Dr Ruwan M Jayatunge ƒÆ’-¡ƒ”š‚ 

ƒÆ’-¡ƒ”š‚ The question is not whether PTSD is real and serious. It’s a devastating mental illness. The question is how many veterans have PTSD, and clearly our goal should be to try to address the veterans’ needs and help them deal with their problems and move on in life. –Chet Edwards

ƒÆ’-¡ƒ”š‚ War is an institutionalized violence that has intrinsic unique elements. It is a manmade disaster, which is multi-dimensional. War can beƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  individual as well as a collective form of trauma.ƒÆ’-¡ƒ”š‚  Wars represent a mental health emergency.ƒÆ’-¡ƒ”š‚ Mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem. War trauma can change the parameters of mental health towards the negative side.ƒÆ’-¡ƒ”š‚  The circumstances of the armed conflict can produce a range of emotional and behavioral stress reactions among soldiers and civilians.

ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ In a war situation, combat stress is an inevitable factor. Combat stress is a specific stress factor that can affect the mental and physical health. It is a form of psychological pathology that is resulted from traumatic exposure to battle events. Combat in most cases involved with fear, despair, shock and anxiety.ƒÆ’-¡ƒ”š‚  ƒÆ’-¡ƒ”š‚ 

ƒÆ’-¡ƒ”š‚ Combat stress is the result of internal and external stresses. Combat stresses do not come from the enemy action alone. Some stresses are generated from the soldiers own unit leaders and mission demands. Combat stress symptoms and reactions interfere with mission performance. Battle stress affects both the combatants as well as civilians especially living in the war zone.ƒÆ’-¡ƒ”š‚  War disrupts the existing social structure. The major impact of war includes disintegration of the psychological wellbeing. It create a specific calamity sub-culture often leads to generate vicious cycles that echoes even after the war.ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ 

ƒÆ’-¡ƒ”š‚ War Trauma

War can produce incredible acts of heroism and courage and it can produce intense fear and chaos. War trauma is a horrendous experience. As Hanscom (2001) points out war trauma refers to an experience that meets the definition of trauma as described in the DSM IV under PTSDƒÆ’-¡ƒ”š‚ that results from exposure to war conditions. War trauma may also occur and persist within the affected society in the aftermath of war.

War trauma survivors may exhibit the substance abuse, mistrust in social institutions, flashbacks, suicidal thoughts, antisocial behavior, and problem with peers.ƒÆ’-¡ƒ”š‚  Their typical responses include sleep disturbances, somatic complaints, anxiety, withdrawal and isolation. The war trauma gives rise to complicated, sometimes uncanny alterations of consciousness and personality. War trauma can alter one’s view of life permanently.

ƒÆ’-¡ƒ”š‚ War is a form of Collective Trauma

ƒÆ’-¡ƒ”š‚ The cumulative effect of terror on the community can be described as collective trauma, which goes beyond the individual. In fact, given the widespread nature of the traumatization due to war, the individualƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s psychosocial reactions may have come to be accepted as a normal part of life. But at the community level, manifestations of the terror can be seen in its social processes and structures. This can be seen in the prevailing cultural coping strategies. People have learned to survive under extraordinarily stressful conditions. (D. Somasundaram )

ƒÆ’-¡ƒ”š‚ The Long Term Effects of War on the Soldiers

War is a multi-layered, multi-factorial phenomenon that can have long lasting affects on physical and mental wellbeing of the soldiers. Soldiers bear disproportionate consequences of armed conflict. Therefore, equal damage is not seen among the combatants. They sustain physical and mental damageƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  that are not commonly seen in civilian populations. Ailments such as depression, adjustment disorders, somatoform disorders post-traumatic stress disorders remains under treated legacies of many soldiers.ƒÆ’-¡ƒ”š‚  In-depth interviews with veterans reveal that their experiences have impacted on their personal and family life. As a result of the combat trauma mental health problems, alcohol and drug abuse, physical and sexual violence, child abuse and family disharmony found among the combatants.ƒÆ’-¡ƒ”š‚ 

ƒÆ’-¡ƒ”š‚ The Soldiers with Combat Related PTSD

The circumstances of war can produce a range of emotional, psychological and behavioral stress reactions among the soldiers and officers that can lead to a condition known as combat related PTSD. Posttraumatic Stress Disorder (PTSD) is described in the DSM4 (Diagnostic and Statistical Manual of Mental Disorders) as the development of characteristic symptoms following exposure to an extreme traumatic stressor. PTSD is marked by symptoms of re-experiencing, avoidance and arousal, was officially delineated in 1980 as a clinical diagnosis within the category of mental disorders.ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ 

Combat experiences are often traumatic and it can cause catastrophic stressors outside the range of usual human experience. These events include actual or threatened death or serious injury or threat to soldier’s physical integrity or witnessing an event that involves death, injury, or a threat to the physical integrity of another soldier. The person’s response to the event must involve intense fear, defenselessness or horror.

