{"id":104784,"date":"2020-07-23T15:55:17","date_gmt":"2020-07-23T22:55:17","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=104784"},"modified":"2020-07-23T15:55:17","modified_gmt":"2020-07-23T22:55:17","slug":"war-trauma-in-the-military-their-families-and-communities-4","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2020\/07\/23\/war-trauma-in-the-military-their-families-and-communities-4\/","title":{"rendered":"War Trauma in the military, their families and Communities"},"content":{"rendered":"

Ruwan M Jayatunge \u00a0M.D. \u00a0<\/em><\/span><\/h2>\n\n\n
\"\"\/<\/figure>\n\n\n\n

Combatants Affected by the Prolonged War<\/strong><\/p>\n\n\n\n

The 30 year armed conflict in Sri Lanka has\nproduced a new generation of veterans at risk for the chronic mental health\nproblems that resulted following prolonged exposure to the war. Over 200,000\nmembers of the Sri Lanka armed forces and police had been directly or\nindirectly exposed to combat situations during these years. There had been\nnearly 20 major military operations conducted by the Armed Forces from 1987 to\n2009. A large number of combatants from the Sri Lanka armed forces were exposed\nto hostile battle conditions and many soldiers underwent traumatic battle\nevents outside the range of usual human experience. These experiences include\nseeing fellow soldiers being killed or wounded and sight of unburied\ndecomposing bodies, of hearing screams for help from the wounded, and of\nhelplessly watching the wounded die without the possibility of being rescued.\nFollowing the combat trauma in Sri Lanka, a significant number of combatants\nwere diagnosed with Post Traumatic Stress Disorder (PTSD). The combat operations\nin the North and East had involved military personnel in major ground combat\nand hazardous security duty. A significant number of combatants had\nposttraumatic reactions soon after the traumatic combat events. Majority of\nthese reactions were undetected and untreated. The deaths include 27,639\nLTTE carders, 23,327 Sri Lankan soldiers and police officers, 1,155 Indian\nsoldiers, and tens of thousands of civilians. The last phase of the war\nresulted 280,000 internally displaced persons.<\/p>\n\n\n\n

Combat Trauma Experienced by the Soldiers<\/strong><\/p>\n\n\n\n

War is particularly traumatic for soldiers\nbecause it often involves close violence, including witnessing death through\ndirect combat, viewing the enemy before or after killing them, and watching\nfriends and comrades die (Hendin & Haas, 1984). After exposing to combat\ntrauma soldiers are more likely to have psychological ailments predominantly\nstress related symptoms, problems with social relationships and various other\nproblems. The wounds that they received from war are not confined to the\nbattlefield it frequently transformed to their domestic environment as\nwell. Although studies are needed to systematically assess the mental\nhealth of members of the armed services, a very few studies were conducted\nduring the last 30 years. The most common mental health issue for soldiers\nis post-traumatic stress disorder and related symptoms of depression, anxiety,\ninattention, sleeping difficulties, nightmares, and survival guilt.<\/p>\n\n\n\n

The dedication and the courage of the armed\nforces cannot be underestimated and the Sri Lankan combatants fought one of the\nlongest and deadliest armed conflicts in the world and they were able to gain a\nclear victory. Sri Lanka paid an immense price for the victory. As a result of\nthe three-decade war, many soldiers became physical and psychological\ncasualties. Unfortunately the society is gradually forgetting the scarifies\nmade by these people. Although many see war as a heroic effort, there are\nthousands of untold traumatic stories in the Eelam War.  Some soldiers\nshared their traumatic stories with us and these stories reveal the magnitude\nof their suffering. These stories represent the true nature of combat trauma in\nSri Lanka.<\/p>\n\n\n\n

The psychological casualty of the operation\nliberation<\/strong><\/p>\n\n\n\n

The Operation Liberation or Wadamarachi\nOperation was conducted in 1987. It was the first major military operation in\nSri Lanka. Nearly 8,000 soldiers participated in this campaign.  The most\npopular and the famous officer of the Sri Lanka Army the late Gen Denzyl Kobekaduwa\ncommanded this military offensive against the LTTE. Corporal Ax36 is one\nof the psychological casualties of Operation Liberation. During this battle, he\nfaced many battle stresses. He was physically and mentally exhausted. After\nserving, a number of years in the Army Cpl Ax36 witnessed many traumatic\nevents.  He suffered nightmares, intrusions, hyperarousal, and flashbacks.\nHe was avoiding people and places related to his traumatic experiences and\nbecame emotionally numbed. In 2003, Cpl Ax36 was diagnosed with PTSD. <\/p>\n\n\n\n

Corporal Ax36 describes his present emotional\nand physical ailments as follows.<\/p>\n\n\n\n

I was one of the soldiers who took part in\nthe Wadamarachi Operation in 1987. Our main aim was to liberate Jaffna\nPeninsula and destroy the LTTE positions. When we came near the Thondamanaru\nBridge, the LTTE destroyed the bridge using explosives. We had to advance\nslowly. One of our soldiers died in front of my eyes as a result of a booby\ntrap. I can still recall his face filled with blood. It was a horrific incident. Needless\nto say that I was terrified by this event. Because I am a human although I wore\na military uniform. I was shaken by the death and demolition. Even after many\nyears, I still see these events in my dreams. To evade the nightmares I used to\ntake alcohol and go to sleep. I cannot stand any loud noises, I become\nfrightened and my heart started pounding. Often I try not to think about past\nevents. When I see the TV if I see any combat related story or a pictures I\ndisconnect myself with it. I hate to talk about past events especially those\nrelated to the war.<\/em><\/p>\n\n\n\n

I have no strength in my body now. My joints\nare aching. I cannot even walk a mile.  Prematurely I have grown old. My\nmind is full of melancholic feelings. I am unable to feel happiness. For many\nyears, I never experienced cheerfulness.<\/em><\/p>\n\n\n\n

I am unable to concentrate and I am very\nforgetful. I have forgotten the names of my fellow soldiers who served with me\nin the same unit. Sometimes I feel that I have no reason to live. My family\nmembers avoid me because of my hot temper. Unlike early days, I cannot control my\nanger. I have been turned in to an irritable cold person. Several times, I\nthought of disappearing from this world. But according to my religion it is a\nsin. Therefore, I have resisted the idea of committing suicide.<\/em><\/p>\n\n\n\n

Private K and Survival Guilt<\/strong><\/em><\/p>\n\n\n\n

There is a higher incidence of depression in\nveterans who had been in combat and lost a friend. Survival guilt is an\nespecially guilt invoking symptom.<\/p>\n\n\n\n

Survivor guilt\u201d is the term used to describe\nthe feelings of those who, fortunately, emerge from a disaster, which mortally\nengulfs others. On an irrational level, these individuals wince at their\nprivileged escape from death\u2019s clutches(Harvery, 2007).<\/p>\n\n\n\n

Private K is a soldier who was severely\ntroubled by the survival guilt. He joined the Army in 1992 and served in the\nNorth. While serving in the combat his buddy was shot in front of his eyes near\nthe Punani station. He fell down and lost his consciousness. Although Private K\nwanted to help his friend, he could not reach the friend due to heavy fire.\nAlong with the other soldiers, he attacked the enemy and eventually went near\nhis friend. But he was dead. This incident made him so upset. He felt guilty that\nhe could not help the buddy.<\/p>\n\n\n\n

By 1997, he often experienced headaches,\nintrusions about his dead friend and showed a marked depression. He became\nirritable and gave a startling reaction to any slightest sound. Private K felt\nuneasy with the military duties and wanted to avoid military situations. In\n2003, he was referred to the Military Hospital Colombo and diagnosed as having\nPTSD.   Private K\u2019s condition improved following drug therapy (SSRI)\nand psychotherapy (CBT and EMDR). By 2005, he was free of most of the PTSD\nsymptoms. After cognitive restructuring, he got the insight and now Private K\nknows that he was not responsible for the death of his friend.<\/p>\n\n\n\n

Did I bury him alive?<\/strong><\/p>\n\n\n\n

Private Lx26 became pitiful when he witnessed\nthe death of his fellow soldier who got killed by a sniper shot. The troops had\nno means to bring the body back. After confirmation of death, Private Lx26 was\nordered to bury the body. When he touched his friend\u2019s body, he could feel the\nbody warmth may be due to the hot Northern climate. Private Lx26 dug a pit and\nburied his friend\u2019s body in the mist of sorrow. Then they advanced towards\nOmanthai. After a several days, Private Lx26 had an irrational and guilty\nfeeling that he had buried his friend alive. He suppressed this painful feeling\nfor a long time. Gradually it became a distressing thought, which he could not\nbear anymore. In 2003, he experienced a severe depressive reaction following\nsurvival guilt. He had full-blown symptoms of clinical depression. He was\ntreated with Rational Emotive Therapy in which his irrational and illogical\nideas were confronted via a friendly and therapeutic mediation. After the\ntherapeutic intervention, Private Lx26 was free from devastating psychological\nburden that he had carried for long years.<\/p>\n\n\n\n

My Sergeant died in my arms: says Private RS<\/strong><\/em><\/p>\n\n\n\n

I was born in a small village in Pollonarwa\nand often our village became the LTTE target. Several times the LTTE attacked\nour village slaughtering men women and little children. We had mass funerals\nafter these attacks and most of the villagers felt utterly sad and\ninsecure.  As a child, I saw these horrendous things around me. At night,\nwe did not sleep in houses, for security we slept in the jungle. I did not see\na way out for these tremendous problems except joining the military. So I was\ndetermined to join the Army.<\/em><\/p>\n\n\n\n

Our family had to face many financial\nhardships and that affected my education. I could not study further and I\njoined the Army. After my basic training, I served in Welioya and Vavunia.<\/em><\/p>\n\n\n\n

In 1997, I participated in Jayasikuru\n(Victory Assured) operation and we were given a task to capture the Mankulam\nhighway. We fought the enemy face to face. The gunfire lasted for nearly 3\nhours. A commando unit came for our support and we were able to advance further.\nSergeant L who was my senor NCO and my mentor was behind me. He taught me many\ncombat skills. We always fought the enemy together. He used to cover me and I\nused to cover him. Both were lucky for many years. However in Mankulam he was\nhit by a bullet. Sergeant L was bleeding profusely. I helped to evacuate him. I\ncarried him while praying for his life. His breathing became shallow. I could\nnot reach the medics, half way he died in my arms.<\/em><\/p>\n\n\n\n

After his death, my conscience blamed me for\nnot saving him. I felt guilty. I wish I could have taken him to the Medical\nPoint on time. If I had done that, it could have saved his life. But I was late\nand Sergeant L died. I was troubled by this guilty feeling and combat related\nnightmares and various intrusions. My life became to a standstill. I was filled\nwith sorrow and repulsion of combat events. I was disgusted with all these\nissues and once I wanted to shoot myself and end the suffering. Somebody or\nsome power saved me from self-harm and showed the way towards life. Again, I\nsaw light.<\/em><\/p>\n\n\n\n

(Private RS was found with PTSD comorbid with\ndepression.  Following intensive treatment, he was able to recover. He\nbecame free of survival guilt that had troubled him for a long time. Now he is\nserving in his unit without firearms and doing light duty. )<\/p>\n\n\n\n

Rifleman Sn34 and Baptism of Fire<\/strong><\/em><\/p>\n\n\n\n

I became a psychological casualty at the Yal\nDevi operation says Rifleman Sn34 revealing his story thus.<\/p>\n\n\n\n

\u2026Operation\nYal Devi was my first combat experience. We faced the enemy with courage. I\nwitnessed a lot of traumatic incidents there. Our fellow soldiers died in front\nof my eyes leaving us in sorrow. On one occasion, the enemy gave us a surprised\nattack and we were scattered. I jumped in to a pit and waited all night long.\nIt was a dark night. I saw the enemy collecting weapons from our bunkers. I was\nalone and feared for my life because I knew, the enemy had no mercy. I had seen\ndead bodies mutilated by the enemy. I thought they would do the same thing to\nme if they could capture me. It was an awful idea. I had vivid mental pictures\nof my funeral and I saw my parents were crying. I did not want to be captured\nby the enemy and let them mutilate my body.<\/em><\/p>\n\n\n\n

The entire night I was praying for my life\nand by dawn the reinforcements came and they rescued me. I was taken to the\nhospital. Although I had no physical injuries, my mind was deeply wounded.\nNevertheless, doctors said I was ok. I felt something was wrong with me. I was\nsent to the battlefield again. I had fear feelings and every night I saw the\nsame horrible dream. I saw myself trapped in a pit and the enemies were all\nover. Despite the fear and resentment, I did the duty that was requested from a\nsoldier. My mental health was deteriorating and I had no salvage. Finally, I\ndecided to become AWOL.<\/em><\/p>\n\n\n\n

I went home as a completely changed person.\nThe innocence of youth and affection towards the family members had gone away.\nThey saw me as a frightened cold soul. My parents thought that some evil spirit\nhad got in to my body and they did Thovilaya, the ancient ritual to chase dark\nspirits to heal me. But it did not help. My memory was fading and I couldn\u2019t\nsleep. Nightmares ruined me to the end.<\/em><\/p>\n\n\n\n

My family arranged a marriage for me thinking\nthat it would help me to get away from alienation. After my marriage, again I\nwent back for duty. But I was a lost soldier. I was anxious about performing\nmilitary duties. I had intense fear of enemy attacks. The noise of the gunfire\nmade me startle.<\/em><\/p>\n\n\n\n

I went home after several months serving in\nthe North. I had no happy feelings that I got a vacation after so many months\nfighting in the jungle. My emotions became numbed and I was no longer\ninterested in marital life. I became more and more hostile and physically\nabused my wife. Since I couldn\u2019t have a sound sleep, I started indulging in\nalcohol.  Practically day and night, I was drinking secretly. But it made\nme worse. It made me a monster. My wife was afraid of me. When I came home, she\nwas shivering in fear. When I was angry, I destroyed the house property.\nNothing gave me relief.<\/em><\/p>\n\n\n\n

