Shell Shock to Palaly Syndrome
Posted on April 19th, 2010

Dr Ruwan M Jayatunge M.D.

 In war, there are no unwounded soldiers –Jose Narosky

Palaly is a well-known area in Jaffna and it is famous for the Palaly Air Base. Most of the soldiers go to the Northern Peninsula via Palaly airbase.  Therefore, Palaly is a part of them. Palaly is in their memories, sometimes in their intrusions. Palaly syndrome describes various clinical and psychosocial ailments experienced by the Sri Lankan combatants and in the final scores how it affects the society at large.    

 Shell shock to Palaly Syndrome was a long way for the soldiers. 

 In the early years of WW1 Shell Shock was believed to be the result of a physical injury to the nerves. Shell Shock term was coined by the British Pathologist Col. Fredrick Mott. He regarded Shell Shock as an organic condition produced by miniature hemorrhages of the brain. Shell Shocked soldiers exhibited symptoms of extreme fear, shaking, psychogenic blindness, psychogenic paralysis and sometimes aphonia.   The Army was less sympathetic to the ordinary soldiers with Shell Shock. Official figures said that 304 British soldiers were court-martialed and executed. Between 1914 and 1918, the British Army identified 80,000 men as suffering from Shell Shock.

 During the World War 2 traumatic reaction to combat was identifies as War Neurosis or Chronic Fatigue Syndrome. 10% of US Servicemen developed combat exhaustion in the WW2. Nearly 1363,000 soldiers were given medical discharges and 39% had Chronic Fatigue Syndrome.

 During the Korean War the term section 8 was widely used to describe causes of psychological combat trauma. Those who had been diagnosed with section 8 were dealt with in a very situational manner.

 The term PTSD or Post Traumatic Stress Disorder emerged soon after the Vietnam War. PTSD has been found in 15% of 500,000 men who were in Vietnam. There are estimated 50,000 veterans suffering from full blown symptoms of PTSD. At least half a million Vietnam veterans lead lives plagued by serious war related readjustment problems.

 A new form of battle stress began in Sri Lanka mainly after 1983. Many Psychiatrists point out that number of psychiatric illnesses have been increased as a result of the Northern Conflict.   For a combat soldier in World War 2 who served for 4 years the average time spent in actual combat was approximately 40 days. In Vietnam soldiers spent an average of about two thirds of their 12 or 13 month tours over 250 days in combat. But in Sri Lanka a large number of soldiers have spent 10-15 years in combat with short intervals.  

 For nearly three decades, Sri Lanka experienced a social calamity as a result of an armed conflict and people were deeply traumatized.  The echoes of the war trauma will affect Sri Lanka for generations. Although the origin and the history of this conflict is very complicated and carries many versions and explanations, after all it is a collective trauma for the Islanders indeed. The North and South suffered from this conflict creating a large number of physically and psychologically traumatized people. War trauma is still hounding the Sri Lankan society rising as social violence, political violence, political extremism, criminal activities, domestic violence, suicides, homicides, alcohol and drug abuse, cruelty to children and various other forms.

 Combat Related PTSD in Sri Lanka

PTSD is a relatively newly defined disorder with an old history.  According to the Western chronological records the first patients of PTSD were recorded in 1666. These records were based on Samuel Pepy’s diary which describes the bizarre behavior pattern of the survivors of the Great Fire of London. Samuel Pepy vividly portrayed the nightmares, intrusions and flashbacks experienced by these survivors. In 1876 American Civil War doctor Mandez Da Costa published a paper diagnosing Civil War veterans with PTSD like symptoms which he called Irritable Heart. 

 Although the Western World recorded PTSD in 1666, the King Seethawaka Rajasinghe the 16th century monarch of Sri Lanka believed to be suffered from combat related PTSD. King Seethawaka Rajasinghe (born in 1580 AD) was a great warrior who came to the battle field at the age of 16. He fought against the Portuguese invaders and witnessed many deaths and destructions. He was a fearless fighter who used effectual war tactics and overpowered the fully equipped and fully trained Portuguese war machine. Following the long years of combat, he was exhausted and definitely, syffered from battle fatigue.

