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As narrated by a MSF clinical psychologist treating Shareefa. Some names and identifying details have been changed to protect the privacy of individuals.
Shareefa was diagnosed with conversion disorder at the young age of 19. Upon referral from a psychiatrist, she was brought to one of the MSF clinics in North Kashmir by her father and uncle. Hailing from a lower-middle class family of the Pattan region (one of the villages in North Kashmir worst hit by the ongoing socio-political conflict in the state), Shareefa had a family of seven. Her parents, three younger sisters and one elder brother constituted her world until one day she lost her only brother in an encounter in the neighborhood.
Shareefa spoke very little in the first counselling session and mostly just nodded in response to anything asked. “She was alright for few weeks after the death of her brother and in fact tried to emotionally support everyone, especially us. However, there was something unusual in her behavior. She avoided anything and everything that belonged to her brother. She even left the conversation if any one of us happened to talk about him.” shares Shareefa’s father.
This, however, changed. After a few weeks she started going into her brother’s room and started spending more and more time with things that belonged to him and often cried. “One evening when the rest of us were busy with our daily chores, Shareefa came out from her brother’s room and ran out of the house- crying and shouting. When we tried to stop her, she became violent and started hitting us.” She soon lost consciousness and fell with her body tense; eyes and jaws tightly closed and lay unresponsive to everything. This episode lasted for 15-20 minutes. Since then Shareefa started to get these unresponsive spells twice/thrice a day and each episode usually lasted anywhere between an hour or two.
Shareefa was taken to many medical practitioners including some specialists for all necessary examinations. All reports indicated that the problem was purely psychological. Given the famous tradition of consulting a faith healer for all mental health related issues in Kashmir, Shareefa was even taken to a faith healer. However, nothing seemed to help and she soon stopped stepping out on her own. It was on the advice of one of the relatives that the family decided to take Shareefa to a psychiatrist who further referred her to MSF for psycho-therapeutic intervention.
After developing a good rapport and a comfortable therapeutic relationship with the counsellor, Shareefa started to open up in the sessions. “Why did this happen to our family?”, “My brother was innocent.”, “Who will support our poor family?” “My father is old and he spent all his hard earned money on his only son’s education with the hope that he would support the family after completing his education. He recently completed his degree and was about to start working with some company but………” said Shareefa and soon fell partially unconscious for ten minutes.
After regaining consciousness she started to talk again. “My family was living happily but my brother’s sudden death changed everything. I remember that day when everyone was crying, mourning and beating their chest (a gesture to express remorse) except me.” Shareefa was not able to accept her brother’s demise and was in complete denial. “After one week I began to realize that it was for real and I cried. But I always tried to hide my emotions in front of my family members. They were already disturbed and I didn’t want to add to their agony and pain. I have to support the family as I am the eldest among siblings after my brother. Whenever I see anything that belonged to my brother my palpitations increase, I shiver and lose consciousness.” With this, Shareefa broke down again and started to blame herself for adding to the suffering of her family by being sick. Feelings of helplessness and failure were expressed in her conversation with the counsellor.
Shareefa and her entire family received psycho-education. Supportive expressive psycho-therapy and cognitive behavior therapy helped her get better. Shareefa has already undergone many psycho-therapy sessions and is responding well to the therapy. The frequency of episodes of loss of consciousness has decreased and she has started attending college again. Besides, she has started to deal with her emotions and problems more maturely and is also planning to join a vocational course (tailoring) after college to financially support her family.
*As narrated by a MSF clinical psychologist treating Shareefa. Some names and identifying details have been changed to protect the privacy of individuals.
