Pahalgam terror attack: The invisible wounds of PTSD, survivor's guilt

India Today

23-04-2025

The Baisaran meadow, wildly popular as 'mini Switzerland' in Kashmir's Pahalgam, was rattled by one of the most horrific terror attacks on civilians on Tuesday.On what should have been a peaceful afternoon for tourists in the south Kashmir resort, the day turned into terror, crippling shock and a brutal memory of seeing their families and fellow travellers gunned down in cold blood.advertisementTerrorists opened fire on over 40 tourists, killing 26 and injuring others. Survivors saw their close ones being shot right in front of them. An Intelligence Bureau (IB) officer from Hyderabad was shot dead in front of his wife and children.
While the physical wounds sustained by those injured are being treated and will eventually heal, a deeper, less visible trauma lingers: the psychological impact on survivors, especially children.Exposure to such violence, whether direct or indirect, can trigger post-traumatic stress disorder (PTSD), a severe mental health condition that affects how a person thinks, feels, and behaves long after the traumatic event has ended.WHAT IS PTSD?Post-traumatic stress disorder is a psychiatric condition that can develop in people who have experienced or witnessed a terrifying event."PTSD is a response to a scenario where too much has happened too soon. The mind did not have time to process it. An essential factor is trauma resides in the body and not only in the mind," said psychologist Jas K Bhatia.advertisementAccording to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), PTSD is marked by intrusive thoughts, flashbacks, nightmares, emotional numbness, avoidance of reminders of the trauma, and heightened arousal such as jumpiness or irritability.
Mortal remains of Pahalgam terrorist attack being brought to the Police Control Room, in Srinagar. (Photo: PTI)
Symptoms could start within a month of the trauma, but in some cases, they do not appear until years later.The World Health Organisation (WHO) estimates that approximately 3.9% have experienced PTSD at some point in their lives. In conflict zones or areas struck by violence, especially in places like Kashmir, that number can increase significantly.THE PSYCHOLOGICAL IMPACT OF TERRORTerrorist attacks differ from other traumatic events in the sense that they are deliberate, violent, and often public.While any situation can provoke a personal psychological reaction, intentional violence by one person or group of people can have the strongest impact on victims, damaging their health and causing physical harm."Nightmares are the most common signs after a terror attack. The mind would keep playing the entire scene on loop. Bodily reactions like involuntary shaking or jerking, crying incessantly, talking expressions of guilt are also fairly common among survivors," the expert said.advertisementPost-traumatic stress disorder and depression are the most common mental disorders after a terror attack.Several studies have pointed out that depression is a common co-morbidity of PTSD. Along with PTSD, survivors and those who experienced the event indirectly, suffering the death of family members, close friends or colleagues, can lead to bereavement, which itself increases the risk of depression, self-medication, and substance abuse.
Union Home Minister Amit Shah pays his last respects to 26 people killed in the Pahalgam terror attack. (Photo: PTI)
Since terror attacks are always unexpected, the psychological outcome of these attacks is the most disturbing type of disaster, which may include a mixture of reactions.A study in Electronic Journal of Social and Strategic Studies stated that these reactions can vary from person to person, depending on many factors, such as: the severity and extent of the damage, the proximity to the explosion, the cruelty of the incident, and the coping mechanism.advertisementA study published in the Asian Journal of Psychiatry found that survivors of terror attacks often experience persistent fear, distrust, and social withdrawal for years after the incident.Mental health experts have noted that when individuals are caught off-guard in places they perceive as safe, the psychological effects are often more severe.This "shattering of the safety bubble" can result in long-lasting fear of travel, anxiety, and depressive symptoms.Post-traumatic stress disorder can occur when a person experiences a combination of symptoms, such as reliving the traumatic event, avoiding anything that reminds them of it, and feeling constantly alert or on edge.These symptoms can cause emotional distress and interfere with daily life, including relationships, work, school, and social activities, according to WHO.IMPACT ON FAMILIES AND CHILDRENThe trauma doesn't end with the direct victims. People who lost their loved ones, especially those who witnessed the killings, are also at high risk of developing PTSD.Bereavement, when combined with violent imagery, can complicate the grieving process. This condition, known as traumatic grief, has been found to impair daily functioning. advertisementChildren who were present during the attack could be especially vulnerable.Understanding the difference between the effects of terrorism on the mental health of adults and children after trauma is absolutely necessary to develop treatment options.A 2021 study showed that early exposure to violence can alter brain development, increase cortisol levels, and lead to behavioural and emotional disorders. These effects, if left unaddressed, can carry into adulthood.The same study revealed that adolescents are more likely to use drugs to resolve their symptoms. There is no doubt that post-traumatic stress is more likely to harm academic success and psychosocial development of children and teenagers.Therefore, they need continuous and long-term health monitoring.Bhatia stated that such trauma becomes part of the lineage and there is a high probability of it becoming a generational trauma where it is passed from one generation to another."Family members have to navigate a complex set of emotions that range from anger to guilt to 'why me' and their search for answers, at times, drowns them in their own pool of feelings. In such a scenario, guilt seems to be a silent attacker, and because guilt is so personal, people rarely talk about it. Therefore, the mind experiences the incident and the body stores it," she said.advertisementAssociated with PTSD, survivor's guilt is a feeling of distress and negative self-evaluation after a traumatic event.NEED FOR IMMEDIATE PSYCHOLOGICAL INTERVENTIONIn India, PTSD is often underdiagnosed due to lack of awareness, stigma around mental health, and limited access to psychological care.Globally, post-crisis protocols often include psychological first aid (PFA) to help individuals manage initial reactions.Unfortunately, such measures are not uniformly available in India, especially in tourist-heavy but conflict-prone regions like Kashmir.There is also limited follow-up care once tourists return to their home states.Without proper screening or mental health counselling, many survivors may suppress symptoms, only to find themselves struggling with chronic stress, insomnia, and social withdrawal months later. Getting help immediately is the first line of treatment."Empathy and care with asking the right questions and providing a safe space is their first requirement," said Bhatia, adding, "If the person is open to a conversation, listen more and talk less and definitely, don't offer advice."The expert stated that while complete treatment of PTSD is rarely possible, certain exercises, including Cognitive Behavioural Therapy (CBT) can help the body and mind to be at ease."We live in a world where mental health services are enough. The question to ask is - how many trauma patients actually reach out to us? You will be surprised to know that it's a small number. Mental health in India needs education, awareness and acceptance," Bhatia added.Such incidents invoke a myriad of feelings that can lead to dysfunctional days, longer sleeping hours, lack of nutrition and hydration and either aggressive or anxious behaviours.Therefore, seeking help immediately is imperative.Addressing PTSD isn't just about individual healing. Left unchecked, widespread trauma can affect community trust and public morale, a problem now staring at Pahalgam and its visitors.As the survivors of Tuesday's terror attack in Jammu and Kashmir attempt to process what they witnessed, it's essential for institutions to offer structured mental health support to cope with post-traumatic stress.Must Watch