  In the later years, the King Seethawaka Rajasinghe showed outburst of anger, irritability, deep mistrust, alienation, emotional numbing and various other PTSD related symptoms. There were clear personality changes in him. With these changes, the great liberator launched a chain of terror against his own people creating a deep void in the hearts and minds. Hence, the King Seethawaka Rajasinghe lost his due respect in the history. But no one can argue his courage and tactics which he demonstrated in the battle field. The invincible 16th century super power was in the verge of a defeat in front of his sward. But what went wrong? Did combat related PTSD affect him?

 The history shows that the King Seethawaka Rajasinghe experienced a number of PTSD symptoms. On one occasion, he gathered 100,000 soldiers and attacked the Portuguese Fort in Colombo. The Portuguese were desperate. Fear and famine fell upon them. Despite the attacks, the Portuguese were able to get external naval support from Goa. The battle was a fiasco and the King became furious. He suspected most of his Generals and assassinated them one by one. King Seethawaka Rajasinghe poisoned his right wing man Wicramasinghe Maha Senevi then Weerasundara Bandara. These Generals helped him in numerous battles. He was under a deep suspicion and believed in a conspiracy theory.

 He acted as a tyrant and used brutal methods to punish people. He never felt any remorse or compassion. The King Seethawaka Rajasinghe even killed his own father Mayadunne which can be interpreted as a reaction following emotional anesthesia. Emotional anesthesia or emotional numbing is a distinctive feature of PTSD. In the later years he turned against the religion (which can be interpreted as avoidance also a cardinal symptom in PTSD). He embraced Hinduism and murdered thousands of his subjects who refused to follow Hinduism. The King Seethawaka Rajasinghe destroyed Buddhist temples and killed Buddhist monks by drowning.

 His emotions were unstable. Very often, he acted with sudden rage. Gradually he made him self alienated. He had no close associates and the King became an isolated and a broken man. After many battles, he was physically and mentally worn out. Many aristocrats had left him because they could not stand his false accusations and outrageous behavior. The Great warrior had become another victim of combat stress.

 His final battle took place in Kandy. He had to face Konappu Bandara ails the King Wimaladharmasurya the son of Weerasundara Bandara. One time Weerasundara Bandara was King Seethawaka Rajasinghe s faithful supporter. Weerasundara Bandara helped King Seethawaka Rajasinghe to fight Portuguese. But King Seethawaka Rajasinghe unreasonably suspected Weerasundara Bandara and killed him. The battle was atrocious. The King Wimaladharmasurya proclaimed that he would take the revenge for killing his father.

 King Seethawaka Rajasinghe lost the battle. While retreating he fell down from the horse and sustained an injury. A bamboo prick pierced his leg and after a few days he died may be due to tetanus or septicemia. Thus a legend came to an end. He was called the Lion of Seethawaka who brought fear to the Portuguese invaders. He was a liberator but later became an enigma. May be PTSD ruined his inspirations and the goals in life. If these personality changes did not occur he would have been one of the great heroes in the Sri Lankan history.

 Shell Shocked Sri Lankan Combatants

During the World War 2 a small contingent of Sri Lankan soldiers attached to the British Army served in Italy , Singapore , Egypt and Burma. Some were exposed to active combat or witnessed the horrors  of the WW2. Some historical data suggest that a few Sri Lankan veterans suffered from Shell Shock during the WW2. The renowned Sri Lankan novelist Mr. W.A Silva in one of his short stories described the plight of a local soldier who had Shell Shock features.

 Is PTSD an American Illness?

Some have expressed the view that PTSD as developed in the West should not be imposed on countries with different cultures. Even though the concept of PTSD came from the West, it was common and could be seen in many countries irrespective of cultural differences. 

