'What Doesn't Kill You Makes You Stronger' .

Psychiatry

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A Specialty Registrar Doctor in Psychiatry in the hospitals of Oxford Deanery, Dr Shah Tarfarosh is an Oxford University post-graduate with an impressive track record. In a virtual interview with Hira Azmat, he details his Kashmir outreach through various NGOs and social groups in helping Kashmir students and professionals to develop mental toughness.

Dr Shah Tarfarosh

KASHMIR LIFE (KL): How we introduce you Dr Tarfarosh?

DR SHAH TARFAROSH (DST): I come from a middle-class Srinagar family. While growing up, I saw my parents grappling with financial difficulties. Despite that, they ensured I received the best education from two top schools– Iqbal Memorial Institute and Green Valley Educational Institute.

After completing my primary and secondary education, I decided to study medicine. I pursued my MBBS at Jammu, and worked at Delhi before deciding to move out.

I had to fund my Western education and training dreams all by myself, so worked for a year in Delhi, and also did some menial online jobs here and there to pay for my Professional and Linguistic Assessments Board (PLAB) exams, visa and travel to England. I met amazing teachers and nicest seniors, juniors and batchmates at both the schools, medical college and IHBAS, Delhi.

I recently received the MRCPsych degree from the Royal College of Psychiatrists, London after passing all their exams. I am working as a Specialty Registrar Doctor in Psychiatry in the hospitals of Oxford Deanery. Here, I have had the privilege of learning Psychiatry through the Oxford Postgraduate Psychiatry Course (OPPC) under the Department of Psychiatry, University of Oxford.

KL: Why you choose psychiatry?

DST: I had a short period of severe anxiety during my teens. Due to mental health stigma in Kashmir, I was taken to cardiologists instead of psychiatrists. Apparently, it looked like I had a fast heartbeat. One of the cardiologists even falsely diagnosed me with a rarest of the rare heart conditions, but I knew I was struggling with anxiety. I didn’t give up and chose to recover through self-help books, which were the only resources available to me.

I loved brain science, and chose MBBS over-engineering, but was myself professionally stigmatised into thinking that I should choose neurology and not psychiatry as a career choice further down the line.

In fact, for building my CV, I worked in the Neurology Department at the IHBAS Delhi. However, while I was working in that department, I used to see young patients with a huge amount of stress, who would present with symptoms of fainting, paralysis and seizures, because that is a more acceptable way of putting forward distress in the stigmatised Asian societies.

I used to love talking to them, helping them through distress before referring them to the psychiatry department next door for continuous support. Once I landed in the UK, I found how incredible psychiatry as a career choice was and chose to apply for the same.

KL: Some naysayers see psychiatry less of a science and more of guesswork.

DST: Unlike our medical and surgical colleagues who use knee hammers, pulse oximeters, and other such tools to make a diagnosis, our important tools are not visible. We generally use a structured question and observation-based tool called the Mental State Examination. Thus, by asking very specific questions, and making precise observations, we come to a diagnosis.

This is aided by detailed but focussed history taking in which we get to know about the biological, psychological and social factors that play a role in changing an individual`s thoughts, feelings and actions. This science has been there for hundreds of years but shaped through research in the last five decades.

There is a huge amount of psychiatric research work going on in the world, particularly in the UK. We found that our methods of diagnosis, treatment options, and recovery models are all backed up by pure neuro-scientific studies.

KL: At a place like Kashmir, what is the role of a psychiatrist?

DST: Psychiatrists have a huge role to play in Kashmir in terms of assessment of mental disorders from simple mild depression to complex Post Traumatic Stress Disorder (PTSD). After the assessment, sustained treatment of such disorders is vital which is carried on by a psychiatrist either by prescribing medications or by delivering talking therapies.

The Kashmir psychiatrists have a major role to play in helping to highlight the social issues of individuals like unemployment, family disputes, and guide them to specific services. It is sad to know that the Drug addiction is at the peak in Kashmir which psychiatrists are nicely dealing with through diagnosis, treatment and rehabilitation.

Prevention of mental health disorders is another important challenge Kashmiri psychiatrists are involved in by recognising high-risk cases and giving them specific advice to regain mental strength and resilience and prevent the onset of severe mental disorders.