Eventually I decided to talk to one of my\nsenior officers whom we trusted. The officer listened to my grief and helped me\nto get psychological therapies. I was treated at the Psychotherapeutic unit at\nthe Military Hospital Colombo for nearly 3 weeks as an inward patient. Then\nthey got down me to the clinic and treated me. Counseling and medication helped\nme to get away from the trauma that I experienced for a long time. Today I am a\nnew man who is not abusing alcohol and I love my family. I enjoy life and do\nnot live in past memories.<\/em><\/p>\n\n\n\n

The soldier who did not like to attend\nmilitary funerals<\/strong><\/em><\/p>\n\n\n\n

I hate to participate in Military Funerals\nsays Lance Corporal S who described his military life in the following account.<\/p>\n\n\n\n

In 1987, I was posted to Kurumbasevadi camp\nnear the Palali Base Camp. There I faced the baptism of fire. In that camp, I\nserved nearly one and half years and was then sent to Welioya camp. I was at\nthe forward defense line. At the Welioya camp, I witnessed many horrendous\ncombat events. The enemy attacked us with heavy weapons killing my fellow\nsoldiers. I saw how they were lying on the ground with bullet or shrapnel\nwounds. I collected the dead bodies and put them in to body bags. I was utterly\ndevastated when collecting human remains.<\/em><\/p>\n\n\n\n

In 1991, I served in a non-operational area\nbut my official duty was to participate in funerals of our soldiers who died in\naction. When I was at these military funerals, I had various intrusions about\nthe battlefield and my dead buddies. My heart was broken when I heard the\nmourning and wailing of the relatives. At one funeral, I saw a mother\nwas crying for her dead son. He was a good soldier whom I knew. Her weeping\nreverberated in my ear. I recalled the dead soldiers at Welioya, how they were\nlying on the sand. Some with opened eyes.  Many weeks I could not\nsleep. I hated to participate in these depressing military funerals. However,\nmy duty required such participations. In each funeral, I had flashbacks and\ndeep sensation of sadness.<\/em><\/p>\n\n\n\n

By 1998, I got a transfer to Mannar District.\nThere while I was traveling by bus I met with a land mine explosion. I was\nwounded and treated at the hospital. Although my physical wounds healed, the\nfear I experienced at that event was re-occurring. My mind was full of various\nbattle events, military funerals and the land mine explosion, which I met in\nMannar. I had nightmares and fear feelings. I became more irritable and\nsexually inactive.<\/em><\/p>\n\n\n\n

My body became a source of pain. Every joint\nin my body started aching. When I experienced an unbearable headache, I could\nnot stand noises.  After the land mine explosion, I was again posted to\nthe former camp in the non-operational area to fulfill funeral duties, which I\nhated. Regrettably, the senior officers gave no ear to my grievances. I was\nthere for another one and a half years. During that time my illness progressed\nrapidly and once I decided to commit suicide inside the camp. My\nunsuccessful   suicide attempt alarmed the platoon officer and I was\nsent to the hospital. At the hospital, I was treated and given medication and\npsychological support. After months of treatment, my condition improved. Today\nI am doing light military duty in a non-operational area. But still I cannot\nsee the dead and war memorials.<\/em><\/p>\n\n\n\n

(Lance Corporal S was diagnosed with PTSD\ntreated with SSRI and EMDR. After intense therapy, his anxiety based symptoms\nwere reduced to a significant level)<\/p>\n\n\n\n

In my dreams I see the enemy is attacking my\nbunker says Private Rx68 (A known PTSD patient)<\/strong><\/em><\/p>\n\n\n\n

\u2026.My memories are still filled with the\nevents that took place on the 24th<\/sup> of August 1993. Now for many\nyears I still live with these horrendous memories. Practically every day I\nrecall these events and it gives me pain and anguish.<\/em><\/p>\n\n\n\n

On that doomsday at 12 o\u2019clock midnight I was\nat the bunker. Two of my buddies who were with me had a rest while I was on\nguard. Suddenly I heard gunshots and one of our corporals shouted that the\nenemy is attacking the Janakapura North Camp. I awakened two of my buddies and\nasked them to be on alert. Within a few moments, a group of LTTE attacked our\nbunker.<\/em><\/p>\n\n\n\n

I heard the scream at the adjacent bunker.\nThe enemy attacked them with a hand grenade and I presumed that they had\ncaptured that bunker. So we were on our own and fighting the enemy. Three of us\nfired at the enemy from three different directions and we never wanted to\nsurrender.<\/em><\/p>\n\n\n\n

The enemy came towards us like an unceasing\nwave.  I attacked the enemy with my LMG killing a dozen of them. One of my\nbuddies near me sustained a gun shot and fell down. Hence, two of us had to\nface them.<\/em><\/p>\n\n\n\n

We fired at them without giving any break.\nSuddenly they attacked my bunker with a RPG and the bunker collapsed. A large\nPalmyra log fell on to my head and I was semi-conscious.  My ears became\nblocked and I felt bleeding from my head. I knew if we stayed there, we would\nbe killed. Therefore, we came out from the wreck and crawled towards the center\nof the camp. While we were moving several LTTE carders came to capture us alive\nand I threw a grenade to escape.<\/em><\/p>\n\n\n\n

When two of us went further, we met a group\nof our soldiers. We regrouped and attacked the enemy.  The assault went\nfor a long time, by dawn the enemy withdrew from the camp leaving many\ncasualties. Although I was injured and tired, I fought with my guys without\ndropping my weapon.  In the morning, I was sent to the hospital for\ntreatment.<\/em><\/p>\n\n\n\n

I still recall how my friend at the bunker\nfell like a log after being hit by a bullet to the head.  We fought while\nhe was gasping and we had no time to pay attention to him. He must have died\nwithin a few minutes. These memories hound me at nights. When I am half a sleep\nI see shadows, and I become vigilant. I always get a feeling that the enemy is\ncrawling towards me. I fear that the enemy would attack with a RPG. Then I open\nmy eyes and my heart starts to beat like an accelerated machine. Afterward for\nseveral hours, I am unable to sleep. Awake at night I am thinking about my\nfriends who died in the battle. Then I feel that it was so unfair that I am\nalive and they are no more.<\/em><\/p>\n\n\n\n

Sometimes I see battle events in my dreams.\nOften when the enemy attacks I am unable to return fire, my gun is jammed.\nSince I am unable to shoot the enemies, they are approaching me little by\nlittle. I can hear their voices scolding us in Tamil Punde Army, Punde\nArmy.  I become helpless. I hear someone throw a grenade. My fear increases\nand I shout. Then I realize that it was another nightmare.<\/em><\/p>\n\n\n\n

My family members are now used to my\nscreenings at night. My great fear is when I am sleeping I might harm someone\nwho is near me. Therefore, I often tell my wife and children not to be near me\nwhen I am sleeping. My life has changed dramatically and I am not the same\nperson anymore. My emotions are numbed and I cannot cry for my dead friends.<\/em><\/p>\n\n\n\n

The Story of Private UG<\/strong><\/em><\/p>\n\n\n\n

Private UG met with a blast injury in 1997\nnear the Thaladi camp. He was wounded and psychologically shattered by the\nblast. After several months of the injury he complained of severe headache,\ninsomnia and fear feelings. Gradually he developed PTSD symptoms. Private UG\nfound it difficult to sleep and experienced nightmares related to the blast\ninjury. He had fright feelings and always wanted to avoid the places and\nconversations related to the blast injury. Any slightest sound made him jumpy.\nHe became irritated and could not control his anger. Often he experienced\nsexual dysfunctions and as a result of family turmoil, his wife left him.\nFollowing family problems and overwhelming anxiety, he tried to commit suicide.<\/p>\n\n\n\n

When Private UG was referred for\npsychological therapies, he was treated with CBT and EMDR which minimized his\nPTSD symptoms. Today he is able to sleep without nightmares and intrusions\nhardly bother him. He does not get excessively angry as early. He has learnt to\nmanage his anger without destructive behavior. The final follow up revealed\nthat his wife had returned and Private UG is leading a productive life.<\/p>\n\n\n\n

I was hiding in a hole in the ground<\/strong><\/em>:<\/em> Rifleman Mx38<\/em><\/strong><\/p>\n\n\n\n

The night of the 27th<\/sup> of\nSeptember 1998 was the most terrible hours of darkness of my life.  I was\nat the FDL in the Paranthan area. The LTTE attacked my bunker and they managed\nto come very close. My friends had thought that I was dead and the enemy had\ncaptured my bunker. Then they too attacked the bunker with their weapons. I was\ntrapped facing enemy fire as well as friendly fire. Without many options, I\ndecided to abandon the bunker. I crawled and moved away from the FDL. \nThen I found a pit and I was hiding in there. I heard the enemy\u2019s movements and\nlot of gunfire. I thought this would be the end. Within a few moments, they\nwould discover me and they would not think twice to kill me. I saw child\nsoldiers moving towards the FDL with heavy weapons, then the LTTE female carders\nwith AK 47 in their hands. Luckily, no one saw me or not expected me to be in a\nhole in the ground.  I could hear heavy fighting and I decided to stay\ninside the pit. I was trapped there for several days. I had no food  \nand my water bottle finished by the second day.  On the third day, I was\nthirsty and I was compelled to dink my urine. By the fourth day, I had no\nalternative. I decided to move towards the FDL. I noticed the defeated enemy\nretreating group by group. I took cover and avoided them. It was a dark night\nand I made no noise. I was without food and water with severe exhaustion. I\nmoved slowly.<\/em><\/p>\n\n\n\n

When I came near the FDL I had to be vigilant\nnot to attract friendly fire. I shouted at our soldiers. I told them my name,\nunit and my serial number. Then they recognized me with a surprise. They had\nthought that I was killed or captured by the enemy. I was taken to the C\/O and\nhe admired my courage. I evaded death like a miracle. I was lucky to come\nalive. But this happiness lasted for few days. Often the fear and isolation\nthat I experienced inside the ditch bothered me. I could not rest, every time I\nhad to be on guard anticipating an invisible enemy.   Days went by, I\nwas still feeling fear. When I went to an ambush I became restless, I was\nlooking at the front, then my inner feeling said the enemy is behind you, I\nlooked back, and no one was there. I could not concentrate my mind. It was a\nterrible mess and became an obsessive ritual to watch every direction for the\nenemy.<\/em><\/p>\n\n\n\n

My head started aching and often I forgot\nthings. Several times, I was warned by senior NCOs and Officers for leaving my\nweapon elsewhere. I could not concentrate or remember things. At nights, I was\npractically awake. A slightest sound made my heart ooze with fear. My heart\nstarted pounding giving me aches and pains. I had terrible nightmares. In my\ndreams, I saw I was trapped in a hole in the ground and surrounded by the\nenemy. I hated to go to sleep.<\/em><\/p>\n\n\n\n

(Rifleman Mx38 was diagnosed with PTSD\ntreated with SSRI and Psychotherapy \u2013CBT& EMDR. According to the 12th<\/sup> April\n2005 follow up he experienced no major PTSD symptoms. His sleep became normal\nand the startle reactions became minimal. No intrusions or flashbacks troubled\nhim)<\/p>\n\n\n\n

The story of Lance Corporal AS \u2013 The soldier\nwho was living in isolation<\/strong><\/em><\/p>\n\n\n\n

I was happily married but things changed when\nI became wounded. In 1990, I was at the Thaladi Camp, Mannar. There I saw\nfierce battles.  The LTTE attacked us with heavy weapons killing nearly 40\nsoldiers. With utmost difficulty, we were able to defeat the enemy. My heart\ncried when I saw the dead bodies of our fellow soldiers. We were like one large\nfamily. Prior to the attack we had meals together and made jokes about odd\nthings. They have gone forever. When I put their bloodstained bodies in to the\nbody bags, I cursed the enemy.<\/em><\/p>\n\n\n\n

After this event I became more isolated and\nhad intrusive memories. There was no one to speak about my anguish. I became\nalienated.  When I came home, my wife often asked what was wrong with me.\nHowever, I did not tell anything to her. Because it was a pointless effort to\ntell my sorrow to her and she would never understand what happened in the\nbattlefield. Therefore, I silently lived with my grief. But I became more and\nmore irritable.<\/em><\/p>\n\n\n\n

In 1996 we went to Kodikamam and ambushed the\nenemy. There was no proper camp for us. We lived in abandon houses, which were\nruined by the shellfire. It was a hostile ground. The enemy was everywhere. If\nyou do a stupid mistake, you would sleep in a body bag. I was uncertain of my\nlife. We lived day-by-day avoiding enemy fire and booby traps.<\/em><\/p>\n\n\n\n

One day we accidentally walked to an ambush\nand the enemy fired at us in close range. Eight of our men died in this attack\nand they died in front of my eyes. We too attacked the enemy and eventually\nmanaged to escape. But we had to leave the bodies due to the advancing hostile\nforces. I still feel guilty for leaving their bodies. Indeed it was a terrible\ntime. During these years, I saw many dead soldiers as well as the members of\nthe LTTE. Some bodies were decomposed or mutilated. I saw large monsters eating\ndead bodies. The things I have seen confirmed me that there is no glory in\ndeath for sure.  Once I saw a dead body of a staff sergeant (he was known\nto me), the enemy had shot his eyes. It was a horrible image to see, a dead\nbody without eyes and instead of the eyeballs, I could see the deep bullet\nwounds. For many years, that image was deposited in my mind. I even had bad\ndreams.<\/em><\/p>\n\n\n\n

When I came home these battle events started\nroaming around my mind. I wanted to be left alone. But my wife wanted to know\nwhat\u2019s wrong with me. I was not interested in sex life. I was avoiding my wife.\nShe thought I was having an illegal affair. I could not stand her accusations.\nI became depressed and could not tolerate noise. When my children played and\nshouted I became extremely angry. I punished them severely. When my wife\nprotested, I used to beat her too. One day I smashed the TV and chased\neverybody out of the house.<\/em><\/p>\n\n\n\n

My family was suffering with me. When I came\nhome, I used to physically abuse my wife for a slightest argument. She felt\nuneasy during my presence. Even the children feared me as if I am a monster.\nLittle by little, I was losing my family. When the physical abuse escalated, my\nwife went to her parent\u2019s house with the children.  I was all alone and I\nstarted abusing alcohol.<\/em><\/p>\n\n\n\n

