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| Kashmir, Under Siege and Lockdown, Faces a Mental Health Crisis | Kashmir, Under Siege and Lockdown, Faces a Mental Health Crisis |
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| PAHOO, Kashmir — Sara Begum’s suffering began on Aug. 3, when masked policemen barged into her home, badly roughed up her son and whisked him away. | PAHOO, Kashmir — Sara Begum’s suffering began on Aug. 3, when masked policemen barged into her home, badly roughed up her son and whisked him away. |
| Ms. Begum’s son, Fayaz Ahmad Mir, 28, was one of thousands of civilians arrested or detained by order of the Indian government after it moved forcefully to cement its control over Kashmir, a largely Muslim region of about eight million people claimed by both India and Pakistan. The clampdown has disrupted daily life, with many people feeling besieged and afraid to leave their homes. | Ms. Begum’s son, Fayaz Ahmad Mir, 28, was one of thousands of civilians arrested or detained by order of the Indian government after it moved forcefully to cement its control over Kashmir, a largely Muslim region of about eight million people claimed by both India and Pakistan. The clampdown has disrupted daily life, with many people feeling besieged and afraid to leave their homes. |
| Since her son was arrested, Ms. Begum has become gaunt and unsteady, but she and her family say her worst afflictions have been mental and emotional. She now takes sertraline and lithium, both antidepressants. She tried twice to commit suicide, once by consuming rat poison and again by jumping into a river. | Since her son was arrested, Ms. Begum has become gaunt and unsteady, but she and her family say her worst afflictions have been mental and emotional. She now takes sertraline and lithium, both antidepressants. She tried twice to commit suicide, once by consuming rat poison and again by jumping into a river. |
| “When I close my eyes,” Ms. Begum said, “I see my son shouting, ‘Mother, I want to see you.’” | “When I close my eyes,” Ms. Begum said, “I see my son shouting, ‘Mother, I want to see you.’” |
| Eight months after India revoked Kashmir’s semiautonomous status and brought the region fully under its authority, doctors here say a state of hopelessness has morphed into a severe psychological crisis. Mental health workers say Kashmir is witnessing an alarming increase in instances of depression, anxiety and psychotic events. | Eight months after India revoked Kashmir’s semiautonomous status and brought the region fully under its authority, doctors here say a state of hopelessness has morphed into a severe psychological crisis. Mental health workers say Kashmir is witnessing an alarming increase in instances of depression, anxiety and psychotic events. |
| Hard data is difficult to come by, but local medical professionals say they are seeing a rise in suicides and an increase in already disturbingly high rates of domestic abuse. | Hard data is difficult to come by, but local medical professionals say they are seeing a rise in suicides and an increase in already disturbingly high rates of domestic abuse. |
| A nationwide lockdown that India imposed across the country in recent weeks to fight the coronavirus has worsened the problem, the medical professionals say. Police officers block roads with coils of glistening concertina wire. Any residents who step out of their homes, especially in Kashmir’s towns and cities, risk getting beaten up. | A nationwide lockdown that India imposed across the country in recent weeks to fight the coronavirus has worsened the problem, the medical professionals say. Police officers block roads with coils of glistening concertina wire. Any residents who step out of their homes, especially in Kashmir’s towns and cities, risk getting beaten up. |
| Doctors and researchers say the Kashmir Valley, tucked into the Himalayas, has few resources to cope. This area has been mired in conflict for decades, with its majority-Muslim population agitating for independence or at least more autonomy from India, which is majority Hindu and controls most of Kashmir. Pakistan controls a smaller slice. | Doctors and researchers say the Kashmir Valley, tucked into the Himalayas, has few resources to cope. This area has been mired in conflict for decades, with its majority-Muslim population agitating for independence or at least more autonomy from India, which is majority Hindu and controls most of Kashmir. Pakistan controls a smaller slice. |
| Even before the events of recent months, decades of violence between Indian security forces and Kashmiri militants had taken a physical and mental toll on the region and its people. Nearly 1.8 million Kashmiris, or nearly half of all adults, have some form of mental disorder, Doctors Without Borders estimated after surveying 5,600 households in 2015. Nine of 10 have experienced conflict-related traumas. The figures are much higher than in India, according to other surveys. | Even before the events of recent months, decades of violence between Indian security forces and Kashmiri militants had taken a physical and mental toll on the region and its people. Nearly 1.8 million Kashmiris, or nearly half of all adults, have some form of mental disorder, Doctors Without Borders estimated after surveying 5,600 households in 2015. Nine of 10 have experienced conflict-related traumas. The figures are much higher than in India, according to other surveys. |
