process and not letting people work freely.  Obviously, it is hard to ignore the security concerns when it comes to the Kashmir valley.  Although there were many offers of international help, the Government of India did not accept that, claiming that the country was more than capable of dealing with the calamity.  Many in Kashmir felt that keeping away international aid was a step-motherly treatment to the people of Jammu and Kashmir and they were being taught a lesson for political reasons.
Indian Prime Minister Modi visited the valley pledging his support and announcing special assistance of Rs1000 crore for relief and rehabilitation.  He declared the floods as ‘national level disaster’.  On a subsequent visit, Mr Modi announced a relief package of Rs745 crore out of which Rs 570 were earmarked for relief to flood victims and Rs 175 crore for renovation of the six major hospitals. Meanwhile, the state government asked for a relief package of Rs44 000 crores from the centre for rehabilitation of flood affected.  Subsequently, the state officials denied that any money was received from the centre.  It was also alleged that a bill of Rs650 crore was raised against the Jammu and Kashmir State by the NDRF for the relief and rescue work.  Locally with the administration and the revenue department caught up in the election preparation, it was hard for people to even get the estimates of the damages they had suffered.
Despite all these announcements, estimates, packages, the fact remains that people on the ground did not get much relief or help.  Many families spent the last winter with their relatives where possible, some rented on extortionist prices and some suffered badly in open.   When the estimates were finally done, it was equally distressing for people as someone with a 2-3 storey building costing more than Rs 75-100 lakhs or  more, was given a meagre sum of Rs50-70 thousand which was not even enough for demolishing and clearing the site.  People who were considered to have partial damage of their houses were given a paltry sum of Rs 2300, which some felt was an insult to their suffering.  Actually ‘partially damaged’ meant that the house can crumble anytime with minor shakes, that too in this volatile earthquake prone area. Most people chose not to collect the money from the district administration.  Ironically, the second winter has arrived and the relief and rehabilitation has yet to start.  The red tape and bureaucracy of the place did not spare the flood victims and people mostly elected to depend on their own means. With the change in regime and the coalition between PDP and ruling BJP, things did not go any easy.  The State and central governments still seem to be at logger heads when it comes to the rehabilitation of flood affected though the same party (BJP) is in power at both places.
In November 2015, Prime Minister Modi again announced another package of Rs80 000 crore for the state of Jammu and Kashmir. Out of this, Rs2000 crore were earmarked for relief and rehabilitation of the flood affected population.  As the state came under Governor’s rule due to the death of ex-chief minister Mufti Mohammed Sayed, one could guess that whatever plans coalition government had proposed over the months are essentially lost.  It is surprising to know that orders for dredging the Jhelum River had to finally come from the Governor in January 2016 than the two elected Chief Ministers.  It is again announced that some money has been released from the Prime Ministers fund to rehabilitate the flood victims of 2014, but will they actually get it, remains to be seen.  One wonders, isn’t it too little, too late? Kashmir was engulfed by the uprising in 2016 with hardly any government or administration on ground barring the security apparatus busy with killings and blinding people. The great flood of 2014 became a distant memory, though the flood risk is higher than ever keeping in view nothing has changed on ground and Kashmir has received the best snowfall in years which would mean the water bodies will be running high in summer and any climatic change can lead to an unimaginable disaster. The proposed dredging never happened and flood is back like a flashback and it is only April and not September.
The state has yet to put in place the Flood Early Warning System (FEWS) for the Jhelum River.  At least, this could give a timely warning and people can attempt to leave for safety within a reasonable time. But it is hard to understand why there is so much delay even after repeated warnings from the experts.  Coming to the prevention of future floods, nothing solid has been put in place. Writing in the daily Greater Kashmir, Dr Romshoo quotes that when the flood was it its peak, Jhelum was discharging around 120 000 cusecs of water5.  Suggesting using the strategy of Relief, rehabilitation, reconstruction and risk reduction (4Rs) to deal with the disaster, he sounds dismayed that nothing moved beyond political jargon.  It seems that the state government did not use any proper methodology for assessing the damage, and if that was done, the centre will have little excuse in releasing more funds.  Experts have warned that post floods, the state is highly vulnerable for further flooding due to the weaker defences of the river banks, higher underground water levels and reduced water carrying capacity of the Jhelum River and its tributaries.  The current carrying capacity of River Jhelum is around 35 000 cusecs and that of flood channel around 5000 cusecs.  Even if Jhelum is dredged fully, its carrying capacity would not be more than 50 000 cusecs and 10000 cusecs for flood channel. What about if the rain doesn’t stop with water levels cross 120 000 cusecs?
Hence, the risk of impending floods is looming on the population who are still awaiting rehabilitation.  It is worth mentioning that the state of Jammu and Kashmir with its water resources, is a leader in the generation of hydroelectricity, most of which goes to the NHPC limited.  Would it not be reasonable that in return, the State gets some financial assistance from the NHPC to strengthen the rivers and make them more useful to carry the ever increasing load of water?  This may in return help with generating more electricity and revenue.
To conclude climate change, deforestation, encroachments and unplanned construction are continuing at full speed. The rivers have little capacity to carry increased load of water while the risk of incessant rainfall looms over Kashmir more than ever.  The state government is still in slumber and hardly anything has been done to prepare for and prevent further such disasters. With ever increasing political uncertainty in the state, one wonders if there would be any sincere efforts to save the population from further floods, earthquakes and other manmade disasters.  There should be, in place some form of prevention and preservation plan, before it is too late.