My nights became more and more disturbed. I\nexperienced battle events in my dreams and relived painful moments. Sometimes I\ncould hear gunshots, artillery fire and helicopter sounds. I was trapped in\nreality and illusion. I had a deep loathe when I saw military vehicles and\nuniforms. I was afraid of going back to the battlefield. I never knew what fear\nwas but now my body shivers even for a slightest sound like a firecracker.<\/em><\/p>\n\n\n\n

My wife refused to come back then I became\nmore depressed. I wanted to end suffering by shooting myself. Once when I was\non duty at the Army camp, I took a weapon to take my life. A senior NCO jumped\nand grabbed the weapon. Then I was produced before my Officer in Command. I\nthought I had to face charges violating military discipline. Instead of\npunishing me, they sent me to the Military Hospital. There I was treated and\nthe doctors were kind enough to arrange an open interview with my family. The\ndoctors convinced my wife to come back and finally she\nagreed. With   treatment, I was able to control my anger. My\nintrusions and nightmares diminished and gradually I became a productive\nperson. Now for over two years, I live with my family and I do not abuse them.<\/em><\/p>\n\n\n\n

I lost my voice in the height of the battle \u2013\nLance Corporal W<\/strong><\/em><\/p>\n\n\n\n

Psychogenic dysphonia refers to loss of voice\nwhere there is insufficient structural or neurological pathology to account for\nthe nature and severity of the dysphonia, and where loss of volitional control\nover phonation seems to be related to psychological processes such as anxiety,\ndepression, or dissociative reaction. Psychogenic aphonia is a conversion\nsymptom, which arises following an unconscious psychological conflict. \nThere were many soldiers who lost their voices without any organic factors in\nthe Eelam War. These soldiers mainly had overwhelming combat stress factors,\nwhich led to their aphonic condition. Lance Corporal W who is a known PTSD\npatient described how he lost his voice in the midst of the war.<\/p>\n\n\n\n

I joined the military in 1995 and faced many\nbattle events. In 2000, I went to serve in the Pallai camp where the LTTE\nattacked us with mortars. I was shattered by the sound of this mortar fire. I\nfelt a profound breakdown inside my body. Every time I took cover to incoming\nmortars. I could feel the shockwave.  I saw how our soldiers sustained\ninjuries. I still recall one event in which a soldier succumbed to a mortar\nblast. His bowels came out and blood splashed  all over. It was a cruel\nand painful death. I was always on guard for incoming mortars. When that\n\u2018zooooo\u2019\u2026..noise comes I always took cover. I knew what was going to happen in\nthe next moment.  Mortar come with that sound and gives a terrible blast.\nIf you don\u2019t go down you would be hit by shrapnels. Although I was extra\ncareful, I was not lucky. Once I sustained minor injuries as a result of a\nmortar attack. Shrapnel pierced my thigh.   I was hospitalized and\ntreated for a few days.<\/em><\/p>\n\n\n\n

Pallai experience was a horrendous experience\nfor me. I was not sure of my life and often lived in uncertain situations.\nHowever, I was lucky to be alive and returned from Pallai. Then I served in a\nrelatively favorable environment. In 2003, I re-experienced Pallai events and I\nfrequently had nightmares. My fellow soldiers did not like me because I used to\nscream at midnight with fear. Some thought that I was smoking ganga. One night\nwhen I was sleeping, I saw an incoming mortar. I cried for help but there was\nno sound. I became speechless. . Ever since, I could not speak and I lost my\nvoice.<\/em><\/p>\n\n\n\n

(Lance Corporal W was aphonic for several\nweeks and underwent psychotherapy. He was treated with hypnotherapy and was\nable to regain his voice. His PTSD condition lasted for a long time. Medication\nand CBT helped him to minimize the condition)<\/p>\n\n\n\n

I had walked to the enemy lines: Private\nSK<\/strong><\/em><\/p>\n\n\n\n

I was confused and did not know what I was\ndoing. I had walked to the enemy lines. Luckily, a team of Special Forces saved\nme. When they found me, I had dropped my weapon and was wondering towards the\nenemy lines. I don\u2019t remember how I left my defense point or where I dropped my\nT56. I was taken to the camp and produced before Col \u2026.. I was heavily\nquestioned.  Later they blamed me for abandoning my post and losing the\nweapon. I was severely punished for that offence\u201d.<\/em><\/p>\n\n\n\n

(Private SK had gone into a psychogenic fugue\nstate following overwhelming battle stress. He could not recall what really\ntook place on that day. He served at Nedunkurni and witnessed the death of four\nsoldiers as a result of an artillery fire. He saw how their bodies had been\nblown into pieces and instantly he was shocked. After this incident, he\ngradually became a victim of combat related PTSD which was undiagnosed and\nuntreated. He had dissociative features as well. Several times, he went into\nfugue states and in the final event, he had walked to the enemy\nlines.   After he was rescued Private SK was referred to the\nPsychological Treatment Center at the Military Hospital, Colombo. At the\ncenter, he underwent a series of psychological assessments and cyber testing\nmethod to elicit autonomic arousal. He was diagnosed as having PTSD. Private SK\nwas treated with SSRI and SPDT (Short Term Psychodynamic Therapy). With the\ntreatment, his mental state improved)<\/p>\n\n\n\n

POW s with PTSD<\/strong><\/p>\n\n\n\n

There are a number of POWs of the Eelam War\nwho still carry the psychological scars. Most of them suffer from DDD Syndrome\nwhich was delineated by Farber Harlow in 1956. The DDD Syndrome consists of\nDebility, Dependency and Dread.  POWs often show depression, apathy,\nsuspicion and fear. Some have large memory gaps and still feel guilty about\ntheir POW days.<\/p>\n\n\n\n

Lance Corporal U has served 17 years in the\nSri Lanka Army. During the Balawegaya operation, he sustained a gun short\ninjury to his leg and became immobile. When the enemy advanced, he could not\nmove and hence he became a prisoner. When he was captured, he was severely\nbeaten and threatened with death. But one of the LTTE regional leaders stopped\nthe beatings and sent him for medical treatment.<\/p>\n\n\n\n

When the medical treatment was over, he had\nto undergo vigorous interrogations. He was tortured to get information about\nhis Camp and its inner structure and guard points. He was handcuffed and kept\nin painful positions for long time. Frequently his guards physically assaulted\nand humiliated him. However, Lance Corporal U admits that there were some\nmembers who were kind to him and brought food sometimes.<\/p>\n\n\n\n

From July 1991 to March 1995 L\/Cpl U spent\nhis life as a POW facing torture, humiliations and uncertainty. He was kept in\na very small cell with forty other prisoners. They had no space to move. The\nprisoners were allowed to take a bath once in two weeks or sometimes longer\nthan that. Many suffered skin infections. Their meals were not served\nregularly. Following the intolerable conditions, the prisoners launched a\nhunger strike and eventually he was released in March 1995 after the\ninterference by the ICRC.<\/p>\n\n\n\n

Although Lance Corporal U became a free man,\nhe often suffered from an unexplainable fear. The POW days memories hounded him\nseverely. Some nights he used to wake up with fear thinking that he is still in\nthe LTTE prison cell. He was depressed and surrounded by guilty feelings. In\norder to avoid nightmares, he was indulging in alcohol. More he used alcohol more\nhe became depressed. He often physically abused his spouse. Lance Corporal U\nbegan to avoid everything related to his traumatic experiences.<\/p>\n\n\n\n

He was suspicious about the surroundings. He\nlost the ability to trust and feel intimate. He was affected by emotional\nanesthesia. He had flashbacks and sometimes he could not distinguish reality\nfrom fantasy. His physical strength was weakening and slightest exertion gave\nhim an immense body pain. In 2003, he was diagnosed as having PTSD.<\/p>\n\n\n\n

The Cook of the Poonari Camp<\/strong><\/p>\n\n\n\n

Mr. N -a civilian worked as a cook in the\nPoonareen Camp. When the LTTE attacked the Poonari camp in 1993, many lost\ntheir lives. To evade the enemy he was hiding inside the building complex and\nwas later found by LTTE carders. He was beaten and threatened to be killed on\nthe spot. He was mistakenly identified as an officer in disguise. He was\nsubjected to numerous physical and mental tortures. Eventually the Red Cross\nintervened and established his correct identity.<\/p>\n\n\n\n

For nearly nine and half years, he lived his\nlife as a prisoner under the LTTE. He was homesick and practically every day\nprayed for his freedom. For long time he lived with uncertainty without knowing\nwhat his future would be. When the Air Force attacked the LTTE camps, their guards\nused to ill-treat them severely. His condition significantly improved when he\nmet another POW \u2013 Capt Boyagoda from the Sri Lanka Navy. Captain Ajith Boyagoda\nbecame a POW when his naval ship   Sagarawardene,\u201d was attacked by\nthe Sea Tigers in 1994. Capt Boyagoda gave him courage and strength to face the\ncallous conditions. Along with the other POWs, he spent the time discussing\ntheir release and writing letters home via ICRC.<\/p>\n\n\n\n

He was released on the 30th<\/sup> of\nSeptember 2002. After his release, he gradually developed stress related\nphysical symptoms like headaches, backaches which did not subside to\npainkillers. He was unable to sleep. At nights, he was awake and thinking of\nthe past. He often felt melancholic feelings, and troubled by emotional\nanesthesia. He could not feel the happiness of becoming a free man. His\nemotions were dead. Mr. N was losing the will to live. Several times, he\nplanned to commit suicide.<\/p>\n\n\n\n

He was referred for psychological therapies\nand in the assessment, many somatoform features were found in him. Despite the\ntraumatic symptoms, he positively responded to psychological and drug\ntherapies. Gradually he was able to get away from his melancholic feelings,\nintrusions and psychosomatic troubles. He was lucky to receive a lot of\npsychosocial support, even a house donated by the Ceylinco Group. Today Mr. N\nis very much symptoms free and living a productive life.<\/p>\n\n\n\n

Combatants with Partial PTSD<\/strong><\/p>\n\n\n\n

According to Kulka partial PTSD is a sub\ndiagnostic constellation of symptoms that was associated with significant\nimpairment. They have sufficient features of re-experiencing and hyperarousal\nwith insufficient features of avoidance and numbing and comorbid alcohol abuse\nor dependence.<\/p>\n\n\n\n

Cpl Tx3 was a member of the Army Special\nForces engaged in a number of military operations. He often worked with the\nlong-range reconnaissance patrols (LRPP). Cpl Tx3 met with numerous hostile\nenemy conditions, which affected him psychologically. On one occasion, they had\ndeeply penetrated the enemy area. He was with a five-man team and they operated\nsilently. Suddenly he met with two LTTE female carders face to face and none of\nthem fired. Cpl Tx3 was in a dilemma situation, if he had fired at the two LTTE\nfemale carders his team would have been in a great danger. Unbelievably, the\ntwo women disppeared into the jungle. He was confused and dazed for a while but\nwas able to return safely.<\/p>\n\n\n\n

For many years, this incident stuck in his\nmind. He always questioned himself why didn\u2019t they shoot? With these intrusive\nthoughts, he re-experienced combat events that occurred in the North. He would\nhave a startle reaction to any loud noise and became vigilant all the time.\nDespite the posttraumatic features, he was not avoiding combat situations.\nTherefore, the avoidance feature was not seen in Cpl Tx3.<\/p>\n\n\n\n

Lance Corporal Ax4<\/strong><\/p>\n\n\n\n

Lance Corporal Ax4 who was diagnosed as\nhaving partial PTSD, expresses his combat experience thus.<\/p>\n\n\n\n

In 1992 I was posted to Kaytes Island. My\nown brother served with me in the same unit and I was not comfortable with it.\nTherefore I requested for a transfer and I was asked to serve in Kajuwatta,\nMannar. While I was serving in Kajuwatta camp, one day I got a message saying\nthat my brother was killed in action at Keerimalei. Although I was given leave\nto attend my brother\u2019s funeral, when I went home the funeral was over. But I\nattended  the religious ceremonies after his funeral.<\/em><\/p>\n\n\n\n

When my leave was over, I had to report back\nto the camp. My mother was devastated over my brother\u2019s death. When I went to\nsay goodbye to her she asked me to stay with her. But I had to report to duty.\nSo I left home. While I was traveling to the camp, again I got a message near\nPuttalam stating that I should report home immediately. My inner mind told me\nthat some bad thing had occurred. When I went home, I met with another\ndisaster. My mother had committed suicide. I was relentlessly shattered. I lost\nmy brother and now my mother. This time after her funeral, I did not report to\nwork and became AWOL. After several months,   I decided to report for\nduty and this time I was posted to a rescue mission at Poonary. In this mission\nI sustained a mortar blast injury and was taken to the hospital.<\/em><\/p>\n\n\n\n

After I was discharged from the hospital I\nparticipated in Rivirasa operation. We walked up to Killinochchi facing hostile\nenemy attacks. A lot of buddies died in front of my eyes. At Killinochchi the\nenemy attacked us with mortars. I sustained injuries and I was bleeding. I\nasked others to help me. No one came to help me and I felt fear. Then I saw a\nsergeant passing near me and I asked him to help me. But he left me just giving\na glance. I was helpless and in pain. I gathered my entire energy and\nstrolled   towards Elephant Pass. Half way, a group of soldiers\nhelped me. They put me in a cab and took me to the nearest Med Aid Point. There\nI lost my consciousness and when I opened my eyes, I was at Anuradapura\nhospital.\u201d<\/em><\/p>\n\n\n\n

I was treated several weeks at the\nAnuradapura hospital and then discharged. I realized that I was experiencing\nsome distressing past events and these intrusive memories troubled me. I could\nnot tolerate sudden noises. My mind was full of traumatic events that I had\nexperienced in the recent past. Some nights I could not sleep and I was having\na severe headache. When I am with physical and emotional pain, I become\nrestless. I am not afraid of the battle. As a soldier, I can go to the warfront\nat any time. The war does not scare me anymore\u201d<\/em><\/p>\n\n\n\n

My commanding officer was hit in\nfront of my eyes: Private SN<\/em><\/strong><\/p>\n\n\n\n

