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How unprocessed trauma is kindling communal violence in South Asia in the 21st century

Stanford psychiatrist Shaili Jain’s research and experience are creating more awareness of PTSD.

Stanford psychiatrist Shaili Jain’s research and experience are creating more awareness of PTSD.   | Photo Credit: Special Arrangement

Stanford psychiatrist Shaili Jain is among the world’s leading experts on post-traumatic stress disorder

Stanford psychiatrist Shaili Jain’s family history is one of trauma and tragedy. Her paternal grandfather was murdered during Partition in 1947. Her father, who was 10 at the time, was forced to flee his home and become a refugee in India, where he worked as a child labourer.

Two decades later, he would immigrate to England, where Jain was born and raised. “I spent chunks of my youth living in the shadow Partition had cast on his life and with a feeling that no matter how much I loved him, and he loved me, a part of him forever changed in 1947 and remained inaccessible,” she says.

This lingering trauma, more commonly known as post-traumatic stress disorder (PTSD), influenced her decision to opt for a career in medicine and later specialise in psychiatry. She has always been fascinated by “the connections between thought, emotion and behaviour, in deconstructing emotional suffering and finding ways to alleviate psychological distress” — to the extent that she decided that Partition, which had, all along, been central to her own life and career choices, should be at the heart of her first book, The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, released last August.

“Trauma often represents the violation of all we hold to be dear and sacred. Such events are simply too terrible to utter aloud and hence they become unspeakable,” says Jain, explaining the book’s title. “Sometimes the survivor wishes to speak, but the wider community is unwilling or unable to bear witness to their story, so the survivor is forced into silence.”

Science of suffering

The problem is that PTSD thrives in such conditions.

In her capacity as a trauma scientist, Jain diagnoses the festering sectarian tensions in South Asia as a result of repression, dissociation and denial operating on a societal level. “The science of suffering tells us that there is a big price to pay for such collective denial. Atrocities don’t remain buried forever. As powerful as the desire is to deny, in the long run, it does not work. I feel strongly, that this unprocessed collective trauma has engendered future spirals of communal violence in South Asia, a violence that continues to be re-enacted in the 21st century.”

Today, she is considered to be one of the world’s leading experts on PTSD. Her research and almost two decades of treating thousands of trauma survivors are part of a revolution in understanding and treating the illness. “Traumatic thoughts and memories that remain “unspeakable” or “unthinkable” for too long often impede our brain’s natural process of recovery after trauma,” says Jain. “They become stuck points that inhibit the mental reintegration needed for healing to occur. PTSD mutes happiness and yields, instead, to an irritability that keeps sufferers on the perpetual verge of withdrawal from the world and alienation from those who love them.”

The causes of PTSD are many. Rape, family violence, being mugged, escaping a major accident, being a political or economic refugee are just some examples. Higher rates of PTSD are found in the armed forces, but they are also found in police officers and low-income women and youth who reside in urban ghettos and shanties. PTSD is often found among the depressed, alcohol- and drug-addicted, and the anxiety-ridden. All sufferers are at higher risk of death by suicide, so the collective mental health burden is huge.

Dr. Jain is playing a significant role in informing the world about how widespread the condition is and the urgency of treatment. Indeed, trauma-related disorders, overall, are the largest cause of health problems and disability worldwide, more than cardiovascular diseases and cancer combined. They can also be infectious. Family members of people with the condition are at higher risk of inheriting it themselves. “PTSD seeps beyond the confines of the mind or brain and alters the body’s hormone secretion, neurochemistry and immune system. This contributes to diseased cells, organs, and other bodily systems. It has emerged as a risk factor for many conditions — cancer, heart disease and obesity — to name a few.”

A ‘Western’ problem

According to a recent World Health Organization-sponsored study, India is the world’s most depressed country, with one of the highest suicide rates in the world. According to the study, a student commits suicide every hour in India and over 2,20,000 people take their own lives every year. Data from the 2015-16 National Mental Health Survey (NMHS) indicates that every sixth person in India needs mental health help of some sort. Despite all this, there is an unsettling resistance — on the part of influential thought leaders — to mental health being a problem in India. There is a belief that it is somehow an American/ Western problem. The average Indian would rather go to a ‘spiritual’ healer than seek professional help for their issues. And the concept of psychotherapy is largely unknown outside of the major metros.

PTSD has always been endemic to our society, however, it has not always been acknowledged as such. Partly because hidden psychological wounds are harder for people to understand, but also because the socially disadvantaged are most vulnerable to the effects of prolonged exposure to trauma. So, if the victim is from a marginalised or impoverished background, historically, their trauma account might not be validated by wider society.

“When it comes to trauma and PTSD, as a society we must accept how one’s social reality can have a profound influence on one’s mental health and biology,” says Jain. “As an example, if you are raised in a culture where family violence is the norm or perpetrating sexual violence is acceptable, the odds are that will leave an imprint on the way you think and behave, not only on a psychological level but on a cellular level too. Hurt people, hurt people. There is no shame in recognising a need to undo such harm.”

Silence and denial

It is also important to challenge the stigma around mental health in India. People are not likely to open up if disclosing a history of trauma or mental health distress will expose them to prejudice or have a detrimental effect on their professional or personal life. If victim-shaming continues, then the silence and denial surrounding mental health will not go away. Therefore legal and societal protection for victims must be set in stone. Compounding the problem, there is an extreme shortage of qualified mental health professionals — only 10% of the patients having access to treatment, accounting for a negligible 0.06% of India’s healthcare budget.

The government needs to earmark sufficient funding and set long-term goals for creating a mental health infrastructure, including the training and hiring of professionals and promoting research, development and public awareness.

“There is no health without mental health, so there would be a very tangible return on such an investment — a healthier, more productive and hopeful population,” says Jain. “Of course, one’s psychological well-being takes a back seat when one does not have food to eat, clothes to wear or a roof to live under. Any public awareness effort will fall flat if poverty, lack of access to education or healthcare are also not addressed.”

The cultural critic, author and filmmaker likes to hang out with his cats, toucan and pet iguana.

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Printable version | Jul 10, 2020 3:01:39 AM | https://www.thehindu.com/society/how-unprocessed-trauma-is-kindling-communal-violence-in-south-asia-in-the-21st-century/article31001469.ece

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