Footnotes:
3.      Humayun Rashid and Gowher Naseem, ‘Proceeding of Taal2007’: The 12th World Lake Conference, 653-658.
4.      Dal Lake". International Lake Environment Committee. http://www.ilec.or.jp/database/asi/asi-38.html

Friday 7 April 2017

Depression in Kashmir: In The Heart

Kashmir is a picturesque valley wedged between India, Pakistan and China. I trained and later worked as a psychiatrist at the only psychiatric diseases hospital of the valley which is based in the capital city of Srinagar. I remember the walk-in clinics, where at times we had up to 300 patients waiting eagerly to have few minutes with a psychiatrist despite the huge stigma associated with mental illness. The number of people seeking help for emotional problems grew exponentially after the armed conflict started in 1989. One of our studies reported the lifetime prevalence of exposure to the trauma of about 59%[1]. A recent survey by Medicines Sans Frontiers (MSF) reported that about half of the population is suffering from some kind of mental illness, with 50% women and 37% men suffering from a depressive illness[2].  During my research on PTSD patients, depression was again the most common comorbidity in more than 80% of the study sample[3].
One can argue that the diagnostic criteria as suggested in the ICD and DSM may not fully hold true in the local cultural context for the diagnosis of depression or even other disorders.   Asking the golden question, ‘How is your mood?’ usually gets a blank response.  People often talk in the context of ‘heart’ when talking about their emotions and feelings, rather than the mind. Typically, someone with depression would come saying, ‘My heart is not good’, usually pointing to their chest.  I remember asking, ‘How is your heart?’ more often than ‘How is your mood?’ Even the people from middle class and educated backgrounds would find it hard to discuss mood.  The same is true about anxiety disorders with palpitations and other somatic symptoms often being taken as a symptom of physical illness. http://www.rcpsych.ac.uk/pdf/VIPSIG_Depression_around_the_world.pdf
People usually do not come to the doctor with an idea that they will get treatment for depression or even that they may be depressed. It is usually the physical symptoms like tiredness, pain, palpitations, memory difficulties, medically unexplained symptoms, and weakness in limbs and headaches that bring them to the doctor.  Conversion symptoms are the most common presentations to the A&E department, typically a teenage girl not able to talk, move a limb or being unresponsive. This has a great cultural significance and is protective. If a woman reports feeling low to her husband, she would hardly be taken seriously and probably get told off for being lazy. However, when someone reports pain or physical symptoms, it is often taken seriously and considered a valid reason to seek help from a doctor. 