Combat related PTSD is not restricted to the combat experienced veterans. Those who spent time in war zones and were surrounded by death or were put in to life threatening situations may also suffer from PTSD. In the Kulka et al.(1990) study the prevalence of current PTSD for Vietnam veterans was 15% among all veterans. In Sri Lanka, this figure could be 12% or more than that.

ƒÆ’-¡ƒ”š‚ Stress factors experienced by the combatants

ƒÆ’-¡ƒ”š‚ 1) Physical Stressors

Environmental

Heat, cold

Vibration, noise, blast

Poison, chemicals, radiation

Infectious agents / disease

Bright light, darkness

Skin irritants

ƒÆ’-¡ƒ”š‚ 2) Physiological stressors

Strenuous work

Sleep debt

Dehydration

Malnutrition

Illness or injury

ƒÆ’-¡ƒ”š‚ 3) Cognitive stressors

Uncertainty

Deprivation

Unpredictability

ƒÆ’-¡ƒ”š‚ 4) Emotional stressors

ƒÆ’-¡ƒ”š‚ Fear and anxiety

ƒÆ’-¡ƒ”š‚ Anger & rage producing frustration

ƒÆ’-¡ƒ”š‚ Boredom

ƒÆ’-¡ƒ”š‚ Homesick

ƒÆ’-¡ƒ”š‚ Interpersonal feelings

ƒÆ’-¡ƒ”š‚ Battle Fatigue

Battle Fatigue is a military term used to categorize a range of behaviors resulting from the stress of battle which decrease the combatant’s fighting efficiency. The term “Battle Fatigue” was introduced after World War II and the experts point out that 5%-15% of battle fatigue casualties fail to improve sufficiently to return to duty in the combat zone. The most common signs include slowing of the reaction time, slowness of thought, difficulty prioritizing, difficulty initiating routine tasks, preoccupation with minor issues and familiar tasks, indecision and lack of concentration, loss of initiative with fatigue and exhaustion.

ƒÆ’-¡ƒ”š‚ Combat Shock

Soldiers can go in to a state of traumatic shock after exposing to vigorous stress. Shock is a sudden and often intense disturbance emotional state that may leave soldiers feeling stunned or dazed. The initial traumatic event must have involved actual or threatened death or serious injury or a threat to the physical integrity of self or another person, and the person must have felt fear, helplessness or horror. During the event or immediately after soldiers usually experience numbing, detachment, derealization, depersonalization or dissociative amnesia. As the initial shock subsides, reactions vary from one soldier to another.

ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ Common symptoms displayed by soldiers after exposing to heavy combat.

1. Difficulty completing tasks
2. shame, impulsiveness )
3. Trouble concentrating / Making decisions
4. Fear and anxiety
5. Apathy and emotional numbing
6. Irritability and anger
7. Depression
8. Feeling powerless or lack of energy
9. Change of appetite
10. Somatic pain and myalgia
11. Difficulty in sleeping
12. Excessive drinkingƒÆ’-¡ƒ”š‚  / drug abuse
13. Feeling withdrawn
14. Persistent fatigue
15. Prolonged feelings of anxiety
16. Psychosocial impairments (Rage, guilt,

ƒÆ’-¡ƒ”š‚ Effects of war trauma on the Civilians

ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ In a military conflict, the first casualties are always the innocent civilians and it has become the naked truth of an armed conflict. Nearly 85% of victims killed in WWI were combatants (Graves, 2003). However, “today, some 90% of all people killed in wars are innocent, civilian women and children” (Ehrenreich, 1997; Kolb-Angelbeck, 2000, cited in Graves, 2003, p. 203). In a war today, heavy artillery shelling and aerial bombings take place and because of high tech warfare, innocent civilians suffer.

ƒÆ’-¡ƒ”š‚ The Northern conflict in Sri Lanka has led tens of thousands of people fled from their native villages. Some families had left to avoid LTTE child forcible recruitments. Many houses in the conflict zone are now in ruins.ƒÆ’-¡ƒ”š‚  Some civilians perished in cross fires.

ƒÆ’-¡ƒ”š‚ Stanley Krippner and Teresa M. McIntyre highlight the psychological impact of war trauma on civilians. They point out that psychological and emotional injuries maybe the most enduring effects of war, yet historically they maybe the least addressed in terms of rebuilding a society and preventing future violence.

ƒÆ’-¡ƒ”š‚ War dislocates the social fabric affecting livelihoods.ƒÆ’-¡ƒ”š‚  According to Professor Daya Somasundaram disasters have an effect not only on individuals but also on their family, extended family, group, community, village and wider society. The civilians of the North and South faced the pungent effects of the war.

ƒÆ’-¡ƒ”š‚ The civilians exposed to war were traumatized in different ways. The effects have longer-lasting consequences than destruction itself. Sometimes unintentionally, parents inflict their psychological baggage on their children and it leads to a vicious cycle of trauma. On most occasions, the impact of war and extreme stress on civilian populations has caused numerous personality changes in them. Psychological responses to these phenomena were expressed as social aggression, alcoholism, family discard, child abuse and self-harm and suicides.