The Mental Health Issues of the Sri Lankan War Widows

By Dr Ruwan M Jayatunge

If men were the principle casualties of the War, these widows represent its collateral damage.- Ed Payne: “Collateral Damage

(March 24, Ontario, Sri Lanka Guardian) One harsh reality of the war is that the every soldier killed in war leaves behind grieving relatives. It has been a reality since the Trojan War.

The women who were left widows as a result of the Sri Lankan conflict are facing radically altered circumstances. There are estimated thousands of War widows and war-affected family members from the Tri Forces who still experience grief reactions. Many widows are in the 22 to 35 age group and with the death of their husbands; these women have become a psychologically and socially vulnerable group. Most of the women who underwent severe emotional pain still have not completely recovered. Many have become the victims of pathological grief. They are unable to work through their grief despite the passage of time. With the widowhood, they experience identity change, role adjustment and change in social status.

Many researches concur that the mental trauma of the war widows can last for long years. Julie E. Byles of the University of Newcastle Australia developed and evaluated a brief measure of depression for use within a population of older Australian war veterans and war widows. Derived from the Geriatric Depression Scale (GDS), the 12-item GDS-Veterans is designed to include items that most closely represent the thoughts and feelings of older veterans in relation to their war experiences. The scale was administered to 1,620 veterans and widows concurrent with the 36-item Medical Outcomes Study Short Form (MOS SF-36) quality of life measure. Of those surveyed, 13.5% indicated that they often or always worry about things that happened during the war, indicating that this item tapped an important dimension for many of the veteran population.

Depressive reactions are common among the Sri Lanka war widows. In 2005, 86 Sri Lankan war widows were clinically interviewed based on Beck’s depression scale and depression was diagnosed in 23. Ten war widows said that they had contemplated suicide after they lost their husbands. (Psychological Management of Combat Stress – A Study Based on Sri. Lankan Combatants. Ruwan M. Jayatunge)

The war widows of the other conflictive areas in the globe are facing similar consequences. The conflict in Iraq had recorded high numbers of war widows. The Iraqi war has made widows of an estimated 740,000 women and left many others fatherless ( Olga Ghazaryan, Oxfam’s regional director for the Middle East) After 1991, many Iraqi war widows became sole wage earners, often going hungry to feed their children; possibly 60% suffered from psychological problems, with physical manifestations such as weight loss and difficulty breast-feeding (Hoskins, 1997).

Death of a close family member is a highly stressful event. According to Homes and Rahie stress scale the loss of a family member carries the highest stress level. In the psychological context, a traumatic experience like sudden death of a relative can cause long lasting negative effects.

In the conservative Asian societies, widows face social, economic and legal handicaps. Widow as its name denotes associated with some form of socio-cultural stigma and humiliation. They are considered as bad omen in many Sri Lankan rural areas. They are marginalized by their own communities. These factors affect their self-esteem. In some events, the accusations were made by the in laws stating that the husband’s death occurred because of the unluckiness of the wife and they are partially answerable for the husband’s death. They experience lack of social support and loss of their social possession in their own family circles.

The war widows face a number of mental health problems. They have suffered bereavement as a result of the violent deaths of their husbands and these traumatic memories hound them for long years. They are often subjected to extreme forms of discrimination and physical, sexual, and mental abuse. Therefore, widowhood represents a form of "social death" for these women. Their plight and vulnerability lead to numerous psychological ailments.

Many of the widows carry the memories of their late husbands. They are emotionally troubled by the loss and grief. In the overall view the large percentage of women are having following psychological features.

1- intrusive memories about their dead husbands
2- fear and uncertainty about the future
3- self pity
4- low self esteem
5- sleep disturbances
6- irritability
7- displacement of anger
8- emotional numbing
9- feelings of guilt for being happy

10- Psycho physiological reactions such as persistent headaches, backaches, without any medical basis and these symptoms do not respond to painkillers.

Many Sri Lankan widows have a tendency to experience and communicate psychological distress in the form of physical symptoms. Some have multiple unexplained somatic symptoms. Most often, the complaints involve chronic pain and problems with the digestive system, nervous system, and reproductive system. These young war widows who have suppressed their biological needs following the cultural pressure and family honor often-manifest conversion reactions.

People who experience severe symptoms of separation distress also tend to suffer from certain symptoms of traumatic distress. Psychiatric comorbidity or the presence of multiple disorders is common following bereavement. In 1997, a series of studies of independent samples of bereaved people and found that elements of separation distress and traumatic distress form a single cluster, and that this cluster is distinct from depressive and anxiety symptom clusters.