Private SN who was shattered by war stress\nexpresses his past experience in the following manner\u2026\u2026<\/p>\n\n\n\n

At Mallakam (1995) the LTTE attacked us with\nRPG. I stood near my commanding officer. I fired at the enemy with my T56, killing\ntwo of them, then a mortar exploded near us. I saw my commanding officer\nwounded and bleeding heavily. His uniform was soaked with blood. I expected\nhelp form our buddies. When I looked at the right flank, I saw no one. I\nshouted for help. Then another mortar exploded near me. I too sustained\ninjuries. Blood came from my left ear.  I had no strength to help my\ncommanding officer. While he was lying on the ground I crawled towards the rear\nside. I had severe guilty feelings for abandoning him on a hostile ground. But\nI had no option. When I was crawling,    I met some of our\nsoldiers. Then I shouted at them the CO is wounded get him soon\u201d .<\/em><\/p>\n\n\n\n

So they went to rescue him. I went further. I\ncould not crawl anymore. I lost my energy. The world was trembling in front of\nmy eyes. I could hear the gunfire, artillery explosions and the incoming mortar\nsounds. My eyes were covered with a dark strip. I lost consciousness. When I\nopened my eyes, I was at the Palali Hospital.<\/em><\/p>\n\n\n\n

I was treated at the hospital for nearly one\nand half months. When I was discharged from the hospital, I went back to my\nunit. I realized that my personality was changing   little by little.\nI was a daring soldier. But the events at Mallakam changed my life. Day and\nnight, my mind was full of these events. Gunfire, black smoke, incoming\nmortars, images of the enemies and the wounded commanding officer were vivid\nmental pictures that were ruminating inside my mind. I became more vigilant. I\ncould not sleep at nights.  I used to wake up for a slightest sound. These\nsounds gave me fear. When I was disturbed by a slightest sound, I felt a\nburning sensation in my chest.  I used to get up in the middle of the\nnight with fear and sweat. Gradually I became depressed and felt that my life\nwas wasted. I wanted to commit suicide. One day when I was at the bunker alone,\nI tried to release the pin of a hand grenade. Then I saw the eyes of my wife. I\nput the grenade aside.<\/em><\/p>\n\n\n\n

My world was upside down.  I did not\nlike to stay in the operational areas. I felt uneasy when I saw military\nuniforms and vehicles. I disliked participating in ground operations. But I had\nno option. I was compelled to fulfill military duties. I went with my platoon\nsecretly suppressing my fear and avoidance. My symptoms were aggravating. \nI was about to explode.<\/em><\/p>\n\n\n\n

Finally, I told my fears to one of my unit\nleaders. He listened to me for a long time and said you need medical treatment\u201d.\nSo I went to the military hospital seeking salvage. I was referred to the\npsychiatric unit and treated for nearly three months. I received drug therapy\nand psychotherapy. My symptoms reduced little by little. Then I felt much\neasier. Today I am doing light duty. But I have not been completely freed from\nthe Malakam events. Occasionally I see the face of my commanding officer.<\/em><\/p>\n\n\n\n

The Johny Batta that changed a young life<\/strong><\/p>\n\n\n\n

Private Hx26 became a victim of an\nanti-personnel mine in the North and underwent B\/K[1]<\/a> amputation.\nHe became shocked when his foot had blown off from the ankle and for a long\nperiod, he relived this traumatic incident. After he met with the injury, his\nlife fell apart. The girl who promised to marry Private Hx26 left him.  He\ncould not adjust to the life with a prosthetic foot. He became more and more\nalienated and stopped associating with people. His life was limited to a wheel\nchair.<\/p>\n\n\n\n

Although he was recommended rehab therapy,\nPrivate Hx26 did not actively participate in the rehabilitation program. Once\nhe made an unsuccessful attempt to jump into the pool at the rehab center with\nhis wheel chair. After his attempted suicide, Private Hx26 was referred for\npsychological therapies and he was diagnosed with PTSD.<\/p>\n\n\n\n

Private Hx26 \u2019s therapeutic schedule\nconsisted of drug therapy as well as counseling. After 6 weeks of inward\ntreatment, his suicidal ideation changed and he was gradually came to terms\nwith his disabled condition. Private Hx26 underwent further psychotherapy and\nfinally he gave his consent to undergo the rehabilitation program with the\nPsychiatrist\u2019s supervision. He selected a handicraft profession- shoemaking and\nsuccessfully completed it. Two year follow-up revealed that Private Hx26 is\nfree of PTSD symptoms.<\/p>\n\n\n\n

The EPS debacle was my worst experience<\/strong><\/p>\n\n\n\n

The Elephant Pass debacle that occurred in\n2000 due to poor leadership and inefficient strategic evacuation plan led to\nloss of many lives. It was a tactical withdrawal of the Elephant Pass camp but\nit was carried out in the hot sunny afternoon. Many soldiers died of\ndehydration and heat stroke. During the EPS debacle, 359 military personnel\nwere killed, 349 were listed as Missing in Action and some 2500 were injured.\nCorporal K described the events that took place between the 21st<\/sup> and\n22nd<\/sup> of April 2000.<\/p>\n\n\n\n

On the 21 of April 2000, I was at the FDL of\nthe Elephant Pass Camp. We were told that the evacuation order would be given\nat any moment. The following day at about 10.30 am, the enemy attacked the\nElephant Pass camp with heavy artillery. While the enemy was attacking, our\nsoldiers withdrew towards Kilalli lagoon. There we met Brigadier Percy Fernando\nwho was a brave officer. He tried to reorganize and launch an attack\u2019 then to\ngo for a safe withdrawal. We assaulted the enemy and moved toward Pallai. The\nLTTE attacked us with mortars and their snipers targeted our officers and\nsignalmen. I saw Brigadier Percy Fernando sustain a gunshot injury. It was a\ndisastrous moment. Brigadier Percy did not abandon us. Some cowardly senior\nofficers saved their skin and got away leaving us to the enemy. But Brigadier\nPercy Fernando stayed with us and gave us leadership until the end. When he\nfell down, I knew that we were doomed.<\/em><\/p>\n\n\n\n

We were tired and exhausted. Many of our soldiers\ncould not walk. Hot sun and dry wind sapped our energy. I felt thirsty but my\nwater bottle was empty. Many of us did not have sufficient water. We were\nwalking like zombies in the hot sand. Some drank salty water from the lagoon.\nSome began to sing songs as they lost their minds.  Many fell down with\nexhaustion and never got up.<\/em><\/p>\n\n\n\n

While we were moving enemy attacked us with\nmortars. Many soldiers were dying without water and facing enemy attacks. We\nhad to walk fast to avoid the enemy fire. There was no air cover for us. Some\nfainted in front of my eyes. I knew they would never return home. One solder\nbecame insane. He was singing and dancing asking for a cup of tea. Wounded\nsoldiers asked us to carry them. But we all were worn out and had no energy to\ncarry a fellow soldier. We were on our own and every man for himself. It was an\negoistic moment that I cannot forget until my last day.<\/em><\/p>\n\n\n\n

My energy was ending. I could not carry the\nammunition pack. I had to throw my belongings.  Finally, I threw my weapon\nwhich was my savior for a long time. I walked in the hot son with other\nsoldiers. All I needed was water. My head was dizzy and I fell down. I saw the\nhot sun. There were no clouds in the sky.  Many soldiers passed me by but\nno one helped me. I knew if I stayed there, I would be dead soon.  I\ngathered my energy and again started to crawl avoiding enemy attacks. Panicked\nsolders trampled me and ran towards Pallai. On my way, I saw many dead bodies.<\/em><\/p>\n\n\n\n

One soldier grasped my boots. He was wounded\nand bleeding. He pleaded with me and those very words still echoes in my mind.\nHe said I am dying and I don\u2019t want you to carry me, then he gave his name and\naddress and asked me to convey his death to his parents. I still cannot forget\nthis incident. I didn\u2019t know who he was and by the time I came to Pallai I was\nunconscious. I too suffered a heat stroke and later recovered. I have forgotten\nhis name and the address. I could not convey the message to his relatives\nup-to-date. But I still remember his face filled with utter despair. <\/em><\/p>\n\n\n\n

The acute PTSD victim of 2005 ceasefire<\/strong><\/p>\n\n\n\n

Signalman Px54 met with a claymore mine\nexplosion in Jaffna in December 2005. He sustained minor injuries to the left\nhand as a result of this explosion. But 13 other soldiers died in this\nincident. Signalman Px54 witnessed the terrible deaths of two privates and a\nsergeant. These events changed the psychological equilibrium in Signalman Px54\nand he was diagnosed with acute PTSD. This is how he describes the event that\ndrastically changed his psyche.<\/p>\n\n\n\n

That was a horrible event indeed. We went to\nJaffna town by a truck.  I was in the middle holding my weapon. Suddenly I\nheard a large noise. The soldiers in front of me fell down. Then I realized\nthat, it was an enemy attack. Despite the ceasefire<\/em> <\/em><\/strong>agreement they\nattacked us with claymore mines and then with small arms. When the enemy\nattacked, our driver sustained injuries.  But he was able to keep the\nvehicle stable and we kept on going further. There was a large tyre inside the\ntruck beside which I took cover. While I was lying down two wounded soldiers\nasked for water from me. But there was no water. We had to travel a few more\nkilometers to the nearest camp. Another wounded sergeant crawled near me and\nsaid something. His mouth was full of blood.  Within a minute or two, he\nbecame motionless. His eyes were open and he was dead. When the truck entered\nthe nearest camp, I rushed to help the wounded men. Most of them were dead,\nincluding the two soldiers who had asked for water. I felt really sorry for\nthem. I could not help these soldiers even to give a cup of water.<\/em><\/p>\n\n\n\n

The soldier who became overwhelmed after\nkilling the enemy<\/strong><\/em><\/p>\n\n\n\n

Sergeant Sx78 served nearly ten years in the\noperational areas exposed to heavy combat. He faced fierce battle events\ndefending the Jaffna Fort. The Jaffna Fort was under siege and the enemy\nattacked them with heavy weapons. The operation Midnight Express\u201d was launched\nto rescue troops that were trapped inside the Fort. During the confrontation,\nhe killed five of the enemy carders. After some years, he became preoccupied\nwith the thoughts that were related to these killings. Although they came to\nkill us, they too human beings says Sergeant Sx78.<\/p>\n\n\n\n

They\nwere poor village boys like us<\/strong><\/em> <\/strong>who\nhad no many options in life<\/strong><\/em>. <\/strong>They\nwere indoctrinated, poisoned with hatred and directed to attack us. We had no\nalternative except firing at them. In a war things are intense, either you or\nthe enemy. If you don\u2019t kill him, he will kill you. Anyhow, these Tamil youths\nhad parents like us, they too had expectations. All ended sadly. Someone,\nsomewhere may be still missing them. I know killing is bad. It is a violation\nof the first Buddhist precept. I was compelled to do that act\u201d.<\/strong><\/em><\/p>\n\n\n\n

Sergeant Sx78 feels that one day he has to\nface the Karmic repercussions. His conscience was shattered and he became more\nreligious. Sergeant Sx78 wishes to be a monk after his retirement from the\nArmy.<\/p>\n\n\n\n

The final days of the War<\/strong><\/p>\n\n\n\n

Lt Col \u2026\u2026\u2026 is an experienced field officer\nwho participated in many operations.  He shared his experiences on\nthe final days of the Eelam War.<\/em><\/p>\n\n\n\n

\u2026\u2026\u2026.When we liberated Thoppigala I knew we\nwere invincible. Others may have felt that. So we advanced further. The last\ndays of Eelam War were hectic. The LTTE built a large sand walls and it was\ndifficult to penetrate it following heavy fire. They were among the civilians\ncreating a human shield. We had to be extra cautious not to harm civilians.<\/em><\/p>\n\n\n\n

However, in a war civilian casualties are\ninevitable. For instance, how many civilians died in Iraq and in Afghanistan\nwhen the US forces retaliated? But I remember several events, when the enemy\nattacked, our soldiers did not attack back due to the civilian factor. The\noutside world would never know about these facts.<\/em><\/p>\n\n\n\n

I remember when the enemy fired from a\nbunker, one of our soldiers tried to attack the bunker with a Tomba gun.\nAnother soldier stopped him saying that there were civilians near the bunker.\nThey had to find other means to destroy the bunker without causing civilian\ncasualties.<\/em><\/p>\n\n\n\n

In another event, I saw soldiers carrying\nlittle Tamil children when the civilians broke the sand wall and came towards\nus. These humane stories were never told and only negative points were\nhighlighted.<\/em><\/p>\n\n\n\n

I agree, in a war atrocities are often\ncommitted and in every army you see people like William Calley who did the My\nLai Massacre. I personally think that the media should comment on atrocities as\nwell as humane stories of the war. Otherwise, there will be no reconciliation\nat any point. After all, man is not pure evil.<\/em><\/p>\n\n\n\n

I have been living with the war for many\nyears. I have seen perished soldiers, and dead LTTE carders. All these people\nwere the children of this land. The final days of the war were traumatic. I saw\nhuman suffering. I have seen enough blood. Those who cry for war and glorify\nthe war from Colombo should have been there. Then they would know what the war\nis really like.<\/em><\/p>\n\n\n\n

I felt sorry for the Tamil civilians who\nfollowed a mirage. When I first came to the North as a schoolboy at the age of\n16, I was touched by the kindness of the Tamil people. The Jaffna people were\ncultured and educated. They had a great civilization that cherished\nnon-violence. When the conflict erupted in early seventies, things changed\ndrastically. Then I had to come to the North in a combat fatigue.<\/em><\/p>\n\n\n\n

Tamil people in the North paid an immense\nprice for the war. Their property were destroyed, children were forcibly\nrecruited. They faced deaths and destruction. They lived under poverty. What\nhappened to the millions of dollars that was pumped by the NGOs and by the\nTamil Diaspora to the North? The people of Wanni had no infrastructure, people\nwere malnourished. If this money was used to develop the North, they could have\nbuilt a little Singapore.<\/em><\/p>\n\n\n\n