| A leading psychiatrist said he was overwhelmed. Dr. Majid Shafi, a government psychiatrist, said that last year he saw a hundred patients a week. Now he sees more than 500. Overall, Kashmir has fewer than 60 psychiatrists. | A leading psychiatrist said he was overwhelmed. Dr. Majid Shafi, a government psychiatrist, said that last year he saw a hundred patients a week. Now he sees more than 500. Overall, Kashmir has fewer than 60 psychiatrists. |
| A long line snakes out of Dr. Shafi’s office — teenagers traumatized by violence; mothers too worried about their incarcerated children to sleep; businesspeople owing a mountain of debt that is climbing higher and higher under a lockdown that has shuttered nearly everything. | A long line snakes out of Dr. Shafi’s office — teenagers traumatized by violence; mothers too worried about their incarcerated children to sleep; businesspeople owing a mountain of debt that is climbing higher and higher under a lockdown that has shuttered nearly everything. |
| “This is just the tip of an iceberg,” said Dr. Shafi, the single government psychiatrist for around a million people in the district of Pulwama. “The crisis is growing.” | “This is just the tip of an iceberg,” said Dr. Shafi, the single government psychiatrist for around a million people in the district of Pulwama. “The crisis is growing.” |
| Every season of turmoil in Kashmir brings a new kind of pain. One season is marked by the corpses of teenage boys felled by Indian forces. Another brings an epidemic of dead eyes, as Kashmiris refer to protesters left blind after being struck in the eyes by pellets fired by police officers. | Every season of turmoil in Kashmir brings a new kind of pain. One season is marked by the corpses of teenage boys felled by Indian forces. Another brings an epidemic of dead eyes, as Kashmiris refer to protesters left blind after being struck in the eyes by pellets fired by police officers. |
| This past year will be remembered for the crackdown. In August, the Indian government suddenly stripped away statehood from Jammu and Kashmir, which had been India’s one Muslim-majority state. | This past year will be remembered for the crackdown. In August, the Indian government suddenly stripped away statehood from Jammu and Kashmir, which had been India’s one Muslim-majority state. |
| Security forces flooded the area, cut off roads, shut down landlines, cellphone lines and the internet, and arrested thousands of Kashmiris, from students to top elected officials. Some have been released, but many remain in jail. Though some phone and internet service have been restored, they remain nothing close to pre-crackdown levels. | Security forces flooded the area, cut off roads, shut down landlines, cellphone lines and the internet, and arrested thousands of Kashmiris, from students to top elected officials. Some have been released, but many remain in jail. Though some phone and internet service have been restored, they remain nothing close to pre-crackdown levels. |
| Many Kashmiris, who used social media to socialize because it was dangerous to hang out in the streets, now feel completely isolated. Children have remained out of school for months. Because of the military crackdown and then the coronavirus lockdown, students have been in school only a few weeks. | Many Kashmiris, who used social media to socialize because it was dangerous to hang out in the streets, now feel completely isolated. Children have remained out of school for months. Because of the military crackdown and then the coronavirus lockdown, students have been in school only a few weeks. |
| Ms. Begum’s family said her son, a farmer, participated in protests against the Indian government a few years ago, as did thousands of other Kashmiris. They believe this is why he was arrested in the roundups in August. Ms. Begum, who is in her 60s, raised Mr. Mir during the heyday of the insurgency, shielding him from the wrath of security forces and militants alike. | Ms. Begum’s family said her son, a farmer, participated in protests against the Indian government a few years ago, as did thousands of other Kashmiris. They believe this is why he was arrested in the roundups in August. Ms. Begum, who is in her 60s, raised Mr. Mir during the heyday of the insurgency, shielding him from the wrath of security forces and militants alike. |
| He is being held in a jail hundreds of miles away on vague charges of being a “threat to peace,” family members said. They don’t have money to visit. When the cellphone network was switched back on in October, the authorities promised a video call. That has not yet happened. | He is being held in a jail hundreds of miles away on vague charges of being a “threat to peace,” family members said. They don’t have money to visit. When the cellphone network was switched back on in October, the authorities promised a video call. That has not yet happened. |
