There has been a slowdown in the flow of patients after the state of emergency, caused largely by the transport problem, but the number of people with mental problems is on the rise. The number of patients coming to the outpatient department of the Tribhuvan University Teaching Hospital was 2,500 in 1990. In 1996-the year the Maoist insurgency began-the number grew to 3,500, and last year it was 4,800. The number of people in the first three months of the New Year 2059 (starting mid-April) has already crossed 1,500. At this rate the number of patients by year end could reach 6,000.

Experts say this could be a sign of "mass depression", resulting from the deteriorating situation in the country, combined with the violence and instability that is all around. The violence since 1996 has already cost over 4,500 lives. There is no data on those who have been maimed or displaced. Experts told us that such a situation causes helplessness, fear, anxiety and worries about relocation. Not everyone who falls prey to depression needs to have been directly affected by the conflict. Mental problems can result even in those who have read about the incidents, or those who have relatives and neighbours who have been affected. Not all the 1,500 patients at the Teaching Hospital had problems related to the violence; there are also some with other "regular" mental problems. But more recent statistics show that the number of those suffering from "other" mental problems is decreasing, while more people are tormented by stress, anxiety and depression is on the rise. Of the 117 patients who visited the Teaching Hospital from mid-April to mid-May this year, 85 were diagnosed as having an acute sense of helplessness, fear and anxiety about relocation. In 1996, the number of patients diagonsed with such problems was 37 out of 102. The greater part of the patients with depression came from districts where the Maoist insurgency has been the most intense.

The Teaching Hospital is not the only one that treats people with mental problems-there are at least six other government hospitals that do so, and most private hospitals also provide treatment for mental illness. But the statistics available with the Teaching Hospital give an idea of how far-reaching the problem of depression is becoming. The army and police personnel fighting the Maoists, and their families, generally visit their own hospitals. Ajit Kumar Gurung, who heads the department of mental illness at the Birendra Police Hospital, says that the incidence of acute anxiety and fear has been lower than officials had feared it would be among policemen on the frontlines.

These are some typical cases that exemplify what the doctors at the Teaching Hospital see:
. A 13-year-old from Chitwan began fainting frequently after he saw television footage of an incident in Rolpa. His doctor referred him to a mental health specialist. The child had witnessed a violent act five years ago and the Rolpa footage reminded him of the gory incident-some people had come to his house and dragged his father outside, chopped off both his hands, crushed the bones in his feet to a pulp, and then shot him in the head. The boy had some mental trauma then, but had been cured by treatment. The Rolpa footage reminded him of his father's death, and his symptoms of depression began to resurface. His studies were affected by the anxiety, which often resulted up in nightmares and sleeplessness. When he simply could not cope any more, he began fainting. The child is not recovering.
. A well-to-do 38-year-old woman from Sallyan was forced to seek refuge with relatives in Dang after Maoists threatened her family. But the threats and acts of violence in Dang reminded her of what had happened in her own village. In three months, she had started to lose sleep and get irritated about petty things. She seemed fed up with working, and soon even daily chores such as washing and cleaning became a huge burden. Suddenly, a woman who used to be cheerful was weeping most of the time and trying to cut herself off from other people. Even though she had a caring family and children, she believed her life had become meaningless. She was brought to hospital after she attempted suicide, and has been treated for depression. But the problems that caused her depression in the first place remain. This woman can have a relapse anytime, unless society is freed from the problems that cause her to be sick.