I am glad that the war is over. We must\nrebuild the North and work for the ethnic harmony. We must forget our petty\nracial differences and work for peace with our Tamil brothers. Otherwise,\nwithin 20 years there will be another bloody war\u2026\u2026\u2026\u2026<\/em><\/p>\n\n\n\n

Functional Impairment Following Combat Trauma<\/strong><\/p>\n\n\n\n

Warfare has placed great stress on\ncombatants. Death, grief and social disorganization have been inevitable\naccompaniments of war. Violent conflict is part of social experience and memory\n(Davis, 1992).  Combat can produce distant reactions involving<\/p>\n\n\n\n

Affective (anxiety, depression,\nirritability), Motivational (low productivity), Cognitive (confusions, poor\nattention and memory), Interpersonal (conflicts and withdrawal), and Biological\n(associated with somatic complaints) dimensions causing maladaptive behavior.<\/p>\n\n\n\n

Difficulties in parenting<\/strong><\/p>\n\n\n\n

Many of the skills children acquire are\nfundamentally dependent on their interactions with their parents. Parent-child\ninteractions are crucial in child development especially self-esteem, academic\nachievement, cognitive development and behavior.  PTSD patients find\ndifficulties in parenting. Many PTSD patients are unable to express love since\nthere are troubled by emotional anesthesia.<\/p>\n\n\n\n

Sergeant KP8 a known PTSD patient described\nhis inability to enjoy his role as a father in following manner\u2026..<\/p>\n\n\n\n

Since I became ill, my 8-year-old daughter is\ndetached from me. She is highly frightened when I went in to tantrums and had\nquarrels with my wife.   Once I got very angry and dashed plates and\ncups, which were on the table. She started crying and hid under the bed. In the\npast years, she used to sleep with us, but I wake up for a slightest sound with\nterror and overwhelming reaction. I have fears that I might harm her when I\nexperience flashbacks of the battlefield. I am unable to express my love for\nher and my feelings may be dead. I have become a cold father.<\/em><\/p>\n\n\n\n

Domestic Violence<\/strong><\/p>\n\n\n\n

Family violence is a widespread problem that\noccurs among the combatants with PTSD. They use force to inflict injury, either\nemotional or physical, upon their spouses. Many combatants sublimate their\nrage. Domestic violence is a form of sublimation and transformation of anger.\nBased on our study, out of 56 Sri Lankan soldiers with PTSD, 13 of them\nfrequently physically abused their spouses. Beatings and house property damage\nwere common among them. Their anger and rage were focused towards their wives.\nThey were irritable and hostile in family affairs.<\/p>\n\n\n\n

There are many types of abuse that take place\nas part of domestic violence. These are emotional abuse, physical abuse and\nverbal abuse. They have gradual withdrawal from day to day activities. There\nare marked personality changes which affect their function as an active member\nin society as well as in family circles. Often they break family commitments,\nboth major and minor. They become impulsive, numbed and inhibited. These\nfeatures destroy a successful family life and positive parenting.<\/p>\n\n\n\n

Men with PTSD commonly have sexual\ndysfunctions. This may be due to the anxiety and depression that they suffer.\nLong term use of antidepressants for their PTSD and Depression also can cause\nerectile dysfunctions. Some males become suspicious and have sexual jealousies.\nThis factor too escalates family violence.<\/p>\n\n\n\n

Many combatants with PTSD admit that when\nthey go in to tantrums they over punish their children. Children often live in\nfear and despair. The physical abuse takes place inside the family system and\nrarely mothers admit that the beatings were done by their husbands. When the\nchildren are hospitalized for physical abuse, mothers always conceal the\nphysical beatings in order to evade child protection laws.<\/p>\n\n\n\n

Once a soldier with PTSD went in to flashbacks\nand strangulated his little daughter. The girl was choking and luckily\nneighbours came and rescued her. In another incident, a PTSD father became\nannoyed when his eight year old son could not solve mathematical sums and he\nbeat his son with a cricket bat. Later the child was admitted to the hospital\nand treated for three weeks.<\/p>\n\n\n\n

Lance Corporal P has served seven years in\nthe combat zone. He sustained a gunshot injury to the right leg. After he came\nhome he could not get a sound sleep. He had nightmares with startle reactions.\nTo avoid his sleep difficulties and intrusions, he consumed alcohol practically\nevery night. He became depressed and aggressive. Lance Corporal P used to\nphysically abuse his children and the spouse. Several times he became AWOL. For\nnearly 3 years he went undiagnosed and untreated. Subsequently, he was referred\nto the Psychological Unit Military Hospital Colombo and diagnosed with combat\nrelated PTSD.  After 6 months of successful medication and psychotherapy\nprogram, Lance Corporal P was free of his PTSD symptoms. Today he is having a\nproductive family life.<\/em><\/p>\n\n\n\n

Occupational Problems<\/strong><\/p>\n\n\n\n

Soldiers who suffer from PTSD have\noccupational problems. Their productivity is weakened. They are detached from\nco-workers. Soldiers with combat stress have dysfunctional interactions at work\nplaces. Traumatized soldiers develop their own peculiar defenses to cope with\nintrusions and increased psychological arousal. One officer who was diagnosed\nwith PTSD felt uneasy and often manifested startle reactions when soldiers come\nand halted with a salute. The noise made him frightened. Therefore, he used to\nstay away from others. Another soldier who had trepidation of uniforms felt\nuneasy when he comes to the camp. The irritability and spontaneous rage make\nthem more socially isolated. They deliberately keep away from people in order\nto avoid confrontations. They easily get provoked. Some have homicidal\ntendencies.<\/p>\n\n\n\n

Private WX6, who sustained a gun short injury\nto the face in  Operation Ranagosa in 1999, became more and more\ndysfunctional. He had intense rage, suspicion and homicidal ideas. He\nfrequently had conflicts with the soldiers and officers in his unit. In 2002,\nfollowing a work related dispute, Private WX6 planned to kill six of his\nplatoon members including the platoon sergeant. His movements became suspicious\nand he was not issued firearms. Later, Private WX6 was referred for\npsychological counseling and work related disputes were resolved avoiding a\nmajor disaster.<\/p>\n\n\n\n

Compulsive Exposure<\/strong><\/p>\n\n\n\n

Some traumatized individuals have a\ncompulsive urge to expose to situations reminiscent of trauma. Professor Bessel\nVan der Kolk (1996) gives numerous examples. This is a common feature among the\nSri Lankan combatants too. Many combatants believed to be suffering from combat\ntrauma have joined the private security firms, working with politicians and\nengage in violence during election periods, or working with the mob. Repetition\ncause further suffering for the victim and for the people around them (Kolk, et\nal., 1996).<\/p>\n\n\n\n

Cpl FC8 was psychologically devastated when\nhe witnessed the deaths of three of his platoon members in Silavathura and\nlater developed PTSD symptoms. He left the military prematurely and joined with\na local politician. During the 1999 infamous Wayamba PC election, Cpl FC8\nengaged in many election related violence that was instigated by his political\nmaster.<\/p>\n\n\n\n

Private AX4 experienced numerous traumatic\ncombat events from 1996 to 2001. He became AWOL and joined with an underground\ncriminal gang that committed several bank robberies. For several years he was\nevading the police and the CCMP. In 2005 when the criminal gang attempt to rob\na bank in Mathara district, they were arrested by the Police. Today Private AX4\nis serving a prison term.<\/p>\n\n\n\n

Capt KF9 lost his leg in the Northern\nterritory as a result of an anti-personal land mine which was called Johnny\nBatta. He underwent below knee amputation and was transferred to a non-combat\nunit. After serving several years in a non-combat environment, he became\ndistressed and wanted to go to the war front. He had marked posttraumatic\nfeatures with intense rage. He was affected by severe hyper arousal and\ntraumatic reminiscences. After leaving the Army, he joined a private security\nfirm and worked for several years. His occupational difficulties were\nintensifying. Once he had a severe conflict with the Police and was arrested\nfor assaulting a Police Officer.<\/p>\n\n\n\n

Suicide and Deliberate Self-Harm<\/strong><\/p>\n\n\n\n

Studies estimate that patients suffering from\nPTSD have up to a seven-fold increased incidence of suicide, and four-fold\nincreased risk of death from all external sources (Bullman & Kang, 1994). A\nsignificant number of soldiers have committed suicide in the battlefield during\nthe Eelam War. In addition, considerable number of attempted suicides has been\nrecorded. Suicide is a complex event. There are biological, psychological and\nsociological causes of suicide and suicidal behavior. Among the 824 combatants\nreferred to the Psychiatric Unit, Military Hospital Colombo during 2002 Aug \u2013\n2005 March, 22 of them had suicidal attempts. These combatants had used various\nmethods such as self-poisoning, shooting, hanging and in one case a planned\nroad traffic accident.<\/p>\n\n\n\n

Private HX67 was deployed in Kokkuthuduwai in\nthe height of the Eelam war and he felt that his life was in danger. His\nplatoon was in the jungle, they had minimal facilities and continuous heavy\nrain made things worse. Private HX67 shot his leg with his weapon and forced an\nevacuation. He was immediately taken to the hospital and treated. After his\nrecovery Private HX67 had to face disciplinary charges.<\/p>\n\n\n\n

Sergeant LX54 witnessed a number of traumatic\nevents in the North. He witnessed the death of his platoon members and handled\nhuman remains. By 2002, Sergeant LX54 had no life interests. He had an intense\ndeath wish. Once he went to the armory, took a T-56, and placed it under his\nchin. The soldiers who were on duty grabbed the weapon. Subsequently he was\nreferred for psychological therapies. Sergeant LX54 was treated with SSRI and\nCBT. After the treatment, he became free of suicidal ideas.<\/p>\n\n\n\n

Alcohol and Substance Abuse<\/strong><\/p>\n\n\n\n

Alcohol and substance abuse is an observable\ncondition among the combatants especially those who suffer from combat stress.\nThese negative stress coping methods are often used to displace the intrusions\nand negative thoughts. Alcohol and other substances give a temporary sedation\nbut in long term, it causes an enormous damage to the soldier both in\nphysically and psychologically.<\/p>\n\n\n\n

Alcohol abuse, as described in the DSM-IV, is\na psychiatric diagnosis describing the recurring use of alcoholic beverages\ndespite negative consequences. It is differentiated from alcohol dependence by\nthe lack of symptoms such as tolerance and withdrawal. Traditionally alcohol\nhas become a part of the military culture. Alcoholic beverages are offered in\nthe Officers Mess and sometimes the officers are indirectly encouraged to have\nalcohol.<\/p>\n\n\n\n

Rise in alcohol and Substance Abuse among the\nSri Lankan combat veterans suffering from PTSD have been observed. The veterans\nconsume alcohol and other substances to suppress traumatic war-related\nmemories, escape flashbacks and to achieve a combat nightmareless sleep.<\/p>\n\n\n\n

A number of reports indicate that individuals\nmeeting diagnostic criteria for Post Traumatic Stress Disorder (PTSD) are\nlikely to also meet DSM-3 R criteria for alcoholism and \/or drug abuse. Among\nVietnam Veterans seeking treatment for PTSD 60-80% exhibit concurrent diagnoses\nof drug or alcohol abuse or dependence (Kofoed, Friedman, & Peck, 1993).<\/p>\n\n\n\n

Alcohol dependence, as described in the DSM\n-4, is a psychiatric diagnosis describing an entity in which an individual\nuses alcohol despite significant areas of dysfunction, evidence of physical\ndependence, and\/or related hardship. Chronic Alcoholism has serious\nconsequences on a person\u2019s health and personal life, on family and friends, and\non society.<\/p>\n\n\n\n

Combatants suffering from combat stress\neasily go into negative stress coping methods like alcohol abuse. Alcohol and\nsubstance abuse is evident among the combatants suffering from war trauma.\nThose veterans who experienced prolonged exposure to heavy combat are\nespecially vulnerable. Soldiers abuse substances such as drugs, alcohol, and\ntobacco for varied and complicated reasons. When we interviewed 56 Sri Lankan\ncombatants with full blown symptoms of PTSD we found 8.9% of them were severely\naddicted to alcohol. They were found to have alcohol related symptoms and their\nliver function were seriously affected following the misuse of alcohol. They\nconsumed a large amount of alcohol in order to avoid sleep disturbances and\neliminate scary nightmares. The heavy drinking may also seem to relieve anxiety\nand block out intrusive memories associated with combat events. But the truth\nis excessive drinking can disturb the natural sleep process, interrupting REM\ndream patterns; the veteran may become more vulnerable to the symptoms of PTSD.<\/p>\n\n\n\n

Capt NX453 served in the Army for over 16\nyears and exposed to heavy combat situations. In an incident near Paranthan,\nhis team was ambushed by the enemy. He saw the death of fellow soldiers\nand their final outcry. Another member was shot in the abdomen and his bowels\ncame out. After they made an unsuccessful attempt to resuscitate him, the\nsoldier died in Capt N\u2019s arms. For number of years he blamed himself for taking\nhis men to the enemy\u2019s jaws.<\/p>\n\n\n\n

He was disturbed over the incident and he\nincreased his alcohol intake in order to get a better sleep and disassociate\nfrom the horrific combat event. Hence, he could not sleep without alcohol.\nGradually Capt NX453 had   long periods of being drunk, he\nstarted drinking alone. He was neglecting his official duties and the senior\nofficers could not trust his capabilities anymore. Several times, he was\nreprimanded for being drunk on working hours. In 2004, he was diagnosed with\nHarmful Use of Alcohol.<\/p>\n\n\n\n

Tobacco addiction is another unseen factor,\nwhich has serious health related consequences.  Nicotine dependence is an\naddiction to tobacco products caused by the drug nicotine.  Nicotine\ncan produces physical and mood-altering effects and frequent usage can increase\nrisk of numerous health problems. The common symptoms of nicotine\ndependence are inability to stop smoking, experiencing strong withdrawal\nsymptoms such as anxiety, irritability, restlessness, difficulty\nconcentrating and sometimes headaches.<\/p>\n\n\n\n

Veld and  colleagues (2002)found that\ncigarette smoking was more prevalent in those with current PTSD. The\nresearchers hypothesized that, in trauma survivors, current substance use is\nassociated with peri-traumatic patterns of psychological tension\u2013reduction\nmodes.<\/p>\n\n\n\n