 Psychological stress reactions to traumatic events occur in diverse societies and cultures.  (Post-Traumatic Stress Disorder: Cross-Cultural Aspects -Padmal De Silva “â„¢ Department of Psychology, Institute of Psychiatry UK). Human response to trauma is universal but the cultural context of the trauma is an imperative dimension. The meaning of trauma is often culturally specific. Cultural factors may also influence the manner in which PTSD symptoms are manifested. Therefore culture based assessment had to be introduced. In addition, the specifications of the Sri Lankan conflict should be taken in to considerations. These specifications were prolonged combat exposure, lack of psychological first aid soon after the combat, lack of social support system and on the other hand as the positive specifications-   the usage of traditional healing methods, the impact of religion must not be forgotten.   

 The US Veteran Administration found 50,000 US servicemen soon after the Vietnam War. For many years, Sri Lankan authorities considered PTSD was an American illness, which could never affect Sri Lankan soldiers. Some expressed the view that we should not dig in to unnecessary issues like combat related PTSD which can lead to litigation and compensation. Therefore deaf and blind policy was adopted for the official convenience. But during this period combat stress increased in large numbers.  Most of them were undiagnosed and untreated.  

 In 2002 I was invited to the Defense Review Committee at the BMICH to serve as a member by the Lt Gen Dennis Perera “”…” former Commander of the Sri Lanka Army.  At the Defense Review Committee I expressed my views about the PTSD which was a ruining factor in the military and the mission performance as well as a damaging factor for the Sri Lankan society.   I stated that PTSD has to be detected and treated effectively before it’s too late.  Dr Narme Wicramsinghe the President of the Ranaviru Sewa Authority seconded my suggestion.  The high-ranking Army officers who were there on that day kept silence and did not support this idea and one of the senior offices of the Air Force directly opposed it. However, Lt Gen Dennis Perera man with a vision understood the profound effects of combat stress. He supported our idea of detecting and treating combat related PTSD in the Sri Lanka Army. This landmark decision helped us to study and treat PTSD in the Army at large.

 In 2002 Psychological treatment center was opened at the Military Hospital Colombo and a large number of combatants who were affected by combat stress were treated in this center. This treatment center used various types of psychotherapies including EMDR. Unfortunately, in 2006 one of the commanding authorities at the Military Hospital felt that psychological treatment center has no use since there is no major war in the North. He wanted to transfer the personnel and other resources to the operational theater and this psychotherapeutic center collapsed. Hence the SL Army lost the valuable services of an eminent Psychiatrist Dr Neil Fernando. I would describe this shortsighted act as the biggest betrayal to the Military.  

 The Echoes of Palaly Syndrome

War is a multi-layered, multi-factorial phenomenon, which is filled with gruesome acts of violence. In a war not only the combatants even the civilians undergo a tremendous amount of combat stress. Stresses are unavoidable in a situation like war. Therefore people who lived in war zones become vulnerable. Their psychological makeup change rapidly.  

 War is a wholly human-made catastrophe, which is a gigantic process of social and self-destruction. As Plato once said “only dead have seen the end of the war. This means the psychological scars following combat can stay behind for many years. It can change the psychological markup of a person making him more dysfunctional. As the Salvadorian psychologist Martin-Baro(1990) wrote of his own country, what was left traumatized were not just Salvadorian individuals , but Salvadorian society. This expression is totally applicable to Sri Lanka. Many combatants, civilians as well as members of the rebel group have become the victims of Palaly Syndrome.  

 The Country was in an armed conflict for thirty years and during that period the society was severely traumatized and if necessary psychosocial rehabilitation is not provided the war trauma would harm the spirit of the Nation. During the past years, psychological needs of the combatants were not properly addressed. Much attention was paid to the physical injuries rater than psychological damages. Effective rehabilitation was not conducted and the repercussions of the mismanagement of combat trauma are visible even today. 

  Following the Sri Lankan conflict a large number of civilians, members of the Armed Forces and   the LTTE carders have been killed. Total deaths estimate over 70,000 lives. Many have become permanently disabled. A large numbers carry psychological scars of the war with them and suffer silently.  Some have sublimated their anxiety and stress to the family members and to the society. Hence, war trauma has become a vicious cycle.

