Four weeks on from the tragic earthquake of April 25 and deep down, I’m still speechless. It is hard to believe that some of the people I knew who disappeared on that day are never coming back, that so many lives have been changed forever.

I have come to notice a deep sense of fear, despair, and uncertainty in the eyes of many of my family members. Last week, looking at the sky, my 60-year-old mother told me, “Kanchha, I feel that nature will not let us survive this season.” I turned my gaze down and I could feel that the ground was still not done shaking. My father, who looked tired and defeated, was lying on the bed. Breaking our silence, he said, “We will be safe. Our house is strong enough, otherwise we can hide under our bed.” I had no comment, but have found so many people with similar thoughts in these past weeks.

Mere chance

These days, even when I plan a short walk or go out for work, my wife is slightly more cautious and wants to do things together. I understand the ground is still unstable. Tremors are recurrent. We are actually all shaken and terrified. We don’t want to be separated from friends and family for too long. But despite all this, what we all know and what is perhaps the greatest lesson from this disaster is that we have no choice but to accept the grand design of nature. Life and death are almost completely out of our control.

The fact that I survived and my family members survived was merely chance. Sure, class and geography have a role to play, but ultimately, nothing can really buy security from a natural disaster. And either way, the loss and damage we have seen will deeply affect entire lives and the new generation as well.  

Once or twice every night, flashbacks of the quake wake me up. I am more shaky and sweaty than usual. I feel tremors even when the ground is still. I know the tremors will stop one day but I also know that it will take me and most Nepalis a long time to overcome this anxious state of affairs.   

Mental states

Feeling low, a loss of motivation, tiredness, and lack of sleep are things I hear everyone, including myself, talking about and experiencing. The mind seems to be distracted.

I even checked these symptoms with the International Classification of Diseases (ICD)-10 depression diagnostic criteria, which is widely used in clinical settings to diagnose depression. ICD-10 uses an agreed list of 10 depressive symptoms, which include persistent sadness or low mood; loss of interest or pleasure; fatigue or low energy; disturbed sleep; poor concentration or indecisiveness; low self-confidence; poor or increased appetite; suicidal thoughts or acts; agitation or slowing movements; and guilt or self-blame. According to this tool, if an individual expresses these symptoms persistently for at least two weeks, they are depressive. Four symptoms indicate mild depression. Five to six symptoms mean moderate depression. Seven or more symptoms are considered as a severe form of depression.

Struggling with these seven or more symptoms for the last four weeks, I know any professional would tell me that I need medication. But when I talk to my family, friends, and others, I know my case is not unique. Currently, it seems many Nepalis are struggling with similar symptoms.   

The emotional and mental situation of those who have been injured, who have lost family members and their homes is simply beyond our measurement. According to the Nepal Police, until May 21, 8,633 people were dead and 21,843 seriously injured, and these numbers are increasing. A few hundred people are still missing and with their whereabouts unknown, one can only imagine what kind of torture their family members are experiencing. About 4.2 million people have been directly affected by the earthquake and 2.8 million are displaced. I don’t even count in these statistics and yet, I feel so affected.

This, however, doesn’t mean that all us Nepalis are now mentally ill, the ‘diagnosis’ be damned. But the threat is that, over time, unless people’s needs are met and fears are quelled, what is now a shared sense of fear and loss will morph into a long-term and serious mental illness.  

It really doesn’t help when newspapers ignorantly make headlines proclaiming that ‘the number of mentally ill patients [is] rising after the quake’. It is untrue. At the same time, it is complacent for leaders to give statements that declare that it’s ‘time to be happy and forget the quake’. Obviously, we cannot really be happy during such a difficult time.

News reporters and editors must be careful and respectful in reporting human loss and suffering. Labeling our grief as ‘mental illness’ is alien and frightening. People have their own ways of grieving and dealing with loss. It’s a very individualised process. The media and mental health professionals must respect people’s emotional states as diverse human experiences. If we rush to label these experiences as mental illnesses, it will stigmatise the problem, which will ultimately discourage people to talk openly about their experiences, let go of their grief, and seek professional help, if required.

Talk and express

Now is the time to encourage people to talk honestly about their emotional state and suffering with family members, friends, and volunteers. Depressive and traumatic moods should be accepted and respected as a normal human reaction to such a high-scale disaster. Irrespective of the degree of emotional and mental difficulties, self-care, like getting enough sleep, physical and emotional engagement with friends and in the community-rebuilding process, eating healthy, walking and exercise, breathing and relaxation, are vital for our collective recovery.

Emotional and mental healing is not an isolated process. It has direct links to our physical and existential realities, like shelter, food, clothes, social circles, community, family, health services, and other aspects of life, all of which give us a sense of security. The only answer is to work together to rebuild our homes, communities, and lives from the inside out.

Lamichhane is the Founder of the Nepal Mental Health Foundation and Principal Coordinator for the Movement for Global Mental Health