Lance Cpl RXC143 met with traumatic combat\nevents at Mandathivu. He was troubled by the war trauma that he experienced\nthere. He became more and more isolated and took to smoking. He became a chain\nsmoker and couldn\u2019t be without a cigarette. According to his wife, Lance Cpl\nRXC143 smokes 30 -40 cigarettes per day.<\/p>\n\n\n\n

Warrant Officer AXE86 joined the Military in\n1973 and participated in all the combat operations until 1999. During these\ntimes, he witnessed numerous traumatic events especially in 1988 -89. He was\ndiagnosed with Adjustment Disorder and Nicotine Addiction. Warrant Officer\nAXE86 smoked over 30 cigarettes per day which caused serious vascular\nobstruction in his lower extremities. In 2003, he underwent below knee\namputation.<\/p>\n\n\n\n

Substance abuse is another issue that has to\nbe dealt effectively. Substance abuse refers to the overindulgence in and\ndependence on a stimulant, depressant, chemical substance, or herb leading\nto effects that are detrimental to the individual\u2019s physical health or mental\nhealth, or the welfare of others.<\/p>\n\n\n\n

Our 2005 study revealed that cannabis was the\nmost frequent substance that was often used by the Sri Lankan combatants.<\/p>\n\n\n\n

Cpl  WXC45 who was an experienced\ncombatant diagnosed with Cannabis intoxication described how he became addicted\nto cannabis. The narration below is based on his testimonial.<\/p>\n\n\n\n

I was first posted to Nadenkerni. Our\nteam consisted of young fearless soldiers. We knew our days were\nnumbered; death was several inches ahead of us. To evade the nostalgic\nfeelings and homesickness we smoked ganga. When you take the puff\ninside, you feel that you are disconnected with the reality. No enemy, no\nbullets, no mortar attacks make you frightened. In an attack, you can advance\nlike a wind. You don\u2019t feel the heaviness of your backpack, you don\u2019t \nfeel pain even when you sustain a gunshot injury.<\/em><\/p>\n\n\n\n

The supply was a problem. We used to buy the\nstuff in Colombo. There were many joints where you could buy it. There\nwere a number of places in Boralla, Maradana, Slave Island etc.  Only\nproblem was to bring it to the Northern war front. If we travel by air through\nRatmalana, the Air force guys used to search us. If you get caught you are in a\nreal trouble. We used several methods to traffic it. The popular method was to\nput the stuff in to a condom and then insert it inside the anal cavity.<\/em><\/p>\n\n\n\n

Although there were many restrictions, our\nguys used to bring it and we smoked it. When we did bunker duties ganga\ncigars kept us awake. Thus, we were on guard all night long.<\/em><\/p>\n\n\n\n

We often used Madana Modaka (Aurvedic\ncannabinoid product) as well. It\u2019s like a toffee. When some of our group\nmates went for the operations, they kept it in the wallet. Madana Modaka gave a\nsensational feeling. You can run, jump and move your body like a rubber when\nthe effect comes. We feel no pain even we sustain injuries. Some said it\nprolongs your ejaculation and we used to take it home when we got duty leave.<\/em><\/p>\n\n\n\n

After long usage of cannabis, Cpl WXC45 had\nlow motivation, aimlessness, apathy and sluggishness in mental and\nphysical responses. He presented with poor self-care and transient\ndisorientation, as well as impaired memory. Today he knows the negative effects\nof cannabis.<\/p>\n\n\n\n

Heroin usage was not in abundance among the\nSri Lankan combatants according to our experience. From 2002 to 2005, we\nsystematically interviewed 824 soldiers and we found only three heroin users.\nHeroin is a highly addictive opiate, which is processed from morphine.\nAlthough it\u2019s illegal in Sri Lanka, the addicts know the places where\nit can be bought. Sri Lankan heroin addicts usually sniffed or\nsmoke it and intravenous injection of heroin is not popular among them. Why we\nhad very minimal number of heroin addicts among the soldiers that we\ninterviewed? When strict rules and regulations are applied to the soldiers in\nthe Army camps, heroin uses find it extremely difficult to obtain and use it.\nOften they become AWOL and continue their addiction with heroin.<\/p>\n\n\n\n

The effective measures have to be taken to\nprevent alcohol and substance abuse among the combatants. In the post war era,\nthere is a possible risk that is prevailing and we have to take urgent\nmeasures.There are many examples from other countries that indicate the\nexcessive use of alcohol and other substances among the combatants. According to\nthe 2000 and 2001 NHSDUH reports[2]<\/a> on\nillicit drug use among the US Veterans, an estimated 6 percent of all veterans\nliving in the United States used an illicit drug in the past year. Of\nthe 256,000 veterans in need of treatment for illicit drug use in the past\nyear, 20 % had received treatment during the past year. These studies show\nthat we too are at risk.<\/p>\n\n\n\n

Untreated and undiagnosed PTSD<\/strong><\/p>\n\n\n\n

As pointed out by Lipkin, Blank, Parson and\nSmith (1982) many cases of PTSD go underreported because many Psychiatrists and\nPsychologists fail to ask about military experience or what happened to the\nperson while in the military. We have found a number of combatants who had\nmanifested dissociative reactions; symptoms of acute PTSD in the height of the\nbattle who were not treated or referred to psychological therapies. When the\nsymptoms aggravated with malignant PTSD they were referred to the Psychiatric\nUnit, Military Hospital Colombo.<\/p>\n\n\n\n

Hence we can give a case example. Corporal T\nhad nightmares, intrusions and disorientation during the operation Jayasikuru\nor the Victory Assured in 1997. He became distressed and asked for medical\nattention. He was taken to the nearest MSD and treated with analgesics. With\nthe difficulty that he experienced he was sent back to the battle front. After\ntwo weeks he lost his voice or in other words he had a dissociative reaction of\npsychogenic aphonia. Still he was not sent for any kind of treatment. After many\nmonths, he became depressed and threatened to commit suicide. Then he was\nposted to Anuradhapura where there was no active combat, but had to handle dead\nbodies and human remains. Only in 2002, he was referred to the Psychological\ntherapies. By this time, Corporal T had developed chronic PTSD with severe\nfunctional impairments.<\/p>\n\n\n\n

Kessler\u2019s Phenomena<\/strong><\/p>\n\n\n\n

According to Kessler 16% of PTSD patients can\nhave psychotic features. When the PTSD sufferers are affected by the psychosis,\nthey seem to loose of contact with reality. They are affected by\nhallucinations, delusions and thought disorders.<\/p>\n\n\n\n

Private SK67 was actively involved in combat\nand on one occasion, he and a small team of soldiers were trapped behind enemy\nlines for over 3 days. By 2003, his mental condition was failing and he\nexperienced passivity feelings, ideas of reference, thought broadcasting,\nthought insertion and disorganized thinking pattern. He was diagnosed with\nSchizophrenia at the North Colombo Teaching Hospital, but on re-assessment he was\nfound to have key symptoms of PTSD such as hypervigilance , avoidance, \nnightmare etc in  Private SK67.<\/p>\n\n\n\n

Recruit SD45 developed an abnormal reaction\nafter being wounded by a MBI (Mortar Blast Injury) to the left shoulder. His\nflashbacks were wrongly interpreted as visual hallucinations and distress\nreaction was misinterpreted as manic features. After a detail assessment, this\nsoldier was diagnosed as having PTSD.<\/p>\n\n\n\n

Delayed Reactions of PTSD<\/strong><\/p>\n\n\n\n

Currently the definition of delayed-onset\nPTSD encompasses symptoms that surface only up to 6 months following an event.\nSometimes PTSD can emerge many years after the original trauma. According to\nRobertson and colleagues (Ruzich, Looi, & Robertson, 2005), large numbers\nof older veterans are present with nightmares and intrusive memories of the\nwar. Some are experiencing these features for the first time in their lives.\nFor some World War II veterans, memories of the war can still be upsetting more\nthan 50 years later.<\/p>\n\n\n\n

Late onset trauma plagues war veterans in a devastating\nmanner. Those who are in their old age are now troubled by disturbing war\nmemories. The delayed reaction, could be triggered by a subsequent stressful\nevent<\/p>\n\n\n\n

In a study of 147 Dutch veterans who had\nfought in the Resistance against the Nazis in WW2, it was found that forty\nyears after the end of the war over half of these people are still suffering\nfrom PTSD and  only 4% showed no symptoms at all (Hovens et al., 1992).<\/p>\n\n\n\n

A new study (Boscarino & Adams, 2009)\nthat assessed New Yorkers exposed to the events of September 11, 2001 provides\nadditional evidence that posttraumatic stress disorder (PTSD) can surface up to\n2 years after the event in individuals with preexisting emotional or social\nproblems.<\/p>\n\n\n\n

Some of the Sri Lankan veterans too have\nshown delayed-onset PTSD reactions. They have manifested posttraumatic features\nmany years after original trauma.  Combat trauma experienced by them may\nresult in long-term sequelae.<\/p>\n\n\n\n

Sergeant TH7 was an experienced combatant who\nparticipated in numerous combat operations in the North. During 1988 \/ 89\ninsurgency period, his platoon was deployed in the Southern part of Sri Lanka\nto fight the left wing Sinhala rebels who launched attacks against the\nGovernment. In the height of the conflict, the rebels attacked the Army killing\nseveral soldiers. This incident escalated to fathomless atrocities.<\/p>\n\n\n\n

In 1989, Sergeant TX7 and his group arrested\nsome of the suspects and eliminated them.  Sergeant TX7 tortured one of\nthe suspects who was believed to have masterminded the attack on soldiers. He\nshot the suspect, poured petrol while the victim was alive. Then set fire. When\nthe victim was on fire, he made an unsuccessful attempt to grab Sergeant\nTX7.  Sergeant TX7 narrowly escaped the fire and he became shocked and\nutterly frightened. Then he aimed his firearm towards the blazing man and fired\nseveral shots. Then the suspect died instantly. After a few weeks, he\ncompletely forgot the incident.<\/p>\n\n\n\n

In 2002, thirteen years after this incident\none night Sergeant TX7 s wife tried to light the Kerosene lamp while they were\nhaving dinner. Then she accidentally dropped it and the lamp exploded. His wife\ns clothes caught the fire. She was on flames. Immediately Sergeant TX7 poured\nwater onto his wife and extinguished the fire. She went unharmed. But Sergeant\nTX7 was utterly devastated.<\/p>\n\n\n\n

When his wife was on fire, the 1989 incident\ncame into his mind immediately. Instead of his wife, he saw the JVP suspect who\ntried to grab him a moment before death. From that night, he had nightmares of\nthe original incident and continuous intrusive memories. Sergeant TX7 startled\neasily and he was gradually turned in to different person. He became depressed\nand started abusing alcohol. He lost his life interests. Once he planned to\ncommit suicide. He went to the railway station and walked along the railway\ntract. When the train was a few meters away, he changed his mind and jumped\noff.<\/p>\n\n\n\n

Sergeant TX7 was diagnosed with PTSD in late\n2002 and treated with medication and psychotherapy. (EMDR and CBT). By 2003, he\nwas free of most of the PTSD symptoms.<\/p>\n\n\n\n

Lt Col XXD participated in the Operation\nBalawegaya in 1991 and faced heavy fire by the enemy. In front of his eyes,\nseveral soldiers died following sniper fire. He took a key effort to prevent\nthe enemy advance and sustained a gun short injury to the leg. He thought that\nhe would be dead as his fallen soldiers. While lying on the battlefield his\nthoughts, were about his home, parents, wife and the children.<\/p>\n\n\n\n

He was bleeding profusely and the other\ncombatants took a great effort to evacuate him immediately. He was transferred\nto Palaly hospital and then air lifted to Colombo.<\/p>\n\n\n\n

The doctors took massive effort to save his\nleg and eventually the operation became successful. He recovered his physical\ninjuries soon and went back to his unit. His physical and mental health was\nstable.<\/p>\n\n\n\n

In 2003, he suffered DVT or Deep Vein\nthrombosis and experienced unbearable pain. While he was in physical pain he\nhad flashbacks of the 1991 Operation Balawegaya events, how he sustained a\ngunshot injury, how he was lying on the ground etc. he even saw the late\nGeneral Denzel Kobbekaduwa in his flashbacks. He became restless and had a PTSD\nattack.<\/p>\n\n\n\n

After he was treated for the Deep Vein\nThrombosis his pain subsided, but he was hounded by the battle events. He\nexperienced intrusive memories, flashbacks and startling reactions. His\nsleeping pattern changed and in order to avoid nightmares he started to work\nuntil late nights. Lt Col XXD adopted a workaholic attitude to evade disturbing\nruminations. After sometime, he was physically and mentally exhausted. His\nsystem could not cope any more. Then he had a second attack, which manifested\nas an aggressive fearful reaction.  Lt Col XXD was treated with SSRI and\nrelaxation therapies for a long time and gradually his posttraumatic symptoms subsided.<\/p>\n\n\n\n

Eelam War and the War Widows<\/strong><\/p>\n\n\n\n

One harsh reality of the war is that the\nevery soldier killed in war leaves behind grieving family and relatives. It has\nbeen a reality since the Trojan War.<\/p>\n\n\n\n

The women who were left widows as a result of\nthe Sri Lankan conflict are facing radically altered circumstances. There are\nestimated thousands of war widows and war-affected family members from the Tri\nForces who still experience grief reactions. Many widows are in the 22 to 35\nage group; and with the death of their husbands these women have become a\npsychologically and socially vulnerable group. Most of the women who underwent\nsevere emotional pain still have not completely recovered. Many have become the\nvictims of pathological grief. They are unable to work through their grief\ndespite the passage of time. With the widowhood, they experience identity\nchange, role adjustment and change in social status.<\/p>\n\n\n\n

Many researches concur that the mental trauma\nof the war widows can last for long years. Depressive reactions are common\namong the Sri Lanka war widows. In 2005, 86 Sri Lankan war widows were\nclinically interviewed based on Beck\u2019s depression scale and depression was\ndiagnosed in 23 (27%). Ten war widows said that they had contemplated suicide\nafter they lost their husbands (12%). (Jayatunge, 2005)<\/p>\n\n\n\n