In a study by Gabriel Silverman and colleagues (2000), traumatic grief, PTSD, and major depressive episode were found to overlap with each other to similar degrees. Of those with traumatic grief, 47 percent also received a diagnosis of major depressive episode, 33 percent met criteria for PTSD, and 40 percent had traumatic grief.

As described by Prigerson (Prigerson H.G. Complicated grief: when the path of adjustment leads to a dead end. Bereavement Care 2004) individuals who meet the diagnostic criteria for prolonged grief disorder have been shown to be at an increased risk of developing clinically distinct posttraumatic stress disorder, generalized anxiety disorder, major depressive disorder as well as suicidal ideation.

Bereavement is the reaction to the loss of a close relationship. Bereavement is defined as a state of sadness or loneliness. Sometimes these reactions are prolonged and affect the women who have lost their husbands. The violence of war does not end with the return to peace for those living closest to former combatants. Following is the experience of a war widow whose husband died in the operation Jayasikuru in 1997.

When I heard the death of my husband, my entire world collapsed. He was a Lance Cpl in the Army and we were living in his house with his mother and two unmarred sisters.

I still have a fragmented memory of the funeral. Some events I cannot remember. My three-year daughter who had no clue about father’s death asked various questions. I did not know what would happen to the daughter and me after my husband’s death.

After several months, my mother in law and husband’s two sisters started passing negative comments. They blamed me for his death. They implied that I was unlucky and since I came to their house, the things changed negatively. Even the neighbors avoided me.

I had to go to Panagoda the Army pay and pension branch to get my dead husbands’ pension. They said he was a volunteer and it would take some time and gave me papers to fill up. I had no idea how to do the paper work. I asked my cousin brother to help me. The day I went to his house with the daughter to get the paper work done my mother in law came up with false accusations and blamed me for seeing men soon after the husband’s death. She humiliated me and demanded

the full pension of my husband saying that I have no financial rights.

I had no place to go and my parents died when I was small. My relative had no financial ability to look after me and my daughter. Therefore, I had no other option living with the husband’s relatives facing humiliations every day. When I received my husband’s pension, my mother in law took it. We were given only food.

Every month I had to go to the Grama Niladari to confirm that I am still a widow and not remarried. When I went to get sign, the document he used to pass inappropriate jocks and once tried to touch my hand. I scolded him and left the office. Ever since, he delayed signing my papers.

I became depressed and when the daughter went to sleep, I cried alone. If not for her, I would have committed suicide ending this suffering. My mind preoccupied with the events of my husband’s funeral. I had the mental pictures of the coffin, his dead body, ceremonial uniform, and many more things. I had mental pictures of these miserable events. Constantly I had fear feelings and uncertainty of future. My memory started fading and I could not concentrate. Gradually I have become a living dead………….

Mrs AT87 had been married only for seven months when her husband became MIA (missing in action). This is her story.

……..When my husband went missing in action, I was 30 years old. We had been married for seven months. As a young widow, I had to face the challenges of life. I waited for him many years but he did not return. Every day was a painful anticipatory day for me. I went to many army camps, to the ICRC and even went to the North during the ceasefire era in search of my husband. There was no news about him. My relatives urged me to marry again but I refused. I still cannot believe that he is dead. I hope one day he would come back…..

Mrs. HK34 faced severe hardships with the death of her husband who was a full corporal in the Army. She was driven out from the husband’s family accusing that she was unlucky. She was living in a small house with her four years old son. Her neighbor – a middle-aged man tried to help her with different motives in his mind. When his intentions were reveled Mrs. HK34 did not speak to him and avoided him. Then he started spreading malicious rumors about her in the village. The villagers especially the women humiliated her publicly. Some nights stones were thrown to her house. As Mrs. HK34 believed, her neighbor was behind all these mock incidents. When the troubles intensified, she decided to leave the village but she had no place to go.

The conflict in Sri Lanka has generated a large number of war widows in the North and East. Widows in the North and East province totaled 49 612 in March 2002, and female-headed households numbered 19787 in the five NEP districts in 2000. (Sri Lanka NEP, 2003). Many women are living in abject poverty and despair.

