July uprising: What about the wounds on the mind?

Sameer Faiyaz did not shy away from the conversation. "I need help. I know it." 

The day after Hasina's ousting, Sameer volunteered in traffic control and clean-up campaigns. Then came the flood relief efforts, and somewhere in between, he also became engaged in rehabilitation efforts for gunshot victims. 

He has kept busy, almost non-stop, but what about sleep? 

"I sleep three-four hours per day. I cannot sleep through the night. As if I have to see the light and only then can I fall asleep," he replied. 

Sameer, a Dhaka University student, is among the thousands who actively participated in the July Uprising. In his case, it started on 15 July. 

"The things I have seen, and by the end of the month [July], the police started showing up to our houses. I was targeted too," he recounted. 

During the internet blackout, Chhatra League (BCL) members ran social media campaigns to target student protestors, he recalled. 

He remembers seeing BCL men waiting for him in front of mosques, and police cars in front of his house in Nikunja, continuously fearing for his life. 

I sleep three-four hours per day. I cannot sleep through the night. As if I have to see the light and only then can I fall asleep.

The fear has not dissipated yet. 

"I cannot trust anyone easily now, or at all. But there's just no time to seek mental health help. But I know I need it." 

The July Uprising killed over 1,000 people across the country between 16 July to 5 August, according to the interim government's count.

After nearly two months since the historic day, hundreds remain in hospitals in critical condition from bullet injuries, while thousands live on with life-altering injuries.

But what about the mental trauma? 

"When you're experiencing trauma, you are in survival mode, you're just going through the motions," explained Dr Nadine Shaanta Murshid, associate professor at the University of Buffalo's School of Social Work. "It's later when your brain and when your body is in a safer place, or you think that you're in a safer place, that the effects will emerge." 

Dr Murshid has extensive experience working with victims of domestic and political violence, suffering from post-traumatic stress disorder (PTSD) and other trauma effects. 

One of the effects is hyper-vigilance. "Let's say being hyper-vigilant about noise: thinking it's a gunshot as opposed to [noise of] construction work because that's where your mind goes," she added. 

Tanvir Ahmed Novel, currently enrolled in a master's program at Jagannath University, feels instant fear and panic when he sees or hears the sound of a helicopter or aeroplane. "Although shots were not fired from the helicopters on 18 July — many remained overhead of Brac, East West University (EWU) and the Canadian University."

Novel graduated from EWU last year. He was present at Brac's Badda campus on the fateful 18 July. "But during that time, we heard of multiple reported instances of protestors being shot at from helicopters," he added. 

Triggers work in different ways for different people. Additionally, according to mental health experts, there is no one-size-fits-all guide to the possible effects of trauma on the mind. It can take shape and form in a wide range of ways and over a wide time frame as well. 

What can we look out for? 

One of the three main forms of PTSD, according to psychiatrist and associate consultant Dr SM Yasir Arafat at the Bangladesh Specialised Hospital, is hyper-alertness (symptoms are sleeplessness, restlessness, anxiety, short-temper, irritability, etc). 

Then there is re-experience (symptoms are repeated nightmares related to the event, unintentionally fixating on the traumatic events and intrusive thoughts). 

Lastly, avoidance — meaning the person suffering from this form of PTSD won't go to the same place where the event occurred, avoid people, or for instance avoid phones or watching videos. 

"There are other symptoms too of course, like depressive states, withdrawals i.e., the person feels demotivated to engage in hobbies, etc. Also, sometimes, the person fails to recognise friends or places," added Dr Arafat. 

The time frame for PTSD or other kinds of trauma effects to emerge varies, anywhere between a couple of months to more than a year, according to experts. 

"PTSD can also emerge after two or even four years," said Dr Arafat. 

Dr Murshid said, "If left untreated, it can last for years or even a lifetime."

After a traumatic event, it is natural to experience mental health symptoms. "But if the symptoms persist one month after the said event, then we consider it as PTSD," said psychologist Ifrat Jahan at Jahangirnagar University.

Shami Shurid, a psychosocial counsellor and lecturer at Brac University since 2010, offered a more concrete timeline. "There is a concept called post-traumatic growth. It takes generally five to six months to reach it after the fact, and it is when the person learns from the event, how the person grew or matured because of it [through introspection]," he said, adding, "We need to stay vigilant and be kind to each other till then." 

Generational gaps and lack of support from families do not bode well for those affected by PTSD or trauma. It is time family and guardians make the effort to understand their children. 

"I even have cases where the family said [after the person asked the family to take him to a psychiatrist] 'Why? You can just sleep it off. Give it some time'," said Ifrat. 

She continued, "The misconception is that if you seek professional help, then people think that the person has gone mad as clinically insane. So the family stands in the way. 

"I also have cases where the family said, you went to the protest out of volition... why did you? We said not to, we knew this was going to happen."

Mental health resources available, but not awareness 

"Be it in-person or online, if a person explores, they can reach these [mental health] resources. Especially in metropolitan cities where the majority of the massacres occurred," said Dr Helal Uddin Ahmed, associate professor at the National Institute of Mental Health.  

The consensus between the five experts TBS interviewed is that resources are available, but not the awareness. 

"It is just that we are failing to reach the students with the message that there is treatment for the psychological conditions or trauma they are experiencing," said JU's Ifrat, where a higher number of students are seeking mental help.  

Moreover, while resources are limited in public educational institutions, and absent almost entirely in colleges and schools, private universities are faring better. 

"We held several 'town hall' meetings and individual and group sessions to address the effects of the massacre on mental health," said Dr Shamsad Mortuza, former pro-VC of ULAB. "In the first session, we were in tears. We have students, many, who saw dead bodies and killings. One student said he had to walk over five dead bodies." 

Hundreds have been reached via these initiatives, according to Dr Mortuza, who currently teaches at ULAB and is an advisor to the board of trustees. 

Similarly, Brac has received several hundreds of students seeking help from their psychology centre, according to Shurid. 

Fahmida Faiza, currently a master's student at Jahangirnagar University, said, "More than us, it is the younger ones like school and college students that need counselling." 

She mentioned a young boy who took part in the protests and lives near the campus. 

He still comes down with fevers regularly. "He is not a student. But we check up on him from time to time. The doctor said the fever is a trauma response. And that we need to stay connected." 

Fahmida herself was attacked by the Chhatra League on 15 July.  She was beaten with sticks. "We were mentally ready for the worst really. We are generally a strong-willed bunch." 

What about you, any fears? "Oh yes, we fear anything can happen at any time really. There are so many political parties and factions like Chhtara Dal, League etc. We also get threats."  

How to move forward?

Dr Murshid recommended not to force anything — even mental health support — on the students because they have lost their agency and a forceful approach may prove counterintuitive. 

Brac University faculty Nirnoy Islam, concerned for his students, has started a story circle, where the students are to share their experiences. "In the first session, 30 minutes was allotted. We spent over 2.5 hours that day. Many cried, and all shared." 

"[Human] connection is treatment," said Shurid, "and the language we use to communicate with this generation is important." He recommended using "fitness" narratives — such as social-emotional fitness and intellectual fitness along with physical fitness instead of wellness and illness narratives. 

It is a long-term process with no immediate solutions. "Change in the environment helps also," said Ifrat, while Dr Murshid said there is a critical need to institutionalise mental health.