Healing Kashmir
By Arunima Rajan
From schools in Srinagar to remote villages, this NGO tries to soothe the psychological wounds of conflict.
Jammu &Kashmir is not an easy place to be even during times of peace. For the rest of India, it may be hard to understand the trauma of people in the valley people where there is no guarantee that your family member will come back home from work. Justine Hardy, a journalist and mental health practitioner, has witnessed this trauma up close. She has been working as a mental health activist in the field of trauma in South Asia for the last thirty years.
Hardy had been visiting J&K since she was a child and covered it during the 1990s as a journalist. She was also studying psychology at that time. She wrote two of several post-graduate theses on the treatment of trauma in conflict zones, including Kashmir.
After a major earthquake struck the Kashmir valley in October 2005, she began researching ways of treating traumatic stress that could harness local knowledge and the social systems in place. She started working in rural clinics, hospitals and schools in Kashmir. In 2008 Hardy founded Healing Kashmir (now Healing Minds Foundation), an integrated mental health organisation based in Kashmir’s capital, Srinagar. The Foundation has outreach centres around J&K, a suicide helpline, a primary mental health care programme, paramedic training, mental well-being models in schools and colleges, and national and international internship programmes. She continues to work with the team on a daily basis, both in situ and remotely. In addition, she is the senior clinician of another conflict trauma programme. There, she functions in additional roles as well. Arunima Rajan spoke to her about what it meant to undertake this mission in a region long battered by strife.
How did you and your co-founder Dr. Arshad Hussain begin to build trust in communities that have every reason to be wary?
The work with Dr Arshad Hussain was confined to hospital settings. His courtesy to his patients in the noise and throng of over-crowded psychiatric OPDs (out-patient departments) gave those he was seeing a level of dignity and attention that was rare in such places. It was clear that a ‘Western-informed’ diagnostic/clinical model was being applied which overlooked the local systems of community support. Then there was the major issue of the stigma around mental health at every level of community life. Working within communities, as we do now, has a very different quality as trust only comes as the dividend of long investment in time and attention. They are not really aha! moments, but more a series of slow realisations springing from connection and trust.
Our team is drawn directly from the communities in which we work so they are familiar faces. Let me give an example. One of our team members, working beyond Baramulla, paid his way through college by working with his father, a wazwani, a Kashmiri feast cook. Years later, once qualified and working with us, he was at a PHC, a primary health centre. ‘Ah, so what are you now, a wazwani or a doctor?’ asked a gentleman waiting there, recognising our
colleague from his wazwan days. As a result of this question our colleague was able to have an easy conversation with the gentleman, the connection allowing the older man to talk about the stressors in his life in a way that would have been harder, if even possible, with a stranger.
You’ve reported from militant camps and sat with survivors in the aftermath of war. When you look back at your time as a conflict journalist, how did those encounters with human fragility shape the way you now approach trauma? Was there a particular moment in the rubble of the 2005 Kashmir earthquake that made you realise the limits of storytelling and the need for something more?
It is interesting that you ask about ‘the limits of storytelling’. Beyond writing, storytelling remains a constant in trauma therapy. For those who have been silenced or who are feeling helpless, the chance to be able to tell their story is an early and important step towards a return to health. I have always felt very grateful to be doing these things side by side, as in listen to very personal stories in the privacy of the therapeutic setting while also exploring how to write about the life of the mind in ways that might engage readers in a deeper understanding of their own inner stories and patterns. The connection between writing and trauma has always been moving in tandem as, earlier in my career, while I was writing, I was also training as a trauma practitioner. At every stage, each part seemed to help inform the other. But can I think of a particular moment of realisation? I think it was more of a growing sense of the ‘loss of self’ amongst individuals and communities living through violence, as this kept posing the question, ‘What would a return to self look like?’
What does sustainable engagement mean in a place where aid is often temporary and trust is slow to come?