The mental health consequences of war: gender specific issues described by Marianne C Kastrupi thus,

Many women may in war be faced with the main responsibility for care giving in the family, with the destiny of their husbands unknown and new and unfamiliar duties placed on them. If the household is facing disaster, this may overload women's capacity to cope; as preoccupation with the needs of the family may lead to that they are not able to consider their own needs, especially if they become widows. Mental health consequences of war: gender specific issues. (Marianne C Kastrupi - Transcultural Psychiatry Centre, Psychiatric Department, Copenhagen, Denmark)

The late Air Chief Marshall Harry Goonetilleke conducted a valuable psychosocial assisting project for the war widows of Sri Lanka under the Ranaviru Family Counselling Association. This project helped the war widows to reconstruct their lives and gain confidence. He believed that there should be a permanent rehabilitation policy for the war widows at the national-level. Until his death in 2008, Air Chief Marshall Harry Goonetilleke actively engaged in the rehabilitation work of the Sri Lankan war widows.
Mrs. KL342 was able to face her destiny with courage and determination after her husband’s premature death that occurred in the Eelam war.

…………. When I heard the terrible news of my husband’s death in the war front, I was utterly devastated. For many months, I was in a denial stage and could not believe that he would never come back. Somehow, I had to gather strength for the sake of my two little children. I knew that being a widow in a deeply conservative society is not easy. But I had no alternative and with courage I faced the consequences.

Ranaviru Family Counselling Association offered me strength and guidance. At the meetings, I saw women like me who were struggling to survive. I learned new skills and started to work in an income-generating project. While working and attending my children’s work my emotional trauma reduced. But the deep sorrow was always with me. I had to be the sole breadwinner of the family; I had to be responsible for my children. I was determined to live a life with dignity.

During the cease-fire in 2002, a group of war widows from the North visited us. Their husbands were LTTE carders who died in the battle. When I saw them, I had angry feelings. I thought for a while probably one of the husbands of these women had killed my husband. My heart stated beating rapidly. I saw they were looking at us. Simultaneously I thought they would be having the same feelings about us. That moment I realized that anger and hatred offer nothing but destruction. My anger dropped to the zero level. We welcomed them, the women from the opposite side but who share the same grief as us. We all are victims of the war no matter of racial differences. After all our teats and suffering had no ethnic difference. We spoke with these women and exchanged ideas. Soon we became friends. We cried together for the memories of our dead husbands who left us so unexpectedly. At the end of the day, we parted like sisters. Some of these women still write to me and we are good friends…….

Mrs. GF54 lost her sense of purpose in life when she underwent a pathological grief reaction following her husband’s death in 2001 during the Operation 'Agni Kheela'. She was extremely focused on the loss and reminders of her husband, problems accepting the death, preoccupation with sorrow, inability to enjoy and moving on with life, trouble carrying out normal routines, withdrawing from social activities. She was treated with medication and EMDR, which gave optimum results. Today Mrs. GF54 s rationally facing her life. She is self employed and building a house for her and for the children.

Professor Rachel Tribe and Padmal De Silva (Senior Lecturer in Psychology at the Institute of Psychiatry, University of London) in their research paper - Psychological intervention with displaced widows in Sri Lanka highlight the importance of integrating coping strategies self-help principles changing perceptions, attitudes and stereotyped beliefs when improving mental health issues of the Sri Lankan women who widowed following extreme traumatic events. As they recommend the cultural and socio-political issues should be taken in to consideration.

As a matter of fact a very few governments and non-government organizations view widows as a special category with individual problems and special status. Therefore, war widows are marginalized in many communities around the world.

The higher levels of stress and mental illness among women, common in many post conflict societies, may be even higher in Sri Lanka due to the prolonged war. The war widows carry extra burden than the average women in the Sri Lankan society. Apart from their traumatic experience, daily stressors such as poverty, family conflict, health problems, unemployment, social isolation and harassments exert a significant effect on their stress levels. Some widows take care not only of their children but often of their extended family as well.

The mental health interventions of the war widows should be followed with the specific cultural contexts and not contradicting religious believes of the victims. The war widows need strength-based psychosocial interventions. Welfare and rehabilitation of widows are essential with teaching coping strategies, facilitating education and job training for the socially shunned widows. The measures are needed to help women to transform their new skills into financial independence and sustainability and strengthen women’s existing skills and to introduce new skills in traditional and non-traditional fields.

There must be a permanent rehabilitation policy for the war widows at the national-level that helps widows to build a new life regain confidence and gently adjust to a new life. The children of these war widows should have a secure and dignified future as their fathers always expected. It is the duty of the Nation to repay their dues to these families who have become the invisible victims of the Eelam war.