The war widows of the other conflictive areas\nin the globe are facing similar consequences. The conflict in Iraq had recorded\nhigh numbers of war widows.  According to Olga Ghazaryan, Oxfam\u2019s regional\ndirector for the Middle East, the Iraqi war has made widows of an estimated\n740,000 women and left many others fatherless (Rubin, 2009).  After 1991,\nmany Iraqi war widows became sole wage earners, often going hungry to feed\ntheir children; possibly 60% suffered from psychological problems, with\nphysical manifestations such as weight loss and difficulty breast-feeding\n(Hoskins, 1997 quoted in (Salvage, 2002).<\/p>\n\n\n\n

In the conservative Asian societies, widows\nface social, economic and legal handicaps. Widow as its name denotes is associated\nwith some form of socio-cultural stigma and humiliation. They are considered as\nbad omen in many Sri Lankan rural areas. They are marginalized by their own\ncommunities. These factors affect their self-esteem. In some events, the\naccusations were made by the in laws stating that the husband\u2019s death occurred\nbecause of the unluckiness of the wife and they are partially answerable for\nthe husband\u2019s death. They experience lack of social support and loss of their\nsocial possession in their own family circles.<\/p>\n\n\n\n

The war widows face a number of mental health\nproblems. They have suffered bereavement as a result of the violent deaths of\ntheir husbands and these traumatic memories hound them for long years. They are\noften subjected to extreme forms of discrimination and physical, sexual, and\nmental abuse. Therefore, widowhood represents a form of social death\u201d for\nthese women.  Their plight and vulnerability lead to numerous\npsychological ailments.<\/p>\n\n\n\n

Many of the widows carry the memories of\ntheir late husbands. They are emotionally troubled by the loss and grief. \nIn the overall view the large percentage of women are having following\npsychological features.<\/p>\n\n\n\n

Common symptoms included intrusive memories\nabout their dead husbands, fear and uncertainty about the future, self-pity,\nlow self-esteem, sleep disturbances, irritability, displacement of anger,\nemotional numbing, feelings of guilt, and psychosomatic complaints like\npersistent headaches and backaches which do not have any medical basis and do\nnot respond to painkillers.<\/p>\n\n\n\n

Many Sri Lankan widows have a tendency to\nexperience and communicate psychological distress in the form of physical\nsymptoms. Some have multiple unexplained somatic symptoms. Most often, the\ncomplaints involve chronic pain and problems with the digestive system, nervous\nsystem, and reproductive system. These young war widows, who have suppressed\ntheir biological needs following the cultural pressure and family honor, often\nmanifest conversion reactions.<\/p>\n\n\n\n

In a study by Gabriel Silverman and\ncolleagues (2000), traumatic grief, PTSD, and major depressive episode were\nfound to overlap with each other to similar degrees. Of those with traumatic\ngrief, 47 percent also received a diagnosis of major depressive episode, 33\npercent met criteria for PTSD, and 40 percent had traumatic grief.<\/p>\n\n\n\n

Individuals who meet the diagnostic criteria\nfor prolonged grief disorder have been shown to be at an increased risk of\ndeveloping clinically distinct posttraumatic stress disorder, generalized\nanxiety disorder, major depressive disorder as well as suicidal ideation (Grey,\nPrigerson, & Litz, 2004). The violence of war does not end with the return\nto peace for those living closest to former combatants. Following is the experience\nof a war widow whose husband died in the operation Jayasikuru in 1997.<\/p>\n\n\n\n

When I heard of the death of my husband, my\nentire world collapsed. He was a Lance Cpl in the Army and we were living in\nhis house with his mother and two unmarried sisters. I still have a fragmented\nmemory of the funeral. Some events I cannot remember. My three-year daughter\nwho had no clue about father\u2019s death asked various questions. I did not know\nwhat would happen to my daughter and me after my husband\u2019s death.<\/em><\/p>\n\n\n\n

After several months, my mother in law and\nhusband\u2019s two sisters started passing negative comments. They blamed me for his\ndeath. They implied that I was unlucky and since I came to their house, the\nthings changed negatively. Even the neighbors avoided me.<\/em><\/p>\n\n\n\n

I had to go to Panagoda Army pension branch\nto get my dead husbands\u2019 pension. They said he was a volunteer and it would\ntake some time and gave me papers to fill up. I had no idea how to do the paper\nwork. I asked my cousin brother to help me. The day I went to his house with\nthe daughter to get the paper work done my mother in law came up with false\naccusations and blamed me for seeing men soon after the husband\u2019s death. She\nhumiliated me and demanded the full pension of my husband saying that I have no\nfinancial rights.<\/em><\/p>\n\n\n\n

I had no place to go and my parents died when\nI was small. My relative had no financial ability to look after me and my\ndaughter. Therefore, I had no other option but to live with the husband\u2019s\nrelatives, facing humiliations every day. When I received my husband\u2019s pension,\nmy mother in law took it. We were given only food.<\/em><\/p>\n\n\n\n

Every month I had to go to the Grama Niladari\nto confirm that I am still a widow and not remarried. When I went to get his\nsignature on the document he used to pass inappropriate jokes and once tried to\ntouch my hand. I scolded him and left the office. Ever since, he delayed\nsigning my papers.<\/em><\/p>\n\n\n\n

I became depressed and when my daughter goes\nto sleep, I cry alone. If not for her, I would have committed suicide, ending\nthis suffering. My mind is preoccupied with the events of my husband\u2019s funeral.\nI had the mental pictures of the coffin, his dead body, ceremonial uniform, and\nmany more things. I had mental pictures of these miserable events. Constantly I\nhad feelings of fear and uncertainty about the future. My memory started fading\nand I could not concentrate. Gradually I have become a living dead\u2026\u2026\u2026\u2026.<\/em><\/p>\n\n\n\n

Mrs AT87 had been married only for seven\nmonths when her husband became MIA (missing in action). This is her story.<\/p>\n\n\n\n

\u2026\u2026..When my husband went missing in action, I\nwas 30 years old. We had been married for seven months. As a young wife, I had\nto face the challenges of life. I waited for him many years but he did not\nreturn. Every day was a painful anticipatory day for me. I went to many\narmy camps, to the ICRC and even went to the North during the ceasefire era in\nsearch of my husband. There was no news about him. My relatives urged me to\nmarry again but I refused.  I still cannot believe that he is dead. I hope\none day he would come back\u2026..<\/em><\/p>\n\n\n\n

Mrs. HK34 faced severe hardships with the\ndeath of her husband who was a full corporal in the Army. She was driven out\nfrom the husband\u2019s family which accused her of being unlucky. She was living in\na small house with her four years old son. Her neighbor \u2013 a middle-aged man\ntried to help her with different motives in his mind.  When his intentions\nwere revealed, Mrs. HK34 did not speak to him and avoided him. Then he started\nspreading malicious rumors about her in the village. The villagers, especially\nthe women, humiliated her publicly.  Some nights, stones were thrown to\nher house. As Mrs. HK34 believed, her neighbor was behind all these mock\nincidents. When the troubles intensified, she decided to leave the village but\nshe had no place to go.<\/p>\n\n\n\n

The conflict in Sri Lanka has generated a\nlarge number of war widows in the North and East.  Widows in the North and\nEast province totaled some 89,000 in 2010 (Mohamed Hizbullah, 2010). Many women\nare living in abject poverty and despair.<\/p>\n\n\n\n

Many women in war are faced with the main\nresponsibility for care giving in the family, with the destiny of their\nhusbands unknown and new and unfamiliar duties placed on them. If the household\nis facing hardships, this may overload women\u2019s capacity to cope; as\npreoccupation with the needs of the family may lead to neglecting their own\nneeds, especially if they become widows.<\/p>\n\n\n\n

The late Air Chief Marshall Harry\nGoonetilleke conducted a valuable psychosocial assisting project for the war\nwidows of Sri Lanka under the Ranaviru Family Counselling Association. This\nproject helped the war widows to reconstruct their lives and gain confidence.\nHe believed that there should be a permanent rehabilitation policy for the war\nwidows at the national-level. Until his death in 2008, Air Chief Marshall Harry\nGoonetilleke actively engaged in the rehabilitation work of the Sri Lankan war\nwidows.<\/p>\n\n\n\n

Mrs. KL342 was able to face her destiny with\ncourage and determination after her husband\u2019s premature death that occurred in\nthe Eelam war.<\/p>\n\n\n\n

\u2026\u2026\u2026\u2026. When I heard the terrible news of my\nhusband\u2019s death in the war front, I was utterly devastated. For many months, I\nwas in a denial stage and could not believe that he would never come\nback.  Somehow, I had to gather strength for the sake of my two little\nchildren. I knew that being a widow in a deeply conservative society is not\neasy. But I had no alternative and with courage I faced the consequences.<\/em><\/p>\n\n\n\n

Ranaviru Family Counselling Association\noffered me strength and guidance. At the meetings, I saw women like me who were\nstruggling to survive. I learned new skills and started to work in an\nincome-generating project. While working and attending to my children\u2019s needs,\nmy emotional trauma was reduced. But the deep sorrow was always with me. I had\nto be the sole breadwinner of the family; I had to be responsible for my\nchildren.  I was determined to live a life with dignity.<\/em><\/p>\n\n\n\n

During the cease-fire in 2002, a group of war\nwidows from the North visited us. Their husbands were LTTE carders who died in\nthe battle. When I saw them, I had angry feelings. I thought for a while\nprobably one of the husbands of these women had killed my husband. My heart\nstated beating rapidly. I saw they were looking at us. Simultaneously I thought\nthey would be having the same feelings about us. That moment I realized that\nanger and hatred offer nothing but destruction. My anger dropped to the zero level.\nWe welcomed them, the women from the opposite side but who share the same grief\nas us. We all are victims of the war no matter the racial differences. After\nall our tears and suffering had no ethnic difference. We spoke with these women\nand exchanged ideas. Soon we became friends. We cried together for the memories\nof our dead husbands who left us so unexpectedly. At the end of the day, we\nparted like sisters. Some of these women still write to me and we are good\nfriends\u2026\u2026.<\/em><\/p>\n\n\n\n

Mrs. GF54 lost her sense of purpose in life\nwhen she underwent a pathological grief reaction following her husband\u2019s death\nin 2001 during the Operation \u2018Agni Kheela\u2019. She was extremely focused on the\nloss and reminders of her husband. She had problems accepting the death,\npreoccupied with sorrow, inability to enjoy and move on with life, trouble\ncarrying out normal routines and was withdrawn from social activities. She was\ntreated with medication and EMDR, which gave optimum results. Today Mrs. GF54\nis rationally facing her life. She is self-employed and building a house for\nherself and her children.<\/p>\n\n\n\n

Rachel Tribe and Padmal De Silva (1999)\nhighlight <\/em>the\nimportance of integrating coping strategies, self-help principles changing\nperceptions, attitudes and stereotyped beliefs when improving mental health\nissues of the Sri Lankan women who were widowed following extreme traumatic\nevents. As they recommend the cultural and socio-political issues should be\ntaken in to consideration.<\/p>\n\n\n\n

As a matter of fact, very few governments and\nnon-government organizations view widows as a special category with individual\nproblems and special status. Therefore, war widows are marginalized in many\ncommunities around the world. The higher levels of stress and mental illness\namong women, common in many post conflict societies, are even higher in Sri\nLanka due to the prolonged war(Somasundaram, 1998). The war widows carry extra\nburden than the average women in the Sri Lankan society. Apart from their\ntraumatic experience, daily stressors such as poverty, family conflict, health\nproblems, unemployment, social isolation and harassments exert a significant\neffect on their stress levels. Some widows take care not only of their children\nbut often of their extended family as well.<\/p>\n\n\n\n

The mental health interventions of the war\nwidows should be followed with the specific cultural contexts and not\ncontradicting religious beliefs of the victims. The war widows need\nstrength-based psychosocial interventions. Welfare and rehabilitation of widows\nare essential with teaching of coping strategies, facilitating education and\njob training for the socially shunned widows. The measures are needed to help\nwomen transform their new skills into financial independence and\nsustainability. At the same time as strengthening women\u2019s existing skills, new\nskills should be introduced in traditional and non-traditional fields.<\/p>\n\n\n\n

There must be a permanent rehabilitation\npolicy for the war widows at the national-level that helps widows to build a\nnew life, regain confidence and gently adjust to a new life. The children of\nthese war widows should have a secure and dignified future as their fathers\nalways expected.  It is the duty of the nation to repay their dues to\nthese families who have become the invisible victims of the Eelam war.<\/p>\n\n\n\n

Children Affected by the Eelam War<\/strong><\/p>\n\n\n\n

UNICEF recently estimated that over 90% of\nthe victims of today\u2019s warfare is women and children. Children who are a\nvulnerable group have suffered severe traumatic events during the Eelam War.<\/p>\n\n\n\n

Worldwide studies indicate children of the\nwar zones undergo severe psychological trauma. The research in Gaza, Rwanda,\nMozambique and Cambodia reveal children who were exposed to war and atrocities\nare at a high risk of developing PTSD. Thabet (2000) did a study to estimate\nthe rate of Posttraumatic stress reactions in Palestinian children who\nexperienced war traumas. The sample consisted of 239 children of 6 to 11 years\nof age. 174 children (72.8%) reported PTSD reactions of at least mild\nintensity, while 98 (41%) reported moderate\/severe PTSD reactions.<\/p>\n\n\n\n

Organized and institutionalized violence like\nwar can affect children in many ways. The effects of traumatic events on\nchildren are even greater when that trauma is due to modern warfare. In Sri\nLanka a large number of children have been exposed to war trauma.<\/p>\n\n\n\n

Little K was nine years old when she became a\nvictim of a cross fire between the armed forces and Tamil militants in the\nNorth. She sustained a gunshot injury to her left arm. She underwent a\ntraumatic amputation of the left hand. The doctors were compelled to perform\nthis operation in order to save her life. After the operation she was taken to\nan orphanage in Mulangavil in the Killinochi district. She has feelings of\nfear, night terror, bed wetting, hyperarousal and alienation. Traumatized war-\nzone children like little K carry the psychological scars throughout their\nlives.<\/p>\n\n\n\n

