In the past few weeks, displacement has been the headline and discussion points almost everywhere in Assam. While there are different socio-political explanations and reactions to forced internal displacement, there is a continuous and lifelong mental health impact on the displaced and those living with everyday fear of eviction and/or displacement.
According to a fact-sheet by World Health Organisation (WHO), sadness, hopelessness, sleeping difficulty, fatigue, irritability, anger, and pain are common amongst people subjected to forced displacement. Common mental disorders like depression, anxiety, and posttraumatic stress disorder (PTSD) are high amongst the displaced. Suicide and psychosis are also threats. Children are at risk for depression, anxiety, suicide, conduct, and substance use disorders.
As the fears escalate lately with the news of displacement at Sipajhar, we look at the mental health impact on inhabitants of Borbeel and Halodhibari areas in Assam awaiting similar fate any day because they have been living around the Kaziranga National Park and Tiger Reserve. The world celebrates Mental Health Day on 10 October every year, and the preceding week is dedicated to building mental health-related awareness. This year the theme is ‘Mental Health in an Unequal World.’ In the unequal world we live in, the people facing forced displacement are even more vulnerable. Therefore, all the more need to address and redress their mental health issues.
The Borbeel Adarsha Mising Gaon is a settlement village established in the early 1970s after large-scale displacements caused by massive Brahmaputra floods and erosion at Mariahola, Bokakhat. Between the 1930s and the 1970s, thousands lost land and livelihood after around 10 embankments supposedly constructed for erosion protection broke. It took a massive agitation and multiple arrests at Mariahola for the government to take up any rehabilitation measure. Around 52 families from Bilotiya Bamun Gaon and nearby villages at Mariahola were settled at the current location of Borbeel near Kaziranga. They were promised land entitlements, and they pay land revenue. Faced with multiple eviction threats, the people sought help from the court as well but a lost case only added to their despair. Now at a political scenario where a piece of paper has the right to decide one’s right to life, the people of Borbeel await such assurance from the authorities.
Pointing to the Sipajhar incident, one inhabitant from Borbeel explained their similar fate: “We are not birds to fly away and make a home somewhere else. We did not even come here because we wished so. The government settled us here after we lost everything to the Brahmaputra. We protect Kaziranga’s wildlife with our hard-earned harvests and many more ways than their rifled guards can ever do. There’s no need for eviction because we are ready to move for the sake of Kaziranga if you give us similar land and livelihood somewhere else. The same could have been done at Sipajhar to avoid all the trouble and resources for eviction. I don’t understand why don’t they understand such a simple way!”
Many of us passing through the beautiful landscape of Kaziranga stop at the roadside Burhimai than at Halodhibari to offer prayers and seek blessings. What we don’t know is that the people living nearby have faced multiple displacements in their lifetime losing their land and livelihood, and facing yet more evictions. An agriculture-dependent population belonging to Karbi, Bengali, Nepali, Schedule caste, and Adivasi communities living with the forest in mutual dependence have no alternative means to begin a different life. Existing socio-economic vulnerabilities aggravates the situation further. In this scenario, children’s education takes a backstage. “As it is it is hard to get by each day, what will they do even if we work harder to continue their schooling, we might be evicted anytime, and then education will discontinue anyway,” a father of two explained.
A report by WHO suggests that mental disorders affect 1 in 4 people in their lifetime worldwide. Given the stigma associated and lack of awareness, reporting of mental health issues in Assam are low and therefore numbers inconclusive. However, the state report of the National Mental Health Survey 2015-16 shows the weighted lifetime prevalence of any mental morbidity in the state was 8.01 per cent. We live in a culture and society where discussion about mental health is used and received with laughter, sarcasm, insults, or abuse. Normalising mental health discussion itself is a far cry, let alone addressing the societal factors behind it. It is a difficult and endless battle for the affected. The very words ‘eviction’ and ‘displacement’ are capable of inducing fear and causing trauma in human minds. Facing it and living with fear and uncertainty every day has manifold effects on the mental health of adults and children.
The inhabitants of both Borbeel and Halodhibari reported persistence of fear and uncertainty in their everyday lives and their work and decisions were also reported to be affected by it. We need to understand fear not only in social terms but clinically as well. In clinical terms, our brains respond to immediate or persisting threats by fear and fear-induced reactions. Along with fear, there are other mild to severe forms of reaction in terms of anger and sadness, etc.
An almond-shaped brain centre, the amygdala determines fear response. Fear is not only a feeling. It also includes motor response. That response can be a fight, flight, or freeze. Amygdala’s connection with the hypothalamus (another brain centre) causes hormonal changes that accompany fear. A quick rise in cortisol hormone following short-term threat helps in survival. But, chronic and persistent fear leads to medical morbidity. Coronary artery disease, type 2 diabetes, and stroke are risks along with brain atrophy. Amygdala’s connection with the brainstem changes breathing during fear. The accelerated respiratory rate during fight/flight reaction has an adaptive component to fear in terms of survival. But, excess leads to shortness of breath, exacerbation of asthma, and a sense of being smothered. Connections between the amygdala and locus coeruleus (a brain part) determine the relation of the autonomic nervous system and cardiovascular system. One example is fear resulting in increased pulse and blood pressure. Repetitive and inappropriate or chronic triggers lead to atherosclerosis, cardiac ischaemia, hypertension, myocardial infarction, and even sudden death. Neither is it an exaggeration when we say, “scared to death” nor a figure of speech! (Stahl, 2013) Moreover, traumatic memories also trigger anxiety as found in posttraumatic stress disorder because of the amygdala’s connection with the hippocampus (one of the brain centres for memory).
It is pertinent to note the potential impact of the environment on our brain and mind. Our body can handle many stresses. Certain stresses are necessary for growth and optimal functioning. They may even help in future to develop resilience. But, specific types can sensitise a child and make them vulnerable in later life. This is what we call epigenetics whereby an early life assault without causing disorder has the potential to make one vulnerable for later development of the disorder in adult life following a stressor that would otherwise be insignificant. Chronic stress can turn off the genes for the brain-derived neurotrophic factor (BDNF) that is required for the growth and maintenance of brain cells and their connections. Without BDNF, the brain will lose its creativity and maintenance (Stahl 2013).
Individual and community resilience has been argued as one of the coping mechanisms developed by the communities living in prolonged fear of displacement. Resilience is viewed as a measure of stress coping ability in children and adults to adapt or adjust to or overcome the different levels of adversities. It is a multidimensional characteristic that varies with context, time, age, gender, culture as well as one’s own (and community as a whole in case of displacement) life circumstances. In the context of Assam, due to lack of evidence and detailed study, it is not possible to make conclusive remarks on levels of resilience formed amongst the communities facing displacement or already displaced.
Though the people-friendly Forest Rights Act (2006) can recognise the rights of these communities living with the forest and guarantee a life with dignity, the state of Assam lacks political and administrative will to implement the act. The regressive Wild Life Protection Act (1972) is in place instead. While Kaziranga has expanded from 430 square kilometres in the year 1968 when Kaziranga was declared a National Park, to an area of 915 square kilometres after multiple expansions, numerous evictions, and disaster-led displacements, the affected still lack basic rights in the lack of proper rehabilitation measures. Caught in this political and environmental confusion is the mental health of thousands living with everyday fear and uncertainties.
Devyani Borkataki is a community activist who also works in the field of rehabilitation care for mental health conditions. Dr Shyamanta Das is a Psychiatrist and Editor-in-Chief, Open Journal of Psychiatry & Allied Sciences (www.ojpas.com).
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