The Post War Period and Psychosocial Health of Combatants 
Posted on February 8th, 2016

Dr Ruwan M Jayatunge

The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her own abilities can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. War trauma negatively affects the mental health parameters. Odenwald et al. (2007) have shown that consequences of war-related trauma cause enormous suffering and problems adjusting to post-war life in many parts of the world.

After facing traumatic combat events the soldiers experience hopelessness, low self-fulfillment, rage, guilt, sense of emptiness, alienation and whole range of negative emotions. War has a catastrophic effect on the health and well-being of nations (Murthy& Lakshminarayana, 2006). Wars can change the psychological makeup of the combatants making them vulnerable to psychological disorders. Recent research suggests that military employees are at risk for acquiring PTSD (Danckwerts & Leathem, 2003).

The armed conflict in Sri Lanka ended in 2009 and the Sri Lankan Armed Forces militarily defeated the LTTE. But the military victory came with a huge human and social cost. Over 300,000 members of the Sri Lanka Armed Forces (including the Police Force) had been directly or indirectly exposed to combat situations during these three decades. Following the thirty year armed conflict in Sri Lanka many combatants underwent traumatic battle experiences that caused immense physical, emotional, and psychological distress. These experiences were events outside the range of usual human experience. Some combatants were diagnosed with combat related PTSD and other battle related psychological trauma. It has been estimated that there are a large number of combatants with undiagnosed combat related psychological ailments and many are without any kind of treatment. Stigma, lack of information, lack of resources etc. have prevented them getting professional help. For many veterans the combat stress has become an insidious disease – existing without marked symptoms but ready to become active upon some slightest psychological trigger.

War is profoundly political and social, yet terms such as, “trauma” tends to medicalize and individualize the problem (Martín-Bar”, 1994; Punamäki, 1989)., The armed conflict in Sri Lanka became extremely political and political decisions overruled the military decisions. Hence the war became a part of the political power struggle and war trauma naturally became an under discussed subject. There was no National strategy to address  combat trauma.

The Sri Lankan military authorities delayed to recognize the psychological impact of the Eelam War. Combat related PTSD was not regarded as a disabling condition that could affect the soldiers. Although the armed conflict started in way back in 1980s until 2005 the Sri Lanka Army did not give a medical discharge based on the diagnostic criteria “PTSD”. There were no strong socio political voices to address the psychological repercussions of the armed conflict. The Health Ministry had less power and minimal access to treat the soldiers with battle trauma. The health care providers did not receive adequate training to identify combat related symptoms among the combatants. These hindering factors have increased the psychological casualties among the armed forces.

Post-war situations are often characterized by the traumatization of large groups. In war, situations, people become victims of violence, destruction and displacement. Some have, experienced violence personally, others have lost relatives and friends, all, however, continue to live in an environment still marked by war and its consequences, even after, the end of the war (Scherg, 2003). The sequence of the, survivors’ post-war experiences usually, follows a pattern that includes a profound disorientation; despair and lust, for revenge (sometimes denied and/or, turned upon themselves); a process of, deep but incomplete mourning; the tentative reaching out for emotional solace in the form of new relationships and the rebuilding of a family world (Wolberg &Aronson,1975).

During the post war period in Sri Lanka delayed combat related posttraumatic reactions surfaced. Some extreme reactions manifested as self-harm, suicides and social violence. According to the Military Spokesperson of the Sri Lanka Army from 2009 to 2012 postwar period nearly 400 soldiers had committed suicide.

War related psychological symptoms could last for many years affecting individuals, their families and society. Van der Kolk et al. (1996) identified the significance of dissociation, affect, dysregulation, and somatization as “associated features” of PTSD. According to Van der Kolk and colleagues these associated features lasted for years even after full-blown, PTSD symptoms, subside. The combatants with affect dysregulation have persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or inhibited anger, compulsive or inhibited sexuality. Therefore Posttraumatic Mental Health of the combatants should be addressed appropriately. Evidence-based care system has to be introduced to increase and improve the post war psychosocial health.

 

Preventing Re-traumatization

Veterans affected by war trauma have a re-traumatization risk. Re- traumatisation is defiend as a situation, attitude, interaction, or environment that replicates the events or dynamics of the original trauma and triggers the overwhelming feelings and reactions associated with them. Dutton et al.( 2005) elucidate that sometimes the term “revictimization” rather than “retraumatization” is used to, designate re-experiencing interpersonal trauma again, especially later in life after an, earlier trauma.

Combat involves multiple types of life-and-death experiences associated with strong and wide-ranging emotional reactions. The emotional scars of the war remain for a long period. Traumatized veterans are a vulnerable group and measures would be needed to prevent them from re-traumatization. Many traumatized people expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. These behavioral reenactments are rarely consciously understood to be related to earlier life experiences (van der Kolk, 1989).

Redeployment , working in adverse environments could trigger past traumatic memories. When the working environment becomes adverse or less supportive, there is a high tendency for the soldiers to become AWOL. A large number of Sri Lankan soldiers have become deserters over the past few decades. The numbers are exceeding over 50, 000 (AFP, 2011). Many deserters were exposed to battle events and they still relive with traumatic combat memories. A large number of traumatized combatants have joined the underworld gangs and committed crimes. Some have joined with local politicians and engaged in election related violence: the irony is many veterans who had got honorable military discharges have rejoined as security officers in private firms. van der Kolk (1987) indicates that some traumatized people remain preoccupied with the trauma at the expense of other life experiences. Effective measures must be implemented to minimize the re traumatization of combatants who underwent gruesome realities of the Eelam War.

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