| Ms. Begum, increasingly demoralized, said her son had been “stolen” from her. Ms. Begum says she sees her son in dreams, his face covered in bandages, his hands shaking in fear. He begs for water, but she feels chained, unable to move. | Ms. Begum, increasingly demoralized, said her son had been “stolen” from her. Ms. Begum says she sees her son in dreams, his face covered in bandages, his hands shaking in fear. He begs for water, but she feels chained, unable to move. |
| According to India’s home ministry, Mr. Mir was among more than 7,000 people arrested in August. Of those, more than 450 are still in jail, including Mr. Mir. | According to India’s home ministry, Mr. Mir was among more than 7,000 people arrested in August. Of those, more than 450 are still in jail, including Mr. Mir. |
| Many, including three former chief ministers, were detained under India’s Public Safety Act, a law that allows the authorities to jail suspects without charge for up to two years. | Many, including three former chief ministers, were detained under India’s Public Safety Act, a law that allows the authorities to jail suspects without charge for up to two years. |
| People who were recently released spoke of the humiliation and fear they experienced behind bars. | People who were recently released spoke of the humiliation and fear they experienced behind bars. |
| Bilal Sultan, a politician, was placed with hardened criminals, he said. He slipped into depression. In February, he said, he was set free because his doctors were afraid he might kill himself. | Bilal Sultan, a politician, was placed with hardened criminals, he said. He slipped into depression. In February, he said, he was set free because his doctors were afraid he might kill himself. |
| Mr. Sultan takes sleeping pills and complains of a recurring dream in which he is traveling to a tourist resort before soldiers stop him and shoot him between the eyes. | Mr. Sultan takes sleeping pills and complains of a recurring dream in which he is traveling to a tourist resort before soldiers stop him and shoot him between the eyes. |
| Updated June 5, 2020 | Updated June 5, 2020 |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| “I was a very strong man,” Mr. Sultan, 55, said recently at his house in Srinagar. “Now I fear my own children.” | “I was a very strong man,” Mr. Sultan, 55, said recently at his house in Srinagar. “Now I fear my own children.” |
| Kashmir’s new generation, long accustomed to violence and bloodshed, may be the hardest hit. | Kashmir’s new generation, long accustomed to violence and bloodshed, may be the hardest hit. |
| Before the August clampdown, Nida Rehman, 28, wanted to lift the spirits of others by setting up a nonprofit organization to raise awareness for mental health issues. But she says she has failed to learn the lessons she gave to others. | Before the August clampdown, Nida Rehman, 28, wanted to lift the spirits of others by setting up a nonprofit organization to raise awareness for mental health issues. But she says she has failed to learn the lessons she gave to others. |
| In pictures, she looks happy. But the trauma has withered her. She has lost weight, her cheeks sunken, her eyes ringed by dark circles. | In pictures, she looks happy. But the trauma has withered her. She has lost weight, her cheeks sunken, her eyes ringed by dark circles. |
| Last year, Ms. Rehman visited a psychiatrist, who diagnosed acute depression. She doesn’t sleep for days. She found some relief by spending hours with a caged parrot, Noor, that her family kept. | Last year, Ms. Rehman visited a psychiatrist, who diagnosed acute depression. She doesn’t sleep for days. She found some relief by spending hours with a caged parrot, Noor, that her family kept. |
| “I felt I was living in a cage, like Noor,” Ms. Rehman said. “That happy world slipped out of my hands.” | “I felt I was living in a cage, like Noor,” Ms. Rehman said. “That happy world slipped out of my hands.” |
| After her relatives found her talking to the parrot, they grew worried and embarrassed, persuading her to release it. One evening, in October, Ms. Rehman set Noor free. | After her relatives found her talking to the parrot, they grew worried and embarrassed, persuading her to release it. One evening, in October, Ms. Rehman set Noor free. |
| It didn’t help. Ms. Rehman is now taking regular doses of antidepressants. | It didn’t help. Ms. Rehman is now taking regular doses of antidepressants. |
| So is Ms. Begum, the mother of the imprisoned Mr. Mir. As days get longer and weather begins to warm, she finds herself staring at a tractor parked outside her house. Mr. Mir bought it on a loan. The bank is now threatening to seize the family’s home. | So is Ms. Begum, the mother of the imprisoned Mr. Mir. As days get longer and weather begins to warm, she finds herself staring at a tractor parked outside her house. Mr. Mir bought it on a loan. The bank is now threatening to seize the family’s home. |
| Ms. Begum’s hands tremble and her lips quiver as she speaks. The desperation has incapacitated her. She can’t even cook, she said. | Ms. Begum’s hands tremble and her lips quiver as she speaks. The desperation has incapacitated her. She can’t even cook, she said. |
| “I may never see my son again,” she said. “I feel I will die before he comes back home.” | “I may never see my son again,” she said. “I feel I will die before he comes back home.” |
| Iqbal Kirmani contributed reporting. | Iqbal Kirmani contributed reporting. |