 The Sri Lankan society has experienced and still experiencing the echoes of the Palaly Syndrome. Many distressing and heartbreaking stores reveal the magnitude of combat trauma in the country.

 A Distinguished Officer Turned in to a Serial Murder

Major Anuruddha Wijebahus’s story could be described as one of the horrifying stories of Palaly Syndrome. Anuruddha Wijebahu was a bright student from a leading school in Kandy. After completing his school education, he joined the Kothalawala Military Academy and passed out as an infantry officer. He was attached to the VIR or   Vijayaba Infantry Regiment.  Anuruddha Wijebahu served in the operational areas experiencing numerous combat related stresses. Gradually his psychological make up changed and there were clear personality changes in him. Major Anuruddha Wijebahus’s became cold-blooded serial killer and murdered a number of innocent men. His last victim he took to the Manthottam camp and drugged him. Then he chopped off the victim’s body, put the remains in to a barrel, and set fire. Later he was caught and while in the custody, Major Anuruddha Wijebahu committed suicide.

 The Story of Army Jine

Army Jine was brave soldier from the Sri Lanka Commando unit who had exceptional combat skills. Affected by the combat stress his conduct became intolerable. Hence, Jine became AWOL. While in AWOL Jine committed highway robberies, murders and rapes. He lived in the jungle and with the survival tactics, which mastered,  Jine evaded the law and enforcement authorities for a long time. According to some reports, Jine had committed nearly 27 rapes. Eventually he was gun downed by the Police.

 Kadawatha Madura

Madura was a top sportsman in the Army who was mishandled by his superiors. Many occasions he was harassed and Madura underwent harsh work related stress. Following unbearable work related atmosphere he became AWOL and joined the underworld. Madura organized several armed robberies and he was engaged in   extortions mainly in Kadawatha.  Madura was shot dead in Kadawatha town while he was confronted by  the Police.

 Wambotta  the ex Army Soldier

Kitulgamaralalage Ajit Wasantha alias Wambotta  was born in Embilipitiya. In 1993, he joined the Army, enlisting as a member of the 3rd Sinha Regiment.  After sometime, he left the Army and formed a criminal, gang, which   consisted of over 50 heavily armed military deserters. Since Vambotta had the powerful political backing and political patronage, the Police found it extremely difficult   to make any arrests.  The gang led by Wambotta had done over ten murders and a number of extortions.   The notorious gangster Wambotta was   ambushed and killed by another underworld gang at Aswatte in Kosgama 

 A Lady Accountant killed by a Deserter

At Mutwal a lady accountant from a private firm was murdered and her 12 year daughter was raped by an army soldier in 2008. The perpetrator became AWOL several months before the crime. He waited near her house then entered and committed the crime. The victim was assaulted with a blunt weapon to her head and she succumbed to the injuries.

 A Lady Doctor was shot by a Disabled Soldier

A lady doctor named Dr Miss Indunil from Bandagiriya Central Dispensary was shot by a disabled soldier from the Commando Regiment. According to the internal sources, the disabled soldier who was wounded in the battle had not received appropriate rehabilitation and psychological mode of management was affected by posttraumatic stress. Following an argument with the lady doctor   he went in to a sudden rage and shot her.

 A Brigadier was charged with shooting of his wife 

A Brigadier who had served in the North and participated in numerous military operations was arrested by the Police for murdering his wife. According to the investigations, the suspect had used his service pistol to commit the murder.     

 The SF Rider who became a Criminal

Lance Corporal Harshana Nuwan was an expert motor cycle rider in the Special Forces who participated in SF operations in the North. He encountered copious battle stress, which he could not cope with. Often he was charged with disciplinary infractions and to evade the punishments he became an absentee. While hiding from the military police Lance Corporal Harshana Nuwan organized several bank robberies in which he used his riding skills. He was nick named as Son Baba by the underworld.  He masterminded several contact killings and abductions. The Police took an immense effort to track him down. 