Depression and other mental health problems form the biggest group of illnesses and burden of disease in the local population. With such a variable presentation of symptoms, patients often go to all kinds of specialists, quacks and faith healers. This results in unnecessary costs, inadequate or wrong treatment and, at times, iatrogenic harm.  There is a need for training doctors and other health professionals in better identification and treatment of depression and other mental health disorders.  There has been some awareness both among the doctors and the general public in seeking right help for mental health problems.  Finally, medication still remains the sole therapeutic modality, keeping in view the lack of allied professionals like psychiatric nurses, psychologists and therapists. 


[1] Margoob, M. A., Firdosi, MM, Banal, R., et al. (2006). Community prevalence of trauma in south Asia: Experience from Kashmir. JK-Practitioner, 13(Supplement 1), S14-S17.
[2] Medicine Sans Frontiers (Doctors without Borders) ‘’Kashmir Mental Health Survey 2015’’ https://www.msfindia.in/sites/india/files/research_summary.pdf
[3] Firdosi MM, Margoob MA. Socio-demographic profile and psychiatric comorbidity in patients with a diagnosis of Post Traumatic Stress Disorder–A study from Kashmir Valley. Acta Medica International. 2016;3(2):97-100

Depression: Let's Talk

The theme of the World Health Day 2017 is “Depression: Let's Talk”, which is being celebrated on the 7th of April 2017.  According to the World Health Organization (WHO) estimates, the number of people living with depression has increased by more than 18% between 2005 and 2015.  More than 80% of this disease burden is among people living in low- and middle-income countries.  Globally, it is estimated that more than 300 million people suffered from depression in 2015.  Nearly half of these people live in South East Asia, China and India to be specific. As per WHO estimate, around 56,675,969 people suffer from depression in India, which is 4.5% of the total population. The same report suggests that depression is responsible for 10,050,411 years lived with the disability which is around 7.1% of the global burden of disease. Depression is ranked as the single largest contributor to global disability.  Depression is also the major contributor to suicide deaths which is close to 800,000 annually. However, when it comes to the allocation of resources and funds to tackle this global epidemic and disability, depression or mental health, in general, is usually not a priority for the policy makers.
Kashmir is not foreign to the concept of psychological problems and many reports have been published in the last year alone about the high prevalence of depression and other mental health problems in the local population. The number of people seeking help for emotional problems grew exponentially after the armed conflict started in 1989.  One of our studies reported the lifetime prevalence of exposure to the trauma of around 59% with most people having suffered directly or indirectly from some traumatic incident. A recent survey by the Medicines Sans Frontiers (MSF) reported that, about half of the population is suffering from some kind of mental illness, with 50% women and 37% men suffering from a depressive illness.  During my research on PTSD patients, depression was again the most common diagnosis in more than 80% of the patients.  Another study published by Action Aid India showed a high prevalence of depressive illness, anxiety disorders and other mental health problems.
The burden of disease more so in the female population is huge although we do not have actual numbers. The number of patients coming to the hospital is just the tip of the iceberg and many more do not seek help or aren’t aware that they can be helped. The awareness about depression and other mental disorders has improved overtime; however, there is still a lot of stigma associated with visiting a psychiatrist. I know of cases where families would not allow members to seek help for emotional problems fearing they would be judged by the society which at times, is true. Some families still prefer for their children to be in prison than in a psychiatric hospital and some go as far as paying to get their loved ones locked up.
Depression can present in various forms and I believe that the Western criteria set by the WHO or the American Psychiatric Association (APA) to diagnose depressive illness, are not always applicable to our population. The core symptoms of depression are low mood and lack of interest in pleasurable and day to day activities.  When we talk about mood, and expressing it in words, apart from some highly educated people, most are not aware of what it means. Hence asking someone, ‘how is your mood?’ does not apply. Most of us think in terms of ‘Heart' and something not right with it. ‘Meh Haz dil pareshan (My heart is sad)', ‘meh haz weanijih rawan (my heart is missing beats/palpitations)', are the classical statements one hears when talking to someone with depressive symptoms in our cultural context. It is one of the reasons why people suffering from depression end up visiting cardiologists and at times undergo expensive and unnecessary investigations, when in reality nothing is wrong with their heart or its proper functioning.