KL: How can Kashmir’s mental health be improved within the limitations we have?

DST: There are three pillars of psychiatric diagnosis and treatment – biological, psychological and social. Kashmiri psychiatrists are effectively using the latest research-based medications to treat severe illnesses. Psychiatrists as well as psychologists are delivering science-backed talking therapies, like Cognitive Behavioural Therapy. However, the social pillar of treatment could be improved more, maybe as per the UK model.

In the UK, we have Community Psychiatric Nurses, Mental Health Social workers, Occupational therapists, Drug and Alcohol Workers, Community Support Workers, Counsellors and Mental Health Pharmacists. These individuals work together as a multi-disciplinary team to deliver high-quality care to the individual at home.

Sometimes, we have patients with Severe Paranoid Schizophrenia, or Social Phobia or Agoraphobia. These individuals worry about going out of home and meeting people because of their mental health condition. As a result of good social mental health support, the patients or their distressed family members don’t even have to come to the hospital after the initial diagnosis. These amazing set of professionals make sure that mentally unwell patients and their distressed families get support at home as directed by psychiatrists.

In Kashmir, we can push the policymakers to improve such support in the community, which will generate more employment. Alternatively, because of a number of limitations, the people, particularly youth can form NGOs and start to liaise with mental health teams in hospitals to train volunteers. This can help to at least kick-start developing such care in the community. Some Kashmiri NGOs have already started to work towards educating people, for instance regarding child abuse, which leads to mental health problems in adulthood. Others are addressing social issues like helping fund marriages of poor women. Their work is highly admirable.

KL: How can Kashmir manage substance abuse?

DST: Let me just make it simple. Drug abusers may be at one of the four stages – those using for fun, those knowing the bad and fun aspects of tits use, those who have decided to change and those who have already given up. All the four categories need different handling that the psychiatrists in Kashmir are aware of. They are tackling them using the best methods known to medical science.

Families and schools can play a vital role in identifying the reasons for drug abuse and addressing those. Police and NGOs can find such individuals who do it in isolated places, be nice to them and direct them to proper services. Media can play a special part in not just highlighting the free sources and traps for youth, but also educating the people regarding the ill-effects of substance abuse.

KL: In a pandemic, what advice would you give to people going through hard times?

DST: I am a strong believer of the fact that `what doesn’t kill you makes you stronger`. There is no doubt that the situation in Kashmir has always created difficulties for the people, now induced by a pandemic. Remember, God never puts more trouble on our shoulders than we can bear. That means we can sustain all these difficult moments that we have. The best approaches to go through hard times include – have a properly balanced diet, exercise whenever you can, sleep for 7-8 hours, have a purpose in life and work towards your goals with a proper routine. Taking care of your physical, mental, social and spiritual health is necessary. And if you need help, doctors and other healthcare professionals work 24×7 in Kashmir, and some are even providing online/phone support.

KL: Are you somehow contributing to Kashmir by way of tackling the load?

DST: I am currently working with JK Scientists in creating other parts of our online Mental Strength Mastery Series thereby, helping Kashmir students and professionals of Kashmir to develop mental toughness. I am also liaising with Kashmir schools to provide resources for mental health strengthening for our young students who are experiencing a big change in their lives – homeschooling.

I had a chance to contribute to numerous Kashmiri population-based research papers in the past by collaborating with Kashmir psychiatrists – on depression, Electro-convulsive therapy, PTSD and Alzheimer’s disease. In one of the studies, we found how much of an impact the poverty has on the development of depressive disorders in the Kashmir Valley.

KL: Did people approach you for help?

DST: Yes, a lot of people sought help. A young Kashmiri student, who was quite distressed because his parents were unwell, needed psychological support – so I just listened to him. Another person who was quite worried that his OCD might get worse due to pandemic and didn’t go out of his room needed some reassurance.

Numerous people from Kashmir contact me daily via social media platforms who need help with their life-style issues, like not being able to focus, not clear in their goals for future and also those who want tips for avoiding too much procrastination.

I redirected all distressed persons to IMHANS and gave them their helpline number, or to psychiatrists because it is best to see patients in person.