Children who have experienced or been exposed\nto war trauma often have anxieties and insecurities that can cause them to\nperceive every aspect of the world as being unsafe and frightening. They grow\nup with a generalized fear and hostility which affects their future lives.\nTrauma is often associated with intense feelings of humiliation, self-blame,\nshame and guilt, which result from the sense of powerlessness and may lead to a\nsense of alienation and avoidance. Therefore the initial trauma could become a\nvicious cycle.<\/p>\n\n\n\n

The following case study gives the\nlongitudinal effects of psychological trauma on children, which can affect\ntheir later lives.<\/p>\n\n\n\n

Master S was 12 years old when the 1983\ncommunal riots erupted. His family was hiding in a neighbour\u2019s house to evade\nthe mob attack. The attackers burnt their house while Master S and his kid\nsister were hiding under a bed in their Sinhalese neighbour\u2019s house. He could\nhear the shouting of the mob and the screaming of the victims. Master S had\nfeelings of fear and he thought that the mob would kill him. These fears lasted\nfor many years as he grew older.<\/p>\n\n\n\n

The following day, their kind neighbour with\nthe help of the Police took them to the refugee camp at Bambalapitiya\nKadirashan Kovil. Before going to the camp Master S had a quick glance at their\nhouse which was completely destroyed by the fire. He felt sorry for losing his\nbooks and toys.<\/p>\n\n\n\n

After spending several months in the refugee\ncamp, his father was managed to get asylum in West Germany. For many years S\nhad nostalgic feelings for his lost books and toys and also feared that a group\nof people would come and attack him unexpectedly.<\/p>\n\n\n\n

After coming to West Germany S underwent a\nprolonged cultural shock and frequently felt a misfit in Western society. He\nbecame more isolated and neglected his studies. As a teenager he became more\nand more hostile and frequently had conflicts with his parents. After spending\n12 years in West Germany S moved to Canada and got married. But he always felt\nthe empty space and became emotionally numbed. On some occasions, he could not\ncontrol his temper and engaged in domestic violence. His violent outburst\nresulted in an injury to his wife and S was charged by the Canadian\nauthorities. Today he is serving a prison term.<\/p>\n\n\n\n

Children who had witnessed the war trauma and\natrocities can have diminished cognitive abilities. They frequently have\nlearning difficulties at school. Some have behavioral disorders. Most of them\ndo not receive proper psychological therapies and rehabilitation. As Osofsky\n(1995) indicates the differential response to trauma depends, in part, on the\nchild\u2019s age and level of psychological maturity. Children vary in their\nreactions to traumatic events. Some suffer from fears and terrifying memories\nimmediately after the event, which dissolve with time and emotional support.\nOther children are more severely affected by trauma and experience long-term\nproblems. Children of the war zone may exhibit regressive behaviors such as\nbed-wetting, thumb-sucking or fear of the dark. They may have increased\ndifficulties separating from their parents. Also they can have attention\nproblems and learning difficulties at school. Many of these affected children\ncan have somatic complaints, irrational fears, sleep problems, nightmares,\nirritability and angry outbursts. They may appear to be depressed and more\nwithdrawn.<\/p>\n\n\n\n

Adolescent (ages 12 to 18) responses are more\nsimilar to adults and they are at increased risk for problems with substance\nabuse, peer problems and depression. Child soldiers have been exposed to\nevents beyond the normal boundaries of human experiences. This is a story of a\nchild solder whose pseudonym is SE .<\/p>\n\n\n\n

SE was 11 years old when he was forcefully\nrecruited as a child soldier by the LTTE. During the training period he was\nbeaten and threatened to be killed if he did not obey the orders. Once he saw a\nkilling of a rival member by the LTTE. Along with other children he had to take\npart in a number of attacks against the Sri Lankan Army. They were called the\nmembers of the Baby Brigade. The Baby Brigade was a support team for the adult\nfighters. They never had the opportunity of going to school after they became\nchild soldiers. Instead of books they carried AK 47 and grenades. Their\nchildhood had been stolen.<\/p>\n\n\n\n

Little SE witnessed a number of horrific\nevents which changed his psychological makeup drastically. He was forced to\nobserve torture, then forced to induce it on victims. Today SE is in a\nrehabilitation center but his horrendous psychological scars have not left him\ncompletely. He has intense rage, suicidal urge and alienation. Once a bright\nand innocent student has now become a victim of the Eelam War.<\/p>\n\n\n\n

Exposure to war situations cause children to\nlose predictability in their lives. They become withdrawn from daily routines\nand daily habits which provide security for them. It affects their psychosocial\ndevelopment negatively.<\/p>\n\n\n\n

Master P was terrified when air attacks took\nplace in Jaffna. During this attack his neighbor\u2019s house was destroyed and some\nwere critically injured. They were taken to the Jaffna hospital. Master P\nbecomes anxious when he hears aircraft sounds. He has startle reactions,\nintrusive memories of the air attacks and sometimes nightmares.<\/p>\n\n\n\n

Children\u2019s well-being and development depend\nvery much on the security of family relationships and a predictable\nenvironment. Miss L was 13 when the LTTE attacked their village in the North\nCentral Province of Sri Lanka. The attackers shot the adults and killed the\nchildren and women with knives. She was lucky to be alive. When the village was\nattacked she managed to escape with her uncle. But her parents and the younger\nbrother got killed. Miss L couldn\u2019t continue her education after the tragedy.\nShe became more depressed and had constant feelings of being threatened,\nnightmares of the attack, and psycho somatic ailments.<\/p>\n\n\n\n

During the Eelam war some of the Sinhalese\nand Tamil children witnessed the deaths of their parents or other family\nmembers. They have experienced loss of loved ones and loss of property. These\nchildren have undergone severe grief and some have developed pathological grief\nreactions. These children carry the psychological scars of these past traumatic\nevents. Obviously the majority of them have not received adequate treatment and\nrehabilitation; they will become adults with the unhealed trauma. Their anger\nwill be sublimated to the society and this is going to be a vicious cycle.<\/p>\n\n\n\n

Master D (10 Y) was a bright student who\nsuddenly showed learning difficulties and behavioral problems when his father\ndied in the Rivirasa operation. He became aggressive and started bed wetting.\nHe lost interest in social activities and showed positive features of Paternal\nDeprivation Syndrome. He was not a happy child after his father\u2019s death.<\/p>\n\n\n\n

Living with a father who is affected by the\ncombat trauma is another predicament faced by some children. Little B was an\neight year old boy who was beaten by his PTSD father an ex-combatant with\nsudden rage. The boy was hospitalized and received treatment for his physical\ninjuries.<\/p>\n\n\n\n

Miss M (15Y) and master L (12Y) are sister\nand brother of the same family. Many days they had to spend the nights at\nneighbor\u2019s house when their father became aggressive and went into tantrums. He\nis a combatant suffering from PTSD. When he experienced combat related\nflashbacks, he became extremely violent. Their mother left the house following\ncontinuous physical aggression by the father.<\/p>\n\n\n\n

In recent years, since 1990, nearly 49 wars\nhave been waged, and 46 have been fought with small weapons. Over 40 million\nmen, women, and children have been forced into refugee status due to war\nviolence. A situation of war, frequently experienced by refugees, has a\ndisorganizing and traumatizing effect on the entire family. The Eelam war\ncaused displacements of civilians at large. Many are still living in refugee\ncamps.<\/p>\n\n\n\n

Master M (9Y) and his family had to flee from\nhis village with the other neighbors when the LTTE ordered the Muslim people to\nleave the North. Their family came to Puttalam and lived in a small hut without\nbasic facilities in Alankuda, Kalpitiya. Master M became more isolated and\nshowed positive features of anxiety and depression. He was nostalgic for his\nnative village in Mannar. His education was disrupted and today M works as a\nthree wheel driver in Puttalam town. M feels himself as an alien in Kalpitiya\n.He is addicted to cannabis and has no long term life plans.<\/p>\n\n\n\n

During the Eelam War, the LTTE launched a\nnumber of suicide bombings sometimes targeting civilians. Master N (15Y) was a\npsychological victim of the dreaded Central Bank Bombing by the LTTE. When the\nblast occurred they were in a motor car. They sustained minor injuries, but\nmaster L was psychologically shattered. He had feelings of fear, startle\nreactions, intrusive memories and nightmares for nearly a year.<\/p>\n\n\n\n

How to heal the wounds that occurred due to\nthe armed conflict ? These children need medication, psychotherapy,\npsychosocial rehabilitation and long term monitoring. In Sri Lanka there is a\nbig scarcity of experts in this area. Very often traumatized children grow up\nwithout psychosocial support. Unhealed traumas affect their cognitive and\npersonality development.<\/p>\n\n\n\n

Time does not heal the trauma. Therefore\nactive measures are needed. Social support should be given to the children who\nwere exposed to war trauma. Children\u2019s resiliency to traumatic events is\ninfluenced by the degree of social support and positive community influences\n(Garbarino & Kostelny, 1996).<\/p>\n\n\n\n

To minimize the psychological damage the\nchildren need effective care. Parental support is highly essential to heal the\nemotional scars experienced by the war-zone children. As the experts point out\nchildren with adequate family cohesion manifest less stress in reaction to\ntrauma and are better able to recover from the initial impact of the trauma.<\/p>\n\n\n\n

Cultural factors and traditional healing\nsystems play a vital role. Community ideology, beliefs and value systems\ncontribute to resiliency by giving meaning to traumatic events, allowing\nchildren to identify with cultural values, and enabling children and adults to\nfunction under extreme conditions (Melville and Lykes, 1992). In treating war\nzone children family therapy, group therapy, Cognitive-behavioral therapy (CBT)\n, art therapy, music therapy, EMDR and school and community interventions have\nbeen used. Also they are helped with coping skills.<\/p>\n\n\n\n

War trauma in Sri Lanka has created a\ncritical situation. A large number of children have been affected by the\nprolonged armed conflict in Sri Lanka. This has become one of the crucial\nproblems that would affect our future. Consider that a significant numbers of\nour next generation are traumatized and unhealed.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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Boscarino, J., & Adams, R. (2009). PTSD\nonset and course following the World Trade Center disaster: findings and\nimplications for future research. Social\nPsychiatry and Psychiatric Epidemiology 44<\/em>(10), 887-898.<\/p>\n\n\n\n

Bullman, T. A., & Kang, H. K. (1994).\nPosttraumatic Stress Disorder and the Risk of Traumatic Deaths Among Vietnam\nVeterans. Journal of Nervous\n& Mental Disease, 182<\/em>(1), 604-610.<\/p>\n\n\n\n

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Garbarino, J., & Kostelny, K. (1996). The\nEffects of Political Violence on Palestinian Children\u2019s Behavior Problems: A\nRisk Accumulation Model. Child\nDevelopment, 67<\/em>(1), 33-45. doi: 10.1111\/j.1467-8624.1996.tb01717.x<\/p>\n\n\n\n

Grey, M., Prigerson, H., & Litz, B.\n(2004). Conceptual and Definitial Issues in Complicated Grief. In B. Litz\n(Ed.), Early Intervention\nforTrauma and Traumatic Loss<\/em> (pp. 65-111). New York: The\nGuilford Press.<\/p>\n\n\n\n

Harvery, D. (2007). Intergenerational\nTransmission of Trauma from Holocaust Survivors to their Children.Baycrest, 7<\/em>. Retrieved from http:\/\/www.baycrest.org\/If_Not_Now\/Volume7\/default_11222.asp<\/a><\/p>\n\n\n\n

Hendin, H., & Haas, A. (1984).\nPosttraumatic Stress Disorders in veterans of early American wars.Psychohistory Review, 12<\/em>(4),\n25\u201330.<\/p>\n\n\n\n

Hovens, J., Op den Velde, W., Falger, P.,\nSchouten, E., De Groen, J., & Van Duijn, H. (1992). Anxiety, depression and\nanger in Dutch Resistance veterans from World War II. Psychotherapy and Psychosomatics, 57<\/em>(4),\n172-179.<\/p>\n\n\n\n

Jayatunge R (2004) PTSD Sri Lankan Experience\n, ANL Publishers Colombo<\/p>\n\n\n\n

Kofoed, L., Friedman, M. J., & Peck, R.\n(1993). Alcoholism and Drug Abuse in patients with PTSD. PSYCHIATRIC QUARTERLY, 64<\/em>(2),\n151-171. doi: 10.1007\/BF01065867<\/p>\n\n\n\n

Kolk, B. v. d., McFarlane, A., &\nWeisaeth, L. (Eds.). (1996). Traumatic\nStress: the effects of overwhelming experience on mind, body, and society<\/em>.\nNew York: Guilford Press.<\/p>\n\n\n\n

Lipkin, J., Blank A. Parson E, and Smith .J\n(1982) Vietnam Veterans and Posttraumatic Stress<\/p>\n\n\n\n

Disorder (retrieved from<\/p>\n\n\n\n

\nhttp:\/\/psychservices.psychiatryonline.org\/cgi\/content\/abstract\/33\/11\/908\n<\/div><\/figure>\n\n\n\n

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Velde, W. o. d., Aarts, P. G. H., Falger, P.\nR. J., Hovens, J. E., Duijn, H. v., Groen, J. H. M. d., & Duijn, M. A. J.\nv. (2002). ALCOHOL USE, CIGARETTE CONSUMPTION AND CHRONIC POST-TRAUMATIC STRESS\nDISORDER.Alcohol and Alcoholism, 37<\/em>(4),\n355-336. doi: 10.1093\/alcalc\/37.4.355<\/p>\n","protected":false},"excerpt":{"rendered":"

Ruwan M Jayatunge \u00a0M.D. \u00a0 Combatants Affected by the Prolonged War The 30 year armed conflict in Sri Lanka has produced a new generation of veterans at risk for the chronic mental health problems that resulted following prolonged exposure to the war. Over 200,000 members of the Sri Lanka armed forces and police had been […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-104784","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/104784","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=104784"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/104784\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=104784"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=104784"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=104784"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}