Several Pakistani medical and mental health professionals told us that they have seen a number of physical manifestations of stress in their Waziri patients.505 Ateeq Razzaq and Sulayman Afraz, both psychiatrists, attributed the phenomenon in part to Pashtun cultural norms that discourage the expression of emotional or psychological distress.506 “People are proud,” Razzaq explained to us, “and it is difficult for them to express their emotions. They have to show that they are strong people.”507 Reluctant to admit that they are mentally or emotionally distressed, the patients instead “express their emotional ill health through their body symptoms,” resulting in what Afraz called “hysterical reactions,” or “physical symptoms without a real [organic] basis, such as aches, and pains, vomiting, etcetera.”508 The mental health professionals with whom we spoke told us that when they treat a Waziri patient complaining of generic physical symptoms, such as body pain or “headaches, backaches, respiratory distress, and indigestion,” they attempt to determine whether the patient has been through a traumatic experience. It is through this questioning that they have uncovered that some of their patients had experienced drones, or lost a relative in a drone strike.509 Mental health professionals we spoke with in Pakistan also said that they had seen numerous cases of Post-Traumatic Stress Disorder (PTSD)510 among their patients from
505 Interview with Sulayman Afraz (anonymized name and location), in Pakistan (2012); Interview with Ateeq Razzaq (anonymized name and location), in Pakistan (2012); Interview with Hatim Sheikh (anonymized name), in Peshawar, Pakistan (2012); Interview with Abbas Uddin (anonymized name and location), in Pakistan (2012). 506 Interview with Sulayman Afraz (anonymized name and location), in Pakistan (2012); Interview with Ateeq Razzaq (anonymized name and location), in Pakistan (2012). 507 Interview with Ateeq Razzaq (anonymized name and location), in Pakistan (2012). 508 Id.; see Interview with Sulayman Afraz (anonymized name and location), in Pakistan (2012). 509 Interview with Ateeq Razzaq (anonymized name and location), in Pakistan (2012); see also Interview with Sulayman Afraz (anonymized name and location), in Pakistan (2012); Interview with Hatim Sheikh (anonymized name), in Peshawar, Pakistan (2012). 510 PTSD is an anxiety disorder experienced by some individuals who have been exposed to a traumatic event. In diagnosing PTSD, psychiatrists look for three main categories of symptoms not present before the traumatic event took place: “intrusive recollection,” which can include flashbacks and nightmares; “avoidance of stimuli associated with the trauma and numbing of general responsiveness”; and persistent symptoms of anxiety or “increased arousal,” which can include difficulty sleeping, irritability, or an exaggerated startle response. AMERICAN PSYCHIATRIC ASSOCIATION, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, § 309.81 (4th ed. 2000); see also John H. Casada, et. al., Psychophysiologic Responsivity in Posttraumatic Stress Disorder: Generalized Hyperresponsiveness Versus Trauma Specificity, 44 BIOLOGICAL PSYCHIATRY 1037 (1998).
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