The common symptoms for someone suffering from depressing in our cultural context are tiredness, difficulties with memory, stomach problems, aches and pains, headaches, back pain, weakness in arms and legs, inability to move an arm or leg, episodes of loss of consciousness, weight changes, irritability, tearfulness, and suicidal thoughts. People usually do not come to the doctor with an idea that they will get treatment for depression or even that they may be depressed.  It is usually the physical symptoms like tiredness, pain, palpitations, memory difficulties, medically unexplained symptoms, and weakness in limbs and headaches that bring them to the doctor.  Conversion symptoms are the most common presentations to the casualty department, typically a teenage girl not able to talk or move her arms or legs or being unresponsive.  This has a great cultural significance and is protective. If a woman reports feeling low to her husband, she would hardly be taken seriously and probably be told off for being lazy.  However, when someone reports pain or physical symptoms, it is often taken seriously and considered a valid reason to seek help from a doctor. It is important then to be mindful, when going to the doctor repeatedly and not getting better, even after undergoing multiple treatments – one should strongly consider depression or an anxiety disorder as a possibility of on-going poor health.
Hence if you are suffering from symptoms as mentioned above or someone in your family is, please do consider depression and seek help. Depression is a treatable condition at a much lower cost than one would spend visiting various specialists and undergoing costly investigations.  Sometimes your psychiatrists or doctor may request tests like thyroid function and blood sugar which can be associated with depression.  People who suffer from long term physical health conditions like diabetes or heart disease are at an increased risk of developing depression than rest of the population.  Treatment of depression is necessary in such patients as it can affect the physical health condition adversely and worsen the outcome.  In people suffering from diabetes, treatment of depression helps with better blood sugar control.
One cannot blame the general public for not knowing where to seek help as it is not always easy to make sense of the symptoms.  It becomes the duty of every doctor to identify depression, treat it if they can and refer if they feel it is beyond their capability or area of expertise.  Unfortunately, at times people are put through unnecessary investigations and even invasive tests, deliberately or unknowingly when the problem lies somewhere else. Some female patients typically suffering from vague pain symptoms are advised to have surgeries like removal of the uterus which not only deprives the woman of an essential organ but in long run, makes her depression and pain symptoms worse. It is an open secret that there is an epidemic of such unnecessary surgeries and even young girls who have even not conceived are deprived of their womb.  This can only be stopped when people are aware about their symptoms.  It is therefore imperative that patients seek a second opinion and rule out depression before going under the knife.
Lately, there has been a surge in the number of people, including doctors writing about depression, its causes, suicide and other mental health issues.  This may seem a harmless enough exercise to most people, but when doctors who are themselves uninformed write about such issues in a manner that causes more harm than good, the results can be devastating.  Many articles have been published which instead of informing, misinform the general public and increase the stigma already attached to depression and suicide.  Sadly, some have even gone as far as to suggest that depression and suicidality are due to a lack of willpower and go on to sermonise with threats of hell and wrath of God.  People who suffer from depression and suicidal thoughts are already under tremendous pressure from the illness and need treatment, not threats.  They need support and empathy.  To call people suffering from depression and suicidal thoughts as weak-willed or cowards or idiots is not only derogatory but deeply shameful and inhumane.  Such articles and misinformation can trigger or even push someone over the edge by worsening their feelings of guilt and putting them through shame.  Let's reiterate again that depression and other mental health problems are clinical conditions, mostly treatable and at times curable.  Like diabetes and high blood pressure, people suffering from depression need medicine and other help on an ongoing basis.  Hence it is better to seek the right help at the right time to reduce the disease burden and improve the quality of life.  Doctors have a huge role to play in reducing the stigma, identifying those suffering from depression and providing the right treatment.  The media houses also have a huge responsibility to check that what is printed is not misleading and ask expert opinion before publishing in public domain.


SUICIDE AND RESPONSIBLE MEDIA REPORTING: WHAT IS WRONG IN KASHMIR?

Suicide is not new to any society including Kashmir Valley. However, in recent months there has been an escalation both in the number of sui...