SRINAGAR, India — The wounds of Kashmir's never-ending war are reflected in Arshid Malik's red, downcast eyes, in the tremble of the cigarette in his hand, in the self-inflicted knife scars gouged into his left forearm.
Tormented by unrelenting memories of death and violence, he tried 13 times to end his pain with suicide, sometimes slicing open his wrists, other times swallowing fistfuls of pills, he said.
"I was crying inside, but there was nobody I could talk to because everyone was grieving," the 36-year-old said.
More than two decades of brutal warfare between largely Muslim separatist insurgents and largely Hindu Indian troops in this Himalayan region have left Kashmiris exhausted, traumatized and broken.
The rate of suicide, once unthinkable in this Islamic society, has gone up 26-fold, from .5 per 100,000 before the insurgency to 13 per 100,000 now, according to Dr. Arshad Hussain, a Kashmiri psychiatrist. Drug abuse is epidemic. Depression, stress and mental illness are rampant.
"Directly or indirectly, everyone is suffering," said Dr. Muzafer Khan, who runs a small rehab clinic in Srinagar, the main city in the part of Kashmir controlled by India.
One man turned to drugs after seeing an uncle and two cousins shot in front of him; another became an addict after he was kidnapped by a pro-government militia, Khan said. A third-grader wouldn't go back to school for two years after he watched gunmen break into his classroom, tie up his teacher and shoot him, another doctor said.
'Midnight knock syndrome'
Villagers accustomed to late-night searches by security forces have developed "midnight knock syndrome" and are so jumpy they can't sleep without pills, Khan said.
For more than 60 years, the stunning Kashmir valley has been a flashpoint for tensions and wars between rivals India and Pakistan, which both control part of it and lay claim to all of it. Despite the fierce fighting, the tight-knit Muslim families of Kashmir formed a durable safety net.
That fell apart when a separatist insurgency erupted in 1989.
Children were caught in the crossfire between Muslim separatists and the pro-Indian government militia. Others were forced into informing on their families. Parents disappeared in the middle of the night, many into mass graves where their bodies were never unidentified.
An estimated 68,000 people were killed. Nearly every one of the valley's 6 million people has been touched by violence. The conflict has created two lost generations, the teenagers of 1989 who saw their childhoods collapse into civil war, and the teenagers of today who never had a childhood at all.
About 19 percent of Kashmiris suffer from depression, said Dr. Mushtaq Margoob, a psychiatrist who has done extensive studies on trauma in Kashmir. Nearly 16 percent have post-traumatic stress disorder. In the U.S., less than 7 percent of adults suffer from depression and 3.5 percent have post-traumatic stress disorder, according to the National Institute of Mental Health.
"They see someone get killed in their presence, some friend, some relative, and they get stuck in that moment," Margoob said.
Suffering and soothing the pain
Kashmir's mental health network is overwhelmed. Before the conflict, Margoob and the other doctors at the psychiatric hospital in Srinagar saw 1,700 patients a year; now they see 100,000, he said. A newly opened psychiatric ward in a nearby hospital sees another 40,000.
One-third of Kashmiris questioned in a 2006 Doctors Without Borders survey said they had thought of killing themselves in the previous month. Most said they were nervous, tense or worried, were easily frightened and suffered from trembling hands. Nearly half had trouble sleeping and cried more than usual.
Children, inured to the violence, have become angry, aggressive and helpless, said Margoob. Worse, they don't fear death. It is this generation that picked up rocks in violent protests this summer, ignoring a crackdown by security forces that has killed more than 50 people.
There is a complete breakdown of the social fabric, said Dr. Wiqar Bashir, who is haunted by the 9-year-old he was unable to revive after the boy hanged himself four months ago. Children that young are simply not supposed to think about suicide, he said.
Drug abuse has become widespread. Kashmir, a traditional center of mystical Sufi Islam, has a long history of opium and marijuana use in cultural practices. But now many are addicted to smoking heroin and hash, while others are taking codeine-laced cough syrup and prescription opiates from the rash of unregulated pharmacies that sell even morphine without a prescription. Teens regularly sniff glue, corrective liquid and even cooking gas.
"It's rampant here, it's really rampant," said Bashir, who works at a small drug rehab center in Srinagar that has seven beds and a waiting list of 150 people.
Ahmed Dar, 25, came to the clinic last year broken in mind and body. He had two crushed legs from a bus accident and convulsions from heroin withdrawal.
When he was 17, he toyed with joining the insurgents for a month, but never picked up a gun. Then he went over to the army side and toyed with becoming an informant. He smoked hash and drank cough syrup to deal with the pressure, he said.
When he met the militants again, they shot him three times in the arm and leg, sending him to the hospital for a month. Then a business setback sent him crashing into heroin addiction.
"Whenever I took the heroin, I never felt my wounds," he said. "I felt tremendous solace."
With the help of the clinic, Dar has cleaned himself up. But Kashmir, which has only 13 or 14 psychiatrists in addition to a Doctors Without Borders therapy team, would need 200 psychiatrists and thousands of therapists to deal with the trauma, doctors say.
'People were aghast'
Malik, a Muslim, was 15 when the fighting started. His school, run by Hindus who were largely seen as pro-government collaborators, shut down when the administrators fled. His Hindu friends ran as well.
Checkpoints choked off his Srinagar neighborhood. Gunfights broke out. Acquaintances got killed.
Then, on Jan. 20, 1990, Indian paramilitary troops fired on a peaceful demonstration crossing the nearby Gawakadal Bridge, killing more than 50 people and sending thousands fleeing in terror past the teenaged Malik.
"People were running. Blood was rushing out. They were falling in the gutter. People were aghast. Women were crying," he said.
Malik wasn't physically wounded, but he would never recover.
"There was a deeper kind of hurt that passed onto me," he said quietly, as his eyes welled up.
The ensuing years were filled with crackdowns on protesters, militant grenade attacks on government forces, and late-night police raids that forced his family and their neighbors to sit in the winter cold for hours, "not knowing what was going to happen next, and fearing," he said.
By the time he got to college, the playful, talkative boy who loved cricket and badminton had shut down. People were so busy burying the dead, tending to the wounded and trying to survive that no one paid attention to his suffering.
"It used to come in huge flows that would sweep me off," he said. "I used to think, let me get this over with."
One day as he studied quietly in his room, he swallowed 100 tranquilizers. His family got his stomach pumped. Three months later, he took more pills. Later he turned to knives.
Some were serious attempts to end his pain; others were screams for attention, he said.
His family and friends were furious. How could he be so selfish when so many were dying?
His mother took him to a faith healer, who said he was cursed. His father burned his books, because he thought they were making it worse. Psychiatrists debated whether he was bipolar or borderline schizophrenic.
On the brink of being institutionalized, Malik decided he couldn't stand to cause his family any more pain. He suppressed his agony, got a job as a business executive, got married and had a son.
But he suffers from headaches and stomach problems, and his emotional issues, though under control, remain unresolved, he said.
"I hardly talk to anybody about this," he said. "Nobody would be interested anyway."
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