 An Army Sergeant   Plants a Bomb in a School Van

An army explosives expert was arrested for alleged involvement in the Kurunegala school van explosion which left one 12-year-old school girl dead and 11 injured in 2009. According to the initial investigations indicated that the army sergeant had smuggled two kilos of C-4 explosives out of the Minneriya camp and planted them on the van around midnight in an apparent bid to kill the owner-driver, whom he suspected of having an illicit affair with his wife.

 War Trauma and Social Violence

The 30 year armed conflict in Sri Lanka has produced a new generation of veterans at risk for the battle stress.  Over 150, 000 members of the armed forces had been directly or indirectly exposed to traumatic combat stress. There had been nearly 18 major military operations conducted by the Armed Forces from 1987 to 2001 and when the conflict aggravated in 2006 new military operations were  launched.   A large number of combatants  were exposed to hostile conditions. Following the traumatic combat stress, many combatants suffered from anxiety reactions that could be manifested as social aggression.

 Psychosocial Rehabilitation of the Affected Veterans

The magnitude of combat trauma in Sri Lanka cannot be ignored. Most of the   psychological scars are unhealed and it can affect the person as well as society. These psychological and emotional traumas were resulted from witnessed killings, handling human remains, exposing to life and death situations, and numerous other battle stresses. This is a form of invisible trauma in the military. But it has direct implications on the mental health of the soldiers as well as their family members and the society at large.

 The combatants gave an enormous contribution to end the war in Sri Lanka. Their blood and sweat  were used by the politicians for their glory and at the end of the day the combatants received nothing except so called the Ranaviru Upahara which consisted of empty  words. There should be an effective rehabilitation for the combatants affected by the Palay Syndrome. For long years, the veterans did not gain adequate rehabilitation and their battle stresses increased risking not only the combatants also their family members. In the final account, these stresses affect the entire society.

 Combat Trauma in the Post War Era

There were many examples from other countries that reveal how combat trauma affected in the post war era. For example soon after the American Civil War, traumatized solders formed an extremist movement that called KKK which engaged in racial violence. Many American volunteers who participated in the Spanish Civil War engaged in social violence and some Lincoln Brigade soldiers became top criminals. Post Vietnam War caused a vast social chaos in USA. Similarly, many Afghanistan veterans of the Red Army engaged in organized crimes in the former USSR. 

 Soon after a mass conflict like war, there is a tendency of political extremism and sometimes fundamentalism to emerge. In a post conflict, society social fabric is fragile, people are traumatized and they become easy targets to these extreme and damaging forces. Soon after the WW 1, Germany faced such a situation and NAZIS could exploit the collective trauma experienced by the German people. The Taliban fundamentalists grabbed the power at the end of the Afghan conflict. Hence, there is an impending risk that we face today and the Democratic forces have an absolute responsibility to restore peace and justice system in the Country

 The major impact of war includes disintegration of the psychological well-being. Therefore, major psychosocial interventions are required to restore the damages caused by the war. Promotion of human rights and justice are the key way to reinstate the social equilibrium. The victims of war need psychosocial support and rehabilitation. Rehabilitation programs include education, vocational training, income generating projects, loans and housing that is tailored to the needs of the survivors and post disaster situation. 

 Wars represent mental health emergencies. It can affect the mental well-being of individuals. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society.  The discovery of delayed reactions of battle stress by Dr Michael Robertson of the Mayo Clinic reveals another threat of combat trauma. Those who are free of any type of combat stress signs today could be a future vulnerable group. Therefore, psycho education and effective treatment measures should be introduced to our health system.

Books and Publications by Dr Ruwan M Jayatunge

http://www.lankaweb.com/news/items10/Publications%20by%20Dr%20Ruwan%20M%20Jayatunge.pdf

One Response to “Shell Shock to Palaly Syndrome”

  1. Sita Perera Says:

    Ruwan, the best Psychiatrist/Psychologist (bothl) to come up from Sri Lanka after the Great Prof Nalaka Mendis

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