The foundation blends immediate crisis care with longer-term programmes within communities. In a region where stability is often short-lived, it is very hard to build quantitative research on this in a setting that is so volatile. So, we rely on qualitative feedback and this shows up in many ways. An example is our schools programme, Young Minds. This involves working with students over an extended period, giving them a ‘psychological tool kit’ that helps them to recognise when they are destabilised, as in dysregulated, and how to manage extreme emotions and the physical reactions that accompany those extremes of emotion. As we implement in each school, we support programme volunteers from amongst the students. We keep following up, both with the volunteers and with the teaching staff. The teachers report to us the extent of improved classroom behaviour and how much they believe their students’ attention and focus have increased.
Students add another perspective, telling us that they are finding things easier at home, that they are doing well with their friends and even how they are teaching their families the same skills, laughing as they tell us something like teaching their grandmother or grandfather how to release tension in their shoulders.
How do you get around the stigma that is associated with seeking help for mental health?
Magical and momentous breakthroughs are rare because of our minds being designed to be vigilant for our protection. Within violent societies that vigilance become hyper, making any shifts in perception a long, slow process. Let’s take the make-up of Kashmiri society, with, say, the older generation still perpetuating this idea of the pagal khanas (mental asylums), passing the stigma down the generations. Then you hit the internet era when people begin to see the global conversations going on about mental health, and so the stigma shifts a little, with blips when internet rumours fuel various scares, such as the one about the Covid vaccination making people sterile or impotent. As another, newer generation begins to find it easier to speak about their mental health, they are also being pressured by the dangerous standards of perceived perfection on social media, bringing with them another whole new variety of anxiety. So, self-stigma remains a constant, fuelling anxiety in just about every aspect of society.
How does a child growing up amidst curfews and gunfire learn what safety feels like? In the wake of recent events such as the Pahalgam attacks and Operation Sindoor, what patterns are you noticing in the kinds of trauma people carry, especially among young people who have never known peace?
Children and young adults whose early lives have been spent against a backdrop of violence adapt in ways, both physically and psychologically, that can make it very hard for them to enter adulthood without extensive internal and external scars, particularly when it comes to the idea of safety. Each round of renewed violence adds another obstructive layer to this development. In the aftermath of recent violence, we are seeing a marked increase in anxiety amongst school and university students who are frightened for their physical safety because of the current situation in Kashmir. This state of existing in their sympathetic, survival, nervous systems for so much of the time makes it hard for them to focus on studies as the anxiety constantly distracts them. This circles around to add yet another layer of anticipatory anxiety about their futures.
As our team grew up and was educated in this same environment, it is wholly sympathetic to the challenges these students are facing. A core aspect of how we work as a team is a constant focus on both personal wellbeing and group self-care, and nurturing family and friendship connections. As they already live and work with these coping skills themselves, it makes it easier for them to share them with the groups of people that they are working with, particularly at times of crisis when ‘psychological first aid’ becomes so important.
Healing Minds employs over 30 Kashmiris and works closely with Anganwadi workers. A long-term part of our practice has been a push against the imposition of ‘Western clinical models’. These models and frameworks can be highly effective in their settings of original research and implementation, but can a diagnosis for complex grief, researched in a society that has almost clinically edited death out of daily life, really apply in a setting where death is omnipresent? And so, is it ‘leading from behind’ to support an on-going focus on context, on the ‘here and now’ of the team’s daily situations? I keep hoping so.
What are your future plans?
This century, most of the global mental health focus has been on large-scale interventions. The nature of trauma defies this approach because every individual’s story is different. I will continue to advocate for working deeper rather than wider, and to practise this - go into communities, become known, build trust, support people in overcoming their fears around mental health.
The evidence is that this ‘taking it to scale’ has not really worked. At our core is a way of working that is almost the opposite of this, as in working at depth. We focus on becoming increasingly integrated within the communities in which we work, using ideas and models that are both sustainable and adaptable to changing circumstance.
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