Dr Ruwan M Jayatunge
Sri Lankan conflict was one of the longest armed conflicts of the 20th centaury. Sri Lankan society was shattered by hate and brutalization as a result of the internal war which caused over 95,000 lives and destruction of property worth over billions. This prolonged conflict generated massive numbers of PTSD victims. Combatants as well as a large numbers of civilians including members of the LTTE had undergone a tremendous amount of stress for the last three decades.
The civilians of the Northern Sri Lanka witnessed the War in firsthand. Many became the victims of the collateral damages. Prof Daya Somasundaram in the Journal of Mental Health Systems 2007 estimates that 14% of the Tamil population living in the Northern Sri Lanka suffer from PTSD.
Many civilians in the endangered villages and in the South became physical and psychological casualties following the attacks conducted by the LTTE aiming civilian targets.
There had been large military operations where the combatants were directly exposed to hostile conditions. Many combatants suffered combat trauma. The shock wave of combat still echoes the Sri Lankan society. Although the war is over the psychosocial scars of the war will remain for a long time.
There are no empirical data that directly address the prevalence of PTSD among the Sri Lankan combatants. But the 3 year study (2002-2005) done by the author with the Consultant Psychiatrist of the Sri Lanka Army Dr. Neil Fernando reveals that combat related PTSD is emerging in Sri Lanka. In one separate study which was done with the 824 Sri Lankan combatants who were referred to the Psychiatric ward Military Hospital Colombo, , full blown symptoms of PTSD was found among 56 people. PTSD diagnosed done according to the DSM 4.
Based on our rough estimations 8% – 12 % of combatants are severely affected by combat stress and many of them are not under any type of treatment. According to our survey among the 824 combatants who were referred to the Psychiatric Unit Military Hospital Colombo from August 2002 to March 2005 found a prevalence of conditions like PTSD (6.8%) depression (15.6%) alcohol abuse (3.5%), Somatoform Disorders (7.89%) and psychiatric illnesses such as Schizophrenia, Bipolar Affective Disorder, Acute Transient Psychotic Disorders etc (9.4%).
This may be the tip of the ice burg that is visible yet. This sample was referred to the Military Hospital Colombo for various psychiatric as well as stress and anxiety related conditions. Although this was not a randomly selected field sample it includes combatants who were exposed prolonged combat trauma. Over 95 % of the participants were on active duty. This survey discloses the bitter truth about the war and effective measures would be needed to prevent further damage. A traumatized soldier can transform his stresses to his family and to the community. Hence, in the long run the whole country will be affected by the repercussions of combat stress. This would lead to a vicious cycle and the scares will remain for decades.
The American Psychiatric Association (2000) discusses risk factors that affect the likelihood of developing PTSD. Among the risk factors the severity, duration, and proximity of an individual’s exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. The researches indicate that social support, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of posttraumatic Stress Disorder. It can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme.
There were several risk factors that affected the Sri Lankan combatants and it played a crucial role in developing combat related PTSD. The authorities did not welcome the term PTSD for a long time and they considered PTSD as an American illness that cannot be found in Sri Lanka. Therefore, psychological management of combat stress was not in the priority list during the 30-year war. Unfortunately, combat stress was not identified as a vital factor that should be dealt with effectively. The authorities felt that talking about combat stress could affect the soldier’s morale. Many filed military doctors disregarded psychological wounds of the war and gave immense attention to the physical wounds. Lack of experts in military psychology as well as the lack of funds has made psychological trauma management painstakingly difficult.
Some of the socioeconomic factors too contributed high rates in PTSD following combat related stress. During the height of the war, youth from the lower socio economic levels joined the Army and some of them had faced severe economic hardships, affected by the Middle East syndrome (maternal deprivation) or subjected to childhood trauma. Their psychological makeup had been changed negatively and they were psychologically vulnerable. Our 2002 – 2006 combat related PTSD study revealed that among the 56 Sri Lankan combatants who suffered from PTSD 30 of them had experienced childhood trauma such as chronic maternal deprivation, physical and sexual abuses, neglect etc. during the childhood.
As Gen Gerry De Silva- the former Commander of the Sri Lankan Army points out, the Sri Lanka army was the only army in the world whose full binate strength had been mobilized for over three decades. A large number of soldiers had served in the operational areas for 10-15 years facing hostile combat events. These factors had increased the psychological casualties in the military.
Even though the war over by 2009, the psychological aftermath of war has not ceased. Today we see the psychological reverberations of the Eelam War in our society. Murders, suicides, rapes and child abuses have been increased over the past few years. There is a sense of alienation; mistrust and culture of silence prevailing in the post war Sri Lankan society. The war stress especially the posttraumatic reactions of the Eelam war will echo in the Sri Lankan society for another generation unless we take appropriate measures to heal the Nation.